title: Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With COVID-19 Diagnosis and Mortality

text: Importance: It has been hypothesized that angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) may make patients more susceptible to coronavirus disease 2019 (COVID-19) and to worse outcomes through upregulation of the functional receptor of the virus, angiotensin-converting enzyme 2. Objective: To examine whether use of ACEI/ARBs was associated with COVID-19 diagnosis and worse outcomes in patients with COVID-19. Design, Setting, and Participants: To examine outcomes among patients with COVID-19, a retrospective cohort study using data from Danish national administrative registries was conducted. Patients with COVID-19 from February 22 to May 4, 2020, were identified using ICD-10 codes and followed up from day of diagnosis to outcome or end of study period (May 4, 2020). To examine susceptibility to COVID-19, a Cox regression model with a nested case-control framework was used to examine the association between use of ACEI/ARBs vs other antihypertensive drugs and the incidence rate of a COVID-19 diagnosis in a cohort of patients with hypertension from February 1 to May 4, 2020. Exposures: ACEI/ARB use was defined as prescription fillings 6 months prior to the index date. Main Outcomes and Measures: In the retrospective cohort study, the primary outcome was death, and a secondary outcome was a composite outcome of death or severe COVID-19. In the nested case-control susceptibility analysis, the outcome was COVID-19 diagnosis. Results: In the retrospective cohort study, 4480 patients with COVID-19 were included (median age, 54.7 years [interquartile range, 40.9-72.0]; 47.9% men). There were 895 users (20.0%) of ACEI/ARBs and 3585 nonusers (80.0%). In the ACEI/ARB group, 18.1% died within 30 days vs 7.3% in the nonuser group, but this association was not significant after adjustment for age, sex, and medical history (adjusted hazard ratio [HR], 0.83 [95% CI, 0.67-1.03]). Death or severe COVID-19 occurred in 31.9% of ACEI/ARB users vs 14.2% of nonusers by 30 days (adjusted HR, 1.04 [95% CI, 0.89-1.23]). In the nested case-control analysis of COVID-19 susceptibility, 571 patients with COVID-19 and prior hypertension (median age, 73.9 years; 54.3% men) were compared with 5710 age- and sex-matched controls with prior hypertension but not COVID-19. Among those with COVID-19, 86.5% used ACEI/ARBs vs 85.4% of controls; ACEI/ARB use compared with other antihypertensive drugs was not significantly associated with higher incidence of COVID-19 (adjusted HR, 1.05 [95% CI, 0.80-1.36]). Conclusions and Relevance: Prior use of ACEI/ARBs was not significantly associated with COVID-19 diagnosis among patients with hypertension or with mortality or severe disease among patients diagnosed as having COVID-19. These findings do not support discontinuation of ACEI/ARB medications that are clinically indicated in the context of the COVID-19 pandemic.


title: Early assessment of the impact of mitigation measures on the COVID-19 outbreak in Italy

text: BACKGROUND: On March 11, 2020, the World Health Organization characterized the novel coronavirus disease 2019 (COVID-19) outbreak as a pandemic. The first cases in Italy were reported on January 30, 2020, and the outbreak quickly escalated. On March 19, 2020, deaths in Italy surpassed those in China. The Italian government implemented progressively restrictive measures leading to a nationwide lockdown on March 8, 2020. This study aimed to assess the impact of mitigation measures implemented in Italy on the spread of COVID-19. METHODS: Publicly available data were used to evaluate changes in the growth curve of the number of patients hospitalized in intensive care (IC) at three time intervals between February 19, 2020, and April 9, 2020, after the implementation of progressive measures: (1) containment and travel restrictions, (2) lockdown of the epicenter of the outbreak, and (3) school closures and nationwide lockdown. The models that showed the highest reliability according to the Akaike information criterion and based on data from the three time intervals were projected to assess how the epidemic would have evolved if no other measure had been implemented. RESULTS: The most reliable models were (1) exponential, (2) quadratic, and (3) cubic (R2 = 0.99, >0.99, and > 0.99 respectively), indicating a progressive decrease in the growth of the curve. CONCLUSION: This study suggests the measures were effective in flattening the epidemic curve and bought valuable time, allowing for the number of IC beds to be nearly doubled before the national health system reached maximum capacity.


title: Navigating regulatory statutes during the Coronavirus Disease 2019

text: Disclaimer: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.


docid: uuhwpjis

title: The dark cloud with a silver lining: Assessing the impact of the SARS COVID-19 pandemic on the global environment

text: The Severe Acute Respiratory Syndrome-Coronavirus Disease 2019 (COVID-19) pandemic caused by a novel coronavirus known as SARS-CoV-2 has caused tremendous suffering and huge economic losses. We hypothesized that extreme measures of partial-to-total shutdown might have influenced the quality of the global environment because of decreased emissions of atmospheric pollutants. We tested this hypothesis using satellite imagery, climatic datasets (temperature, and absolute humidity), and COVID-19 cases available in the public domain. While the majority of the cases were recorded from Western countries, where mortality rates were strongly positively correlated with age, the number of cases in tropical regions was relatively lower than European and North American regions, possibly attributed to faster human-to-human transmission. There was a substantial reduction in the level of nitrogen dioxide (NO2: 0.00002 mol m-2), a low reduction in CO (<0.03 mol m-2), and a low-to-moderate reduction in Aerosol Optical Depth (AOD: ~0.1-0.2) in the major hotspots of COVID-19 outbreak during February-March 2020, which may be attributed to the mass lockdowns. Our study projects an increasing coverage of high COVID-19 hazard at absolute humidity levels ranging from 4 to 9 g m-3 across a large part of the globe during April-July 2020 due to a high prospective meteorological suitability for COVID-19 spread. Our findings suggest that there is ample scope for restoring the global environment from the ill-effects of anthropogenic activities through temporary shutdown measures.


The Path Forward: Academic Neurology Responds to COVID-19


Heart Failure Editorial Emergencies in the COVID-19 Era


Covid-19 and lack of linked datasets for care homes


title: Correction to: Energy replacement diminishes the postprandial triglyceridelowering effect from accumulated walking in older women

text: The original version of this article unfortunately contained a mistake. The error of NEFA AUC values in first (mean and 95% CI) and the main text (effect size and 95% CI).


A chilblain epidemic during the COVID-19 pandemic. A sign of natural resistance to SARS-CoV-2?


Wissenschaft in Zeiten von Corona - alles und nichts geht


With COVID-19, modeling takes on life and death importance


Baricitinib therapy in COVID-19: A pilot study on safety and clinical impact


Editorial - High dose intravenous immunoglobulins as a therapeutic option for COVID-19 patients


title: Play or science?: a study of learning and framing in crowdscience games

text: Crowdscience games may hold unique potentials as learning opportunities compared to games made for fun or education. They are part of an actual science problem solving process: By playing, players help scientists, and thereby interact with real continuous research processes. This mixes the two worlds of play and science in new ways. During usability testing we discovered that users of the crowdscience game Quantum Dreams tended to answer questions in game terms, even when directed explicitly to give science explanations.We then examined these competing frames of understanding through a mixed correlational and grounded theory analysis. This essay presents the core ideas of crowdscience games as learning opportunities, and reports how a group of players used"game","science"and"conceptual"frames to interpret their experience. Our results suggest that oscillating between the frames instead of sticking to just one led to the largest number of correct science interpretations, as players could participate legitimately and autonomously at multiple levels of understanding.


title: Caffeine removal using Elaeis guineensis activated carbon: adsorption and RSM studies

text: The palm (Elaeis guineensis), known as dendê, is an important oleaginous Brazilian plant with a high performance of oil production. In this work, a 23 full experimental design was performed and the response surface method (RSM) was used to indicate the optimum parameter of caffeine adsorption on Elaeis guineensis endocarp activated carbon, since the endocarp is the main by-product from dendê oil production. It was set the adsorbent point of zero charge (pHpzc), and the material was characterized by Fourier transform infrared spectroscopy (FT-IR), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM). The RSM results indicate removal efficiency (%) at the optimal conditions, 0.20 g of adsorbent, and caffeine initial concentration of 20 mg/L, and acidic medium was about 95%. Based on ANOVA and F test (Fcalculated > Fstandard), the mathematical/statistical model obtained fits well to the experimental data. The overall kinetic studies showed time was achieved after 5 h and caffeine adsorption followed the pseudo-second-order model suggesting chemisorption is a predominant mechanism. Redlich-Peterson and Sips models best represented the experimental data (0.967 < R2 < 0.993). Thermodynamic revealed that caffeine adsorption was spontaneous at all temperatures studied, exothermic, and probably with changes in the adsorbate-adsorbent complex during the process. The tests conducted in different water matrixes corroborate the suitability of this adsorbent to be used in caffeine removal even in a complex solution.


Using echocardiography to guide the treatment of novel coronavirus pneumonia


title: The role of testing in infectious disease control: A case of COVID-19 in Africa

text: The dramatic increase in COVID-19 suspected cases in Africa has placed enormous burden on public and private clinical facilities. Till date, the most commonly used method for the identification and confirmation of the virus is the laboratory-based reverse transcription-polymerase chain reaction (RT-PCR) testing. Unfortunately, testing capacities have been limited in many parts of Africa because of inadequate test kits which have restricted scaling up beyond the few public health laboratories at designated locations. We present in this mini-review Africa's preparedness and readiness toward testing, why testing is crucial, the need to immediately strengthen existing facilities and what it involves as combined approaches for managing the COVID-19 crisis. The review highlights the urgent need for speedy expansion and distribution of several laboratory testing platforms to public health facilities and fully accredited private clinical laboratories, including real-time PCR and serological assays.


title: Just the Facts: Airway management during the coronavirus disease 2019 (COVID-19) pandemic

text: A previously healthy 42-year-old male developed a fever and cough shortly after returning to Canada from overseas. Initially, he had mild upper respiratory tract infection symptoms and a cough. He was aware of the coronavirus disease-2019 (COVID-19) and the advisory to self-isolate and did so; however, he developed increasing respiratory distress over several days and called 911. On arrival at the emergency department (ED), his heart rate was 130 beats/min, respiratory rate 32 per/min, and oxygenation saturation 82% on room air. As per emergency medical services (EMS) protocol, they placed him on nasal prongs under a surgical mask at 5 L/min and his oxygen saturation improved to 86%.


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


title: Medical leadership in the NHS during the COVID-19 pandemic

text: Amid the global COVID-19 pandemic, adaptation of healthcare systems, with strong medical leadership, has been integral to coping with the ever-changing situation. This article is based on the personal experiences of doctors in the NHS and insights into the frontline response to this situation. It reflects on leadership dilemmas and strategies implemented to overcome them, with a focus on systems thinking and adaptive leadership.


Editorial. Impact of COVID-19 on neurosurgery resident training and education


title: [An analysis of global research on SARS-CoV-2]

text: The SARS-CoV-2 has been spread to 26 countries around the world since its outbreak. By February 16, 2020, more than 68 000 people had been diagnosed with COVID-19. Researchers from all over the world have carried out timely studies on this public health emergency and produced a number of scientific publications. This review aims to re-analyze and summarize the current research findings in a timely manner to guide scholars in relevant fields to further SARS-CoV-2 research and assist healthcare professionals in their work and decision-making. The SARS-CoV-2 related terms were selected in both English and Chinese and were searched in several major databases, including Pubmed, Web of Science, CNKI, Wanfang, and VIP databases. The reference list of each search result was screened for relevance, which was further supplemented to the search results. The included studies were categorized by topics with key characteristics extracted, re-analyzed, and summarized. A total of 301 articles were finally included with 136 in Chinese and 165 in English. The number of publications has rapidly increased since mid-January, 2020, and a peak day was 6th February on which 50 articles were published. The top three countries publishing articles were China, the United States and the United Kingdom. The Lancet and its specialty journals have published the most articles, with contribution also from journals such as New England Journal of Medicine ( NEJM), The Journal of the American Medical Association ( JAMA), and Nature. All articles were categorized into epidemiology, clinical diagnosis and treatment, basic research, pregnant women and children, mental health, epidemic prevention & control, and others. The literatures related to SARS-CoV-2 are emerging rapidly. It is necessary to sort out and summarize the research topic in time, which has a good reference value for staff in different positions. At the same time, it is necessary to strengthen the judgment of the quality of literatures.


title: Self-Control Moderates the Association Between Perceived Severity of Coronavirus Disease 2019 (COVID-19) and Mental Health Problems Among the Chinese Public

text: Coronavirus disease 2019 (COVID-19) has caused thousands of deaths in China. Prior research suggests that individuals' perceived severity of COVID-19 is related to a range of negative emotional and behavioral reactions among the Chinese public. However, scant research has examined the underlying mechanisms. Drawing upon the risk-resilience model, this study proposes that self-control, as a resilient factor, would potentially moderate the association between perceived severity of COVID-19 and mental health problems. Data from a national survey was used to examine this idea. Participants were 4607 citizens from 31 regions in China (Mage = 23.71 years, 72.5% female) who completed a national survey at the beginning of February 2020. Results of hierarchical regression showed that after controlling for a number of demographic variables, perceived severity of COVID-19 and self-control were positively and negatively related to mental health problems, respectively. More importantly, self-control moderated the "perceived severity of COVID-19-mental health problems" association, with this link attenuating as the levels of self-control increased. These findings suggest that compared to those with high self-control, individuals with low self-control are more vulnerable and are more in need of psychological aids to maintain mental health in the encounter of the COVID-19 outbreak. Practically, enhancing individuals' self-control ability might be a promising way to improve individuals' mental health during the early period of the COVID-19 outbreak.


title: A cluster of COVID-19 in pilgrims to Israel

text: This report describes a cluster of SARS-CoV-2 infections in pilgrims returning from Israel to Greece. Out of 53 pilgrims, 48 (90.5%) were tested positive for SARS-CoV-2; of them, 41 (85.4%) developed symptoms consistent with COVID-19, and 7 (14.6%) remained asymptomatic. These cases suggest a high risk of COVID-19 infection for pilgrims traveling during the pandemic. Although at that time the prevalence of the disease was low in the origin and destination countries, crowded exposure to other pilgrims from many other countries led to this cluster. Increasing awareness about the risks in pilgrims is important and particularly for elderly pilgrims and those with underlying conditions.


The effective use of telemedicine to save lives and maintain structure in a healthcare system: Current response to COVID-19


title: COVID-19 Outbreak: An Overview on Dentistry

text: Coronavirus disease 2019, also called COVID-19, is the latest infectious disease to rapidly develop worldwide [...].


title: Scientific comment on"Tail risk of contagious diseases"

text: Cirillo and Taleb [Nature Phys. 16, 606-613 (2020)] study the size of major epidemics in human history in terms of the number of fatalities. Using the figures from 72 epidemics, from the plague of Athens (429 BC) to the COVID-19 (2019-2020), they claim that the resulting fatality distribution is ``extremely fat-tailed'', i.e., asymptotically a power law. This has important consequences for risk, as the mean value of the fatality distribution becomes infinite. Reanalyzing the same data, we find that, although the data may be compatible with a power-law tail, these results are not conclusive, and other distributions, not fat-tailed, could explain the data equally well. Simulation of a log-normally distributed random variable provides synthetic data whose statistics are undistinguishable from the statistics of the empirical data.


Unprecedented surge in publications related to COVID-19 in the first three months of pandemic: A bibliometric analytic report


docid: maiezowr

title: Everything Old is New again: COVID-19 and Public Health


title: Screening for COVID-19: Patient factors predicting positive PCR test

text: To inform the efficient allocation of testing resources, we evaluated the characteristics of those tested for COVID-19 to determine predictors of a positive test. Recent travel and exposure to a confirmed case were both highly predictive of positive testing. Symptom-based screening strategies alone may be inadequate to control the ongoing pandemic.


docid: cbptisfd

title: How Do We Balance Tensions Between COVID-19 Public Health Responses and Stigma Mitigation? Learning from HIV Research


docid: rsjvuumi

title: COVID-19: What Should Interventional Radiologists Know and What Can They Do?

text: The outbreak of coronavirus disease 2019 (COVID-19) in late December 2019 in Wuhan, China, has been characterized as a "pandemic" by the World Health Organization and has resulted in 81,603 confirmed cases in China, among the 334,981 cases confirmed in 189 countries as of 09:00 am, March 24, 2020 (China central standard time). During the past 3 months, hundreds of thousands of Chinese health care workers, including interventional radiologists (IRs), have been fighting this battle against the horrifying COVID-19 disease. As IRs, what should we know and what can we do when facing this challenge? This paper shares the experience we have gone through.


COVID-19: Considerations of Diabetes and Cardiovascular Disease Management


title: Mütter-Screening in einem COVID-19-Niedrig-Pandemiegebiet: Bestimmung SARS-CoV-2-spezifischer Antikörper bei 401 Rostocker Müttern mittels ELISA und Immunfluoreszenz-Bestätigungstest./ [Screening of Mothers in a COVID-19 Low-Prevalence Region: Determination of SARS-CoV-2 Antibodies in 401 Mothers from Rostock by ELISA and Confirmation by Immunofluorescence]

text: BACKGROUND: In children, the infection with SARS-CoV-2, the cause of COVID-19, tends to be clinically inapparent more often or less severe than in adults. The spread of this infection from children poses a danger to vulnerable adults. Therefore, child care institutions and schools currently are widely closed. METHODS: Since the status of infection tends to be congruent in mothers and their children, we tested 401 mothers of children between 1 and 10 years in the city of Rostock (State of Mecklenburg-Westpomerania, northeast of Germany), for the presence of RNA of SARS-CoV-2 in throat swabs, and of antibodies against SARS-CoV-2 in serum. RESULTS: In none of the mothers tested, RNA of this virus was detected in the throat swab. In the ELISA test, IgG antibodies were positive in one serum sample, IgA antibodies were positive in 11, and borderline in 3 serum samples. All 401 sera were negative in the indirect immunofluorescence test (IIFT) with FITC-labeled IgG, IgA, und IgM antibodies. CONCLUSION: At the time of this study, neither SARS-CoV-2 RNA, nor specific antibodies against SARS-CoV-2 were detectable in the mothers tested in Rostock.


Reverse quarantine in Kerala: managing the 2019 novel coronavirus in a state with a relatively large elderly population


Immunomodulation for the management of corona virus disease (COVID-19)


title: Contact Tracing: An Overview of Technologies and Cyber Risks

text: The 2020 COVID-19 pandemic has led to a global lockdown with severe health and economical consequences. As a result, authorities around the globe have expressed their needs for better tools to monitor the spread of the virus and to support human labor. Researchers and technology companies such as Google and Apple have offered to develop such tools in the form of contact tracing applications. The goal of these applications is to continuously track people's proximity and to make the smartphone users aware if they have ever been in contact with positively diagnosed people, so that they could self-quarantine and possibly have an infection test. A fundamental challenge with these smartphone-based contact tracing technologies is to ensure the security and privacy of their users. Moving from manual to smartphone-based contact tracing creates new cyber risks that could suddenly affect the entire population. Major risks include for example the abuse of the people's private data by companies and/or authorities, or the spreading of wrong alerts by malicious users in order to force individuals to go into quarantine. In April 2020, the Pan-European Privacy-Preserving Proximity Tracing (PEPP-PT) was announced with the goal to develop and evaluate secure solutions for European countries. However, after a while, several team members left this consortium and created DP-3T which has led to an international debate among the experts. At this time, it is confusing for the non-expert to follow this debate; this report aims to shed light on the various proposed technologies by providing an objective assessment of the cybersecurity and privacy risks. We first review the state-of-the-art in digital contact tracing technologies and then explore the risk-utility trade-offs of the techniques proposed for COVID-19. We focus specifically on the technologies that are already adopted by certain countries.


title: Coronavirus and financial volatility: 40 days of fasting and fear

text: 40 days after the start of the international monitoring of COVID-19, we search for the effect of official announcements regarding new cases of infection and death ratio on the financial markets volatility index (VIX). Whereas the new cases reported in China and outside China have a mixed effect on financial volatility, the death ratio positively influences VIX, that outside China triggering a more important impact. In addition, the higher the number of affected countries, the higher the financial volatility is.


title: CT imaging features of 34 patients infected with COVID-19

text: Objective: To retrospectively analyze the CT findings in patients infected with Coronavirus disease 2019 (COVID-19). Materials and methods: The thirty-four cases, 15 females and 19 males, with an age ranging from 7 to 88â¯years old, confirmed by real-time reverse-transcriptase-polymerase chain reaction (RT-PCR), were used for our study. All thin-section CT scans of the lungs were performed in all of patients. The clinical, laboratory and CT imaging were available to evaluate in all patients. Results: The patients present with fever (85.29%, nâ¯=â¯29), cough (67.65%, nâ¯=â¯23), fatigue or myalgia (26.47%, nâ¯=â¯9), and pharyngalgia (8.82%, nâ¯=â¯3). The 4 patients (11.76%) with no symptoms were identified during screening for close contacts, who had typical CT findings. On initial CT scans, the bilateral lung involved was shown in 24 cases (70.59%), while 29 (82.35%) cases were distributed in peripheral. The pure ground glass opacity (GGO) was shown in 18 cases (52.94%), the GGO with consolidation was in 12 cases (35.29%), and full consolidation only in 3 cases. The lesion with air bronchogram was seen in 14 (41.18%) cases, with enlarged blood vessel in 17 (50.00%) cases, with crazy-paving pattern in 8 (23.53%) cases, with fine reticular pattern in 4 (11.77%) cases, and with intralesional vacuole sign in 6 (17.65%) cases. The pleural effusion was seen in one patient. Follow-up imaging in 19 patients during the study time window demonstrated mild, moderate or severe progression of disease, as manifested by increasing extent and density of lung opacities. Conclusions: The bilateral GGO with air bronchogram, enlarged blood vessel, fine reticular pattern, and peripheral distribution are the early CT findings of COVID-19. The crazy-paving pattern and intralesional vacuole sign are the features of progressive stage.


The BTK inhibitor ibrutinib may protect against pulmonary injury in COVID-19-infected patients


title: An urgent impetus for action: safe inhalation interventions to reduce COVID-19 transmission and fatality risk among people who smoke crack cocaine in the United Kingdom

text: Crack cocaine use is rising in the United Kingdom (UK), with smoking the primary form of administration. Provision of safe inhalation equipment for crack cocaine is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply, exacerbating COVID-19 transmission and respiratory risk. This is of concern, given high prevalence of respiratory health harms such as chronic obstructive pulmonary disease (COPD) among people who smoke illegal drugs. This commentary draws on scoping review and mixed method empirical evidence to argue for provision of safe crack inhalation equipment in the UK, with commensurate legal reform. Review of crack inhalation interventions illustrates the health protective and service engagement benefits of smoking equipment supply. Survey data generated with 455 people who inject drugs in London illustrate high prevalence of current crack use (66%, n=299). Qualitative accounts illustrate perceptions of relative smoking safety - alongside accounts of severe respiratory-related health harms. To date, injecting drug use has been of primary concern in relation to harm reduction initiatives. It is crucial that people who smoke illegal drugs are considered a vulnerable population in regard to COVID 19 transmission and fatality risk, with innovative harm reduction measures scaled up in response.


Optical techniques for fast screening - Towards prevention of the coronavirus COVID-19 outbreak


title: O papel da atenção primária no combate ao Covid-19: impacto na saúde pública e perspectivas futuras

text: A doença do novo Coronavírus (Covid-19) é causada pelo SARS-CoV-2 e representa o agente causador de uma doença potencialmente fatal que tem se revelado um problema de saúde pública global A pandemia causada pelo Covid-19 tem causado prejuízos severos nos sistemas de saúde em diversos países Diante do grande número de pessoas infectadas e da ausência de tratamento específico, várias nações têm enfrentado superlotação em seus hospitais Com a confirmação de casos desta doença no Brasil, várias ações têm sido tomadas por gestores públicos e privados, tanto a nível hospitalar quanto em nível de atenção primária, a fim de minimizar os impactos para o Sistema Único de Saúde (SUS) O presente artigo apresenta uma breve análise do papel da atenção primária na luta contra o Covid-19 em âmbito nacional, além do impacto em saúde pública e das futuras perspectivas Com base no grande número de pessoas infectadas no mundo e a experiência de diversos sistemas de saúde, torna-se imperativo a adaptação e adequação do SUS na condução de mecanismos de resposta para pandemia, sendo a atenção primária peça fundamental neste processo The new coronavirus (Covid-19) disease is caused by SARS-CoV-2 and represents the causative agent of a potentially fatal disease that has proved to be a global public health problem The pandemic caused by Covid-19 has caused severe damage to health systems in several countries In view of the large number of infected people and the lack of specific treatment, several nations have faced overcrowding in their hospitals With the confirmation of cases of this disease in Brazil, several actions have been taken by managers, both at the hospital level and at the level of primary care, in order to minimize the damage in the Unified Health System (SUS) This article presents a brief analysis of the role of primary care in the fight against Covid-19 at the national level, in addition to the impact on public health and future perspectives Based on the large number of infected people in the world and the experience of different health systems, it is imperative to adapt and adequation the SUS in conducting response mechanisms for the pandemic, with primary care being a fundamental part of this process La enfermedad del nuevo coronavirus (Covid-19) es causada por el SARS-CoV-2 y representa el agente causal de una enfermedad potencialmente mortal que ha demostrado ser un problema global de salud pública La pandemia causada por Covid-19 ha causado graves daños a los sistemas de salud en varios países En vista de la gran cantidad de personas infectadas y la falta de tratamiento específico, varias naciones han enfrentado hacinamiento en sus hospitales Con la confirmación de los casos de esta enfermedad en Brasil, los gerentes han tomado varias medidas, tanto a nivel hospitalario como a nivel de atención primaria, para minimizar el daño en el Sistema Único de Salud (SUS) Este artículo presenta un breve análisis del papel de la atención primaria en la lucha contra Covid-19 en todo el país, además del impacto en la salud pública y las perspectivas futuras Basado en la gran cantidad de personas infectadas en el mundo y la experiencia de diferentes sistemas de salud, es imperativo adaptar y adaptar el SUS en la conducción de mecanismos de respuesta a la pandemia, siendo la atención primaria una parte fundamental de este proceso


title: Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

text: BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. METHODS: We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FINDINGS: Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25â697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10â736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] -10·2%, 95% CI -11·5 to -7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD -14·3%, -15·9 to -10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD -10·6%, 95% CI -12·5 to -7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. INTERPRETATION: The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. FUNDING: World Health Organization.


Safe delivery for pregnancies affected by COVID-19


title: Unlikely SARS-CoV-2 vertical transmission from mother to child: A case report

text: As the 2019 novel coronavirus disease (COVID-19) rapidly spread across China and to more than 70 countries, an increasing number of pregnant women were affected. The vertical transmission potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is of great concern to the obstetrics, neonatologists, and public health agencies. Though some studies indicated the risk of vertical transmission is low, few cases have been reported with comprehensive serial tests from multiple specimens. In this case, a female preterm infant was born to a mother with confirmed COVID-19. She presented with mild respiratory distress and received general management and a short period of nasal continuous positive airway pressure support. During her stay at the hospital, a series of SARS-CoV-2 nucleic test from her throat and anal swab, serum, bronchoalveolar lavage fluid, and urine were negative. The nucleic acid test from the mother's amniotic fluid, vaginal secretions, cord blood, placenta, serum, anal swab, and breast milk were also negative. The most comprehensively tested case reported to date confirmed that the vertical transmission of COVID is unlikely, but still, more evidence is needed.


Impact of the COVID-19 Epidemic on a Pan-Asian Academic Oncology Clinical Trial


title: Asymptomatic COVID-19: What the Neuroradiologist Needs to Know about Pulmonary Manifestations

text: Coronavirus disease 2019 (COVID-19) is an infectious disease with a high asymptomatic incidence. Asymptomatic infections within a population will inevitably lead to diagnosis via unrelated medical imaging. We report the case of an asymptomatic patient undergoing a spine CT examination for trauma who was incidentally found to have lung abnormalities later confirmed to be COVID-19. We aim to familiarize neuroradiologists with the spectrum of COVID-19 pulmonary manifestations that are likely to be observed on neck and spine CT imaging.


title: 'Do not resuscitate me in Barbados'

text: New ways of encouraging discussion and education around the topic of do not attempt cardiopulmonary resuscitation (DNACPR) decisions in healthcare can prove challenging. Cardiopulmonary resuscitation is still portrayed as an intervention that is successful even in people with multiple long-term conditions. In 2020, during the first months of the COVID-19 pandemic, a letter from a palliative care doctor to his patient was read out as part of an online campaign entitled #ReadALetter, organised by the organisation Letters Live. The letter addresses misconceptions regarding DNACPR decisions and encourages thoughtful dialogue. In particular, it promotes an individualised approach for clinicians, and investigates one patient's journey: from initially rejecting the concept, to later on fully embracing it as part of his holistic care. A journey that took him to Barbados, amongst other places.


title: Suicide risk during the lockdown due to coronavirus disease (COVID-19) in Colombia

text: The study aimed to estimate the high suicide risk during the COVID-19 lockdown in the Colombian population. A total of 700 adults aged between 18 and 76 years (M = 37.1, SD = 12.7; 68.0% women) completed an online questionnaire. Findings showed that 7.6% of participants reported a high suicide risk. High suicide risk was associated with high perceived stress related to COVID-19, risk of depressive episode, and insomnia. Our study suggests that 1 out of 13 Colombians in a non-probability sample reports a high suicide risk during COVID-19. Findings need to be corroborated in a representative sample of Colombians.


title: [Current status for urpper tract transitional cell carcinoma during COVID-19 pandemia.]

text: INTRODUCTION: First cases of COVID-19 were reported in China on December 2019 and rapidly spread globally The explosive increase in number of cases requiring hospitalization has led to a delay in a big number of surgical interventions, including oncologic surgeries Collateral effects of this increase means a challenge for urologists, who have been forced to redistribute their resources Due to its poor pronostic, patients suffering from by upper tract urinary tumours will be negatively affected by this pandemic METHODS: A non sistematic review was performed using literature published until May 23, 2020, using "Uppertract urothelial tumours", "COVID-19" and "nephroureterectomy" as keywords The resulting manuscript was critically revised by national authors in order to establish common criteria about treatment and follow up EVIDENCE SYNTHESIS: Four studies were identified that assessed the impact of delaying radical nephrouretrectomy as curative treatment These studies showed that surgery delays decrease overall survival and cancer specific survival rates in high-risk groups On the other hand, delaying radical nephrouretrectomy due to ureteroscopy did not affect survival in cohorts of patients with predominately low-grade disease CONCLUSIONS: A delay in curative treatment of upper tract urothelial tumours for more than three months results in adverse outcomes as overal survival and cancer specific survival Hence, it is important to prioritize the timely care of this group of patients as far as COVID-19 pandemic allows it


title: Current status for urpper tract transitional cell carcinoma during COVID-19 pandemia./ Situacion actual de los tumores del tracto urinario superior en el contexto de la pandemia por Covid-19

text: INTRODUCTION: First cases of COVID-19 were reported in China on December 2019 and rapidly spread globally The explosive increase in number of cases requiring hospitalization has led to a delay in a big number of surgical interventions, including oncologic surgeries Collateral effects of this increase means a challenge for urologists, who have been forced to redistribute their resources Due to its poor pronostic, patients suffering from by upper tract urinary tumours will be negatively affected by this pandemic METHODS: A non sistematic review was performed using literature published until May 23, 2020, using "Uppertract urothelial tumours", "COVID-19" and "nephroureterectomy" as keywords The resulting manuscript was critically revised by national authors in order to establish common criteria about treatment and follow up EVIDENCE SYNTHESIS: Four studies were identified that assessed the impact of delaying radical nephrouretrectomy as curative treatment These studies showed that surgery delays decrease overall survival and cancer specific survival rates in high-risk groups On the other hand, delaying radical nephrouretrectomy due to ureteroscopy did not affect survival in cohorts of patients with predominately low-grade disease CONCLUSIONS: A delay in curative treatment of upper tract urothelial tumours for more than three months results in adverse outcomes as overal survival and cancer specific survival Hence, it is important to prioritize the timely care of this group of patients as far as COVID-19 pandemic allows it INTRODUCCION: Los primeros casos de la enfermedad por coronavirus (Coronavirus Disease 19, tambien denominada COVID-19) aparecieron en China en diciembre de 2019, desde donde se extendieron al resto del mundo La rapida aparicion de casos y el alto volumen de pacientes que han requerido hospitalizacion han provocado la demora de un gran numero de intervenciones quirurgicas, incluidas las cirugias oncologicas Todo ello esta suponiendo un reto para los servicios de urologia de todo el mundo, y obliga a una redistribucion de sus recursos Los pacientes con tumores del tracto urotelial superior (TUS), en muchos casos de mal pronostico, se pueden ver potencialmente afectadospor esta situacion MATERIAL Y METODOS: Se realizo una busqueda no sistematica en web y en PubMed utilizando las palabras clave Upper tract urothelial tumours, COVID-19 ,nephroureterectomy Se realizo una revision narrativa de la literatura incluyendo solo articulos y documentos escritos en lengua espanola e inglesa Se remitio el documento a varios autores nacionales expertos en patologia del urotelio superior, con el fin de unificar criterios y experiencias para llegar a un rapido consenso sobre la importancia relativa de las distintas actividades, problemas y soluciones EVIDENCIA CIENTIFICA: Diversos estudios tratan de determinar el impacto que presenta el retraso en la realizacion de la nefroureterectomia como tratamiento curativo, siendo el punto de corte de 3 meses en la mayoria de ellos Tres de ellos concluyen que dicha demora implica una disminucion de la supervivencia global y cancer especifica, mientras que el retraso de la nefroureterectomia radical debido a la realizacion de ureterorrenoscopia (URS) como tratamiento conservador en tumores de bajo grado no parece tener impacto en la supervivencia CONCLUSIONES: El retraso en el tratamiento de los tumores del TUS a 3 meses supone una disminucion de la supervivencia global y cancer especifica Por ello, el tratamiento de esta patologia no deberia demorarse, en la medida en que los recursos hospitalarios y la alerta sanitaria por COVID-19 lo permita


Should patients stop their biologic treatment during the COVID-19 pandemic


title: Community pharmacists and communication in the time of COVID-19: Applying the health belief model

text: The emergence of the novel coronavirus disease (COVID-19) pandemic presents an unprecedented health communications challenge. Healthcare providers should reinforce behaviors that limit the spread of the pandemic, including social distancing and remaining in the home whenever possible. Formal communications toolkits may not be prepared in a timely fashion. Community pharmacists can reinforce mitigation behaviors by applying the health belief model (HBM). This commentary provides an overview of the HBM and offers suggestions on how community pharmacists can use it as a guide to patient communication in these uncertain contexts.


title: The COVID-19 pandemic: is there a role for magnesium? Hypotheses and perspectives

text: More and more studies are accumulating about COVID-19. Some aspects of the pathogenesis of the disease recall events occurring in Mg deficiency, such as a drop of T cells, increased plasma concentration of inflammatory cytokines, and endothelial dysfunction. We hypothesize that a low Mg status, which is rather common, might foment the transition from mild to critical clinical manifestations of the disease. Epidemiological, clinical, and fundamental research is needed to clarify the potential role of Mg deficiency in COVID-19.


title: Clinical Pathway for Management of Suspected or Positive Novel Coronavirus-19 Patients With ST-Segment Elevation Myocardial Infarction

text: Novel coronavirus-19 disease (COVID-19) is an escalating, highly infectious global pandemic that is quickly overwhelming healthcare systems. This has implications on standard cardiac care for ST-elevation myocardial infarctions (STEMIs). In the setting of anticipated resource scarcity in the future, we are forced to reconsider fibrinolytic therapy in our management algorithms. We encourage clinicians to maintain a high level of suspicion for STEMI mimics, such as myopericarditis which is a known, not infrequent, complication of COVID-19 disease. Herein, we present a pathway developed by a multidisciplinary panel of stakeholders at NewYork-Presbyterian/Columbia University Irving Medical Center for the management of STEMI in suspected or confirmed COVID-19 patients.


docid: imuoonyi

title: Madagascar's mysterious, murderous cats identified


title: A Case Series of the 2019 Novel Coronavirus (SARS-CoV-2) in 3 Febrile Infants in New York

text: We describe 3 febrile infants <2 months of age admitted to a large tertiary care children's hospital in New York and subsequently found to be infected with severe acute respiratory syndrome coronavirus 2. All 3 patients presented with fever, feeding difficulty, lymphopenia, and thrombocytosis on laboratory evaluation. Two of the 3 patients were found to have neutropenia, and 2 had known exposures to sick contacts. In this case series, we describe 3 of the youngest patients to be reported with severe acute respiratory syndrome coronavirus 2 in the United States.


BACKGROUND: Despite the mainly reassuring outcomes for pregnant women with COVID-19 infection reported by previous case series with small sample sizes, some recent reports of severe maternal morbidity requiring intubation and of maternal deaths show the need for additional data about the impact of COVID-19 on pregnancy outcomes. This study aimed to report the maternal characteristics and clinical outcomes of pregnant women with COVID-19 disease. STUDY DESIGN: This retrospective single-center study includes all consecutive pregnant women with confirmed (laboratory-confirmed) or suspected (according to version 7.0 of the Chinese management guideline) COVID-19 infection, regardless of gestational age at diagnosis, admitted to the Strasbourg University Hospital (France) from March 1 to April 3, 2020. Maternal characteristics, laboratory and imaging findings, and maternal and neonatal outcomes were extracted from medical records. RESULTS: The study includes 54 pregnant women with confirmed (n=38) and suspected (n=16) COVID-19 infection. Of these, 32 had an ongoing pregnancy, one a miscarriage, and 21 live births: 12 vaginal and 9 cesarean deliveries. Among the women who gave birth, preterm deliveries were medically indicated for their COVID-19-related condition for 23.8% (5/21): 14.3% (3/21) before 32 weeks' gestation and 9.5% (2/21) before 28 weeks. Oxygen support was required for 24.1% (13/54), including high flow oxygen (n=2), noninvasive (n=1) and invasive (n=3) mechanical ventilation, and extracorporeal membrane oxygenation (n=1). Of these, three, aged 35 years or older with positive COVID-19 RT-PCR, had respiratory failure requiring indicated delivery before 29 weeks' gestation. All three women were overweight or obese, and two had an additional comorbidity. CONCLUSION: COVID-19 in pregnancy was associated with maternal morbidity and preterm birth. Its association with other well-known risk factors for severe maternal morbidity in noninfected pregnant women, including maternal age above 35 years, overweight, and obesity, suggests further studies are required to determine whether these risk factors are also associated with poorer maternal outcome in these women.


docid: dxfyfhnd

title: Prognostic significance of cardiac injury in COVID-19 patients with and without coronary artery disease

text: OBJECTIVE: COVID-19 is a disease with high mortality, and risk factors for worse clinical outcome have not been well-defined yet. The aim of this study is to delineate the prognostic importance of presence of concomitant cardiac injury on admission in patients with COVID-19. METHODS: For this multi-center retrospective study, data of consecutive patients who were treated for COVID-19 between 20 March and 20 April 2020 were collected. Clinical characteristics, laboratory findings and outcomes data were obtained from electronic medical records. In-hospital clinical outcome was compared between patients with and without cardiac injury. RESULTS: A total of 607 hospitalized patients with COVID-19 were included in the study; the median age was 62.5 ± 14.3 years, and 334 (55%) were male. Cardiac injury was detected in 150 (24.7%) of patients included in the study. Mortality rate was higher in patients with cardiac injury (42% vs. 8%; P < 0.01). The frequency of patients who required ICU (72% vs. 19%), who developed acute kidney injury (14% vs. 1%) and acute respiratory distress syndrome (71%vs. 18%) were also higher in patients with cardiac injury. In multivariate analysis, age, coronary artery disease (CAD), elevated CRP levels, and presence of cardiac injury [odds ratio (OR) 10.58, 95% confidence interval (CI) 2.42-46.27; P < 0.001) were found to be independent predictors of mortality. In subgroup analysis, including patients free of history of CAD, presence of cardiac injury on admission also predicted mortality (OR 2.52, 95% CI 1.17-5.45; P = 0.018). CONCLUSION: Cardiac injury on admission is associated with worse clinical outcome and higher mortality risk in COVID-19 patients including patients free of previous CAD diagnosis.


docid: wnjuadks

title: Clinical Research of the Application of Bone Turnover Markers in Monitoring the Short-Term Therapeutic Efficacy of Vitamin D in Postmenopausal Osteoporotic women in Harbin, China

text: BACKGROUND: The incidence of osteoporosis (OP) is increasing year by year. researches have shown that there was an intense link between the vitamin D (VitD) status and the efficacy of zoledronate (ZOL) in patients with osteoporosis. Since VitD is related to the geogen, its promotion effect on zoledronate has regional specificity. AIM: Combining dual-energy X-ray and bone turnover markers (BTM) to explore the VitD level in postmenopausal osteoporosis patients in Harbin and monitor its effect on the anti-osteoporosis effect of ZOL. METHODS: A total of 120 patients with postmenopausal osteoporosis (PMO) were enrolled .These patients were divided into two groups with 25(OH)D levels = 10ng/ml as a critical point, and each group was randomly divided into experimental groups and control groups). All of the patients were conducted 5 mg ZOL. Then the experimental group was given calcitriol and calcium carbonate, and the control group was only given calcium carbonate. BTM were measured at baseline, 24h, 3 months and 6 months. We also measured bone mineral density (BMD) of bilateral hips (TH BMD) and lumbar spine (LS BMD) at baseline and 6 months. RESULTS: The VitD deficiency rates of the patients enrolled were 84.1%. There was an inverse relationship between the baseline level of VitD and the serum levels of P1NP / ß-CTX, (r=-0.452,p=0.00; r=-0.225, p=0.01). Comparing with baseline, the level of serum P1NP,ß-CTX in each group declined significantly after the treatment (P<0.05). The mean decreasing rates of P1NP and ß-CTX in the both experimental groups were significantly higher than that of the corresponding control groups at the same time point (P<0.05), after 6 months of medication. Both TH BMD and LS BMD at 6 months increased significantly. The increase rate of LS BMD in the high VitD experimental group was significantly higher than the other three groups (P<0.05), the increase rates of TH BMD in the low VitD control group were significantly lower than the other three groups (P<0.05). CONCLUSIONS: The levels of serum VitD in the patients enrolled in this study were generally low. VitD could increase the therapeutic effect of ZOL on osteoporosis.


A Call for Rational Intensive Care in the Era of COVID-19


title: Anti COVID-19 Drugs: Need for More Clinical Evidence and Global Action

text: The World Health Organization (WHO) called the outbreak of coronavirus infectious disease-2019 (COVID-19) a "Public Health Emergency of International Concern" (PHEIC). According to the WHO, Centers for Disease Control and Prevention (CDC), and the US Food and Drug Administration (FDA), currently there are no medicines or vaccines that have been claimed to be useful in the prevention or treatment of COVID-19. Several existing antiviral drugs, previously developed or used as treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), human immunodeficiency virus (HIV), and malaria, are being investigated as COVID-19 treatments and some of them are being used in clinical trials. According to the CDC and Chinese treatment guidelines for COVID-19, chloroquine, hydroxychloroquine, lopinavir/ritonavir, and one of the investigational agents (remdesivir) are recommended in critically ill older patients. The use of other potential drugs reported in different studies may be considered if treatment with first-line drugs is ineffective. There are currently no complete data available from large randomized clinical trials (RCTs) to provide clinical guidance on the use, dosing, or duration to validate the effective role, safety profile, and adverse effects of all of the trial drugs for prophylaxis or treatment of COVID-19. Until now, it is still unclear which drug can successfully fight against the disease. Therefore, for the better safety of patients with COVID-19, further clinical trials and large randomized controlled studies are needed to validate the effective role, safety profile, and adverse effects of all the potential drugs. Such a measure requires action at the global level.


title: Detailed Simulation of Viral Propagation In The Built Environment

text: A summary is given of the mechanical characteristics of virus contaminants and the transmission via droplets and aerosols. The ordinary and partial differential equations describing the physics of these processes with high fidelity are presented, as well as appropriate numerical schemes to solve them. Several examples taken from recent evaluations of the built environment are shown, as well as the optimal placement of sensors.


docid: lvfbqlxf

title: Methemoglobinemia in Patient with G6PD Deficiency and SARS-CoV-2 Infection

text: We report a case of intravascular hemolysis and methemoglobinemia, precipitated by severe acute respiratory syndrome coronavirus 2 infection, in a patient with undiagnosed glucose-6-phosphate dehydrogenase deficiency. Clinicians should be aware of this complication of coronavirus disease as a cause of error in pulse oximetry and a potential risk for drug-induced hemolysis.


SARS-CoV-2 in the peritoneal waste in a patient treated with peritoneal dialysis


Deaths from COVID-19 in healthcare workers in Italy-What can we learn?


title: Coronavirus Disease 2019 (COVID-19) Pandemic Shifts Inpatient Imaging Utilization

text: OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on imaging utilization across practice settings. The purpose of this study was to quantify the change in the composition of inpatient imaging volumes for modality types and Current Procedural Terminology-coded groups during the COVID-19 pandemic. METHODS: A retrospective study of inpatient imaging volumes in a large health care system was performed, analyzing weekly imaging volumes by modality types (radiography, CT, MRI, ultrasound, interventional radiology, nuclear medicine) in years 2020 and 2019. The data set was split to compare pre-COVID-19 (weeks 1-9) and post-COVID-19 (weeks 10-16) periods. Further subanalyses compared early post-COVID-19 (weeks 10-13) and late post-COVID-19 (weeks 14-16) periods. Statistical comparisons were performed using χ2 and independent-samples t tests. RESULTS: Compared with 2019, total inpatient imaging volume in 2020 post-COVID-19, early and late post-COVID-19 periods, declined by 13.6% (from 78,902 to 68,168), 16.6% (from 45,221 to 37,732), and 9.6% (from 33,681 to 30,436), respectively. By week 16, inpatient imaging volume rebounded and was only down 4.2% (from 11,003 to 10,546). However, a statistically significant shift (P < .0001) in the 2020 composition mix was observed largely comprised of radiography (74.3%), followed by CT (12.7%), ultrasound (8%), MRI (2.4%), interventional radiology (2.3%) and nuclear medicine (0.4%). Although the vast majority of imaging studies declined, few Current Procedural Terminology-coded groups showed increased trends in imaging volumes in the late post-COVID-19 period, including CTA chest, radiography chest, and ultrasound venous duplex. DISCUSSION: During the COVID-19 pandemic, we observed a decrease in inpatient imaging volumes accompanied by a shift away from cross-sectional imaging toward radiography. These findings could have significant implications in planning for a potential resurgence.


Religious cliché and COVID-19 management: a barrier for physicians


title: Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection

text: OBJECTIVE: This study aimed to assess the presence of novel coronavirus in tears and conjunctival secretions of SARS-CoV-2-infected patients. METHODS: A prospective interventional case series study was performed, and 30 confirmed novel coronavirus pneumonia (NCP) patients were selected at the First Affiliated Hospital of Zhejiang University from 26 January 2020 to 9 February 2020. At an interval of 2 to 3 days, tear and conjunctival secretions were collected twice with disposable sampling swabs for reverse-transcription polymerase chain reaction (RT-PCR) assay. RESULTS: Twenty-one common-type and nine severe-type NCP patients were enrolled. Two samples of tear and conjunctival secretions were obtained from the only one patient with conjunctivitis yielded positive RT-PCR results. Fifty-eight samples from other patents were all negative. CONCLUSION: We speculate that SARS-CoV-2 may be detected in the tears and conjunctival secretions in NCP patients with conjunctivitis.


Facing the future-what lessons could we learn from Covid-19?


Comment on "Central Nervous System Involvement by Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2)"


docid: fssokqty

title: Minimizing the risk of COVID-19 among patients on dialysis


Point-of-care ultrasound in respiratory and critical care: consolidation and expansion of imaging skills


title: On A-numerical radius inequalities for $2 \times 2$ operator matrices

text: Let ($\mathcal{H}, \langle . , .\rangle )$ be a complex Hilbert space and $A$ be a positive bounded linear operator on it. Let $w_A(T)$ be the $A$-numerical radius and $\|T\|_A$ be the $A$-operator seminorm of an operator $T$ acting on the semi-Hilbertian space $(\mathcal{H}, \langle .,.\rangle_A),$ where $\langle x, y\rangle_A:=\langle Ax, y\rangle$ for all $x,y\in \mathcal{H}$. In this article, we establish several upper and lower bounds for $B$-numerical radius of $2\times 2$ operator matrices, where $B=\begin{bmatrix} A&0 0&A \end{bmatrix}$. Further, we prove some refinements of earlier $A$-numerical radius inequalities for operators.


COVID-19 pandemic: palliative care for elderly and frail patients at home and in residential and nursing homes


title: Quantifying what could have been - The impact of the Australian and New Zealand governments' response to COVID-19

text: BACKGROUND: The Australian and New Zealand governments both initiated strict social distancing measures in response to the COVID-19 pandemic in late March. It remains difficult to quantify the impact this had in reducing the spread of the virus. METHODS: Bayesian structural time series model provide a model to quantify the scenario in which these government-level interventions were not placed. Our models predict these strict social distancing measures caused a 79% and 61% reduction in the daily cases of COVID-19 across Australia and New Zealand respectively. CONCLUSION: This provides both evidence and impetus for governments considering similar measures in response to COVID-19 and other pandemics.


Alone, the hardest part


docid: ngjyxrdc

title: Handling the COVID-19 pandemic: Proposing a community based toolkit for psycho-social management and preparedness


Home Care and Use of Telehealth Amidst the COVID-19 Pandemic


title: Inflammatory Type 2 cDCs Acquire Features of cDC1s and Macrophages to Orchestrate Immunity to Respiratory Virus Infection

text: The phenotypic and functional dichotomy between IRF8+ type 1 and IRF4+ type 2 conventional dendritic cells (cDC1s and cDC2s, respectively) is well accepted; it is unknown how robust this dichotomy is under inflammatory conditions, when additionally monocyte-derived cells (MCs) become competent antigen-presenting cells (APCs). Using single-cell technologies in models of respiratory viral infection, we found that lung cDC2s acquired expression of the Fc receptor CD64 shared with MCs and of IRF8 shared with cDC1s. These inflammatory cDC2s (inf-cDC2s) were superior in inducing CD4+ T helper (Th) cell polarization while simultaneously presenting antigen to CD8+ T cells. When carefully separated from inf-cDC2s, MCs lacked APC function. Inf-cDC2s matured in response to cell-intrinsic Toll-like receptor and type 1 interferon receptor signaling, upregulated an IRF8-dependent maturation module, and acquired antigens via convalescent serum and Fc receptors. Because hybrid inf-cDC2s are easily confused with monocyte-derived cells, their existence could explain why APC functions have been attributed to MCs.


title: A risk balancing act - tourism competition using health leverage in the COVID-19 era

text: The world is currently in the throes of the COVID-19 pandemic which has halted the tourism sector and created an unprecedented global economic crisis. This paper will outline economics pertaining to COVID-19 lockdown, recovery and the inevitable competition that will occur between countries for tourists who will be scarcer and therefore more valuable. Countries are competing with a variety of incentives in order to lure visitors. However, persistent first waves that extend into July will put off tourists, further reducing tourism revenues and accelerate job losses and bankruptcies in affected countries. The example of Sweden's response to COVID-19 in this regard will be described. Countries that have COVID-19 relatively under control but experience second waves will also manifest negative tourism effects. Governments and public health must act in unison so as to exit lockdown as speedily and as safely as feasible, with COVID-19 rises that are as low and brief as possible in order to better compete in the tourism sector with other countries. Websites are already online comparing not only safety for travellers vis-à-vis COVID-19 but also the incentives offered by different countries in their attempts to woo tourists in this difficult market.


COVIDep: a web-based platform for real-time reporting of vaccine target recommendations for SARS-CoV-2


title: Existence Theory for the EED Inpainting Problem

text: We establish an existence theory for an elliptic boundary value problem in image analysis known as edge-enhancing diffusion (EED) inpainting. The EED inpainting problem aims at restoring missing data in an image as steady state of a nonlinear anisotropic diffusion process where the known data provide Dirichlet boundary conditions. We prove existence of a weak solution by applying the Leray-Schauder Fixed point theorem and show that the set of all possible weak solutions is bounded. Moreover, we demonstrate that under certain conditions, the sequences resulting from iterative application of the operator from the existence theory contain convergent subsequences.


title: Impact of Human Disasters and COVID-19 Pandemic on Mental Health: Potential of Digital Psychiatry

text: Deep emotional traumas in societies overwhelmed by large-scale human disasters, like, global pandemic diseases, natural disasters, man-made tragedies, war conflicts, social crises, etc., can cause massive stress-related disorders. Motivated by the ongoing global coronavirus pandemic, the article provides an overview of scientific evidence regarding adverse impact of diverse human disasters on mental health in afflicted groups and societies. Following this broader context, psychosocial impact of COVID-19 as a specific global human disaster is presented, with an emphasis on disturbing mental health aspects of the ongoing pandemic. Limited resources of mental health services in a number of countries around the world are illustrated, which will be further stretched by the forthcoming increase in demand for mental health services due to the global COVID-19 pandemic. Mental health challenges are particularly important for the Republic of Croatia in the current situation, due to disturbing stress of the 2020 Zagreb earthquake and the high pre-pandemic prevalence of chronic Homeland-War-related posttraumatic stress disorders. Comprehensive approach based on digital psychiatry is proposed to address the lack of access to psychiatric services, which includes artificial intelligence, telepsychiatry and an array of new technologies, like internet-based computer-aided mental health tools and services. These tools and means should be utilized as an important part of the whole package of measures to mitigate negative mental health effects of the global coronavirus pandemic. Our scientific and engineering experiences in the design and development of digital tools and means in mitigation of stress-related disorders and assessment of stress resilience are presented. Croatian initiative on enhancement of interdisciplinary research of psychiatrists, psychologists and computer scientists on the national and EU level is important in addressing pressing mental health concerns related to the ongoing pandemic and similar human disasters.


Dealing With the CARDS of COVID-19


title: Risk Communication in Asian Countries: COVID-19 Discourse on Twitter

text: COVID-19 has become one of the most widely talked about topics on social media. This research characterizes risk communication patterns by analyzing the public discourse on the novel coronavirus from four Asian countries: South Korea, Iran, Vietnam, and India, which suffered the outbreak to different degrees. The temporal analysis shows that the official epidemic phases issued by governments do not match well with the online attention on COVID-19. This finding calls for a need to analyze the public discourse by new measures, such as topical dynamics. Here, we propose an automatic method to detect topical phase transitions and compare similarities in major topics across these countries over time. We examine the time lag difference between social media attention and confirmed patient counts. For dynamics, we find an inverse relationship between the tweet count and topical diversity.


title: Hypolipidemia is associated with the severity of COVID-19

text: BACKGROUND: Many patients with coronavirus disease 2019 (COVID-19) suffer multiple organ dysfunctions. However, whether patients develop dyslipidemia is unknown. OBJECTIVE: In this study, we aimed to investigate the pathological alterations of low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and total cholesterol (TC) in COVID-19 patients and their relationships with the disease severity. METHODS: A retrospective study was performed to examine serum levels of LDL-c, HDL-c, and TC on 597 COVID-19 patients (mild: 394; severe, 171; critical: 32) who were hospitalized in our center between February 1 and March 3, 2020. Age- and gender-matched normal subjects (n = 50) who had routine laboratory lipid tests between October 1 and November 1, 2019 in our center were included as the control group. RESULTS: LDL-c and TC levels were significantly lower in COVID-19 patients as compared with normal subjects (P < .001). There were significant and gradual decreases in levels of LDL-c (median (IQR) in mg/dL, mild: 91 (76, 104); severe: 86 (69, 102); critical: 69 (48, 81); P < .02) and TC (mild: 173 (148, 203); severe: 167 (138, 197); critical: 125 (95, 162); P < .05) across all three groups. HDL-c levels only decreased significantly in critical cases as compared with levels in mild and severe cases. LDL-c and TC levels inversely correlated with C-reactive protein and interleukin-6, and positively correlated with the number of lymphocytes in patients. CONCLUSIONS: Development of hypolipidemia begins in patients with mild symptoms. It progressively becomes worse in an association with the disease severity.


title: Is Low Alveolar Type II Cell SOD3 in the Lungs of Elderly Linked to the Observed Severity of COVID-19?

text: Human lungs single-cell RNA sequencing data from healthy donors (elderly and young; GEO accession no. GSE122960) were analyzed to isolate and specifically study gene expression in alveolar type II cells. Colocalization of angiotensin-converting enzyme 2 (ACE2) and TMPRSS2 enables severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) to enter the cells. Expression levels of these genes in the alveolar type II cells of elderly and young patients were comparable and, therefore, do not seem to be responsible for worse outcomes observed in coronavirus disease 2019 (COVID-19) affected elderly. In cells from the elderly, 263 genes were downregulated and 95 upregulated. Superoxide dismutase 3 (SOD3) was identified as the top-ranked gene that was most downregulated in the elderly. Other redox-active genes that were also downregulated in cells from the elderly included activating transcription factor 4 (ATF4) and metallothionein 2A (M2TA). ATF4 is an endoplasmic reticulum stress sensor that defends lungs via induction of heme oxygenase 1. The study of downstream factors known to be induced by ATF4, according to Ingenuity Pathway Analysis™, identified 24 candidates. Twenty-one of these were significantly downregulated in the cells from the elderly. These downregulated candidates were subjected to enrichment using the Reactome Database identifying that in the elderly, the ability to respond to heme deficiency and the ATF4-dependent ability to respond to endoplasmic reticulum stress is significantly compromised. SOD3-based therapeutic strategies have provided beneficial results in treating lung disorders including fibrosis. The findings of this study propose the hypotheses that lung-specific delivery of SOD3/ATF4-related antioxidants will work in synergy with promising antiviral drugs such as remdesivir to further improve COVID-19 outcomes in the elderly.


title: A potential role for cyclophosphamide in the mitigation of acute respiratory distress syndrome among patients with SARS-CoV-2

text: While humanity struggles to develop a vaccine against SARS-CoV-2, it is imperative that effective and affordable therapeutic strategies be evolved. Since a majority of the SARS-CoV-2 deaths are due to acute respiratory distress syndrome (ARDS), a strategy to mitigate the same could save countless lives. Since SARS-CoV-2 related ARDS has a strong immunological component, many investigators are utilizing monoclonal antibodies against IL-6, TNF-alpha and CCR5. However, targeting a single cytokine with an expensive monoclonal antibody could be a less pragmatic approach. We propose the use of cyclophosphamide as an immunomodulator, given its proven role in various settings including autoimmune diseases, and in the post-haploidentical stem cell transplant. Cyclophosphamide could deplete cytotoxic and effector T cell populations while relatively sparing the regulatory T cells (Tregs). Cyclophosphamide could tip the balance away from the overtly pro-inflammatory and could be a less expensive and effective alternative to the currently investigated monoclonal antibodies.


title: Neurologically Devastating Intraparenchymal Hemorrhage in COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Case Series

text: BACKGROUND AND IMPORTANCE: Extracorporeal membrane oxygenation (ECMO) represents a life-saving therapy in cases of refractory hypoxia and has been utilized in patients suffering from the most severe forms of coronavirus disease 2019 (COVID-19). A strikingly high mortality rate of 94% was described in early reports of patients with COVID-19 transitioned to ECMO. Later case reports and series demonstrating successful recovery from COVID-19 after ECMO have revived interest in this therapeutic modality, including the recent approval of ECMO for COVID-19 patients by the Food and Drug Administration (FDA). Here, we present the first reports of devastating intracranial hemorrhage as a complication of veno-venous (VV) ECMO in two COVID-19 patients. CLINICAL PRESENTATION: We performed a retrospective analysis of 2 cases of devastating intracranial hemorrhage in patients on VV-ECMO for the treatment of COVID-19. Collected data included clinical history, laboratory results, treatment, and review of all available imaging. Both patients demonstrated activated partial thromboplastin times (aPTT) within an appropriate therapeutic range. No risk factors that clearly predicted likelihood of this complication were identified. CONCLUSION: Understanding the complications of ECMO in this cohort and developing therapeutic algorithms to aid in optimal patient selection will be critical in the limited resource setting experienced as a result of global pandemic. We propose the use of head computed tomography (CT) to identify devastating neurological complications as early as possible, aiding in the resource allocation of ECMO machines to the most appropriately selected patients.


title: IL-6: Relevance for immunopathology of SARS-CoV-2

text: COVID-19 mortality is strongly associated with the development of severe pneumonia and acute respiratory distress syndrome with the worst outcome resulting in cytokine release syndrome and multiorgan failure. It is becoming critically important to identify at the early stage of the infection those patients who are prone to develop the most adverse effects. Elevated systemic interleukin-6 levels in patients with COVID-19 are considered as a relevant parameter in predicting most severe course of disease and the need for intensive care. This review discusses the mechanisms by which IL-6 may possibly contribute to disease exacerbation and the potential of therapeutic approaches based on anti-IL-6 biologics.


title: Patients with interstitial lung disease and pulmonary sarcoidosis are at high risk for severe illness related to COVID-19

text: Analyses of COVID-19 patients with preexisting interstitial lung disease (ILD) or pulmonary sarcoidosis is lacking but registries are ongoing. Treatment of COVID-19 in patients with underlying ILD or sarcoidosis may include hospital admission, possible drug treatment, caution with steroids, and avoidance of mechanical ventilation in acute exacerbation of ILD. Patients with COVID-19 respiratory illness are at risk for developing ILD.


A local response to COVID-19 for advanced liver disease: Current model of care, challenges and opportunities


title: Neutralizing antibodies mediate virus-immune pathology of COVID-19

text: SARS-CoV-2 is a novel beta-coronavirus causing over 200.000 lethal cases within six months of first infecting humans. SARS-CoV-2 causes COVID-19, a form of severe acute respiratory syndrome (SARS). COVID-19 is characterized by two phases: the first resembles the flu with pneumonia, but after about seven or eight days the disease suddenly worsens to a sepsis-like syndrome. It is difficult to explain this virus-immune-pathology sequence from virology or immunology only. This paper hypothesizes that host-produced anti-spike protein antibodies are responsible for immune-induced viral dissemination. Subsequently, systemic distribution of virus-antibodies complexes activates the immune pathology observed in severe COVID-19. This hypothesis may be counterintuitive to immunologist that consider many anti-spike antibodies to be virus-neutralizing antibodies. Although anti-spike antibodies may hinder infection of epithelial cells, antibody binding to the spike protein may facilitate virus infection of myeloid leukocytes. If myeloid leukocytes reenter the circulation, they could spread the virus from a locoregional infection to a systemic disease. Disseminated virus in combination with antibodies results in dispersed virus-antibody complexes that overstimulate the immune system. The hypothesis aligns with the sequences of virus, immune and pathological events in COVID-19. The delay in onset from both syndromes results from an immune system still naïve to the non-cross-reactive spike protein. Details of this hypothesis are in concordance with many clinical characteristics of COVID-19, including its predominant lethality for the elderly, and the mostly asymptomatic course of disease in children. It predicts putative detrimental effects of vaccines that induce virus-neutralizing antibodies against the spike protein, as has been shown for other coronaviruses. This hypothesis has consequences for treatment of patients, evaluation of personal and herd immunity and vaccine development. In patients, cellular immunity should be stimulated. Neutralizing antibodies might not be indicative for immunity. Vaccines should aim to stimulate cellular immunity COVID-19 and/or stimulate humoral immunity against viral proteins except for the immunodominant spike protein.


Thrombotic and hemorrhagic events in critically ill COVID-19 patients: a French monocenter retrospective study


title: Does COVID19 Infect the Brain? If So, Smokers Might Be at a Higher Risk

text: COVID19 is a devastating global pandemic with epicenters in China, Italy, Spain, and now the United States. While the majority of infected cases appear mild, in some cases, individuals present serious cardiorespiratory complications with possible long-term lung damage. Infected individuals report a range of symptoms from headaches to shortness of breath to taste and smell loss. To that end, less is known about how the virus may impact different organ systems. The SARS-CoV2 virus, which is responsible for COVID19, is highly similar to SARS-CoV. Both viruses have evolved an ability to enter host cells through direct interaction with the angiotensin converting enzyme (ACE) 2 protein at the surface of many cells. Published findings indicate that SARS-CoV can enter the human nervous system with evidence from both postmortem brains and detection in cerebrospinal fluid of infected individuals. Here, we consider the ability of SARS-CoV2 to enter and infect the human nervous system based on the strong expression of the ACE2 target throughout the brain. Moreover, we predict that nicotine exposure through various kinds of smoking (cigarettes, electronic cigarettes, or vape) can increase the risk for COVID19 neuroinfection based on known functional interactions between the nicotinic receptor and ACE2. We advocate for higher surveillance and analysis of neurocomplications in infected cases. SIGNIFICANCE STATEMENT: The COVID19 epidemic has spurred a global public health crisis. While many of the cases requiring hospitalization and intensive medical care center on cardiorespiratory treatment, a growing number of cases present neurological symptoms. Viral entry into the brain now appears a strong possibility with deleterious consequences and an urgent need for addressing.


Emergency department infection control strategies in response to COVID-19


docid: hfvsdnri

title: COVID-19 response measures - a Singapore Neurosurgical Academic Medical Centre experience segregated team model to maintain tertiary level neurosurgical care during the COVID-19 outbreak

text: Aim: This article aims to inform and share the experience of a Singaporean tertiary level neurosurgical unit in an academic medical centre during the COVID-19 outbreak. Method: This is a descriptive study of our segregation team model which is designed with the aim of optimizing manpower and ensuring the safety and welfare of the neurosurgical unit, while maintaining and prioritizing excellent patient care. Result: We describe our method of team segregation, rostering, and outline some principles that we adhere to in its design. We also summarise the restructuring of our inpatient and outpatient service, including the operating theatre and protocols for specific procedures, intensive care and general wards, as well as clinic services and multidisciplinary meetings. Conclusion: We end with a commentary on residency training and anticipated challenges. Given the likely protracted course of the pandemic, it is key to account for sustainability of such measures and the conservation of resource via the reduction of pateint volume, upkeep of staff emotional and physical health and harnessing technologies such as telemedicine.


CT Is Not a Screening Tool for Coronavirus Disease (COVID-19) Pneumonia


title: Analysis of Epidemiological and Clinical features in older patients with Corona Virus Disease 2019 (COVID-19) out of Wuhan

text: BACKGROUND: The outbreak of COVID-19 has become a big threat to China, with high contagious capacity and varied mortality. This study aimed to investigate the epidemiological and clinical characteristics of older patients with COVID-19 out of Wuhan. METHODS: A retrospective study was performed, with collecting data from medical records of confirmed COVID-19 patients in Zhejiang province from Jan 17 to Feb 12, 2020. Epidemiological, clinical and treatment data were analyzed between those older (≥60y) and younger (<60y) patients. RESULTS: Total 788 patients with confirmed COVID-19 were selected, where 136 were older patients with corresponding age of 68.28y±7.314y. There was a significantly higher frequency of women in the older patients compared with the younger patients (57.35% vs 46.47%, P=0.021). The presence of coexisting medical condition was significantly higher in older patients compared with younger patients (55.15% vs 21.93%, P<0.001), including the rate of hypertension, diabetes, heart diseases and COPD. Significantly higher rates of severe (older vs younger groups: 16.18% vs 5.98%, P<0.001)/critical (8.82% vs 0.77%, P<0.001) type, shortness of breath (12.50% vs 3.07%, P<0.001) and high temperature of >39.0â (13.97% vs 7.21%, P=0.010) were observed in older patients compared with younger patients. Finally, Higher rates of ICU admission (9.56% vs 1.38%, P<0.001) and methylprednisolone application (28.68% vs 9.36%, P<0.001) were also identified in older patients. CONCLUSIONS: The specific epidemiological and clinical features of older COVID-19 patients included significantly higher female gender, body temperature, co-existing of basic diseases and rate of severe and critical type.


title: The Canadian Association for Interventional Radiology (CAIR) and Canadian Association of Radiologists (CAR) Guidelines for Interventional Radiology Procedures for Patients With Suspected or Confirmed COVID-19

text: The current coronavirus disease 2019 (COVID-19) pandemic is creating significant challenges to the Canadian health system, including the practice of interventional radiology (IR). Interventional radiology will continue to play an important role in patient care, during this crisis. This document serves to guide interventional and general radiologists in safely performing IR procedures on patients with suspected or confirmed COVID-19, using the best evidence, guidelines and expert recommendations available. These strategies include reviewing procedural indications, development of tactics to minimize cross contamination prior to the intervention, appropriate usage of personal protection equipment according to the type of procedure (along with defining aerosol-generating procedures in IR), along with developing the appropriate work environment during the COVID-19 pandemic. By adopting the policies described, hospitals will protect the interventional radiologists, medical radiation technologists, nurses, ancillary staff, along with patients who benefit from their care.


Visualization of putative coronavirus in kidney


title: Coronavirus research before 2020 is more relevant than ever, especially when interpreted for COVID-19

text: The speed with which biomedical researchers were able to identify and characterise COVID-19 was clearly due to prior research with other coronaviruses. Early epidemiological comparisons with two previous coronaviruses, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), also made it easier to predict COVID-19's likely spread and lethality. This article assesses whether academic interest in prior coronavirus research has translated into interest in the primary source material, using Mendeley reader counts for early academic impact evidence. The results confirm that SARS and MERS research 2008-2017 experienced anomalously high increases in Mendeley readers in April-May 2020. Nevertheless, studies learning COVID-19 lessons from SARS and MERS or using them as a benchmark for COVID-19 have generated much more academic interest than primary studies of SARS or MERS. Thus, research that interprets prior relevant research for new diseases when they are discovered seems to be particularly important to help researchers to understand its implications in the new context.


Going viral: how to boost the spread of coronavirus science on social media


Conquering COVID-19: How DDS Is CoVering the Pandemic


Clinical and histopathological study of skin dermatoses in patients affected by COVID-19 infection in the Northern part of Italy


Google Trends provides a tool to monitor population concerns and information needs during COVID-19 pandemic


Invasive pulmonary fusariosis in an immunocompetent critically ill patient with severe COVID-19


Potential Implications of COVID-19 for the 2020-2021 Residency Application Cycle


title: An in silico approach for identification of novel inhibitors as potential therapeutics targeting COVID-19 main protease

text: Respiratory disease caused by a novel coronavirus, COVID-19, has been labeled a pandemic by the World Health Organization. Very little is known about the infection mechanism for this virus. More importantly, there are no drugs or vaccines that can cure or prevent a person from getting COVID-19. In this study, the binding affinity of 2692 protease inhibitor compounds that are known in the protein data bank, are calculated against the main protease of the novel coronavirus with docking and molecular dynamics (MD). Both the docking and MD methods predict the macrocyclic tissue factor-factor VIIa (PubChem ID: 118098670) inhibitor to bind strongly with the main protease with a binding affinity of -10.6 and -10.0 kcal/mol, respectively. The TF-FVIIa inhibitors are known to prevent the coagulation of blood and have antiviral activity as shown in the case of SARS coronavirus. Two more inhibitors, phenyltriazolinones (PubChem ID: 104161460) and allosteric HCV NS5B polymerase thumb pocket 2 (PubChem ID: 163632044) have shown antiviral activity and also have high affinity towards the main protease of COVID-19. Furthermore, these inhibitors interact with the catalytic dyad in the active site of the COVID-19 main protease that is especially important in viral replication. The calculated theoretical dissociation constants of the proposed COVID-19 inhibitors are found to be very similar to the experimental dissociation constant values of similar protease-inhibitor systems.Communicated by Ramaswamy H. Sarma.


Melatonin Inhibits COVID-19-induced Cytokine Storm by Reversing Aerobic Glycolysis in Immune Cells: A Mechanistic Analysis


Epilepsy and COVID-19: Associations and important considerations


title: Varicella-like exanthem associated with COVID-19 in an 8-year-old girl: A diagnostic clue?

text: It has been reported that the novel coronavirus disease (COVID-19) may be associated with a papulovesicular skin eruption predominantly involving the trunk. We hereby present a case of COVID-19-associated varicella-like exanthem in an 8-year-old girl with mild systemic symptoms.


title: Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies

text: Data on pathologic changes of the 2019 novel coronavirus disease (COVID-19) are scarce. To gain knowledge about the pathology that may contribute to disease progression and fatality, we performed postmortem needle core biopsies of lung, liver, and heart in four patients who died of COVID-19 pneumonia. The patients' ages ranged from 59 to 81, including three males and one female. Each patient had at least one underlying disease, including immunocompromised status (chronic lymphocytic leukemia and renal transplantation) or other conditions (cirrhosis, hypertension, and diabetes). Time from disease onset to death ranged from 15 to 52 days. All patients had elevated white blood cell counts, with significant rise toward the end, and all had lymphocytopenia except for the patient with leukemia. Histologically, the main findings are in the lungs, including injury to the alveolar epithelial cells, hyaline membrane formation, and hyperplasia of type II pneumocytes, all components of diffuse alveolar damage. Consolidation by fibroblastic proliferation with extracellular matrix and fibrin forming clusters in airspaces is evident. In one patient, the consolidation consists of abundant intra-alveolar neutrophilic infiltration, consistent with superimposed bacterial bronchopneumonia. The liver exhibits mild lobular infiltration by small lymphocytes, and centrilobular sinusoidal dilation. Patchy necrosis is also seen. The heart shows only focal mild fibrosis and mild myocardial hypertrophy, changes likely related to the underlying conditions. In conclusion, the postmortem examinations show advanced diffuse alveolar damage, as well as superimposed bacterial pneumonia in some patients. Changes in the liver and heart are likely secondary or related to the underlying diseases.


docid: etqlqmmm

title: Clinical and laboratory findings from patients with COVID-19 pneumonia in Babol North of Iran: a retrospective cohort study

text: BACKGROUND: In December, 2019, China, has experienced an outbreak of novel coronavirus disease 2019 (COVID-19). Coronavirus has now spread to all of the continents. We aimed to consider clinical characteristics, laboratory data of COVID-19 that provided more information for the research of this novel virus. METHODS: We performed a retrospective cohort study on the clinical symptoms and laboratory findings of a series of the 100 confirmed patients with COVID-19. These patients were admitted to the hospitals affiliated to Babol University of Medical Sciences (Ayatollah Rohani, Shahid Beheshti and Yahyanejad hospitals) form 25 February 2020 to 12 March 2020. RESULTS: Nineteen patients died during hospitalization and 81 were discharged. Non-survivor patients had a significantly higher C-reactive protein (CRP) (MD: 46.37, 95% CI: 20.84, 71.90; P= 0.001), white blood cells (WBCs) (MD: 3.10, 95% CI: 1.53, 4.67; P< 0.001) and lower lymphocyte (MD: -8.75, 95% CI: -12.62, -4.87; P< 0.001) compared to survivor patients Data analysis showed that comorbid conditions (aRR: 2.99, 95%CI: 1.09, 8.21, P= 0.034), higher CRP levels (aRR: 1.02, 95%CI: 1.01, 1.03, P= 0.044), and lower lymphocyte (aRR: 0.82, 95%CI: 0.73, 0.93, P= 0.003) were associated with increased risk of death. CONCLUSIONS: Based on our findings, most non-survivors are elderly with comorbidities. Lymphopenia and increased levels of WBCs along with elevated CRP were associated with increased risk of death. Therefore, it is best to be regularly assessed these markers during treatment of COVID-19 patients.


title: [Epidemiology, Treatment, and Epidemic Prevention and Control of the Coronavirus Disease 2019: a Review]

text: This review summarizes the ongoing researches regarding etiology, epidemiology, transmission dynamics, treatment, and prevention and control strategies of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with comparison to severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and pandemic H1N1 virus. SARS-CoV-2 may be originated from bats, and the patients and asymptomatic carriers are the source of epidemic infection. The virus can be transmitted human-to-human through droplets and close contact, and people at all ages are susceptible to this virus. The main clinical symptoms of the patients are fever and cough, accompanied with leukocytopenia and lymphocytopenia. Effective drugs have been not yet available thus far. In terms of the prevention and control strategies, vaccine development as the primary prevention should be accelerated. Regarding the secondary prevention, ongoing efforts of the infected patients and close contacts quarantine, mask wearing promotion, regular disinfection in public places should be continued. Meanwhile, rapid detection kit for serological monitoring of the virus in general population is expected so as to achieve early detection, early diagnosis, early isolation and early treatment. In addition, public health education on this disease and prevention should be enhanced so as to mitigate panic and mobilize the public to jointly combat the epidemic.


title: Genetic diversity and evolution of SARS-CoV-2

text: COVID-19 is a viral respiratory illness caused by a new coronavirus called SARS-CoV-2. The World Health Organization declared the SARS-CoV-2 outbreak a global public health emergency. We performed genetic analyses of eighty-six complete or near-complete genomes of SARS-CoV-2 and revealed many mutations and deletions on coding and non-coding regions. These observations provided evidence of the genetic diversity and rapid evolution of this novel coronavirus.


docid: jzjsxksk

title: Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety?

text: According to cognitive-behavioral models, traits, triggering events, cognitions, and adverse behaviors play a pivotal role in the development and maintenance of health anxiety. During virus outbreaks, anxiety is widespread. However, the role of trait health anxiety, cyberchondria, and coping in the context of virus anxiety during the current COVID-19 pandemic has not yet been studied. An online survey was conducted in the German general population (N = 1615, 79.8 % female, Mage = 33.36 years, SD = 13.18) in mid-March 2020, which included questionnaires on anxiety associated with SARS-CoV-2, trait health anxiety, cyberchondriaPandemic (i.e. excessive online information search), and emotion regulation. The participants reported a significantly increasing virus anxiety in recent months (previous months recorded retrospectively), especially among individuals with heightened trait health anxiety. CyberchondriaPandemic showed positive correlations with current virus anxiety (r = .09-.48), and this relationship was additionally moderated by trait health anxiety. A negative correlation was found between the perception of being informed about the pandemic and the current virus anxiety (r=-.18), with adaptive emotion regulation being a significant moderator for this relationship. The findings suggest that trait health anxiety and cyberchondria serve as risk factors, whereas information about the pandemic and adaptive emotion regulation might represent buffering factors for anxiety during a virus pandemic.


title: COVID-19 and rhinology: A look at the future

text: The novel Coronavirus (COVID-19) has created a deadly pandemic that is now significantly impacting the United States. Otolaryngologists are considered high risk for contracting disease, as the virus resides in the nasal cavity, nasopharynx, and oropharynx. While valuable work has been publicized regarding several topics in Rhinology, we discuss other aspects of our specialty in further detail. There are several issues regarding Rhinologic practice that need to be clarified both for the current epidemic as well as for future expected "waves." In addition, as the pandemic dies down, guidelines are needed to optimize safe practices as we start seeing more patients again. These include protocols pertinent to safety, in-office Rhinologic procedures, the substitution of imaging for endoscopy, and understanding the appropriate role of telemedicine. We discuss these aspects of Rhinology as well as practical concerns relating to telemedicine and billing, as these issues take on increasing importance for Rhinologists both in the present and the future.


docid: osimybyj

title: Convalescent donor SARS-COV-2-specific cytotoxic T lymphocyte infusion as a possible treatment option for COVID-19 patients with severe disease has not received enough attention till date


Coronavirus close-up, faded star and orchestral operation - February's best science images


How might the NHS protect the mental health of health-care workers after the COVID-19 crisis?