title: SARS-CoV-2 (COVID-19): What do we know about children? A systematic review

text: BACKGROUND: Few paediatric cases of COVID-19 have been reported and we know little about the epidemiology in children, though more is known about other coronaviruses. We aimed to understand the infection rate, clinical presentation, clinical outcomes and transmission dynamics for SARS-CoV-2, in order to inform clinical and public health measures. METHODS: We undertook a rapid systematic review and narrative synthesis of all literature relating to SARS-CoV-2 in paediatric populations. The search terms also included SARS-CoV and MERS-CoV. We searched three databases and the COVID-19 resource centres of eleven major journals and publishers. English abstracts of Chinese language papers were included. Data were extracted and narrative syntheses conducted. RESULTS: 24 studies relating to COVID-19 were included in the review. Children appear to be less affected by COVID-19 than adults by observed rate of cases in large epidemiological studies. Limited data on attack rate indicate that children are just as susceptible to infection. Data on clinical outcomes are scarce but include several reports of asymptomatic infection and a milder course of disease in young children, though radiological abnormalities are noted. Severe cases are not reported in detail and there are little data relating to transmission. CONCLUSIONS: Children appear to have a low observed case rate of COVID-19 but may have similar rates to adults of infection with SARS-CoV-2. This discrepancy may be because children are asymptomatic or too mildly infected to draw medical attention, be tested and counted in observed cases of COVID-19.


title: Covid-19 lockdown improves air quality in Morocco

text: Due to the Covid-19 pandemic, almost all non-essential activities in Morocco have been halted since March 15, 2020. In this sense, several measures have been taken to mitigate the effects of this pandemic. Morocco has been on lockdown since March 20, 2020. The main objective of this paper is to study the effects of the lockdown measures on air quality, by presenting the spatio-temporal evolution of PM2,5 and NO2 pollutants, based on satellite data from Sentinel 5P and MERRA. Then, these results are compared to the data predicted by the Copernicus Atmosphere Monitoring Service (CAMS). Results show that, on one hand, Morocco has experienced an improvement in air quality by a significant reduction in NO2 and a relative reduction in PM2,5. On the other hand, we demonstrate that the particulate pollution in Morocco is partly due to synoptic weather patterns, and that a significant part of NO2 emissions is incoming mainly from the outside northern borders of Morocco. Finally we show that PM2,5 CAMS global forecasts underestimate the observed MERRA data.


Clinical characteristics of COVID-19 patients with abnormal liver tests


title: Combination of serological total antibody and RT-PCR test for detection of SARS-COV-2 infections

text: The purpose of this study was to investigate the feasibility of serological total antibody tests combined with RT-PCR for detection of SARS-COV-2. We conducted a retrospective study in which 375 patients were enrolled during the outbreak of SARS-COV-2 from 25th January to 16th March 2020. Patients were divided into a COVID-19 group (n = 141) and a control group (n = 234). Serum samples and throat swabs were collected from 375 patients for total antibody testing against SARS-COV-2 and RT-PCR analysis, respectively. The results indicated that diagnostic sensitivity and specificity were 95.7 % and 98.7 %, 92.2 % and 100 % by total antibody tests and RT-PCR, respectively. The sensitivity and specificity of total antibody tests combined with RT-PCR were 98.6 % and 98.7 %. The sensitivity of the combined method was significantly higher than RT-PCR (X2 = 5.16, P < 0.05), and similar to that of total antibody tests (X2 = 1.15, P> 0.05). This study supported the advantage of the combined method for detection of SARS-COV-2 with a high degree of sensitivity and specificity, as a useful tool for accurate diagnosis and timely treatment of suspected patients, epidemiological investigation, as well as monitoring ongoing outbreaks of infections with SARS-COV-2.


Late STEMI and NSTEMI Patients' Emergency Calling in COVID-19 Outbreak


docid: ocafdhkt

title: Propagation, Inactivation, and Safety Testing of SARS-CoV-2

text: In late 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, the capital of the Chinese province Hubei. Since then, SARS-CoV-2 has been responsible for a worldwide pandemic resulting in over 4 million infections and over 250,000 deaths. The pandemic has instigated widespread research related to SARS-CoV-2 and the disease that it causes, COVID-19. Research into this new virus will be facilitated by the availability of clearly described and effective procedures that enable the propagation and quantification of infectious virus. As work with the virus is recommended to be performed at biosafety level 3, validated methods to effectively inactivate the virus to enable the safe study of RNA, DNA, and protein from infected cells are also needed. Here, we report methods used to grow SARS-CoV-2 in multiple cell lines and to measure virus infectivity by plaque assay using either agarose or microcrystalline cellulose as an overlay as well as a SARS-CoV-2 specific focus forming assay. We also demonstrate effective inactivation by TRIzol, 10% neutral buffered formalin, beta propiolactone, and heat.


Combination of CT and RT-PCR in the screening or diagnosis of COVID-19


title: Use of CT and artificial intelligence in suspected or COVID-19 positive patients: statement of the Italian Society of Medical and Interventional Radiology

text: The COVID-19 pandemic started in Italy in February 2020 with an exponential growth that has exceeded the number of cases reported in China. Italian radiology departments found themselves at the forefront in the management of suspected and positive COVID cases, both in diagnosis, in estimating the severity of the disease and in follow-up. In this context SIRM recommends chest X-ray as first-line imaging tool, CT as additional tool that shows typical features of COVID pneumonia, and ultrasound of the lungs as monitoring tool. SIRM recommends, as high priority, to ensure appropriate sanitation procedures on the scan equipment after detecting any suspected or positive COVID-19 patients. In this emergency situation, several expectations have been raised by the scientific community about the role that artificial intelligence can have in improving the diagnosis and treatment of coronavirus infection, and SIRM wishes to deliver clear statements to the radiological community, on the usefulness of artificial intelligence as a radiological decision support system in COVID-19 positive patients. (1) SIRM supports the research on the use of artificial intelligence as a predictive and prognostic decision support system, especially in hospitalized patients and those admitted to intensive care, and welcomes single center of multicenter studies for a clinical validation of the test. (2) SIRM does not support the use of CT with artificial intelligence for screening or as first-line test to diagnose COVID-19. (3) Chest CT with artificial intelligence cannot replace molecular diagnosis tests with nose-pharyngeal swab (rRT-PCR) in suspected for COVID-19 patients.


Generalizability of COVID-19 Clinical Prediction Models


The alleviation of suffering during the COVID-19 pandemic


title: Rampant CâU Hypermutation in the Genomes of SARS-CoV-2 and Other Coronaviruses: Causes and Consequences for Their Short- and Long-Term Evolutionary Trajectories

text: The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has motivated an intensive analysis of its molecular epidemiology following its worldwide spread. To understand the early evolutionary events following its emergence, a data set of 985 complete SARS-CoV-2 sequences was assembled. Variants showed a mean of 5.5 to 9.5 nucleotide differences from each other, consistent with a midrange coronavirus substitution rate of 3 × 10-4 substitutions/site/year. Almost one-half of sequence changes were CâU transitions, with an 8-fold base frequency normalized directional asymmetry between CâU and UâC substitutions. Elevated ratios were observed in other recently emerged coronaviruses (SARS-CoV, Middle East respiratory syndrome [MERS]-CoV), and decreasing ratios were observed in other human coronaviruses (HCoV-NL63, -OC43, -229E, and -HKU1) proportionate to their increasing divergence. CâU transitions underpinned almost one-half of the amino acid differences between SARS-CoV-2 variants and occurred preferentially in both 5' U/A and 3' U/A flanking sequence contexts comparable to favored motifs of human APOBEC3 proteins. Marked base asymmetries observed in nonpandemic human coronaviruses (U â« A > G â« C) and low G+C contents may represent long-term effects of prolonged CâU hypermutation in their hosts. The evidence that much of sequence change in SARS-CoV-2 and other coronaviruses may be driven by a host APOBEC-like editing process has profound implications for understanding their short- and long-term evolution. Repeated cycles of mutation and reversion in favored mutational hot spots and the widespread occurrence of amino acid changes with no adaptive value for the virus represent a quite different paradigm of virus sequence change from neutral and Darwinian evolutionary frameworks and are not incorporated by standard models used in molecular epidemiology investigations.IMPORTANCE The wealth of accurately curated sequence data for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), its long genome, and its low substitution rate provides a relatively blank canvas with which to investigate effects of mutational and editing processes imposed by the host cell. The finding that a large proportion of sequence change in SARS-CoV-2 in the initial months of the pandemic comprised CâU mutations in a host APOBEC-like context provides evidence for a potent host-driven antiviral editing mechanism against coronaviruses more often associated with antiretroviral defense. In evolutionary terms, the contribution of biased, convergent, and context-dependent mutations to sequence change in SARS-CoV-2 is substantial, and these processes are not incorporated by standard models used in molecular epidemiology investigations.


Domestic violence amid COVID-19


title: Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19

text: BACKGROUND: Several studies have described the clinical characteristics of patients with novel coronavirus (SARS-CoV-2) infected pneumonia (COVID-19), indicating severe patients tended to have higher neutrophil to lymphocyte ratio (NLR). Whether baseline NLR could be an independent predictor of in-hospital death in Chinese COVID-19 patients remains to be investigated. METHODS: A cohort of patients with COVID-19 admitted to the Zhongnan Hospital of Wuhan University from January 1 to February 29 was retrospectively analyzed. The baseline data of laboratory examinations, including NLR, were collected. Univariate and multivariate logistic regression models were developed to assess the independent relationship between the baseline NLR and in-hospital all-cause death. A sensitivity analysis was performed by converting NLR from a continuous variable to a categorical variable according to tertile. Interaction and stratified analyses were conducted as well. RESULTS: 245 COVID-19 patients were included in the final analyses, and the in-hospital mortality was 13.47%. Multivariate analysis demonstrated that there was 8% higher risk of in-hospital mortality for each unit increase in NLR (Odds ratio [OR]â¯=â¯1.08; 95% confidence interval [95% CI], 1.01 to 1.14; Pâ¯=â¯0.0147). Compared with patients in the lowest tertile, the NLR of patients in the highest tertile had a 15.04-fold higher risk of death (ORâ¯=â¯16.04; 95% CI, 1.14 to 224.95; Pâ¯=â¯0.0395) after adjustment for potential confounders. Notably, the fully adjusted OR for mortality was 1.10 in males for each unit increase of NLR (ORâ¯=â¯1.10; 95% CI, 1.02 to 1.19; Pâ¯=â¯0.016). CONCLUSIONS: NLR is an independent risk factor of the in-hospital mortality for COVID-19 patients especially for male. Assessment of NLR may help identify high risk individuals with COVID-19.


title: [Infection Control: The Roles and Functions of Nurses Working at the International Medical Center]

text: Travelers are known to convey infectious diseases across international borders. After its experience with SARS, Taiwan established a comprehensive mechanism at its border to prevent the entry of infectious diseases. However, people with chronic infectious diseases, carriers with no symptoms, and those likely to be infected are not easy to identify during border screenings. Therefore, Taiwan must implement internal disease-containment measures in addition to stopping infectious disease at its borders. With increasing numbers of patients coming to Taiwan for medical examinations, medical aesthetic treatments, and medical treatments and care, the risk of acute, chronic, and contagious diseases originating from non-residents must be considered and addressed. This article was developed to discuss the role and importance of nurses in preventing transnational infectious diseases from the perspective of international medical care. In addition to showing rich nursing experience, sensitivity, and conducting the management and communication of international cases, it is also necessary to make good use of information tools for remote screening care. Taking the period of the COVID-19 outbreak as an example, several procedures have been conducted. First, online detailed history of infectious diseases and nursing evaluations are conducted before admission. Second, preparation and movement notifications are given before admission. Third, online health education and follow-up care as well as cross-unit communication and coordination are implemented. International medical nurses directly affect the quality and effectiveness of international medical treatment. As Taiwan builds up its brand as an international medical caring destination, nursing professionals should help further this trend and announce to the world: Taiwan can help! Nursing can help!


title: Psychiatric hospitalization rates in Italy before and during COVID-19: did they change? An analysis of register data

text: OBJECTIVES.: To assess admission rates to seven General Hospital Psychiatric Wards (GHPWs) located in the Lombardy Region in the 40 days after the start of Coronavirus disease 2019 (COVID-19) epidemic, compared to similar periods of 2020 and 2019. METHODS.: Anonymized data from the regional psychiatric care register have been obtained and analyzed. The seven GHPWs care for approximately 1.4 million inhabitants and have a total of 119 beds. RESULTS.: In the 40-day period (February 21-March 31, 2020) after the start of the COVID-19 epidemic in Italy, compared to a similar 40-day period prior to February 21, and compared to two 40-day periods of 2019, there has been a marked reduction in psychiatric admission rates. The reduction was explained by voluntary admissions, while there was not a noticeable reduction for involuntary admissions. The reduction was visible for all diagnostic groups, except for a group of 'Other' diagnoses, which includes anxiety disorders, neurocognitive disorders, etc. CONCLUSIONS.: Large-scale pandemics can modify voluntary admission rates to psychiatric facilities in the early phases following pandemic onset. We suggest that the reduction in admission rates may be due to fear of hospitals, seen as possible sites of contagion, as well as to a change in thresholds of behavioral problems acting as a trigger for admission requests from family relatives or referrals from treating clinicians. It is unclear from the study whether the reduction in admissions was contributed to most by the current pandemic or the lockdown imposed due to the pandemic.


Sixty seconds on . . . the clap


title: Prediction of the COVID-19 spread in African countries and implications for prevention and control: A case study in South Africa, Egypt, Algeria, Nigeria, Senegal and Kenya

text: COVID-19 (Corona Virus Disease 2019) is globally spreading and the international cooperation is urgently required in joint prevention and control of the epidemic. Using the Maximum-Hasting (MH) parameter estimation method and the modified Susceptible Exposed Infectious Recovered (SEIR) model, the spread of the epidemic under three intervention scenarios (suppression, mitigation, mildness) is simulated and predicted in South Africa, Egypt, and Algeria, where the epidemic situations are severe. The studies are also conducted in Nigeria, Senegal and Kenya, where the epidemic situations are growing rapidly and the socio-economic are relatively under-developed, resulting in more difficulties in preventing the epidemic. Results indicated that the epidemic can be basically controlled in late April with strict control of scenario one, manifested by the circumstance in the South Africa and Senegal. Under moderate control of scenario two, the number of infected people will increase by 1.43-1.55 times of that in scenario one, the date of the epidemic being controlled will be delayed by about 10 days, and Algeria, Nigeria, and Kenya are in accordance with this situation. In the third scenario of weak control, the epidemic will be controlled by late May, the total number of infected cases will double that in scenario two, and Egypt is in line with this prediction. In the end, a series of epidemic controlling methods are proposed, including patient quarantine, close contact tracing, population movement control, government intervention, city and county epidemic risk level classification, and medical cooperation and the Chinese assistance.


docid: yjcmlwmr

title: Evaluation of a high-speed but low-throughput RT-qPCR system for SARS-CoV-2 detection

text: With the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated with COVID-19, a high-speed and convenient detection technology should be at the forefront of medical care worldwide. In this study, we evaluated the usefulness of GeneSoC®, a compact, high-speed reciprocal flow RT-qPCR system, for the detection of SARS-CoV-2. Our results support the use of this system for the rapid identification of SARS-CoV-2. This approach can contribute to the strategic selection of initial management strategies for patients with COVID-19.


North East London coronavirus disease 2019 protocol for diagnostics in two-week wait head and neck cancer patients


title: Addressing the mental health concerns of migrant workers during the COVID-19 pandemic: An experiential account

text: The COVID pandemic has affected the world in a drastic manner taking a toll of not only human lives but also the economy and lifestyle. Of all the population suffering, the underprivileged and vulnerable groups have faced the maximum economic burden. Within India, an ample quota of people migrates annually for elementary occupations in service, sales, building and domestic industries. Generally, they are exposed to discrimination, work-rights exploitation and job insecurity. The onset of COVID 19 has accentuated these issues in unprecedented ways. The Apex Court of the country took note of this plight and gave directions to the governments to take care of the immediate needs of the migrant workers. This article attempts to reflect the mental health concerns of the migrant workers who were temporarily sheltered at relief camps across Bengaluru city in the state of Karnataka, during the ongoing COVID pandemic. The article ends with giving recommendations.


Risks to children and young people during covid-19 pandemic


SARS-CoV-2 infection in conjunctival tissue


title: Implementation of radiotherapy in a tertiary hospital in Zhejiang province during the epidemic of COVID-19/ 中华放射医学与防护杂志

text: Objective@#To explore the clinical practice of delivering radiotherapy during the outbreak of 2019 novel coronavirus disease(COVID-19).@*Methods@#During this epidemic period, available methods including but not limited to: strict disinfection, body temperature monitoring, learning relevant knowledge by all staffs to ensure the safety of radiotherapy treatment. Relevant data including proportion of radiotherapy, time from scanning to the first time of radiation delivery and degree of satisfaction in the view of staffs and patients, respectively.@*Results@#A total of 60 patients received radiation therapy in the department of radiotherapy of Zhejiang Provincial People’s Hospital (2020-02-11). Compared with the same period in 2019 (after the Spring Festival), the total number of patients receiving radiotherapy was decreased from 72 to 60(83.3%). Among them, the number of patients receiving palliative radiation therapy decreased significantly, while the proportion of radical, preoperative and/or postoperative radiotherapy/radiochemotherapy did not significantly decrease. There was significant difference between different years (χ2=6.967, P<0.05). The median time for newly admitted patients to receive radiotherapy was two days, which was not significantly longer than the interval in 2019 (P>0.05). Staffs and patients were generally satisfied with the current prevention measures.@*Conclusions@#Using a variety of prevention and control methods, and taking full account of medical safety and patient benefits, radiation-related activities can be carried out during the epidemic.


title: Participation in adherence clubs and on-time drug pickup among HIV-infected adults in Zambia: A matched-pair cluster randomized trial

text: BACKGROUND: Current models of HIV service delivery, with frequent facility visits, have led to facility congestion, patient and healthcare provider dissatisfaction, and suboptimal quality of services and retention in care. The Zambian urban adherence club (AC) is a health service innovation designed to improve on-time drug pickup and retention in HIV care through off-hours facility access and pharmacist-led group drug distribution. Similar models of differentiated service delivery (DSD) have shown promise in South Africa, but observational analyses of these models are prone to bias and confounding. We sought to evaluate the effectiveness and implementation of ACs in Zambia using a more rigorous study design. METHODS AND FINDINGS: Using a matched-pair cluster randomized study design (ClinicalTrials.gov: NCT02776254), 10 clinics were randomized to intervention (5 clinics) or control (5 clinics). At each clinic, between May 19 and October 27, 2016, a systematic random sample was assessed for eligibility (HIV+, age ≥ 14 years, on ART >6 months, not acutely ill, CD4 count not <200 cells/mm3) and willingness to participate in an AC. Clinical and antiretroviral drug pickup data were obtained through the existing electronic medical record. AC meeting attendance data were collected at intervention facilities prospectively through October 28, 2017. The primary outcome was time to first late drug pickup (>7 days late). Intervention effect was estimated using unadjusted Kaplan-Meier survival curves and a Cox proportional hazards model to derive an adjusted hazard ratio (aHR). Medication possession ratio (MPR) and implementation outcomes (adoption, acceptability, appropriateness, feasibility, and fidelity) were additionally evaluated as secondary outcomes. Baseline characteristics were similar between 571 intervention and 489 control participants with respect to median age (42 versus 41 years), sex (62% versus 66% female), median time since ART initiation (4.8 versus 5.0 years), median CD4 count at study enrollment (506 versus 533 cells/mm3), and baseline retention (53% versus 55% with at least 1 late drug pickup in previous 12 months). The rate of late drug pickup was lower in intervention participants compared to control participants (aHR 0.26, 95% CI 0.15-0.45, p < 0.001). Median MPR was 100% in intervention participants compared to 96% in control participants (p < 0.001). Although 18% (683/3,734) of AC group meeting visits were missed, on-time drug pickup (within 7 days) still occurred in 51% (350/683) of these missed visits through alternate means (use of buddy pickup or early return to the facility). Qualitative evaluation suggests that the intervention was acceptable to both patients and providers. While patients embraced the convenience and patient-centeredness of the model, preference for traditional adherence counseling and need for greater human resources influenced intervention appropriateness and feasibility from the provider perspective. The main limitations of this study were the small number of clusters, lack of viral load data, and relatively short follow-up period. CONCLUSIONS: ACs were found to be an effective model of service delivery for reducing late ART drug pickup among HIV-infected adults in Zambia. Drug pickup outside of group meetings was relatively common and underscores the need for DSD models to be flexible and patient-centered if they are to be effective. TRIAL REGISTRATION: ClinicalTrials.gov NCT02776254.


title: Vaccines for SARS-CoV-2: Lessons from Other Coronavirus Strains

text: The emergence of the strain of coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and its impact on global health have made imperative the development of effective and safe vaccines for this lethal strain. SARS-CoV-2 now adds to the list of coronavirus diseases that have threatened global health, along with the SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) coronaviruses that emerged in 2002/2003 and 2012, respectively. As of April 2020, no vaccine is commercially available for these coronavirus strains. Nevertheless, the knowledge obtained from the vaccine development efforts for MERS and SARS can be of high value for COVID-19 (coronavirus disease 2019). Here, we review the past and ongoing vaccine development efforts for clinically relevant coronavirus strains with the intention that this information helps in the development of effective and safe vaccines for COVID-19. In addition, information from naturally exposed individuals and animal models to coronavirus strains is described for the same purpose of helping into the development of effective vaccines against COVID-19.


title: [The importance of strengthening the ability of fundamental disease prevention and control system from the perspective of the epidemic situation of anti COVID-19]

text: COVID-19 has been an epidemic for nearly two months. The prevention and control measures have achieved remarkable results. From the response and disposal process of this epidemic, it is revealed that human resources of fundamental disease prevention and control system are insufficient and the ability of laboratory testing is also weak. It is suggested that institutions for disease control and prevention should strengthen the construction in these aspects in the future.


Who comes first: Rescheduling endoscopic activity after the acute phase of the Covid 19 pandemic


title: The Impact of COVID-19 Infection on Labor and Delivery, Newborn Nursery, and Neonatal Intensive Care Unit: Prospective Observational Data from a Single Hospital System

text: OBJECTIVE: Since its emergence in late 2019, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the novel coronavirus that causes novel coronavirus disease 2019 (COVID-19), has spread globally. Within the United States, some of the most affected regions have been New York, and Northern New Jersey. Our objective is to describe the impact of COVID-19 in a large delivery service in Northern New Jersey, including its effects on labor and delivery (L&D), the newborn nursery, and the neonatal intensive care unit (NICU). MATERIALS AND METHODS: Between April 21, 2020 and May 5, 2020, a total of 78 mothers (3.6% of deliveries) were identified by screening history or examination to either be COVID-19 positive or possible positives (persons under investigation). Of the mothers who were tested after admission to L&D, 28% tested positive for SARS-CoV-2. DISCUSSION: Isolation between mother and infant was recommended in 62 cases, either because the mother was positive for SARS-CoV-2 or because the test was still pending. Fifty-four families (87%) agreed to isolation and separation. The majority of infants, 51 (94%), were initially isolated on the newborn nursery. Six needed NICU admission. No infants had clinical evidence of symptomatic COVID-19 infection. Fourteen infants whose mothers were positive for SARS-CoV-2, and who had been separated from the mother at birth were tested for SARS-CoV-2 postnatally. All were negative. RESULTS: COVID-19 posed a significant burden to mothers, infants, and staff over the 5-week study period. The yield from screening mothers for COVID-19 on L&D was high. Most families accepted the need for postnatal isolation and separation of mother and newborn. CONCLUSION: Our study suggests that the transmission of SARS-CoV-2 from mother to her fetus/newborn seems to be uncommon if appropriate separation measures are performed at birth. KEY POINTS: · The yield of targeted testing for SARS-CoV-2, on mothers on Labor and Delivery is high.. · Agreement to separation of mothers and infants to reduce transmission of SARS-CoV-2 was high.. · The incidence of symptomatic COVID-19 in newborns is low, if appropriate separation occurs at birth..


title: Elective procedures for prostate cancer in the time of Covid-19: a multidisciplinary team experience

text: On March 29th 2020, 97,689 cases of COVID-19 have been diagnosed only in Italy, with 73,880 actually positive cases, a daily increase of 3815 cases, 27,386 hospitalized and 3906 patients in intensive care units, causing a total of 10,779 known deaths. In all urological departments, quickly inpatient and outpatient services have been significantly reduced. Even in this COVID-19 situation, urological neoplasm care must go on, but significant changes need to be made in the way some care is delivered. We compared diagnostic and therapeutic elective procedures requested and performed for PC management from our multidisciplinary team (MDT) during 1 month activity in the highest national level of COVID-19 infection (March 2020) and under restrictions for all the population, with the management performed in a no-COVID-19 month (March 2019) 1 year ago. The only management that did not received a significant reduction are medical therapies for advanced hormone sensitive (HS) or castration resistant (CR) PC. We describe our MDT identifications of elective undeferrable PC management in this COVID-19 time. These suggestions have been considered for a country (ITALY) under a rapid increase of COVID-19 cases and complications, but in a region with an actual lower impact (2914 actual positive and 1079 hospitalized cases) from the infection and in an hospital not completely converted to COVID-19 management. Indications should be different and restricted only to emergencies on the basis of COVID-19 pandemic situation and hospital involvement.


Orthopaedic Documentation and Coding Primer for Telemedicine and Electronic Patient Communication for the COVID-19 Pandemic


Letter to the Editor: Changes in Neurosurgery Resident Education During the COVID-19 Pandemic: An Institutional Experience from a Global Epicenter


Changes in Neurosurgery Resident Education During the COVID-19 Pandemic: An Institutional Experience from a Global Epicenter


docid: edevlflf

title: Keratoconjunctivitis as the initial medical presentation of the novel coronavirus disease 2019 (COVID-19)

text: We present a case of coronavirus disease 2019 (COVID-19) with an initial medical presentation of keratoconjunctivitis, the first such reported case in North America. The patient's primary symptom was a red eye with watery discharge, though she did have mild respiratory symptoms, without fever. She was diagnosed with keratoconjunctivitis; evolving corneal findings were characterized through repeat visits to ophthalmology. A conjunctival swab of the affected eye was positive for the SAR-CoV-2 virus. This case emphasizes the importance of ensuring that first-line health care providers, including ophthalmologists, optometrists, emergency physicians, and family physicians, consider COVID-19 on the differential for any patient with recent travel who presents with acute conjunctivitis. Having a high index of suspicion with this presentation would allow for appropriate precautions to be taken to prevent further spread of COVID-19.


Antipsoriatic treatments during COVID-19 outbreak


docid: qywsgpia

title: Heparin as a Therapy for COVID-19: Current Evidence and Future Possibilities

text: Coronavirus Disease 2019 (COVID-19), the clinical syndrome associated with infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has impacted nearly every country in the world. Despite an unprecedented focus of scientific investigation, there is a paucity of evidence-based pharmacotherapies against this disease. Due to this lack of data-driven treatment strategies, broad variations in practice patterns have emerged. Observed hypercoagulability in COVID-19 patients has created debate within the critical care community on the therapeutic utility of heparin. We seek to provide an overview of the data supporting the therapeutic use of heparin, both unfractionated and low molecular weight, as an anticoagulant for the treatment of SARS-CoV-2 infection. Additionally, we review preclinical evidence establishing biological plausibility for heparin and synthetic heparin-like drugs as therapies for COVID-19 through anti-viral and anti-inflammatory effects. Finally, we discuss known adverse effects and theoretical off-target effects that may temper enthusiasm for the adoption of heparin as a therapy in COVID-19 without confirmatory prospective randomized controlled trials. Despite previous failures of anticoagulants in critical illness, plausibility of heparin for COVID-19 is sufficiently robust to justify urgent randomized controlled trials to determine the safety and effectiveness of this therapy.


title: Time-optimal control strategies in SIR epidemic models

text: We investigate the time-optimal control problem in SIR (Susceptible-Infected-Recovered) epidemic models, focusing on different control policies: vaccination, isolation, culling, and reduction of transmission. Applying the Pontryagin's Minimum Principle (PMP) to the unconstrained control problems (i.e. without costs of control or resource limitations), we prove that, for all the policies investigated, only bang-bang controls with at most one switch are admitted. When a switch occurs, the optimal strategy is to delay the control action some amount of time and then apply the control at the maximum rate for the remainder of the outbreak. This result is in contrast with previous findings on the unconstrained problems of minimizing the total infectious burden over an outbreak, where the optimal strategy is to use the maximal control for the entire epidemic. Then, the critical consequence of our results is that, in a wide range of epidemiological circumstances, it may be impossible to minimize the total infectious burden while minimizing the epidemic duration, and vice versa. Moreover, numerical simulations highlighted additional unexpected results, showing that the optimal control can be delayed also when the control reproduction number is lower than one and that the switching time from no control to maximum control can even occur after the peak of infection has been reached. Our results are especially important for livestock diseases where the minimization of outbreaks duration is a priority due to sanitary restrictions imposed to farms during ongoing epidemics, such as animal movements and export bans.


A risk-based approach is best for decision making on holding mass gathering events


title: A chronicle of SARS-CoV-2: Part-I - Epidemiology, diagnosis, prognosis, transmission and treatment

text: In order to benefit the public, community workers and scientific community, we hereby present a chronicle of SARS-CoV-2 that leads to the unseen precedent of social distancing and lockdown owing to coronavirus disease (COVID-19). Information on this life-threatening pandemic of COVID-19 is sparse and discrete; and the urgency is such that the dissemination of information is increasing with numerous daily publications on the topic. Therefore, we developed a comprehensive review on various aspects of SARS-CoV-2 and COVID-19. We scientifically compiled published research, news, and reports from various sources to comprehend and summarize the information and findings on Coronaviruses. The review explicitly covers the aspects like genome and pedigree of SARS-CoV-2; epidemiology, prognosis, pathogenesis, symptoms and diagnosis of COVID-19 in order to catalog the right information on transmission route, and influence of environmental factors on virus transmissions, for the robust understanding of right strategical steps for proper COVID-19 management. We have explicitly highlighted several useful information and facts like: i) No established relationship between progression of SARS-CoV-2 with temperature, humidity and/or both, ii) The underlying mechanism of SARS-CoV-2 is not fully understood, iii) Respiratory droplet size determines drop and airborne-based transmission, iv) Prognosis of COVID-19 can be done by its effects on various body organs, v) Infection can be stopped by restricting the binding of S protein and AE2, vi) Hydroxychloroquine is believed to be better than chloroquine for COVID-19, vii) Ivermectin with Vero-hSLAM cells is able to reduce infection by ~5000 time within 2 days, and viii) Nafamostat mesylate can inhibit SARS-CoV-2 S protein-initiated membrane fusion. We have also suggested future research perspectives, challenges and scope.


Covid-19: the crisis of personal protective equipment in the US


title: Questionnaire assessment helps the self-management of patients with inflammatory bowel disease during the outbreak of Coronavirus Disease 2019

text: OBJECTIVE: This study aimed to assess the disease conditions of patients with inflammatory bowel disease (IBD) in Hubei Province during the outbreak of Coronavirus Disease 2019 (COVID-19) by questionnaire online and guide their self-management during this epidemic. RESULTS: A total of 102 eligible questionnaires were included. No patient we surveyed reported a diagnosis of COVID-19. Our result showed that 67.86% of patients with ulcerative colitis (UC) and 80.43% of patients with Crohn's disease (CD) were in remission, 85.29%of patients had a good quality of life. Part of the patients (21.57%) reported their disease conditions worsening. The reduction in physical exercise was a risk factor for worsening conditions (OR=17.593, p=0.009). Some patients reported an alteration of medication regimens during the epidemic. CONCLUSIONS: The epidemic of COVID-19 might have a certain impact on many aspects of Hubei IBD patients within four weeks after the traffic control. Doctors could utilize the results from our questionnaire to guide IBD patients' self-management. METHODS: A questionnaire was designed containing the Harvey-Bradshaw Index (HBI), the 6-point Mayo Score, the short inflammatory bowel disease questionnaire (SIBDQ) and distributed to Hubei IBD patients online within four weeks of traffic control after the outbreak, it also included questions about patients' self-reported disease conditions and their epidemiological features of COVID-19.


title: Go local: The key to controlling the COVID-19 pandemic in the post lockdown era

text: The UK government announced its first wave of lockdown easing on 10 May 2020, two months after the non-pharmaceutical measures to reduce the spread of COVID-19 were first introduced on 23 March 2020. Analysis of reported case rate data from Public Health England and aggregated and anonymised crowd level mobility data shows variability across local authorities in the UK. A locality-based approach to lockdown easing is needed, enabling local public health and associated health and social care services to rapidly respond to emerging hotspots of infection. National level data will hide an increasing heterogeneity of COVID-19 infections and mobility, and new ways of real-time data presentation to the public are required. Data sources (including mobile) allow for faster visualisation than more traditional data sources, and are part of a wider trend towards near real-time analysis of outbreaks needed for timely, targeted local public health interventions. Real time data visualisation may give early warnings of unusual levels of activity which warrant further investigation by local public health authorities.


title: How the world's collective attention is being paid to a pandemic: COVID-19 related 1-gram time series for 24 languages on Twitter

text: In confronting the global spread of the coronavirus disease COVID-19 pandemic we must have coordinated medical, operational, and political responses. In all efforts, data is crucial. Fundamentally, and in the possible absence of a vaccine for 12 to 18 months, we need universal, well-documented testing for both the presence of the disease as well as confirmed recovery through serological tests for antibodies, and we need to track major socioeconomic indices. But we also need auxiliary data of all kinds, including data related to how populations are talking about the unfolding pandemic through news and stories. To in part help on the social media side, we curate a set of 1000 day-scale time series of 1-grams across 24 languages on Twitter that are most `important' for March 2020 with respect to March 2019. We determine importance through our allotaxonometric instrument, rank-turbulence divergence. We make some basic observations about some of the time series, including a comparison to numbers of confirmed deaths due to COVID-19 over time. We broadly observe across all languages a peak for the language-specific word for `virus' in January followed by a decline through February and a recent surge through March. The world's collective attention dropped away while the virus spread out from China. We host the time series on Gitlab, updating them on a daily basis while relevant. Our main intent is for other researchers to use these time series to enhance whatever analyses that may be of use during the pandemic as well as for retrospective investigations.


title: Performance of Pneumonia Severity Index and CURB-65 in Predicting 30-day mortality in patients with COVID-19

text: OBJECTIVE: The aim of the study was to analyze the usefulness of the CURB-65 and pneumonia severity index (PSI) in predicting 30-day mortality in patients with COVID-19 and to identify other factors associated with higher mortality. METHODS: A retrospective study was performed at a pandemic hospital in Istanbul, Turkey and 681 laboratory-confirmed patients with COVID-19 were included. Data on characteristics, vital signs and laboratory parameters were recorded form electronic medical records. We used receiver operating characteristic analysis to quantify the discriminatory abilities of the prognostic scales. Univariate and multivariate logistic regression analyses were performed to identify other predictors of mortality. RESULTS: Higher CRP levels were associated with an increased risk for mortality (OR:1.015, 95% CI 1.008 to 1.021, p < 0.001). The PSI performed significantly better than the CURB-65 (AUC: 0.91, 95% CI 0.88-0.93 vs AUC:0.88, 95% CI:0.85-0.90; p = 0.01) and the addition of CRP levels to PSI did not improve the performance of PSI in predicting mortality (AUC: 0.91, 95% CI 0.88-0.93 vs AUC:0.92, 95% CI:0.89-0.94; p = 0.29). CONCLUSION: In a large group of hospitalized patients with COVID-19, we found that PSI performed better than CURB-65 in predicting mortality. Adding CRP levels to PSI did not improve the 30-day mortality prediction.


title: A preliminary experience with a new intramedullary nail for trochanteric fractures

text: BACKGROUND AND AIM OF THE WORK: The worldwide incidence of fractures of the proximal end of the femur is increasing as the average age of the population rises. The current surgical gold treatment standard is intramedullary nail fixation. The Authors present their experience with the D-Nail system for intertrochanteric femur fractures. METHODS: From January 1st to February 21st 2020 (breakout of COVID-19 pandemic) 34 patients were treated with the D-Nail system: 11 with basicervical fractures, 16 with intertrochanteric stable fractures and 7 with intertrochanteric unstable fractures. In 11 cases, a single cephalic screw was used; in 23 cases, two of them were used. Distal locking was executed in 7 patients. Follow-up time ranged from 2 to 3 months. RESULTS: None of the reported intra- or post-operative complication was linked to the fixation device or the surgical technique. Patients were monitored with clinical and radiological checkups using modified Harris Hip Score to accurately evaluate the fluctuations in the rehabilitation period. CONCLUSION: The main advantages of this synthesis device are the proximal hole's peculiar shape, which allows the possibility to position one or two cephalic screws on the same nail, and the silicon coating, which provides numerous biological advantages. Distal locking was executed in selected cases only, based on fracture type. Optimum treatment involves rapid execution of surgery, minimal trauma during surgery, maximum mechanical stability, and rapid weight-bearing. Although our case number is small and follow-up time brief, our results are encouraging.


title: Forecasting the outcome and estimating the epidemic model parameters from the fatality time series in COVID-19 outbreaks

text: In the absence of other tools, monitoring the effects of protective measures, including social distancing and forecasting the outcome of outbreaks is of immense interest. Real-time data is noisy and very often hampered by systematic errors in reporting. Detailed epidemic models may contain a large number of empirical parameters, which cannot be determined with sufficient accuracy. In this paper, we show that the cumulative number of deaths can be regarded as a master variable, and the parameters of the epidemic such as the basic reproduction number, the size of the susceptible population, and the infection rate can be determined. In the SIR model, we derive an explicit single variable differential equation for the evolution of the cumulative number of fatalities. We show that the epidemic in Spain, Italy, and Hubei Province, China follows this master equation closely. We discuss the relationship with the logistic growth model, and we show that it is a good approximation when the basic reproduction number is less than $2.3$. This condition is valid for the outbreak in Hubei, but not for the outbreaks in Spain, Italy, and New York. The difference is in the shorter infectious period in China, probably due to the separation policy of the infected. For more complex models, with more internal variables, such as the SEIR model, the equations derived from the SIR model remain valid approximately, due to the separation of timescales.


title: The role of palliative care in COVID-19

text: In light of the COVID-19 pandemic, many healthcare systems are experiencing an increased demand for palliative care (PC). To meet this challenge, the PC team at Cleveland Clinic designed an enterprise-wide response plan organized around 4 domains: staff (educational resources and tools), stuff (medications and supplies), space (recommendations for optimizing physical space and facilities), and systems to facilitate high-quality PC delivery to patients. To mitigate isolation during end-of-life care, the Clinic offers "compassionate exceptions" to strict visitation policies, provides personal protective equipment to visitors of these patients, and facilitates virtual visitation via electronic devices.


We Got This and We Don't: Pediatricians Going to Battle for the "Big Children" of COVID-19


docid: xwoyeypp

title: Catastrophe Compassion: Understanding and Extending Prosociality Under Crisis

text: How do people behave when disasters strike? Popular media accounts depict panic and cruelty, but in fact individuals often cooperate with and care for one another during crises. I summarize evidence for such 'catastrophe compassion', discuss its roots, and consider how it might be cultivated in more mundane times.


title: [Clinical features of children with SARS-CoV-2 infection: an analysis of 13 cases from Changsha, China]

text: OBJECTIVE: To study the clinical features of children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: A retrospective analysis was performed for the clinical data of 13 children with SARS-CoV-2 infection who hospitalized in a Changsha hospital. RESULTS: All 13 children had the disease onset due to family aggregation. Of the 13 children, 2 had no symptoms, and the other 11 children had the clinical manifestations of fever, cough, pharyngeal discomfort, abdominal pain, diarrhea, convulsions, or vomiting. As for clinical typing, 7 had mild type, 5 had common type, and 1 had severe type. The median duration of fever was 2 days in 6 children. All 13 children had normal levels of peripheral blood lymphocyte counts, immunoglobulins, CD4, CD8, and interleukin-6. The median time to clearance of SARS-CoV-2 was 13 days in the nasopharyngeal swabs of the 13 children. Three children presented false negatives for RT-PCR of SARS-CoV-2. SARS-CoV-2 RNA remained detectable in stools for 12 days after the nasopharyngeal swab test yielded a negative result. Abnormal CT findings were observed in 6 children. All 13 children were cured and discharged and they were normal at 2 weeks after discharge. CONCLUSIONS: Intra-family contact is the main transmission route of SARS-CoV-2 infection in children, and there is also a possibility of fecal-oral transmission. Mild and common types are the major clinical types in children with SARS-CoV-2 infection, and cytokine storm is not observed. Children with SARS-CoV-2 infection tend to have a good short-term prognosis, and follow-up is needed to observe their long-term prognosis. Multiple nucleic acid tests should be performed for patients with SARS-CoV-2 infection and their close contacts by multiple site sampling.


title: Management of Structural Heart Disease and Acute Coronary Syndromes in the COVID-19 Pandemic

text: Transcatheter interventions for structural heart disease (SHD) now represent an effective alternative to surgery in selected patients. A clear premise is that delay in or neglect of treating patients in need of SHD intervention is associated with unavoidable morbidity and mortality because many of them have life-threatening conditions. However, the recent outbreak of coronavirus-associated disease-2019 (COVID-19) is placing an unprecedented strain on patients, physicians and world healthcare systems that resulted in deferral of elective and semi-elective procedures, such as SHD, and delay in the treatment of patients with acute coronary syndrome (ACS). We hereby present the case for a focused resumption of transcatheter SHD interventions in selected centers, in order to preserve patient safety and avoid that death rate will extend far beyond that directly associated with COVID-19. A similar approach should be applied to the invasive management of ACS. Indeed, a proactive and vigilant stance on managing SHD and ACS is crucial, especially in the context of the COVID-19 pandemic, when the risk of overlooking severely sick patients or postponing life-saving treatments is high. If such corrective measures are not put into effect, we may expect in the near future an excess of avoidable fatalities indirectly due to COVID-19 but truly caused by cardiovascular diseases, as well as an exceedingly large number of patients with severe heart failure leading to shorter life expectancy, reduced quality of life and increased healthcare cost.


title: Do underlying cardiovascular diseases have any impact on hospitalised patients with COVID-19?

text: OBJECTIVES: An outbreak of the highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has sickened thousands of people in China. The purpose of this study was to explore the early clinical characteristics of COVID-19 patients with cardiovascular disease (CVD). METHODS: This is a retrospective analysis of patients with COVID-19 from a single centre. All patients underwent real-time reverse transcription PCR for SARS-CoV-2 on admission. Demographic and clinical factors and laboratory data were reviewed and collected to evaluate for significant associations. RESULTS: The study included 541 patients with COVID-19. A total of 144 (26.6%) patients had a history of CVD. The mortality of patients with CVD reached 22.2%, which was higher than that of the overall population of this study (9.8%). Patients with CVD were also more likely to develop liver function abnormality, elevated blood creatinine and lactic dehydrogenase (p<0.05). Symptoms of sputum production were more common in patients with CVD (p=0.026). Lymphocytes, haemoglobin and albumin below the normal range were pervasive in the CVD group (p<0.05). The proportion of critically ill patients in the CVD group (27.8%) was significantly higher than that in the non-CVD group (8.8%). Multivariable logistic regression analysis revealed that CVD (OR: 2.735 (95% CI 1.495 to 5.003), p=0.001) was associated with critical COVID-19 condition, while patients with coronary heart disease were less likely to reach recovery standards (OR: 0.331 (95% CI 0.125 to 0.880), p=0.027). CONCLUSIONS: Considering the high prevalence of CVD, a thorough CVD assessment at diagnosis and early intervention are recommended in COVID-19 patients with CVD. Patients with CVD are more vulnerable to deterioration.


title: Preservação da privacidade no enfrentamento da COVID-19: dados pessoais e a pandemia global./ Preservação da privacidade no enfrentamento da COVID-19: dados pessoais e a pandemia global./ Personal data usage and privacy considerations in the COVID-19 global pandemic

text: Data has become increasingly important and valuable for both scientists and health authorities searching for answers to the COVID-19 crisis. Due to difficulties in diagnosing this infection in populations around the world, initiatives supported by digital technologies are being developed by governments and private companies to enable the tracking of the public's symptoms, contacts and movements. Considering the current scenario, initiatives designed to support infection surveillance and monitoring are essential and necessary. Nonetheless, ethical, legal and technical questions abound regarding the amount and types of personal data being collected, processed, shared and used in the name of public health, as well as the concomitant or posterior use of this data. These challenges demonstrate the need for new models of responsible and transparent data and technology governance in efforts to control SARS-COV2, as well as in future public health emergencies.


Dermatology practices as vectors for COVID-19 transmission: A call for immediate cessation of nonemergent dermatology visits


COVID-19 vaccines: neutralizing antibodies and the alum advantage


Clinical features and outcomes of adult COVID-19 patients co-infected with Mycoplasma pneumoniae


title: Convergent antibody responses to SARS-CoV-2 in convalescent individuals

text: During the COVID-19 pandemic, SARS-CoV-2 infected millions of people and claimed hundreds of thousands of lives. Virus entry into cells depends on the receptor binding domain (RBD) of the SARS-CoV-2 spike protein (S). Although there is no vaccine, it is likely that antibodies will be essential for protection. However, little is known about the human antibody response to SARS-CoV-21-5. Here we report on 149 COVID-19 convalescent individuals. Plasmas collected an average of 39 days after the onset of symptoms had variable half-maximal pseudovirus neutralizing titres: less than 1:50 in 33% and below 1:1,000 in 79%, while only 1% showed titres above 1:5,000. Antibody sequencing revealed expanded clones of RBD-specific memory B cells expressing closely related antibodies in different individuals. Despite low plasma titres, antibodies to three distinct epitopes on RBD neutralized at half-maximal inhibitory concentrations (IC50 values) as low as single digit nanograms per millitre. Thus, most convalescent plasmas obtained from individuals who recover from COVID-19 do not contain high levels of neutralizing activity. Nevertheless, rare but recurring RBD-specific antibodies with potent antiviral activity were found in all individuals tested, suggesting that a vaccine designed to elicit such antibodies could be broadly effective.


Independent Correlates of Hospitalization in 2040 Patients with COVID-19 at a Large Hospital System in Michigan, United States


title: COVID-19 transmission in Mainland China is associated with temperature and humidity: A time-series analysis

text: COVID-19 has become a pandemic. The influence of meteorological factors on the transmission and spread of COVID-19 is of interest. This study sought to examine the associations of daily average temperature (AT) and relative humidity (ARH) with the daily counts of COVID-19 cases in 30 Chinese provinces (in Hubei from December 1, 2019 to February 11, 2020 and in other provinces from January 20, 2020 to Februarys 11, 2020). A Generalized Additive Model (GAM) was fitted to quantify the province-specific associations between meteorological variables and the daily cases of COVID-19 during the study periods. In the model, the 14-day exponential moving averages (EMAs) of AT and ARH, and their interaction were included with time trend and health-seeking behavior adjusted. Their spatial distributions were visualized. AT and ARH showed significantly negative associations with COVID-19 with a significant interaction between them (0.04, 95% confidence interval: 0.004-0.07) in Hubei. Every 1 °C increase in the AT led to a decrease in the daily confirmed cases by 36% to 57% when ARH was in the range from 67% to 85.5%. Every 1% increase in ARH led to a decrease in the daily confirmed cases by 11% to 22% when AT was in the range from 5.04 °C to 8.2 °C. However, these associations were not consistent throughout Mainland China.


title: COVID-19 and the liver: overview

text: On 12 March 2020, the WHO declared that the coronavirus disease 2019 (COVID-19) constitutes a pandemic. Cases of liver damage or dysfunction (mainly characterized by moderately elevated serum aspartate aminotransferase levels) have been reported among patients with COVID-19. However, it is currently uncertain whether the COVID-19 related liver damage/dysfunction is due mainly to the viral infection by itself or other coexisting conditions, such as the use of potentially hepatotoxic medications and the coexistence of systemic inflammatory response, respiratory distress syndrome-induced hypoxia, and multiple organ dysfunction. Individuals at high risk for severe COVID-19 are typical of older age and/or present with comorbid conditions such as diabetes, cardiovascular disease, and hypertension. This is also the same profile for those at increased risk for unrecognized underlying liver disease, especially nonalcoholic fatty liver disease. This could make them more susceptible to liver injury from the virus, medications used in supportive management, or hypoxia. So the aim of this review was to illustrate the clinical implications of COVID-19 on the liver in healthy and diseased states as well as the implications of common liver disorders on the outcome of COVID-19.


title: Correlation between Chest Computed Tomography Scan Findings and Mortality of COVID-19 Cases;a Cross sectional Study

text: INTRODUCTION: Predicting the outcomes of COVID-19 cases using different clinical, laboratory, and imaging parameters is one of the most interesting fields of research in this regard This study aimed to evaluate the correlation between chest computed tomography (CT) scan findings and outcomes of COVID-19 cases METHODS: This cross sectional study was carried out on confirmed COVID-19 cases with clinical manifestations and chest CT scan findings based on Iran's National Guidelines for defining COVID-19 Baseline and chest CT scan characteristics of patients were investigated and their correlation with mortality was analyzed and reported using SPSS 21 0 RESULTS: 380 patients with the mean age of 53 62 ± 16 66 years were evaluated (66 1% male) The most frequent chest CT scan abnormalities were in peripheral (86 6%) and peribronchovascular interstitium (34 6%), with ground glass pattern (54 1%), and round (53 6%) or linear (46 7%) shape There was a significant correlation between shape of abnormalities (p = 0 003), CT scan Severity Score (CTSS) (p <0 0001), and pulmonary artery CT diameter (p = 0 01) with mortality The mean CTSS of non-survived cases was significantly higher (13 68 ± 4 59 versus 8 72 ± 4 42;<0 0001) The area under the receiver operating characteristic (ROC) curve of CTSS in predicting the patients' mortality was 0 800 (95% CI: 0 716-0 884) The best cut off point of chest CTSS in this regard was 12 with 75 82% (95% CI: 56 07%-88 98%) sensitivity and 75 78% (95% CI: 70 88%-80 10%) specificity The mean main pulmonary artery diameter in patients with CTSS ≥ 12 was higher than cases with CTSS < 12 (27 89 ± 3 73 vs 26 24 ± 3 14 mm;p < 0 0001) CONCLUSION: Based on the results of the present study it seems that there is a significant correlation between chest CT scan characteristics and mortality of COVID-19 cases Patients with lower CTSS, lower pulmonary artery CT diameter, and round shape opacity had lower mortality


title: Coronavirus Disease 2019 in Children Cared for at Texas Children's Hospital: Initial Clinical Characteristics and Outcomes

text: We describe the clinical course of 57 children with coronavirus disease 2019 (COVID-19) cared for through a single hospital system. Most children were mildly symptomatic, and only a few patients with underlying medical conditions required hospitalization. System-wide patient evaluation processes allowed for prompt identification and management of COVID-19 patients.


title: Combination antiviral therapy with lopinavir/ritonavir, arbidol and interferon-α1b for COVID-19

text: Since the outbreak of coronavirus disease (COVID-19) that was discovered in 2019 in Wuhan, China, no standard therapy guideline has been set despite the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its high infectivity. The globally pandemic outbreak suggests that COVID-19 was highly infectious and difficult to control. A dual-combination of ribavirin and interferon-α has been the widely used regimen for the treatment of this disease in China. However, due to the varying results of treatment with these drugs, a novel antiviral combination therapy is urgently needed. This case reports the usage of lopinavir/ritonavir-based combination antiviral regimen for a patient with SARS-CoV-2 infection.


Management of CO2 absorbent while using the anesthesia machine as a mechanical ventilator on patients with COVID-19


title: COVID-19 pandemic: an overview of epidemiology, pathogenesis, diagnostics and potential vaccines and therapeutics

text: At the time of writing this review, severe acute respiratory coronavirus syndrome-2 (SARS-CoV-2) has infected more than 2,355,853 patients and resulted in more than 164,656 deaths worldwide (as of 20 April 2020). This review highlights the preventive measures, available clinical therapies and the potential of vaccine development against SARS-CoV-2 by taking into consideration the strong genetic similarities of the 2003 epidemic SARS-CoV. Recent studies are investigating the repurposing of US FDA-approved drugs as there is no available vaccine yet with many attempts under clinical evaluation. Several antivirals, antimalarials and immunomodulators that have shown activity against SARS-CoV and Middle East coronavirus respiratory syndromes are being evaluated. In particular, hydroxychloroquine, remdesivir, favipiravir, arbidol, tocilizumab and bevacizumab have shown promising results. The main aim of this review is to provide an overview of this pandemic and where we currently stand.


title: Low-tech solutions for the COVID-19 supply chain crisis

text: A global effort is ongoing in the scientific community and in the maker movement, which focuses on creating devices and tinkering with them, to reverse-engineer commercial medical equipment and get it to healthcare workers. For these 'low-tech' solutions to have a real impact, it is important for them to coalesce around approved designs.


title: Low-tech solutions for the COVID19 supply chain crisis

text: A global effort is ongoing in the scientific community and in the Maker Movement, which focuses on creating devices and tinkering with them, to reverse engineer commercial medical equipment and get it to healthcare workers. For these low-tech solutions to have a real impact, it is important for them to coalesce around approved designs.


title: The Fight Against Obesity Escalates: New Drugs on the Horizon and Metabolic Implications

text: PURPOSE OF REVIEW: There is currently a steep rise in the global prevalence of obesity. Pharmaceutical therapy is a valuable component of conservative obesity therapy. Herein, medications currently in the phase of preclinical or clinical testing are reviewed, along with an overview of the mechanisms that regulate energy intake and expenditure. In addition, the current and potential future directions of obesity drug therapy are discussed. RECENT FINDINGS: Although the current arsenal of obesity pharmacotherapy is limited, a considerable number of agents that exert their actions through a variety of pharmacodynamic targets and mechanisms are in the pipeline. This expansion shapes a potential near future of obesity conservative management, characterized by tailored combined therapeutic regimens, targeting not only weight loss but also improved overall health outcomes. The progress regarding the elucidation of the mechanisms which regulate the bodily energy equilibrium has led to medications which mimic hormonal adaptations that follow bariatric surgery, in the quest for a "Medical bypass." These, combined with agents which could increase energy expenditure, point to a brilliant future in the conservative treatment of obesity.


docid: arshbwhm

title: Commentary: Vulnerability and resilience demonstrated: Cardiac surgeons during coronavirus disease 2019 (COVID-19)


title: Additional cusp reconstruction does not compromise valve durability and mid-term survival after the David procedure: results from 449 patients

text: OBJECTIVES: The aim of this study was to evaluate whether additional cusp interventions and valve types affect aortic valve-related reoperation and mortality rates after the David procedure. METHODS: Between 1997 and 2018, a total of 449 patients {372 males; mean age 54.2 [standard deviation (SD) 15.2] years, range: 12.7-79.9 years} underwent elective valve-sparing aortic root replacement (David procedure) for aortic regurgitation and were prospectively followed up clinically and echocardiographically. RESULTS: The follow-up was 94% complete. Cumulative follow-up time was 2268 patient-years [mean follow-up time 5.1 (4.3 SD) years]. Thirty-day mortality was 2.2% (n = 10). Late (>30 days) survival did not differ from that of the age- and gender-matched general population. Freedom from reoperation in patients without additional cusp reconstruction was 94% [95% confidence interval (CI) 91-98] and 92% (95% CI 88-97) at 5 and 10 years, respectively, which was not significantly different (P = 1) for patients who did require additional cusp reconstruction 98% (95% CI 95-100) and 89% (95% CI 81-99). In patients with tricuspid aortic valves (n = 338), freedom from reoperation was 96% (95% CI 94-99) and 93% (95% CI 88-97) at 5 and 10 years, respectively. Patients with bicuspid aortic valves (n = 111) had a freedom from reoperation of 94% (95% CI 89-99) at 5 years and 88% (95% CI 79-98) at 10 years (P = 0.021 for the comparison to tricuspid aortic valve). Overall, 23 patients (5%; 1%/patient-year) required reoperation with a mean interval of 4.5 (4.8 SD) months. CONCLUSIONS: The David procedure revealed low mid-term reoperation risk and excellent survival independent of adjunctive cusp interventions/valve morphology and is comparable with that of the age- and gender-matched general population.


Guest Editorial: Ethics and equity in the time of Coronavirus


title: Reverse-Surge Planning During the COVID-19 Pandemic: A Cautionary Ramp-up for the Otolaryngologist

text: As the coronavirus disease 2019 (COVID-19) pandemic continues to evolve through the United States and other countries, differing rates of progression and decline are occurring based on varied population densities. While some health systems are reaching a steady state of new patient cases, others are seeing a leveling off or decline, allowing for restoration of normal practices. This "reverse-surge" planning and implementation process is a colossal undertaking for health systems trying to reacquire patient access and financial stability while preserving necessary resources and maintaining precautions for another potential surge. For the otolaryngologist, reverse-surge planning involves additional workflow adjustments in the outpatient and operating room settings given the abundance of COVID-19 virus in the upper aerodigestive tract. As the reverse-surge best practices are still under development, open communication between otolaryngology colleagues and health system leadership is paramount to optimize efficiency and maintain an adequate measure of safety for patients and our health care teams.


COVID-19 and Katrina: recalcitrant racial disparities


title: Structural Basis for Potent Neutralization of Betacoronaviruses by Single-Domain Camelid Antibodies

text: Coronaviruses make use of a large envelope protein called spike (S) to engage host cell receptors and catalyze membrane fusion. Because of the vital role that these S proteins play, they represent a vulnerable target for the development of therapeutics. Here, we describe the isolation of single-domain antibodies (VHHs) from a llama immunized with prefusion-stabilized coronavirus spikes. These VHHs neutralize MERS-CoV or SARS-CoV-1 S pseudotyped viruses, respectively. Crystal structures of these VHHs bound to their respective viral targets reveal two distinct epitopes, but both VHHs interfere with receptor binding. We also show cross-reactivity between the SARS-CoV-1 S-directed VHH and SARS-CoV-2 S and demonstrate that this cross-reactive VHH neutralizes SARS-CoV-2 S pseudotyped viruses as a bivalent human IgG Fc-fusion. These data provide a molecular basis for the neutralization of pathogenic betacoronaviruses by VHHs and suggest that these molecules may serve as useful therapeutics during coronavirus outbreaks.


title: Facts and myths: Efficacies of repurposing chloroquine and hydroxychloroquine for the treatment of COVID-19

text: The emergence of coronavirus disease 2019 (COVID-19) is caused by the 2019 novel coronavirus (2019-nCoV). The 2019-nCoV first broke out in Wuhan and subsequently spreads worldwide owing to its extreme transmission efficiency. The fact that the COVID-19 cases and mortalities are reported in globally and the WHO has declared this outbreak as the pandemic. The international health authorities have focused on rapid diagnosis and isolation of patients as well as search for therapies able to counter the disease severity. Due to the lack of known specific, effective and proven therapies as well as the situation of public-health emergency, drug repurposing appears to be the best armour to find therapeutic solution against 2019-nCoV infection. Repurposing anti-malarial drugs, chloroquine (CQ)/ hydroxychloroquine (HCQ) have shown efficacy to inhibit most coronaviruses, including SARS-CoV-1 coronavirus. These CQ analogues have shown potential efficacy to inhibit 2019-nCoV in vitro that lead to focus in several future clinical trials. This review discusses the possible effective roles and mechanisms of CQ analogues for interfering with the 2019-nCoV replication cycle and infection.


title: Parasitos gastrintestinais em caprinos no município de Quixadá, Ceará/ Gastrointestinal parasites in goats from Quixadá, Ceará

text: O objetivo desse trabalho foi avaliar a ocorrência dos principais parasitos gastrintestinais que acometem caprinos adultos e jovens do município de Quixadá-Ceará durante a época seca e chuvosa, além de identificar e quantificar as espécies de Eimeria presentes no rebanho. Foram utilizados 654 animais, sendo 334 animais no período seco, dos quais eram 149 matrizes e 185 crias e 320 animais no período chuvoso, sendo 106 matrizes e 214 crias, independente de padrão racial e sistema de criação. As coletas foram realizadas nos meses de novembro e dezembro de 2012 e maio de 2013 no município de Quixadá-Ceará e encaminhadas ao Laboratório de Parasitologia da Embrapa Caprinos e Ovinos na cidade de Sobral-Ceará. Foram coletadas fezes para contagem do número de ovos por gramas de fezes (OPG), contagem de Oocistos por gramas de fezes (OOPG), coprocultura e identificação das espécies de Eimeria com base na morfometria. As matrizes apresentaram maiores médias de ovos do tipo Strongyloidea (372,03) e Strongyloides (8,45) no período seco e no período chuvoso apresentaram maiores médias apenas para Strongyloidea (502,85). O inverso aconteceu com o OOPG, onde as crias apresentaram maiores médias no período seco (9387,41) e no chuvoso (9630,37). O gênero de nematódeo mais frequente na coprocultura foi o Trichostrongylus sp. (63,67%) no período seco e o Haemonchus sp. no chuvoso (66,67%). Em 100% dos rebanhos, foram encontrados oocistos de Eimeria, com 81% dos animais infectados. A ocorrência da eimeriose nas categorias jovens e adultas foi de 64,3% e 83,2% no período seco e de 87,4% e 92,4% no período chuvoso. As espécies identificadas foram: Eimeria alijevi, E. apsheronica, E. arloingi, E. caprina, E. caprovina, E. christenseni, E. hirci, E. jolchijevi e E. ninakohlyakimovae. Nas crias a E. alijevi foi a mais freqüente no período seco e a E. ninakohlyakimovae no chuvoso. Já nas matrizes a espécie E. alijevi apresentou a maior frequência em ambos os períodos. Nos rebanhos estudados foi evidenciado a presença de ovos de nematódeos gastrointestinais e oocistos de Eimeria spp. independente da categoria animal.(AU)


Comment on "Epidemiological and clinical characteristics of heart transplant recipients during the 2019 coronavirus outbreak in Wuhan, China" by Ren et al


Cancer guidelines during the COVID-19 pandemic


title: Anosmia Is a Key Symptom of COVID-19 Infection and Should Be Used as a Diagnostic Tool

text: Based on observations described in our letter, we can draw the following conclusions: (1) anosmia must imperatively be added to the list of specific symptoms of COVID-19 infection, (2) anosmia can serve as a free and specific diagnostic tool for developing countries currently affected by the pandemic, (3) the mechanisms of COVID-19 anosmia seem not to directly involve nasal obstruction but rather seem to be related to damage the olfactory neuroepithelium.


title: Spatial Disparities in Coronavirus Incidence and Mortality in the United States: An Ecological Analysis as of May 2020

text: PURPOSE: This ecological analysis investigates the spatial patterns of the COVID-19 epidemic in the United States in relation to socioeconomic variables that characterize US counties. METHODS: Data on confirmed cases and deaths from COVID-19 for 2,814 US counties were obtained from Johns Hopkins University. We used Geographic Information Systems (GIS) to map the spatial aspects of this pandemic and investigate the disparities between metropolitan and nonmetropolitan communities. Multiple regression models were used to explore the contextual risk factors of infections and death across US counties. We included population density, percent of population aged 65+, percent population in poverty, percent minority population, and percent of the uninsured as independent variables. A state-level measure of the percent of the population that has been tested for COVID-19 was used to control for the impact of testing. FINDINGS: The impact of COVID-19 in the United States has been extremely uneven. Although densely populated large cities and their surrounding metropolitan areas are hotspots of the pandemic, it is counterintuitive that incidence and mortality rates in some small cities and nonmetropolitan counties approximate those in epicenters such as New York City. Regression analyses support the hypotheses of positive correlations between COVID-19 incidence and mortality rates and socioeconomic factors including population density, proportions of elderly residents, poverty, and percent population tested. CONCLUSIONS: Knowledge about the spatial aspects of the COVID-19 epidemic and its socioeconomic correlates can inform first responders and government efforts. Directives for social distancing and to "shelter-in-place" should continue to stem the spread of COVID-19.


title: Rare Anaemias, Sickle-Cell Disease and COVID-19

text: For rare haematological diseases (RHD), the first question to be answered is if patients with be- nign red blood cell (RBC) defects like haemoglobinopathies, membranopathies and enzymopathies are more vulnerable to COVID-19 infection. Up to now, there is no yet literature on the subject, but, like in general population, the presence of comorbidities such as diabetes, heart disease, pulmonary hypertension, reduced kidney and/or liver function, worsen the effects of the infection. Splenectomy may be an additional risk factor.


A cluster of COVID-19 cases in a small Italian town: a successful example of contact tracing and swab collection


title: Mutations on COVID-19 diagnostic targets

text: Effective, sensitive, and reliable diagnostic reagents are of paramount importance for combating the ongoing coronavirus disease 2019 (COVID-19) pandemic at a time there is no preventive vaccine nor specific drug available for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It would be an absolute tragedy if currently used diagnostic reagents are undermined in any manner. Based on the genotyping of 7818 SARS-CoV-2 genome samples collected up to May 1, 2020, we reveal that essentially all of the current COVID-19 diagnostic targets have had mutations. We further show that SARS-CoV-2 has the most devastating mutations on the targets of various nucleocapsid (N) gene primers and probes, which have been unfortunately used by countries around the world to diagnose COVID-19. Our findings explain what has seriously gone wrong with a specific diagnostic reagent made in China. To understand whether SARS-CoV-2 genes have mutated unevenly, we have computed the mutation ratio and mutation $h$-index of all SARS-CoV genes, indicating that the N gene is the most non-conservative gene in the SARS-CoV-2 genome. Our findings enable researchers to target the most conservative SARS-CoV-2 genes and proteins for the design and development of COVID-19 diagnostic reagents, preventive vaccines, and therapeutic medicines.


title: Management of patients with ovarian cancer in the COVID-19 era

text: At the beginning of 2020, coronavirus disease 2019 (COVID-19) spreads worldwide. Patients with ovarian cancer should be considered at high-risk of developing severe morbidity related to COVID-19. Most of them are diagnosed in advanced stages of disease, and they are fragile. Here, we evaluated the major impact of COVID-19 on patients with ovarian cancer, discussing the effect of the outbreak on medical and surgical treatment.


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title: Shifting Paradigms in Head and Neck Reconstructive Surgery During the COVID-19 Crisis


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title: Management of ART and COVID-19: Infertility in Times of Pandemic. What Now?


Protecting health-care workers: Use of a Body Covering Transparent Sheet during and after Intubation of Patients with Covid-19


[Perioperative management of cesarean section for pregnant women with suspected or confirmed COVID-19]


Heparin-Related Major Bleeding in Covid-19-Positive Patient: Perspective from the Outbreak


Cancer care under the outbreak of COVID-19: A perspective from Italian tertiary referral center for surgical oncology


COVID 19 Outbreak: Potential of Biochemistry Speciality


The hidden vulnerability of homelessness in the COVID-19 pandemic: Perspectives from India


Prevention and infection control of COVID-19 in Nursing Homes: experience from China


Praticiens de la cavité orale. Recommandations professionnelles. Risques infectieux par le COVID-19. Faire front pour faire face./ [Practitioners specialized in oral health and coronavirus disease 2019: Professional guidelines from the French society of stomatology, maxillofacial surgery and oral surgery, to form a common front against the infectious risk]


title: What Does Resilience Signify? An Evaluation of Concepts and Directions for Future Research

text: Throughout the life course, individuals are confronted with adversities that challenge their ability to live the life they imagined. Adversities that are the most prominently studied and shown to bring about the most serious consequences for adjustment across the adult lifespan include job loss, disease and disability onset, and spousal and child bereavement. However, not all individuals show sustained declines to adversity; some are able to bounce back. The resilience literature is built on the premise that individuals are able to bounce back, or adapt to adversity. The past 15-20 years have seen an abundance of resilience research examining resilience to diverse types of adversity across the adult life-span. The overarching goal of this paper is to evaluate psychological concepts of resilience in adulthood and old age and recommend avenues for future research. To do so, I first evaluate and discuss definitions of resilience and their overlap across literatures with an emphasis on sociological approaches to studying adversity across the adult lifespan. Second, I discuss promising conceptual and methodological approaches to advance the resilience literature in adulthood and old age. Conceptual approaches to furthering the resilience literature include incorporating an anticipation component into the definition of resilience. Methodological approaches to furthering the resilience literature include prospective longitudinal designs that incorporate quantitative and qualitative approaches, multidimensional assessments, and the need to examine repeated adversities or multiple adversities that transpire in relatively close proximity to one another.


Comment on "Are erythema multiforme and urticaria related to a better outcome of COVID 19?" Eosinophil count in seven patients with COVID-19 and urticarial rash


title: The amount of cytokine-release defines different shades of Sars-Cov2 infection

text: The recent outbreak of coronavirus disease (COVID 19), spreading from China all around the world in early 2020, has led scientists to investigate the immuno-mediated mechanisms underlying the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) infection. Depending on the amount of cytokines released as the result of the immunological activation induced by SARS-CoV2, three major clinical phenotypes can be identified: "mild",symbolized as a "drizzle" of cytokines, severe as a "storm", and critical as a "hurricane". In patients with mild symptoms, the release of pro-inflammatory cytokines is balanced to obtain a defense response against the virus which is often self-limiting and overcomes without tissue damage. In severe phenotype, resembling a "cytokine-release syndrome", SARS-CoV2 causes the lysis of the immune-mediators leading to a cytokine storm able to induce lung epithelium damage and acute respiratory distress syndrome. In critical patients, the immune response may become uncontrolled, thus the cytokine burst resembles a form of secondary hemophagocytic lymphohistiocytosis which may result in a multi organ failure. In addition to the standard of care, an immune-modulatory therapy tailored to each one of the different phenotypes should be used in order to prevent or reduce the release of cytokines responsible for organ damage and disease progression.


title: The Synthetic Curcumin Analogue GO-Y030 Effectively Suppresses the Development of Pressure Overload-induced Heart Failure in Mice

text: Curcumin is a naturally occurring p300-histone acetyltransferase (p300-HAT) inhibitor that suppresses cardiomyocyte hypertrophy and the development of heart failure in experimental animal models. To enhance the therapeutic potential of curcumin against heart failure, we produced a series of synthetic curcumin analogues and investigated their inhibitory activity against p300-HAT. The compound with the strongest activity was further evaluated to determine its effects on cardiomyocyte hypertrophy and pressure overload-induced heart failure in mice. We synthesised five synthetic curcumin analogues and found that a compound we have named GO-Y030 most strongly inhibited p300-HAT activity. Furthermore, 1 µM GO-Y030, in a manner equivalent to 10 µM curcumin, suppressed phenylephrine-induced hypertrophic responses in cultured cardiomyocytes. In mice undergoing transverse aortic constriction surgery, administration of GO-Y030 at a mere 1% of an equivalently-effective dose of curcumin significantly attenuated cardiac hypertrophy and systolic dysfunction. In addition, this low dose of GO-Y030 almost completely blocked histone H3K9 acetylation and eliminated left ventricular fibrosis. A low dose of the synthetic curcumin analogue GO-Y030 effectively inhibits p300-HAT activity and markedly suppresses the development of heart failure in mice.


title: Neurosonology during the COVID-19 pandemic (Editorial commentary from the chairs of the ultrasound panel of the EAN)

text: The COVID-19 pandemic is seriously affecting the lives of billions of people around the world, especially in the healthcare systems.1 Although the impact of pandemic on health services are mostly negative, there is still a chance to use this situation as an opportunity for positive changes. Neurosonological examination involves direct contact between the patient and the sonographer, often for several tens of minutes.


Introduction. On pandemics: the impact of COVID-19 on the practice of neurosurgery


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title: Mental health services in Italy during the COVID-19 outbreak


Seroconversion in household members of COVID-19 outpatients


title: Modelling the role of media induced fear conditioning in mitigating post-lockdown COVID-19 pandemic: perspectives on India

text: Several countries that have been successful in constraining the severity of COVID-19 pandemic via"lockdown"are now considering to slowly end it, mainly because of enormous socio-economic side-effects. An abrupt ending of lockdown can increase the basic reproductive number and undo everything; therefore, carefully designed exit strategies are needed to sustain its benefits post upliftment. To study the role of fear conditioning on mitigating the spread of COVID-19 in post-lockdown phase, in this work, we propose an age- and social contact- structures dependent Susceptible, Feared, Exposed, Infected and Recovered (SFEIR) model. Simulating the SFEIR model on Indian population with fear conditioning via mass media (like, television, community radio, internet and print media) along with positive reinforcement, it is found that increase in fraction of feared people results in the significant decrease in the growth of infected population. The present study suggests that, during post-lockdown phase, media induced fear conditioning in conjunction with closure of schools for about one more year can serve as an important non-pharmaceutical intervention to substantially mitigate this pandemic in India. The proposed SFEIR model, by quantifying the influence of media in inducing fear conditioning, underlies the importance of community driven changes in country specific mitigation of COVID-19 spread in post-lockdown phase.


title: Epidemiological, clinical characteristics of cases of SARS-CoV-2 infection with abnormal imaging findings

text: PURPOSE: To investigate the epidemiological and clinical characteristics of COVID-19 patients with abnormal imaging findings. METHODS: Patients confirmed with SARS-CoV-2 infection in Zhejiang province from January 17 to February 8 who had undergone CT or X-ray were enrolled. Epidemiological and clinical data were analyzed among those with abnormal or normal imaging findings. RESULTS: Excluding 72 patients with normal images, 230 of 573 patients showed abnormalities affecting more than two lung lobes. The median radiographic score was 2.0, and there was a negative correlation between that score and the oxygenation index (ρ = -0.657, P < 0.001). Patients with abnormal images were older (46.65 ± 13.82), with a higher rate of coexisting condition (28.8%), a lower rate of exposure history, and longer time between onset and confirmation (5 days) than non-pneumonia patients (all P < 0.05). A higher rate of fever, cough, expectoration and headache, a lower level of lymphocytes, albumin, and serum sodium levels and a higher total bilirubin, creatine kinase, lactate dehydrogenase, and C-reactive protein levels and a lower oxygenation index were observed in pneumonia patients (all P < 0.05). Muscle ache, shortness of breath, nausea and vomiting, lower lymphocytes levels, and higher serum creatinine and radiographic score at admission were predictive factors for the severe/critical subtype. CONCLUSION: Patients with abnormal images have more obvious clinical manifestations and laboratory changes. Combing clinical features and radiographic scores can effectively predict severe/critical types.


title: Teamworking in Endoscopy: a Human Factors Toolkit for the Covid-19 Era

text: Background and Aims Endoscopy services have had to rapidly adapt working practices in response to COVID-19. As recovery of endoscopy proceeds, there are numerous challenges facing our workforce which can impair effective teamworking. We designed and developed a novel toolkit to support teamworking in endoscopy during the pandemic. Methods A human factors model was developed to understand the impact of COVID-19 on endoscopy teams. From this, we identified a set of key teamworking goals which informed the development of a toolkit to support several team processes. The toolkit was refined following expert input and refinement over a six-week period. Results The toolkit consists of four cognitive aids that can be used to support team huddles, briefings and debriefs, alongside techniques to optimise endoscopic non-technical skills across the patient procedure pathway. We describe the processes that local endoscopy units can employ to implement this toolkit. Conclusion A toolkit of cognitive aids, based on human factors principles, may be useful in supporting teams, helping them adapt to working safely in the era of COVID-19.


title: Avaliação da frequência cardíaca materna, fetal e neonatal e sua variabilidade em equinos da raça Paint Horse/ Maternal, fetal and neonatal heart rate evaluation and its variability in the Paint Horse breed

text: Os objetivos deste estudo foram descrever a frequência cardíaca (FC) e os índices de variabilidade da frequência cardíaca (VFC) materna e fetal no terço final da gestação, bem como descrever a evolução do desenvolvimento do sistema nervoso autônomo durante o período fetal e neonatal. Foram avaliados 20 animais de cada categoria, cujos exames eletrocardiográficos, maternos e fetais, foram realizados aos 15 e sete dias pré-parto. Quanto ao eletrocardiograma neonatal, os momentos avaliados foram ao nascimento até as primeiras 48 horas de vida, e posteriormente, uma vez por semana até os 35 dias de idade. Ocorreram diferenças significativas na frequência cardíaca fetal (FCF) no período avaliado, porém os índices de VFC fetais não se alteraram. Não foram encontradas diferenças significativas nos índices de VFC materna. A média da FCF diminuiu significativamente dos 15 para sete dias do pré-parto (95,6±11,4 bpm; 83,1±12,6, respectivamente), entretanto os índices de VFC fetal não diminuíram. Os resultados obtidos da VFC fetal e neonatal deste estudo, quando comparados aos maternos, indicaram predomínio parassimpático durante a fase fetal e, simpático durante a neonatal, até a terceira e/ou quarta semanas de idade, momento no qual se inicia o equilíbrio entre os dois sistemas.(AU)


Ultrasound in COVID-19: a timeline of ultrasound findings in relation to CT


title: Social and administrative issues related to the COVID-19 pandemic in Pakistan: better late than never

text: The study critically reviewed Pakistan's provincial updates of coronavirus disease 2019 (COVID-19) and discussed the current challenges faced by the government in a given context. The coronavirus-associated death tolls have been increasing rapidly in a country. The provincial status of confirmed cases of coronavirus is higher in Punjab, followed by the Sindh, Khyber Pakhtunkhwa (KPK), and Balochistan. The case fatality ratio shows that KPK has a higher ratio, i.e., 5.11%, followed by the Punjab, i.e., 1.82%; Sindh, i.e., 1.80%; Balochistan, i.e., 1.28%; Gilgit-Baltistan, i.e., 0.71%; and Federal territory, i.e., 0.66%. The country has a less testing capacity to identify more suspected coronavirus patients. The study calculated that if we increase five times our testing capacity from the current date, the total registered cases will be reached to 137,370 and death tolls will increase up to 3090. It is highly needed to increase testing capacity across Pakistan in order to minimize the outbreak of coronavirus. The provincial government should follow the Federal Government instructions to contain coronavirus by increasing testing capacities, tracing suspected patients, smart lockdowns, emergency relief to the poor, and vigilant monitoring system.


title: [The Agreed Experts' Position of the Eurasian Association of Therapists on Some new Mechanisms of COVID-19 Pathways: Focus on Hemostasis, Hemotransfusion Issues and Blood gas Exchange]

text: The article discusses pathogenesis and treatment of COVID-19. The authors presented state-of-the-art insight into hemostatic disorders in patients with COVID-19 and clinical recommendations on prevention of thrombosis and thromboembolism in patients infected with SARS-CoV-2. The article discussed in detail a new hypothesis proposed by Chinese physicians about a new component in the pathogenesis of COVID-19, namely, about the effect of SARS-CoV-2 virus on the hemoglobin beta-chain and the formation of a complex with porphyrin, which results in displacement of the iron ion. Thus, hemoglobin loses the capability for transporting oxygen, which aggravates hypoxia and worsens the prognosis. The article stated rules of hemotransfusion safety in the conditions of COVID-19 pandemic.


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title: [risk Assessment for Aerosol Infection by the New Corona Virus and Protection by Respirators]

text: INTRODUCTION: SARS-CoV-2 is dispersed from patients by talking, coughing and sneezing. The generated micro-droplets aerosols can travel up to 8 meters, stay suspended for long periods and preserve viral infectivity for a median of 2.7 hours. An unprotected person exposed to this cloud, might inhale a considerable amount of infectious viral doses, which will attach to the ACE 2 receptors on alveoli epithelium, resulting in infection. N95 respirators and surgical masks block 95% and 50-60% respectively of inhalable particles and protect the wearer from infection. Surgical masks and N95 without exhalation valve, protect both the wearer and the environment from carriers and sick people.


[Protection suggestions on medical staff in obstetrics and gynecology in COVID-19-designated hospitals]


title: Hospital preparedness for COVID-19 pandemic: experience from department of medicine at Veterans Affairs Connecticut Healthcare System

text: The 2019-2020 pandemic Coronavirus Disease 2019 (COVID-19) has inundated hospital systems globally, as they prepare to accommodate surge of patients requiring advanced levels of care. Pandemic preparedness has not been this urgently and widely needed in the last several decades. According to epidemiologic predictions, the peak of this pandemic has still not been reached, and hospitals everywhere need to ensure readiness to care for more patients than they usually do, and safety for healthcare workers who strive to save lives. We share our hospital-wide rapid preparedness and response to COVID-19 to help provide information to other healthcare systems globally.


title: A three-component cyclocondensation reaction for the synthesis of new triazolo[1,5-a]pyrimidine scaffolds using 3-aminotriazole, aldehydes and ketene N,S-acetal

text: This study describes the use of 3-aminotriazole, different aldehydes and N-methyl-1-(methylthio)-2-nitroethenamine as a ketene N,S-acetal in a three-component condensation for the synthesis of a novel library of triazolo[1,5-a]pyrimidine scaffolds. The presence of trichloroacetic acid as a Brønsted-Lowry acidic promoter in acetonitrile or water solvent and room temperature condition resulting novel triazolo[1,5-a]pyrimidine systems named N-methyl-6-nitro-5-aryl-3,5-dihydro-[1, 2, 4]triazolo[1,5-a]pyrimidine-7-amine. The structure of products and direction of the N-cyclization could be confirmed using spectral data. The effect of various solvents on the progress of process was investigated in the paper. The presence of five nitrogen heteroatoms, the use of various aldehydes affording a range of skeletally distinct triazolo[1,5-a]pyrimidine-based heterocycles, the potency to create numerous hydrogen bonds in the product structure, and direction of cyclization are attractive features of this reaction.


The COVID-19 outbreak: a snapshot from down under