docid: cbldknnx

title: Tele-rounding in a university hospital pulmonary ward during the COVID-19 pandemic: a pilot study


Innovation in a post-Covid 'new normal'


docid: eyfbszaq

title: Initial impacts of global risk mitigation measures taken during the combatting of the COVID-19 pandemic

text: This paper presents an analysis of risk mitigation measures taken by countries around the world facing the current COVID-19 outbreak. In light of the current pandemic the authors collated and clustered (using harmonised terminology) the risk mitigation measures taken around the globe in the combat to contain, and since March 11 2020, to limit the spread of the SARS-CoV-2 virus known to cause the Coronavirus disease 2019 (COVID-19). This overview gathers lessons learnt, providing an update on the current knowledge for authorities, sectors and first responders on the effectiveness of said measures, and may allow enhanced prevention, preparedness and response for future outbreaks. Various measures such as mobility restrictions, physical distancing, hygienic measures, socio-economic restrictions, communication and international support mechanisms have been clustered and are reviewed in terms of the nature of the actions taken and their qualitative early-perceived impact. At the time of writing, it is still too premature to express the quantitative effectiveness of each risk mitigation cluster, but it seems that the best mitigation results are reported when applying a combination of voluntary and enforceable measures.


title: Overview: The history and pediatric perspectives of severe acute respiratory syndromes: Novel or just like SARS

text: Many respiratory viral infections such as influenza and measles result in severe acute respiratory symptoms and epidemics. In the spring of 2003, an epidemic of coronavirus pneumonia spread from Guangzhou to Hong Kong and subsequently to the rest of the world. The WHO coined the acronym SARS (severe acute respiratory syndrome) and subsequently the causative virus as SARS-CoV. In the summer of 2012, epidemic of pneumonia occurred again in Saudi Arabia which was subsequently found to be caused by another novel coronavirus. WHO coined the term MERS (Middle East respiratory syndrome) to denote the Middle East origin of the novel virus (MERS-CoV). In the winter of 2019, another outbreak of pneumonia occurred in Wuhan, China which rapidly spread globally. Yet another novel coronavirus was identified as the culprit and has been named SARS-CoV-2 due to its similarities with SARS-CoV, and the disease as coronavirus disease-2019. This overview aims to compare and contrast the similarities and differences of these three major episodes of coronavirus outbreak, and conclude that they are essentially the same viral respiratory syndromes caused by similar strains of coronavirus with different names. Coronaviruses have caused major epidemics and outbreaks worldwide in the last two decades. From an epidemiological perspective, they are remarkably similar in the mode of spread by droplets. Special focus is placed on the pediatric aspects, which carry less morbidity and mortality in all three entities.


Análisis de la amenaza percibida por la COVID-19 en población española./ [Analysis of the threat perceived by the COVID-19 in the Spanish population]


COVID-19 Pandemic: A Collection of Relevant Publications from Military Medicine


Rapid Development and Deployment of an International Omaha System Evidence-Based Guideline to Support the COVID-19 Response


title: What orthopedic surgeons need to know about Covid-19 pandemic

text: The ongoing outbreak of COVID-19, also known as SARS-CoV-2 and coronavirus disease 2019, is considered a major public concern that propagates steadily by the increased number of the infected cases and the mortality rate. In this article, we provide a brief review for Orthopedic surgeons as regard COVID-19 virus microbiology, epidemiology, clinical picture, and diagnosis. Moreover, what measures should be taken amid this pandemic to assess its control, maintain the urgent duties, and protect health care workers (HCW) are also discussed.


title: Knowledge, attitude and preventive practices related to COVID-19: a cross-sectional study in two Pakistani university populations

text: Objective: The aim of this study was to assess COVID-19-related knowledge, attitudes, and preventive practices of two Pakistani university populations. Methods: A cross-sectional study was conducted among students and employees of two higher education institutions in Lahore, Pakistan, namely the University of Lahore and the Gulab Devi Educational Complex. Participants were recruited using a convenient sampling method. A validated 45-item, self-administered questionnaire was used to collect data. Total possible scores were 0-14 for knowledge (scores < 7, 7-10 and > 10 were considered to indicate poor, moderate and good knowledge, respectively); 0-7 for attitude (scores > 5 were considered to indicate a good attitude); and 0-18 for COVID-19 preventative practices (scores > 12 were considered to indicate good preventative practices). Results: Of the 417 enrolled participants, 416 reported that they were aware of COVID-19 and social media was the major source of their information. Mean scores were 10.12 ± 2.20 for knowledge (good, moderate and poor knowledge in 50.2%, 42.8% and 7.0% of participants, respectively); 5.74 ± 1.28 for attitude (65.4% of individuals had a positive attitude); and 11.04 ± 3.34 for COVID-19 preventative practices (only 36.5% of participants had good preventive practices). Conclusion: Pakistani university students and employees have good knowledge and attitudes regarding COVID-19, but unsatisfactory preventive practices. Therefore, health regulators should use multiple communication approaches, such as electronic, print and social media, phone messages, etc., to increase awareness and improve practices related to COVID-19.


title: Spatial network connectivity of population and development in the USA; Implications for disease transmission

text: Zipfs Law states that rank-size distributions of city populations follow a power law with an exponent of -1. The assertion of a universal power law is controversial because the linearity and slope appear to vary over time and among countries. We compare census enumerations and night light luminance as proxies for population density and intensity of development in the contiguous United States. Treating population density and development intensity as continuous quantities allows for the definition of spatial networks based on the level of spatial connectivity. The resulting distributions of spatial network components (subsets of connected nodes) vary with degree of connectivity, but maintain consistent scaling over a wide range of network sizes. At continental scales, spatial network rank-size distributions obtained from both population density and night light brightness are well-fit by power laws with exponents near -1 for a wide range of density and luminance thresholds. However, the largest components (10,000 - 100,000 sq.km) are far larger than individual cities and represent spatially contiguous agglomerations of urban, suburban and periurban development. Projecting county-level numbers of confirmed cases of SARS-CoV-2 for the US onto spatial networks of population and development allows the spatiotemporal evolution of the epidemic to be quantified as propagation within networks of varying connectivity.. The results show an abrupt transition from slow increases in confirmed cases in a small number of network components to rapid geographic dispersion to a larger number of components before mobility reductions occurred in March 2020.


Mental Health in Chronic Disease Patients during the COVID-19 Quarantine in Greece


COVID-19 in Madrid


Obesity Is a Risk Factor for Greater COVID-19 Severity


title: Desafios na condução de pesquisas sobre a COVID-19 envolvendo seres humanos no Brasil

text: Objetivo:analisar aspectoséticos e regulatórios adotados para a realização de pesquisas científicas, em situação de excepcionalidade provocada pela pandemia daCOVID-19 Método:Estudo exploratório realizado a partir da análise documental e de informações existentes nas páginas da Comissão Nacional de Ética em Pesquisa (Conep), Plataforma Brasil e da Agência Nacional de Vigilância Sanitária (Anvisa) Resultados:A análise dos documentos encontrados nas páginas pesquisadas, revelou que a Conep (incluindo a Plataforma Brasil) e Anvisa divulgaram as estratégias adotadas para dar celeridade à revisão ética e científica para os projetos relacionados à COVID-19 A Conep inicialmente revisou todos os protocolos submetidos e posteriormente dividiu essa responsabilidade com todo osistema A Anvisa divulgou uma Resolução da Diretoria Colegiada (RDC) e três Notas Técnicas contendo procedimentos extraordinários e temporários para a realização de pesquisas clínicas com medicamentos, estudos de bioequivalência e produtos para terapia avançada Conclusão:As medidas adotadas demonstraram efetividade, considerando-se que a Conep avaliou até o dia 20/04/2020, 146 protocolos de pesquisas provenientes de todo o Brasil e de diferentes áreas do conhecimento, incluindo 30 ensaios clínicos Essas pesquisas representam a possibilidade de produzir evidências para o enfrentamento da doença,assim comoa proteção das pessoas mais vulneráveis nesse contexto (AU)


title: Medical Education During the COVID-19 Pandemic: A Single Institution Experience

text: Social distancing to curb the COVID-19 pandemic has caused suspension of classroom teaching in all educational institutions We implemented a novel online classroom platform at our institute to continue medical education The program attracted encouraging feedback from the students It may serve as a model for uninterrupted teaching and training during times of crisis


Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm


Ten work-life balance tips for researchers based at home during the pandemic


title: Scalable Identification of Partially Observed Systems with Certainty-Equivalent EM

text: System identification is a key step for model-based control, estimator design, and output prediction. This work considers the offline identification of partially observed nonlinear systems. We empirically show that the certainty-equivalent approximation to expectation-maximization can be a reliable and scalable approach for high-dimensional deterministic systems, which are common in robotics. We formulate certainty-equivalent expectation-maximization as block coordinate-ascent, and provide an efficient implementation. The algorithm is tested on a simulated system of coupled Lorenz attractors, demonstrating its ability to identify high-dimensional systems that can be intractable for particle-based approaches. Our approach is also used to identify the dynamics of an aerobatic helicopter. By augmenting the state with unobserved fluid states, a model is learned that predicts the acceleration of the helicopter better than state-of-the-art approaches. The codebase for this work is available at https://github.com/sisl/CEEM.


Glucocorticoid versus immunoglobulin in the treatment of COVID-19-associated fulminant myocarditis


title: Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019: A Review

text: Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019, causing human coronavirus disease 2019 (COVID-19), which has now spread into a worldwide pandemic. The pulmonary manifestations of COVID-19 have been well described in the literature. Two similar human coronaviruses that cause Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV-1) are known to cause disease in the central and peripheral nervous systems. Emerging evidence suggests COVID-19 has neurologic consequences as well. Observations: This review serves to summarize available information regarding coronaviruses in the nervous system, identify the potential tissue targets and routes of entry of SARS-CoV-2 into the central nervous system, and describe the range of clinical neurological complications that have been reported thus far in COVID-19 and their potential pathogenesis. Viral neuroinvasion may be achieved by several routes, including transsynaptic transfer across infected neurons, entry via the olfactory nerve, infection of vascular endothelium, or leukocyte migration across the blood-brain barrier. The most common neurologic complaints in COVID-19 are anosmia, ageusia, and headache, but other diseases, such as stroke, impairment of consciousness, seizure, and encephalopathy, have also been reported. Conclusions and Relevance: Recognition and understanding of the range of neurological disorders associated with COVID-19 may lead to improved clinical outcomes and better treatment algorithms. Further neuropathological studies will be crucial to understanding the pathogenesis of the disease in the central nervous system, and longitudinal neurologic and cognitive assessment of individuals after recovery from COVID-19 will be crucial to understand the natural history of COVID-19 in the central nervous system and monitor for any long-term neurologic sequelae.


docid: mxslgmkq

title: COVID-19 with spontaneous pneumothorax,pneumomediastinum and subcutaneous emphysema

text: We present a case of COVID-19 pneumonia associated with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema.


title: Prevention and treatment strategies of Traditional Chinese and Western Medicine for acute abdomen during the outbreak of COVID-19/ 中国医师杂志

text: At present, the prevention and control of the COVID-19 is still severe, its pathogen SARS-CoV-2 is highly infectious and pathogenic, and the population is generally susceptible. In order to deal with the epidemic, selective operation can be postponed, but most of the patients with acute abdominal diseases are commonly in clinic, with acute onset and severe condition, and most of them are accompanied with fever and gastrointestinal symptoms, so emergency operation is needed.Under the condition of the current epidemic—COVID-19, it requires a higher standard to diagnose and treat patients with acute abdomen. The first step is to carry out procedures to identify whether the patient is infected or not. Those who are not infected can go through the normal treating procedures.For patients diagnosed with COVID-19 or suspected patients, the second step is to achieve classified diagnoses and treatments, and to adopt a treating plan that integrates TCM and western medicine.In order to protect patients and medical staff, the COVID-19 in hospital transmission must be avoided. For patients with COVID-19 who need emergency surgery, we must strictly comply with the hospital's protection regulations, closely coordinate the relevant departments of surgery, perform the three-level protection, operate in accordance with the principle of damage control in the negative pressure surgery room, and return to the isolation ward according to the prevention and control process after operation. For units without surgical conditions, patients should be transferred to hospital in time on the premise of maximum damage control, and patients must not be delayed for timely diagnosis and treatment due to the epidemic.


Self-harm and COVID-19 Pandemic: An emerging concern - A report of 2 cases from India


title: Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases/ 中华围产医学杂志

text: Objective To evaluate the clinical characteristics and pregnant outcomes of gravidae with COVID-19. Methods This study involved nine gravidae with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 22 to February 1, 2020. Their clinical data, including epidemiological history, clinical symptoms, laboratory examinations, chest CT, treatment, delivery mode, and pregnancy outcomes, were analyzed retrospectively. Specimens of maternal vaginal swab were collected in six pregnant women, and the specimens of amniotic fluid, cord blood, neonatal throat swab and breast milk samples were collected in four pregnant women who had a delivery during our study. All samples were tested for the existence of COVID-19. Descriptive analysis was applied in this study. Results (1) Among the nine cases, five were admitted in the third trimester and four in the second trimester. The median incubation period of COVID-19 was 8 (1-14) d. Fever was presented in all cases on admission, and the other commonly seen symptoms were cough (seven cases) and diarrhea (five cases). Other signs and symptoms were also reported, including shortness of breath, myalgia and fatigue (four cases in each), nasal obstruction, pharyngalgia, chest pain, and headache/dizziness (three cases in each), rash (two cases), and chills and expectoration (one case in each). The most common laboratory abnormalities were a decreased number of lymphocytes (seven cases) and elevated C-reactive protein (six cases). Chest CT scans were performed in seven women, and all showed patchy areas or ground-glass opacity in both lungs. Oligohydramnios was detected in only one case at 37 +5 weeks, which was 7 d after the diagnosis of COVID-19. (2) All nine cases received empiric antibiotic and antiviral therapy with Chinese medicine as adjuvant treatment. Eight patients required oxygen inhalation, and eight were treated with glucocorticoid. Six cases received immunotherapy. (3) Four of the nine cases had delivered, including three cesarean sections and one spontaneous vaginal preterm birth after premature rupture of membranes, and the mother was transferred to the intensive care unit 2 d after delivery due to acute respiratory distress syndrome. One case was terminated at 26 gestational weeks. Of the four neonates, there were two term and two premature babies, and one preterm baby was small-for-gestational-age. No neonatal asphyxia was observed. Serial real-time quantitative reverse transcription-polymerase chain reaction showed negative results in the detection of 2019-novel coronavirus in all samples obtained from amniotic fluid, umbilical cord blood, neonatal nasopharynx, breast milk, and vagina. Maternal conditions were all stable in all cases, including the four continuing pregnancy, and the terminated ones, except the case mentioned above. Conclusions There is no distinguishable clinical feature between pregnant and non-pregnant COVID-19 patients. So far, there is no evidence for vertical transmission or worsening perinatal outcome in mothers and babies.


The versatile heparin in COVID-19


Prevention and control of COVID-19 in neurointerventional surgery: expert consensus from the Chinese Federation of Interventional and Therapeutic Neuroradiology (CFITN) and the International Society for Neurovascular Disease (ISNVD)


title: COVID-19 mitigation strategies and overview on results from relevant studies in Europe

text: In December 2019, the first patients in Wuhan, China were diagnosed with a primary atypical pneumonia, which showed to be unknown and contagious. Since then, known as COVID-19 disease, the responsible viral pathogen, SARS-CoV-2, has spread around the world in a pandemic. Decisions on how to deal with the crisis are often based on simulations of the pandemic spread of the virus. The results of some of these, as well as their methodology and possibilities for improvement, will be described in more detail in this paper in order to inform beyond the current public health dogma called"flatten-the-curve". There are several ways to model an epidemic in order to simulate the spread of diseases. Depending on the timeliness, scope and quality of the associated real data, these multivariable models differ in the value of used parameters, but also in the selection of considered influencing factors. It was exemplarily shown that epidemics in their course are simulated more realistically by models that assume subexponential growth. Furthermore, various simulations of the COVID-19 pandemic were presented in an European perspective, compared against each other and discussed in more detail. It is difficult to estimate how credible the simulations of the pandemic models currently are, so it remains to be seen whether the spread of the pandemic can be effectively reduced by the measures taken. Whether a model works well in reality is largely determined by the quality and scope of its underlying data. Past studies have shown that countermeasures are able to reduce reproduction numbers or transmission rates in epidemics. In addition to that, the presented modelling study provides a good framework for the creation of subexponential-growth-models for assessing the spread of COVID-19.


title: A scalable method of applying heat and humidity for decontamination of N95 respirators during the COVID-19 crisis

text: A lack of N95 Filtering Facepiece Respirators (FFRs) during the COVID-19 crisis has placed healthcare workers at risk. It is important for any N95 reuse strategy to determine the effects that proposed protocols would have on the physical functioning of the mask, as well as the practical aspects of implementation. Here we propose and implement a method of heating N95 respirators with moisture (85°C, 60-85% humidity). We test both mask filtration efficiency and fit to validate this process. Our tests focus on the 3M 1860, 3M 1870, and 3M 8210 Plus N95 models. After five cycles of the heating procedure, all three respirators pass both quantitative fit testing (score of >100) and show no degradation of mask filtration efficiency. We also test the Chen Heng V9501 KN95 and HKYQ N95 finding no degradation of mask filtration efficiency, however even for unheated masks these scored <50 for every fit test. The heating method presented here is scalable from individual masks to over a thousand a day with a single industrial convection oven, making this method practical for local application inside health-care facilities.


title: Erythropoietin as candidate for supportive treatment of severe COVID-19

text: In light of the present therapeutic situation in COVID-19, any measure to improve course and outcome of seriously affected individuals is of utmost importance. We recap here evidence that supports the use of human recombinant erythropoietin (EPO) for ameliorating course and outcome of seriously ill COVID-19 patients. This brief expert review grounds on available subject-relevant literature searched until May 14, 2020, including Medline, Google Scholar, and preprint servers. We delineate in brief sections, each introduced by a summary of respective COVID-19 references, how EPO may target a number of the gravest sequelae of these patients. EPO is expected to: (1) improve respiration at several levels including lung, brainstem, spinal cord and respiratory muscles; (2) counteract overshooting inflammation caused by cytokine storm/ inflammasome; (3) act neuroprotective and neuroregenerative in brain and peripheral nervous system. Based on this accumulating experimental and clinical evidence, we finally provide the research design for a double-blind placebo-controlled randomized clinical trial including severely affected patients, which is planned to start shortly.


title: Learning from the Past: Possible Urgent Prevention and Treatment Options for Severe Acute Respiratory Infections Caused by 2019-nCoV

text: With the current trajectory of the 2019-nCoV outbreak unknown, public health and medicinal measures will both be needed to contain spreading of the virus and to optimize patient outcomes. Although little is known about the virus, an examination of the genome sequence shows strong homology with its better-studied cousin, SARS-CoV. The spike protein used for host cell infection shows key nonsynonymous mutations that might hamper the efficacy of previously developed therapeutics but remains a viable target for the development of biologics and macrocyclic peptides. Other key drug targets, including RNA-dependent RNA polymerase and coronavirus main proteinase (3CLpro), share a strikingly high (>95 %) homology to SARS-CoV. Herein, we suggest four potential drug candidates (an ACE2-based peptide, remdesivir, 3CLpro-1 and a novel vinylsulfone protease inhibitor) that could be used to treat patients suffering with the 2019-nCoV. We also summarize previous efforts into drugging these targets and hope to help in the development of broad-spectrum anti-coronaviral agents for future epidemics.


Future of Chernobyl research: the urgency for consolidated action


COVID-19: What Comes Next for IRs


title: Directiva administrativa que regula los procesos, registros y accesos a la información para garantizar el seguimiento integral de los casos sospechosos y confirmados de COVID-19 (Sistema Integrado para COVID-19-SICOVID-19)/ Administrative directive that regulates the processes, records and access to information to guarantee comprehensive monitoring of suspected and confirmed cases of COVID-19 (Integrated System for COVID-19-SICOVID-19)

text: El documento contiene los procesos, procedimientos, aplicaciones tecnológicas de captura de datos y acceso a la información con el objeto de hacer el seguimiento longitudinal en tiempo real de los casos sospechosos y confirmados de COVID-19 a nivel nacional regional y local.


title: COVID-19: animals, veterinary and zoonotic links

text: Coronavirus disease 2019 (COVID-19), has spread over 210 countries and territories beyond China shortly. On February 29, 2020, the World Health Organization (WHO) denoted it in a high-risk category, and on March 11, 2020, this virus was designated pandemic, after its declaration being a Public Health International Emergency on January 30, 2020. World over high efforts are being made to counter and contain this virus. The COVID-19 outbreak once again proves the potential of the animal-human interface to act as the primary source of emerging zoonotic diseases. Even though the circumstantial evidence suggests the possibility of an initial zoonotic emergence, it is too early to confirm the role of intermediate hosts such as snakes, pangolins, turtles, and other wild animals in the origin of SARS-CoV-2, in addition to bats, the natural hosts of multiple coronaviruses such as SARS-CoV and MERS-CoV. The lessons learned from past episodes of MERS-CoV and SARS-CoV are being exploited to retort this virus. Best efforts are being taken up by worldwide nations to implement effective diagnosis, strict vigilance, heightened surveillance, and monitoring, along with adopting appropriate preventive and control strategies. Identifying the possible zoonotic emergence and the exact mechanism responsible for its initial transmission will help us to design and implement appropriate preventive barriers against the further transmission of SARS-CoV-2. This review discusses in brief about the COVID-19/SARS-CoV-2 with a particular focus on the role of animals, the veterinary and associated zoonotic links along with prevention and control strategies based on One-health approaches.


title: Soy Isoflavones and Gastrointestinal Health

text: PURPOSE OF REVIEW: Soy isoflavones are known to have beneficial effects on several aspects of gastrointestinal physiological functions (contractility or motility, secretion, morphology, and barrier function). In this review, we discuss the effects of soy isoflavones on the overall gut function and inflammation and assess how these effects might be implicated in the treatment of several gut-related diseases. RECENT FINDINGS: Soy isoflavones influence several key aspects of gastrointestinal health: improve basal intestinal secretion, alleviate inflammation, limit intestinal morphological damage, and improve epithelial barrier function in several clinically relevant murine models of gastrointestinal diseases. Dietary supplementation with isoflavones proves to be a key means to improve the overall gut function and health. Future mechanistic studies with isoflavone interventions will help treat clinically related diseases such as cystic fibrosis and inflammatory-related gut problems such as colitis and diabetes.


Coronavirus: NHS staff get power to keep patients in isolation as UK declares "serious threat"


Letter to the Editor (COVID-19 and Stroke)


Stellungnahme der AG pneumologische Altersmedizin zu COVID-19 bei geriatrischen Patienten./ [Recommendations for the Treatment of Elderly Patients with COVID-19 from the Taskforce for Gerontopneumology]


title: COVID - A Caring Reflection

text: Those of us who can come to work every day and provide emotional and spiritual support to the patients, families, staff, and to each other despite all challenges. COVID-19 has not robbed us of our ability to care. COVID-19 has not robbed us of our voices in using kind words, thoughts, sentiments, and prayers to comfort others and each other. Most importantly, COVID-19 has not broken us.


The Roadmap to Pituitary in COVID-19 Crisis


title: Cambios a partir de la COVID-19. Una perspectiva desde la pediatría interna hospitalaria./ [Changes from COVID-19. A perspective from internal pediatric medicine]

text: SARS-CoV-2 pandemic dimension has affected the Hospital Pediatrics Medicine assistance in our country. New challenges generated by COVID-19 require a series of proactive measures, based on existing scientific knowledge and standards of good practice, that allow the Pediatric Hospital services readiness and operability. Hospital Internal Pediatrics, as responsible of integral care of the hospitalized child, plays a leading role in the new hospital model emerging from this crisis. This review analyzes the impact of the current SARS-CoV-2 epidemic on pediatric care, and perspective of new COVID-19 outbreaks in coexistence with other viral infections. Changes secondary to pandemic involved in Hospital Pediatric units, how to prepare for future epidemics, also the involvement of pediatric units in adult care and the possible opportunities for improvement need to be revised. Assistance of patients with chronic complex conditions in epidemic circumstances, safety aspects, opportunities for teaching and ethical considerations are reviewed. The Spanish Society of Hospital Pediatrics Medicine offers with this article a series of resources for Internal Pediatric Medicine practitioners responsible to face next challenges in pediatric hospitalization units.


Optimisation of Vitamin D Status for Enhanced Immuno-protection Against Covid-19


title: Surgical wait list management in Canada during a pandemic: many challenges ahead

text: Summary: The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact on waits for elective operations, with tens of thousands of scheduled surgeries being cancelled or postponed across Canada. Provincial governments will likely not only reopen elective surgical capacity when it is deemed safe, but also target new funding to address the backlog of cases. There is a dearth of research on whether the provinces' approaches to managing wait lists are equitable from a patients' needs perspective or if they are associated with patients' perception of outcomes. The surgical cost models used in the past won't be useful to governments and hospital managers. New models based on hospitals' marginal costs, associated with running on weekends or off-hours and social distancing parameters, will be needed. Surgeon input, collaboration and leadership during the strategy development, implementation and management of surgical wait lists postpandemic will be imperative, as these decisions will significantly affect the health and lives of many Canadians.


docid: tgunokrk

title: SARS-CoV-2 infection: The role of cytokines in COVID-19 disease

text: COVID-19 disease, caused by infection with SARS-CoV-2, is related to a series of physiopathological mechanisms that mobilize a wide variety of biomolecules, mainly immunological in nature. In the most severe cases, the prognosis can be markedly worsened by the hyperproduction of mainly proinflammatory cytokines, such as IL-1, IL-6, IL-12, IFN-Î³, and TNF-α, preferentially targeting lung tissue. This study reviews published data on alterations in the expression of different cytokines in patients with COVID-19 who require admission to an intensive care unit. Data on the implication of cytokines in this disease and their effect on outcomes will support the design of more effective approaches to the management of COVID-19.


title: Patient blood management during the COVID-19 pandemic: a narrative review

text: As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient blood management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on blood supply and specifies important aspects of donor management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient blood management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient blood management during the COVID-19 pandemic.


title: What Was the Change in Telehealth Usage and Proportion of No-show Visits for an Orthopaedic Trauma Clinic During the COVID-19 Pandemic?

text: BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Medicare and Medicaid Services pledged payment for telehealth visits for the duration of this public health emergency in an effort to decrease COVID-19 transmission and allow for deployment of residents and attending physicians to support critical-care services. Although the COVID-19 pandemic has vastly expanded telehealth use, no studies to our knowledge have analyzed the implementation and success of telehealth for orthopaedic trauma. This population is unique in that patients who have experienced orthopaedic trauma range in age from early childhood to late adulthood, they vary across the socioeconomic spectrum, may need to undergo emergent or urgent surgery, often have impaired mobility, and, historically, do not always follow-up consistently with healthcare providers. QUESTIONS/PURPOSES: (1) To what extent did telehealth usage increase for an outpatient orthopaedic trauma clinic at a Level 1 trauma center from the month before the COVID-19 stay-at-home order compared with the month immediately following the order? (2) What is the proportion of no-show visits before and after the implementation of telehealth? METHODS: After nonurgent clinic visits were postponed, telehealth visits were offered to all patients due to the COVID-19 stay-at-home order. Patients with internet access who had the ability to download the MyChart application on their mobile device and agreed to a telehealth visit were seen virtually between March 16, 2020 and April 10, 2020 (COVID-19) by three attending orthopaedic trauma surgeons at a large, urban, Level 1 trauma center. Clinic schedules and patient charts were reviewed to determine clinical volumes and no-show proportions. The COVID-19 period was compared with the 4 weeks before March 16, 2020 (pre-COVID-19), when all visits were conducted in-person. The overall clinic volume decreased from 340 to 233 (31%) between the two periods. The median (range) age of telehealth patients was 46 years (20 to 89). Eighty-four percent (72 of 86) of telehealth visits were postoperative and established nonoperative patient visits, and 16% (14 of 86) were new-patient visits. To avoid in-person suture or staple removal, patients seen for their 2-week postoperative visit had either absorbable closures, staples, or nonabsorbable sutures removed by a home health registered nurse or skilled nursing facility registered nurse. If radiographs were indicated, they were obtained at outside facilities or our institution before patients returned home for their telehealth visit. RESULTS: There was an increase in the percentage of office visits conducted via telehealth between the pre-COVID-19 and COVID-19 periods (0% [0 of 340] versus 37% [86 of 233]; p < 0.001), and by the third week of implementation, telehealth comprised approximately half of all clinic visits (57%; [30 of 53]). There was no difference in the no-show proportion between the two periods (13% [53 of 393] for the pre-COVID-19 period and 14% [37 of 270] for the COVID-19 period; p = 0.91). CONCLUSIONS: Clinicians should consider implementing telehealth strategies to provide high-quality care for patients and protect the workforce during a pandemic. In a previously telehealth-naïve clinic, we show successful implementation of telehealth for a diverse orthopaedic trauma population that historically has issues with mobility and follow-up. Our strategies include postponing long-term follow-up visits, having sutures or staples removed by a home health or skilled nursing facility registered nurse, having patients obtain pertinent imaging before the visit, and ensuring that patients have access to mobile devices and internet connectivity. Future studies should evaluate the incidence of missed infections or stiffness as a result of telehealth, analyze the subset of patients who may be more vulnerable to no-shows or technological failures, and conduct patient surveys to determine the factors that contribute to patient preferences for or against the use of telehealth. LEVEL OF EVIDENCE: Level III, therapeutic study.


EAHP launches COVID-19 resource centre for hospital pharmacists


title: The response of Synechococcus sp. PCC 7002 to micro-/nano polyethylene particles - Investigation of a key anthropogenic stressor

text: Microplastics or plastic particles less than 5 mm in size are a ubiquitous and damaging pollutant in the marine environment. However, the interactions between these plastic particles and marine microorganisms are just starting to be understood. The objective of this study was to measure the responses of a characteristic marine organism (Synechococcus sp. PCC 7002) to an anthropogenic stressor (polyethelene nanoparticles and microparticles) using molecular techniques. This investigation showed that polyethylene microparticles and nanoparticles have genetic, enzymatic and morphological effects on Synechococcus sp. PCC 7002. An RT-PCR analysis showed increases in the expression of esterase and hydrolase genes at 5 days of exposure to polyethylene nanoparticles and at 10 days of exposure to polyethylene microparticles. A qualitative enzymatic assay also showed esterase activity in nanoparticle exposed samples. Cryo-scanning electron microscopy was used to assess morphological changes in exopolymer formation resulting from exposure to polyethylene microparticles and nanoparticles. The data from this paper suggests that microplastic and nanoplastics could be key microbial stressors and should be investigated in further detail.


title: Estimation of the secondary attack rate of COVID-19 using proportional meta-analysis of nationwide contact tracing data in Taiwan

text: Crude secondary attack rate (SAR) of COVID-19 in Taiwan was 0.84% using nationwide contact-tracing data till April 8, 2020. The random-effect Bayesian metaanalysis yielded 95% credible intervals of 0.42%-1.69% and 0.08%-8.32%, respectively, for estimated SAR pooling from 15 case series and for predicted SAR in the future if pandemic continues.


Novel Coronavirus and Orthopaedic Surgery: Early Experiences from Singapore


title: COVID-19 and religious congregations: Implications for spread of novel pathogens

text: The COVID-19 pandemic is ravaging the world. A principal preventive strategy is practicing social distancing. Congregations of the faithful at the local and transnational levels are strongly recommended by several world religions and religious orders, however, a gathering of large numbers of people in close approximation could be fertile ground for the spread of novel pathogens. The refusal to suspend such gatherings could lead to potential widespread dispersal of infections.


title: Immunological and inflammatory profiles in mild and severe cases of COVID-19

text: COVID-19 is associated with 5.1% mortality. Although the virological, epidemiological, clinical, and management outcome features of COVID-19 patients have been defined rapidly, the inflammatory and immune profiles require definition as they influence pathogenesis and clinical expression of COVID-19. Here we show lymphopenia, selective loss of CD4+ T cells, CD8+ T cells and NK cells, excessive T-cell activation and high expression of T-cell inhibitory molecules are more prominent in severe cases than in those with mild disease. CD8+ T cells in patients with severe disease express high levels of cytotoxic molecules. Histochemical studies of lung tissue from one fatality show sub-anatomical distributions of SARS-CoV-2 RNA and massive infiltration of T cells and macrophages. Thus, aberrant activation and dysregulation of CD8+ T cells occur in patients with severe COVID-19 disease, an effect that might be for pathogenesis of SARS-CoV-2 infection and indicate that immune-based targets for therapeutic interventions constitute a promising treatment for severe COVID-19 patients.


The COvid-19 Vascular sERvice (COVER) Study: An International Vascular and Endovascular Research Network (VERN) Collaborative Study Assessing the Provision, Practice, and Outcomes of Vascular Surgery During the COVID-19 Pandemic


title: ASReview: Open Source Software for Efficient and Transparent Active Learning for Systematic Reviews

text: For many tasks - including guideline development for medical doctors and systematic reviews for research fields - the scientific literature needs to be checked systematically. The current practice is that scholars and practitioners screen thousands of studies by hand to find which studies to include in their review. This is error prone and inefficient. We therefore developed an open source machine learning (ML)-aided pipeline: Active learning for Systematic Reviews (ASReview). We show that by using active learning, ASReview can lead to far more efficient reviewing than manual reviewing, while exhibiting adequate quality. Furthermore, the presented software is fully transparent and open source.


title: Games of Social Distancing during an Epidemic: Local vs Statistical Information

text: The spontaneous behavioral changes of the agents during an epidemic can have significant effects on the delay and the prevalence of its spread. In this work, we study a social distancing game among the agents of a population, who determine their social interactions during the spread of an epidemic. The interconnections between the agents are modeled by a network and local interactions are considered. The payoffs of the agents depend on their benefits from their social interactions, as well as on the costs to their health due to their possible contamination. The information available to the agents during the decision making plays a crucial role in our model. We examine two extreme cases. In the first case, the agents know exactly the health states of their neighbors and in the second they have statistical information for the global prevalence of the epidemic. The Nash equilibria of the games are studied and, interestingly, in the second case the equilibrium strategies for an agent are either full isolation or no social distancing at all. Experimental studies are presented through simulations, where we observe that in the first case of perfect local information the agents can affect significantly the prevalence of the epidemic with low cost for their sociability, while in the second case they have to pay the burden of not being well informed. Moreover, the effects of the information quality (fake news), the health care system capacity and the network structure are discussed and relevant simulations are provided, which indicate that these parameters affect the size, the peak and the start of the outbreak, as well as the possibility of a second outbreak.


title: Glycyrrhizic-Acid-Based Carbon Dots with High Antiviral Activity by Multisite Inhibition Mechanisms

text: With the gradual usage of carbon dots (CDs) in the area of antiviral research, attempts have been stepped up to develop new antiviral CDs with high biocompatibility and antiviral effects. In this study, a kind of highly biocompatible CDs (Gly-CDs) is synthesized from active ingredient (glycyrrhizic acid) of Chinese herbal medicine by a hydrothermal method. Using the porcine reproductive and respiratory syndrome virus (PRRSV) as a model, it is found that the Gly-CDs inhibit PRRSV proliferation by up to 5 orders of viral titers. Detailed investigations reveal that Gly-CDs can inhibit PRRSV invasion and replication, stimulate antiviral innate immune responses, and inhibit the accumulation of intracellular reactive oxygen species (ROS) caused by PRRSV infection. Proteomics analysis demonstrates that Gly-CDs can stimulate cells to regulate the expression of some host restriction factors, including DDX53 and NOS3, which are directly related to PRRSV proliferation. Moreover, it is found that Gly-CDs also remarkably suppress the propagation of other viruses, such as pseudorabies virus (PRV) and porcine epidemic diarrhea virus (PEDV), suggesting the broad antiviral activity of Gly-CDs. The integrated results demonstrate that Gly-CDs possess extraordinary antiviral activity with multisite inhibition mechanisms, providing a promising candidate for alternative therapy for PRRSV infection.


docid: cniyembt

title: Could India be the origin of next COVID-19 like epidemic?

text: The COVID-19 global pandemic is not even over yet but it has already taught us a lot of lessons - the hard way. The vast majority of the global community has blamed the Chinese Illegal wildlife markets for the origin of this pandemic. Through careful scientific analysis, I have explained in this article that we don't need such wildlife markets for these kinds of outbreaks to occur in the future. I have also explained how India which is the second-most populous country in the world, could be the origin of the next outbreak, even though such wildlife markets are either very rare or do not exist at all in India.


title: Clinical course of COVID-19 pneumonia in a patient undergoing pneumonectomy and pathology findings during the incubation period

text: BACKGROUND: The cause of coronavirus disease 2019 (COVID-19) is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical information about patients undergoing lung resection while infected with this virus and pathological information about early COVID-19 pneumonia are still scarce. CASE PRESENTATION: A 69-year-old male patient underwent a right pneumonectomy for squamous cell lung carcinoma. Until the fourth postoperative day, the patient, who had minor radiological changes on chest x-ray, was asymptomatic. From this day, the COVID-19 test, which was performed after the appearance of symptoms such as fever and shortness of breath, lymphopenia and diffuse ground glass opacity in the left lung on computed tomography, was reported to be positive. The patient was given NIMV (non-invasive mechanical ventilation), and hydroxychloroquine, favipiravir and azithromycin in isolation intensive care, with the diagnosis of severe pneumonia. He was discharged on the 17th postoperative day with healing of the lung lesions. The pathology specimen of the patient, who was found to have been infected with SARS-CoV-2 before the day of surgery, was examined retrospectively. Irregular and severe pneumocyte hyperplasia, interstitial thickening, oedema, pronounced protein exudates, diffuse enlargement of the alveolar walls, macrophage infiltration and fibroblastic proliferation, which is an indicator of early organisation, were detected. CONCLUSION: We believe that the clinical course and pathology findings obtained after right pneumonectomy in a patient with pre-symptomatic COVID-19 pneumonia will guide the diagnosis and treatment of patients infected with SARS-CoV-2.


Promoting and supporting children's health and healthcare during COVID-19 - International Paediatric Association Position Statement


Important role of emergency department doctors after the outbreak of COVID-19 in China


Modulation of immune crosstalk in COVID-19


The Utah model: mental bandwidth and strategic risk generation in COVID-19 airway management


Time to 'Buddy Up' - Simple Strategies to Support Oncologists During the Covid-19 Pandemic


title: Minimum costs to manufacture new treatments for COVID-19

text: Introduction: 'Repurposing' existing drugs to treat COVID-19 is vital to reducing mortality and controlling the pandemic Several promising drugs have been identified and are in various stages of clinical trials globally If efficacy of these drugs is demonstrated, rapid, mass availability at an affordable cost would be essential to ensuring equity and access especially amongst low- and middle-income economies Methods: Minimum costs of production were estimated from the costs of active pharmaceutical ingredients using established methodology, which had good predictive accuracy for medicines for hepatitis C and HIV amongst others Data were extracted from global export shipment records or analysis of the route of chemical synthesis The estimated costs were compared with list prices from a range of countries where pricing data were available Results: Minimum estimated costs of production were US $0 93/day for remdesivir, $1 45/day for favipiravir, $0 08/day for hydroxychloroquine, $0 02/day for chloroquine, $0 10/day for azithromycin, $0 28/day for lopinavir/ritonavir, $0 39/day for sofosbuvir/daclatasvir and $1 09/day for pirfenidone Costs of production ranged between $0 30 and $31 per treatment course (10-28 days) Current prices of these drugs were far higher than the costs of production, particularly in the US Conclusions: Should repurposed drugs demonstrate efficacy against COVID-19, they could be manufactured profitably at very low costs, for much less than current list prices Estimations for the minimum production costs can strengthen price negotiations and help ensure affordable access to vital treatment for COVID-19 at low prices globally


Endovascular stroke treatment during the COVID-19 pandemic


title: Cutaneous signs in COVID-19 patients: A review

text: Coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the epithelium of the airways. With the increasing involvement of dermatologist in management of this crisis, cutaneous symptoms gained more and more attention. In this review, we will describe cutaneous symptoms of patients of all ages in association with COVID-19. We will focus on such disorders that are caused by direct action of SARS-CoV-2 on tissues, complement, and coagulation system and on nonspecific eruption of the systemic viral infection. Drug-induced reactions are only mentioned in the differential diagnoses. Although more systematic investigations are warranted, it becomes clear that some symptoms are clinical signs of a milder COVID-19 course, while others are a red flag for a more severe course. Knowledge of the cutaneous manifestations of COVID-19 may help in early diagnosis, triage of patients, and risk stratification.


title: Detection of low levels of SARS-CoV-2 RNA from nasopharyngeal swabs using three commercial molecular assays

text: In response to the COVID-19 pandemic, commercial molecular assays for SARS-CoV-2 testing have been rapidly developed and broadly deployed in laboratories worldwide. Although these assays have been reported to correlate well, we sought to compare the Xpert® Xpress SARS-CoV-2 to the cobas® SARS-CoV-2 or the Lightmix® Modular SARS and Wuhan CoV E-gene assay for nasopharyngeal (NP) swabs with low levels of SARS-CoV-2 RNA. Thirty-seven NP swabs were studied, including 10 samples with a moderate cycle threshold (Ct) between 30-33.9, and 22 with Ct≥34, and 5 negative for SARS-CoV-2. Overall concordance on initial comparison was 86.5 % (32/37), which was 100 % concordance for samples with Ct values ranging between 30-33.9. Discordance amongst samples showing a Ct ≥34 was 22.7 % (5/22). Endpoint value analysis on the Xpress SARS-CoV-2 within the discordant samples noted two with an endpoint value >5, which were detected by the cobas® or Lightmix®. Testing of SARS-CoV-2 on the three commercial assays was comparable for NP swabs with moderate Ct values, while high Ct values were less concordant. Importantly, analysis of Xpert® endpoint values improved interpretation of discrepant results.


COVID-19-related cardiac involvement and potential implications for cardiothoracic imaging


Visual Dermatology: Acral Erythemato-purpuric Lesions During COVID-19 Pandemic


The evolution of CT characteristics in the patients with COVID-19 pneumonia


title: COVID-19 Pandemic: Exacerbating Racial/Ethnic Disparities in Long-Term Services and Supports

text: What services are available and where racial and ethnic minorities receive long-term services and supports (LTSS) have resulted in a lower quality of care and life for racial/ethnic minority users. These disparities are only likely to worsen during the COVID-19 pandemic, as the pandemic has disproportionately affected racial and ethnic minority communities both in the rate of infection and virus-related mortality. By examining these disparities in the context of the pandemic, we bring to light the challenges and issues faced in LTSS by minority communities with regard to this virus as well as the disparities in LTSS that have always existed.


The Essential Business Conundrum in COVID-19 Hotspots


title: [Study on medication regularity of traditional Chinese medicine in treatment of COVID-19 based on data mining]

text: The coronavirus disease 2019(COVID-19) is developing rapidly and posing great threat to public health. There is no specific medicine available for treating the disease. Luckily, traditional Chinese medicine has played a positive role in the fighting against COVID-19. In this paper, We collected and sorted the prescriptions of modern Chinese medicine for COVID-19 released by national government, different provinces, autonomous regions and municipalities, as well as online databases, such as CNKI, WanFang medical network, and VIP database. These prescriptions were combined with the inheritance of traditional Chinese medicine auxiliary V2.5, and the complex system entropy clustering method was used to determine the association rules and frequency of single drug and drug combination in the prescription. In the end, 96 effective prescriptions were included. Among them, the four properties were mainly concentrated in temperature, cold and level, the five tastes were mainly concentrated in bitter, hot and sweet, and the meridians were mainly concentrated in lung, stomach and spleen. The high-frequency drugs were Glycyrrhizae Radix et Rhizoma, Armeniacae Semen Amarum, Gypsum Fibrosum, etc., and the high-frequency combinations are Gypsum Fibrosum-Armeniacae Semen Amarum, Gypsum Fibrosum-Glycyrrhizae Radix et Rhizoma, Armeniacae Semen Amarum-Glycyrrhizae Radix et Rhizoma, the core combinations are Lepidii Semen-Armeniacae Semen Amarum-Gypsum Fibrosum, Pogostemonis Herba-Zingiberis Rhizoma Recens-Magnoliae Officinalis Cortex, Ophiopogonis Radix-Armeniacae Semen Amarum-Scutellariae Radix and so on. Form new prescriptions Lepidii Semen, Armeniacae Semen Amarum, Gypsum Fibrosum, Pogostemonis Herba, Zingiberis Rhizoma Recens, Magnoliae Officinalis Cortex. Ophiopogonis Radix, Armeniacae Semen Amarum, Scutellariae Radix, Schisandrae Sphenantherae Fructus, Panacis Quinquefolii Radix. From the medicinal properties to high-frequency drugs and new prescriptions, it could be seen that the overall treatment of COVID-19 by traditional Chinese medicine was to strengthen body resistance, eliminate pathogenic factors, and give attention to Qi and Yin.


Clinical features in pediatric COVID-19


title: Remote reporting in the COVID-19 era: from pilot study to practice

text: AIM: To assess the benefits and challenges of remote reporting using an intra-departmental teleradiology system. MATERIALS AND METHODS: A pilot of an in-hospital Trust radiologist reporting on in-hospital Trust patients via a remote login was undertaken. Reporting output, training impact, and quality improvement were measured. RESULTS: Reporting output increased by 140%. Trainee satisfaction was high in a qualitative survey, particularly for out-of-hours support and teaching. Clinicians found the service to be similar to the same service provided by a locally based radiologist. CONCLUSION: In the COVID-19 era, remote working has developed rapidly. This study shows that radiology departments can provide remote reporting that is equal in standard to reporting from within the hospital, and in addition, that there are advantages to output and training.


Covid-19: Ethnic minority doctors feel more pressured and less protected than white colleagues, survey finds


docid: pdxfchbf

title: COVID-19: challenges for a new epoch


Whither pediatric physician-scientist training in the COVID-19 era


title: Retraction of the Research Article: "Police Violence and the Health of Black Infants"

text: [This retracts the article DOI: 10.1126/sciadv.aax7894.].


COVID-19 Psychosis: A Potential New Neuropsychiatric Condition Triggered by Novel Coronavirus Infection and the Inflammatory Response?


Coronavirus in Hematologic Malignancies: Targeting Molecules Beyond the Angiotensin-Converting Enzyme 2 (ACE2) Wall in COVID-19


title: Comparison of pulmonary availability and anti-inflammatory effect of dehydroandrographolide succinate via intratracheal and intravenous administration

text: Dehydroandrographolide succinate (DAS) injection, which was approved in China for the treatment of viral pneumonia and upper respiratory tract infections, is often off-label used for nebulization therapy to avoid the adverse drug reactions associated with the injection. However, the aerodynamic properties and pulmonary fate of nebulized DAS was largely uninvestigated. In this study, the main objectives were to evaluate the in vitro aerodynamic deposition profiles of nebulizer generated aerosols and comparatively investigate the local drug availability and anti-inflammatory efficacy of DAS between intratracheal and intravenous dosing. The in vitro evaluation of aerodynamic characteristics and droplet size distribution showed more than 50% aerosol particles with size being <5 µm, allowing the aerosols to reach the lower respiratory tract. Following intratracheal administration, the drug underwent pulmonary absorption into the bloodstream, rendering an absolute bioavailability of 47.3%. Compared to the intravenous delivery, the intratracheal administration dramatically increased the drug availability in the lung tissue in rats by more than 80-fold, leading to an improved and prolonged local anti-inflammatory efficacy in a lipopolysaccharide induced lung injury model in mice. The present results demonstrated that inhalation delivery of DAS is a convenient and effective alternative to intravenous injections.


Aktuální problematika COVID-19 z pohledu imunologa


Orthopaedic surgeons and orthopaedic surgery in the era of COVID-19


Socioeconomical transformation and mental health impact by the COVID-19's ultimate VUCA era: Toward the New Normal, the New Japan, and the New World


What does it mean to be made vulnerable in the era of COVID-19?


docid: brwnmkij

title: Reproductive healthcare during a pandemic: a New York state of mind

text: The purpose of this Commentary is to assess whether the designation by New York State Department of Health of 'sexual and reproductive health services as essential' is consonant with the seemingly divergent objectives of providing patient-centred care and advancing national public health objectives in the resource-constrained setting of a global pandemic.


title: Density functional theory study on adsorption of L-cysteine by Y, Zr, Nb, Mo-doped graphenes

text: The adsorption properties of l-cysteine (L-cys) on [Kr] 4d1-4 (Y-Mo) doped graphenes with single and double vacancies are studied by using density functional theory calculations with dispersion correction. The results showed that Y, Zr, Nb and Mo doped single-vacancy and double-vacancy graphenes show chemical adsorption characteristics towards L-cys. For the respective S, O and N-end adsorption, the binding strengths of L-cys on XSVs decrease from Y to Nb, and then increase. The binding strengths of L-cys on XDVs have no regular trend. Nb-doped graphene exhibits the most stable adsorption characteristics in the [Kr] 4d1-4 element series, which is independent of the vacancy type. Zr-doped single and double vacancy graphene sensors have higher sensitivity than Y, Nb, Mo.


title: The Effects of 11-Ketotestosterone Implants on Transcript Levels of Gonadotropin Receptors, foxl2 and dmrt1 Genes in the Previtellogenic Ovary of Cultured Beluga (Huso huso)

text: The in vivo effect of 11-ketotestosterone (11KT) on transcript levels of the gonadotropin receptors (fshr and lhr) and sex differentiation-related genes (dmrt1 and foxl2) was examined in ovaries of immature female beluga. For this purpose, six fish were treated with implants containing 2.5 mg 11KT and a placebo group of six females of the same age and gametogenic stage were given a blank implant. The implants were intraperitoneally inserted into 4-year-old females at the previtellogenic stage (mean body weight 5580 ± 165 g) and maintained under culture conditions for 8 weeks. Ovary samples for gene expression analysis of lhr, fshr, dmrt1 and foxl2 were collected by biopsy at 3 and 8 weeks post-implantation. Diameters of oocytes increased in response to 11KT treatment, both at 3 and at 8 weeks post-implantation, but no obvious changes were evident in cytology. Three weeks of 11KT treatment did not affect target gene expression, but a tendency for a time-dependent decrease of lhr and dmrt1 mRNA levels was observed in both treatment and placebo groups. By 8 weeks of treatment, however, 11KT implants provoked the upregulation of fshr and foxl2 transcript levels. Furthermore, lhr and dmrt1 transcript abundances recovered by 8 weeks of exposure in both blank- and 11KT-implanted beluga. These results suggest that 11KT, either directly or indirectly, may affect gametogenesis and regulate some key components of the reproductive axis in female beluga. This article is protected by copyright. All rights reserved.


The novel Chinese coronavirus (2019-nCoV) infections: Challenges for fighting the storm


docid: qfxdydgp

title: Clinical characteristics of 3062 COVID-19 patients: A meta-analysis

text: We aimed to systematically review the clinical characteristics of coronavirus disease 2019 (COVID-19). Seven databases were searched to collect studies about the clinical characteristics of COVID-19 from January 1, 2020 to February 28, 2020. Then, meta-analysis was performed by using Stata12.0 software. A total of 38 studies involving 3062 COVID-19 patients were included. Meta-analysis showed that a higher proportion of infected patients was male (56.9%). The incidence rate of respiratory failure or acute respiratory distress syndrome was 19.5% and the fatality rate was 5.5%. Fever (80.4%), fatigue (46%), cough (63.1%), and expectoration (41.8%) were the most common clinical manifestations. Other common symptoms included muscle soreness (33%), anorexia (38.8%), chest tightness (35.7%), shortness of breath (35%), dyspnea (33.9%). Minor symptoms included nausea and vomiting (10.2%), diarrhea (12.9%), headache (15.4%), pharyngalgia (13.1%), shivering (10.9%), and abdominal pain (4.4%). The proportion of patients that was asymptomatic was 11.9%. Normal leukocyte counts (69.7%), lymphopenia (56.5%), elevated C-reactive protein levels (73.6%), elevated ESR (65.6%), and oxygenation index decreased (63.6%) were observed in most patients. About 37.2% of patients were found with elevated D-dimer, 25.9% of patients with leukopenia, along with abnormal levels of liver function (29%), and renal function (25.5%). Other findings included leukocytosis (12.6%) and elevated procalcitonin (17.5%). Only 25.8% of patients had lesions involving a single lung and 75.7% of patients had lesions involving bilateral lungs. The most commonly experienced symptoms of COVID-19 patients were fever, fatigue, cough, and expectoration. A relatively small percentage of patients were asymptomatic. Most patients showed normal leucocytes counts, lymphopenia, elevated levels of C-reactive protein and ESR. Bilateral lung involvement was common.


Practical experience on emergency ophthalmic surgery during the prevalence of COVID-19


title: Impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on COVID-19 in a western population. CARDIOVID registry

text: INTRODUCTION AND OBJECTIVES: Coronavirus disease (COVID-19) has been designated a global pandemic by the World Health Organization. It is unclear whether previous treatment with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) affects the prognosis of COVID-19 patients. The aim of this study was to evaluate the clinical implications of previous treatment with ACEI/ARB on the prognosis of patients with COVID-19 infection. METHODS: Single-center, retrospective, observational cohort study based on all the inhabitants of our health area. Analyses of main outcomes (mortality, heart failure, hospitalization, intensive care unit [ICU] admission, and major acute cardiovascular events [a composite of mortality and heart failure]) were adjusted by multivariate logistic regression and propensity score matching models. RESULTS: Of the total population, 447 979 inhabitants, 965 patients (0.22%) were diagnosed with COVID-19 infection, and 210 (21.8%) were under ACEI or ARB treatment at the time of diagnosis. Treatment with ACEI/ARB (combined and individually) had no effect on mortality (OR, 0.62; 95%CI, 0.17-2.26; P=.486), heart failure (OR, 1.37; 95%CI, 0.39-4.77; P=.622), hospitalization rate (OR, 0.85; 95%CI, 0.45-1.64; P=.638), ICU admission (OR, 0.87; 95%CI, 0.30-2.50; P=.798), or major acute cardiovascular events (OR, 1.06; 95%CI, 0.39-2.83; P=.915). This neutral effect remained in a subgroup analysis of patients requiring hospitalization. CONCLUSIONS: Previous treatment with ACEI/ARB in patients with COVID-19 had no effect on mortality, heart failure, requirement for hospitalization, or ICU admission. Withdrawal of ACEI/ARB in patients testing positive for COVID-19 would not be justified, in line with current recommendations of scientific societies and government agencies.


title: SARS-CoV-2 surveillance for a non-human primate breeding research facility

text: BACKGROUND: The emergence of SARS-CoV-2 and the ensuing COVID-19 pandemic prompted the need for a surveillance program to determine the viral status of the California National Primate Research Center non-human primate breeding colony, both for reasons of maintaining colony health and minimizing the risk of interference in COVID-19 and other research studies. METHODS: We collected biological samples from 10% of the rhesus macaque population for systematic testing to detect SARS-CoV-2 virus by RT-PCR and host antibody response by ELISA. Testing required the development and validation of new assays and an algorithm using in laboratory-developed and commercially available reagents and protocols. RESULTS AND CONCLUSIONS: No SARS-CoV-2 RNA or antibody was detected in this study; therefore, we have proposed a modified testing algorithm for sentinel surveillance to monitor for any future transmissions. As additional reagents and controls become available, assay development and validation will continue, leading to the enhanced sensitivity, specificity, accuracy, and efficiency of testing.


Orkney's approach to COVID-19


Hydroxychloroquine-based treatments in the CoViD-19 pandemic


title: Observing Responses to the COVID-19 Pandemic using Worldwide Network Cameras

text: COVID-19 has resulted in a worldwide pandemic, leading to"lockdown"policies and social distancing. The pandemic has profoundly changed the world. Traditional methods for observing these historical events are difficult because sending reporters to areas with many infected people can put the reporters' lives in danger. New technologies are needed for safely observing responses to these policies. This paper reports using thousands of network cameras deployed worldwide for the purpose of witnessing activities in response to the policies. The network cameras can continuously provide real-time visual data (image and video) without human efforts. Thus, network cameras can be utilized to observe activities without risking the lives of reporters. This paper describes a project that uses network cameras to observe responses to governments' policies during the COVID-19 pandemic (March to April in 2020). The project discovers over 30,000 network cameras deployed in 110 countries. A set of computer tools are created to collect visual data from network cameras continuously during the pandemic. This paper describes the methods to discover network cameras on the Internet, the methods to collect and manage data, and preliminary results of data analysis. This project can be the foundation for observing the possible"second wave"in fall 2020. The data may be used for post-pandemic analysis by sociologists, public health experts, and meteorologists.


Flattening the Curve for Incarcerated Populations - Covid-19 in Jails and Prisons


title: Agile Requirements Engineering and Software Planning for a Digital Health Platform to Engage the Effects of Isolation Caused by Social Distancing: Case Study

text: BACKGROUND: Social distancing and shielding measures have been put in place to reduce social interaction and slow the transmission of the coronavirus disease (COVID-19). For older people, self-isolation presents particular challenges for mental health and social relationships. As time progresses, continued social distancing could have a compounding impact on these concerns. OBJECTIVE: This project aims to provide a tool for older people and their families and peers to improve their well-being and health during and after regulated social distancing. First, we will evaluate the tool's feasibility, acceptability, and usability to encourage positive nutrition, enhance physical activity, and enable virtual interaction while social distancing. Second, we will be implementing the app to provide an online community to assist families and peer groups in maintaining contact with older people using goal setting. Anonymized data from the app will be aggregated with other real-world data sources to develop a machine learning algorithm to improve the identification of patients with COVID-19 and track for real time use by health systems. METHODS: Development of this project is occurring at the time of publication, and therefore, a case study design was selected to provide a systematic means of capturing software engineering in progress. The app development framework for software design was based on agile methods. The evaluation of the app's feasibility, acceptability and usability shall be conducted using Public Health England's guidance on evaluating digital health products, Bandura's model of health promotion, the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework and the Nonadoption, Abandonment and Challenges to the Scale-up, Spread and Suitability (NASSS) framework. RESULTS: Making use of a pre-existing software framework for health behavior change, a proof of concept was developed, and a multistage app development and deployment for the solution was created. Grant submissions to fund the project and study execution have been sought at the time of publication, and prediscovery iteration of the solution has begun. Ethical approval for a feasibility study design is being sought. CONCLUSIONS: This case study lays the foundations for future app development to combat mental and societal issues arising from social distancing measures. The app will be tested and evaluated in future studies to allow continuous improvement of the app. This novel contribution will provide an evidence-based exemplar for future app development in the space of social isolation and loneliness.


The clinical dynamics of 18 cases of COVID-19 outside of Wuhan, China


Corona pandemic-let us not be part of the problem


title: Reentry to Metabolic and Bariatric Surgery During the COVID19 Pandemic

text: Patients with obesity and diabetes have higher risk for severe complications and mortality from COVID19 infection. In addition, unexpected mortalities were reported in a small series of asymptomatic COVID19-positive patients undergoing metabolic and bariatric surgery (MBS). Several organization including IFSO and the American College of Surgeons (ACS) endorsed recommendations to suspend elective nonessential surgery including MBS during the peak period of COVID19. However, both recommendations have no clear guidelines on how to prioritize MBS patients after the peak of COVID19 cases has passed, but there remain patients with asymptomatic COVID19 in the community. We present a tiered approach to restart MBS during the COVID19 pandemic once the peak of new cases has passed or the curve of new COVID19 cases has flattened.


Letter to editor in response to article "COVID-19: From bench to bedside" (Singh et al.)


title: Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors

text: Since the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, it has rapidly spread across many other countries. While the majority of patients were considered mild, critically ill patients involving respiratory failure and multiple organ dysfunction syndrome are not uncommon, which could result death. We hypothesized that cytokine storm is associated with severe outcome. We enrolled 102 COVID-19 patients who were admitted to Renmin Hospital (Wuhan, China). All patients were classified into moderate, severe and critical groups according to their symptoms. 45 control samples of healthy volunteers were also included. Inflammatory cytokines and C-Reactive Protein (CRP) profiles of serum samples were analyzed by specific immunoassays. Results showed that COVID-19 patients have higher serum level of cytokines (TNF-α, IFN-Î³, IL-2, IL-4, IL-6 and IL-10) and CRP than control individuals. Within COVID-19 patients, serum IL-6 and IL-10 levels are significantly higher in critical group (n = 17) than in moderate (n = 42) and severe (n = 43) group. The levels of IL-10 is positively correlated with CRP amount (r = 0.41, P < 0.01). Using univariate logistic regression analysis, IL-6 and IL-10 are found to be predictive of disease severity and receiver operating curve analysis could further confirm this result (AUC = 0.841, 0.822 respectively). Our result indicated higher levels of cytokine storm is associated with more severe disease development. Among them, IL-6 and IL-10 can be used as predictors for fast diagnosis of patients with higher risk of disease deterioration. Given the high levels of cytokines induced by SARS-CoV-2, treatment to reduce inflammation-related lung damage is critical.


docid: msethhsr

title: Spiking Pandemic Potential: Structural and Immunological Aspects of SARS-CoV-2

text: SARS-Coronavirus-2 (SARS-CoV-2) causes Coronavirus disease 2019 (COVID-19), an infectious respiratory disease causing thousands of deaths and overwhelming public health systems. The international spread of SARS-CoV-2 is associated with the ease of global travel, and societal dynamics, immunologic naiveté of the host population, and muted innate immune responses. Based on these factors and the expanding geographic scale of the disease, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic-the first caused by a coronavirus. In this review, we summarize the current epidemiological status of COVID-19 and consider the virological and immunological lessons, animal models, and tools developed in response to prior SARS-CoV and MERS-CoV outbreaks that can serve as resources for development of SARS-CoV-2 therapeutics and vaccines. In particular, we discuss structural insights into the SARS-CoV-2 spike protein, a major determinant of transmissibility, and discuss key molecular aspects that will aid in understanding and fighting this new global threat.


title: The internal cranial anatomy of Champsosaurus (Choristodera: Champsosauridae): Implications for neurosensory function

text: Although isolated Champsosaurus remains are common in Upper Cretaceous sediments of North America, the braincase of these animals is enigmatic due to the fragility of their skulls. Here, two well-preserved specimens of Champsosaurus (CMN 8920 and CMN 8919) are CT scanned to describe their neurosensory structures and infer sensory capability. The anterior portion of the braincase was poorly ossified and thus does not permit visualization of a complete endocast; however, impressions of the olfactory stalks indicate that they were elongate and likely facilitated good olfaction. The posterior portion of the braincase is ossified and morphologically similar to that of other extinct diapsids. The absence of an otic notch and an expansion of the pars inferior of the inner ear suggests Champsosaurus was limited to detecting low frequency sounds. Comparison of the shapes of semicircular canals with lepidosaurs and archosauromorphs demonstrates that the semicircular canals of Champsosaurus are most similar to those of aquatic reptiles, suggesting that Champsosaurus was well adapted for sensing movement in an aquatic environment. This analysis also demonstrates that birds, non-avian archosauromorphs, and lepidosaurs possess significantly different canal morphologies, and represents the first morphometric analysis of semicircular canals across Diapsida.


Covid-19: WHO halts hydroxychloroquine trial to review links with increased mortality risk


docid: gzzwsswn

title: Cancer has not gone away: A primary care perspective to support a balanced approach for timely cancer diagnosis during COVID-19


title: Clinical Features of COVID-19-Infected Patients With Elevated Liver Biochemistries: A Multicenter, Retrospective Study

text: In December 2019, an outbreak of coronavirus disease 2019 (COVID-19) emerged in Wuhan, China. Although it has been reported that some COVID-19 patients showed elevated liver biochemistries, there are few studies regarding clinical features and prognosis of these patients. In this multicenter, retrospective study, we collected data on laboratory-confirmed COVID-19 patients from three hospitals in Wuhan, China, who died or were discharged between February 1, 2020, and February 20, 2020. The data on demographics, comorbidities, clinical symptoms, laboratory examinations on admission, complications, treatment, and outcome were collected. A total of 482 patients were enrolled in this study. Of those, 142 (29.5%) patients showed abnormal liver biochemistries on admission, and patients with elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) accounted for 67.6%, 69.0%, and 16.2%, respectively. Those with abnormal liver biochemistries showed higher percentages of severe cases and comorbidities and were more likely to have dyspnea, chest distress or pain, and increased hemoglobin (Hb) on admission. Higher rates of complications and mortality and worse recovery when discharged were observed in patients with abnormal AST or TBIL. The multivariable regression analysis showed that chest distress or pain (odds ratio [OR], 1.765; P = 0.018), dyspnea (OR, 2.495; P = 0.001), elevated C-reactive protein [CRP] level (OR, 1.007; P = 0.008), elevated white blood count (WBC) (OR, 1.139; P = 0.013), and elevated Hb concentration (OR, 1.024; P = 0.001) were independent factors associated with elevated liver biochemistries in COVID-19 patients. Conclusion: Elevated liver biochemistries were common in COVID-19 patients. Patients with hypoxia or severe inflammation are more likely to experience increased liver biochemistries on admission. Those with abnormal AST or TBIL on admission are more likely to suffer from severe complications and death.


title: Spatial variations in and environmental significance of nitrogen forms in river sediments from two different watersheds in eastern China

text: Nitrogen is considered an essential nutrient element limiting water productivity, and its distribution in sediments directly affects its release potential. This study aimed to analyse the spatial characteristics, distribution, and influence of nitrogen forms in two different river catchments situated in eastern China. Using sequential extraction methods, the study divided sediment nitrogen into four forms, namely, an ion-exchangeable form (IEF-N), weak acid-extractable form (WAEF-N), strong alkali-extractable form (SAEF-N), and strong oxidant-extractable form (SOEF-N). The results for the two catchments showed significant differences in the physicochemical properties as well as variations in space. The mean proportion of total transferable nitrogen (TTN) in the Anhe, Suihe, Dongtiaoxi, and Xitiaoxi rivers accounted for 50.64%, 32.87%, 34.63%, and 40.45%, respectively. The results also revealed a higher total TTN in the Hongze watershed than in the Tiaoxi watershed. The order of mean TTN in sediments from the Hongze watershed was SOEF-N > SAEF-N > IEF-N > WAEF-N, whereas that for the Tiaoxi watershed was SOEF-N > SAEF-N > WAEF-N > IEF-N. The distribution of nitrogen forms in the sediments was significantly impacted by the sediment composition and environmental factors, as shown by correlation and redundancy analysis (RDA).


Erupción medicamentosa en paciente infectado por SARS-CoV-2./ [Cutaneous drug eruption in a patient infected with SARS-CoV2]


Cessation of cancer screening: An unseen cost of the COVID-19 pandemic?


title: Increased Mortality and Major Complications in Hip Fracture Care During the COVID-19 Pandemic: A New York City Perspective

text: OBJECTIVES: To examine one health system's response to the essential care of its hip fracture population during the COVID-19 pandemic and report on its effect on patient outcomes. DESIGN: Prospective cohort study SETTING:: Seven musculoskeletal care centers with New York City and Long Island. PATIENTS/PARTICIPANTS: 138 recent and 115 historical hip fracture patients. INTERVENTION: Patients with hip fractures occurring between February 1, 2020 and April 15, 2020 or between February 1, 2019 and April 15, 2019 were prospectively enrolled in an orthopedic trauma registry and chart reviewed for demographic and hospital quality measures. Patients with recent hip fractures were identified as COVID positive (C+), COVID suspected (Cs) or COVID negative (C-). MAIN OUTCOME MEASUREMENTS: Hospital quality measures, inpatient complications and mortality rates. RESULTS: Seventeen (12.2%) patients were confirmed C+ by testing and another 14 (10.1%) were suspected (Cs) of having had the virus but were never tested. The C+ cohort, when compared to Cs and C- cohorts, had: an increased mortality rate (35.3% vs 7.1% vs 0.9%), increased length of hospital stay, a greater major complication rate and a greater incidence of ventilator need postoperatively. CONCLUSIONS: COVID-19 had a devastating effect on the care of hip fracture patients during the pandemic. Although practice patterns generally remained unchanged, treating physicians need to understand the increased morbidity and mortality in hip fracture patients complicated by COVID-19. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.


title: Functional characterization of a low-frequency V1937I variant in FASN associated with susceptibility to esophageal squamous cell carcinoma

text: Metabolic reprogramming has been regarded as one of the core hallmarks of cancer and increased de novo fatty acid synthesis has been documented in multiple tumors including esophageal squamous cell carcinoma (ESCC). Our previous exome-wide analyses found a Val1937Ile variant (rs17848945) in the 34th exon of fatty acid synthase (FASN) that showed a strong association with the risk of ESCC. In this study, we performed a series of functional assays to investigate the biological functions underlying this variant in the development of ESCC. We demonstrated that FASN was upregulated in ESCC and both knockdown and knockout of FASN significantly inhibited ESCC cell proliferation, suggesting a tumor promoter role for this gene in ESCC. Furthermore, the results showed that overexpression of FASN[I] in the ESCC cells substantially enhanced cell proliferation, compared with overexpression of FASN[V], or the control vector. Intriguingly, we found that the FASN[I] variant can enhance the enzyme activity of FASN, and, thus, increase the amount of the FASN end-product, palmitate in the ESCC cells. We also observed elevated palmitate levels in the plasma of the FASN[I] genotype carriers among a total of 632 healthy Chinese adults. In conclusion, our results suggested that the FASN V1937I variant influenced ESCC cell proliferation and susceptibility by altering the catabolic activity of FASN on palmitate. These findings may highlight an important role of palmitate metabolism in the development of ESCC and may contribute to the personalized medicine of this disease.


Remdesivir bei Patienten mit schwerer COVID-19./ [Remdesivir for patients with severe COVID-19]


title: CCL20 induced by visfatin in macrophages via the NF-κB and MKK3/6-p38 signaling pathways contributes to hepatic stellate cell activation

text: Chemokines interact with hepatic resident cells during inflammation and fibrosis. CC chemokine ligand (CCL) 20 has been reported to be important in inflammation and fibrosis in the liver. We hypothesized that visfatin, an adipocytokine, could play a role in hepatic fibrosis via CCL20. We investigated the effect of visfatin on CCL20 in THP-1 human promonocytic cells and examined the molecular mechanisms involved. Following treatment of THP-1 cells with visfatin, CCL20 expression and secretion were assessed. We assessed the intracellular signaling molecules IKK/NF-κB, JAK2/STAT3, MAPKs, and MKK3/6 by western blotting. We treated THP-1 cells with visfatin and signaling inhibitors, and examined CCL20 mRNA and protein levels. To investigate the effect of visfatin-induced CCL20 expression in hepatic stellate cells (HSCs), LX-2 cells were co-cultured with the culture supernatant of THP-1 cells with or without anti-CCL20 neutralizing antibodies, and fibrosis markers were examined by RT-PCR and immunoblotting. In THP-1 cells, visfatin increased the CCL20 mRNA and protein levels. visfatin increased the activities of the NF-κB, p38, and MLK3/6 signaling pathways but not those of the JAK2/STAT3 and ERK pathways. Visfatin treatment together with an NF-κB, p38, or MLK3 inhibitor reduced the mRNA and protein levels of CCL20. The visfatin-induced CCL20 increased the expression of fibrosis markers and CCR6 in HSCs. Following neutralization of CCL20, the levels of fibrosis markers and CCR6 were decreased. Visfatin increases the expression of CCL20 via the NF-κB and MKK3/6-p38 signaling pathways in macrophages, and visfatin-induced CCL20 expression promotes the fibrosis markers in HSCs.


title: Thrombocytopaenia in pregnancy: the importance of differential diagnosis during the COVID-19 pandemic

text: Since the beginning of the COVID-19 pandemic, an optimal management of vulnerable patients, such as pregnant women, has been regarded as a challenge for healthcare professionals. Although thrombocytopaenia is considered a minor criterion for admission within an intensive care unit, a low platelet count has been observed in COVID-19 patients, including a pregnant woman, who developed severe pulmonary complications. Furthermore, thrombocytopaenia has been proposed as a potential biomarker in order to identify cases at high-risk complications. Nevertheless, thrombocytopaenia is a relatively frequent condition observed in pregnancy. In this context, a differential diagnosis is essential for the correct management of COVID-19 pregnant women.


Strange days


title: Household transmission of SARS-CoV-2

text: BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an epidemic in China and many other countries. Many infected clusters have been found within familial households, but the data about secondary transmission among household contacts is limited. METHODS: In this retrospective case series, we enrolled 85 patients infected with SARS-CoV-2 and their household members in Wuhan. Patients were confirmed infected with SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (RT-PCR) assays on throat swabs. Epidemiological, clinical and laboratory data of the household members were collected. RESULTS: There were 155 close contacts in total. 104 contacts received RT-PCR assays, with 47 (30%) positive cases and 57 (37%) negative cases. 51 (33%) cases did not received RT-PCR tests for they showed no symptoms of pneumonia during the 2 weeks of quarantine. The infection rate of close contacts was 38% for households with 1 contact, 50% for households with 2 contacts, and 31% for households with 3 contacts. CONCLUSIONS: The rate of secondary transmission among household contacts of patients with SARS-CoV-2 infection was 30%. Our data provide insight into the rate of secondary transmission of SARS-CoV-2 in home.


title: The ICMR bulletin on targeted hydroxychloroquine prophylaxis for Covid-19: Need to interpret with caution

text: The National Task Force for Covid-19 of the Indian Council of Medical Research (ICMR) in a bulletin dated March 21, 2020 recommended the use of hydroxychloroquine for prophylaxis in asymptomatic health care workers caring for suspected or confirmed patients and household contacts of confirmed patients. This is cause for concern with regard to bioethics and good clinical practice. The evidence for the efficacy of chloroquine and hydroxychloroquine is currently derived from open label trials and cell culture studies with no conclusive evidence available from randomised clinical trials. Hydroxychloroquine also carries contraindications in the case of conditions such as maculopathy, retinopathy and QTc prolongation and should be used with caution in vulnerable populations such as children, pregnancy, lactation and the elderly. Despite this, there has been a rush to procure and self-medicate with hydroxychloroquine, which has been addressed by the National Task Force. The WHO and the FDA have not found adequate evidence to recommend any specific medication for the treatment of Covid-19. While further evidence is awaited, including from trials registered with the FDA and the ICMR, it is recommended that the administration of hydroxychloroquine for chemo-prophylaxis be considered on a case by case basis with monitoring by a registered medical practitioner including electrocardiography (ECG). The potential for retinal and cardiac toxicity must also be borne in mind. It is further recommended that a public advisory regarding the need for caution in chemo-prophylaxis be made available in the public domain. Keywords: Coronavirus, Covid-19, SARS-CoV-2, hydroxychloroquine, chloroquine, chemoprophylaxis, bioethics, evidence- based medicine.


Epidemiological and clinical characteristics of a familial cluster of COVID-19


title: Modified management mode for colorectal cancer during COVID-19 outbreak - a single-center experience

text: During the epidemic of COVID-19, the management model of colorectal cancer has to be changed at our center due to relatively limited medical resources. Outpatient visits are reduced under well protected after appointment, and rigorous investigation of epidemiological history and clinical symptoms are needed. We prefer a simple and convenient treatment regimen, which may also be postponed appropriately. Minimally invasive CRC surgery combined with a perioperative program of enhanced recovery after surgery should be recommended. We also focus on mental health treatments and healthy lifestyle education. In addition, routine follow-up can be moderately delayed. In total, adequate doctor-patient communication is also recommended throughout the treatment.


title: Origin, Potential Therapeutic Targets and Treatment for Coronavirus Disease (COVID-19)

text: The ongoing episode of coronavirus disease 19 (COVID-19) has imposed a serious threat to global health and the world economy. The disease has rapidly acquired a pandemic status affecting almost all populated areas of the planet. The causative agent of COVID-19 is a novel coronavirus known as SARS-CoV-2. The virus has an approximate 30 kb single-stranded positive-sense RNA genome, which is 74.5% to 99% identical to that of SARS-CoV, CoV-pangolin, and the coronavirus the from horseshoe bat. According to available information, SARS-CoV-2 is inferred to be a recombinant virus that originated from bats and was transmitted to humans, possibly using the pangolin as the intermediate host. The interaction of the SARS-CoV-2 spike protein with the human ACE2 (angiotensin-converting enzyme 2) receptor, and its subsequent cleavage by serine protease and fusion, are the main events in the pathophysiology. The serine protease inhibitors, spike protein-based vaccines, or ACE2 blockers may have therapeutic potential in the near future. At present, no vaccine is available against COVID-19. The disease is being treated with antiviral, antimalarial, anti-inflammatory, herbal medicines, and active plasma antibodies. In this context, the present review article provides a cumulative account of the recent information regarding the viral characteristics, potential therapeutic targets, treatment options, and prospective research questions.


Improved sensitivity using a dual target, E and RdRp assay for the diagnosis of SARS-CoV-2 infection: Experience at a large NHS Foundation Trust in the UK


Using the Systems Engineering Initiative for Patient Safety (SEIPS) model to describe critical care nursing during the SARS-CoV-2 pandemic (2020)


The Need to Include Assisted Living in Responding to the COVID-19 Pandemic


COVID-19: From Epidemic to Pandemic


title: Resultados de un modelo de organización asistencial para COVID-19 en hemodiálisis en un hospital terciario y sus centros concertados./ Resultados de un modelo de organización asistencial para COVID-19 en hemodiálisis en un hospital terciario y sus centros concertados./ Results of a healthcare organization model for COVID-19 on hemodialysis in a tertiary hospital and its subsidized centers

text: The experience of a tertiary hospital and four hemodialysis centers attached to it during the COVID-19 epidemic is described. The organization of care that has been carried out and the clinical course of the 16cases of COVID-19 in hemodialysis patients are summarized. The joint application of measures, including patient screening, the early investigation of possible cases, the isolation of confirmed, investigational or contact cases, as well as the use of individual protection measures, has enabled the epidemic to be controlled. The clinical course of these 16patients is compared with the series published by the Wuhan University Hospital and with the data from the COVID-19 infection registry of the Spanish Society of Nephrology. In our experience, and unlike what was reported by the Wuhan Center, COVID-19 disease in hemodialysis patients is severe in a significant percentage of cases, and high lethality is mostly caused by the infection itself. Measures to contain the epidemic are effective.


title: Re-Engineering Academic Departments of Obstetrics and Gynecology to Operate in a Pandemic World and Beyond - A Joint AGOS/CUCOG Statement

text: The COVID-19 pandemic has significantly disrupted operations in academic Departments of Obstetrics and Gynecology throughout the U.S. and will continue to impact them for the foreseeable future. It has also created an environment conducive to innovation and the accelerated implementation of new ideas. These departments will need to adapt their operations to accomodate COVID-19 and to continue to meet their tripartite mission of clinical excellence, medical education, and women's health research. This "Call to Action" paper from leaders of AGOS and CUCOG provides a framework to help leaders of Departments of Obstetrics and Gynecology re-imagine and re-engineer their operations in light of the current COVID-19 crisis and future pandemics.


title: [Clinical consideration and management of coronavirus disease 2019]

text: Coronavirus disease 2019 (COVID-19) outbreak in Wuhan city, Hubei province in December 2019 and the epidemic so rapidly happened within the whole country and abroad, raising serious problems and urgent concerns, such as: how to control most effectively human-to-human transmission? When does infection rate rise to its peak? What will eventually be the number of infected patients? How to make early diagnosis? What effective antiviral drugs are available? How to use the existing drugs to achieve the best effect? Can available drugs effectively improve the survival rate of critical patients? In view of the above questions, this article now puts forwards the corresponding suggestions and considerations from the perspective of clinical infectious diseases physician.


title: Induction of Labor in an Intubated Patient With Coronavirus Disease 2019 (COVID-19)

text: BACKGROUND: In the global coronavirus disease 2019 (COVID-19) pandemic, to date, delivery of critically ill pregnant patients has predominantly been by cesarean. CASE: A 27-year-old pregnant woman was admitted to a 166-bed community hospital at 33 weeks of gestation with acute hypoxemic respiratory failure secondary to COVID-19. She underwent mechanical ventilation for 9 days. While ventilated, she underwent induction of labor, resulting in a successful forceps assisted-vaginal birth. She was extubated on postpartum day 5 and discharged on postpartum day 10. The neonate was intubated for 24 hours but was otherwise healthy and discharged home at 36 2/7 weeks postmenstrual age. CONCLUSION: Critically ill patients requiring mechanical ventilation, in this case due to COVID-19, may undergo induction of labor and vaginal delivery when carefully selected.