title: Conscious Proning: An Introduction of a Proning Protocol for Nonintubated, Awake, Hypoxic Emergency Department COVID-19 Patients

text: The novel coronavirus, or COVID-19, has rapidly become a global pandemic. A major cause of morbidity and mortality due to COVID-19 has been the worsening hypoxia that, if untreated, can progress to acute respiratory distress syndrome (ARDS) and respiratory failure. Past work has found that intubated patients with ARDS experience physiological benefits to the prone position, because it promotes better matching of pulmonary perfusion to ventilation, improved secretion clearance, and recruitment of dependent areas of the lungs. We created a systemwide multi-institutional (New York-Presbyterian Hospital enterprise) protocol for placing awake, nonintubated, emergency department patients with suspected or confirmed COVID-19 in the prone position. In this piece, we describe the background literature and the approach we have taken at our institution as we care for a high burden of COVID-19 cases with respiratory symptoms.


title: Incidental Discovery of a COVID-19 Infection on a Reevaluation FDG PET/CT in a Patient Treated for Hodgkin Lymphoma

text: We report the results of F-FDG PET/CT in an asymptomatic case of COVID-19 infection. A 27-year-old woman underwent FDG PET/CT for revaluation of a stage IIIE B Hodgkin lymphoma after the fourth cycle of chemotherapy. It showed intense avid FDG subpleural mixed ground-glass and consolidative lesions, especially in the left lung. Because of this morpho-metabolic aspect and the epidemic context, a viral pneumopathy was suspected. The patient who was initially asymptomatic was admitted for fever 28 hours after the PET/CT. The nasopharyngeal swab was positive for COVID-19, and the outcome was favorable.


[Recommendations for the diagnosis, prevention and control of the 2019 novel coronavirus infection in children (first interim edition)]


title: Pathological Findings in the Testes of COVID-19 Patients: Clinical Implications

text: BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), involves multiple organs. Testicular involvement is largely unknown. OBJECTIVE: To determine the pathological changes and whether SARS-CoV-2 can be detected in the testes of deceased COVID-19 patients. DESIGN, SETTING, AND PARTICIPANTS: Postmortem examination of the testes from 12 COVID-19 patients was performed using light and electron microscopy, and immunohistochemistry for lymphocytic and histiocytic markers. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the virus in testicular tissue. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Seminiferous tubular injury was assessed as none, mild, moderate, or severe according to the extent of tubular damage. Leydig cells in the interstitium were counted in ten 400× microscopy fields. RESULTS AND LIMITATIONS: Microscopically, Sertoli cells showed swelling, vacuolation and cytoplasmic rarefaction, detachment from tubular basement membranes, and loss and sloughing into lumens of the intratubular cell mass. Two, five, and four of 11 cases showed mild, moderate, and severe injury, respectively. The mean number of Leydig cells in COVID-19 testes was significantly lower than in the control group (2.2 vs 7.8, p < 0.001). In the interstitium there was edema and mild inflammatory infiltrates composed of T lymphocytes and histiocytes. Transmission EM did not identify viral particles in three cases. RT-PCR detected the virus in one of 12 cases. CONCLUSIONS: Testes from COVID-19 patients exhibited significant seminiferous tubular injury, reduced Leydig cells, and mild lymphocytic inflammation. We found no evidence of SARS-CoV-2 virus in the testes in the majority (90%) of the cases by RT-PCR, and in none by electron microscopy. These findings can provide evidence-based guidance for sperm donation and inform management strategies to mitigate the risk of testicular injury during the COVID-19 disease course. PATIENT SUMMARY: We examined the testes of deceased COVID-19 patients. We found significant damage to the testicular parenchyma. However, virus was not detected in testes in the majority of cases.


title: Application of personal-oriented digital technology in preventing transmission of COVID-19, China

text: We reported several personal-oriented and mobile phone-based information technologies which were recently developed and widely used during the outbreak of COVID-19 in China. These technologies help reduce the transmission of COVID-19 and maintain normal social order.


docid: kbiqszbd

title: Doubters and Believers in the Time of the Pandemic


title: A Machine Learning Application for Raising WASH Awareness in the Times of COVID-19 Pandemic

text: Proactive management of an Infodemic that grows faster than the underlying epidemic is a modern-day challenge. This requires raising awareness and sensitization with the correct information in order to prevent and contain outbreaks such as the ongoing COVID-19 pandemic. Therefore, there is a fine balance between continuous awareness-raising by providing new information and the risk of misinformation. In this work, we address this gap by creating a life-long learning application that delivers authentic information to users in Hindi and English, the most widely used languages in India. It does this by matching sources of verified and authentic information such as the WHO reports against daily news by using machine learning and natural language processing. It delivers the narrated content in Hindi by using state-of-the-art text to speech engines. Finally, the approach allows user input for continuous improvement of news feed relevance daily. We demonstrate this approach for Water, Sanitation, Hygiene information for containment of the COVID-19 pandemic. Thirteen combinations of pre-processing strategies, word-embeddings, and similarity metrics were evaluated by eight human users via calculation of agreement statistics. The best performing combination achieved a Cohen's Kappa of 0.54 and was deployed as On AIr, WashKaro's AI-powered back-end. We introduced a novel way of contact tracing, deploying the Bluetooth sensors of an individual's smartphone and automatic recording of physical interactions with other users. Additionally, the application also features a symptom self-assessment tool based on WHO-approved guidelines, human-curated and vetted information to reach out to the community as audio-visual content in local languages. WashKaro - http://tiny.cc/WashKaro


title: COVID-19: clinical issues from the Japan Surgical Society

text: In this unprecedented COVID-19 pandemic, several key issues must be addressed to ensure safe treatment and prevent rapid spread of the virus and a consequential medical crisis. Careful evaluation of a patient's condition is crucial for deciding the triage plan, based on the status of the disease and comorbidities. As functionality of the medical care system is greatly affected by the environmental situation, the treatment may differ according to the medical and infectious disease circumstances of the institution. Importantly, all medical staff must prevent nosocomial COVID-19 by minimizing the effects of aerosol spread and developing diagnostic and surgical procedures. Polymerase chain reaction (PCR) screening for COVID-19 infection, particularly in asymptomatic patients, should be encouraged as these patients are prone to postoperative respiratory failure. In this article, the Japan Surgical Society addresses the general principles of surgical treatment in relation to COVID-19 infection and advocates preventive measures against viral transmission during this unimaginable COVID-19 pandemic.


title: Effect of hydroxychloroquine on COVID-19 prevention in cancer patients undergoing treatment: a structured summary of a study protocol for a randomised controlled trial

text: OBJECTIVES: In this study, we investigate the effect of hydroxychloroquine on the prevention of Novel Coronavirus Disease (COVID-19) in cancer patients being treated. TRIAL DESIGN: This is a multi-centre, two-arm, parallel-group, triple-blind, phase 2-3 randomised controlled trial. PARTICIPANTS: All patients over the age of 15 from 5 types of cancer are included in the study. Patients with acute lymphoid and myeloid leukemias in the first line treated with curative intent, patients with high-grade non-Hodgkin's lymphoma treated with leukemia protocols and patients with non-metastatic breast and colon cancer in the first line of treatment will enter the study. The exclusion criteria will include known sensitivity to Hydroxychloroquine, weight below 35 kilograms, history of retinopathy, history of any cardiac disease, acute respiratory tract infection in the last 2 months, having COVID-19 in the first two weeks of entering the trial, having Diabetes Mellitus, having an immuno-suppressive disease other than cancer, having chronic pulmonary disease and taking immuno-suppressant drug other than chemotherapeutic agents for current cancer. This study is performed in five academic centres affiliated to Mashhad University of Medical Sciences, Mashhad, Iran. INTERVENTION AND COMPARATOR: Patients are randomly assigned to two groups; one being given hydroxychloroquine and the other is given placebo. During two months of treatment, the two groups are treated with either hydroxychloroquine (Amin® Pharmaceutical Company, Isfahan, Iran) or placebo (identical in terms of shape, colour, smell) as a single 200 mg tablet every other day. Patients will be monitored for COVID-19 symptoms during the follow-up period. If signs or symptoms occur (fever, cough, shortness of breath), they will be examined and investigated with a high-resolution computed tomography (CT) scan of the lungs, COVID-19 specific IgM, IgG antibody assay and a nucleic acid amplification test (NAT) for the SARS-CoV-2 virus. MAIN OUTCOMES: The primary end point of this study is to investigate the incidence of COVID-19 in patients being treated for their cancer over a 2-month period. RANDOMISATION: Randomisation will be performed using randomly permuted blocks. By using an online website (www.randomization.com) the randomization sequence will be produced by quadruple blocks. The allocation ratio in intervention and control groups is 1:1. BLINDING (MASKING): Participants and caregivers do not know whether the patient is in the intervention or the control group. The outcome assessor and the data analyst are also blinded to group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The calculated total sample size is 60 patients, with 30 patients in each group. TRIAL STATUS: The trial began on April 14, 2020 and recruitment is ongoing. Recruitment is anticipated to be completed by June 14, 2020 There has been no change in study protocol since approval, protocol version 1 was approved April 12, 2020. TRIAL REGISTRATION: This trial has been registered by the title of "Effect of Hydroxychloroquine on Novel Coronavirus Disease (COVID-19) prevention in cancer patients under treatment" in Iranian Registry of Clinical Trials (IRCT) with code "IRCT20200405046958N1", https://www.irct.ir/trial/46946. Registration date is April 14, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Hygiène des mains et masques contre COVID-19 : oser le dégradé ?/ [Hand hygiene and facemasks against COVID-19: Should we consider alternate strategies?]


title: ProtTrans: Towards Cracking the Language of Life's Code Through Self-Supervised Deep Learning and High Performance Computing

text: Motivation: NLP continues improving substantially through auto-regressive and auto-encoding Language Models. These LMs require expensive computing resources for self-supervised or un-supervised learning from huge unlabelled text corpora. The information learned is transferred through so-called embeddings to downstream prediction tasks. Bioinformatics provide vast gold-mines of structured and sequentially ordered text data leading to extraordinarily successful protein sequence LMs that promise new frontiers for generative and predictive tasks at low inference cost. Here, we addressed two questions: (1) To which extent can HPC up-scale protein LMs to larger databases and larger models? (2) To which extent can LMs extract features from single proteins to get closer to the performance of methods using evolutionary information? Methodology: Here, we trained two auto-regressive language models (Transformer-XL and XLNet) and two auto-encoder models (BERT and Albert) using 80 billion amino acids from 200 million protein sequences (UniRef100) and 393 billion amino acids from 2.1 billion protein sequences (BFD). The LMs were trained on the Summit supercomputer, using 5616 GPUs and one TPU Pod, using V3-512 cores. Results: The results of training these LMs on proteins was assessed by predicting secondary structure in three- and eight-states (Q3=75-83, Q8=63-72), localization for 10 cellular compartments (Q10=74) and whether a protein is membrane-bound or water-soluble (Q2=89). Dimensionality reduction revealed that the LM-embeddings from unlabelled data (only protein sequences) captured important biophysical properties of the protein alphabet, namely the amino acids, and their well orchestrated interplay in governing the shape of proteins. In the analogy of NLP, this implied having learned some of the grammar of the language of life realized in protein sequences.


Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2) infection in cancer population: Are patient-related symptoms helpful to track a harmful invisible?


title: The Hypothesis of Testing: Paradoxes arising out of reported coronavirus case-counts

text: Many statisticians, epidemiologists, economists and data scientists have registered serious reservations regarding the reported coronavirus case-counts. Limited testing capacity across the country has been widely identified as a key driver of suppressed coronavirus case-counts. The calls to increase testing capacity are well-justified as they become a more frequent point of discussion in the public sphere. While expanded testing is a laudable goal, selection bias will impact estimates of disease prevalence and the effective reproduction number until the entire population is sampled. Moreover, tests are imperfect as false positive/negative rates interact in complex ways with selection bias. In this paper, we attempt to clarify this interaction. Through simple calculations, we demonstrate pitfalls and paradoxes that can arise when considering case-count data in the presence of selection bias and measurement error. The discussion guides several suggestions on how to improve current case-count reporting.


Considerations for resuscitation and transfer of paediatric patients with COVID-19


title: Recommended operating room practice during the COVID-19 pandemic: systematic review

text: BACKGROUND: The COVID-19 pandemic poses a critical global public health crisis. Operating room (OR) best practice in this crisis is poorly defined. This systematic review was performed to identify contemporary evidence relating to OR practice in the context of COVID-19. METHODS: MEDLINE was searched systematically using PubMed (search date 19 March 2020) for relevant studies in accordance with PRISMA guidelines. Documented practices and guidance were assessed to determine Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence, and recommendations for practice within five domains were extracted: physical OR, personnel, patient, procedure, and other factors. RESULTS: Thirty-five articles were identified, of which 11 met eligibility criteria. Nine articles constituted expert opinion and two were retrospective studies. All articles originated from the Far East (China, 9; Singapore, 2); eight of the articles concerned general surgery. Common themes were identified within each domain, but all recommendations were based on low levels of evidence (median OCEBM level 5 (range 4-5)). The highest number of overlapping recommendations related to physical OR (8 articles) and procedural factors (13). Although few recommendations related to personnel factors, consensus was high in this domain, with all studies mandating the use of personal protective equipment. CONCLUSION: There was little evidence to inform this systematic review, but there was consensus regarding many aspects of OR practice. Within the context of a rapidly evolving pandemic, timely amalgamation of global practice and experiences is needed to inform best practice.


title: Impact of the COVID-19 Pandemic on Emergency Department Visits - United States, January 1, 2019-May 30, 2020

text: On March 13, 2020, the United States declared a national emergency to combat coronavirus disease 2019 (COVID-19). As the number of persons hospitalized with COVID-19 increased, early reports from Austria (1), Hong Kong (2), Italy (3), and California (4) suggested sharp drops in the numbers of persons seeking emergency medical care for other reasons. To quantify the effect of COVID-19 on U.S. emergency department (ED) visits, CDC compared the volume of ED visits during four weeks early in the pandemic March 29-April 25, 2020 (weeks 14 to 17; the early pandemic period) to that during March 31-April 27, 2019 (the comparison period). During the early pandemic period, the total number of U.S. ED visits was 42% lower than during the same period a year earlier, with the largest declines in visits in persons aged ≤14 years, females, and the Northeast region. Health messages that reinforce the importance of immediately seeking care for symptoms of serious conditions, such as myocardial infarction, are needed. To minimize SARS-CoV-2, the virus that causes COVID-19, transmission risk and address public concerns about visiting the ED during the pandemic, CDC recommends continued use of virtual visits and triage help lines and adherence to CDC infection control guidance.


Covid-19 is an opportunity for gender equality within the workplace and at home


title: Miller Fisher Syndrome and polyneuritis cranialis in COVID-19

text: OBJECTIVE: To report two patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) who acutely presented with Miller Fisher syndrome and polyneuritis cranialis, respectively. METHODS: Patient data were obtained from medical records from the University Hospital "Príncipe de Asturias", Alcalá de Henares, Madrid, Spain and from the University Hospital "12 de Octubre", Madrid, Spain. RESULTS: The first patient was a 50-year-old man who presented with anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia, areflexia, albuminocytologic dissociation and positive testing for GD1b-IgG antibodies. Five days before, he had developed a cough, malaise, headache, low back pain, and a fever. The second patient was a 39-year-old man who presented with ageusia, bilateral abducens palsy, areflexia and albuminocytologic dissociation. Three days before, he had developed diarrhea, a low-grade fever, and a poor general condition. The oropharyngeal swab test for coronavirus disease 2019 (COVID-19) by qualitative real-time reverse-transcriptase-polymerase-chain-reaction assay was positive in both patients and negative in the cerebrospinal fluid. The first patient was treated with intravenous immunoglobulin and the second, with acetaminophen. Two weeks later, both patients made a complete neurological recovery, except for residual anosmia and ageusia in the first case. CONCLUSIONS: Our two cases highlight the rare occurrence of Miller Fisher syndrome and polyneuritis cranialis during the COVID-2 pandemic. Neurological manifestations may occur because of an aberrant immune response to COVID-19. The full clinical spectrum of neurological symptoms in patients with COVID-19 remains to be characterized.


'Closed' supraglottic airway guided intubation during the COVID-19 pandemic: a Glo Germ ™ follow up


Oligohydramnion in COVID19


Supporting Patients With Autism During COVID-19


Important lessons for infection control in radiology departments during the COVID-19 pandemic


title: Using eHealth to Support COVID-19 Education, Self-Assessment, and Symptom Monitoring in the Netherlands: Observational Study

text: BACKGROUND: The coronavirus disease (COVID-19) situation demands a lot from citizens, health care providers, and governmental institutions. Citizens need to cope with guidelines on social interaction, work, home isolation, and symptom recognition. Additionally, health care providers and policy makers have to cope with unprecedented and unpredictable pressure on the health care system they need to manage. By providing citizens with an app, they always have access to the latest information and can assess their own health. This data could be used to support policy makers and health care providers to get valuable insights in the regional distribution of infection load and health care consumption. OBJECTIVE: The aim of this observational study is to assess people's use of an app to support them with COVID-19 education, self-assessment, and monitoring of their own health for a 7-day period. In addition, we aim to assess the usability of this data for health care providers and policy makers by applying it to an interactive map and combining it with hospital data. The secondary outcomes of the study were user's satisfaction with the information provided in the app, perceived usefulness of the app, health care providers they contacted, and the follow-up actions from this contact. METHODS: This observational cohort study was carried out at the nonacademic teaching hospital "Elisabeth Twee Steden" (ETZ) in Tilburg, Netherlands. From April 1, 2020, onwards ETZ offered the COVID-19 education, self-assessment, and symptom tracking diary to their already existing app for patient education and monitoring. RESULTS: Between April 1 and April 20, 2020, a total of 6194 people downloaded the app. The self-assessment functionality was used abundantly to check one's health status. In total, 5104 people responded to the question about severe symptoms, from which 242 indicated to suffer from severe symptoms. A total of 4929 people responded to the question about mild symptoms, from which 3248 indicated to suffer from these. The data was successfully applied to an interactive map, displaying user demographics and health status. Furthermore, the data was linked to clinical data. App users were satisfied with the information in the app and appreciated the symptom diary functionality. In total, 102 users reached out to a health care provider, leading to 91 contacts. CONCLUSIONS: Our study demonstrated the successful implementation and use of an app with COVID-19 education, self-assessment, and a 7-day symptom diary. Data collected with the app were successfully applied to an interactive map. In addition, we were able to link the data to COVID-19 screening results from the hospital's microbiology laboratory. This data could be used to support policy makers and health care providers to get valuable insights in the regional distribution of infection load and health care consumption. TRIAL REGISTRATION: Netherlands Trial Register NL8501; https://www.trialregister.nl/trial/8501.


title: Predicting COVID-19 in China Using Hybrid AI Model

text: The coronavirus disease 2019 (COVID-19) breaking out in late December 2019 is gradually being controlled in China, but it is still spreading rapidly in many other countries and regions worldwide. It is urgent to conduct prediction research on the development and spread of the epidemic. In this article, a hybrid artificial-intelligence (AI) model is proposed for COVID-19 prediction. First, as traditional epidemic models treat all individuals with coronavirus as having the same infection rate, an improved susceptible-infected (ISI) model is proposed to estimate the variety of the infection rates for analyzing the transmission laws and development trend. Second, considering the effects of prevention and control measures and the increase of the public's prevention awareness, the natural language processing (NLP) module and the long short-term memory (LSTM) network are embedded into the ISI model to build the hybrid AI model for COVID-19 prediction. The experimental results on the epidemic data of several typical provinces and cities in China show that individuals with coronavirus have a higher infection rate within the third to eighth days after they were infected, which is more in line with the actual transmission laws of the epidemic. Moreover, compared with the traditional epidemic models, the proposed hybrid AI model can significantly reduce the errors of the prediction results and obtain the mean absolute percentage errors (MAPEs) with 0.52%, 0.38%, 0.05%, and 0.86% for the next six days in Wuhan, Beijing, Shanghai, and countrywide, respectively.


title: Awareness and preparedness of Field Epidemiology Training Program graduates in the Eastern Mediterranean Region to respond to COVID-19: A cross-section study

text: BACKGROUND: The Field Epidemiology Training Program (FETP) is a 2-year training program in applied epidemiology. FETP graduates have contributed significantly to improvements in surveillance systems, control of infectious diseases, and outbreak investigations in the Eastern Mediterranean Region (EMR). OBJECTIVE: Knowing their instrumental roles during the COVID-19 crisis, this study aimed to assess the awareness and preparedness of FETP graduates in three EMR countries to respond to COVID-19 pandemic. METHODS: An online survey was sent to FETP graduates in 3 countries in the EMR in March 2020. The FETP graduates were contacted by email and requested to fill an online survey. Sufficient number of responses were received from three countries only including Jordan, Sudan, and Yemen. Few responses were received from other countries and therefore they were excluded from the analysis. The questionnaire comprised a series of questions pertaining to socio-demographic characteristics, knowledge of the epidemiology of COVID-19, and preparedness to respond to COVID-19. RESULTS: This study included a total of 57 FETP graduates (20 from Jordan, 13 from Sudan, and 24 from Yemen). A total of 31 (54%) graduates had attended training on COVID-19, 29 (51%) are member of a rapid response team against COVID-19 and 54 (95%) had previous experience in response to disease outbreaks or health emergencies. The vast majority were aware of the main symptoms, mode of transmission, high risk groups, and aware of how to use personal protective equipment. A total of 46 (81%) respondents considered themselves well prepared for the COVID-19 outbreak and 40 (70%) reported that they currently have a role in supporting the country efforts in the management of COVID-19 outbreak. CONCLUSIONS: The FETP graduates in Jordan, Sudan, and Yemen were fully aware of the epidemiology COVID-19 and the safety measures and they are well positioned to investigate and respond to COVID-19 pandemic. Therefore, they should be properly and efficiently utilized by the ministries of health to investigate and respond to the current COVID-19 crisis where the needs are vastly growing and access to outside experts becomes limited.


COVID-19 Pneumonia Hospitalizations Followed by Re-Presentation for Presumed Thrombotic Event


MDA5 should be detected in severe COVID-19 patients


docid: fnhmspfg

title: Being a foot and ankle surgeon in Italy in the era of COVID-19


Reply to the letter by Gaetano Loscocco, Secondary hemophagocytic lymphohistiocytosis, HScore and COVID-19


Hepatic manifestations and complications of COVID-19: A systematic review and meta-analysis


title: Transmission potential and severity of COVID-19 in South Korea

text: OBJECTIVES: Since the first case of 2019 novel coronavirus (COVID-19) identified on Jan 20, 2020, in South Korea, the number of cases rapidly increased, resulting in 6284 cases including 42 deaths as of Mar 6, 2020. To examine the growth rate of the outbreak, we present the first study to report the reproduction number of COVID-19 in South Korea. METHODS: The daily confirmed cases of COVID-19 in South Korea were extracted from publicly available sources. By using the empirical reporting delay distribution and simulating the generalized growth model, we estimated the effective reproduction number based on the discretized probability distribution of the generation interval. RESULTS: We identified four major clusters and estimated the reproduction number at 1.5 (95% CI: 1.4-1.6). In addition, the intrinsic growth rate was estimated at 0.6 (95% CI: 0.6, 0.7), and the scaling of growth parameter was estimated at 0.8 (95% CI: 0.7, 0.8), indicating sub-exponential growth dynamics of COVID-19. The crude case fatality rate is higher among males (1.1%) compared to females (0.4%) and increases with older age. CONCLUSIONS: Our results indicate an early sustained transmission of COVID-19 in South Korea and support the implementation of social distancing measures to rapidly control the outbreak.


docid: odseltgg

title: Accidental poisoning by castor bean (Ricinus communis) cake in horses/ Intoxicação acidental por torta de mamona (Ricinus communis) em equinos

text: Ricinus communis is a shrub of the family Euphorbiaceae popularly known in Brazil as "mamona" or "carrapateira". It is an oleaginous plant whose seeds have been used mainly in biodiesel production. Plant seed oil can be extracted mechanically or using solvents, generating castor bean cake and castor bean meal as by-products, respectively. Accidental ingestion of these by-products can cause poisoning in animals and humans, characterized by digestive signs resulting from the presence of a toxalbumin called ricin. Seed toxicity varies among animal species; in horses, the lethal dose of seeds is 0.1 g/kg of body weight. The literature presents plenty of studies addressing poisoning by R. communis in different animal species and in humans; however, reports are scarce and little information is available on the pathological aspects of poisoning regarding equines. Therefore, the present study aimed to describe the epidemiological, clinical and pathological aspects observed in an outbreak of accidental poisoning with castor bean cake in horses. The equines were supplemented with palm kernel (Elaeis guianeesis) cake; however, in the purchase of a new batch, there was an error in the order, and castor bean cake was requested instead. Four horses that received castor bean cake presented clinical signs indicative of colic, which started about 21 hours after administration. Three of these horses died, with clinical evolution from 2 to 4.5 hours; the other animal was treated with intravenous fluid and antibiotic therapy and non-steroidal anti-inflammatory drugs and recovered after five days. In the necropsy of two of these horses, the main lesions were found in the small intestine, where mucosae with pronounced redness and covered with a thin layer of yellow fibrous material were observed. In the intestinal lumen, there was a large amount of bloody liquid. The stomach was full, and dark lumps similar to crushed castor bean seeds were observed in the contents. The adrenal glands of both horses presented congestion and hemorrhage in the cortex. In microscopy, the main lesion was an acute, diffuse and accentuated fibrin-necrotic enteropathy affecting the jejunum. The diagnosis of castor bean cake poisoning was based on the circumstantial evidence of by-product consumption supported by clinical and pathological aspects. The results indicate that castor bean cake commercially available as fertilizer is extremely toxic when ingested, and there is a need for appropriate detoxification or labeling informing of its toxicity.(AU)


title: Incidental COVID-19 Pneumonia on 18F-Fluorocholine PET/CT

text: We present the case of a patient who underwent F-fluorocholine PET/CT for biochemical recurrence of prostate cancer in which bilateral pneumonia was diagnosed. In the current state of COVID-19 pandemic, a high prevalence of incidental pneumonia may be expected, even with previous clinical triage, explained by a nondefined number of patients who were asymptomatic or minimally symptomatic for infectious process. Therefore, nuclear medicine physicians should be prepared to recognize and diagnose incidental COVID-19 pneumonia manifestation on F-fluorocholine PET/CT, due to the crucial epidemiological implications.


Personal protective equipment and concerns over airborne transmission of COVID-19: a reply


docid: qeuagjjn

title: Internet of things (IoT) applications to fight against COVID-19 pandemic

text: BACKGROUND AND AIM: The current global challenge of COVID-19 pandemic has surpassed the provincial, radical, conceptual, spiritual, social, and pedagogical boundaries. Internet of Things (IoT) enabled healthcare system is useful for proper monitoring of COVID-19 patients, by employing an interconnected network. This technology helps to increase patient satisfaction and reduces readmission rate in the hospital. METHODS: Searched the databases of Google Scholar, PubMed, SCOPUS and ResearchGate using the keywords "Internet of things" or "IoT" and "COVID-19". Further inputs are also taken from blogs and relevant reports. RESULTS: IoT implementation impacts on reducing healthcare cost and improve treatment outcome of the infected patient. Therefore, this present study based research is attempted to explore, discuss, and highlight the overall applications of the well-proven IoT philosophy by offering a perspective roadmap to tackle the COVID-19 pandemic. Finally, twelve significant applications of IoT are identified and discussed. It has ultimately forced the researchers, academicians, and scientists to propose some productive solutions to overcome or confront this pandemic. CONCLUSIONS: IoT is helpful for an infected patient of COVID-19 to identify symptoms and provides better treatment rapidly. It is useful for patient, physician, surgeon and hospital management system.


Impact of Small-N Studies During a Pandemic


[67Ga] Ga-citrate and COVID-19-associated pneumonia: an unexpected absence of uptake


title: SARS-CoV-2/COVID-19 and physical distancing: risk for circadian rhythm dysregulation, advice to alleviate it, and natural experiment research opportunities

text: SARS-CoV-2/COVID-19 leads to numerous unplanned or natural experiments with health and disease. Physical (social) distancing - a counter-measure with no alternative, but with no precedence in scope and scale either - is a key intervention and trigger of natural experiments. From a practical perspective, concerned disciplines should increase awareness of, provide recommendations to meet, and develop research for, health challenges arising from physical distancing at home. From the field of chronobiology, prolonged home stays may place undue strain on the body's circadian timing system but straightforward and often underestimated advice for coping can be provided (herein we provide such advice). Of course, advice or recommendations from other concerned disciplines that identify challenges associated with current COVID-19 mitigation strategies are also needed. From a research perspective, different disciplines should rise to the occasion and explore unsuspected natural experiment angles toward novel insights to promote health and prevent disease.


title: Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial

text: BACKGROUND: Chloroquine and hydroxychloroquine have been found to be efficient on SARS-CoV-2, and reported to be efficient in Chinese COV-19 patients. We evaluate the role of hydroxychloroquine on respiratory viral loads. PATIENTS AND METHODS: French Confirmed COVID-19 patients were included in a single arm protocol from early March to March 16th, to receive 600mg of hydroxychloroquine daily and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. Depending on their clinical presentation, azithromycin was added to the treatment. Untreated patients from another center and cases refusing the protocol were included as negative controls. Presence and absence of virus at Day6-post inclusion was considered the end point. RESULTS: Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms. Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination. CONCLUSION: Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin.


Pain Management During the COVID-19 Pandemic


Recommendations for phototherapy during the COVID-19 pandemic


title: Study on the dynamic change law and correlation between CT imaging manifestations and cellular immunity of 2019 novel coronavirus disease

text: PURPOSE: To explore the dynamic changes and correlation between CT imaging manifestations and cellular immunity of COVID-19. MATERIALS AND METHODS: This retrospective review analyzed 23 patients with COVID-19, including 13 males and 10 females aged 27-70 years, with an average age of 48 years. Patients were divided into two groups: group A with 11 critical-severe patients, and group B with 12 common-mild patients. Clinical, laboratory, and radiological data were collected and analyzed. RESULTS: LYM, LYM (%), CD3+, CD4+, and CD8+ decreased, while NEU (%), CRP, and CT scores increased in all patients, WBC in group A increased. In group A, on day 10-12 after disease onset, CT scores and CRP reached the highest point, and day 13-15 LYM, LYM (%) reached the lowest but NEU (%) and WBC reached the highest, CD3+, CD4+ and CD8+ were at the lowest on day 10-15. In group B, on day 7-9, CT scores, NEU (%) and CRP reached the peak, but LYM, LYM (%), CD3+, CD4+ and CD8+ reached the lowest. In all patients, CT scores had a significantly negative correlation with CD3+, CD4+, CD8+, LYM (%), and LYM (p = 0.001, r = - 0.797; p = 0.008, r = - 0.698; p = 0.002, r = - 0.775; p < 0.001, r = - 0.785; p = 0.021, r = - 0.571, respectively), and a significantly positive correlation with WBC and NEU (%) (p < 0.001, r = 0.785; p = 0.003, r = 0.691, respectively). CONCLUSION: Dynamic changes of CT manifestations and cellular immunity of patients with COVID-19 were regular and correlation was high between these two parameters.


title: Relevance of KDPI value and acute rejection on kidney transplant outcomes in recipients with delayed graft function- A retrospective study

text: INTRODUCTION: Delayed graft function (DGF) is associated with poorer graft survival and higher rate of acute rejection (AR). It is unknown if this negative influence relies on the increased risk of AR or the DGF itself. The different Kidney Donor Profile Index (KDPI) values may also play a role in this interaction. METHODS: Retrospective study aimed to evaluate the impact of DGF on graft function and graft survival in a subset of KT recipients (2004-2017). We also analyzed the relationship between KDPI and DGF. RESULTS: The study includes601 KT,226of them (37%) developed DGF. Graft survival was lower in patients with DGF compared with non-DGF patients. Multivariable analysis revealed DGF as risk factor for graft loss, independently of the presence or not of acute rejection. Between DGF patients we observed poorer graft survival in patients with higher KDPI value (>85%).We observed a trend of a greater impact of KDPI in patients with DGF, although this interaction was not statistically significant. Additionally, we observed poorer 12-month graft function in DGF patients. CONCLUSION: DGF is related to poorer graft survival independently of the developed of acute rejection. This negative impact might be influenced by high KDPI values.


title: Orbital cellulitis, sinusitis and intracranial abnormalities in two adolescents with COVID-19

text: We review two cases of adolescents with orbital cellulitis, sinusitis and SARS- CoV-2 infection presenting to emergency departments within a 24 hour period. SARS-CoV-2 samples obtained within 24 hours were positive, supporting prior infection despite relatively limited early symptoms of COVID-19. Unusual clinical and radiographic characteristics included hemorrhagic abscess with blood of varying age in the first, intracranial epidural abscess in the second, radiographic signal consistent with hemorrhagic or thrombotic phenomena, retro-maxillary antral fat changes, and meningeal enhancement or extension in both cases. Radiographic findings thereby mimic fungal infection, although final cultures and ancillary investigation for allergic and invasive fungal disease have remained negative. These cases highlight two unusual orbital presentations of cellulitis occurring in the context of SARS-CoV-2 co-infection.


Covid-19: public health experts demand evidence behind UK's short self-isolation advice


COVID-19 and the Duty to Protect from Communicable Diseases


title: Internalized Stigmatization, Social Support, and Individual Mental Health Problems in the Public Health Crisis

text: This study investigates the relationship between internalized stigmatization brought on by epicenter travel experiences and mental health problems (including anxiety, depression, and shame) during the period of the novel coronavirus disease emergency in China. The cross-sectional data were collected using the time-lag design to avoid the common method bias as much as possible. Regression results using structural equation modeling show that the internalized stigmatization of epicenter travel experiences may have positive relationships with mental health problems (i.e., anxiety, depression, and shame), and such relationships can be moderated by social support. Specifically, the positive relationships between internalized stigmatization and mental health problems are buffered/strengthened when social support is at a high/low level. The findings of this study suggest that, in this epidemic, people who have epicenter travel experience could be affected by internalized stigmatization, no matter whether they have ever got infected.


title: 2019-nCoV (Wuhan virus), a novel Coronavirus: human-to-human transmission, travel-related cases, and vaccine readiness

text: On 31 December 2019 the Wuhan Health Commission reported a cluster of atypical pneumonia cases that was linked to a wet market in the city of Wuhan, China. The first patients began experiencing symptoms of illness in mid-December 2019. Clinical isolates were found to contain a novel coronavirus with similarity to bat coronaviruses. As of 28 January 2020, there are in excess of 4,500 laboratory-confirmed cases, with > 100 known deaths. As with the SARS-CoV, infections in children appear to be rare. Travel-related cases have been confirmed in multiple countries and regions outside mainland China including Germany, France, Thailand, Japan, South Korea, Vietnam, Canada, and the United States, as well as Hong Kong and Taiwan. Domestically in China, the virus has also been noted in several cities and provinces with cases in all but one provinence. While zoonotic transmission appears to be the original source of infections, the most alarming development is that human-to-human transmission is now prevelant. Of particular concern is that many healthcare workers have been infected in the current epidemic. There are several critical clinical questions that need to be resolved, including how efficient is human-to-human transmission? What is the animal reservoir? Is there an intermediate animal reservoir? Do the vaccines generated to the SARS-CoV or MERS-CoV or their proteins offer protection against 2019-nCoV? We offer a research perspective on the next steps for the generation of vaccines. We also present data on the use of in silico docking in gaining insight into 2019-nCoV Spike-receptor binding to aid in therapeutic development. Diagnostic PCR protocols can be found at https://www.who.int/health-topics/coronavirus/laboratory-diagnostics-for-novel-coronavirus.


docid: vfawzzts

title: The hypothetical role of phosphatidic acid in subverting ER membranes during SARS-CoV infection

text: Positive sense (+) RNA viruses exploit membranes from a variety of cellular organelles to support the amplification of their genomes. This association concurs with the formation of vesicles whose main morphological feature is that of being wrapped by a double membrane. In the case of the SARS-CoV virus, the outer membrane is not discrete for each vesicle, but seems to be continuous and shared between many individual vesicles, a difference with other +RNA viruses whose nature has remained elusive. I present morphological, biochemical and pharmacological arguments defending the striking analogy of this arrangement and that of entangled, nascent Lipid Droplets whose birth has been aborted by an excess of Phosphatidic Acid. Since Phosphatidic Acid can be targeted with therapeutical purposes, considering this working hypothesis may prove important in tackling SARS-CoV infection.


title: Walls

text: In a field that strives to care for patients and families together, what can palliative care clinicians do when patients' families are physically absent? The Covid-19 pandemic has put both literal and figurative walls between health care professionals and families. How health care workers respond to these disconnections might have a lasting impact on patients, on families, and on our practice. Recently, I saw this in the case of a patient our palliative care team was consulted to see. Mr. B was minimally responsive and dying from multisystem organ failure of unclear etiology. As in other cases during this pandemic, our team became a facilitator of interaction between the patient and the physically absent family, seeing an intimacy we normally would not, in this case, by being present while our intern held the phone to Mr. B's ear for an end-of-life call from his wife, son, and daughter. Such moments force us clinicians to be even more present for our families and patients, and they allow us to bear witness to the strength and sadness and love that we might otherwise miss.


title: Renal cell carcinoma and COVID-19 pandemia: Management strategies adapted to current practice

text: The COVID-19 pandemic caused by SARS-CoV-2 virus has caused an important health impact that has affected renal cell carcinoma management, among other urology areas The high cancellation rate of surgeries, including those related to renal cancer, will cause an inevitable healthcare overload and probably a potential negative impact on its oncological outcomes, especially in locally advanced and metastatic renal cancer Kidney cancer scenarios are quite different depending on their stage, distinguishing mainly between low priority of localized disease or high priority of locally advanced and metastatic under active treatment The unknown pandemic duration and possibly fluctuating prevalence of the virus are likely to force an adaptation in the management of renal cell carcinoma among urology and oncology departments, ideally individualized ona case-by-case basis within multidisciplinary units To this end, we present algorithms and tables regarding renal cell carcinoma management adapted to the COVID-19 period and stratified according to oncological stage, which might be useful for specialists dedicated to this uro-oncology area


Vascularized Composite Allotransplantation in a Post-COVID-19 Pandemic World


title: Potential specific therapies in COVID-19

text: COVID-19 has grown into a global pandemic that has strained healthcare throughout the world. There is a sense of urgency in finding a cure for this deadly virus. In this study, we reviewed the empiric options used in common practice for COVID-19, based on the literature available online, with an emphasis on human experiences with these treatments on severe acute respiratory syndrome-associated coronavirus (SARS-COV-1) and other viruses. Convalescent blood products are the most promising potential treatment for use in COVID-19. The use of chloroquine or hydroxychloroquine (HCQ), remdesivir, and tocilizumab are some of the other promising potential therapies; however, they are yet to be tested in randomized clinical trials (RCTs). The use of lopinavir-ritonavir did not prove beneficial in a large RCT. The use of corticosteroids should be avoided in COVID-19 pneumonia unless used for other indications, based on the suggestion of harm in patients with SARS-COV-1 and Middle Eastern Respiratory Syndrome (MERS) infection. The reviews of this paper are available via the supplemental material section.


title: Drug treatment options for the 2019-new coronavirus (2019-nCoV)

text: As of January 22, 2020, a total of 571 cases of the 2019-new coronavirus (2019-nCoV) have been reported in 25 provinces (districts and cities) in China. At present, there is no vaccine or antiviral treatment for human and animal coronavirus, so that identifying the drug treatment options as soon as possible is critical for the response to the 2019-nCoV outbreak. Three general methods, which include existing broad-spectrum antiviral drugs using standard assays, screening of a chemical library containing many existing compounds or databases, and the redevelopment of new specific drugs based on the genome and biophysical understanding of individual coronaviruses, are used to discover the potential antiviral treatment of human pathogen coronavirus. Lopinavir /Ritonavir, Nucleoside analogues, Neuraminidase inhibitors, Remdesivir, peptide (EK1), abidol, RNA synthesis inhibitors (such as TDF, 3TC), anti-inflammatory drugs (such as hormones and other molecules), Chinese traditional medicine, such ShuFengJieDu Capsules and Lianhuaqingwen Capsule, could be the drug treatment options for 2019-nCoV. However, the efficacy and safety of these drugs for 2019- nCoV still need to be further confirmed by clinical experiments.


Stay fit, don't quit: Geriatric Exercise Prescription in COVID-19 Pandemic


Bioanalytical research and training in academia during the COVID-19 pandemic


title: Optimization of primer sets and detection protocols for SARS-CoV-2 of coronavirus disease 2019 (COVID-19) using PCR and real-time PCR

text: SARS-CoV-2 is very contagious and has rapidly spread globally. Due to various symptomatic and asymptomatic cases and the possibility of asymptomatic transmission, there is a pressing need for a fast and sensitive detection protocol to diagnose asymptomatic people. Various SARS-CoV-2 diagnostic kits are already available from many companies and national health agencies. However, publicly available information on these diagnostic kits is lacking. In response to the growing need and the lack of information, we developed and made available a low-cost, easy-access, real-time PCR-based protocol for the early detection of the virus in a previous study. During the development of the detection protocol, we found that unoptimized primer sets could inadvertently show false-positive results, raising the possibility that commercially available diagnostic kits might also contain primer sets that produce false-positive results. Here, we provide three-step guidelines for the design and optimization of specific primer sets. The three steps include (1) the selection of primer sets for target genes (RdRP, N, E, and S) in the genome of interest (SARS-CoV-2), (2) the in silico validation of primer and amplicon sequences, and (3) the optimization of PCR conditions (i.e., primer concentrations and annealing temperatures) for specific hybridization between the primers and target genes, and the elimination of spurious primer dimers. Furthermore, we have expanded the previously developed real-time PCR-based protocol to more conventional PCR-based protocols and applied a multiplex PCR-based protocol that allows the simultaneous testing of primer sets for RdRP, N, E, and S all in one reaction. Our newly optimized protocol should be helpful for the large-scale, high-fidelity screening of asymptomatic people, even without any high-specification equipment, for the further prevention of transmission, and to achieve early intervention and treatment for the rapidly propagating virus.


title: Intact Brain Network Function in an Unresponsive Patient with COVID-19

text: Many patients with severe coronavirus disease 2019 (COVID-19) remain unresponsive after surviving critical illness. Although several structural brain abnormalities have been described, their impact on brain function and implications for prognosis are unknown. Functional neuroimaging, which has prognostic significance, has yet to be explored in this population. Here we describe a patient with severe COVID-19 who, despite prolonged unresponsiveness and structural brain abnormalities, demonstrated intact functional network connectivity, and weeks later recovered the ability to follow commands. When prognosticating for survivors of severe COVID-19, clinicians should consider that brain networks may remain functionally intact despite structural injury and prolonged unresponsiveness.


The New Challenge of Geriatrics: Saving Frail Older People from the SARS-COV-2 Pandemic Infection


docid: tbfdqwxc

title: Management of SARS-CoV-2 infection: recommendations of the Polish Association of Epidemiologists and Infectiologists. Annex no. 1 as of June 8, 2020


Dramatic presentation of acquired TTP associated with COVID-19


Coronavirus is spreading under the radar in US homeless shelters


title: Management of COVID-19-Positive Pediatric Patients Undergoing Minimally Invasive Surgical Procedures: Systematic Review and Recommendations of the Board of European Society of Pediatric Endoscopic Surgeons

text: Introduction: Hospital response to the COVID-19 outbreak has involved the cancellation of elective, deferrable surgeries throughout Europe in order to ensure capacity for emergent surgery and a selection of elective but non-deferrable surgeries. The purpose of this document is to propose technical strategies to assist the pediatric surgeons to minimize the potential aerosolization of viral particles in COVID-19 patients undergoing urgent or emergent surgical treatment using laparoscopic approaches, based on the currently available literature. The situation and recommendations are subject to change with emerging information. Materials and Methods: The Scientific Committee and the Board of the European Society of Pediatric Endoscopic Surgeons gathered together in order to address the issue of minimally invasive surgery during this COVID-19 pandemic. A systematic search through PubMed, Embase, and World Wide Web of the terms "COVID-19," "Coronavirus," and "SARS-CoV-2" matched with "pneumoperitoneum," "laparoscopy," "thoracoscopy," "retroperitoneoscopy," and "surgery" was performed. Non-English language papers were excluded. A PRISMA report was performed. Criticalities were identified and a consensus was achieved over a number of key aspects. Results: We identified 121 documents. A total of 11 full-text documents were assessed to address all concerns related to the adoption of minimally invasive surgery. All aspect of pediatric minimally invasive surgery, including elective surgery, urgent surgery, laparoscopy, thoracoscopy, retroperitoneoscopy, and pneumoperitoneum creation and maintainance were extensively addressed through systematic review. A consensus regarding urgent laparoscopic procedures, setting and operation techniques was obtained within the Committee and the Board. Conclusions: The ESPES proposes the following recommendations in case minimally invasive surgery is needed in a COVID-19 positive pediatric patients: (1) consider conservative treatment whenever safely possible, (2) dedicate a theater, columns and reusable laparoscopic instrumentation to COVID-19 pediatric patients, (3) prefer disposable instrumentation and cables, (4) use low CO2 insufflation pressures, (5) use low power electrocautery, (6) prefer closed-systems CO2 insufflation and desufflation systems, and (7) avoid leaks through ports. These recommendations are subject to change with emerging information and might be amended in the near future.


docid: ynzbpuyw

title: Point-of-care ultrasound in COVID-19 pandemic


title: Prospective Prediction of Future SARS-CoV-2 Infections Using Empirical Data on a National Level to Gauge Response Effectiveness

text: Predicting an accurate expected number of future COVID-19 cases is essential to properly evaluate the effectiveness of any treatment or preventive measure. This study aimed to identify the most appropriate mathematical model to prospectively predict the expected number of cases without any intervention. The total number of cases for the COVID-19 epidemic in 28 countries was analyzed and fitted to several simple rate models including the logistic, Gompertz, quadratic, simple square, and simple exponential growth models. The resulting model parameters were used to extrapolate predictions for more recent data. While the Gompertz growth models (mean R2 = 0.998) best fitted the current data, uncertainties in the eventual case limit made future predictions with logistic models prone to errors. Of the other models, the quadratic rate model (mean R2 = 0.992) fitted the current data best for 25 (89 %) countries as determined by R2 values. The simple square and quadratic models accurately predicted the number of future total cases 37 and 36 days in advance respectively, compared to only 15 days for the simple exponential model. The simple exponential model significantly overpredicted the total number of future cases while the quadratic and simple square models did not. These results demonstrated that accurate future predictions of the case load in a given country can be made significantly in advance without the need for complicated models of population behavior and generate a reliable assessment of the efficacy of current prescriptive measures against disease spread.


Erupción tipo pitiriasis rosada de Gibert en una paciente asintomática con positividad para COVID-19./ Erupción tipo pitiriasis rosada de Gibert en una paciente asintomática con positividad para COVID-19./ Pityriasis rosea Gibert type rash in an asymptomatic patient that tested positive for COVID-19


CT chest findings in coronavirus disease-19 (COVID-19)


The Use of Positron Emission Tomography in Coronavirus Disease 2019 Cases


docid: gqsbvold

title: [Pregnant women complicated with COVID-19: a clinical analysis of 3 cases]

text: OBJECTIVE: To analyze the clinical characteristics and pregnancy outcomes of pregnant women complicated with coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 3 pregnant women with COVID-19 admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 19 to February 10, 2020 were retrospectively analyzed. RESULTS: There was one case in the first-trimester pregnancy (case 1), one in the second-trimester pregnancy (case 2) and one in third-trimester pregnancy (case 3). Cough, fever, fatigue, lung imaging changes were the main manifestations. The white cell count, lymphocyte percentage had no significantly changes in case 1 and case 3, while the levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), IL-6 and IL-10 elevated. The lymphocyte count and lymphocyte percentage decreased and the inflammatory indicators significantly increased in case 2. All patients were treated with antiviral, antitussive, oxygen inhalation; case 3 received glucocorticoids, case 2 with severe illness received glucocorticoids and additionally gamma globulin. All three cases were cured and discharged. Case 1 with early pregnancy chose to terminate pregnancy after discharge; case 2 chose to continue pregnancy without obstetric complications; and case 3 had cesarean section delivery due to abnormal fetal heart monitoring. CONCLUSIONS: The report shows that COVID-19 in pregnancy women could be cured with active treatment, and the maternal and fetal outcomes can be satisfactory.


2019 Coronavirus Disease, Beware of Psychogenic Issue


title: SEIR Modeling of the Italian Epidemic of SARS-CoV-2 Using Computational Swarm Intelligence

text: We applied a generalized SEIR epidemiological model to the recent SARS-CoV-2 outbreak in the world, with a focus on Italy and its Lombardy, Piedmont, and Veneto regions. We focused on the application of a stochastic approach in fitting the model parameters using a Particle Swarm Optimization (PSO) solver, to improve the reliability of predictions in the medium term (30 days). We analyzed the official data and the predicted evolution of the epidemic in the Italian regions, and we compared the results with the data and predictions of Spain and South Korea. We linked the model equations to the changes in people's mobility, with reference to Google's COVID-19 Community Mobility Reports. We discussed the effectiveness of policies taken by different regions and countries and how they have an impact on past and future infection scenarios.


title: ACE2 the Janus-faced protein - from cardiovascular protection to severe acute respiratory syndrome-coronavirus and COVID-19

text: Angiotensin converting enzyme 2 (ACE2) is the major enzyme responsible for conversion of Ang II into Ang-(1-7). It also acts as the receptor for severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2, which causes Coronavirus Disease (COVID)-19. In recognition of the importance of ACE2 and to celebrate 20 years since its discovery, the journal will publish a focused issue on the basic science and (patho)physiological role of this multifunctional protein.


title: SARS-CoV-2 Infection in Febrile Neonates

text: Most severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in pediatric patients are mild or asymptomatic. However, infants have emerged at higher risk of hospitalization and severe outcomes in pediatric coronavirus disease 2019 (COVID-19). We report a case series of four full term neonates hospitalized with fever and found to have SARS-CoV-2 infection with a spectrum of illness severities. Two neonates required admission to the intensive care unit for respiratory insufficiency and end organ involvement. Half of the patients were found to have a co-infection. One neonate received antiviral therapy with remdesivir and is, to our knowledge, the youngest patient to receive this drug for COVID-19. All neonates had favorable outcomes.


title: Coronavirus Disease among Persons with Sickle Cell Disease, United States, March 20-May 21, 2020

text: Sickle cell disease (SCD) disproportionately affects Black or African American persons in the United States and can cause multisystem organ damage and reduced lifespan. Among 178 persons with SCD in the United States who were reported to an SCD-coronavirus disease case registry, 122 (69%) were hospitalized and 13 (7%) died.


title: Convalescent plasma: A possible treatment of COVID-19 in India

text: In India, SARS-CoV-2 virus-induced coronavirus disease 2019 (COVID-19) has already infected close to 5500 people, causing the death of 164. While these numbers are not comparable with values observed for the USA, Italy, or Spain, given the population of India, and the fact that the pandemic is now in an exponential stage of growth, the risks of a contagion that affects a large sector of the Indian population are real. There are no current effective strategies to prevent the spread, other than minimizing contact through social distancing, while no fully effective drugs to prevent or treat COVID-19 exist, although several candidate drugs and repurposed antiviral and immune-modulating pharmacotherapies are being tested or in compassionate use. One postexposure prophylaxis, convalescent (immune) plasma (CP), has shown some success in China and previously in the cure and therapy of other coronaviruses, SARS-1 and Middle East respiratory syndrome. Drawn from current patients who are infected with COVID-19, its CP (human anti-SARS-CoV-2 plasma) might be one way to modulate the infectivity of this virus or its effects postinfection.


title: Risk of COVID-19 importation to the Pacific islands through global air travel

text: On 30 January 2020, WHO declared coronavirus (COVID-19) a global public health emergency. As of 12 March 2020, 125 048 confirmed COVID-19 cases in 118 countries had been reported. On 12 March 2020, the first case in the Pacific islands was reported in French Polynesia; no other Pacific island country or territory has reported cases. The purpose of our analysis is to show how travellers may introduce COVID-19 into the Pacific islands and discuss the role robust health systems play in protecting health and reducing transmission risk. We analyse travel and Global Health Security Index data using a scoring tool to produce quantitative estimates of COVID-19 importation risk, by departing and arriving country. Our analysis indicates that, as of 12 March 2020, the highest risk air routes by which COVID-19 may be imported into the Pacific islands are from east Asian countries (specifically, China, Korea and Japan) to north Pacific airports (likely Guam, Commonwealth of the Northern Mariana Islands or, to a less extent, Palau); or from China, Japan, Singapore, the United States of America or France to south Pacific ports (likely, Fiji, Papua New Guinea, French Polynesia or New Caledonia). Other importation routes include from other east Asian countries to Guam, and from Australia, New Zealand and other European countries to the south Pacific. The tool provides a useful method for assessing COVID-19 importation risk and may be useful in other settings.


Covid-19: NHS will restart some paused services this week


Re: "Maxillofacial Trauma Management During COVID-19: Multidisciplinary Recommendations," by Edwards et al. and "A Guide to Facial Trauma Triage and Precautions in the COVID-19 Pandemic" by Hsieh et al


title: An infant with a mild SARS-CoV-2 infection detected only by anal swabs: a case report

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China and has spread rapidly worldwide. We present a mild SARS-CoV-2 infection in a baby with non-productive cough and normal chest computed tomography, in whom only anal swabs tested positive by real-time PCR testing for SARS-CoV-2. She was given atomization inhalation therapy with recombinant human interferon alfa-1b for 10 days. Her anal swabs remained positive for eight days, whereas her throat swabs were persistently negative by real-time PCR testing. Mild and asymptomatic cases, especially in children, might present with PCR negative pharyngeal/nasal swabs and PCR positive anal swabs. Those patients are potential sources of infection via fecal-oral transmission for COVID-19.


Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic


title: Health Equity, Social Policy, and Promoting Recovery from COVID-19

text: The COVID-19 pandemic has revealed starkly and publicly the close interconnections between social and economic inequality, health equity, and population health. To better understand what social policies would best promote population health, economic recovery, and preparedness for future pandemics, we must look both upstream and abroad for inspiration. In this essay, I argue for a suite of near-term and longer-term interventions, including universal health insurance and paid sick leave, upgraded wage insurance policies, tax reform, investments in parental leave, child care, and education, and upgraded government record systems. Policies that equalize the distribution of the social determinants of health and promote social solidarity will also improve population health and economic performance and allow us to confront future pandemics more successfully.


title: Chest CT for detecting COVID-19: a systematic review and meta-analysis of diagnostic accuracy

text: OBJECTIVE: The purpose of this article was to perform a systematic review and meta-analysis regarding the diagnostic test accuracy of chest CT for detecting coronavirus disease 2019 (COVID-19). METHODS: PubMed, Embase, Web of Science, and CNKI were searched up to March 12, 2020. We included studies providing information regarding diagnostic test accuracy of chest CT for COVID-19 detection. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity and specificity were pooled. RESULTS: Sixteen studies (n = 3186 patients) were included. The risks of bias in all studies were moderate in general. Pooled sensitivity was 92% (95% CI = 86-96%), and two studies reported specificity (25% [95% CI = 22-30%] and 33% [95% CI = 23-44%], respectively). There was substantial heterogeneity according to Cochran's Q test (p < 0.01) and Higgins I2 heterogeneity index (96% for sensitivity). After dividing the studies into two groups based on the study site, we found that the sensitivity of chest CT was great in Wuhan (the most affected city by the epidemic) and the sensitivity values were very close to each other (97%, 96%, and 99%, respectively). In the regions other than Wuhan, the sensitivity varied from 61 to 98%. CONCLUSION: Chest CT offers the great sensitivity for detecting COVID-19, especially in a region with severe epidemic situation. However, the specificity is low. In the context of emergency disease control, chest CT provides a fast, convenient, and effective method to early recognize suspicious cases and might contribute to confine epidemic. KEY POINTS: â¢ Chest CT has a high sensitivity for detecting COVID-19, especially in a region with severe epidemic, which is helpful to early recognize suspicious cases and might contribute to confine epidemic.


Tobacco Smoking Increases the Lung Gene Expression of ACE2, the Receptor of SARS-CoV-2


Management of Graves' hyperthyroidism and orbitopathy in time of COVID-19 pandemic


title: Coronavirus infections reported by ProMED, February 2000-January 2020

text: INTRODUCTION: Sources describing the global burden of emerging diseases accurately are still limited. We reviewed coronavirus infections reported by ProMED and assessed the reliability of the data retrieved compared to published reports. We evaluated the effectiveness of ProMED as a source of epidemiological data on coronavirus. METHODS: Using the keyword "coronavirus" in the ProMED search engine, we reviewed all the information from the reports and collected data using a structured form, including year, country, gender, occupation, the number of infected individuals, and the number of fatal cases. RESULTS: We identified 109 entries reported between February 29, 2000 and January 22, 2020. A total of 966 cases were reported, with death reported in 188 cases, suggesting an overall case fatality rate (CFR) of 19.5%. Of 70 cases for which the gender was reported, 47 (67.1%) were male. Most of the cases were reported from China, the United Arab Emirates, and Saudi Arabia, with reports from other countries, including imported cases in Europe and North America. CONCLUSIONS: Internet-based reporting systems such as ProMED are useful to gather information and synthesize knowledge on emerging infections. Although certain areas need to be improved, ProMED provided useful information about coronaviruses especially during outbreaks.


docid: ocreglse

title: The psychophysical impact that COVID-19 has on children must not be underestimated


Orientierung in der Corona-Krise? Nicht mit Doppelbotschaften


Impact of COVID-19 on mental healthcare of older adults: insights from Lebanon (Middle East)


Meta-analysis is not always the best way to round out a systematic review: a few thoughts prompted by the COVID-19 pandemic and "spiced-up" with an earthquake


title: Do Not Forget Afghanistan in Times of COVID-19: Telemedicine and the Internet of Things to Strengthen Planetary Health Systems

text: Health care does not always take place in a setting of peace, prosperity, and social order, a point that is often overlooked in quotidian medical practice. This has become most evident with the current COVID-19 pandemic by the new coronavirus that is wreaking havoc across the planet. Health care providers are facing unprecedented challenges to intervene on numerous nonlinear uncertainties in science and society as the pandemic evolves. In Afghanistan, health care delivery is already a major crosscutting challenge. Although efforts to rebuild the health care systems in Afghanistan have been made (Acerra et al.), both acute and chronic illnesses remain as major medical and critical governance gaps to be remedied. In addition, health care facilities and medical equipment are not adequate in the country. There is a need for medical and scientific expertise to clinically and sociologically contextualize and interpret diagnostic tests as well as drugs and vaccines that will be deployed in the coming months as part of the planetary collective response to the COVID-19 pandemic. In a time of pandemic and facing a novel infectious pathogen, health care workers are in need of planetary scale consultation and support. Even creating a small consultation network using mobile applications might offer improved health outcomes. The Internet of Things and digital health ought to be considered in concert with telemedicine as part of an effective pandemic response.


title: Healthcare impact of COVID-19 epidemic in India: A stochastic mathematical model

text: Background: In India, the SARS-CoV2 COVID-19 epidemic has grown to 1,251 cases and 32 deaths as on 30 Mar 2020. The healthcare impact of the epidemic in India was studied with a stochastic mathematical model. Methods: A compartmental SEIR model was developed, in which the flow of individuals through compartments is modeled using a set of differential equations. Different scenarios were modeled with 1000 runs of Monte Carlo simulation each using MATLAB. Hospitalization, ICU requirements and deaths were modeled on SimVoi software. The impact of Non-Pharmacological Interventions (NPI) including social distancing and lockdown on checking the epidemic was estimated. Results: Uninterrupted epidemic in India would have resulted in over 364 million cases and 1.56 million deaths with peak by mid-July. As per the model, at growth rate of 1.15, India is likely to reach approximately 3 million cases by 25 May, implying 125,455 (±18,034) hospitalizations, 26,130 (±3,298) ICU admissions and 13,447 (±1,819) deaths. This would overwhelm India's healthcare system. The model shows that with immediate institution of NPIs, the epidemic might still be checked by mid-April 2020. It would then result in 241,974 (±33,735) total infections, 10,214 (±1,649) hospitalizations, 2,121 (±334) ICU admissions and 1,081(±169) deaths. Conclusion: At current growth rate of epidemic, India's healthcare resources will be overwhelmed by end-May. With the immediate institution of NPIs, total cases, hospitalizations, ICU requirements and deaths can be reduced by almost 90%.


title: Inflammatory Cell Infiltration of Adrenals in COVID-19

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was originated in November-December 2019 in Wuhan, China, and has rapidly spread around the world causing severe health and socioeconomical damage to the entire civilization. The key feature of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is upper respiratory tract infection, which may be complicated by bilateral pneumonia. Angiotensin converting enzyme 2 (ACE2) has been identified as a key host factor, required for virus entry into cells. Interestingly, ACE2 is expressed not only in the respiratory system, but also in the other organs and systems including adrenal glands. Here we provide the first description of the pathomorphological changes in adrenal glands in patients with severe COVID-19 characterized by perivascular infiltration of CD3+ and CD8+ T-lymphocytes. Due to the central role of the adrenals in the stress response of the organism, this finding is of potential clinical relevance, because infection with the SARS-CoV-2 virus might critically impair adrenal function under pathophysiological conditions.


The COVID-19 vaccine development landscape


Coronavirus disease 2019 and obstructive sleep apnea syndrome


title: An SIS model for the epidemic dynamics with two phases of the human day-to-day activity

text: An SIS model is analyzed to consider the contribution of community structure to the risk of the spread of a transmissible disease. We focus on the human day-to-day activity introduced by commuting to a central place for the social activity. We assume that the community is classified into two subpopulations: commuter and non-commuter, of which the commuter has two phases of the day-to-day activity: private and social. Further we take account of the combination of contact patterns in two phases, making use of mass-action and ratio-dependent types for the infection force. We investigate the dependence of the basic reproduction number on the commuter ratio and the daily expected duration at the social phase as essential factors characterizing the community structure, and show that the dependence is significantly affected by the combination of contact patterns, and that the difference in the commuter ratio could make the risk of the spread of a transmissible disease significantly different.


title: Considering grief in mental health outcomes of COVID-19

text: The novel coronavirus disease of 2019 (COVID-19) pandemic has created challenging circumstances for the physical and mental health of individuals across the United States. This commentary addresses the role of grief in mental health outcomes relating to the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Lung Base Findings of Coronavirus Disease (COVID-19) on Abdominal CT in Patients With Predominant Gastrointestinal Symptoms

text: OBJECTIVE. This series of patients presented to the emergency department (ED) with abdominal pain, without the respiratory symptoms typical of coronavirus disease (COVID-19), and the abdominal radiologist was the first to suggest COVID-19 infection because of findings in the lung bases on CT of the abdomen. CONCLUSION. COVID-19 infection can present primarily with abdominal symptoms, and the abdominal radiologist must suggest the diagnosis when evaluating the lung bases for typical findings.


COVID-19 as a STING disorder with delayed over-secretion of interferon-beta


title: Lopinavir-Ritonavir in the Treatment of COVID-19: A Dynamic Systematic Benefit-Risk Assessment

text: INTRODUCTION AND OBJECTIVE: COVID-19 is an ongoing, global public health crisis for which safe and effective treatments need to be identified. The benefit-risk balance for the use of lopinavir-ritonavir in COVID-19 needs to be monitored on an ongoing basis, therefore a systematic benefit-risk assessment was designed and conducted. A key objective of this study was to provide a platform for a dynamic systematic benefit-risk evaluation; although initially this evaluation is likely to contain limited information, it is required because of the urgent unmet public need. Importantly, it allows additional data to be incorporated as they become available, and re-evaluation of the benefit-risk profile. METHODS: A systematic benefit-risk assessment was conducted using the Benefit-Risk Action Team (BRAT) framework. The exposure of interest was lopinavir-ritonavir treatment in severe COVID-19 compared to standard of care, placebo or other treatments. A literature search was conducted in PubMed and Embase to identify peer-reviewed papers reporting clinical outcomes. Two clinicians constructed a value tree and ranked key benefits and risks in order of considered clinical importance. RESULTS: We screened 143 papers from PubMed and 264 papers from Embase for lopinavir-ritonavir; seven papers were included in the final benefit-risk assessment. In comparison to standard of care, data for several key benefits and risks were identified for lopinavir-ritonavir. Time to clinical improvement was not significantly different for lopinavir-ritonavir in comparison to standard of care (hazard ratio 1.31, 95% confidence interval 0.95-1.80). From one study, there were fewer cases of acute respiratory distress syndrome with lopinavir-ritonavir compared with standard of care (13% vs 27%). There also appeared to be fewer serious adverse events with lopinavir-ritonavir (20%) vs standard of care (32%). Limited data were available for comparison of lopinavir-ritonavir to other treatments. CONCLUSIONS: Based on currently available data, there was no clear benefit for the use of lopinavir-ritonavir compared to standard of care in severe COVID-19. Risk data suggested a possible decrease in serious adverse events. There was a reduction in acute respiratory distress syndrome with lopinavir-ritonavir in one study. Overall, the benefit-risk profile for lopinavir-ritonavir in severe COVID-19 cannot be considered positive until further efficacy and effectiveness data become available.


Obesity, overweight and survival in critically ill patients with SARS-CoV-2 pneumonia: is there an obesity paradox? Preliminary results from Italy


The precarious position of postdocs during COVID-19


Characteristics of SARS-CoV-2 isolated from asymptomatic carrier in Tokyo


Anaesthesia and intensive care in obstetrics during the COVID-19 pandemic


Moderately Severe Diarrhea and Impaired Renal Function With COVID-19 Infection


title: Risk Perception of COVID-19 Among the Portuguese Healthcare Professionals and General Population

text: Risk perception assessment of COVID-19 among Portuguese Healthcare Professionals (HCP) and General Population (GPop) was evaluated in a snowball 3 403 individual's sample. 54.9% of HCP believed there is a high probability of becoming infected, in contrast with 24.0% of GPop (p <0.001) and, in more than 1/4, that this could happen to their family. Regarding prophylactic isolation, more than 70% agreed with its effectiveness. A large proportion perceived that health services are poorly prepared (50.1% GPop versus 63.5% HCP, p<0.001). Regarding Health Authorities' communication, about 60% were "moderately" satisfied. 46.7% GPop and 52.8% HCP had the opinion the pandemic could be controlled in three to six months (p=0.01).


Hypotension, SIRS and COVID-19: a clinical conundrum


title: Asymmetric nexus between temperature and COVID-19 in the top ten affected provinces of China: A current application of quantile-on-quantile approach

text: The present study examines the asymmetrical effect of temperature on COVID-19 (Coronavirus Disease) from 22 January 2020 to 31 March 2020 in the 10 most affected provinces in China. This study used the Sim & Zhou' quantile-on-quantile (QQ) approach to analyze how the temperature quantities affect the different quantiles of COVID-19. Daily COVID-19 and, temperature data collected from the official websites of the Chinese National Health Commission and Weather Underground Company (WUC) respectively. Empirical results have shown that the relationship between temperature and COVID-19 is mostly positive for Hubei, Hunan, and Anhui, while mostly negative for Zhejiang and Shandong provinces. The remaining five provinces Guangdong, Henan, Jiangxi, Jiangsu, and Heilongjiang are showing the mixed trends. These differences among the provinces can be explained by the differences in the number of COVID-19 cases, temperature, and the province's overall hospital facilitations. The study concludes that maintaining a safe and comfortable atmosphere for patients while COVID-19 is being treated may be rational.


Breastfeeding Risk from Detectable Severe Acute Respiratory Syndrome Coronavirus 2 in Breastmilk


Detection of serum immunoglobulin M and immunoglobulin G antibodies in 2019 novel coronavirus infected patients from different stages


COVID-19 pandemic reveals the peril of ignoring metadata standards


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title: Absence of contamination of personal protective equipment (PPE) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)


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title: How does stock market reflect the change in economic demand? A study on the industry-specific volatility spillover networks of China's stock market during the outbreak of COVID-19

text: Using the carefully selected industry classification standard, we divide 102 industry securities indices in China's stock market into four demand-oriented sector groups and identify demand-oriented industry-specific volatility spillover networks. The"deman-oriented"is a new idea of reconstructing the structure of the networks considering the relationship between industry sectors and the economic demand their outputs meeting. Networks with the new structure help us improve the understanding of the economic demand change, especially when the macroeconomic is dramatically influenced by exogenous shocks like the outbreak of COVID-19. At the beginning of the outbreak of COVID-19, in China's stock market, spillover effects from industry indices of sectors meeting the investment demand to those meeting the consumption demands rose significantly. However, these spillover effects fell after the outbreak containment in China appeared to be effective. Besides, some services sectors including utility, transportation and information services have played increasingly important roles in the networks of industry-specific volatility spillovers as of the COVID-19 out broke. By implication, firstly, being led by Chinese government, the COVID-19 is successfully contained and the work resumption is organized with a high efficiency in China. The risk of the investment demand therefore was controlled and eliminated relatively fast. Secondly, the intensive using of non-pharmaceutical interventions (NPIs) led to supply restriction in services in China. It will still be a potential threat for the Chinese economic recovery in the next stage.


Another coronavirus, another epidemic, another warning


Recommendation of fecal specimen for routine molecular detection of SARS-CoV-2 and for COVID-19 discharge criteria


title: Pulmonary pathology and COVID-19: lessons from autopsy. The experience of European Pulmonary Pathologists

text: Since its initial recognition in December 2019, Coronavirus disease 19 (COVID-19) has quickly spread to a pandemic infectious disease. The causative agent has been recognized as a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily affecting the respiratory tract. To date, no vaccines are available nor any specific treatment. To limit the number of infections, strict directives have been issued by governments that have been translated into equally rigorous guidelines notably for post-mortem examinations by international and national scientific societies. The recommendations for biosafety control required during specimen collection and handling have strongly limited the practice of autopsies of the COVID-19 patients to a few adequate laboratories. A full pathological examination has always been considered an important tool to better understand the pathophysiology of diseases, especially when the knowledge of an emerging disorder is limited and the impact on the healthcare system is significant. The first evidence of diffuse alveolar damage in the context of an acute respiratory distress syndrome has now been joined by the latest findings that report a more complex scenario in COVID-19, including a vascular involvement and a wide spectrum of associated pathologies. Ancillary tools such as electron microscopy and molecular biology used on autoptic tissue samples from autopsy are also significantly contributing to confirm and/or identify new aspects useful for a deeper knowledge of the pathogenetic mechanisms. This article will review and summarize the pathological findings described in COVID-19 until now, chiefly focusing on the respiratory tract, highlighting the importance of autopsy towards a better knowledge of this disease.


Coronavirus research updates: Massive contact-tracing effort finds hundreds of cases linked to nightclubs


title: [Clinical observation of heat-sensitive moxibustion treatment for coronavirus disease 2019]

text: OBJECTIVE: To observe clinical effect of heat-sensitive moxibustion on coronavirus disease 2019 (COVID-19) and to discusses the effective moxibustion treatment program. METHODS: A total of 42 patients with COVID-19 (general type) were treated with heat-sensitive moxibustion at the acupoint area of Shenque (CV 8) and Tianshu (ST 25). The treatment was conducted under the standards of heat-sensitive moxibustion manipulation, which were "locating acupoint by feeling, moxibustion by differentiate sensation, dosage varies individually, ending after sufficient dosage". The incidence of deqi after first heat-sensitive moxibustion, the reduction of negative emotions, the improvement of chest distress and impaired appetite, and the active acceptance rate of moxibustion before and after treatment were observed. RESULTS: â The deqi rate of heat-sensitive moxibustion for 20 minã40 minã1 h were respectively 52.4% (22/42), 90.5% (38/42), 100.0% (42/42). â¡ The incidences of feeling relaxed and comfortable immediately after the first, second, and third heat-sensitive moxibustion were 61.9% (26/42), 73.8% (31/42), and 92.9% (39/42), which were higher than 42.9% (18/42) before heat-sensitive moxibustion treatment (P<0.05). â¢ The incidences of chest distress after the first, second, and third heat-sensitive moxibustion were 23.8% (10/42), 16.7% (7/42), and 9.5% (4/42), which were lower than 50.0% (21/42) before heat-sensitive moxibustion treatment (P<0.05); the incidences of impaired appetite after the first, second, and third heat-sensitive moxibustion were 26.2% (11/42), 19.0% (8/42), 9.5% (4/42), which were lower than 57.1% (24/42) before heat-sensitive moxibustion treatment (P<0.05). â£ After the first treatment, the active acceptance rate of patients for heat-sensitive moxibustion was 100.0% (42/42), which was higher than 11.9% (5/42) before heat-sensitive moxibustion (P<0.05). CONCLUSION: The heat-sensitive moxibustion can effectively reduce the negative emotions and improve the symptoms of chest distress and impaired appetite with COVID-19. It is generally accepted by patients, and worthy of popularization and application in clinical treatment.


COVID-19, Ethics and Equity-What Is Our Role as Surgeons?


title: Applied Clinical Pharmacology in a Crisis: Interleukin-6 Axis Blockade and COVID-19

text: The global pandemic of coronavirus disease 2019 (COVID-19) represents an emergent threat to the public health. Mitigation strategies have been employed to varying effect in many Western nations. Treatment strategies to effectively address COVID-19 and equitably distribute resources are needed, especially in overwhelmed hospitals.


The global path forward - Healthy Living for Pandemic Event Protection (HL - PIVOT)


title: Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies

text: Coronavirus-19 (COVI-19) involves humans as well as animals and may cause serious damage to the respiratory tract, including the lung: coronavirus disease (COVID-19). This pathogenic virus has been identified in swabs performed on the throat and nose of patients who suffer from or are suspected of the disease. When COVI-19 infect the upper and lower respiratory tract it can cause mild or highly acute respiratory syndrome with consequent release of pro-inflammatory cytokines, including interleukin (IL)-1ß and IL-6. The binding of COVI-19 to the Toll Like Receptor (TLR) causes the release of pro-IL-1ß which is cleaved by caspase-1, followed by inflammasome activation and production of active mature IL-1ß which is a mediator of lung inflammation, fever and fibrosis. Suppression of pro-inflammatory IL-1 family members and IL-6 have been shown to have a therapeutic effect in many inflammatory diseases, including viral infections. Cytokine IL-37 has the ability to suppress innate and acquired immune response and also has the capacity to inhibit inflammation by acting on IL-18Rα receptor. IL-37 performs its immunosuppressive activity by acting on mTOR and increasing the adenosine monophosphate (AMP) kinase. This cytokine inhibits class II histocompatibility complex (MHC) molecules and inflammation in inflammatory diseases by suppressing MyD88 and subsequently IL-1ß, IL-6, TNF and CCL2. The suppression of IL-1ß by IL-37 in inflammatory state induced by coronavirus-19 can have a new therapeutic effect previously unknown. Another inhibitory cytokine is IL-38, the newest cytokine of the IL-1 family members, produced by several immune cells including B cells and macrophages. IL-38 is also a suppressor cytokine which inhibits IL-1ß and other pro-inflammatory IL-family members. IL-38 is a potential therapeutic cytokine which inhibits inflammation in viral infections including that caused by coronavirus-19, providing a new relevant strategy.


title: Adaptive Invariance for Molecule Property Prediction

text: Effective property prediction methods can help accelerate the search for COVID-19 antivirals either through accurate in-silico screens or by effectively guiding on-going at-scale experimental efforts. However, existing prediction tools have limited ability to accommodate scarce or fragmented training data currently available. In this paper, we introduce a novel approach to learn predictors that can generalize or extrapolate beyond the heterogeneous data. Our method builds on and extends recently proposed invariant risk minimization, adaptively forcing the predictor to avoid nuisance variation. We achieve this by continually exercising and manipulating latent representations of molecules to highlight undesirable variation to the predictor. To test the method we use a combination of three data sources: SARS-CoV-2 antiviral screening data, molecular fragments that bind to SARS-CoV-2 main protease and large screening data for SARS-CoV-1. Our predictor outperforms state-of-the-art transfer learning methods by significant margin. We also report the top 20 predictions of our model on Broad drug repurposing hub.


COVID-19: The time for action is just now; It's still not too late


Improvement of physical training by performance-enhancing substances


COVID-19 deaths in Lombardy, Italy: data in context (vol 5, pg e310, 2020)


COVID-19 deaths in Lombardy, Italy: data in context


The perfect storm: COVID-19, mass incarceration and the opioid epidemic


title: Risk Factors for Mortality in 244 Older Adults With COVID-19 in Wuhan, China: A Retrospective Study

text: BACKGROUND/OBJECTIVES: Previous studies have reported that older patients may experience worse outcome(s) after infection with severe acute respiratory syndrome coronavirus-2 than younger individuals. This study aimed to identify potential risk factors for mortality in older patients with coronavirus disease 2019 (COVID-19) on admission, which may help identify those with poor prognosis at an early stage. DESIGN: Retrospective case-control. SETTING: Fever ward of Sino-French New City Branch of Tongji Hospital, Wuhan, China. PARTICIPANTS: Patients aged 60 years or older with COVID-19 (n = 244) were included, of whom 123 were discharged and 121 died in hospital. MEASUREMENTS: Data retrieved from electronic medical records regarding symptoms, signs, and laboratory findings on admission, and final outcomes of all older patients with COVID-19, were retrospectively reviewed. Univariate and multivariate logistic regression analyses were used to explore risk factors for death. RESULTS: Univariate analysis revealed that several clinical characteristics and laboratory variables were significantly different (ie, P < .05) between discharged and deceased patients. Multivariable logistic regression analysis revealed that lymphocyte (LYM) count (odds ratio [OR] = 0.009; 95% confidence interval [CI] = 0.001-0.138; P = .001) and older age (OR = 1.122; 95% CI = 1.007-1.249; P = .037) were independently associated with hospital mortality. White blood cell count was also an important risk factor (P = .052). The area under the receiver operating characteristic curve in the logistic regression model was 0.913. Risk factors for in-hospital death were similar between older men and women. CONCLUSION: Older age and lower LYM count on admission were associated with death in hospitalized COVID-19 patients. Stringent monitoring and early intervention are needed to reduce mortality in these patients. J Am Geriatr Soc 68:E19-E23, 2020.


What do differences in case fatality ratios between children and adults tell us about COVID-19?


title: Characterization and Noncovalent Inhibition of the Deubiquitinase and deISGylase Activity of SARS-CoV-2 Papain-Like Protease

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent for COVID-19, is a novel human betacoronavirus that is rapidly spreading worldwide. The outbreak currently includes over 3.7 million cases and 260,000 fatalities. As a betacoronavirus, SARS-CoV-2 encodes for a papain-like protease (PLpro) that is likely responsible for cleavage of the coronavirus (CoV) viral polypeptide. The PLpro is also responsible for suppression of host innate immune responses by virtue of its ability to reverse host ubiquitination and ISGylation events. Here, the biochemical activity of SARS-CoV-2 PLpro against ubiquitin (Ub) and interferon-stimulated gene product 15 (ISG15) substrates is evaluated, revealing that the protease has a marked reduction in its ability to process K48 linked Ub substrates compared to its counterpart in SARS-CoV. Additionally, its substrate activity more closely mirrors that of the PLpro from the Middle East respiratory syndrome coronavirus and prefers ISG15s from certain species including humans. Additionally, naphthalene based PLpro inhibitors are shown to be effective at halting SARS-CoV-2 PLpro activity as well as SARS-CoV-2 replication.