title: On the incorporation of iron into hexagonal barium titanate: II. Magnetic moment, electron paramagnetic resonance (EPR) and optical transmission

text: Systematic measurements of the magnetic moment in dependence on temperature and magnetic field of hexagonal 6H-BaTiO3+ 0.04 BaO + x/2 Fe2O3(0.005 ≤ x ≤ 0.05) ceramics were performed to study the influence of Fe ions on the magnetic properties. While the samples show Curie-Weiss paramagnetism for Fe concentrations ≤ 1.0 mol%, antiferromagnetic interactions become manifest for 2.0 and 5.0 mol% iron. With increasing Fe content the antiferromagnetic interaction, which is assumed to be caused by a superexchange mechanism Fe3+Ti(1)- O2-O(2)- Fe3+Ti(2), becomes stronger. At external magnetic fields smaller than 1 T a further, ferromagnetic interaction between Fe3+ions is detected below 200 K. The interactions between Fe3+ions in the samples with 2.0 and 5.0 mol% iron are also manifest in the EPR spectra by numerous lines with low intensity. Q-band EPR investigations of 5.0 mol% Fe doped single crystals confirm the existence of only one type of Fe3+- VOassociates in the samples.


title: The SARS-CoV-2 receptor, ACE-2, is expressed on many different cell types: implications for ACE-inhibitor- and angiotensin II receptor blocker-based cardiovascular therapies

text: SARS-CoV-2 is characterized by a spike protein allowing viral binding to the angiotensin-converting enzyme (ACE)-2, which acts as a viral receptor and is expressed on the surface of several pulmonary and extra-pulmonary cell types, including cardiac, renal, intestinal and endothelial cells. There is evidence that also endothelial cells are infected by SARS-COV-2, with subsequent occurrence of systemic vasculitis, thromboembolism and disseminated intravascular coagulation. Those effects, together with the "cytokine storm" are involved in a worse prognosis. In clinical practice, angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) are extensively used for the treatment of hypertension and other cardiovascular diseases. In in vivo studies, ACE-Is and ARBs seem to paradoxically increase ACE-2 expression, which could favour SARS-CoV-2 infection of host's cells and tissues. By contrast, in patients treated with ACE-Is and ARBs, ACE-2 shows a downregulation at the mRNA and protein levels in kidney and cardiac tissues. Yet, it has been claimed that both ARBs and ACE-Is could result potentially useful in the clinical course of SARS-CoV-2-infected patients. As detected in China and as the Italian epidemiological situation confirms, the most prevalent comorbidities in deceased patients with COVID-19 are hypertension, diabetes and cardiovascular diseases. Older COVID-19-affected patients with cardiovascular comorbidities exhibit a more severe clinical course and a worse prognosis, with many of them being also treated with ARBs or ACE-Is. Another confounding factor is cigarette smoking, which has been reported to increase ACE-2 expression in both experimental models and humans. Sex also plays a role, with chromosome X harbouring the gene coding for ACE-2, which is one of the possible explanations of why mortality in female patients is lower. Viral entry also depends on TMPRSS2 protease activity, an androgen dependent enzyme. Despite the relevance of experimental animal studies, to comprehensively address the question of the potential hazards or benefits of ACE-Is and ARBs on the clinical course of COVID-19-affected patients treated by these anti-hypertensive drugs, we will need randomized human studies. We claim the need of adequately powered, prospective studies aimed at answering the following questions of paramount importance for cardiovascular, internal and emergency medicine: Do ACE-Is and ARBs exert similar or different effects on infection or disease course? Are such effects dangerous, neutral or even useful in older, COVID-19-affected patients? Do they act on multiple cell types? Since ACE-Is and ARBs have different molecular targets, the clinical course of SARS-CoV-2 infection could be also different in patients treated by one or the other of these two drug classes. At present, insufficient detailed data from trials have been made available.


title: Insights into redox mediators-resource harvest/application with power production from waste activated sludge through freezing/thawing-assisted anaerobic acidogenesis coupling microbial fuel cells

text: This first-attempted study demonstrated endogenous redox-mediators harvest/application from waste activated sludge (WAS) through freezing/thawing (F/T) pretreatment-enhanced anaerobic acidogenesis coupled with microbial fuel cells (MFCs). A total of 2.57 kWh electricity was produced from per kg soluble chemical oxygen demand (SCOD) via MFCs just in 2 d with about 90% organics removal, which contained 1.152 kWh/kg COD from F/T liquid together with 1.418 kWh/kg COD from fermentation liquid. The fermentation liquor-MFCs fostered higher anodic biodiversity and more power output as compared with the F/T liquid-MFCs. Essentially, the completely endogenous redox mediators-like substances with relatively high redox activities could be retained after MFC electrogenesis from F/T liquid and played electron shuttle-roles sufficiently in enlarging bio-energy production of MFCs, which seemed to be an effective option for harvesting endogenous redox mediators from sludge. This study might inspire progressive thinking toward aims of high-efficiency of resource recycle/bioenergy production from WAS.


title: Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective

text: In response to the estimated potential impact of coronavirus disease (COVID-19) on New York City hospitals, our institution prepared for an influx of critically ill patients. Multiple areas of surge planning progressed, simultaneously focused on infection control, clinical operational challenges, ICU surge capacity, staffing, ethics, and maintenance of staff wellness. The protocols developed focused on clinical decisions regarding intubation, the use of high-flow oxygen, engagement with infectious disease consultants, and cardiac arrest. Mechanisms to increase bed capacity and increase efficiency in ICUs by outsourcing procedures were implemented. Novel uses of technology to minimize staff exposure to COVID-19 as well as to facilitate family engagement and end-of-life discussions were encouraged. Education and communication remained key in our attempts to standardize care, stay apprised on emerging data, and review seminal literature on respiratory failure. Challenges were encountered and overcome through interdisciplinary collaboration and iterative surge planning as ICU admissions rose. Support was provided for both clinical and nonclinical staff affected by the profound impact COVID-19 had on our city. We describe in granular detail the procedures and processes that were developed during a 1-month period while surge planning was ongoing and the need for ICU capacity rose exponentially. The approaches described here provide a potential roadmap for centers that must rapidly adapt to the tremendous challenge posed by this and potential future pandemics.


Pulmonary Embolism in COVID-19 Patients: Awareness of an Increased Prevalence


COVID-19 and Health Equity-A New Kind of "Herd Immunity"


A Good Death : A Pandemic Lesson


Mortality from COVID-19: A cross-country comparison of containment versus mitigation strategy


Early signs that COVID-19 is being contained in Australia


The Meaning of Care and Ethics to Mitigate the Harshness of Triage in Second-Wave Scenario Planning During the COVID-19 Pandemic


title: Secondary HLH is uncommon in severe COVID-19

text: Severe cases of COVID-19, caused by novel coronavirus SARS-CoV-2, have been associated with a hyperinflammatory state.(Huang, Wang et al. 2020) This has been described as a form of secondary haemophagocytic lymphohistiocytosis (sHLH)(Bergsten, Horne et al. 2017) that may contribute to increased mortality.(Ramos-Casals, Brito-Zeron et al. 2014) Screening with the HScore(Fardet, Galicier et al. 2014) to identify cases has been recommended to guide immunosuppressive therapy(Mehta, McAuley et al. 2020).


title: Home monitoring for COVID-19

text: Cleveland Clinic recognized the importance of mitigating community transmission of COVID-19 by keeping people at home. Patient-care activities quickly pivoted to remote touches, preserving continuity through a variety of digital and telephonic modalities. As the number of confirmed cases grew, standardizing home-based care became critical to managing high-risk patients, moderating the risk of exposure for healthcare workers, and reducing the amount of community spread through appropriate education on home-based care for exposed or infected individuals. This novel, team-based approach to caring for patients with COVID-19 incorporates a self-monitoring app for patient engagement, monitors symptoms for early intervention, and promotes a holistic view of care.


title: Italian suggestions for pulmonary rehabilitation in COVID-19 patients recovering from acute respiratory failure: results of a Delphi process

text: There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts' opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision making within the context of the individual patient. Further studies will evaluate the clinical usefulness of these suggestions.


COVID-19 and gastrointestinal endoscopy: Importance of reducing SARS-CoV-2 infection risks of medical workers and preserving personal protective equipment resources


title: Changes in head and neck oncologic practice during the COVID-19 pandemic

text: INTRODUCTION: The COVID-19 pandemic has raised controversies regarding safe and effective care of patients with head and neck cancer. It is unknown how much the pandemic has changed surgeon practice. METHODS: A questionnaire was distributed to head and neck surgeons assessing opinions related to treatment and concerns for the safety of patients, self, family, and staff. RESULTS: A total of 88 head and neck surgeons responded during the study period. Surgeons continued to recommend primary surgical treatment for oral cavity cancers. Respondents were more likely to consider nonsurgical therapy for patients with early glottic cancers and HPV-mediated oropharynx cancer. Surgeons were least likely to be concerned for their own health and safety and had the greatest concern for their resident trainees. CONCLUSIONS: This study highlights differences in the willingness of head and neck surgeons to delay surgery or alter plans during times when hospital resources are scarce and risk is high.


Clinical diagnostic value of CT imaging in COVID-19 with multiple negative RT-PCR testing


docid: tqwcpnpt

title: Pandemic March: 2019 Coronavirus Disease's First Wave Circumnavigates the Globe

text: OBJECTIVE: March 2020 was a pivotal month for the worldwide geographic and numeric expansion of the first wave of Coronavirus Disease 2019 (COVID-19). We examined the major storylines that depicted this explosive spread of COVID-19 around the globe. METHODS: A detailed review of World Health Organization (WHO) situation reports, surveillance summaries, and online resources allowed us to quantify the increases in cases and deaths by region and by country throughout the month of March 2020. RESULTS: During March, COVID-19 was officially declared by the WHO to be a pandemic. COVID-19 emerged from a focalized outbreak in the Western Pacific Region and rapidly proliferated across all continents worldwide. Globally, cumulative numbers of confirmed cases increased by a factor of nine throughout the month. During the entire month, cases rose exponentially throughout Europe. Starting in mid-March, confirmed cases accelerated coast-to-coast throughout the United States and, on March 26, the United States surpassed all other nations to rank first in numbers of cases. COVID-19 mortality lagged several weeks behind but by month's end, death tolls were also rising exponentially. CONCLUSION: March 2020 was a consequential month when the COVID-19 pandemic wrapped completely around the planet, with outbreaks erupting in most nations worldwide.


Response to Letter to the Editor on "Digital Orthopedics. A Glimpse Into the Future in the Midst of a Pandemic"


Enfermedad por coronavirus2019(COVID-19): laimportancia de estar alerta ante las zoonosis/ Coronavirus disease2019(COVID-19): the importance of being aware of zoonose


The COVID-19 Curriculum


title: Clinical evaluation of AusDiagnostics SARS-CoV-2 multiplex tandem PCR assay

text: BACKGROUND: In the context of the pandemic, the rapid emergency use authorisation of diagnostic assays for SARS-CoV-2 has meant there are few peer-reviewed published studies of clinical performance of commercial assays. AIMS: To evaluate the clinical performance of AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2. METHODS: We reviewed the results following implementation of AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2, and compared with an in-house RT-PCR assay at our State Reference Laboratory. RESULTS: Initial validation using AusDiagnostics coronavirus multiplex tandem PCR assay including SARS-CoV-2 demonstrated good concordance with the State Reference Laboratory. After implementing the AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2, we tested 7839 samples. 127 samples in which SARS-CoV-2 was detected using the AusDiagnostics assay were referred for testing at the State Reference Laboratory, with concordant results in 118/127 (92.9%) of samples. After resolution of discrepancies, 125/127 (98.4%) of AusDiagnostics results were determined to be true positive results. Out of 7839 samples tested for SARS-CoV-2 during this period, only 2 tests (0.02%) were indeterminate results. CONCLUSION: The AusDiagnostics respiratory MT-PCR assay is a reliable assay for detection of SARS-CoV-2.


Successful sequencing of the first SARS-CoV-2 genomes from Croatian patients


title: [Analysis of Symptoms Relieved in Addition to Pain after Administration of Oxycodone or Morphine to Patients with Advanced Cancer Living at Home]

text: Cancer pain was observed in 131 of 160 patients with advanced cancer living at home. Oxycodone or morphine was administered to patients suffering from cancer pain or fentanyl transdermal patch was switched to morphine. Subsequently, 70 patients were found to have alleviation of symptoms such as nausea/vomiting, dyspnea, abdominal fullness, general fatigue, cough, and urinary urgency in addition to pain. Pain was defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage by the International Association for the Study of Pain. This definition of pain is cited in a lot of books. However, the author was unable to intervene with detailed reports of unpleasant sensations associated with tissue damage. Therefore, here the author reports about an unpleasant sensation caused by tissue damage of cancer that was alleviated by oxycodone or morphine.


title: The invisible victims - Impact of the pandemic on patients without COVID-19

text: The coronavirus disease (COVID-19) pandemic has shocked the world to a standstill. Routine healthcare has been severely disrupted. Healthcare service is a finite resource and in the current pandemic situation the risks of providing care to individual patients, whether they be confirmed, probable or suspected cases, should be balanced against the ability to provide safe routine long-term care to others. But how far can the healthcare system protect itself and fear the unknown, before it starts causing harm by omission? Herein we provide a review of cases that were misdiagnosed, left stranded in the system or had to face unnecessary delays due to the lack of an organised pathway.


title: Improving the care of older patients during the COVID-19 pandemic

text: The SARS-CoV-2 pandemic has led to a dramatic crisis of Health Care Systems worldwide, and older people have been among the most disadvantaged. Specific recommendations and reports have been released both at International and National level, regarding the diagnosis and management of COVID-19 in the elderly. However, little has been proposed for an appropriate response to older, frail and multimorbid patients in different settings of care (acute care units, long term care facilities, nursing homes and primary care) and for the management of geriatric syndromes (i.e. delirium, sarcopenia, falls). We presume that the current pandemic of will leads to substantial changes in health care systems, and we suggest some key guide principles that could inspire the provision of healthcare services to older people and their families. These principles are primarily directed to physicians and nurses working in the geriatric field but could also be useful for other specialists.


docid: ovgdbsab

title: Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing, China


title: Repurposing Quaternary Ammonium Compounds as Potential Treatments for COVID-19

text: The COVID-19 pandemic has highlighted an important role for drug repurposing. Quaternary ammonium compounds such as ammonium chloride, cetylpyridinium and miramistin represent widely accessible antiseptic molecules with well-known broad-spectrum antiviral activities and represent a repurposing opportunity as therapeutics against SARS-CoV-2.


Potential for global spread of a novel coronavirus from China


Procedures to minimize viral diffusion in the intensive care unit during the COVID-19 pandemic


title: Restructuring Structural Heart Disease Practice During the COVID-19 Pandemic: JACC Review Topic of the Week

text: Patients with structural heart disease are at increased risk of adverse outcomes from the coronavirus disease-2019 (COVID-19) due to advanced age and comorbidity. In the midst of a global pandemic of a novel infectious disease, reality-based considerations comprise an important starting point for formulating clinical management pathways. The aims of these "crisis-driven" recommendations are: 1) to ensure appropriate and timely treatment of structural heart disease patients; 2) to minimize the risk of COVID-19 exposure to patients and health care workers; and 3) to limit resource utilization under conditions of constraint. Although the degree of disruption to usual practice will vary across the United States and elsewhere, we hope that early experiences from a heart team operating in the current global epicenter of COVID-19 may prove useful for others adapting their practice in advance of local surges of COVID-19.


title: In-store epidemic behavior: scale development and validation

text: Epidemics of infectious diseases have accompanied humans for a long time and, depending on the scale, cause various undesirable social and economic consequences. During the ongoing COVID-19 pandemic, governments of many countries impose restrictions to inhibit spreading of infection. Isolation and limiting interpersonal contacts are particularly recommended actions. Adhering to the rule of isolation may involve restrictions in freedom during daily activities, such as shopping. The aim of the study was to develop a scale of in-store pandemic behavior. The whole process involved 3 stages: qualitative inquiry, scale purification and scale validation, which were based on 3 studies: 1 qualitative (20 in-depth interviews) 2 two quantitative (373 and 584 respondents, respectively), and allowed to identify 8 factors. Following, a theoretical model was created to investigate the impact of in-store infection threat on identified variables. All identified factors significantly correlated with the in-store infection threat which reiterates the importance of providing information revealing the true scale of the pandemic and not leaving space for individuals to create subjective probability judgments. The developed scale can help counteract disinformation and assess consumer behavior compliance and understanding of the official recommendations imposed by governments, enabling more efficient educational efforts.


Editorial: increasing IBD prevalence and its complications in the context of the COVID-19 pandemic. Authors' reply


docid: wwucpqin

title: Why African Americans Are a Potential Target for COVID-19 Infection in the United States

text: Since the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic, significant changes have occurred in the United States as the infection spread reached and passed its exponential phase. A stringent analysis of COVID-19 epidemiologic data requires time and would generally be expected to happen with significant delay after the exponential phase of the disease is over and when the focus of the health care system is diverted away from crisis management. Although much has been said about high-risk groups and the vulnerability of the elderly and patients with underlying comorbidities, the impact of race on the susceptibility of ethnic minorities living in indigent communities has not been discussed in detail worldwide and specifically in the United States. There are currently some data on disparities between African American and Caucasian populations for COVID-19 infection and mortality. While health care authorities are reorganizing resources and infrastructure to provide care for symptomatic COVID-19 patients, they should not shy away from protecting the general public as a whole and specifically the most vulnerable members of society, such as the elderly, ethnic minorities, and people with underlying comorbidities.


title: Any unique image biomarkers associated with COVID-19?

text: OBJECTIVE: To define the uniqueness of chest CT infiltrative features associated with COVID-19 image characteristics as potential diagnostic biomarkers. METHODS: We retrospectively collected chest CT exams including n = 498 on 151 unique patients RT-PCR positive for COVID-19 and n = 497 unique patients with community-acquired pneumonia (CAP). Both COVID-19 and CAP image sets were partitioned into three groups for training, validation, and testing respectively. In an attempt to discriminate COVID-19 from CAP, we developed several classifiers based on three-dimensional (3D) convolutional neural networks (CNNs). We also asked two experienced radiologists to visually interpret the testing set and discriminate COVID-19 from CAP. The classification performance of the computer algorithms and the radiologists was assessed using the receiver operating characteristic (ROC) analysis, and the nonparametric approaches with multiplicity adjustments when necessary. RESULTS: One of the considered models showed non-trivial, but moderate diagnostic ability overall (AUC of 0.70 with 99% CI 0.56-0.85). This model allowed for the identification of 8-50% of CAP patients with only 2% of COVID-19 patients. CONCLUSIONS: Professional or automated interpretation of CT exams has a moderately low ability to distinguish between COVID-19 and CAP cases. However, the automated image analysis is promising for targeted decision-making due to being able to accurately identify a sizable subsect of non-COVID-19 cases. KEY POINTS: â¢ Both human experts and artificial intelligent models were used to classify the CT scans. â¢ ROC analysis and the nonparametric approaches were used to analyze the performance of the radiologists and computer algorithms. â¢ Unique image features or patterns may not exist for reliably distinguishing all COVID-19 from CAP; however, there may be imaging markers that can identify a sizable subset of non-COVID-19 cases.


Understanding COVID-19 new diagnostic guidelines - a message of reassurance from an internal medicine doctor in Shanghai


title: Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

text: BACKGROUND: An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. METHODS: In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. FINDINGS: Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3-11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. INTERPRETATION: The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1-2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. FUNDING: None.


Altered taste in patients with COVID-19: The potential role of salivary glands


title: The Microbiology of Coronaviruses

text: The end of 2019 marked the start of coronavirus disease (COVID-19) pandemic from China, which went on to envelope more than 190 countries and territories across the globe. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from a group of betacoronaviruses, is responsible for COVID-19. The virulent factors include the presence of envelope and spike proteins having receptor bonding domains (RBD). Clinical manifestations can range from mild respiratory infections to fatal outcomes. The viability of virus ranges from 3 to 72 hours. Polymerase chain reaction (PCR) is the diagnostic test of choice in this pandemic situation. Due to the absence of specific antivirals and vaccine, adoption of preventive option can help to combat the specific life-threatening outcomes.


COVID-19 in Canada and the use of Personal Protective Equipment


title: How we should respond to the Coronavirus SARS-CoV-2 outbreak: A German perspective

text: BACKGROUND: In the early phase of the COVID-19 pandemic Germany missed to set up efficient containment measures. Consequently, the number of cases increased exponentially until a lockdown was implemented to suppress the spread of SARS-CoV-2. Fortunately, Germany has a high capability for coronavirus lab testing and more than 30,000 ICU beds. These capabilities and the lockdown turned out to be an advantage to combat the pandemic and to prevent a health-system overload. AIM: The aim was to predict the plateau day of SARS-CoV-2 infections or deaths. RESULTS: The effect on the viral spread of the German measures taken and the impact on the peak of new infection cases is shown. By normalizing daily case numbers, the plateau day of the current outbreak in Germany could be calculated to be reached at April 12, 2020 (day 103 of 2020). CONCLUSION: Normalized case number curves are helpful to predict the time point at which no further new infections will occur if the epidemic situation remains stable. Upon reaching the plateau day during a lockdown phase, a residual time-period of about 2-3 weeks can be utilized to prepare a safe unlocking period. As can be learned from Asian countries such as South Korea and Taiwan there must be strict rules to keep the risk of infection low. Those include social distancing, face mask wearing in combination with digital contact tracing and serosurveillance studies. Following those rules, a safe dance around the infection curve allows to keep the population at a reduced infection rate.


title: COVID-19 in recent kidney transplant recipients

text: As the coronavirus disease 2019 (COVID-19) pandemic spread across the globe, transplant programs suffered a setback. We report the first experience of COVID-19 infection within 1 month of living donor kidney transplant (LDKT). We describe 2 LDKT recipients who were detected positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at day 19 and day 7 posttransplant. They had minimal symptoms at diagnosis and did not develop any respiratory complications or allograft dysfunction. Immunosuppression was de-escalated; however, nasopharyngeal swab real-time reverse transcription polymerase chain reaction (rRT-PCR) remained positive for SARS-CoV-2 for a prolonged time. Younger age, absence of other comorbidities, and lower dose of anti-thymocyte globulin (ATG) used as induction possibly contributed to good outcome in our recent LDKT recipients compared with earlier published cases of recent deceased donor kidney transplant recipients with COVID-19.


Lack of type 1 diabetes involvement in SARS-COV-2 population: Only a particular coincidence?


title: Reconfiguring the scope and practice of regional anesthesia in a pandemic: the COVID-19 perspective

text: The COVID-19 outbreak is on the world. While many countries have imposed general lockdown, emergency services are continuing. Healthcare professionals have been infected with the virulent severe acute respiratory syndrome coronavirus-2 (SARS), which spreads by close contact and aerosols. The anesthesiologist is particularly vulnerable to aerosols while performing intubation and other airway related procedures. Regional anesthesia (RA) minimizes the need for airway manipulation and the risks of cross infection to other patients, and the healthcare personnel. In this context, for prioritizing RA over general anesthesia, wherever possible, a structured algorithmic approach is outlined. The role of percentage saturation of hemoglobin with oxygen (oxygen saturation), blood pressure and early use of point-of-care ultrasound in differential diagnosis and specific management is detailed. The perioperative anesthetic implications of multisystem manifestations of COVID-19, anesthetic management options, the scope of RA and considerations for its safe conduct in operating rooms is described. An outline for safe and rapid training of healthcare personnel, with an Entrustable Professional Activity framework for ascertaining the practice readiness among trained residents for RA in COVID-19, is suggested. These are the authors' experiences gained from the current pandemic and similar SARS, Middle East Respiratory Syndrome and influenza outbreaks in recent past faced by our authors in Singapore, India, Hong Kong and Canada.


title: Public Health Communication in Time of Crisis: Readability of On-Line COVID-19 Information

text: OBJECTIVE: The purpose of this study was to assess the readability of information on the Internet posted about coronavirus disease 2019 (COVID-19) to determine how closely these materials are written to the recommended reading levels. METHODS: Using the search term "coronavirus," information posted on the first 100 English language websites was identified. Using an online readability calculator, multiple readability tests were conducted to ensure a comprehensive representation would result. RESULTS: The mean readability scores ranged between grade levels 6.2 and 17.8 (graduate school level). Four of the 5 measures (GFI, CLI, SMOG, FRE) found that readability exceeded the 10th grade reading level indicating that the text of these websites would be difficult for the average American to read. The mean reading level for nearly all noncommercial and commercial websites was at or above the 10th grade reading level. CONCLUSIONS: Messages about COVID-19 must be readable at an "easy" level, and must contain clear guidelines for behavior. The degree to which individuals seek information in response to risk messages is positively related to the expectation that the information will resolve uncertainty. However, if the information is too complex to interpret and it fails to lead to disambiguation, this can contribute to feelings of panic.


COVID-19 cytokine storm and novel truth


title: Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic

text: INTRODUCTION: Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols. OBJECTIVE: To demonstrate the utility of a modified anesthesia protocol for ECT utilizing preoxygenation by facemask and withholding the use of BMV for only those patients who desaturate during the apneic period. METHODS: This chart review study analyzes patients who were treated with ECT using both the traditional and modified anesthesia protocols. RESULTS: A total of 106 patients were analyzed, of whom 51 (48.1%) required BMV using the new protocol. Of clinical factors, only patient BMI was significantly associated with the requirement for BMV. Mean seizure duration reduced from 52.0 ± 22.4 to 46.6 ± 17.1 s, but seizure duration was adequate in all cases. No acute physical, respiratory, or psychiatric complications occurred during treatment. CONCLUSIONS: A modified anesthesia protocol reduces the use of BMV by more than 50%, while retaining adequate seizure duration.


title: Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China

text: BACKGROUND: On January 20, 2020, a new coronavirus epidemic with human-to-human transmission was officially declared by the Chinese government, which caused significant public panic in China. In light of the coronavirus disease 2019 outbreak, pregnant women may be particularly vulnerable and in special need for preventive mental health strategies. Thus far, no reports exist to investigate the mental health response of pregnant women to the coronavirus disease 2019 outbreak. OBJECTIVE: This study aimed to examine the impact of coronavirus disease 2019 outbreak on the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women across China. STUDY DESIGN: A multicenter, cross-sectional study was initiated in early December 2019 to identify mental health concerns in pregnancy using the Edinburgh Postnatal Depression Scale. This study provided a unique opportunity to compare the mental status of pregnant women before and after the declaration of the coronavirus disease 2019 epidemic. A total of 4124 pregnant women during their third trimester from 25 hospitals in 10 provinces across China were examined in this cross-sectional study from January 1, 2020, to February 9, 2020. Of these women, 1285 were assessed after January 20, 2020, when the coronavirus epidemic was publicly declared and 2839 were assessed before this pivotal time point. The internationally recommended Edinburgh Postnatal Depression Scale was used to assess maternal depression and anxiety symptoms. Prevalence rates and risk factors were compared between the pre- and poststudy groups. RESULTS: Pregnant women assessed after the declaration of coronavirus disease 2019 epidemic had significantly higher rates of depressive symptoms (26.0% vs 29.6%, P=.02) than women assessed before the epidemic declaration. These women were also more likely to have thoughts of self-harm (P=.005). The depressive rates were positively associated with the number of newly confirmed cases of coronavirus disease 2019 (P=.003), suspected infections (P=.004), and deaths per day (P=.001). Pregnant women who were underweight before pregnancy, primiparous, younger than 35 years, employed full time, in middle income category, and had appropriate living space were at increased risk for developing depressive and anxiety symptoms during the outbreak. CONCLUSION: Major life-threatening public health events such as the coronavirus disease 2019 outbreak may increase the risk for mental illness among pregnant women, including thoughts of self-harm. Strategies targeting maternal stress and isolation such as effective risk communication and the provision of psychological first aid may be particularly useful to prevent negative outcomes for women and their fetuses.


title: Perinatal depressive and anxiety symptoms of pregnant women along with COVID-19 outbreak in China

text: BACKGROUND: On January 20, 2020, a new coronavirus epidemic with "human-to-human" transmission was officially announced by the Chinese government, which caused significant public panic in China. Pregnant women may be particularly vulnerable and in special need for preventative mental health strategies. Thus far, no reports exist to investigate the mental health response of pregnant women to the COVID-19 outbreak. OBJECTIVE: The aim of the present study is to examine the impact of COVID-19 outbreak on the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women across China. STUDY DESIGN: A multi-center cross-sectional study was initiated in early December 2019 to identify mental health concerns in pregnancy using the Edinburgh Postnatal Depression Scale (EPDS). This study provided a unique opportunity to compare the mental status of pregnant women before and after the announcement of the COVID-19 epidemic. A total of 4124 pregnant women during their third trimester from 25 hospitals in 10 provinces across China were examined in this cross-sectional study from January 1 to February 9, 2020. Of these women, 1285 were assessed after January 20, 2020 when the coronavirus epidemic was publically announced and 2839 were assessed before this pivotal time point. The internationally recommended EPDS was used to assess maternal depression and anxiety symptoms. Prevalence rates and risk factors were compared between the pre and post study groups. RESULTS: Pregnant women assessed after the declaration of COVID-19 epidemic had significantly higher rates of depressive symptoms (26.0% vs 29.6%, P=0.02) than women assess pre-epidemic announcement. These women were also more likely to endorse thoughts of self-harm (P=0.005). The depressive rates were positively associated with the number of newly-confirmed COVID-19 cases (P=0.003), suspected infections (P=0.004), and death cases per day (P=0.001). Pregnant women who were underweight pre-pregnancy, primiparous, < 35 years old, employed full-time, middle income, and had appropriate living space were at increased risk to develop depressive and anxiety symptoms during the outbreak. CONCLUSION: Major life-threatening public health events such as the COVID-19 outbreak may increase the risk for mental illness among pregnant women including thoughts of self-harm. Strategies targeting maternal stress and isolation such as effective risk communication and the provision of psychological first aid may be particularly useful to prevent negative outcomes for women and their fetuses.


COVID-19: a danger and an opportunity for the future of general practice


Lung Ultrasound in COVID-19 Patients - More Shadows Than Information - Letter to the Editor on the Article "W. LU et al. Ultraschall in Med. 2020 Apr 15"


title: WiFiTrace: Network-based Contact Tracing for Infectious Diseases Using Passive WiFi Sensing

text: Contact tracing is a well-established and effective approach for containment of spread of infectious diseases. While bluetooth-based contact tracing method using phones have become popular recently, these approaches suffer from the need for a critical mass of adoption in order to be effective. In this paper, we present WifiTrace, a network-centric approach for contact tracing that relies on passive WiFi sensing with no client-side involvement. Our approach exploits WiFi network logs gathered by enterprise networks for performance and security monitoring and utilizes it for reconstructing device trajectories for contact tracing. Our approach is specifically designed to enhance the efficacy of traditional methods, rather than to supplant it with a new technology. We design an efficient graph algorithm to scale our approach to large networks with tens of thousands of users. We have implemented a full prototype of our system and deployed it on two large university campuses. We validate our approach and demonstrate its efficacy using case studies and detailed experiments using real-world WiFi datasets.


Second-Trimester Miscarriage in a Pregnant Woman With SARS-CoV-2 Infection


title: NCI's Work to Advance Cancer Research while Responding to the COVID-19 Pandemic

text: During the COVID-19 pandemic, the National Cancer Institute (NCI) is bringing to bear its considerable expertise and capabilities to understand, treat, and prevent the disease. While responding to the pandemic, NCI's priority remains the advancement of cancer research. NCI has implemented many flexibilities for grantees and trainees.


COVID-19 and Perinatal Psychiatry


title: Serology characteristics of SARS-CoV-2 infection since exposure and post symptom onset

text: BACKGROUND: Timely diagnosis of SARS-CoV-2 infection is a prerequisite for treatment and prevention. The serology characteristics and complement diagnosis value of the antibody test to RNA test need to be demonstrated. METHOD: Serial sera of 80 patients with PCR-confirmed COVID-19 were collected at the First Affiliated Hospital of Zhejiang University, China. Total antibody (Ab), IgM and IgG antibodies against SARS-CoV-2 were detected, and the antibody dynamics during the infection were described. RESULTS: The seroconversion rates for Ab, IgM and IgG were 98.8%, 93.8% and 93.8%, respectively. The first detectible serology marker was Ab, followed by IgM and IgG, with a median seroconversion time of 15, 18 and 20â days post exposure (d.p.e) or 9, 10 and 12â days post onset (d.p.o), respectively. The antibody levels increased rapidly beginning at 6â d.p.o. and were accompanied by a decline in viral load. For patients in the early stage of illness (0-7â d.p.o), Ab showed the highest sensitivity (64.1%) compared to IgM and IgG (33.3% for both, p<0.001). The sensitivities of Ab, IgM and IgG increased to 100%, 96.7% and 93.3% 2â weeks later, respectively. When the same antibody type was detected, no significant difference was observed between enzyme-linked immunosorbent assays and other forms of immunoassays. CONCLUSIONS: A typical acute antibody response is induced during SARS-CoV-2 infection. Serology testing provides an important complement to RNA testing in the later stages of illness for pathogenic specific diagnosis and helpful information to evaluate the adapted immunity status of patients.


Reumataxi: una experiencia solidaria en tiempos de COVID-19./ Reumataxi: una experiencia solidaria en tiempos de COVID-19./ Reumataxi: An experience of solidarity in times of COVID-19


title: [Psychological status and sleep quality of nursing interns during the outbreak of COVID-19]

text: OBJECTIVE: To investigate the psychological status and sleep quality of nursing interns in collective isolation during the outbreak of coronavirus disease 2019 (COVID-19) and provide evidence for adequate interventions. METHODS: We surveyed a total of 95 nursing interns who were isolated collectively in a general teaching hospital in Guangzhou using a self-designed questionnaire, which consisted of a basic information form, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Pittsburgh Sleep Quality Index (PSQI). Descriptive analysis, single factor analysis and correlation analysis were used to analyze the current status of the interns' psychology and sleep quality, the potential factors affecting their psychology and sleep quality, and the correlation between their psychological status and sleep quality. RESULTS: The surveyed interns had SAS, SDS and PSQI score of 37.79±6.59, 43.98±9.74 and 5.20±3.14, respectively, which were significant higher than the national norms in China (P < 0.05). Correlation analysis indicated that both anxiety and depression were positively correlated with the sleep quality score (r=0.508 and 0.546, respectively). Univariate analysis showed that the major factors affecting the psychological status and sleep quality of the interns during collective isolation included recent contact with persons from the affected area before isolation and the onset of fever during the isolation. CONCLUSIONS: These interns showed relatively high levels of anxiety and depression during the collective isolation to affect their sleep quality, and interventions should be timely administered to improve their mental health and sleep quality.


Going viral with kindness


title: SARS-CoV-2-specific antibody detection in healthcare workers in Germany with direct contact to COVID-19 patients

text: BACKGROUND: The novel coronavirus SARS-CoV-2 is associated with a severe respiratory manifestation, COVID-19, and presents a challenge for healthcare systems worldwide. Healthcare workers are a vulnerable cohort for SARS-CoV-2 infection due to frequent and close contact to patients with COVID-19. STUDY DESIGN: Serum samples from 316 healthcare workers of the University Hospital Essen, Germany were tested for SARS-CoV-2-IgG antibodies. A questionnaire was used to collect demographic and clinical data. Healthcare workers were grouped depending on the frequency of contact to COVID-19 patients in high-risk-group (n = 244) with daily contact to known or suspected SARS-CoV-2 positive patients, intermediated-risk-group (n = 37) with daily contact to patients without known or suspected SARS-CoV-2 infection at admission and low-risk-group (n = 35) without patient contact. RESULTS: In 5 of 316 (1.6 %) healthcare workers SARS-CoV-2-IgG antibodies could be detected. The seroprevalence was higher in the intermediate-risk-group vs. high-risk-group (2/37 (5.4 %) vs. 3/244 (1.2 %), p = 0.13). Four of the five subject were tested negative for SARS-CoV-2 via PCR. One (20 %) subject was not tested via PCR since he was asymptomatic. CONCLUSION: The overall seroprevalence of SARS-CoV-2 in healthcare workers of a tertiary hospital in Germany is low (1.6 %). The data indicate that the local hygiene standard might be effective.


Treating neovascular age-related macular degeneration in the era of COVID-19


China coronavirus: cases surge as official admits human to human transmission


Maintaining quality newborn care in Ghana amid the COVID-19 pandemic


Severe acute respiratory syndrome coronavirus 19 and human pregnancy


title: Redesign of a GI endoscopy unit during the COVID-19 emergency: A practical model

text: The pandemic diffusion of the SARS-CoV-2 infection throughout the world required measures to prevent and strategies to control the infection, as well as the reallocation of the hospital structures in order to take care of an increased number of infected patients. Endoscopy Units should be able to perform endoscopic procedures on COVID-19 infected as well as on noninfected patients. The aim of this manuscript is to propose a model for a fast reorganization of the endoscopy department environment in order to safely perform endoscopic procedures in this Pandemic COVID-19 scenario, according to the current advices given by the Scientific Societies.


docid: drmaffxn

title: M3d-CAM: A PyTorch library to generate 3D data attention maps for medical deep learning

text: M3d-CAM is an easy to use library for generating attention maps of CNN-based PyTorch models improving the interpretability of model predictions for humans. The attention maps can be generated with multiple methods like Guided Backpropagation, Grad-CAM, Guided Grad-CAM and Grad-CAM++. These attention maps visualize the regions in the input data that influenced the model prediction the most at a certain layer. Furthermore, M3d-CAM supports 2D and 3D data for the task of classification as well as for segmentation. A key feature is also that in most cases only a single line of code is required for generating attention maps for a model making M3d-CAM basically plug and play.


title: Keeping people with epilepsy safe during the COVID-19 pandemic

text: OBJECTIVES: To provide information on the effect of the coronavirus disease of 2019 (COVID-19) pandemic on people with epilepsy and provide consensus recommendations on how to provide the best possible care for people with epilepsy while avoiding visits to urgent care facilities and hospitalizations during the novel coronavirus pandemic. METHODS: The authors developed consensus statements in 2 sections. The first was "How should we/clinicians modify our clinical care pathway for people with epilepsy during the COVID-19 pandemic?" The second was "What general advice should we give to people with epilepsy during this crisis? The authors individually scored statements on a scale of -10 (strongly disagree) to +10 (strongly agree). Five of 11 recommendations for physicians and 3/5 recommendations for individuals/families were rated by all the authors as 7 or above (strongly agree) on the first round of rating. Subsequently, a teleconference was held where statements for which there was a lack of strong consensus were revised. RESULTS: After revision, all consensus recommendations received a score of 7 or above. The recommendations focus on administration of as much care as possible at home to keep people with epilepsy out of health care facilities, where they are likely to encounter COVID-19 (including strategies for rescue therapy), as well as minimization of risk of seizure exacerbation through adherence, and through ensuring a regular supply of medication. We also provide helpful links to additional helpful information for people with epilepsy and health providers. CONCLUSION: These recommendations may help health care professionals provide optimal care to people with epilepsy during the coronavirus pandemic.


title: Cerebrovascular events in COVID-19 patients

text: Neurological manifestations in patients with COVID-19 are more frequently being reported. Cerebrovascular events have been reported in around 3% of patients. In this review we summarize the published literature on cerebrovascular events in patients with COVID-19 as available on the PubMed database. So far, 3 studies have reported cerebrovascular events. Cerebrovascular events were identified on screening patients with decreased consciousness or in the presence of focal neurological deficits. These events were common in elderly, critically ill patients and in patients with prior cardio-cerebrovascular comorbidities. The diagnosis of cerebrovascular events was confirmed with computed tomography of the brain in most studies reporting neurological events. Multiple pathological mechanisms have been postulated regarding the process of neurological and vascular injury among which cytokine storm is shown to correlate with mortality. Patients with severe illness are found to have a higher cardio- cerebrovascular comorbidity. With an increasing number of cases and future prospective studies, the exact mechanism by which these cerebrovascular events occur and attribute to the poor outcome will be better understood.


title: Facial Plastic and Reconstructive Surgery During the COVID-19 Pandemic: Implications in Craniomaxillofacial Trauma and Head and Neck Reconstruction

text: BACKGROUND: The global COVID-19 pandemic has had a profound impact on facial plastic and reconstructive surgery. Our review serves as a safety resource based on the current literature and is aimed at providing best-practice recommendations. Specifically, this article is focused on considerations in the management of craniomaxillofacial trauma as well as reconstructive procedures after head and neck oncologic resection. METHODS: Relevant clinical data were obtained from peer-reviewed journal articles, task force recommendations, and published guidelines from multiple medical organizations utilizing data sources including PubMed, Google Scholar, MEDLINE, and Google search queries. Relevant publications were utilized to develop practice guidelines and recommendations. CONCLUSIONS: The global COVID-19 pandemic has placed a significant strain on health care resources with resultant impacts on patient care. Surgeons operating in the head and neck are particularly at risk of occupational COVID-19 exposure during diagnostic and therapeutic procedures and must therefore be cognizant of protocols in place to mitigate exposure risk and optimize patient care.


title: Renal transplantation during COVID-19 period in Spain./ Trasplante renal en epoca COVID-19 en Espana

text: INTRODUCTION: The COVID-19 pandemic poses significant challenges in the area of kidney donation and transplantation The objective of this article is to establish general recommendations for surgical teams to manage the kidney transplant program duringthe COVID-19 era MATERIAL AND METHODS: This document is based on the scientific evidence available on the infection caused by SARS-CoV-2 and the experience of authors during the COVID-19 pandemic A web and Pubmed search was performed using the keywords "SARS-CoV-2"," COVID-19", "COVID Urology", "COVID-19 surgery", and "kidney transplantation " A modified nominal group technique was used RESULTS: When health system saturation occurs, kidney transplants should be deferred, except in patients with low transplant possibilities and an optimal kidney available, combined transplants or life-threatening situations Screening for the SARS-CoV-2 virus should be done in all those donors and recipients with clinical symptoms consistent with COVID-19, who have visited or live inhigh-risk areas, or who have been in close contact with confirmed cases of COVID-19 Donation and transplantation will not proceed in confirmed cases of COVID-19 Surgeries should be based on general recommendations in the COVID-19 era and will be efficient, short, and focused on those with the shortest hospital stay In emergencies, protective measures will be taken with persona lprotection equipment Surgical staff will be only the strictly necessary, and permanence in the OR should be minimized Transplant urology consultations will be conducted by teleconsultation when possible CONCLUSION: The safety of potential donors and recipients must be guaranteed, adopting individual protection measures and screening for SARS-CoV-2 Kidney transplant surgery must be efficient in terms of health, human resources, and clinical benefit All non-urgent transplant activities should be delayed until the improvement of the local condition of each center INTRODUCCION: La epidemia de COVID-19 plantea importantes retos en el ambito de la donacion y el trasplante renal El objetivo de este articulo es establecer unas recomendaciones generales dirigidas a los equipos quirurgicos de trasplante renal durante la era COVID-19 MATERIAL Y METODOS: El documento se basa en la evidencia cientifica disponible sobre la infeccion causada por SARS-CoV-2 y la experiencia de los autores en la pandemia COVID-19 Se realizo una busqueda web y en PubMed utilizando las palabras clave SARSCoV-2, COVID-19, COVID Urology, COVID-19 surgery y kidney transplantation Se ha utilizado una tecnica de grupo nominal modificada RESULTADOS: En momentos de saturacion del sistema sanitario, se deberan diferir los trasplantes renales, salvo en pacientes con bajas posibilidades de trasplante y un rinon optimo disponible, trasplantes combinados o pacientes en situacion de urgencia vital Se debera hacer cribado del virus SARS-CoV-2 en todos aquellos donantes y receptores que tengan sospecha clinica, hayan estado en zonas de alto riesgo o hayan compartido proximidad con casos confirmados de COVID-19 Nos e procedera con la donacion ni con el trasplante en casos confirmados de COVID-19 Las cirugias deberans er eficientes, cortas y centradas en las que menor estancia hospitalaria conlleven En casos de urgencia, se extremaran las medidas de proteccion con equipos de proteccion individual El personal quirurgico sera el menor posible y se minimizaran las estancias en quirofano Las consultas urologicas de trasplante sin riesgo seran realizadas telematicamente cuando sea posible CONCLUSION: La cirugia de trasplante renal debe ser eficiente en cuanto a recursos sanitarios, humano sy beneficio clinico Se debe garantizar la seguridad de los potenciales donantes y receptores, adoptando medidas de proteccion individual y realizando cribado para SARS-CoV-2


title: [Renal transplantation during COVID-19 period in Spain.]

text: INTRODUCTION: The COVID-19 pandemic poses significant challenges in the area of kidney donation and transplantation The objective of this article is to establish general recommendations for surgical teams to manage the kidney transplant program duringthe COVID-19 era MATERIAL AND METHODS: This document is based on the scientific evidence available on the infection caused by SARS-CoV-2 and the experience of authors during the COVID-19 pandemic A web and Pubmed search was performed using the keywords "SARS-CoV-2"," COVID-19", "COVID Urology", "COVID-19 surgery", and "kidney transplantation " A modified nominal group technique was used RESULTS: When health system saturation occurs, kidney transplants should be deferred, except in patients with low transplant possibilities and an optimal kidney available, combined transplants or life-threatening situations Screening for the SARS-CoV-2 virus should be done in all those donors and recipients with clinical symptoms consistent with COVID-19, who have visited or live inhigh-risk areas, or who have been in close contact with confirmed cases of COVID-19 Donation and transplantation will not proceed in confirmed cases of COVID-19 Surgeries should be based on general recommendations in the COVID-19 era and will be efficient, short, and focused on those with the shortest hospital stay In emergencies, protective measures will be taken with persona lprotection equipment Surgical staff will be only the strictly necessary, and permanence in the OR should be minimized Transplant urology consultations will be conducted by teleconsultation when possible CONCLUSION: The safety of potential donors and recipients must be guaranteed, adopting individual protection measures and screening for SARS-CoV-2 Kidney transplant surgery must be efficient in terms of health, human resources, and clinical benefit All non-urgent transplant activities should be delayed until the improvement of the local condition of each center


title: CSANZ Position Statement on the Evaluation of Patients Presenting With Suspected Acute Coronary Syndromes During the COVID-19 Pandemic

text: A pandemic of Coronavirus-19 disease was declared by the World Health Organization on March 11, 2020. The pandemic is expected to place unprecedented demand on health service delivery. This position statement has been developed by the Cardiac Society of Australia and New Zealand to assist clinicians to continue to deliver rapid and safe evaluation of patients presenting with suspected acute cardiac syndrome at this time. The position statement complements, and should be read in conjunction with, the National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016: Section 2 'Assessment of Possible Cardiac Chest Pain'.


title: The Exponentially Increasing Rate of Patients Infected with COVID-19 in Iran

text: BACKGROUND: Coronavirus, the cause of severe acute respiratory syndrome (COVID-19), is rapidly spreading around the world. Since the number of corona positive patients is increasing sharply in Iran, this study aimed to forecast the number of newly infected patients in the coming days in Iran. METHODS: The data used in this study were obtained from daily reports of the Iranian Ministry of Health and the datasets provided by the Johns Hopkins University including the number of new infected cases from February 19, 2020 to March 21, 2020. The autoregressive integrated moving average (ARIMA) model was applied to predict the number of patients during the next thirty days. RESULTS: The ARIMA model forecasted an exponential increase in the number of newly detected patients. The result of this study also show that if the spreading pattern continues the same as before, the number of daily new cases would be 3574 by April 20. CONCLUSION: Since this disease is highly contagious, health politicians need to make decisions to prevent its spread; otherwise, even the most advanced and capable health care systems would face problems for treating all infected patients and a substantial number of deaths will become inevitable.


title: Advertisers Jump on Coronavirus Bandwagon: Politics, News, and Business

text: In the age of social media, disasters and epidemics usher not only a devastation and affliction in the physical world, but also prompt a deluge of information, opinions, prognoses and advice to billions of internet users. The coronavirus epidemic of 2019-2020, or COVID-19, is no exception, with the World Health Organization warning of a possible"infodemic"of fake news. In this study, we examine the alternative narratives around the coronavirus outbreak through advertisements promoted on Facebook, the largest social media platform in the US. Using the new Facebook Ads Library, we discover advertisers from public health and non-profit sectors, alongside those from news media, politics, and business, incorporating coronavirus into their messaging and agenda. We find the virus used in political attacks, donation solicitations, business promotion, stock market advice, and animal rights campaigning. Among these, we find several instances of possible misinformation, ranging from bioweapons conspiracy theories to unverifiable claims by politicians. As we make the dataset available to the community, we hope the advertising domain will become an important part of quality control for public health communication and public discourse in general.


title: Pandemics and Their Impact on Medical Training: Lessons From Singapore

text: The ongoing COVID-19 crisis has hit Singapore hard. As of February 25, 2020, Singapore had the 4th highest number of confirmed COVID-19 infections outside of China, only trailing behind South Korea, Italy, and Japan. This has had reverberating effects on Singapore's health care system, and has, consequently, also affected medical education all the way from the undergraduate to the postgraduate level. While efforts are underway to contain disease spread and transmission, the authors believe that this is an opportune time to examine and reflect on the impact that medical crises like COVID-19 can have on medical training and education and to evaluate "business continuity plans" to ensure quality medical education even in the face of constant disruptions from pandemic outbreaks. Medical training is as important a mandate as patient care and service. The authors believe that even in trying times like this, rich and precious lessons can be sought and taught, which will immensely benefit medical students and residents-the health care leaders of tomorrow. In this Perspective, the authors discuss the various ways in which the COVID-19 crisis has affected medical instruction in Singapore and explore pertinent practical and creative solutions for the continuity of medical training in these trying times, drawing on their previous experience with the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 as well as the current ongoing COVID-19 crisis.


Obesity Is a Risk Factor for Severe COVID-19 Infection: Multiple Potential Mechanisms


title: Coronavirus disease (Covid-19): how does the exercise practice in active people with Type 1 Diabetes change? A preliminary survey

text: AIMS: Coronavirus disease (Covid-19) could lead persons with pre-existing medical conditions to severe respiratory infections. The Italian Government introduced quarantine to limit viral transmission. This measure could lead people with type 1 diabetes (PWT1D) to disrupt daily care routine including PA practice with difficulties in glycemia management. This study aims to explore PA level in PWT1D before and during quarantine and to describe variation in glycemia values. METHODS: An online survey investigating medical factors and the perceived and PA level in pre-established period before and after the introduction of quarantine was developed. Comparison between pre and post quarantine was assessed by Wilcoxon Signed Ranks test for continuous variables. RESULTS: A total of 154 subjects satisfied the eligibility criteria (54.5% males, 44.8±12.5 years). We found a decrease of PA level (Godin Scale Score 25±1.7vs38.6±1.7 points), steps number and minutes of exercise (respectively 12.606±5026vs4.760±3.145 and 66±4vs38±3) and an increase of glycemia values (142.1± 25.4 mg/dLvs150.8±29.4 mg/dL) CONCLUSIONS: PWT1D reported a decrease in exercise and worst glycemia. Although PWT1D tried to remain active, their PA level was inadequate to prevent glycemia rising. The difficult to maintain a glycemic control could expose patients to diabetes complications and to an higher risk to counteract infections.


title: Immunosuppressive therapy maintenance in a kidney transplant recipient with SARS-CoV-2 pneumonia: A case report

text: The role of systemic inflammation is proving crucial in determining unfavorable outcome in SARS-CoV-2-infected patients. Limited data are available regarding immunosuppression management in kidney transplant recipients (KTRs) with SARS-CoV-2 pneumonia. We report a case of a 32-year-old KTR who developed SARS-CoV-2 infection and fully recovered in 15 days while maintaining standard immunosuppressive therapy.


Repurposing a Pediatric ICU for Adults


Covid-19 in Italy: Lesson from the Veneto Region


title: Genomic surveillance reveals multiple introductions of SARS-CoV-2 into Northern California

text: The COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 has spread globally, with >52,000 cases in California as of May 4, 2020. Here we investigate the genomic epidemiology of SARS-CoV-2 in Northern California from late January to mid-March 2020, using samples from 36 patients spanning 9 counties and the Grand Princess cruise ship. Phylogenetic analyses revealed the cryptic introduction of at least 7 different SARS-CoV-2 lineages into California, including epidemic WA1 strains associated with Washington State, with lack of a predominant lineage and limited transmission between communities. Lineages associated with outbreak clusters in 2 counties were defined by a single base substitution in the viral genome. These findings support contact tracing, social distancing, and travel restrictions to contain SARS-CoV-2 spread in California and other states.


Short Communication: COVID-19-Pandemie und HNO


Coronavirus disease 2019 pandemic: Do not forget patients with severe mental illness


title: A predictive model and scoring system combining clinical and CT characteristics for the diagnosis of COVID-19

text: OBJECTIVES: To develop a predictive model and scoring system to enhance the diagnostic efficiency for coronavirus disease 2019 (COVID-19). METHODS: From January 19 to February 6, 2020, 88 confirmed COVID-19 patients presenting with pneumonia and 80 non-COVID-19 patients suffering from pneumonia of other origins were retrospectively enrolled. Clinical data and laboratory results were collected. CT features and scores were evaluated at the segmental level according to the lesions' position, attenuation, and form. Scores were calculated based on the size of the pneumonia lesion, which graded at the range of 1 to 4. Air bronchogram, tree-in-bud sign, crazy-paving pattern, subpleural curvilinear line, bronchiectasis, air space, pleural effusion, and mediastinal and/or hilar lymphadenopathy were also evaluated. RESULTS: Multivariate logistic regression analysis showed that history of exposure (ß = 3.095, odds ratio (OR) = 22.088), leukocyte count (ß = - 1.495, OR = 0.224), number of segments with peripheral lesions (ß = 1.604, OR = 1.604), and crazy-paving pattern (ß = 2.836, OR = 2.836) were used for establishing the predictive model to identify COVID-19-positive patients (p < 0.05). In this model, values of area under curve (AUC) in the training and testing groups were 0.910 and 0.914, respectively (p < 0.001). A predicted score for COVID-19 (PSC-19) was calculated based on the predictive model by the following formula: PSC-19 = 2 × history of exposure (0-1 point) - 1 × leukocyte count (0-2 points) + 1 × peripheral lesions (0-1 point) + 2 × crazy-paving pattern (0-1 point), with an optimal cutoff point of 1 (sensitivity, 88.5%; specificity, 91.7%). CONCLUSIONS: Our predictive model and PSC-19 can be applied for identification of COVID-19-positive cases, assisting physicians and radiologists until receiving the results of reverse transcription-polymerase chain reaction (RT-PCR) tests. KEY POINTS: â¢ Prediction of RT-PCR positivity is crucial for fast diagnosis of patients suspected of having coronavirus disease 2019 (COVID-19). â¢ Typical CT manifestations are advantageous for diagnosing COVID-19 and differentiation of COVID-19 from other types of pneumonia. â¢ A predictive model and scoring system combining both clinical and CT features were herein developed to enable high diagnostic efficiency for COVID-19.


title: Time, distance, shielding and ALARA; drawing similarities between measures for radiation protection and Coronavirus disease pandemic response

text: The practice of radiation oncology requires stringent adherence to specific steps and principles designed to minimize exposure of an individual to unnecessary doses of radiation. The basic principles of such measures to reduce the risk of exposure and limit the doses of irradiation follow the "as low as reasonably achievable " or ALARA principle by using the concepts of time, distance and shielding. Potential exposures in radiation oncology are controlled through combination of optimal design and installation of radiation delivery equipment with well-defined standard operating procedures (SOPs). In the modern era of viral pandemics, similar principles can also be applied toward prevention of viral transmission and protection of populations at risk. In the ongoing COVID-19 pandemic, the probability of an individual getting infected is dependent on the viral load that an individual is exposed to in public spaces over a period of time. All prevention and control measures are based on preventing any such exposure to the virus, that can be achieved through limiting space for movement of the virus, using barriers and increasing distance to vulnerable surfaces, and limiting the duration of exposure. Apart from adhering to the laid-down provisions of a lock-down, preventive measures recommended for the general public include maintaining hand-hygiene, social distancing, and using facemasks to break the chain of transmission. Appropriate triage and customization of treatment protocols can help curtail hospital visits and time-spent by cancer patients during pandemic times, thereby reducing their risk of exposure as well as allowing efficient utilization of resources. The outbreak of the contagious COVID-19 pandemic threatens to disrupt healthcare systems globally with its unprecedented challenges. However, despite all the difficulties and hardships, it has also enabled new ways of learning and communication, which are likely to persist even in the post-COVID world.


title: Seroprevalence of Middle East Respiratory Syndrome Corona Virus in dromedaries and their traders in upper Egypt

text: INTRODUCTION: Camel trade in Egypt depends mainly on importation. Seemingly healthy imported camels are responsible for the ingress of serious diseases into Egypt. A striking example of this concerning public health globally is the Middle East respiratory coronavirus (MERS-CoV) which causes case fatalities of over 34%. Here, we determined the seroepidemiological situation of the MERS-CoV in imported camels and their traders in Upper Egypt. METHODOLOGY: Sera of sixty-three dromedaries and twenty-eight camel traders were recruited (January 2015-December 2016). The age, gender, and sampling locality of each sampled camel and human were obtained. Semi-quantitative anti-MERS-CoV IgG ELISAs which utilize the purified spike protein domain S1 antigen of MERS coronavirus (MERS-CoV S1) were used to detect specific IgG antibodies against the virus. RESULTS: The data showed that 58.73% of imported camels and 25% of traders had antibodies specific to MERS-CoV. Interestingly, like seroreactive camels, all seropositive humans were apparently healthy without any history of developing severe respiratory disease in the 14 days prior to sampling. Having specific antibodies among the examined camel sera was significantly different (P < 0.0001) in relation to various sampling localities, gender and age groups. In contrast, the seropositivity rate of MERS-CoV IgG in humans did not differ significantly by any of the studied factors. CONCLUSIONS: The current study provides the first serological evidence of occupational exposure of humans to MERS-CoV in Africa. Additionally, it reports that imported camels could be implicated in introducing MERS-CoV into Egypt. Accordingly, application of strict control measures to camel importation is a priority.


title: Comparing and Integrating US COVID-19 Daily Data from Multiple Sources: A County-Level Dataset with Local Characteristics

text: Over the past several months, the outbreak of COVID-19 has been expanding over the world. A reliable and accurate dataset of the cases is vital for scientists to conduct related research and for policy-makers to make better decisions. We collect the COVID-19 daily reported data from four open sources: the New York Times, the COVID-19 Data Repository by Johns Hopkins University, the COVID Tracking Project at the Atlantic, and the USAFacts, and compare the similarities and differences among them. In addition, we examine the following problems which occur frequently: (1) the order dependencies violation, (2) the delay-reported issue on weekends and/or holidays, and (3) abnormal data point or data period. We also integrate the COVID-19 reported cases with the county-level auxiliary information of the local features from official sources, such as health infrastructure, demographic, socioeconomic, and environment information, which are important for understanding the spread of the virus.


Should Infants Be Separated from Mothers with COVID-19? First, Do No Harm


docid: yelsnurc

title: Coronavirus Outbreak: Is Radiology Ready? Mass Casualty Incident Planning

text: On March 11, 2020, the World Health Organization declared a coronavirus disease 2019 (COVID-19) pandemic. Health care systems worldwide should be prepared for an unusually high volume of patients in the next few weeks to months. Even the most efficient radiology department will undergo tremendous stress when victims of a mass casualty flood the emergency department and in turn the radiology department. A significant increase is expected in the number of imaging studies ordered for the initial diagnosis and treatment follow-up of cases of COVID-19. Here, we highlight recommendations for developing and implementing a mass casualty incident (MCI) plan for a viral outbreak, such as the current COVID-19 infection. The MCI plan consists of several steps, including preparation, mobilization of resources, imaging chain, adjusting imaging protocols, and education, such as MCI plan simulation and in-service training. Having an MCI plan in place for a viral outbreak will protect patients and staff and ultimately decrease virus transmission. The use of simulations will help identify throughput and logistical issues.


title: Iron supplementation for lambs experimentally infected by Haemonchus contortus: response to anemia and iron store in the bone marrow/ Suplementação com ferro em cordeiros infectados experimentalmente por Haemonchus contortus: resposta a anemia e as reservas de ferro na medula óssea

text: To evaluate the effect of supplementation of iron dextran on blood variables and iron metabolism in lambs experimentally infected by Haemonchus contortus, four experimental groups were used: uninfected and non-supplemented animals (GI); infected animals supplemented with iron (GII); uninfected animals supplemented with iron (GIII); and infected non-supplemented animals (GIV). Groups II and IV received 10,000 larvae (L3) of Haemonchus contortus, and groups II and III received three doses of iron dextran (20mg/kg) intramuscularly with seven days of interval. Blood and faeces samples were collected on days 10 (D10), 17 (D17), 24 (D24), and 31 (D31), in order to determine red blood cell counts, iron metabolism, and EPG. Infected animals developed anemia from D24 and anemia was more severe on D31. Animals from GII had higher hematocrit and hemoglobin concentration compared to animals of GIV on D31. Iron stores in the bone marrow were higher in GII and GIII compared to GI and GIV. The GIV showed lower seric levels of iron on D24 compared to the other groups. The iron supplementation reduces the severity of the anemia caused by infection with Haemonchus contortus in lambs, improving erythropoietic response after blood loss.(AU)


European Federation for Colposcopy (EFC) and European Society of Gynaecological Oncology (ESGO) joint considerations about human papillomavirus (HPV) vaccination, screening programs, colposcopy, and surgery during and after the COVID-19 pandemic


Clinical significance of blue-green neutrophil and monocyte cytoplasmic inclusions in SARS-CoV-2 positive critically ill patients


docid: roxzvrtr

title: Orthopedic Surgery Training During the COVID-19 Pandemic: Dusting Off My Stethoscope


title: Airflows inside passenger cars and implications for airborne disease transmission

text: Transmission of highly infectious respiratory diseases, including SARS-CoV-2 are facilitated by the transport of tiny droplets and aerosols (harboring viruses, bacteria, etc.) that are breathed out by individuals and can remain suspended in air for extended periods of time in confined environments. A passenger car cabin represents one such situation in which there exists an elevated risk of pathogen transmission. Here we present results from numerical simulations of the potential routes of airborne transmission within a model car geometry, for a variety of ventilation configurations representing different combinations of open and closed windows. We estimate relative concentrations and residence times of a non-interacting, passive scalar -- a proxy for infectious pathogenic particles -- that are advected and diffused by the turbulent airflows inside the cabin. Our findings reveal that creating an airflow pattern that travels across the cabin, entering and existing farthest from the occupants can potentially reduce the transmission.


Letter: does vitamin D have a potential role against COVID-19? Authors' reply


COVID-19 infection in Crohn's disease under treatment with adalimumab


title: Thrombosis risk associated with COVID-19 infection. A scoping review

text: BACKGROUND: Infection by the 2019 novel coronavirus (COVID-19) has been reportedly associated with a high risk of thrombotic complications. So far information is scarce and rapidly emerging. METHODS: We conducted a scoping review using a single engine search for studies assessing thrombosis and coagulopathy in COVID-19 patients. Additional studies were identified by secondary review and alert services. RESULTS: Studies reported the occurrence of venous thromboembolism and stroke in approximately 20% and 3% of patients, respectively. A higher frequency seems to be present in severely ill patients, in particular those admitted to intensive care units. The thrombotic risk is elevated despite the use of anticoagulant prophylaxis but optimal doses of anticoagulation are not yet defined. Although an increase of biomarkers such as D-dimer has been consistently reported in severely ill COVID-19, the optimal cut-off level and prognostic value are not known. DISCUSSION: A number of pressing issues were identified by this review, including defining the true incidence of VTE in COVID patients, developing algorithms to identify those susceptible to develop thrombotic complications and severe disease, determining the role of biomarkers and/or scoring systems to stratify patients' risk, designing adequate and feasible diagnostic protocols for PE, establishing the optimal thromboprophylaxis strategy, and developing uniform diagnostic and reporting criteria.


title: Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections

text: In early December 2019 a cluster of cases of pneumonia of unknown cause was identified in Wuhan, a city of 11 million persons in the People's Republic of China. Further investigation revealed these cases to result from infection with a newly identified coronavirus, termed the 2019-nCoV. The infection moved rapidly through China, spread to Thailand and Japan, extended into adjacent countries through infected persons travelling by air, eventually reaching multiple countries and continents. Similar to such other coronaviruses as those causing the Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS), the new coronavirus was reported to spread via natural aerosols from human-to-human. In the early stages of this epidemic the case fatality rate is estimated to be approximately 2%, with the majority of deaths occurring in special populations. Unfortunately, there is limited experience with coronavirus infections during pregnancy, and it now appears certain that pregnant women have become infected during the present 2019-nCoV epidemic. In order to assess the potential of the Wuhan 2019-nCoV to cause maternal, fetal and neonatal morbidity and other poor obstetrical outcomes, this communication reviews the published data addressing the epidemiological and clinical effects of SARS, MERS, and other coronavirus infections on pregnant women and their infants. Recommendations are also made for the consideration of pregnant women in the design, clinical trials, and implementation of future 2019-nCoV vaccines.


Covid-19: medical schools given powers to graduate final year students early to help NHS


docid: raslbgyu

title: Covid-19: Medical conferences around the world are cancelled after US cases are linked to Massachusetts meeting


Protection of forensic scene investigation and postmortem examination during the epidemic period of COVID-19


Pulmonary infarction secondary to pulmonary thromboembolism in COVID-19 diagnosed with dual-energy CT pulmonary angiography


Extracorporeal membrane oxygenation support in 2019 novel coronavirus disease: indications, timing, and implementation


title: [Study on assessing early epidemiological parameters of COVID-19 epidemic in China]

text: Objective: To study the early dynamics of the epidemic of coronavirus disease (COVID-19) in China from 15 to 31 January, 2020, and estimate the corresponding epidemiological parameters (incubation period, generation interval and basic reproduction number) of the epidemic. Methods: By means of Weibull, Gamma and Lognormal distributions methods, we estimated the probability distribution of the incubation period and generation interval data obtained from the reported COVID-19 cases. Moreover, the AIC criterion was used to determine the optimal distribution. Considering the epidemic is ongoing, the exponential growth model was used to fit the incidence data of COVID-19 from 10 to 31 January, 2020, and exponential growth method, maximum likelihood method and SEIR model were used to estimate the basic reproduction number. Results: Early COVID-19 cases kept an increase in exponential growth manner before 26 January, 2020, then the increase trend became slower. The average incubation period was 5.01 (95%CI: 4.31-5.69) days; the average generation interval was 6.03 (95%CI: 5.20-6.91) days. The basic reproduction number was estimated to be 3.74 (95%CI: 3.63-3.87), 3.16 (95%CI: 2.90-3.43), and 3.91 (95%CI: 3.71-4.11) by three methods, respectively. Conclusions: The Gamma distribution fits both the generation interval and incubation period best, and the mean value of generation interval is 1.02 day longer than that of incubation period. The relatively high basic reproduction number indicates that the epidemic is still serious; Based on our analysis, the turning point of the epidemic would be seen on 26 January, the growth rate would be lower afterwards.


title: Cardiac imaging procedures and the COVID-19 pandemic: recommendations of the European Society of Cardiovascular Radiology (ESCR)

text: The severe acute respiratory syndrome coronavirus 2019 (SARS-CoV-2) pandemic currently constitutes a significant burden on worldwide health care systems, with important implications on many levels, including radiology departments. Given the established fundamental role of cardiovascular imaging in modern healthcare, and the specific value of cardiopulmonary radiology in COVID-19 patients, departmental organisation and imaging programs need to be restructured during the pandemic in order to provide access to modern cardiovascular services to both infected and non-infected patients while ensuring safety for healthcare professionals. The uninterrupted availability of cardiovascular radiology services remains, particularly during the current pandemic outbreak, crucial for the initial evaluation and further follow-up of patients with suspected or known cardiovascular diseases in order to avoid unnecessary complications. Suspected or established COVID-19 patients may also have concomitant cardiovascular symptoms and require further imaging investigations. This statement by the European Society of Cardiovascular Radiology (ESCR) provides information on measures for safety of healthcare professionals and recommendations for cardiovascular imaging during the pandemic in both non-infected and COVID-19 patients.


docid: cyfsdouk

title: Aging veterans' mental health and well-being in the context of COVID-19: The importance of social ties during physical distancing

text: Prior wartime trauma likely acts as a double-edged sword that promotes both aging veterans' vulnerability and resilience in the context of the current COVID-19 pandemic. During this stressful time, aging veterans may benefit from having an array of socially supportive network ties. We therefore suggest that clinicians working with veterans encourage veterans to (a) create or sustain positive social connections while maintaining physical distance and (b) call upon coping strategies that helped them manage past difficulties. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Comment on 'Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital'. Pseudoherpetic Grover disease seems to occur in patients with COVID-19 infection


The response to COVID-19 in prisons must consider the broader mental health impacts for people in prison


title: Early Short Course Corticosteroids in Hospitalized Patients with COVID-19

text: BACKGROUND: There is no proven antiviral or immunomodulatory therapy for COVID-19. The disease progression associated with the pro-inflammatory host response prompted us to examine the role of early corticosteroid therapy in patients with moderate to severe COVID-19. METHODS: We conducted a single pre-test, single post-test quasi-experiment in a multi-center health system in Michigan from March 12 to March 27, 2020. Adult patients with confirmed moderate to severe COVID were included. A protocol was implemented on March 20, 2020 using early, short-course, methylprednisolone 0.5 to 1 mg/kg/day divided in 2 intravenous doses for 3 days. Outcomes of standard of care (SOC) and early corticosteroid groups were evaluated, with a primary composite endpoint of escalation of care from ward to ICU, new requirement for mechanical ventilation, and mortality. All patients had at least 14 days of follow-up. RESULTS: We analyzed 213 eligible subjects, 81 (38%) and 132 (62%) in SOC and early corticosteroid groups, respectively.The composite endpoint occurred at a significantly lower rate in the early corticosteroid group (34.9% vs. 54.3%, p=0.005). This treatment effect was observed within each individual component of the composite endpoint. Significant reduction in median hospital length of stay was also observed in the early corticosteroid group (8 vs. 5 days, p < 0.001). Multivariate regression analysis demonstrated an independent reduction in the composite endpoint at 14-days controlling for other factors (aOR: 0.41; 95% CI [0.22 - 0.77]). CONCLUSION: An early short course of methylprednisolone in patients with moderate to severe COVID-19 reduced escalation of care and improved clinical outcomes.


title: The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries

text: BACKGROUND: To limit the spread of SARS-CoV-2, an evidence-based understanding of the symptoms is critical to inform guidelines for quarantining and testing. The most common features are purported to be fever and a new persistent cough, although the global prevalence of these symptoms remains unclear. The aim of this systematic review is to determine the prevalence of symptoms associated with COVID-19 worldwide. METHODS: We searched PubMed, Embase, CINAHL, AMED, medRxiv and bioRxiv on 5th April 2020 for studies of adults (>16 years) with laboratory test confirmed COVID-19. No language or publication status restrictions were applied. Data were independently extracted by two review authors into standardised forms. All datapoints were independently checked by three other review authors. A random-effects model for pooling of binomial data was applied to estimate the prevalence of symptoms, subgrouping estimates by country. I2 was used to assess inter-study heterogeneity. RESULTS: Of 851 unique citations, 148 articles were included which comprised 24,410 adults with confirmed COVID-19 from 9 countries. The most prevalent symptoms were fever (78% [95% CI 75%-81%]; 138 studies, 21,701 patients; I2 94%), a cough (57% [95% CI 54%-60%]; 138 studies, 21,682 patients; I2 94%) and fatigue (31% [95% CI 27%-35%]; 78 studies, 13,385 patients; I2 95%). Overall, 19% of hospitalised patients required non-invasive ventilation (44 studies, 6,513 patients), 17% required intensive care (33 studies, 7504 patients), 9% required invasive ventilation (45 studies, 6933 patients) and 2% required extra-corporeal membrane oxygenation (12 studies, 1,486 patients). The mortality rate was 7% (73 studies, 10,402 patients). CONCLUSIONS: We confirm that fever and cough are the most prevalent symptoms of adults infected by SARS-CoV-2. However, there is a large proportion of infected adults which symptoms-alone do not identify.


Endovascular Therapy for Patients With Acute Ischemic Stroke During the COVID-19 Pandemic: A Proposed Algorithm


title: Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis

text: BACKGROUND: Many studies on COVID-19 have reported diabetes to be associated with severe disease and mortality, however, the data is conflicting. The objectives of this meta-analysis were to explore the relationship between diabetes and COVID-19 mortality and severity, and to determine the prevalence of diabetes in patients with COVID-19. METHODS: We searched the PubMed for case-control studies in English, published between Jan 1 and Apr 22, 2020, that had data on diabetes in patients with COVID-19. The frequency of diabetes was compared between patients with and without the composite endpoint of mortality or severity. Random effects model was used with odds ratio as the effect size. We also determined the pooled prevalence of diabetes in patients with COVID-19. Heterogeneity and publication bias were taken care by meta-regression, sub-group analyses, and trim and fill methods. RESULTS: We included 33 studies (16,003 patients) and found diabetes to be significantly associated with mortality of COVID-19 with a pooled odds ratio of 1.90 (95% CI: 1.37-2.64; p < 0.01). Diabetes was also associated with severe COVID-19 with a pooled odds ratio of 2.75 (95% CI: 2.09-3.62; p < 0.01). The combined corrected pooled odds ratio of mortality or severity was 2.16 (95% CI: 1.74-2.68; p < 0.01). The pooled prevalence of diabetes in patients with COVID-19 was 9.8% (95% CI: 8.7%-10.9%) (after adjusting for heterogeneity). CONCLUSIONS: Diabetes in patients with COVID-19 is associated with a two-fold increase in mortality as well as severity of COVID-19, as compared to non-diabetics. Further studies on the pathogenic mechanisms and therapeutic implications need to be done.


title: Could Respiratory Fluoroquinolones, Levofloxacin and Moxifloxacin, Prove to be Beneficial as an Adjunct Treatment in COVID-19?

text: Since the beginning of the COVID-19 pandemic, researchers have focused on repurposing of existing antibiotics, antivirals and anti-inflammatory drugs to find an effective therapy. Fluoroquinolones are broad spectrum synthetic antimicrobial agents, being chemical derivatives of quinoline, the prodrome of chloroquine. Interestingly, fluoroquinolones may exert antiviral actions against vaccinia virus, papovavirus, CMV, VZV, HSV-1, HSV-2, HCV and HIV. A recent in silico study has shown that the fluoroquinolones, ciprofloxacin and moxifloxacin, may inhibit SARS-CoV-2 replication by exhibiting stronger capacity for binding to its main protease than chloroquine and nelfinavir, a protease inhibitor antiretroviral drug. Remarkably, fluoroquinolones have shown multiple immunomodulatory actions leading to an attenuation of the inflammatory response through the inhibition of pro-inflammatory cytokines. Noteworthy, respiratory fluoroquinolones, levofloxacin and moxifloxacin, constitute fist line therapeutic agents for the management of severe community-acquired pneumonia. They are characterized by advantageous pharmacokinetic properties; higher concentrations in the lungs; and an excellent safety profile comparable to other antibiotics used to treat respiratory infections, such as macrolides and b-lactams. Based on their potential antiviral activity and immunomodulatory properties, the favorable pharmacokinetics and safety profile, we propose the use of respiratory fluoroquinolones as adjuncts in the treatment of SARS-CoV-2 associated pneumonia.