title: TNFα inhibitor may be effective for severe COVID-19: learning from toxic epidermal necrolysis

text: Increased inflammatory cytokines [such as tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6)] are observed in COVID-19 patients, especially in the severe group. The phenomenon of a cytokine storm may be the central inducer of apoptosis of alveolar epithelial cells, which leads to rapid progression in severe group patients. Given the similarities of clinical features and pathogenesis between toxic epidermal necrolysis (TEN) and COVID-19, we hypothesize that the application of etanercept, an inhibitor of TNFα, could attenuate disease progression in severe group COVID-19 patients by suppressing systemic auto-inflammatory responses. The reviews of this paper are available via the supplemental material section.


Coronavirus and children


COVID-19 Severity Scoring Tool for low resourced settings


Airborne Spread of SARS-CoV-2 and a Potential Role for Air Disinfection


COVID-19 and ACE2 in the liver and gastrointestinal tract: Putative biological explanations of sexual dimorphism


How fossil fuel-derived pesticides and plastics harm health, biodiversity, and the climate


Clinical considerations for managing dermatology patients on systemic immunosuppressive or biologic therapy, or both, during the COVID-19 pandemic


docid: trmufqky

title: Pandemic Fatigue: Facing the Body's Inexorable Demands in the Time of COVID-19


Coronavirus


CCI 2020 CIT special issue


title: Are we all in this together? Longitudinal assessment of cumulative adversities by socioeconomic position in the first 3 weeks of lockdown in the UK

text: BACKGROUND: Despite media claims that coronavirus disease 2019 (COVID-19) is uniting societies and countries in shared experience, there has been concern that the pandemic is in fact exposing and widening existing inequalities within societies. Data have shown these differences for cases and fatalities, but data on other types of adversities are lacking. Therefore, this study explored the changing patterns of adversity relating to the COVID-19 pandemic by socioeconomic position (SEP) during the early weeks of lockdown in the UK. METHODS: Data were from 12 527 UK adults in the University College London COVID-19 Social Study (a panel study that involves online weekly data collection from participants during the COVID-19 pandemic). We analysed data collected from 25 March to 14 April 2020. The sample was well-stratified and weighted to population proportions of gender, age, ethnicity, education and country of living. We used Poisson and logit models to assess 10 different types of adverse experiences depending on an index of SEP over time. RESULTS: There was a clear gradient across the number of adverse events experienced each week by SEP. This was most clearly seen for adversities relating to finances (including loss of employment and cut in income) and basic needs (including access to food and medications) but less for experiences directly relating to the virus. Inequalities were maintained with no reductions in discrepancies between socioeconomic groups over time. CONCLUSIONS: There were clear inequalities in adverse experiences during the COVID-19 pandemic in the early weeks of lockdown in the UK. Results suggest that measures taken to try to reduce such adverse events did not go far enough in tackling inequality.


Remote Psychological First Aid (rPFA) in the time of Covid-19: A preliminary report of the Malaysian experience


title: Clinical interventions for severe and critical COVID-19: What are the options

text: The coronavirus disease 2019 (COVID-19) has been ongoing outbreak and declared as a global public health emergency by the World Health Organization Severe and critical COVID-19 has high fatality rate due to complications like acute respiratory distress syndrome, acute respiratory failure or multiple organ failure So far, there have been mounting research on the epidemiological and clinical characteristics of COVID-19 However, the information regarding treatment of severe and critical COVID-19 is limited The current study reviewed published evidence of clinical interventions of severe and critical COVID-19, aiming to provide an up-to-date reference for further clinical treatment


title: Are soft tissues of urban rats good indicators of exposure to heavy metal pollution? A study conducted in one of the most polluted basins of Buenos Aires, Argentina

text: The overall goal of this work was to analyze the relationship between the concentration of lead in the kidney, liver, and stomach contents of rats captured in a polluted urban basin and the concentration of this metal in the environment, meteorological factors, and different intrinsic characteristics of the individuals. To this end, we determined the concentration of lead in the kidney, liver, and stomach contents of 133 Norway rats (Rattus norvegicus) captured in the Matanza-Riachuelo River Basin (Buenos Aires, Argentina). This basin is one of the most severe cases of water pollution in Latin America and metals like lead represent the most common chemical pollutants. Rats were trapped in nine sites with different soil and water lead concentrations, between 2014 and 2015. A positive relationship was found between lead concentration in the liver and kidney of R. norvegicus and the environmental concentration of this metal in water and soil. Although the remaining variables analyzed were also related to the lead concentration in soft tissues, they did not affect the association between the lead concentration in soft tissues and that in the environment. The lead concentration in the stomach contents was not related to any of the variables analyzed. Our results constitute the first study in an urban basin with a gradient of environmental lead concentration and suggest that the quantification of lead in the kidney and liver of rats can be used as an indicator of exposure to this metal within a large city.


title: COVID-19 and Headache: A Primer for Trainees

text: OBJECTIVE: To summarize for the trainee audience the possible mechanisms of headache in patients with COVID-19 as well as to outline the impact of the pandemic on patients with headache disorders and headache medicine in clinical practice. BACKGROUND: COVID-19 is a global pandemic caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2, of which a large subset of patients features neurological symptoms, commonly headache. The virus is highly contagious and is, therefore, changing clinical practice by forcing limitations on in-person visits and procedural treatments, more quickly shifting toward the widespread adaptation of telemedicine services. DESIGN/RESULTS: We review what is currently known about the pathophysiology of COVID-19 and how it relates to possible mechanisms of headache, including indirect, potential direct, and secondary causes. Alternative options for the treatment of patients with headache disorders and the use of telemedicine are also explored. CONCLUSIONS: Limited information exists regarding the mechanisms and timing of headache in patients with COVID-19, though causes relate to plausible direct viral invasion of the nervous system as well as the cytokine release syndrome. Though headache care in the COVID-19 era requires alterations, the improved preventive treatment options now available and evidence for feasibility and safety of telemedicine well positions clinicians to take care of such patients, especially in the COVID-19 epicenter of New York City.


title: The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African Region: a predictive model

text: The spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been unprecedented in its speed and effects. Interruption of its transmission to prevent widespread community transmission is critical because its effects go beyond the number of COVID-19 cases and deaths and affect the health system capacity to provide other essential services. Highlighting the implications of such a situation, the predictions presented here are derived using a Markov chain model, with the transition states and country specific probabilities derived based on currently available knowledge. A risk of exposure, and vulnerability index are used to make the probabilities country specific. The results predict a high risk of exposure in states of small size, together with Algeria, South Africa and Cameroon. Nigeria will have the largest number of infections, followed by Algeria and South Africa. Mauritania would have the fewest cases, followed by Seychelles and Eritrea. Per capita, Mauritius, Seychelles and Equatorial Guinea would have the highest proportion of their population affected, while Niger, Mauritania and Chad would have the lowest. Of the World Health Organization's 1 billion population in Africa, 22% (16%-26%) will be infected in the first year, with 37 (29 - 44) million symptomatic cases and 150 078 (82 735-189 579) deaths. There will be an estimated 4.6 (3.6-5.5) million COVID-19 hospitalisations, of which 139 521 (81 876-167 044) would be severe cases requiring oxygen, and 89 043 (52 253-106 599) critical cases requiring breathing support. The needed mitigation measures would significantly strain health system capacities, particularly for secondary and tertiary services, while many cases may pass undetected in primary care facilities due to weak diagnostic capacity and non-specific symptoms. The effect of avoiding widespread and sustained community transmission of SARS-CoV-2 is significant, and most likely outweighs any costs of preventing such a scenario. Effective containment measures should be promoted in all countries to best manage the COVID-19 pandemic.


docid: bkhwiwnj

title: Hope in a global pandemic


More bricks in the wall against SARS-CoV-2 infection: involvement of Î³9Î´2 T cells


docid: irezeynr

title: Persistent severe acute respiratory syndrome coronavirus 2 detection after resolution of coronavirus disease 2019-associated symptoms/signs

text: There are limited data on the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in respiratory specimens after resolution of coronavirus disease 2019 (COVID-19)-associated symptoms/signs. We determined duration of SARS-CoV-2 virus shedding in symptomatic patients after remission of symptoms. We investigated the duration of SARS-CoV-2 RNA detection using real-time reverse transcriptase polymerase chain reaction for SARS-CoV-2 in nasopharyngeal/oropharyngeal swabs or sputum or saliva. Six patients were included in the final analysis. The median (range) duration of SARS-CoV-2 viral detection after hospitalization was 34 days (22 to 67). After resolution of symptoms/signs, SARS-CoV-2 RNA was detected for median (range) of 26 days (9 to 48). Among the six patients, one had persistent detection of SARS-CoV-2 RNA until day 67 of hospitalization, which was 30 days after symptom resolution. This case represents the longest duration of SARS-CoV-2 detection, and highlights the need for long-term follow up of COVID-19 patients despite resolution of symptoms to confirm SARS-CoV-2 clearance.


Management of mCRPC patients treated with 223Radium-dicloride in the scenario of the COVID-19 outbreak


title: Government Intervention, Risk Perception, and the Adoption of Protective Action Recommendations: Evidence from the COVID-19 Prevention and Control Experience of China

text: This study examines the relationships between government interventions, risk perception, and the public's adoption of protective action recommendations (PARs) during the COVID-19 coronavirus disease emergency in mainland China. We conducted quota sampling based on the proportion of the population in each province and gender ratios in the Sixth Census and obtained a sample size of 3837. Government intervention was divided into government communication, government prevention and control, and government rescue. We used multiple regression and a bootstrap mediation effect test to study the mechanism of these three forms of government intervention on the public's adoption of PARs. The results show that government prevention and control and government rescue significantly increased the likelihood of the public adopting PARs. Risk perception was significantly associated with the public's adoption of PARs. The effects of government interventions and risk perception on the public's adoption of PARs was not found to vary by region. Risk perception is identified as an important mediating factor between government intervention and the public's adoption of PARs. These results indicate that increasing the public's risk perception is an effective strategy for governments seeking to encourage the public to adopt PARs during the COVID-19 pandemic.


title: SARS-CoV-2 prevalence in an asymptomatic cancer cohort - results and consequences for clinical routine

text: BACKGROUND: Starting in December 2019, the current pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confronts the world with an unprecedented challenge. With no vaccine or drug being currently available to control the pandemic spread, prevention and PCR (Polymerase chain reaction) testing becomes a crucial pillar of medical systems. Aim of the present study was to report on the first results of the measures taken in a large German Department of Radiation Oncology, including PCR testing of asymptomatic cancer patients. METHODS: Pandemic-adapted hygiene regulations and prevention measures for patients and staff were implemented. A visiting ban on both wards was implemented from the beginning and medical staff and patients were required to wear face masks at all times. The waiting rooms were rearranged to ensure distance between patients of at least 1.5 m. Clinical follow up was mainly done by telephone and all patients had to complete a questionnaire regarding symptoms and contacts with COVID-19 patients before entering our department. Educational documents were created for patients to raise awareness of symptoms and avoidance strategies for interactions with other people. Indications for therapy and fractionation schemes were adapted when possible. In a subsequent step, all new asymptomatic patients were tested via nasopharyngeal swab at our screening station shortly before their simulation CT. RESULTS: All these measures and implementations have been well accepted semiquantitatively measured by the consent received from patients and staff. Regarding the PCR testing, only 1 out of 139 asymptomatic patients of our cohort so far tested positive for SARS-CoV-2, reflecting a prevalence of 0.72% in this cancer patient population. Up to this point no staff members was tested positive. The start of the treatment for the PCR-positive patient was deferred for 2 weeks. CONCLUSION: Due to the pandemic-adapted implementations, our department seems well prepared during this crisis. The initial screening helps to identify asymptomatic COVID-19 patients in order to protect other patients and our staff from infection and the observed PCR prevalence is in line with comparable studies. A regular PCR testing (e.g. twice a week) of all patients and staff would in principle be desirable but is limited due to testing capacities at present.


title: A Multimodal Multi-Institutional Solution to Remote Medical Student Education for Otolaryngology During COVID-19

text: During the coronavirus 2019 pandemic, there has been a surge in production of remote learning materials for continued otolaryngology resident education. Medical students traditionally rely on elective and away subinternship experiences for exposure to the specialty. Delays and cancellation of clinical rotations have forced medical students to pursue opportunities outside of the traditional learning paradigm. In this commentary, we discuss the multi-institutional development of a robust syllabus for medical students using a multimodal collection of resources. Medical students collaborated with faculty and residents from 2 major academic centers to identify essential otolaryngology topics. High-quality, publicly available, and open-access content from multiple sources were incorporated into a curriculum that appeals to a variety of learners. Multimodal remote education strategies can be used as a foundation for further innovation aimed at developing tomorrow's otolaryngologists.


COVID-19 research: promising tracks leading to uro-oncology


title: Development and validation of the HNC-LL score for predicting the severity of coronavirus disease 2019

text: BACKGROUND: Information regarding risk factors associated with severe coronavirus disease (COVID-19) is limited. This study aimed to develop a model for predicting COVID-19 severity. METHODS: Overall, 690 patients with confirmed COVID-19 were recruited between 1 January and 18 March 2020 from hospitals in Honghu and Nanchang; finally, 442 patients were assessed. Data were categorised into the training and test sets to develop and validate the model, respectively. FINDINGS: A predictive HNC-LL (Hypertension, Neutrophil count, C-reactive protein, Lymphocyte count, Lactate dehydrogenase) score was established using multivariate logistic regression analysis. The HNC-LL score accurately predicted disease severity in the Honghu training cohort (area under the curve [AUC]=0.861, 95% confidence interval [CI]: 0.800-0.922; P<0.001); Honghu internal validation cohort (AUC=0.871, 95% CI: 0.769-0.972; P<0.001); and Nanchang external validation cohort (AUC=0.826, 95% CI: 0.746-0.907; P<0.001) and outperformed other models, including CURB-65 (confusion, uraemia, respiratory rate, BP, age ≥65 years) score model, MuLBSTA (multilobular infiltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hypertension, and age) score model, and neutrophil-to-lymphocyte ratio model. The clinical significance of HNC-LL in accurately predicting the risk of future development of severe COVID-19 was confirmed. INTERPRETATION: We developed an accurate tool for predicting disease severity among COVID-19 patients. This model can potentially be used to identify patients at risks of developing severe disease in the early stage and therefore guide treatment decisions. FUNDING: This work was supported by the National Nature Science Foundation of China (grant no. 81972897) and Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme (2015).


Novel Coronavirus-Induced NLRP3 Inflammasome Activation: A Potential Drug Target in the Treatment of COVID-19


Telehealth monitoring for hypertrophic cardiomyopathy and amyloid cardiomyopathy patients: lessons from the coronavirus disease 2019 lockdown in Italy


title: Geospatial Hotspots Need Point-of-Care Strategies to Stop Highly Infectious Outbreaks: Ebola and Coronavirus

text: Context. Point-of-care testing (POCT), diagnostic testing at or near the site of patient care, is inherently spatial, that is, performed at points of need, and also intrinsically temporal, because it produces fast actionable results. Outbreaks generate geospatial "hotspots." POC strategies help control hotspots, detect spread, and speed treatment of highly infectious diseases. Objectives. To stop outbreaks, accelerate detection, facilitate emergency response for epidemics, mobilize public health practitioners, enhance community resilience, and improve crisis standards of care. Data Sources. PubMed, WWW, newsprint, others were searched until COVID-19 was declared a pandemic, the US, a national emergency, and Europe, the epicenter. Coverage comprised interviews in Asia, email to/from Wuhan, papers, articles, chapters, documents, maps, flowcharts, schematics, and geospatial-associated concepts. EndNote X9.1 (Clarivate Analytics) consolidated literature as abstracts, ULRs, and PDFs, recovering 136 hotspot articles. More than 500 geospatial science articles were assessed for relevance to point-of-care testing. Conclusions POCT can interrupt spirals of dysfunction and delay by enhancing disease detection, decision making, contagion containment, and safe spacing, thereby softening outbreak surges and diminishing risk before human, economic, and cultural losses mount. Point-of-care tests results identify where infected individuals spread COVID-19, when delays cause death, and how to deploy resources. Results in national cloud databases help optimize outbreak control, mitigation, emergency response, and community resilience. The COVID-19 pandemic demonstrates unequivocally that governments must support POCT and multidisciplinary healthcare personnel must learn its principles, then adopt POC geospatial strategies, so that onsite diagnostic testing can ramp up to meet needs in times of crisis.


title: Revisiting conservative orthopaedic management of fractures during COVID-19 pandemic

text: COVID-19 pandemic has brought the need to revisit the conservative management of orthopaedic injuries back into sharp focus. On the advent of COVID-19 pandemic, it has been acknowledged by the British Orthopaedic Association (BOA) emergency COVID-19 and the National Health Service England (NHSE) guidelines to manage urgent orthopaedic and trauma conditions pragmatically balancing optimum treatment of patients against clinical safety with resource utilization .The current Coronavirus outbreak has refocussed orthopaedic minds on managing many injuries conservatively, which would have otherwise been managed with operative fixations. We revisit the role of conservative orthopaedic management of fractures in the context of COVID-19 and current guidelines.


A plea for unification of surgical guidelines in the COVID-19 outbreak


title: A COVID-19-betegek, tünetmentes hordozók, illetve a betegségen már átesettek periodikus monitorizálási lehetosége IgM/IgG antitest alapú gyorstesztekkel az egészségügyi személyzet körében a SARS-CoV-2-járvány idején./ Opportunity of periodic monitoring of COVID-19 patients, asymptomatic virus carriers, and postinfectious individuals with IgM/IgG rapid antibody tests among healthcare workers during SARS-CoV-2 pandemic

text: The first Hungarian COVID-19 case was reported on March 4, 2020 by Hungarian officials. Healthcare workers (HCWs) are at the highest risk of contracting the novel coronavirus (SARS-CoV-2), with 12% of total coronavirus cases confirmed among them recently. 80% of the infected persons show only mild, moderate symptoms or stay asymptomatic. The single-stranded viral RNA can be detected by RT-PCR from the respiratory tract, urine, blood and, particulary in children, from stool samples for 30-40 days. We have no valid data of how many HCWs have been infected since the Hungarian SARS-CoV-2 outbreak, due to the lack of the systematic screening. HCWs could play a critical role in transmission and might jeopardize the health of both their patients and their own family members. Both cross-sectional and longitudinal sudies are recommended to evaluate the ratio of the recovered, i.e., "already protected", the ones in the acute phase, i.e., "the infectious", and the virus-naive, i.e., "at risk" workers. Of the available molecular diagnostic options, in addition to RT-PCR it would be advisable to introduce the novel rapid antibody tests which can give quick results, reveal the timeline of the infection, are easy to handle, inexpensive and can be used periodically to monitor HCWs' viral status during the still unkown duration of the SARS-CoV-2 pandemic. Orv Hetil. 2020; 161(21): 854-860.


Pulmonary embolism in coronavirus disease-19 (COVID-19) and use of compression ultrasonography in its optimal management


Ethics and governance for digital disease surveillance


docid: rsmfpaes

title: Comment on "Colchicine may not be effective in COVID-19 infection; it may even be harmful?"


A call for a global COVID-19 Neuro Research Coalition


title: OUTBREAK: A user-friendly georeferencing online tool for disease surveillance

text: The current COVID-19 pandemic has already claimed more than 100,000 victims and it will cause more deaths in the coming months. Tools that can track the number and locations of cases are critical for surveillance and can help in making policy decisions for controlling the outbreak. The current surveillance web-based dashboards run on proprietary platforms, which are often expensive and require specific computational knowledge. We present a new tool (OUTBREAK) for studying and visualizing epidemiological data. It permits even non-specialist users to input data most conveniently and track outbreaks in real-time. This tool has the potential to guide and help health authorities to intervene and minimize the effects of the outbreaks. It is freely available at http://outbreak.sysbio.tools/.


title: Real-world Treatment Patterns and Outcomes in Non-Transplant Newly Diagnosed Multiple Myeloma in France, Germany, Italy, and the United Kingdom

text: OBJECTIVES: The treatment paradigm in newly diagnosed multiple myeloma (NDMM) is evolving towards individualized, risk-directed and longer duration of therapy (DOT). The objective of this study was to describe treatment patterns and outcomes in non-transplant NDMM in four European countries. METHODS: This retrospective chart review included adults with NDMM diagnosed between January 1, 2012 and December 31, 2013 (early cohort) or April 1, 2016 and March 31, 2017 (recent cohort). RESULTS: Among 836 patients, molecular testing was performed in 21% and 35% patients of early vs. recent cohorts; proteasome inhibitor (PI)/alkylator combinations were the principal first-line (1L) therapy (39% vs. 43%). Use of immunomodulatory drug (IMID)/alkylator combinations declined from early to recent cohort (26% vs. 13%) but IMID (7% vs. 16%) use increased. Few patients (5%) received 1L maintenance therapy. Two-thirds of patients were treated with a fixed duration intent, with a median 7-month 1L DOT and progression-free survival (PFS) of 32.8 months in the early cohort. Both 1L DOT and PFS were longer with oral compared to injectable regimens. CONCLUSIONS: Although frontline treatment patterns changed significantly, 1L DOT is short. The uptake of molecular testing and 1L maintenance is low. These results highlight areas of unmet need in NDMM.


title: Fatal Eosinophilic Myocarditis in a Healthy 17-Year-Old Male with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2c)

text: Background: Cardiac damage is frequently referred to in patients with SARS-CoV-2, is usually diagnosed by enzyme elevations, and is generally thought to be due to underlying coronary artery disease. There are references to cardiomyopathies accompanying coronavirus, but there has been no histologic confirmation.Case report: A previously healthy 17 year male old presented in full cardiac arrest to the emergency department after a 2 day history of headache, dizziness, nausea and vomiting. Autopsy demonstrated an enlarged flabby heart with eosinophilic myocarditis. There was no interstitial pneumonia or diffuse alveolar damage. Postmortem nasopharyngeal swabs detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) known to cause coronavirus disease 2019 (COVID-19). No other cause for the eosinophilic myocarditis was elucidated.Conclusion: Like other viruses, SARS-CoV-2 may be associated with fulminant myocarditis.


docid: viahyetk

title: Unknown Unknowns: Surgical Consent during the COVID-19 Pandemic


title: Metformin and SARS-CoV-2: mechanistic lessons on air pollution to weather the cytokine/thrombotic storm in COVID-19

text: Pathological signaling in the lung induced by particulate matter (PM) air pollution partially overlaps with that provoked by COVID-19, the pandemic disease caused by infection with the novel coronavirus SARS-CoV-2. Metformin is capable of suppressing one of the molecular triggers of the proinflammatory and prothrombotic processes of urban PM air pollution, namely the mitochondrial ROS/Ca2+ release-activated Ca2+ channels (CRAC)/IL-6 cascade. Given the linkage between mitochondrial functionality, ion channels, and inflamm-aging, the ability of metformin to target mitochondrial electron transport and prevent ROS/CRAC-mediated IL-6 release might illuminate new therapeutic avenues to quell the raging of the cytokine and thrombotic-like storms that are the leading causes of COVID-19 morbidity and mortality in older people. The incorporation of infection rates, severity and lethality of SARS-CoV-2 infections as new outcomes of metformin usage in elderly populations at risk of developing severe COVID-19, together with the assessment of bronchial/serological titers of inflammatory cytokines and D-dimers, could provide a novel mechanistic basis for the consideration of metformin as a therapeutic strategy against the inflammatory and thrombotic states underlying the gerolavic traits of SARS-CoV-2 infection.


title: Perioperative care of the newborns with CHDs in the time of COVID-19

text: Coronavirus disease 2019 (COVID-19), caused by a novel betacoronavirus (SARS-CoV-2), has led to an unexpected outbreak affecting people of all ages. The first data showed that COVID-19 could cause severe pulmonary disease, cardiac injury, and death in adults, especially the elderly and those with concomitant diseases. Currently, it was demonstrated that severe COVID-19 may also develop in neonatal age, although rarely. Newborns with CHD are known to be at high risk for increased morbidity from viral lower respiratory tract infections because of underlying anatomical cardiac lesions. There are limited data on the implications of COVID-19 on patients with cardiovascular disease, especially for those with CHD. Herein, we aimed to summarise the COVID-19-specific perioperative management issues for newborns with CHD by combining available data from the perspectives of neonatology and paediatric cardiovascular surgery.


title: Evaluate severe acute respiratory syndrome coronavirus 2 infectivity by pseudoviral particles

text: Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in humans in late 2019, it has rapidly spread worldwide. To identify the biological characteristics of SARS-CoV-2 in a normal laboratory environment (biosafety level 2 [BSL-2]), a lentiviral-based nucleocapsid was used to carry the spike protein of SARS-CoV-2 onto the surface of pseudoviral particles as a surrogate model to evaluate the infective characterization of SARS-CoV-2. This study indicated that SARS-CoV-2 has extensive tissue tropism for humans and may infect monkeys and tree shrews but not rodents. More importantly, the use of pseudoviral particles in this study allows rapid assessment of neutralizing antibodies in serum in a BSL-2 laboratory. This study will provide a quick and easy tool for evaluating neutralizing antibodies in the serum of recovering patients and assessing the potency of candidate vaccines.


Breastfeeding, Human Milk Collection and Containers, and Human Milk Banking: Hot Topics During the COVID-19 Pandemic


title: Hidroxicloroquina. Mensajes desde la cardiología en tiempos de pandemia por coronavirus./ [Hydroxychloroquine. Cardiology's viewpoint in times of coronavirus pandemic]

text: Due to the coronavirus disease 2019 (COVID-19) pandemic, a wide number of compounds are under scrutiny regarding their antiviral activity, one of them being hydroxychloroquine. Cardiac aspects of the use of chloroquine and hydroxychloroquine are reviewed in this manuscript. A non-systematic review of the medical literature was performed. Information about their safety and efficacy as antimalarials, antivirals, as well as in the long-term treatment of rheumatic diseases was collected. We found an anti-inflammatory effect with reduction of longterm cardiovascular events, a very infrequent heart disease due to a lysosomal effect of the drug, and at the hemodynamic level hypotension, tachycardia, and QT interval prolongation, exacerbated when combined with azithromycin. However, the rate of adverse cardiac events of hydroxychloroquine (and chloroquine) was low.


Perplexité d'un virologue retraité face au SARS-CoV-2./ Perplexity of a retired virologist facing at SARS-CoV-2


title: Impact of immune enhancement on Covid-19 polyclonal hyperimmune globulin therapy and vaccine development

text: The pandemic spread of a novel coronavirus - SARS coronavirus-2 (SARS-CoV-2) as a cause of acute respiratory illness, named Covid-19, is placing the healthcare systems of many countries under unprecedented stress. Global economies are also spiraling towards a recession in fear of this new life-threatening disease. Vaccines that prevent SARS-CoV-2 infection and therapeutics that reduces the risk of severe Covid-19 are thus urgently needed. A rapid method to derive antiviral treatment for Covid-19 is the use of convalescent plasma derived hyperimmune globulin. However, both hyperimmune globulin and vaccine development face a common hurdle - the risk of antibody-mediated disease enhancement. The goal of this review is to examine the body of evidence supporting the hypothesis of immune enhancement that could be pertinent to Covid-19. We also discuss how this risk could be mitigated so that both hyperimmune globulin and vaccines could be rapidly translated to overcome the current global health crisis.


title: Systematic review and meta-analysis of treating meibomian gland dysfunction with azithromycin

text: To systematically review studies of managing meibomian gland dysfunction (MGD) with azithromycin and pool clinical outcomes to show its effectiveness. Eligible studies were retrieved from five main electronic databases. Symptom score was the primary outcome, while clinical signs and objective measurements were secondary outcomes. Pooled rates for adverse events were also calculated. Improvements in each outcome after administering either oral azithromycin (OA) or topical azithromycin (TA) were pooled and measured by standard mean difference (SMD) to show the overall effectiveness. Then the effectiveness was sub-grouped by TA and OA. In addition, pooled outcomes after administering TA and oral doxycycline (OD) were compared with assess their effectiveness. Finally, 18 eligible studies were included. The overall pooled symptom scores were significantly reduced after administering both TA and OA [P < 0.0001; SMD = 1.54 (95% CI: 1.15-1.92)]. Similarly, the overall combined eyelid signs, plugging of the meibomian gland, meibum quality, and tear secretion were also distinctly improved. However, significant improvements for tear break-up time (TBUT) and corneal staining (CS) were achieved by TA (TBUT: P = 0.02; CS: P = 0.02) but not by OA (TBUT: P = 0.08; CS: P = 0.14). The pooled adverse event rates for TA and OA were 25% and 7%, respectively. Moreover, TA was comparable to OD to treat MGD regarding symptom score, TBUT and tear secretion. This study showed that MGD could be treated effectively with oral or topical azithromycin by improving symptoms, clinical signs, and stabilization of tear film. Topical azithromycin seemed to be superior over oral azithromycin or doxycycline in improving the quality of tear film in the short term.


docid: wufgmico

title: Non-COVID-19 general practice and our response to the pandemic


title: Remote Methods for Conducting Tobacco-Focused Clinical Trials

text: Most tobacco-focused clinical trials are based on locally-conducted studies that face significant challenges to implementation and successful execution. These challenges include the need for large, diverse, yet still representative study samples. This often means a protracted, costly, and inefficient recruitment process. Multi-site clinical trials can overcome some of these hurdles but incur their own unique challenges. With recent advances in mobile health (mHealth) and digital technologies, there is now a promising alternative: Remote Trials. These trials are led and coordinated by a local investigative team, but are based remotely, within a given community, state, or even nation. The remote approach affords many of the benefits of multi-site trials (more efficient recruitment of larger study samples) without the same barriers (cost, multi-site management, regulatory hurdles). The Coronavirus Disease 2019 (COVID-19) global health pandemic has resulted in rapid requirements to shift ongoing clinical trials to remote delivery and assessment platforms, making methods for the conduct of remote trials even more timely. The purpose of the present manuscript it to provide an overview of available methods for the conduct of remote tobacco-focused clinical trials as well as illustrative examples of how these methods have been implemented across recently completed and ongoing tobacco studies. We focus on key aspects of the clinical trial pipeline including remote: 1) study recruitment and screening, 2) informed consent, 3) assessment, 4) biomarker collection, and 5) medication adherence monitoring.


docid: imivtyuv

title: Why Is Modeling COVID-19 So Difficult?


title: [Laboratory testing techniques for SARS-CoV-2]

text: The ongoing epidemic of caused by the coronavirus SARS-CoV-2 starting in December 2019 poses a serious public health threat globally. The virus is highly infectious and transmitted mainly through droplets and contacts, and is associated with a high risk of pneumonia. A small number of patients may present with acute respiratory distress syndrome with severe respiratory complications, which can lead even to death. The selection of appropriate detection techniques and methods for accurate and rapid identification of pathogens therefore plays a key role in improving the diagnosis and treatment of the patients and containing the outbreak. In this review, the authors gives an overview of the virus laboratory detection technology, including virus isolation and culture, real-time fluorescent PCR, gene sequencing, serological antibody detection, and the gene editing technology based on CRISPR/Cas13 system. These techniques are expected to provide valuable assistance in controlling the epidemic and new ideas for future researches.


Trauma and orthopaedics in the COVID-19 pandemic: breaking every wave


title: Patients' Perceptions on Surgical Care Suspension for Pelvic Floor Disorders During the COVID-19 Pandemic

text: OBJECTIVES: The primary objective of the study was to evaluate patients' attitudes toward the postponement of their scheduled procedures for pelvic floor disorders (PFD) because of the COVID-19 pandemic. Secondary objectives were to identify patients who were upset with the postponement of their PFD procedures and to identify factors that are associated with being upset because of the delay in care. METHODS: This was a cross-sectional, survey-based study of women from a single urban, academic practice using a novel questionnaire. The study cohort included women whose PFD surgeries or office procedures were postponed between March 17 and April 30, 2020. RESULTS: Ninety-eight women had surgeries postponed; 68 (70%) responded to our questionnaire. Nearly half of the respondents (32/68, 47.1%) were upset about their procedures being postponed. Upset patients reported a greater impact of PFD symptoms on their mood than those who were not upset (P = 0.002). Those who were upset were also more likely to report feelings of isolation (P = 0.006), fear that their PFD would worsen because of delayed care (P < 0.001), and anxiety over surgery postponement (P < 0.001) than those who were not upset about the delays. When controlling for anxiety, social isolation, and impact of PFD symptom, anxiety (adjusted odds ratio = 15.7; 95% confidence interval = 3.7-66.6) and feeling of isolation (adjusted odds ratio = 9.7; 95% confidence interval = 1.5-63.7) remained associated with increased odds of being upset because of procedure delays. CONCLUSIONS: Half of women whose pelvic reconstructive procedures were postponed because of the COVID-19 pandemic were upset because of the delay in care, especially those who are emotionally and socially vulnerable during the COVID-19 pandemic.


title: Strong correlations between power-law growth of COVID-19 in four continents and the inefficiency of soft quarantine strategies

text: In this work, we analyze the growth of the cumulative number of confirmed infected cases by a novel coronavirus (COVID-19) until March 27, 2020, from countries of Asia, Europe, North America, and South America. Our results show that (i) power-law growth is observed in all countries; (ii) by using the distance correlation, the power-law curves between countries are statistically highly correlated, suggesting the universality of such curves around the world; and (iii) soft quarantine strategies are inefficient to flatten the growth curves. Furthermore, we present a model and strategies that allow the government to reach the flattening of the power-law curves. We found that besides the social distancing of individuals, of well known relevance, the strategy of identifying and isolating infected individuals in a large daily rate can help to flatten the power-laws. These are the essential strategies followed in the Republic of Korea. The high correlation between the power-law curves of different countries strongly indicates that the government containment measures can be applied with success around the whole world. These measures are scathing and to be applied as soon as possible.


title: Antiviral effects of probiotic metabolites on COVID-19

text: SARS coronavirus (COVID-19) is a real health challenge of the 21st century for scientists, health workers, politicians, and all humans that has severe cause epidemic worldwide. The virus exerts its pathogenic activity through by mechanism and gains the entry via spike proteins (S) and Angiotensin-Converting Enzyme 2 (ACE2) receptor proteins on host cells. The present work is an effort for a computational target to block the residual binding protein (RBP) on spike proteins (S), Angiotensin-Converting Enzyme 2 (ACE2) receptor proteins by probiotics namely Plantaricin BN, Plantaricin JLA-9, Plantaricin W, Plantaricin D along with RNA-dependent RNA polymerase (RdRp). Docking studies were designed in order to obtain the binding energies for Plantaricin metabolites. The binding energies for Plantaricin W were -14.64, -11.1 and -12.68 for polymerase, RBD and ACE2 respectively comparatively very high with other compounds. Plantaricin W, D, and JLA-9 were able to block the residues (THR556, ALA558) surrounding the deep grove catalytic site (VAL557) of RdRp making them more therapeutically active for COVID-19. Molecular dynamics studies further strengthen stability of the complexes of plantaricin w and SARS-CoV-2 RdRp enzyme, RBD of spike protein, and human ACE2 receptor. The present study present multi-way options either by blocking RBD on S proteins or interaction of S protein with ACE2 receptor proteins or inhibiting RdRp to counter any effect of COVID-19 by Plantaricin molecules paving a way that can be useful in the treatment of COVID-19 until some better option will be available.Communicated by Ramaswamy H. Sarma.


title: Leaning In to Serious Illness Care Through Stories and Science

text: This volume was planned prior to the COVID-19 pandemic as the North Carolina Institute of Medicine (NCIOM) completed a yearlong task force on serious illness. Beyond the task force report, we wanted to dedicate a special edition of the NCMJ to serious illness issues. We commissioned authors who could discuss the challenges, the current practices, and the extensive personal and professional skills needed to navigate these complicated medical diagnoses that often end in death. Little did we know how timely this would be in light of the current pandemic, and we can only speculate on how the world will look as this is published. Our pre-COVID planning reflected personal experiences we all face with the common denominator of serious illness impacting and shaping our lives. As guest editors, we considered how this NCMJ edition would address personal concerns for you, our reader, as well as ourselves. A physician, a social worker, and a nurse, we each have our stories and we want to invite you to lean in and bring both your head and your heart to this reading. We start by relating two very personal experiences that shaped not only life following loss, but also career choices, clinical practices, and scholarship. As you focus on this journal's content, we hope you will also reflect on the people you care for, as well as the issues we all inevitably face.


Mortality and psychological stress in pregnant and postnatal women during COVID-19 outbreak in West Sumatra, Indonesia


Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?


docid: fnbuagwg

title: A case report of serious haemolysis in a glucose-6-phosphate dehydrogenase-deficient COVID-19 patient receiving hydroxychloroquine

text: While the COVID-19 epidemic occurred since December 2019, as of end April 2020, no treatment has been validated or invalidated by accurate clinical trials. Use of hydroxychloroquine has been popularised on mass media and put forward as a valid treatment option without strong evidence of efficacy. Hydroxychloroquine (HCQ) has its own side effects, some of which are very serious like acute haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient patients. Side effects may be worse than the disease itself. Belgian national treatment guidelines recommend the use of HCQ in mild to severe COVID-19 disease. As opinions, politics, media and beliefs are governing COVID-19 therapy, performance of randomised controlled blinded clinical trials became difficult. Results of sound clinical trials are eagerly awaited. We report a case of acute haemolysis leading to admission in intensive care unit and renal failure in a patient with uncovered G6PD deficiency.


Cardiology practice in the COVID-19 era


How poorer countries are scrambling to prevent a coronavirus disaster


title: Addressing caregiver moral distress during the COVID-19 pandemic

text: Moral distress is the psychological distress that is experienced in relation to a morally challenging situation or event. Although it was first observed within nursing, caregivers across all disciplines-including physicians, respiratory therapists, social workers and chaplains-experience moral distress. In this consult, we discuss 5 types of moral distress using examples of changes to clinical practice that have occurred due to COVID-19. We also provide suggestions for responding to moral distress and outline the resources available at Cleveland Clinic.


Schwartz rounds for healthcare personnel in coping with COVID-19 pandemic


Experiencia desde el punto de vista de un traumatólogo en el Hospital COVID-IFEMA en Madrid durante la pandemia del coronavirus en España./ Experiencia desde el punto de vista de un traumatólogo en el Hospital COVID-IFEMA en Madrid durante la pandemia del coronavirus en España./ An orthopaedic surgeon's experience at COVID-IFEMA Hospital during coronavirus pandemic in Spain


title: Implementatie van een stoppen-met-rokenprogramma in een psychiatrisch ziekenhuis: eerste resultaten./ [Implementation of a stop-smoking support program for patients and employees in a psychiatric hospital: First results]

text:
BACKGROUND: In contrast to several other countries, smoking is not an integral part of treatment during admission to a psychiatric hospital in The Netherlands.
 AIM: Implementation of a smoking cessation program for patients and employees of a psychiatric ward of an academic medical center in The Netherlands.
 METHOD: Prospective, mixed-method study of implementation of a smoking cessation program for patients and employees of a psychiatric academic hospital in Amsterdam. The program consisted of 7 weekly group meetings by certified smoking cessation coaches. Nicotine replacement therapy was provided for free, if necessary.
 RESULTS: During 14 months, 65 individuals were seeking help to stop smoking: 39 patients and 26 employees. Of these, 29 patients and 16 employees participated in group meetings with an average of 2.6 times per person. There were 20 individuals who visited the group meetings or received individual coaching at least 3 times (6 patients and 14 employees). Fifty-five percent of these individuals reported to be smoke-free at 3 months after joining the first meeting. Employees were much more likely to quit than patients. From interviews with 20 participants, it was noticed that combining patients and employees in one group was perceived as a barrier due to a gap in processing speed.
 CONCLUSION: On the psychiatric ward of an academic hospital in The Netherlands, there was a positive experience with providing smoking cessation treatment. A small number of employees and patients participated in a smoking cessation program and quitting smoking was reached by only a few patients. Supporting smoking cessation in a psychiatric hospital asks for intensive screening, diagnosing, treatment and smoke-free policies.


El tratamiento de la pandemia por COVID 19. Ante la expectativa de evitar una oportunidad perdida./ [Treatment of the COVID-19 pandemic: Preventing a missed opportunity]


title: Digital Technologies-Enabled Smart Manufacturing and Industry 4.0 in the Post-COVID-19 Era: Lessons Learnt from a Pandemic

text: The "Severe Acute Respiratory Syndrome Coronavirus Type 2" (SARS-CoV-2) has been identified as the infectious agent responsible for the generally mild but sometimes life-threatening communicable disease known as "Coronavirus Disease 2019" (COVID-19) [...].


Poor outcome of intestinal ischemic manifestations of COVID 19


title: Public Health Academic Alliance for COVID-19 Response: The Role of a National Medical Task Force in Puerto Rico

text: Alliances between the government and academic communities can be a key component of the public health response to an emergency such as the coronavirus disease 2019 (COVID-19) pandemic. The Governor of Puerto Rico designated the Puerto Rico Medical Task Force (MTF) COVID-19 to provide direct guidance and evaluation of the government response to the epidemic in Puerto Rico. Several work groups were formed within the MTF to create protocols and provide evidence-based recommendations on different public health aspects. The collaboration between the academia and the government enhanced the Puerto Rican public health response and contributed to the reduction seen in the contagion curve. Healthcare services and hospitals have not reached their maximum patient care capacity and the death toll has been controlled. Incorporating a national MTF with members of the academia into the government structure was beneficial during the COVID-19 response in Puerto Rico. A similar strategy could serve as a model for other states or territories and countries in similar scenarios.


Is molecular mimicry the culprit in the autoimmune haemolytic anaemia affecting patients with COVID-19?


Occupational skin conditions on the front line: a survey among 484 Chinese healthcare professionals caring for Covid-19 patients


El reto de una unidad de cuidados intensivos en un recinto ferial./ El reto de una unidad de cuidados intensivos en un recinto ferial./ The challenge of an intensive care unit in a fairground


Anatomy of a response


title: Acute kidney injury in pregnant women following SARS-CoV-2 infection: A case report from Iran

text: We reported a 33-year-old female case with novel coronavirus disease 2019 (COVID-19) accompanied by Acute tubular necrosis (ATN). She had a gestational age of 34 weeks. The patient referred to treatment clinic for COVID-19 in Imam Reza hospital of Tabriz (Iran) after having flu-like symptoms. In radiologic assessment, ground glass opacity (GGO) with consolidation was found in upper right lobe. Lopinavir/ritonavir (200mg/50mg) two tablet tow times, Ribavirin 200mg every six hours, and Oseltamivir 75mg tow times were given for the treatment of COVID-19. The medications used for treatment of pneumonia were Meropenem, Ciprofloxacin, Vancomycin. All doses of medications were administrated by adjusted dose assuming the patient is anephric. Also, a few supplements were also given after ATN development including daily Rocaltrol and Nephrovit (as a multivitamin appropriate for patients with renal failure), Folic acid and Calcium carbonate. The patient is still under ventilator with a Fraction of inspired oxygen (FiO2) of 60% and Positive end-expiratory pressure (PEEP) of eight. SpO2 is 94% but the patient's ATN problem has been resolved. We started weaning from mechanical ventilator. The patient is conscious with full awareness to time, person and place. The maternal well-being is achieved and her neonate was discharged.


docid: qfqlwhrr

title: Covid-19 and the Stiff Upper Lip - The Pandemic Response in the United Kingdom


Time to Reconsider Diverse Ways of Working in Japan to Promote Social Distancing Measures against the COVID-19


Telemedicine in prisons: A Crime in Mind perspective


title: Risk Factors for Mortality among COVID-19 Patients

text: AIMS: COVID-19 is a current globalpandemic. However, comprehensive global data analyses for its mortality risk factors are lacking. The current investigation aimed to assess the predictors of death among COVID-19 patients from worldwide open access data. METHODS: A total of 828 confirmed cases of COVID-19 with definite outcomes were retrospectively identified from open access individual-level worldwide data. Univariate followed by multivariable regression analysis were used to evaluate the association between potential risk factors and mortality. RESULTS: Majority of the patients were males 59.1% located in Asia 69.3%. Based on the data, older age (adjusted odds ratio (aOR), 1.079; 95% confidence intervals (95% CI), 1.064-1.095 per year increase), males (aOR, 1.607; 95% CI, 1.002-2.576), patients with hypertension (aOR, 3.576; 95% CI, 1.694-7.548), diabetes mellitus (aOR, 12.234; 95% CI, 4.126-36.272), and patients located in America (aOR, 7.441; 95% CI, 3.546-15.617) were identified as the risk factors of mortality among COVID-19 patients. CONCLUSIONS: Males, advanced age, hypertension patients, diabetes mellitus patients, and patients located in America were the independent risk factors of death among COVID-19 patients. Extra attention is required to be given to these factors and additional studies on the underlying mechanisms of these effects.


title: COVID-19: Social Media Sentiment Analysis on Reopening

text: The novel coronavirus (COVID-19) pandemic is the most talked topic in social media platforms in 2020. People are using social media such as Twitter to express their opinion and share information on a number of issues related to the COVID-19 in this stay at home order. In this paper, we investigate the sentiment and emotion of peoples in the United States on the subject of reopening. We choose the social media platform Twitter for our analysis and study the Tweets to discover the sentimental perspective, emotional perspective, and triggering words towards the reopening. During this COVID-19 pandemic, researchers have made some analysis on various social media dataset regarding lockdown and stay at home. However, in our analysis, we are particularly interested to analyse public sentiment on reopening. Our major finding is that when all states resorted to lockdown in March, people showed dominant emotion of fear, but as reopening starts people have less fear. While this may be true, due to this reopening phase daily positive cases are rising compared to the lockdown situation. Overall, people have a less negative sentiment towards the situation of reopening.


title: Profile of natural anticoagulant, coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients

text: The outbreak of novel coronavirus disease 2019 (COVID-19) has now become a global pandemic. Coagulopathy has been reported widely in critically ill COVID-19 patients and was related to high mortality. However, the comprehensive coagulation profiles have not been examined and the underlying mechanism of the coagulopathy in COVID-19 patients is unclear. To study the coagulation profiles of routine hemostasis tests, natural anticoagulants, coagulant factors and antiphospholipid antibodies in critically ill COVID-19 patients. This single-center and cross-section study included 19 patients with COVID-19, who were admitted to intensive care unit (ICU) at Tongji hospital in Wuhan, China, from Feb 23 to Mar 3, 2020. Demographic data, laboratory parameters, treatments and clinical outcomes of the patients were collected and analyzed. The final date of follow-up was Mar 31, 2020. In this study, 12 thrombotic events occurred in 9 patients, including 4 cerebral infarctions, 7 acro-ischemia and 1 internal jugular vein thrombosis. The common abnormalities of routine coagulation tests included evelated D-Dimer level (100%), prolonged prothrombin time (73.7%) and hyperfibrinogenemia (73.7%). The median activities of natural anticoagulants including protein C, protein S and antithrombin were all below the normal range. Factor VIII activities were significantly above normal range (median value 307%, IQR 198-441) in all patients. Factor V and factor VII activities were significantly lower in near-terminal stage patients. Anti-phospholipid antibodies were present in 10 patients. Strikingly, 4 cerebral infarction events were in patients had anti-phospholipid antibodies of multiple isotypes. Sustained hypercoagulable status and thrombotic events were common in critically ill patients with COVID-19. The low activities of natural anticoagulants, elevated factor VIII level and the presence of antiphospholipid antibodies, together, may contribute to the etiopathology of coagulopathy in COVID-19 patients.


docid: eqvzahed

title: Appointment characteristics in an allergy/immunology practice in the immediate aftermath of COVID-19 restrictions


title: Vascular access in COVID-19 patients: Smart decisions for maximal safety

text: The 2020 COVID pandemic has forced everyone to update the usual medical procedures and adapt them to a new situation characterized by a high risk of contamination of the health operator. The placement of a venous access device is no exception. In the experience of the vascular access team of our hospital, hit by the COVID epidemic in March 2020, the safety of both the patient and the staff can be ensured by an insertion bundle of few smart strategies, which include choice of long dwelling peripheral catheters (midline catheters) rather than short venous cannulas; use of power injectable peripherally inserted central catheters in the COVID patients in intensive care unit requiring a central line; use of wireless probes-easy to carry, easy to clean-for ultrasound guided venipuncture; avoidance of x-rays, using alternative methods for tip location such as intracavitary electrocardiography or trans-thoracic echocardiography; strict adoption of the barrier precautions recommended by the international guidelines.


title: Risk factors for 2019 novel coronavirus disease (COVID-19) patients progressing to critical illness: a systematic review and meta-analysis

text: IMPORTANCE: With the rising number of COVID-19 cases, global health resources are strained by the pandemic. No proven effective therapies or vaccines for this virus are currently available. In order to maximize the use of limited medical resources, distinguishing between mild and severe patients as early as possible has become pivotal. OBJECTIVE: To systematically review evidence for the risk factors of COVID-19 patients progressing to critical illness. EVIDENCE REVIEW: We conducted a comprehensive search for primary literature in both Chinese and English electronic bibliographic databases. The American agency for health research and quality tool was used for quality assessment. A meta-analysis was undertaken using STATA version 15.0. RESULTS: Twenty articles (4062 patients) were eligible for this systematic review and meta-analysis. First and foremost, we observed that elderly male patients with a high body mass index, high breathing rate and a combination of underlying diseases (such as hypertension, diabetes, cardiovascular disease, and chronic obstructive pulmonary disease) were more likely to develop severe COVID-19 infections. Second, compared with non-severe patients, severe patients had more serious symptoms such as fever and dyspnea. Besides, abnormal laboratory tests were more prevalent in severe patients than in mild cases, such as elevated levels of white blood cell counts, liver enzymes, lactate dehydrogenase, creatine kinase, C-reactive protein and procalcitonin, as well as decreased levels of lymphocytes and albumin. INTERPRETATION: This is the first systematic review exploring the risk factors for severe illness in COVID-19 patients. Our study may be helpful for clinical decision-making and optimizing resource allocation.


title: Towards Precision Medicine: Inclusion of Sex and Gender Aspects in COVID-19 Clinical Studies-Acting Now before It Is Too Late-A Joint Call for Action

text: The COVID-19 global pandemic is accelerating investigations for effective vaccines and repurposable validated therapeutics [...].


Re: Al-Muharraqi MA. Testing recommendation for COVID-19 (SARS-CoV-2) in patients planned for surgery - continuing the service and 'suppressing' the pandemic. Br J Oral Maxillofac Surg. 2020 Apr 13 pii: S0266-4356(20)30164-9. doi: 10.1016/j.bjoms.2020.04.014. [Epub ahead of print]


The appropriate position of radiology in COVID-19 diagnosis and treatment-current status and opinion from China


COVID-19: Role of neutrophil extracellular traps in acute lung injury


解説編 感染防止策と事業継続計画 (特集 新型コロナウイルス感染症等のパンデミック対策)


COVID-19 and ethnicity: Spotlight on the global rheumatology issues in developing and developed countries


title: Biomarkers of oxidative stress and cell damage in freshwater bivalves Diplodon parodizi exposed to landfill leachate

text: Landfill is a public and environmental health problem; establishing and understanding methodologies to decrease its toxicity are thus necessary. Leachate samples were collected, at a sanitary landfill, immediately after the exit from the landfill, i.e. raw leachate (collection point A), after conventional treatment (point B) and after treatment by wetlands (point C). D. parodizi specimens were exposed to 3%, 10% and control (0%) dilutions of leachate from these collection points for 7 days. Markers of antioxidant defences and cell damage were analysed. At point B, the gills of D. parodizi showed higher glutathione-S-transferase (GST) and glutathione reductase (GR) activity; the latter is a supplier of glutathione reductase (GSH). The low GST activity at point A was associated with the hormesis effect. Higher levels of superoxide dismutase (SOD), ethoxyresorufin-O-deethylase (EROD) and glutathione peroxidase (GPx) occurred at point A. Glucose-6-phosphate dehydrogenase (G6PDH) was inhibited at the points with the highest pollutant load and at the highest leachate dilutions. Higher levels of markers at point A may be related to the high pollutant charge and specific compounds present in the untreated leachate. The multi-xenobiotic resistance mechanism (MXR), metallothionein-like proteins (MT) and lipid peroxidation (LPO) did not vary among treatments. The biomarker responses showed negative effects of the leachate on the freshwater bivalve and simultaneously showed that the wetland treatment employed at the Caximba sanitary landfill is effective.


Planning for the post-COVID-19 pandemic future: Considerations for NP education and practice


title: Dynamic changes of peripheral blood lymphocytes subsets in adult patients with COVID-19

text: INTRODUCTION: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been widely spread. We aim to investigate the dynamic changes of peripheral blood lymphocytes subsets in adult patients with COVID-19. METHODS: Electronic medical records including demographics, clinical manifestation, comorbidities, laboratory data, and radiological materials of 435 hospitalized COVID-19 patients, with confirmed result of SARS-CoV-2 viral infection, were extracted and retrospectively analyzed. The counts of lymphocyte subsets at each week after the onset of the illness were compared with other weeks of illness and with those from normal individuals. RESULTS: The various lymphocyte subsets (CD3 +, CD4 +, CD8 +, CD19 +and CD16/56 +) were below the normal ranges at the first week after the onset of the illness, reaching a nadir during the second week, which increased gradually in the third week and returned to normal levels in the fifth week, but was still lower than the healthy controls. The CD3+, CD4+ and CD8+ counts were significantly lower in those with severe disease compared to those with non-severe disease, and in those patients that died compared to those who recovered. DISCUSSION: our research indicates that the levels of peripheral blood lymphocyte subsets (CD3 +, CD4 +, and CD8 +) are associated with disease progression, severity, and prognosis in patients with COVID-19. Dynamic monitoring of human immune function is one of the indicators for evaluating the severity and prognosis of COVID-19 patients, and it is helpful to formulate appropriate treatment strategies.


docid: bbwousuv

title: Creation of an Interactive Virtual Surgical Rotation for Undergraduate Medical Education During the COVID-19 Pandemic

text: OBJECTIVE: During the coronavirus 2019 pandemic, medical student involvement in direct patient care has been severely limited. Rotations mandatory not only for core curricula but also for informing decisions regarding specialty choice have been postponed during a critical window in the application cycle. Existing virtual rotations are largely observational or lack patient-facing components. SETTING: A virtual Otolaryngology - Head and Neck Surgery rotation at the University of Pennsylvania (Philadelphia, Pennsylvania) was implemented for medical students, comprising interactive live-streamed surgeries, outpatient telehealth visits, and virtual small group didactics. RESULTS: Medical students enrolled in the virtual surgical rotation were able to engage with attending surgeons and operating room staff while remotely viewing surgical procedures captured with first-person audiovisual technology. Students participated in several different aspects of care delivery in both the inpatient and outpatient setting, similar to their typical responsibilities of an in-person rotation. CONCLUSIONS: The authors will continue to develop the virtual surgical education methodology to further disseminate an interactive video-based medical student elective to other procedural specialties and institutions.


Betrayal of Trust? The Impact of the COVID-19 Global Pandemic on Older Persons


docid: kxibovti

title: Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action

text: Emerging evidence shows that severe coronavirus disease 2019 (COVID-19) can be complicated with coagulopathy, namely disseminated intravascular coagulation, which has a rather prothrombotic character with high risk of venous thromboembolism. The incidence of venous thromboembolism among COVID-19 patients in intensive care units appears to be somewhat higher compared to that reported in other studies including such patients with other disease conditions. D-dimer might help in early recognition of these high-risk patients and also predict outcome. Preliminary data show that in patients with severe COVID-19, anticoagulant therapy appears to be associated with lower mortality in the subpopulation meeting sepsis-induced coagulopathy criteria or with markedly elevated d-dimer. Recent recommendations suggest that all hospitalized COVID-19 patients should receive thromboprophylaxis, or full therapeutic-intensity anticoagulation if such an indication is present.


title: Control of pore structure and surface chemistry of activated carbon derived from waste Zanthoxylum bungeanum branches for toluene removal in air

text: Activated carbon adsorption has been considered the most efficient technology toward VOC removal. The waste biomass as alternates solved the problems of high price and nonrenewable of traditional raw materials. The waste Zanthoxylum bungeanum branches were firstly selected as raw materials to prepare activated carbons. Interestingly, the pore structure and surface chemistry can be successfully controlled by adjusting the heating rate. The hierarchical porous carbons exhibited great potential for toluene adsorption. The micro-mesopore structure possessed unique spatial effect; micropores played a dominant role in adsorption process, especially narrow micropores (pore size ≤ 1.0 nm) emerged stronger adsorptive force toward toluene molecules due to overlapping attractive forces from neighboring pore walls. And mesopores not only displayed excellent transport diffusion but also provided adsorption sites. Additionally, the high graphitization degree enhanced the interaction between graphene layer equipped electron-rich regions and π-electrons on the aromatic ring by the π-π conjugated effect. The hydroxyl and carbonyl functional groups served as chemisorption sites and led to higher adsorption amounts. Fortunately, the regeneration can be achieved by thermal treatment at the low temperature (≤ 150 °C) or even gas purging at room temperature (20 °C), which avoided an explosion accident in the process of high-temperature regeneration.


title: An Improved Method for the Fitting and Prediction of the Number of COVID-19 Confirmed Cases Based on LSTM

text: New coronavirus disease (COVID-19) has constituted a global pandemic and has spread to most countries and regions in the world. By understanding the development trend of a regional epidemic, the epidemic can be controlled using the development policy. The common traditional mathematical differential equations and population prediction models have limitations for time series population prediction, and even have large estimation errors. To address this issue, we propose an improved method for predicting confirmed cases based on LSTM (Long-Short Term Memory) neural network. This work compared the deviation between the experimental results of the improved LSTM prediction model and the digital prediction models (such as Logistic and Hill equations) with the real data as reference. And this work uses the goodness of fitting to evaluate the fitting effect of the improvement. Experiments show that the proposed approach has a smaller prediction deviation and a better fitting effect. Compared with the previous forecasting methods, the contributions of our proposed improvement methods are mainly in the following aspects: 1) we have fully considered the spatiotemporal characteristics of the data, rather than single standardized data; 2) the improved parameter settings and evaluation indicators are more accurate for fitting and forecasting. 3) we consider the impact of the epidemic stage and conduct reasonable data processing for different stage.


title: [Etiology of epidemic outbreaks COVID-19 on Wuhan, Hubei province, Chinese People Republic associated with 2019-nCoV (Nidovirales, Coronaviridae, Coronavirinae, Betacoronavirus, Subgenus Sarbecovirus): lessons of SARS-CoV outbreak.]

text: Results of analysis of phylogenetic, virological, epidemiological, ecological, clinical data of COVID-19 outbreaks in Wuhan, China (PRC) in comparison with SARS-2002 and MERS-2012 outbreaks allow to conclude: - the etiological agent of COVID-19 is coronavirus (2019-CoV), phylogenetically close to the SARS-CoV, isolated from human, and SARS-related viruses isolated from bats (SARS-related bat CoV viruses). These viruses belong to the Sarbecovirus subgenus, Betacoronavirus genus, Orthocoronavirinae subfamily, Coronaviridae family (Cornidovirinea: Nidovirales). COVID-19 is a variant of SARS-2002 and is different from MERS-2012 outbreak, which were caused by coronavirus belonged to the subgenus Merbecovirus of the same genus; - according to the results of phylogenetic analysis of 35 different betacoronaviruses, isolated from human and from wild animals in 2002-2019, the natural source of COVID-19 and SARS-CoV (2002) is bats of Rhinolophus genus (Rhinolophidae) and, probably, some species of other genera. An additional reservoir of the virus could be an intermediate animal species (snakes, civet, hedgehogs, badgers, etc.) that are infected by eating of infected bats. SARS-like coronaviruses circulated in bats in the interepidemic period (2003-2019); - seasonal coronaviruses (subgenus Duvinacovirus, Alphacoronavirus) are currently circulating (November 2019 - January 2020) in the European part of Russia, Urals, Siberia and the Far East of Russia, along with the influenza viruses A(H1N1)pdm09, A(H3N2), and Ð, as well as six other respiratory viruses (HPIV, HAdV, HRSV, HRV, HBoV, and HMPV).


title: Psychological assistance during the coronavirus disease 2019 outbreak in China

text: Disaster psychological assistance has become an important part of the disaster relief system, playing a crucial role in restoring and maintaining emotional stability and security of people and reducing trauma-related stress. As the first country to experience the outbreak of the coronavirus disease 2019 (COVID-19), China actively adopted psychological assistance measures in response to the panic caused by the epidemic. These measures are expected to help the Chinese government and governments in other parts of the world to better respond to the outbreaks of COVID-19.


Exergaming for heart failure: an idea so good it just ought to work


title: Twitter and Census Data Analytics to Explore Socioeconomic Factors for Post-COVID-19 Reopening Sentiment

text: Investigating and classifying sentiments of social media users towards an item, situation, and system are very popular among the researchers. However, they rarely discuss the underlying socioeconomic factor associations for such sentiments. This study attempts to explore the factors associated with positive and negative sentiments of the people about reopening the economy, in the United States (US) amidst the COVID-19 global crisis. It takes into consideration the situational uncertainties (i.e., changes in work and travel pattern due to lockdown policies), economic downturn and associated trauma, and emotional factors such as depression. To understand the sentiment of the people about the reopening economy, Twitter data was collected, representing the 51 states including Washington DC of the US. State-wide socioeconomic characteristics of the people, built environment data, and the number of COVID-19 related cases were collected and integrated with Twitter data to perform the analysis. A binary logit model was used to identify the factors that influence people toward a positive or negative sentiment. The results from the logit model demonstrate that family households, people with low education levels, people in the labor force, low-income people, and people with higher house rent are more interested in reopening the economy. In contrast, households with a high number of members and high income are less interested to reopen the economy. The model can correctly classify 56.18% of the sentiments. The Pearson chi2 test indicates that overall this model has high goodness-of-fit. This study provides a clear indication to the policymakers where to allocate resources and what policy options they can undertake to improve the socioeconomic situations of the people and mitigate the impacts of pandemics in the current situation and as well as in the future.


Newborns at risk of COVID-19


Coronavirus disease 2019 (COVID-19) outbreak: Could pigs be vectors for human infections?


docid: ydlbvrog

title: Coronavirus drugs: Using plasma from recovered patients as a treatment for COVID-19

text: The ongoing COVID-19 pandemic has infected nearly 3,582,233 individuals with 248,558 deaths since it was first identified in human populations in December 2019 in Wuhan, China. No antiviral therapies or vaccines are available for their treatment or prevention. Passive immunization PI through broadly neutralizing antibodies that bind to the specific antigens of SARS-CoV 2 might be a potential solution to address the immediate health threat of COVID-19 pandemic while vaccines are being developed. The PI approach in treating COVID-19 is discussed herein, including a summary of its historical applications to confront epidemics.


title: Respiratory and ventilator management of COVID-19

text: The current pandemic of COVID-19 has infected around 2.5 million people with more than 125,000 deaths across the globe till date, and numbers are still rising. The causative organism is a virus of corona family. The International Committee on Taxonomy of Viruses (ICTV) named it severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to its similarities with the virus was caused SARS outbreak (SARS-CoV). Although most of the patients present with less severe symptoms like rhinitis, cough, fever, and mild flu-like symptoms, it may progress to severe acute respiratory illness, pneumonia or acute respiratory distress syndrome (ARDS) mainly in immunocompromised hosts. Severe infections mainly involve lungs, and compromise its capacity of ventilation. Respiratory and mechanical ventilation is one of the important parts of management.


title: Building a PubMed knowledge graph

text: PubMed is an essential resource for the medical domain, but useful concepts are either difficult to extract or are ambiguated, which has significantly hindered knowledge discovery. To address this issue, we constructed a PubMed knowledge graph (PKG) by extracting bio-entities from 29 million PubMed abstracts, disambiguating author names, integrating funding data through the National Institutes of Health (NIH) ExPORTER, collecting affiliation history and educational background of authors from ORCID, and identifying fine-grained affiliation data from MapAffil. Through the integration of the credible multi-source data, we could create connections among the bio-entities, authors, articles, affiliations, and funding. Data validation revealed that the BioBERT deep learning method of bio-entity extraction significantly outperformed the state-of-the-art models based on the F1 score (by 0.51%), with the author name disambiguation (AND) achieving a F1 score of 98.09%. PKG can trigger broader innovations, not only enabling us to measure scholarly impact, knowledge usage, and knowledge transfer, but also assisting us in profiling authors and organizations based on their connections with bio-entities. The PKG is freely available on Figshare (https://figshare.com/s/6327a55355fc2c99f3a2, simplified version that exclude PubMed raw data) and TACC website (http://er.tacc.utexas.edu/datasets/ped, full version).


title: Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection

text: It has been known that, the novel coronavirus, 2019-nCoV, which is considered similar to SARS-CoV, invades human cells via the receptor angiotensin converting enzyme II (ACE2). Moreover, lung cells that have ACE2 expression may be the main target cells during 2019-nCoV infection. However, some patients also exhibit non-respiratory symptoms, such as kidney failure, implying that 2019-nCoV could also invade other organs. To construct a risk map of different human organs, we analyzed the single-cell RNA sequencing (scRNA-seq) datasets derived from major human physiological systems, including the respiratory, cardiovascular, digestive, and urinary systems. Through scRNA-seq data analyses, we identified the organs at risk, such as lung, heart, esophagus, kidney, bladder, and ileum, and located specific cell types (i.e., type II alveolar cells (AT2), myocardial cells, proximal tubule cells of the kidney, ileum and esophagus epithelial cells, and bladder urothelial cells), which are vulnerable to 2019-nCoV infection. Based on the findings, we constructed a risk map indicating the vulnerability of different organs to 2019-nCoV infection. This study may provide potential clues for further investigation of the pathogenesis and route of 2019-nCoV infection.


title: Artificial Neural Network Modeling of Novel Coronavirus (COVID-19) Incidence Rates across the Continental United States

text: Prediction of the COVID-19 incidence rate is a matter of global importance, particularly in the United States. As of 4 June 2020, more than 1.8 million confirmed cases and over 108 thousand deaths have been reported in this country. Few studies have examined nationwide modeling of COVID-19 incidence in the United States particularly using machine-learning algorithms. Thus, we collected and prepared a database of 57 candidate explanatory variables to examine the performance of multilayer perceptron (MLP) neural network in predicting the cumulative COVID-19 incidence rates across the continental United States. Our results indicated that a single-hidden-layer MLP could explain almost 65% of the correlation with ground truth for the holdout samples. Sensitivity analysis conducted on this model showed that the age-adjusted mortality rates of ischemic heart disease, pancreatic cancer, and leukemia, together with two socioeconomic and environmental factors (median household income and total precipitation), are among the most substantial factors for predicting COVID-19 incidence rates. Moreover, results of the logistic regression model indicated that these variables could explain the presence/absence of the hotspots of disease incidence that were identified by Getis-Ord Gi* (p < 0.05) in a geographic information system environment. The findings may provide useful insights for public health decision makers regarding the influence of potential risk factors associated with the COVID-19 incidence at the county level.


Susceptibility of Southwestern American Indian Tribes to Coronavirus Disease 2019 (COVID-19)


title: Inside the lungs of COVID-19 disease

text: In the setting of the coronavirus disease 2019 (COVID-19) pandemic, only few data regarding lung pathology induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is available, especially without medical intervention interfering with the natural evolution of the disease. We present here the first case of forensic autopsy of a COVID-19 fatality occurring in a young woman, in the community. Diagnosis was made at necropsy and lung histology showed diffuse alveolar damage, edema, and interstitial pneumonia with a geographically heterogeneous pattern, mostly affecting the central part of the lungs. This death related to COVID-19 pathology highlights the heterogeneity and severity of central lung lesions after natural evolution of the disease.


title: Goals of care and COVID-19: A GOOD framework for dealing with uncertainty

text: As the COVID-19 pandemic continues, more patients will require palliative and end-of-life care. In order to ensure goal-concordant-care when possible, clinicians should initiate goals-of-care conversations among our most vulnerable patients and, ideally, among all patients. However, many non-palliative care clinicians face deep uncertainty in planning, conducting, and evaluating such interactions. We believe that specialists within palliative care are aptly positioned to address such uncertainties, and in this article offer a relevant update to a concise framework for clinicians to plan, conduct, and evaluate goals-of-care conversations: the GOOD framework. Once familiar with this framework, palliative care clinicians may use it to educate their non-palliative care colleagues about a timely and critical component of care, now and beyond the COVID-19 era.


title: Deafness and mental health: Clinical challenges during the COVID-19 pandemic

text: The current health crisis scenario has exposed the negative impact on mental health. This commentary highlights the main challenges and barriers that the Deaf community faces in access to health care resources and psychological support during the COVID-19 pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Verapamil as treatment for refractory status epilepticus secondary to PRES syndrome on a SARS-Cov-2 infected patient


title: A data driven analysis and forecast of an SEIARD epidemic model for COVID-19 in Mexico

text: We propose an SEIARD mathematical model to investigate the current outbreak of coronavirus disease (COVID-19) in Mexico. We conduct a detailed analysis of this model and demonstrate its application using publicly reported data. We calculate the basic reproduction number ($R_0$) via the next-generation matrix method, and we estimate the per day infection, death and recovery rates. We calibrate the parameters of the SEIARD model to the reported data by minimizing the sum of squared errors and attempt to forecast the evolution of the outbreak until June 2020. Our results estimate that the peak of the epidemic in Mexico will be around May 2, 2020. Our model incorporates the importance of considering the aysmptomatic infected individuals, because they represent the majority of the infected population (with symptoms or not) and they could play a huge role in spreading the virus without any knowledge.


Revisiting the dangers of the coronavirus in the ophthalmology practice


COVID-19 and the personal protection debate: An exposition on transmission


title: Emergency reconstruction of large general hospital under the perspective of new COVID-19 prevention and control

text: OBJECTIVE: To summarize the successful experience of timely crisis management, correct measures, and successful display of the hospital image in the First Affiliated Hospital of Zhejiang University (FAHZU), to improve the ability of emergency response. METHODS: The FAHZU, as the earliest designated hospital, accomplished the transformation from general hospital to infectious disease hospital under the guiding ideology of centralized patients, centralized experts, centralized resources, and centralized treatment with measures to transfer the Zhijiang campus hospitalized patients quickly, complete the space layout, create diagnosis and treatment space, streamline logistics, and transform logistics facilities within 48â¯h. As of 5 March, the hospital had admitted 104 patients. RESULTS: Of the severe cases in Zhejiang province 95% underwent centralized treatment with the goal of zero deaths for severely ill patients, zero misdiagnoses for infected patients, and zero infections for medical staff, and this served as a reference for large medical institutions regarding how to manage such a public health emergency. CONCLUSION: The successful cases of FAHZU provided a valuable experience for large medical institutions on how to address public health emergencies and how to carry out diagnosis and treatment and streamline the layout and related facilities in emergency reconstruction.


Passive antibody therapy in COVID-19


Letter to the Editor in response to the article "Lack of type 1 diabetes involvement in the SARS-CoV-2 population: Only a particular coincidence?


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title: Cancer in the time of COVID-19: expert opinion on how to adapt current practice


Serological tests facilitate identification of asymptomatic SARS-CoV-2 infection in Wuhan, China


title: B cell depletion in murine lupus using cytotoxic T lymphocytes in vivo: Feasibility and benefit

text: Given the promising results in human lupus with B cell depletion, we tested whether in vivo cytotoxic T lymphocyte (CTL) could eliminate autoreactive B cells in the setting of murine lupus. Using the parent-into-F1 (P â F1) model to generate CTL that eliminate B cells, we found that transfer ofNZB parental splenocytes into lupus-prone female NZB/W F1 mice resulted in profound B cell reduction whereas NZW â F1 mice exhibited defective B cell elimination. Using pre-disease or early disease B/W mice as hosts, NZB â F1 mice exhibited B cell depletion and improved proteinuria but no improvement in survival whereas NZW â F1 mice had significantly reduced proteinuria and prolonged survival. Thus, despite the defective IL-2 environment in B/W F1 mice, generation of CTL and B cell depletion is feasible in NZB â F1 mice. The surprising increase in survival for NZW â F1 mice despite defective B cell elimination suggests that NZW splenocytes may contain a beneficial down regulatory cell.


National COVID numbers - Benford's law looks for errors


docid: xpfjduix

title: SARS-CoV-2 oral associated lesions: discussion of elicited response


title: Role of Rehabilitation Department for Adult Individuals With COVID-19: The Experience of the San Raffaele Hospital of Milan

text: The rapid evolution of the health emergency linked to the spread of severe acute respiratory syndrome coronavirus 2 requires specifications for the rehabilitative management of patients with coronavirus disease 2019 (COVID-19). The symptomatic evolution of patients with COVID-19 is characterized by 2 phases: an acute phase in which respiratory symptoms prevail and a postacute phase in which patients can show symptoms related to prolonged immobilization, to previous and current respiratory dysfunctions, and to cognitive and emotional disorders. Thus, there is the need for specialized rehabilitative care for these patients. This communication reports the experience of the San Raffaele Hospital of Milan and recommends the setup of specialized clinical pathways for the rehabilitation of patients with COVID-19. In this hospital, between February 1 and March 2, 2020, about 50 patients were admitted every day with COVID-19 symptoms. In those days, about 400 acute care beds were created (intensive care/infectious diseases). In the following 30 days, from March 2 to mid-April, despite the presence of 60 daily arrivals to the emergency department, the organization of patient flow between different wards was modified, and several different units were created based on a more accurate integration of patients' needs. According to this new organization, patients were admitted first to acute care COVID-19 units and then to COVID-19 rehabilitation units, post-COVID-19 rehabilitation units, and/or quarantine/observation units. After hospital discharge, telemedicine was used to follow-up with patients at home. Such clinical pathways should each involve dedicated multidisciplinary teams composed of pulmonologists, physiatrists, neurologists, cardiologists, physiotherapists, neuropsychologists, occupational therapists, speech therapists, and nutritionists.


title: Cardiovascular comorbidities, cardiac injury, and prognosis of COVID-19 in New York City

text: Using Mt. Sinai (New York City) EMR health system data, we retrospectively analyzed a cohort of 8438 COVID-19 patients seen between March 1 and April 22, 2020. Risk of intubation and of death rose as a function of increasing age and as a function of greater cardiovascular comorbidity. Combining age and specific comorbidity markers showed patterns suggesting that cardiovascular comorbidities increased relative risks for adverse outcomes most substantially in the younger subjects with progressively diminishing relative effects at older ages.


title: The Relationship between the Migrant Population's Migration Network and the Risk of COVID-19 Transmission in China-Empirical Analysis and Prediction in Prefecture-Level Cities

text: The outbreak of COVID-19 in China has attracted wide attention from all over the world. The impact of COVID-19 has been significant, raising concerns regarding public health risks in China and worldwide. Migration may be the primary reason for the long-distance transmission of the disease. In this study, the following analyses were performed. (1) Using the data from the China migrant population survey in 2017 (Sample size = 432,907), a matrix of the residence-birthplace (R-B matrix) of migrant populations is constructed. The matrix was used to analyze the confirmed cases of COVID-19 at Prefecture-level Cities from February 1-15, 2020 after the outbreak in Wuhan, by calculating the probability of influx or outflow migration. We obtain a satisfactory regression analysis result (R2 = 0.826-0.887, N = 330). (2) We use this R-B matrix to simulate an outbreak scenario in 22 immigrant cities in China, and propose risk prevention measures after the outbreak. If similar scenarios occur in the cities of Wenzhou, Guangzhou, Dongguan, or Shenzhen, the disease transmission will be wider. (3) We also use a matrix to determine that cities in Henan province, Anhui province, and Municipalities (such as Beijing, Shanghai, Guangzhou, Shenzhen, Chongqing) in China will have a high risk level of disease carriers after a similar emerging epidemic outbreak scenario due to a high influx or outflow of migrant populations.


title: Gene expression pattern differences in primary human pulmonary epithelial cells infected with MERS-CoV or SARS-CoV-2

text: Coronaviruses such as MERS-CoV and SARS-CoV-2 infect the human respiratory tract and can cause severe pneumonia. Disease severity and outcomes are different for these two infections: the human mortality rate for MERS-CoV and SARS-CoV-2 is over 30% and less than 10%, respectively. Here, using microarray assay, we analyzed the global alterations in gene expression induced by MERS-CoV or SARS-CoV-2 infections in primary human pulmonary epithelial cells. Overall, the number of differentially expressed genes was higher in human lung cells infected with MERS-CoV than in cells with SARS-CoV-2. Out of 44,556 genes analyzed, 127 and 50 were differentially expressed in cells infected with MERS-CoV and SARS-CoV-2, respectively (> 2-fold increase, compared to uninfected cells). Of these, only eight genes, including the one coding for CXCL8, were similarly modulated (upregulated or downregulated) by the two coronaviruses. Importantly, these results were virus-specific and not conditioned by differences in viral load, and viral growth curves were similar in human lung cells infected with both viruses. Our results suggest that these distinct gene expression profiles, detected early after infection by these two coronaviruses, may help us understand the differences in clinical outcomes of MERS-CoV and SARS-CoV-2 infections.


Elderly suicides in India: an emerging concern during COVID-19 pandemic


A deadly spillover: SARS-CoV-2 outbreak


title: Autopsy Findings and Venous Thromboembolism in Patients With COVID-19

text: BACKGROUND: The new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has caused more than 210 000 deaths worldwide. However, little is known about the causes of death and the virus's pathologic features. OBJECTIVE: To validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virologic tests. DESIGN: Prospective cohort study. SETTING: Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction-confirmed diagnosis of COVID-19. PATIENTS: The first 12 consecutive COVID-19-positive deaths. MEASUREMENTS: Complete autopsy, including postmortem computed tomography and histopathologic and virologic analysis, was performed. Clinical data and medical course were evaluated. Results: Median patient age was 73 years (range, 52 to 87 years), 75% of patients were male, and death occurred in the hospital (n = 10) or outpatient sector (n = 2). Coronary heart disease and asthma or chronic obstructive pulmonary disease were the most common comorbid conditions (50% and 25%, respectively). Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Postmortem computed tomography revealed reticular infiltration of the lungs with severe bilateral, dense consolidation, whereas histomorphologically diffuse alveolar damage was seen in 8 patients. In all patients, SARS-CoV-2 RNA was detected in the lung at high concentrations; viremia in 6 of 10 and 5 of 12 patients demonstrated high viral RNA titers in the liver, kidney, or heart. LIMITATION: Limited sample size. CONCLUSION: The high incidence of thromboembolic events suggests an important role of COVID-19-induced coagulopathy. Further studies are needed to investigate the molecular mechanism and overall clinical incidence of COVID-19-related death, as well as possible therapeutic interventions to reduce it. PRIMARY FUNDING SOURCE: University Medical Center Hamburg-Eppendorf.


title: [Recommendations on extracorporeal life support for critically ill patients with novel coronavirus pneumonia]

text: Along with the sharp increase of confirmed cases novel coronavirus infection, more critically ill cases require extracorporeal membrane oxygenation (ECMO) support. Based on the clinical data of novel coronavirus pneumonia (NCP), as well as the dada from previous clinical studies and the recommendations from the Extracorporeal Life Support Organization (ELSO), the committee board of the Chinese Society of Extracorporeal Life Support (CSECLS) made this recommendations to guide clinical ECMO application in the patients with NCP.


title: The COVID-19 outbreak and psychiatric hospitals in China: managing challenges through mental health service reform

text: Recently, more than 300 Chinese patients with psychiatric disorders were diagnosed with the 2019 novel coronavirus disease (COVID-19). Possible reasons quoted in the report were the lack of caution regarding the COVID-19 outbreak in January and insufficient supplies of protective gear. We outlined major challenges for patients with psychiatric disorders and mental health professionals during the COVID-19 outbreak, and also discussed how to manage these challenges through further mental health service reform in China.


COVID-19: A Different Kind of Warfare