docid: ntldwdfk

title: Predictability: Can the turning point and end of an expanding epidemic be precisely forecast?

text: No, they can't. Exponentially growing dynamics are intrinsically unpredictable. The time at which the number of infected individuals starts decreasing cannot be reliably calculated before it is actually attained. A standard SIR model with confinement shows that infection spread is inhibited only above a threshold. Confinement induces a slow-down in the expansion phase that does not guarantee an eventual control of the epidemic. A Bayesian fit to the on-going COVID-19 pandemic in Spain shows that we can infer neither its peaking time nor whether there is a peak at all. The dispersion of possible trajectories grows extremely fast, yielding a short horizon for reliable prediction. As unpredictability is intrinsic, not due to incomplete or wrong data, our study advocates for a scenario of probabilistic forecasting.


Characteristics of deaths amongst health workers in China during the outbreak of COVID-19 infection


docid: woylyufz

title: The Impact of COVID-19 on Diabetes Research in Canada


Coronavirus confinement: A chance to learn on oral cancer-The Spanish experience


title: Inelastic Dark Matter Electron Scattering and the XENON1T Excess

text: Detection of electron recoils by dark matter (DM) may reveal the structure of the dark sector. We consider a scenario where a heavier DM particle inelastically scatters off an electron and is converted into a lighter DM particle. A small mass difference between the two DM particles is transferred into electron recoil energy. We investigate the DM-electron interaction mediated by a massive dark photon and evaluate the inelastic DM scattering rate, taking account of the atomic structure. It is found that the scattering rate is significantly enhanced because of the small mass splitting, which allows for a small momentum transfer matched with the size of the electron wave function. We show that there exists a viable parameter space which explains the excess of electron recoil events around 2-3 keV recently reported by the XENON1T experiment.


title: Antenatal corticosteroids for pregnant women with COVID-19 infection and preterm prelabor rupture of membranes: a decision analysis

text: Background: While antenatal corticosteroids are routinely used to decrease adverse neonatal outcomes following preterm delivery, corticosteroids are also associated with worse outcomes in patients with viral respiratory infections. Currently in the setting of the COVID-19 pandemic, it is unclear whether antenatal corticosteroids for infant benefit outweigh the potential harm to a pregnant woman with a COVID-19 infection.Objective: To determine at which gestational ages administering antenatal corticosteroids is the optimal management strategy for hospitalized women with preterm prelabor rupture of membranes (PPROM) who have a COVID-19 infection.Methods: We designed a decision-analytic model to assess the maternal and infant outcomes associated with antenatal corticosteroid administration for risk of preterm delivery following rupture of membranes in the setting of a COVID-19 infection. We used a theoretical cohort of 10,000 women at each gestational age between 24 and 32 weeks who were hospitalized with PPROM and found to be COVID-19 positive. Maternal outcomes included intensive care unit admission and death related to COVID-19 infection. The infant outcomes of interest included respiratory distress syndrome, intraventricular hemorrhage, neurodevelopmental delay, and death, and were assessed along with maternal and infant quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were used to evaluate model assumptions.Results: In our theoretical cohort of 10,000 women with COVID-19 infection and preterm prelabor rupture of membrane between 24 and 32 weeks, corticosteroid administration resulted in 2,200 women admitted to the ICU and 110 maternal deaths at each gestational age. No antenatal corticosteroid use resulted in 1,500 ICU admissions and 75 maternal deaths at each gestational age. Antenatal corticosteroid administration also resulted in fewer cases of respiratory distress syndrome, intraventricular hemorrhage, and infant death. Overall, we found that between 24 and 30 weeks of gestation, administering antenatal corticosteroids was the optimal management strategy as it resulted in higher combined QALYs than no corticosteroid use. For 31 and 32 weeks of gestation, antenatal corticosteroid administration resulted in lower combined QALYs. On sensitivity analyses, we found that with increasing gestational age, the probability which antenatal corticosteroids was the optimal management strategy decreased.Conclusion: Administration of antenatal corticosteroids was an effective management strategy compared to no corticosteroid administration at gestational ages less than 31 weeks. These results provide data for clinicians to utilize when counseling pregnant patients hospitalized with PPROM and have a COVID-19 infection.


A case of subacute thyroiditis associated with Covid-19 infection


title: [Health protection guideline of mobile cabin hospitals during Novel Coronavirus Pneumonia (NPC) outbreak]

text: This guideline is applicable to the health protection requirements of large indoor stadiums which are reconstructed as treatment sites for the Novel Coronavirus Pneumonia (NPC) patients with mild symptoms during the outbreak. Focusing on the health emergency scenario of severe virus infectious diseases and atypical places where NPC patients with mild symptom gather, from perspectives of functional zones, hygiene facilities, personal protection, and management system, health risk protection recommendations and countermeasures are comprehensively proposed to mainly protect staffs and surrounding environment. The implementation of this guideline will provide technique support for emergency requirements of indoor stadiums reconstructed as mobile cabin hospitals.


title: [Clinical features and high resolution CT imaging evolution of coronavirus disease 2019]

text: Objective: To investigate the clinical manifestations of the clinical characteristics of 141 patients with coronavirus disease 2019 (COVID-19) and the imaging evolution characteristics of High Resolution CT (HRCT) in the chest. Methods: From January 20, 2020 to February 8, 141 COVID-19 patients in Renmin Hospital of Wuhan University, 77 males and 64 females, with a median age of 49 (9,87) , were retrospectively analyzed. The clinical features, laboratory examination indexes and HRCT evolution findings of 141 COVID-19 patients were analyzed. Results: Laboratory examinations of 141 COVID-19 patients showed a decrease in white blood cell count and lymphocyte ratio. Among the 141 patients with COVID-19, fever (>37.5 â) was the most common clinical manifestation in 139 cases (98.58%) , and occasionally non-respiratory symptoms such as diarrhea in 4 cases (2.84%) . 141 patients with COVID-19 had abnormal HRCT. 52 (36.88%) chest HRCT images showed ground-glass opacity (GGO) , mainly under pleural; 23 (16.31%) GGO with focal consolidation; 27 (19.15%) small flaky shadows; 20 cases (14.18%) large flaky consolidation shadows; 48 cases (34.04%) bronchovascular bundle thickening and vascular penetrating signs; 5 cases (3.55%) had air bronchial signs; 7 cases (4.96%) of small nodule shadows; 5 cases (3.55%) of fibrosis, grid shadows or strand shadows.135 cases (95.74%) were positive for the first time nucleic acid test, 6 cases (4.26%) were negative, and 71 cases (50.35%) of common type, 47 cases (33.33%) of severe type and 23 cases (16.31%) of critical type were found during the same period. The average time from onset of each type to the first CT examination was: (2.51±1.32) , (5.02±2.01) , and (5.91±1.76) days; 19 (19/47, 40.43%) of which were severe for the first time CT classification worsened at the second examination and lessened at the third examination. 141 cases (100%) were positive for the second nucleic acid test, and the HRCT results for the same period were 44 cases (31.21%) of common type, 53 cases (37.59%) of severe type, and 44 cases (31.21%) of critical type; the average interval time was (3.32±1.61) , (3.93±1.84) , (4.15±1.57) days;the third nucleic acid test were positive among 113 cases and 28 cases were negative, HRCT results of the same period were 79 cases (56.03%) of common type, 46 cases (32.62%) of severe type, and 16 cases (11.35%) of critical type;the average interval from the first CT examination were: (5.59±1.83) , (7.32±1.37) , (7.55±1.78) days. The differences in CT typing at different time were statistically significant (P<0.05) . Conclusion: The clinical features of COVID-19 and HRCT images are diverse, extensive GGO and infiltrates in both lungs are typical. Viral nucleic acid tests usually occur earlier or at the same time as the CT examination positive, and there are false negatives in nucleic acid tests. In some epidemiological backgrounds, CT imaging manifestations and evolutionary characteristics are of great significance for early warning of lung injury, assessment of disease severity, and assistance in clinical typing and post-treatment follow-up.


Covid-19: Projections of mortality in the US rise as states open up


Adapting a GI Fellowship to a Pandemic: Novel Approaches to Accommodating a Novel Virus


The COVID-19 outbreak in Italy: Preventive and protective measures adopted by the Dermatology Unit of Bologna University Hospital


docid: tirmcptc

title: Novel Coronavirus 2019 (2019-nCoV) Infection: Part I - Preparedness and Management in the Pediatric Intensive Care Unit in Resource-limited Settings

text: First reported in China, the 2019 novel coronavirus has been spreading across the globe. Till 26 March, 2020, 416,686 cases have been diagnosed and 18,589 have died the world over. The coronavirus disease mainly starts with a respiratory illness and about 5-16% require intensive care management for acute respiratory distress syndrome (ARDS) and multi-organ dysfunction. Children account for about 1-2% of the total cases, and 6% of these fall under severe or critical category requiring pediatric intensive care unit (PICU) care. Diagnosis involves a combination of clinical and epidemiological features with laboratory confirmation. Preparedness strategies for managing this pandemic are the need of the hour, and involve setting up cohort ICUs with isolation rooms. Re-allocation of resources in managing this crisis involves careful planning, halting elective surgeries and training of healthcare workers. Strict adherence to infection control like personal protective equipment and disinfection is the key to contain the disease transmission. Although many therapies have been tried in various regions, there is a lack of strong evidence to recommend anti-virals or immunomodulatory drugs.


title: A social identity perspective on COVID-19: Health risk is affected by shared group membership

text: In the face of a novel infectious disease, changing our collective behaviour is critical to saving lives. One determinant of risk perception and risk behaviour that is often overlooked is the degree to which we share psychological group membership with others. We outline, and summarize supporting evidence for, a theoretical model that articulates the role of shared group membership in attenuating health risk perception and increasing health risk behaviour. We emphasize the importance of attending to these processes in the context of the ongoing response to COVID-19 and conclude with three recommendations for how group processes can be harnessed to improve this response.


Molecular diagnostics at the times of SARS-CoV-2 outbreak


Myocardial work index: a glimmer of hope in COVID-19


Social distancing during the COVID-19 pandemic: Staying home save lives


title: A summary of the diagnostic and prognostic value of hemocytometry markers in COVID-19 patients

text: Many studies have reported hemocytometric changes in COVID-19 infection at admission and during the course of disease, but an overview is lacking. We provide a summary of the literature of hemocytometric changes and evaluate whether these changes may assist clinicians in diagnosing and predicting disease progression of COVID-19. Eighty-three out of 250 articles from December 2019 to 20 May 2020 were included from the databases, PubMed, Web of Science Core Collection, Embase, Cochrane and MedRxiv. Our review of the literature indicates that lymphopenia and an elevated neutrophil/lymphocyte ratio are the most consistent abnormal hemocytometric findings and that these alterations may augment in the course of time, especially in those with severe disease.


title: Effect of income on the cumulative incidence of COVID-19: an ecological study

text: OBJECTIVE: to analyze the relationship between per capita income and the cumulative incidence of COVID-19 in the neighborhoods of the city of Rio de Janeiro, RJ, Brazil. METHOD: an ecological study using neighborhoods as units of analysis. The cumulative incidence rate per 100,000 inhabitants and the median of potential confounding variables (sex, race, and age) were calculated. Multiple analysis included quantile regression, estimating the regression coefficients of the variable income for every five percentiles from the 10th to 90th percentiles to verify the relationship between income and incidence. RESULTS: the city's rate was 36.58 new cases per 100,000 inhabitants. In general, the highest rates were observed in the wealthiest regions. Multiple analysis was consistent with this observation since the per capita income affected all percentiles analyzed, with a median regression coefficient of 0.02 (p-value <0.001; R2 32.93). That is, there is an increase of R$ 0.02 in the neighborhood's per capita income for every unit of incidence. CONCLUSION: cumulative incident rates of COVID-19 are influenced by one's neighborhood of residency, suggesting that access to testing is uneven.


Assuring mental health during our current pandemic


title: Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic

text: Oral and maxillofacial surgery is correlated with a high risk of SARS-CoV-2 transmission. Therefore, the aim of the review is to collect and discuss aspects of the management of patients in oral and maxillofacial surgery during the COVID-19 pandemic. In order to save resources and to avoid unnecessary exposure to infected patients, there is the need to schedule interventions depending on their priority. During the peak of the pandemic, no elective surgery should be performed. Even urgent procedures might be postponed if there is a view to recovery of a COVID-19 patient within a few days. Emergency procedures do not allow any delay. Specialties with overlap in therapies should have well defined arrangements among each other concerning the treatment spectra in order to avoid redundancy and loss of resources. Inpatient and outpatient units have to be organized in such a way that the risk of cross-infection among patients is reduced to a minimum. Especially, testing of patients for SARS-CoV-2 is important to detect the infected patients at an early stage. When surgery is performed on COVID-19 patients, adequate personal protective equipment is crucial. There must be negative pressure in the operating room, and aerosol formation must be reduced to a minimum. In order to address the COVID-19 challenge adequately, significant changes in the infrastructure of outpatient units, inpatient units, and operating rooms are needed. In addition, the demands concerning personal protective equipment increase significantly. The major aim is to protect patients as well as the medical staff from unnecessary infection, and to keep the healthcare system running effectively. Therefore, every effort should be taken to make the necessary investments.


Covid-19 and refugees, asylum seekers, and migrants in Greece


Psychosocial support for healthcare frontliners during COVID-19 pandemic in Malaysia


title: A possible strategy to fight COVID-19: Interfering with spike glycoprotein trimerization

text: The recent release of COVID-19 spike glycoprotein allows detailed analysis of the structural features that are required for stabilizing the infective form of its quaternary assembly. Trying to disassemble the trimeric structure of COVID-19 spike glycoprotein, we analyzed single protomer surfaces searching for concave moieties that are located at the three protomer-protomer interfaces. The presence of some druggable pockets at these interfaces suggested that some of the available drugs in Drug Bank could destabilize the quaternary spike glycoprotein formation by binding to these pockets, therefore interfering with COVID-19 life cycle. The approach we propose here can be an additional strategy to fight against the deadly virus. Ligands of COVID-19 spike glycoprotein that we have predicted in the present computational investigation, might be the basis for new experimental studies in vitro and in vivo.


title: Trials and tribulations: so many potential treatments, so few answers

text: PURPOSE: The purpose of this review is to quantify the landscape of current clinical trials ongoing for therapies in the treatment of COVID-19. A secondary purpose is to examine the relationship between public and scientific interests in potential therapies for COVID-19. METHODS: A systematic search of clinicaltrials.gov was undertaken on April 22, 2020, to identify all currently registered clinical trials investigating potential therapies for patients with COVID-19. Public interest in the various therapies was quantified utilizing Google Trends. Public interest in hydroxychloroquine and chloroquine was plotted against the cumulative number of active clinical trials evaluating antimalarials as potential COVID-19 therapies over time. RESULTS: There were 341 interventional studies and 208 different therapies actively registered on clinicaltrials.gov whose primary aim is the treatment of COVID-19. The median sample size was 120 patients (range 4-6000) with 154 (45%) trials reporting a planned sample size of 100 patients or less. There was a strong positive correlation (r = 0.76, p = 0.01) between the number of registered clinical trials and the public interest in the top ten proposed therapies. Following the spike in public interest, the average number of new trials increased tenfold with respect to antimalarial therapies. CONCLUSIONS: The relatively small sample sizes and the number of independent trials investigating similar therapies are concerning. Resources may not be being allocated based on scientific merit and may be driven by public consciousness and speculation. Moving forward, a concerted effort focused on implementing large, well-coordinated and carefully designed multi-armed clinical trials will help to ensure that the most promising therapeutic options are rigorously studied and clinically meaningful results produced.


title: Estimating the infection horizon of COVID-19 in eight countries with a data-driven approach

text: The COVID-19 pandemic has affected all countries of the world producing a substantial number of fatalities accompanied by a major disruption in their social, financial and educational organization. The strict disciplinary measures implemented by China were very effective and thus were subsequently adopted by most world countries to various degrees. The infection duration and number of infected persons are of critical importance for the battle against the pandemic. We use the quantitative landscape of the disease spreading in China as a benchmark and utilize infection data from eight countries to estimate the complete evolution of the infection in each of these countries. The analysis predicts successfully both the expected number of daily infections per country and, perhaps more importantly, the duration of the epidemic in each country. Our quantitative approach is based on a Gaussian spreading hypothesis that is shown to arise as a result of imposed measures in a simple dynamical infection model. This may have consequences and shed light in the efficiency of policies once the phenomenon is over.


Medical education and care in dermatology during the SARS-CoV2 pandemia: challenges and chances


title: A review of the international early recommendations for departments organization and cancer management priorities during the global COVID-19 pandemic: applicability in low- and middle-income countries

text: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new virus that has never been identified in humans before. COVID-19 caused at the time of writing of this article, 2.5 million cases of infections in 193 countries with 165,000 deaths, including two-third in Europe. In this context, Oncology Departments of the affected countries had to adapt quickly their health system care and establish new organizations and priorities. Thus, numerous recommendations and therapeutic options have been reported to optimize therapy delivery to patients with chronic disease and cancer. Obviously, while these cancer care recommendations are immediately applicable in Europe, they may not be applicable in certain emerging and low- and middle-income countries (LMICs). In this review, we aimed to summarize these international guidelines in accordance with cancer types, making a synthesis for daily practice to protect patients, staff and tailor anti-cancer therapy delivery taking into account patients/tumour criteria and tools availability. Thus, we will discuss their applicability in the LMICs with different organizations, limited means and different constraints.


title: Building trust in digital policing: A scoping review of community policing apps

text: Perceptions of police trustworthiness are linked to citizens' willingness to cooperate with police. Trust can be fostered by introducing accountability mechanisms, or by increasing a shared police/citizen identity, both which can be achieved digitally. Digital mechanisms can also be designed to safeguard, engage, reassure, inform, and empower diverse communities. We systematically scoped 240 existing online citizen-police and relevant third-party communication apps, to examine whether they sought to meet community needs and policing visions. We found that 82% required registration or login details, 55% of those with a reporting mechanism allowed for anonymous reporting, and 10% provided an understandable privacy policy. Police apps were more likely to seek to reassure, safeguard and inform users, while third-party apps were more likely to seek to empower users. As poorly designed apps risk amplifying mistrust and undermining policing efforts, we suggest 12 design considerations to help ensure the development of high quality/fit for purpose Police/Citizen apps.


Need for integrated surveillance at human-animal interface for rapid detection & response to emerging coronavirus infections using One Health approach


title: The broad-spectrum antiviral recommendations for drug discovery against COVID-19

text: Despite to outbreaks of highly pathogenic beta and alpha coronaviruses including severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and human coronavirus, the newly emerged 2019 coronavirus (COVID-19) is considered as a lethal zoonotic virus due to its deadly respiratory syndrome and high mortality rate among the human. Globally, more than 3,517,345 cases have been confirmed with 243,401 deaths due to Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19. The antiviral drug discovery activity is required to control the persistence of COVID-19 circulation and the potential of the future emergence of coronavirus. However, the present review aims to highlight the important antiviral approaches, including interferons, ribavirin, mycophenolic acids, ritonavir, lopinavir, inhibitors, and monoclonal antibodies (mAbs) to provoke the nonstructural proteins and deactivate the structural and essential host elements of the virus to control and treat the infection of COVID-19 by inhibiting the viral entry, viral RNA replication and suppressing the viral protein expression. Moreover, the present review investigates the epidemiology, diagnosis, structure, and replication of COVID-19 for better understanding. It is recommended that these proteases, inhibitors, and antibodies could be a good therapeutic option in drug discovery to control the newly emerged coronavirus.HighlightsCOVID-19 has more than 79.5% identical sequence to SARS-CoV and a 96% identical sequence of the whole genome of bat coronaviruses.Acute respiratory distress syndrome (ARDS), renal failure, and septic shock are the possible clinical symptoms associated with COVID-19.Different antivirals, including interferons, ribavirin, lopinavir, and monoclonal antibodies (mAbs) could be the potent therapeutic agents against COVID-19.The initial clinical trials on hydroquinone in combination with azithromycin showed an admirable result in the reduction of COVID-19.The overexpression of inflammation response, cytokine dysregulation, and induction of apoptosis could be an well-organized factors to reduce the pathogenicity of COVID-19.


title: Recomendaciones Del Grupo Español De Investigación En Dermatitis De Contacto Y Alergia Cutánea (Geidac ) De La Aedv En Relación A La Realización De Pruebas Epicutáneas Durante La Pandemia Por Sars-Cov-2 ( Covid-19)./ Recomendaciones Del Grupo Español De Investigación En Dermatitis De Contacto Y Alergia Cutánea (Geidac ) De La Aedv En Relación A La Realización De Pruebas Epicutáneas Durante La Pandemia Por Sars-Cov-2 ( Covid-19)./ Patch Testing During the COVID-19 Pandemic: Recommendations of the AEDV's Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC)

text: As the COVID-19 pandemic gradually comes under control, the members of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) have drawn up a proposed list of the requirements, limitations, and conditioning factors affecting the resumption of work in contact dermatitis units. The assumption is that the severe acute respiratory syndrome coronavirus 2 is still circulating and that occasional or seasonal outbreaks will occur. They recommend that the first step should be to assess how many patch tests each clinic can handle and review the waiting list to prioritize cases according to disease severity and urgency. Digital technologies can, where possible, be used to send and receive the documentation necessary for the patch test (information, instructions, informed consent, etc.). If the necessary infrastructure is available, patients can be offered the option of a remote initial consultation. Likewise, in selected cases, the patch test results can be read in a virtual visit using photographs taken by the patient or a video visit can be scheduled to allow the physician to evaluate the site of application remotely. These measures will reduce the number of face-to-face visits required, but will not affect the time spent on each case, which must be scheduled in the normal manner. All of these recommendations are suggestions and should be adapted to the needs and possibilities of each health centre.


COVID-19 and non-traditional mask use: How do various materials compare in reducing the infection risk for mask wearers?


title: The deadly coronaviruses: The 2003 SARS pandemic and the 2020 novel coronavirus epidemic in China

text: The 2019-nCoV is officially called SARS-CoV-2 and the disease is named COVID-19. This viral epidemic in China has led to the deaths of over 1800 people, mostly elderly or those with an underlying chronic disease or immunosuppressed state. This is the third serious Coronavirus outbreak in less than 20 years, following SARS in 2002-2003 and MERS in 2012. While human strains of Coronavirus are associated with about 15% of cases of the common cold, the SARS-CoV-2 may present with varying degrees of severity, from flu-like symptoms to death. It is currently believed that this deadly Coronavirus strain originated from wild animals at the Huanan market in Wuhan, a city in Hubei province. Bats, snakes and pangolins have been cited as potential carriers based on the sequence homology of CoV isolated from these animals and the viral nucleic acids of the virus isolated from SARS-CoV-2 infected patients. Extreme quarantine measures, including sealing off large cities, closing borders and confining people to their homes, were instituted in January 2020 to prevent spread of the virus, but by that time much of the damage had been done, as human-human transmission became evident. While these quarantine measures are necessary and have prevented a historical disaster along the lines of the Spanish flu, earlier recognition and earlier implementation of quarantine measures may have been even more effective. Lessons learned from SARS resulted in faster determination of the nucleic acid sequence and a more robust quarantine strategy. However, it is clear that finding an effective antiviral and developing a vaccine are still significant challenges. The costs of the epidemic are not limited to medical aspects, as the virus has led to significant sociological, psychological and economic effects globally. Unfortunately, emergence of SARS-CoV-2 has led to numerous reports of Asians being subjected to racist behavior and hate crimes across the world.


title: Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources: Application to the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond

text: BACKGROUND: As of May 4, 2020, the coronavirus disease 2019 (COVID-19) pandemic has affected >3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems worldwide, leading to the cancellation of elective surgical cases and discussions regarding health care resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak and may recur with future pandemics, creating a need for a means of triaging patients for emergent and elective spine surgery. METHODS: Using a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling. RESULTS: The devised scoring system included 8 independent components: neurologic status, underlying spine stability, presentation of a high-risk postoperative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely available Web-based calculator (https://jhuspine3.shinyapps.io/SpineUrgencyCalculator/). CONCLUSIONS: We present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, although not all encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.


Nutrition in critically ill patients with COVID-19: Challenges and special considerations


Supportive treatment of COVID 19 patients with mild respiratory failure in a primary hospital


Adapting WOC Nursing Practice to the COVID-19 Pandemic: A View From Here


title: New (re)Purpose for an old drug: purinergic receptor blockade may extinguish the COVID-19 thrombo-inflammatory firestorm

text: Purinergic modulators, such as dipyridamole, target multiple pathways that have been implicated in COVID-19 pathogenesis, and thus the therapeutic benefit of these should be explored.


title: Correction: Risk factors affecting dairy cattle protective grouping behavior, commonly known as bunching, against Stomoxys calcitrans (L.) on California dairies

text: [This corrects the article DOI: 10.1371/journal.pone.0224987.].


Preparation in the Big Apple: New York City, a New Epicenter of the COVID-19 Pandemic


title: Vasculopathy and Coagulopathy Associated with SARS-CoV-2 Infection

text: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has resulted in > 500,000 deaths worldwide, including > 125,000 deaths in the U.S. since its emergence in late December 2019 and June 2020. Neither curative anti-viral drugs nor a protective vaccine is currently available for the treatment and prevention of COVID-19. Recently, new clinical syndromes associated with coagulopathy and vasculopathy have emerged as a cause of sudden death and other serious clinical manifestations in younger patients infected with SARS-CoV-2 infection. Angiotensin converting enzyme 2 (ACE2), the receptor for SARS-CoV-2 and other coronaviruses, is a transmembrane protein expressed by lung alveolar epithelial cells, enterocytes, and vascular endothelial cells, whose physiologic role is to induce the maturation of angiotensin I to generate angiotensin 1-7, a peptide hormone that controls vasoconstriction and blood pressure. In this review, we provide the general context of the molecular and cellular mechanisms of SARS-CoV-2 infection with a focus on endothelial cells, describe the vasculopathy and coagulopathy syndromes in patients with SARS-CoV-2, and outline current understanding of the underlying mechanistic aspects.


title: Stiripentol fails to lower plasma oxalate in a dialysis-dependent PH1 patient

text: BACKGROUND: Primary hyperoxaluria type 1 (PH1) is a multisystemic metabolic disorder caused by an excessive production of oxalate by the liver. The majority of patients presenting in early infancy have end-stage renal disease (ESRD). While awaiting the results of sRNAi trials, the current standard treatment is combined liver-kidney transplantation. Recently, Stiripentol has been reported as a promising drug in the treatment of primary hyperoxaluria by reducing urinary oxalate (UOx). Stiripentol is an anti-convulsive drug used in the treatment of children suffering from Dravet syndrome. It causes blockage of the last step in oxalate production by inhibition of hepatic lactate dehydrogenase 5 (LDH5). CASE: We administered Stiripentol as compassionate use in an anuric infant with dialysis-dependent PH1 over a period of 4 months. Although achieving plasma concentrations of Stiripentol that were recently reported to lower UOx excretion, we did not observe significant reduction to plasma oxalate concentrations (POx). CONCLUSION: We conclude that Stiripentol may not be useful to reduce POx in PH patients with advanced chronic kidney disease (CKD), but larger studies are needed to confirm this finding.


Health Care Heroes of the COVID-19 Pandemic


Preparedness and Rapid Implementation of External Quality Assessment Helped Quickly Increase COVID-19 Testing Capacity in the Republic of Korea


title: Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery

text: The coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Hence, surgical candidates face prolonged delays of beneficial treatment. Because of the progressive nature of obesity and diabetes, delaying surgery increases risks for morbidity and mortality, thus requiring strategies to mitigate harm. The risk of harm, however, varies among patients, depending on the type and severity of their comorbidities. A triaging strategy is therefore needed. The traditional weight-centric patient-selection criteria do not favour cases based on actual clinical needs. In this Personal View, experts from the Diabetes Surgery Summit consensus conference series provide guidance for the management of patients while surgery is delayed and for postoperative surveillance. We also offer a strategy to prioritise bariatric and metabolic surgery candidates on the basis of the diseases that are most likely to be ameliorated postoperatively. Although our system will be particularly germane in the immediate future, it also provides a framework for long-term clinically meaningful prioritisation.


Am I Part of the Cure or Am I Part of the Disease? Keeping Coronavirus Out When a Doctor Comes Home


When interferon tiptoes through COVID-19: Pernio-like lesions and their prognostic implications during SARS-CoV-2 infection


Olfactory Disorders in Sars-cov-2 Infection: Considerations in Aging


Coagulopathy of COVID-19 and antiphospholipid antibodies


Syndrome of inappropriate antidiuretic hormone as the initial presentation of COVID-19: A novel case report


Covid-19: Japan prepares to extend state of emergency nationwide as "untraceable" cases soar


docid: snorvtez

title: Optimal Management of Acute Lymphoblastic Leukemia (ALL) in Adult Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic

text: The outbreak of coronavirus disease 2019 (COVID-19) has become a public health emergency of major international concern. In December 2019, an outbreak of atypical pneumonia known as COVID-19 was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARSCoV-2), is characterized by rapid human-to-human transmission. Acute lymphoblastic leukemia (ALL) patients are often in need for intensive chemotherapy to induce remission that will be complicated with prolonged period of cytopenias. They are often recalled to the hospital for treatment and disease surveillance. These patients may be immunocompromised due to the underlying malignancy or anti-cancer therapy. ALL patients are at higher risk of developing life-threatening infections. Several factors increase the risk of infection and the presence of multiple risk factors in the same patient is common. Cancer patients had an estimated 2-fold increased risk of contracting SARS-CoV-2 than the general population. With the World Health Organization declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such pandemic on ALL patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the optimal management of ALL patients in any infectious pandemic. In this review, we will address the potential challenges associated with managing ALL patients during the COVID-19 infection pandemic with suggestions of some practical approaches, focusing on screening asymptomatic ALL patients, diagnostic and response evaluation and choice of chemotherapy in different scenarios and setting and use of hematopoietic stem cell transplantation (HSCT).


Response to COVID-19 by the surgical community


Inflammatory Bowel Diseases and COVID-19: The Invisible Enemy


title: Debate: COVID-19 and children in India

text: The COVID-19 pandemic impact on children is a growing concern. The United Nations and its agencies (the World Health Organization and UNICEF), Indian Association For Child and Adolescent Mental Health and National Institute of Mental Health and Neuroscience in India warn about the broader impacts on children and call for urgent action to support the world's children amidst the pandemic which may have lasting consequences. The COVID-19 pandemic and unprecedented control measures to prevent its spread have disrupted nearly every aspect of children's lives - their health, development, learning, behaviour and their families' economic security, including protection from violence and abuse. Given this background, there is an urgent need for action through screening to minimize the mental health issues of children in India who constitute a substantial proportion of the population.


Invasive pulmonary aspergillosis complicating SARS-CoV-2 pneumonia: A diagnostic challenge


title: A Quantitative Portrait of Wikipedia's High-Tempo Collaborations during the 2020 Coronavirus Pandemic

text: The 2020 coronavirus pandemic was a historic social disruption with significant consequences felt around the globe. Wikipedia is a freely-available, peer-produced encyclopedia with a remarkable ability to create and revise content following current events. Using 973,940 revisions from 134,337 editors to 4,238 articles, this study examines the dynamics of the English Wikipedia's response to the coronavirus pandemic through the first five months of 2020 as a"quantitative portrait"describing the emergent collaborative behavior at three levels of analysis: article revision, editor contributions, and network dynamics. Across multiple data sources, quantitative methods, and levels of analysis, we find four consistent themes characterizing Wikipedia's unique large-scale, high-tempo, and temporary online collaborations: external events as drivers of activity, spillovers of activity, complex patterns of editor engagement, and the shadows of the future. In light of increasing concerns about online social platforms' abilities to govern the conduct and content of their users, we identify implications from Wikipedia's coronavirus collaborations for improving the resilience of socio-technical systems during a crisis.


Epidemiological characteristics of SARS-CoV-2 infections in Shaanxi, China by 8 February 2020


title: Mental health of family, friends, and co-workers of COVID-19 patients in Japan

text: As the coronavirus disease 2019 (COVID-19) pandemic rages on, the mental health of both the infected and non-infected is a rising concern. We used administrative survey data (16402 responses in the last two weeks) using a chatbot on LINE, the most popular social networking service (SNS) in Japan, to show that people with COVID-19 patients in a close setting had higher psychological distress level than those without. We believe that the results indicate an urgent need to prioritize the establishment and implementation of mental health and psychosocial support tailored to family, close relatives, and friends of COVID-19 patients.


title: A doubt of multiple introduction of SARS-CoV-2 in Italy: A preliminary overview

text: The emergence of the novel betacoronavirus, recently renamed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised serious concerns due to the virus's rapid dissemination worldwide. Nevertheless, there is limited information about the genomic epidemiology of SARS-CoV-2 circulating in Italy from surveillance studies. The shortage of complete genomic sequences available impairs our understanding of the SARS-CoV-2 introduction and establishment in the country. To better understand its dynamics in Italy, we analyzed complete genomes of SARS-CoV-2 isolates, obtained directly from clinical samples. Our phylogenetic reconstructions suggest possible multiple introduction of SARS-CoV-2. Continued genomic surveillance strategies are needed to improve monitoring and understanding of the current SARS-CoV-2 epidemics, which might help to attenuate public health impact of infectious diseases.


Glucose-6-phosphate dehydrogenase deficiency-associated hemolysis and methemoglobinemia in a COVID-19 patient treated with chloroquine


Red cell bound antibodies and transfusion requirements in hospitalized patients with COVID-19


The convalescent sera option for containing COVID-19


Covid-19: MPs call on government to produce detailed plans for PPE in England


title: Reflections of the Angiotensin Receptor Blocker Recall by the FDA and Repercussions on Healthcare

text: PURPOSE: Beginning in July of 2018, the FDA issued a voluntary recall regarding the presence of a contaminant found in the manufacturing of valsartan. What would ensue has become a largely unprecedented sequence of alarming events since the FDA began reporting public recalls, withdrawals and safety alerts on their website in 2016. Since then, the United States has been significantly impacted by drug recalls affecting angiotensin receptor blockers. This report arms clinicians with additional guidance and provides a framework for responding appropriately to future similar incidents and includes an overview of the angiotensin receptor blockers, and their effects and safety profiles. METHODS: This report includes a review of data from all pertinent clinical and scientific sources including information from the FDA's inspection documents and recall website. Additional information is provided on the specific bottles including all lot numbers, expiration dates, etc. RESULTS: The recalls/withdrawals are attributable to the presence of cancer-causing contaminants identified during the manufacturing process from drug manufacturers abroad. The root causes behind the recalls and subsequent shortage appear multifactorial, and stem to a certain extent from the outsourcing of medication manufacturing overseas and lack of quality checks and appropriate oversight. CONCLUSIONS: This inherent issue is not likely to resolve soon and has eroded the public trust of/in the healthcare system and the pharmaceutical industry. Patients and healthcare providers are significantly affected and should have a full understanding of the matter in order to guide appropriate response and actions.


title: Infection Control in Dental Anesthesiology: A Time for Preliminary Reconsideration of Current Practices

text: Relegated to clinical afterthought, the topic of infection control has never taken center stage in our modern dental sedation and anesthesiology practices. Surgical and procedural masks, gloves, gowns, protective eyewear, and appropriate surgical attire have remained de rigueur in both fashion and custom for decades. However, the emergence of certain seminal events throughout health care history has driven mandated changes when practitioners, staff, patients, and the surrounding communities were exposed or put at risk of exposure to infectious disease. Hepatitis, human immunodeficiency virus, and now the global COVID-19 pandemic involving the novel coronavirus SARS-CoV-2, have forced us into rethinking our current practices. This review article will contextualize previous epidemics and their influence on infection control in dental settings, and it will explore the rapid evolution of current modifications to personal protective equipment and infection mitigation practices specific to sedation and anesthesia in dentistry.


Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis


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title: Searching for a traumatic brain injury biomarker to aid clinical decision making in the emergency department


docid: aszegypb

title: Potential contribution of increased soluble IL-2R to lymphopenia in COVID-19 patients


The importance of a centralized line service during the COVID-19 pandemic


What policy makers need to know about COVID-19 protective immunity


title: Sewage Pooling Test for SARS-CoV-2

text: CoVID-19 is currently one of the biggest threats to mankind. To date, it is the reason for infections of over 35 lakhs and the death of over 2 lakh human beings. We propose a procedure to detect CoVID-19 affected localities using a sewage mass testing and pooling mechanism which has gained ground in recent times. The proposed method named Sewage Pooling Algorithm tests wastewater samples from sewage systems to pinpoint the regions which are affected by maximum chances of the virus spread. The algorithm also uses a priority-based backtracking procedure to perform testing in sewage links depending on the probability of infection in the sub-areas. For places with very rare CoVID cases, we present a gradient-based search method to prune those areas. The proposed method has less human intervention and increases the effective tests/million people over current in-place methods.


COVID-19: Coronavirus replication, pathogenesis, and therapeutic strategies


title: Harmony-Search and Otsu based System for Coronavirus Disease (COVID-19) Detection using Lung CT Scan Images

text: Pneumonia is one of the foremost lung diseases and untreated pneumonia will lead to serious threats for all age groups. The proposed work aims to extract and evaluate the Coronavirus disease (COVID-19) caused pneumonia infection in lung using CT scans. We propose an image-assisted system to extract COVID-19 infected sections from lung CT scans (coronal view). It includes following steps: (i) Threshold filter to extract the lung region by eliminating possible artifacts; (ii) Image enhancement using Harmony-Search-Optimization and Otsu thresholding; (iii) Image segmentation to extract infected region(s); and (iv) Region-of-interest (ROI) extraction (features) from binary image to compute level of severity. The features that are extracted from ROI are then employed to identify the pixel ratio between the lung and infection sections to identify infection level of severity. The primary objective of the tool is to assist the pulmonologist not only to detect but also to help plan treatment process. As a consequence, for mass screening processing, it will help prevent diagnostic burden.


Race for a COVID-19 vaccine


title: Effect of Systemic Inflammatory Response to SARS-CoV-2 on Lopinavir and Hydroxychloroquine Plasma Concentrations

text: Background: Coronavirus disease 2019 (COVID-19) leads to inflammatory cytokine release, which can downregulate the expression of metabolizing enzymes. This cascade affects drug concentrations in the plasma. We investigated the association between lopinavir (LPV) and hydroxychloroquine (HCQ) plasma concentrations and the values of acute phase inflammation marker C-reactive protein (CRP).Methods: LPV plasma concentrations were prospectively collected in 92 patients hospitalized at our institution. Lopinavir/ritonavir was administered 12-hourly, 800/200 mg on day 1, and 400/100 mg on day 2 until day 5 or 7. HCQ was given at 800 mg, followed by 400 mg after 6, 24 and 48 hours. Hematological, liver, kidney, and inflammation laboratory values were analyzed on the day of drug level determination.Results: The median age of study participants was 59 (range 24-85) years, and 71% were male. The median duration from symptom onset to hospitalization and treatment initiation was 7 days (IQR 4-10) and 8 days (IQR 5-10), respectively. The median LPV trough concentration on day 3 of treatment was 26.5 µg/mL (IQR 18.9-31.5). LPV plasma concentrations positively correlated with CRP values (r=0.37, p<0.001), and were significantly lower when tocilizumab was preadministrated. No correlation was found between HCQ concentrations and CRP values.Conclusions: High LPV plasma concentrations were observed in COVID-19 patients. The ratio of calculated unbound drug fraction to published SARS-CoV-2 EC50 values indicated insufficient LPV concentrations in the lung. CRP values significantly correlated with LPV but not HCQ plasma concentrations, implying inhibition of cytochrome P450 3A4 (CYP3A4) metabolism by inflammation.


Estimating case fatality ratio during COVID-19 epidemics: Pitfalls and alternatives


Striving to protect patients and healthcare professionals in endoscopy units during pandemics: from SARS to COVID-19


Covid-19 and healthcare workers


title: Recommendations on diagnosis and treatment in hepatobiliary surgery under 2019-nCoV epidemic

text: 2019 novel coronavirus pneumonia is a serious life-threatening disease and it has affected many people globally, especially the people who live in China. A high prevalence of hepatobiliary diseases has been observed in 2019-nCoV patients and some may require emergency surgery. In the context of the novel coronavirus pneumonia, new challenges have arisen for surgeons in terms of ways to effectively treat outpatients, safety of medical staffs in performing surgery treatment, and the lack of efficient postoperative management and follow-up procedure. It is hoped that through this article, surgeons will have a better system in hepatobiliary diseases classification, treatment selection, and protective measures to improve the clinical practice in accordance with the guidelines for the diagnosis and treatment of the novel coronavirus pneumonia.


COVID-19 and children. From Luis Sepulveda to Madam Mim


title: Hemogram Data as a Tool for Decision-making in COVID-19 Management: Applications to Resource Scarcity Scenarios

text: COVID-19 pandemics has challenged emergency response systems worldwide, with widespread reports of essential services breakdown and collapse of health care structure. A critical element involves essential workforce management since current protocols recommend release from duty for symptomatic individuals, including essential personnel. Testing capacity is also problematic in several countries, where diagnosis demand outnumbers available local testing capacity. This work describes a machine learning model derived from hemogram exam data performed in symptomatic patients and how they can be used to predict qRT-PCR test results. Methods: A Naive-Bayes model for machine learning is proposed for handling different scarcity scenarios, including managing symptomatic essential workforce and absence of diagnostic tests. Hemogram result data was used to predict qRT-PCR results in situations where the latter was not performed, or results are not yet available. Adjusts in assumed prior probabilities allow fine-tuning of the model, according to actual prediction context. Proposed models can predict COVID-19 qRT-PCR results in symptomatic individuals with high accuracy, sensitivity and specificity. Data assessment can be performed in an individual or simultaneous basis, according to desired outcome. Based on hemogram data and background scarcity context, resource distribution is significantly optimized when model-based patient selection is observed, compared to random choice. The model can help manage testing deficiency and other critical circumstances. Machine learning models can be derived from widely available, quick, and inexpensive exam data in order to predict qRT-PCR results used in COVID-19 diagnosis. These models can be used to assist strategic decision-making in resource scarcity scenarios, including personnel shortage, lack of medical resources, and testing insufficiency.


title: Porcine epidemic diarrhea virus: Viral RNA detection and quantification using a validated one-step real time RT-PCR

text: Since 2014, porcine epidemic diarrhea virus (PEDV) has reemerged in Europe. RT-PCR methods have been described for the detection of PEDV, but none have been validated according to a norm. In this study we described the development and validation of a SYBR™ Green one-step RT-qPCR according to the French norm NF U47-600, for the detection and quantification of PEDV viral RNA. The method was validated from sample preparation (feces or jejunum) through to nucleic acid extraction and RT-qPCR detection. Specificity and sensitivity, limit of detection (LoD), limit of quantification (LQ), linearity, intra and inter assay variability were evaluated using transcribed RNA and fecal and jejunum matrices spiked with virus. The analytical and diagnostic specificities and sensitivities of this RT-qPCR were 100% in this study. A LoD of 50 genome copies/5 µl of extract from fecal matrices spiked with virus or RNA transcript and 100 genome copies/5 µl of extract from jejunum matrices spiked with virus were obtained. The Lower LQ (LLQ) was 100 genome copies/5 µl and the Upper LQ (ULQ) 108 copies/5 µl. This method is the first, validated according a norm for PEDV and may serve as a global reference method to harmonize detection and quantification of PEDV viral RNA in both field and experimental settings.


Brain MRI Findings in Patients in the Intensive Care Unit with COVID-19 Infection


title: Exportin 1 inhibition as antiviral therapy

text: Coronavirus 2019 (COVID-19; caused by Severe Acute Respiratory Syndrome Coronavirus 2; SARS-CoV-2) is a currently global health problem. Previous studies showed that blocking nucleocytoplasmic transport with exportin 1 (XPO1) inhibitors originally developed as anticancer drugs can quarantine key viral accessory proteins and genomic materials in the nucleus of host cell and reduce virus replication and immunopathogenicity. These observations support the concept of the inhibition of nuclear export as an effective strategy against an array of viruses, including influenza A, B, and SARS-CoV. Clinical studies using the XPO1 inhibitor selinexor as a therapy for COVID-19 infection are in progress.


Integration of telemedicine into the public health response to COVID-19 must include dentists


title: Symptomatic Infection is Associated with Prolonged Duration of Viral Shedding in Mild Coronavirus Disease 2019: A Retrospective Study of 110 Children in Wuhan

text: BACKGROUND: Information regarding viral shedding in children with coronavirus disease 2019 (COVID-19) was limited. This study aims to investigate the clinical and laboratory characteristics associated with viral shedding in children with mild COVID-19. METHODS: The clinical and laboratory information of 110 children with COVID-19 at Wuhan Children's Hospital, Wuhan, China, from January 30 to March 10, 2020, were analyzed retrospectively. RESULTS: The median age was 6 years old. The median period of viral shedding of COVID-19 was 15 days (interquartile range [IQR], 11-20 days) as measured from illness onset to discharge. This period was shorter in asymptomatic patients (26.4%) compared with symptomatic patients (73.6%) (11 days vs. 17 days). Multivariable regression analysis showed increased odds of symptomatic infection was associated with age <6 years (odds ratio [OR] 8.94, 95% confidence interval [CI]: 2.55-31.35; P = 0.001), hypersensitive C-reactive protein >3.0 mg/L (OR 4.89; 95% CI: 1.10-21.75; P = 0.037) and presenting pneumonia in chest radiologic findings (OR 8.45; 95% CI: 2.69-26.61; P < 0.001). Kaplan-Meier analysis displayed symptomatic infection (P < 0.001), fever (P = 0.006), pneumonia (P = 0.003) and lymphocyte counts <2.0 × 10/L (P = 0.008) in children with COVID-19 were associated with prolonged duration of viral shedding in children with COVID-19. CONCLUSION: Prolonged duration of viral shedding in children with COVID-19 was associated with symptomatic infection, fever, pneumonia and lymphocyte count less than 2.0 × 10/L. Monitoring of symptoms could help to know the viral shedding in children with COVID-19.


title: [Mechanism of Xuanfei Baidu Tang in treatment of COVID-19 based on network pharmacology]

text: The study aimed to investigate the multi-constituent, multi-target mechanism of Xuanfei Baidu Tang(XFBD) in the treatment of coronavirus disease 2019(COVID-19), through exploring the main ingredients and effective targets of XFBD, as well as analyzing the correlation between XFBD targets and COVID-19. The compounds of each herb in XFBD were collected from TCM-PTD, ETCM, TCMSP and SymMap database. Next, the information of meridian tropisms was collected from Chinese Pharmacopoeia(2015 edition), and the target information of the major constituents of XFBD were obtained from TCM-PTD, ETCM, TCMSP and TargetNet database. Subsequently, the target network model and the major modules were generated by Cytoscape, and the functional enrichment analysis of XFBD targets were completed by DAVID and STRING. As a result, ten of the 13 herbs in XFBD belonged to the lung meridian, and 326 of the 1 224 putative XFBD targets were associated with the disease target of COVID-19, among which 109 targets were enriched in the disease pathways of viral infection and lung injury. The main biological pathways regulated by the key XFBD targets included viral infection, energy metabolism, immunity and inflammation, parasites and bacterial infections. In conclusion, the therapeutic mechanism of XFBD in COVID-19 showed a multi-herb, multi-constituent, multi-target pattern, with lung as the chief targeted organ. By regulating a series of biological pathways closely related to the occurrence and development of diseases, XFBD plays a role in balancing immunity, eliminating inflammation, regulating hepatic and biliary metabolism and recovering energy metabolism balance.


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


Reply to Radermacher et al on "Serum Hydrogen Sulfide and Outcome Association in Pneumonia by the Sars-cov-2 Coronavirus"


Asymptomatic COVID-19 positive patient suspected on FDG-PET/CT


title: Repurposing 0.5% povidone iodine solution in otorhinolaryngology practice in Covid 19 pandemic

text: SARS CoV 2 is very much homologous in structure to SARS CoV. Review of literature suggests the in-vitro virucidal action of povidone iodine in SARS CoV and MERS. The oropharynx and nasopharynx are target sites of SARS CoV 2. A significant proportion of COVID 19 sufferers are asymptomatic, but shedding these viral particles, PVP-I has been shown to be a safe therapy when used as a mouthwash or taken nasally or used during ophthalmic surgeries. AIMS: MATERIALS AND METHODS: 0.5% PVP-I solution is prepared from commercially available 10% PVP-I solution. Patients were instructed to put 0.5% PVP-I drops in nose and rinse mouth with gargle prior examinations for 30â¯s. For endoscopic procedure (nasal and throat) nasal douching and gargling to be started one day prior. Douching and rinsing to be repeated just before procedures. Nasal packing with 0.5% PVP-I along with 4% xylocaine/adrenaline solution, tolerability and any allergic reaction noted. RESULTS: The patient and health care workers tolerated the 0.5%. No allergy was noted. CONCLUSION: We propose the use of 0.5% PVP-I in healthcare workers and their patients to minimise the risk of spread of the disease in addition to the recommended PPE.


Preparedness for COVID-19 in the oncology community in Africa


docid: bxgcjbdj

title: Novelty Detection via Robust Variational Autoencoding

text: We propose a new method for novelty detection that can tolerate nontrivial corruption of the training points. Previous works assumed either no or very low corruption. Our method trains a robust variational autoencoder (VAE), which aims to generate a model for the uncorrupted training points. To gain robustness to corruption, we incorporate three changes to the common VAE: 1. Modeling the latent distribution as a mixture of Gaussian inliers and outliers, while using only the inlier component when testing; 2. Applying the Wasserstein-1 metric for regularization, instead of Kullback-Leibler divergence; and 3. Using a least absolute deviation error for reconstruction, which is equivalent to assuming a heavy-tailed likelihood. We illustrate state-of-the-art results on standard benchmark datasets for novelty detection.


title: Examining the effect of social distancing on the compound growth rate of COVID-19 at the county level (United States) using statistical analyses and a random forest machine learning model

text: OBJECTIVES: The goal of the present work is to investigate trends among US counties and coronavirus disease 2019 (COVID-19) growth rates in relation to the existence of shelter-in-place (SIP) orders in that county. STUDY DESIGN: This is a prospective cohort study. METHODS: Compound growth rates were calculated using cumulative confirmed COVID-19 cases from January 21, 2020, to March 31, 2020, in all 3139 US counties. Compound growth was chosen as it gives a single number that can be used in machine learning to represent the speed of virus spread during defined time intervals. Statistical analyses and a random forest machine learning model were used to analyze the data for differences in counties with and without SIP orders. RESULTS: Statistical analyses revealed that the March 16 presidential recommendation (limiting gatherings to ≤10 people) lowered the compound growth rate of COVID-19 for all counties in the US by 6.6%, and the counties that implemented SIP after March 16 had a further reduction of 7.8% compared with the counties that did not implement SIP after March 16. A random forest machine learning model was built to predict compound growth rate after a SIP order and was found to have an accuracy of 92.3%. The random forest found that population, longitude, and population per square mile were the most important features when predicting the effect of SIP. CONCLUSIONS: SIP orders were found to be effective at reducing the growth rate of COVID-19 cases in the US. Counties with a large population or a high population density were found to benefit the most from a SIP order.


Urgent Appeal from International Society for Aerosols in Medicine (ISAM) During COVID-19: Clinical Decision Makers and Governmental Agencies Should Consider the Inhaled Route of Administration: A Statement from the ISAM Regulatory and Standardization Issues Networking Group


title: Effectiveness of Interferon Beta 1a, compared to Interferon Beta 1b and the usual therapeutic regimen to treat adults with moderate to severe COVID-19: structured summary of a study protocol for a randomized controlled trial

text: OBJECTIVES: We will investigate the effectiveness of Interferon Beta 1a, compared to Interferon Beta 1b and the usual therapeutic regimen in COVID-19 in patients that have tested positive and are moderately to severely ill. TRIAL DESIGN: This is a single center, open label, randomized, controlled, parallel group, clinical trial that will be conducted at Loghman Hakim Medical Education Center in conjunction with Shahid Beheshti University of Medical Sciences. PARTICIPANTS: Sixty COVID-19 confirmed cases (using the RT-PCR test) will be enrolled in the trial between April 9th to April 14th 2020. Patients will be randomly assigned to the intervention groups or the control group with the following eligibility criteria: ≥ 18 years of age AND (oxygen saturation (SPO2) ≤ 93% OR respiratory rate ≥ 24) AND at least one of the following: Contactless infrared forehead thermometer temperature of ≥37.8, cough, sputum production, nasal discharge, myalgia, headache or fatigue on admission, and time of onset of the symptoms should be acute (Days ≤ 14). Although Hydroxychloroquine will be administered in a single dose, patients with heart problems (prolonged QT or PR intervals, second- or third-degree heart block, and arrhythmias including torsade de pointes) will be excluded. Other exclusion criteria include using drugs with potential interaction with Hydroxychloroquine + Lopinavir/Ritonavir, Interferon-ß 1a, Interferon-ß 1b, pregnant or lactating women, history of alcohol or drug addiction in the past 5 years, blood ALT/AST levels > 5 times the upper limit of normal on laboratory results and refusal to participate. This study will be undertaken at the Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences and Health Services. INTERVENTION AND COMPARATOR: COVID-19 confirmed patients will be randomly assigned to one of three groups, with 20 patients in each. The first group (Arm 1) will receive Hydroxychloroquine + Lopinavir / Ritonavir (Kaletra) + Interferon-ß 1a (Recigen), the second group (Arm 2) will be administered Hydroxychloroquine + Lopinavir / Ritonavir (Kaletra) + Interferon-ß 1b (Ziferon), and the control group (Arm 3) will be treated by Hydroxychloroquine + Lopinavir / Ritonavir (Kaletra). MAIN OUTCOMES: Time to clinical improvement is our primary outcome measure. This is an improvement of two points on a seven-category ordinal scale (recommended by the World Health Organization: Coronavirus disease (COVID-2019) R&D. Geneva: World Health Organization) or discharge from the hospital, whichever comes first. Secondary outcomes include mortality from the date of randomization until the last day of the study which will be the day all of the patients have had at least one of the following outcomes: 1) Improvement of two points on a seven-category ordinal scale. 2) Discharge from the hospital 3) Death. If any patient dies, we have reached an important secondary outcome. SpO2 Improvement between the last and first day of hospitalization, using pulse-oximetry. Duration of hospitalization from date of randomization until the date of hospital discharge or date of death from any cause, whichever comes first. Incidence of new mechanical ventilation uses from date of randomization until the last day of the study. Please note that we are trying to add further secondary outcomes and this section of the protocol is still evolving. Statistical analysis will be performed by R version 3.6.1 software. We will use Kaplan-Meier to analyze the time to clinical improvement (compared with a log-rank test). Hazard ratios with 95% confidence intervals will be calculated using the Cox proportional-hazards model in crude and adjusted analysis. RANDOMIZATION: Eligible patients will be randomly assigned in a 1:1:1 ratio to receive either Interferon Beta 1a, Interferon Beta 1b or standard care only. Patients will be randomly allocated to three therapeutic arms using permuted, block-randomization to balance the number of patients allocated to each group. The permuted block (three or six patients per block) randomization sequence will be generated, using Package 'randomizeR' in R software version 3.6.1. and placed in individual sealed and opaque envelopes by the statistician. The investigator will enroll the patients and only then open envelopes to assign patients to the different treatment groups. This method of allocation concealment will result in minimum selection and confounding biases. BLINDING (MASKING): The present research is open-label (no masking) of patients and health care professionals who are undertaking outcome assessment of the primary outcome - time to clinical improvement. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): Of the 60 patients who underwent randomization, 20 patients were assigned to receive Interferon beta-1a, 20 patients were assigned to receive Interferon beta 1b plus standard care and the rest of patients were assigned to receive the standard care alone. TRIAL STATUS: Protocol version 1.2.1. Recruitment is finished, the start date of recruitment was on 9th April 2020 and the end date was on 14th April 2020. Last point of data collection will be the last day on which all of the 60 participants have had an outcome of clinical improvement or death, completing the study's follow-up time window. TRIAL REGISTRATION: This study was registered with National Institutes of Health Clinical trials (www.clinicaltrials.gov; identification number NCT04343768, registered April 8, 2020 and first available online April 13, 2020). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


title: Implementation of an Emergency Use Authorization Test During an Impending National Crisis

text: The laboratory response to the current severe acute respiratory syndrome coronavirus 2 pandemic may be termed heroic. From the identification of the novel coronavirus to implementation of routine laboratory testing around the world to the development of potential vaccines, laboratories have played a critical role in the efforts to curtail this pandemic. In this brief report, we review our own effort at a midsized, rural, academic medical center to implement a molecular test for the virus; and we share insights and lessons learned from that process, which might be helpful in similar situations in the future.


title: Clinical features of 30 cases with novel coronavirus pneumonia/ 中华传染病杂志

text: Objective@#To analyze the epidemiological and clinical characteristics of patients with 2019 novel coronavirus (2019-nCoV) infection in Shenyang.@*Methods@#The epidemiological and clinical characteristics of 30 patients diagnosed with 2019-nCoV infection admitted to Shenyang sixth people's hospital on January 22, 2020 and February 8, 2020 were retrospectively analyzed.@*Results@#Among the 30 cases, 21 were imported, including 17 from Hubei Province and four from other provinces. Nine cases were local infections. There were 18 men and 12 women, aging from 21 to 72 years with the median of 43 years. Eight cases had underlying diseases including hypertension, diabetes, coronary heart disease and bronchitis. On admission, two (7%) cases were mild, 19 (63%) cases were ordinary, eight (27%) cases were severe, and one (3%) case was critical. Clinical manifestations mainly include fever, with or without upper respiratory tract symptoms, normal, decreased or slightly increased white blood cell counts, mainly decreased lymphocyte counts, normal or increased c-reactive protein, and normal procalcitonin. The computed tomography (CT) of the early stage of the lungs showed that multiple patchy ground glass shadows were mainly accompanied by consolidation, which often involved both lungs or multiple lobes of one lung. At the moment, the clinical treatment mainly included respiratory support, symptomatic treatment, antiviral treatment adn anti-bacterial treatment. By February 15, a total of nine cases were cured and discharged, including one mild case, six ordinary cases, and two severe cases. In the comparisons between mild/ordinary patients and severe/critical patients, the fever duration in the severe/critical group (median 11.5 d) was significantly longer than that in the light/normal group (median 2 d) (Z=-2.292, P=0.022), and the laboratory tests indicated elevated d-dimer levels (Z=-2.669, P=0.008) and more cases with neutrophilic/lymphocyte ratio > 3 (Z=-4.071, P<0.01).@*Conclusions@#In Shenyang, the early cases with 2019-nCoV infection are mainly imported cases, and expanding local infections gradually develop. Clinical manifestations are mainly characterized by fever and cough. Lung CT performance shows multiple ground glass shadows, mainly accompanied by consolidation. CT changes in the lungs should be closely monitored during the treatment, and CT findings in the lungs may change earlier than the clinical manifestations. Prolonged fever duration, elevated d-dimer level and neutrophil/lymphocyte ratio >3 could be used as early warning indicators for severe cases.


title: COVID-19: la epidemia causada por un nuevo coronavirus./ COVID-19: The outbreak caused by a new coronavirus

text: Before the severe acute respiratory syndrome outbreak in 2003, coronaviruses (CoVs) were not considered to be highly pathogenic to humans. However, it was this epidemic that highlighted this group of viruses and included them among the causative agents of emerging epidemic diseases. In addition, in 2012, another new CoV responsible for the Middle East respiratory syndrome was identified. Both infections were considered a threat to global health security. At present, the third epidemic caused by a CoV is being faced. This new CoV, called 2019-nCoV, was originated in the city of Wuhan, China, and has been linked to severe respiratory infections in humans. Thanks to the collaboration of experts worldwide, more information about this virus and its infection is reported each day, which allows modifying the recommendations for its prevention and treatment, without forgetting that the ultimate goal is to control this epidemic. In this review, the important aspects of this new coronavirus, 2019-nCoV, and its disease, COVID-19, have been summarized with the information available up to February 2020.


title: Out Patient Department practices in orthopaedics amidst COVID-19: The evolving model

text: Severe Acute Respiratory Syndrome COVID-19 was declared as a pandemic on 11th March 2020 by the World Health Organization and consequent lockdown imposed in several areas resulted in a marked reduction in orthopaedic practice. Although some guidelines for patient care in orthopaedic practice have been published, overall, publications focusing exclusively on guidelines on starting orthopaedic outpatient departments (OPD) after the COVID-19 lockdown amidst the on-going pandemic are lacking. We hereby propose the evolving knowledge in changes in OPD management practices for orthopaedic surgeons in the COVID- 19 era. The emphasis on online registration (e-registration) should be given impetus and become the new norm supplemented by telephonic and spot registration for the uneducated patients. The review highlights the safety of patient and orthopaedic surgeons in OPD by screening and maintaining hygiene at various levels. The article also mentions the duties of the help desk, OPD hall supervisor and the new norms of Air Conditioning, ventilation, safe use of elevators, sanitization of OPD premises and biomedical waste disposal. The optimum and safe utilization of human & material resources, DO's and DON'Ts for patients & health staff have also been proposed. The reorganization of plaster room, the precaution during plastering, fracture clinic, dressing and injection room services are discussed as per evolving guidelines. This article will give deep insight into the OPD plan &telemedicine graphically also. The authors suggest updating and downward permeation of existing e-infrastructure of government health services that is up-gradation of existing tertiary level online registration services, a paperless model of OPD Consultation & dispensation. The future updating of Aarogya Setu App (https://mygov.in/aarogya-setu-app/). for convenient online OPD registration and dispensation has been discussed and proposed. This review will help in containing the spread of COVID 19 and build upon the health gains achieved after lockdown. The easy concept of CCCATTT has been introduced, and the OPD Plan has also been suggested. We have endeavoured to holistically detail an orthopaedic OPD setup and its upkeep in COVID-19 pandemic, but since the knowledge of COVID 19 is ever-evolving it needs replenishment by regular education for health staff.


title: Non-Adaptive Group Testing in the Linear Regime: Strong Converse and Approximate Recovery

text: In this paper, we consider the non-adaptive group testing problem in the linear sparsity regime. We prove a strong converse bound for exact recovery, showing that individual testing is asymptotically optimal for any non-zero target success probability, and strengthening the existing weak converse (Aldridge, 2019). To overcome this barrier, we additionally study an approximate recovery criterion. We demonstrate broad scenarios in which randomized test designs can improve on individual testing under this relaxed criterion, and provide a rate-distortion type converse.


title: Asymptotics of maxima of (2,1) and (1,2) random walks with asymptotically zero drifts and product of nonnegative 2-by-2 matrices

text: Consider (2,1) and (1,2) random walks with asymptotically zero drifts. Let $M$ be the maximum of an excursion starting from $2$ and ending at some point below $2.$ We study the distribution of $M$ and characterize its asymptotics, which are quite different from the ones of simple random walks. Our methods are based on the asymptotics of product of 2-by-2 nonnegative matrices and continued fractions. So, we also get a limit theorem of the product of nonnegative 2-by-2 matrices which has its own interest. Let $A_kA_{k-1}\cdots A_1$ be the product of some nonnegative 2-by-2 matrices. Under certain conditions, we show that $\forall i,j= 1,2,$ $(A_kA_{k-1}\cdots A_1)_{i,j}\sim c\varrho(A_k)\varrho(A_{k-1})\cdots \varrho(A_1)$ as $k\rightarrow\infty,$ where $\varrho(A_n)$ is the spectral radius of $A_n$ and $c\in(0,\infty)$ is some constant.


title: Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

text: Importance: Health care workers exposed to coronavirus disease 2019 (COVID-19) could be psychologically stressed. Objective: To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China. Design, Settings, and Participants: This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from 1257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Health care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 were eligible. Main Outcomes and Measures: The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale-Revised, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes. Results: A total of 1257 of 1830 contacted individuals completed the survey, with a participation rate of 68.7%. A total of 813 (64.7%) were aged 26 to 40 years, and 964 (76.7%) were women. Of all participants, 764 (60.8%) were nurses, and 493 (39.2%) were physicians; 760 (60.5%) worked in hospitals in Wuhan, and 522 (41.5%) were frontline health care workers. A considerable proportion of participants reported symptoms of depression (634 [50.4%]), anxiety (560 [44.6%]), insomnia (427 [34.0%]), and distress (899 [71.5%]). Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers (eg, median [IQR] Patient Health Questionnaire scores among physicians vs nurses: 4.0 [1.0-7.0] vs 5.0 [2.0-8.0]; P = .007; median [interquartile range {IQR}] Generalized Anxiety Disorder scale scores among men vs women: 2.0 [0-6.0] vs 4.0 [1.0-7.0]; P < .001; median [IQR] Insomnia Severity Index scores among frontline vs second-line workers: 6.0 [2.0-11.0] vs 4.0 [1.0-8.0]; P < .001; median [IQR] Impact of Event Scale-Revised scores among those in Wuhan vs those in Hubei outside Wuhan and those outside Hubei: 21.0 [8.5-34.5] vs 18.0 [6.0-28.0] in Hubei outside Wuhan and 15.0 [4.0-26.0] outside Hubei; P < .001). Multivariable logistic regression analysis showed participants from outside Hubei province were associated with lower risk of experiencing symptoms of distress compared with those in Wuhan (odds ratio [OR], 0.62; 95% CI, 0.43-0.88; P = .008). Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression (OR, 1.52; 95% CI, 1.11-2.09; P = .01), anxiety (OR, 1.57; 95% CI, 1.22-2.02; P < .001), insomnia (OR, 2.97; 95% CI, 1.92-4.60; P < .001), and distress (OR, 1.60; 95% CI, 1.25-2.04; P < .001). Conclusions and Relevance: In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19.


title: Potential drug-drug interactions associated with drugs currently proposed for COVID-19 treatment in patients receiving other treatments

text: Patients with COVID-19 are sometimes already being treated for one or more other chronic conditions, especially if they are elderly. Introducing a treatment against COVID-19, either on an outpatient basis or during hospitalization for more severe cases, raises the question of potential drug-drug interactions. Here, we analyzed the potential or proven risk of the co-administration of drugs used for the most common chronic diseases and those currently offered as treatment or undergoing therapeutic trials for COVID-19. Practical recommendations are offered, where possible.


Disposable customized aerosol containment chamber for oral cancer biopsy: A novel technique during COVID-19 pandemic


title: Comparison of confirmed COVID-19 with SARS and MERS cases - Clinical characteristics, laboratory findings, radiographic signs and outcomes: A systematic review and meta-analysis

text: INTRODUCTION: Within this large-scale study, we compared clinical symptoms, laboratory findings, radiographic signs, and outcomes of COVID-19, SARS, and MERS to find unique features. METHOD: We searched all relevant literature published up to February 28, 2020. Depending on the heterogeneity test, we used either random or fixed-effect models to analyze the appropriateness of the pooled results. Study has been registered in the PROSPERO database (ID 176106). RESULT: Overall 114 articles included in this study; 52 251 COVID-19 confirmed patients (20 studies), 10 037 SARS (51 studies), and 8139 MERS patients (43 studies) were included. The most common symptom was fever; COVID-19 (85.6%, P < .001), SARS (96%, P < .001), and MERS (74%, P < .001), respectively. Analysis showed that 84% of Covid-19 patients, 86% of SARS patients, and 74.7% of MERS patients had an abnormal chest X-ray. The mortality rate in COVID-19 (5.6%, P < .001) was lower than SARS (13%, P < .001) and MERS (35%, P < .001) between all confirmed patients. CONCLUSIONS: At the time of submission, the mortality rate in COVID-19 confirmed cases is lower than in SARS- and MERS-infected patients. Clinical outcomes and findings would be biased by reporting only confirmed cases, and this should be considered when interpreting the data.


title: Radiographic severity index in COVID-19 pneumonia: relationship to age and sex in 783 Italian patients

text: PURPOSE: To improve the risk stratification of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an experimental chest X-ray (CXR) scoring system for quantifying lung abnormalities was introduced in our Diagnostic Imaging Department. The purpose of this study was to retrospectively evaluate correlations between the CXR score and the age or sex of Italian patients infected with SARS-CoV-2. MATERIALS AND METHODS: Between March 4, 2020, and March 18, 2020, all CXR reports containing the new scoring system were retrieved. Only hospitalized patients with SARS-CoV-2 infection were enrolled. For each patient, age, sex, and the CXR report containing the highest score were considered for the analysis. Patients were also divided into seven groups according to age. Nonparametric statistical tests were used to examine the relationship between the severity of lung disease and the age or sex. RESULTS: 783 Italian patients (532 males and 251 females) with SARS-CoV-2 infection were enrolled. The CXR score was significantly higher in males than in females only in groups aged 50 to 79 years. A significant correlation was observed between the CXR score and age in both males and females. Males aged 50 years or older and females aged 80 years or older with coronavirus disease 2019 showed the highest CXR score (median ≥ 8). CONCLUSIONS: Males aged 50 years or older and females aged 80 years or older showed the highest risk of developing severe lung disease. Our results may help to identify the highest-risk patients and those who require specific treatment strategies.


Hydroxychloroquine and ivermectin: A synergistic combination for COVID-19 chemoprophylaxis and treatment?


title: How Could This Happen? : Narrowing Down the Contagion of COVID-19 and Preventing Acute Respiratory Distress Syndrome (ARDS)

text: In this rapid commentary, a mini-review is given of the present state-of-knowledge regarding the etiology and epidemiology of the new coronavirus 2019-nCoV and the risks for developing Acute respiratory distress syndrome (ARDS). The available knowledge on the viral genomics, molecular biology and pathogenicity of viruses of the Coronaviridae family and other Nidovirales, forms a helpful template for understanding the present pandemic outbreak. However, important questions remain unanswered about the underlying mechanism causing the very high case fatality ratios (CFR) and mechanisms regarding severe reactions like ARDS, fatal cardiac and renal failures, associated with a number of important comorbidity factors. Immunological reactions to lung alveoles in particular (involving lung macrophages and alveolar epithelial cell damage) in late phase ARDS in SARS-like CoV diseases, so far may not have received enough attention. Finally a shortlist of questions for high priority further research is suggested.


title: Metformin Treatment Was Associated with Decreased Mortality in COVID-19 Patients with Diabetes in a Retrospective Analysis

text: Metformin was proposed to be a candidate for host-directed therapy for COVID-19. However, its efficacy remains to be validated. In this study, we compared the outcome of metformin users and nonusers in hospitalized COVID-19 patients with diabetes. Hospitalized diabetic patients with confirmed COVID-19 in the Tongji Hospital of Wuhan, China, from January 27, 2020 to March 24, 2020, were grouped into metformin and no-metformin groups according to the diabetic medications used. The demographics, characteristics, laboratory parameters, treatments, and clinical outcome in these patients were retrospectively assessed. A total of 283 patients (104 in the metformin and 179 in the no-metformin group) were included in this study. There were no significant differences between the two groups in gender, age, underlying diseases, clinical severity, and oxygen-support category at admission. The fasting blood glucose level of the metformin group was higher than that of the no-metformin group at admission and was under effective control in both groups after admission. Other laboratory parameters at admission and treatments after admission were not different between the two groups. The length of hospital stay did not differ between the two groups (21.0 days for metformin versus 19.5 days for no metformin, P = 0.74). However, in-hospital mortality was significantly lower in the metformin group (3/104 (2.9%) versus 22/179 (12.3%), P = 0.01). Antidiabetic treatment with metformin was associated with decreased mortality compared with diabetics not receiving metformin. This retrospective analysis suggests that metformin may offer benefits in patients with COVID-19 and that further study is indicated.


docid: ywshypko

title: Prolonged social isolation of the elderly during COVID-19: Between benefit and damage


title: A critical evaluation of glucocorticoids in the management of severe COVID-19

text: The viral infection by SARS-CoV-2 has irrevocably altered the life of the majority of human beings, challenging national health systems worldwide, and pushing researchers to rapidly find adequate preventive and treatment strategies. No therapies have been shown effective with the exception of dexamethasone, a glucocorticoid that was recently proved to be the first life-saving drug in this disease. Remarkably, around 20 % of infected people develop a severe form of COVID-19, giving rise to respiratory and multi-organ failures requiring subintensive and intensive care interventions. This phenomenon is due to an excessive immune response that damages pulmonary alveoli, leading to a cytokine and chemokine storm with systemic effects. Indeed glucocorticoids' role in regulating this immune response is controversial, and they have been used in clinical practice in a variety of countries, even without a previous clear consensus on their evidence-based benefit.


title: JNK1 and ERK1/2 modulate lymphocyte homeostasis via BIM and DRP1 upon AICD induction

text: The Activation-Induced Cell Death (AICD) is a stimulation-dependent form of apoptosis used by the organism to shutdown T-cell response once the source of inflammation has been eliminated, while allowing the generation of immune memory. AICD is thought to progress through the activation of the extrinsic Fas/FasL pathway of cell death, leading to cytochrome-C release through caspase-8 and Bid activation. We recently described that, early upon AICD induction, mitochondria undergo structural alterations, which are required to promote cytochrome-C release and execute cell death. Here, we found that such alterations do not depend on the Fas/FasL pathway, which is instead only lately activated to amplify the cell death cascade. Instead, such alterations are primarily dependent on the MAPK proteins JNK1 and ERK1/2, which, in turn, regulate the activity of the pro-fission protein Drp1 and the pro-apoptotic factor Bim. The latter regulates cristae disassembly and cooperate with Drp1 to mediate the Mitochondrial Outer Membrane Permeabilization (MOMP), leading to cytochrome-C release. Interestingly, we found that Bim is also downregulated in T-cell Acute Lymphoblastic Leukemia (T-ALL) cells, this alteration favouring their escape from AICD-mediated control.


Urgent need to develop evidence-based self-help interventions for mental health of healthcare workers in COVID-19 pandemic


Returning to Sport Following COVID-19: Considerations for Heat Acclimatization in Secondary School Athletics


title: COVID19 in South Asians/Asian Indians: Heterogeneity of data and implications for pathophysiology and research

text: Despite a large population and limited health infrastructure, the incidence and mortality of Coronavirus Disease 2019 (COVID-19) has been lower in South Asia than many regions. The underlying reasons and mechanisms for this relative protection are not established. However both genetic and environmental factors might play a role. Polymorphisms in ACE2 gene, ACE gene and in genes for some of the host cell proteases could affect the viral entry and replication. There is some evidence that HLA polymorphisms and several pathways involved in immune and inflammatory response could contribute to ethnic variation. Cross immunity because of past exposure to viral infections as well as malaria is likely to protect from the severe manifestations of disease. Role of BCG vaccination in trained innate immunity is recognised and could be a protective factor against COVID-19. There is limited evidence of the possibility of a less virulent viral strain circulating in South Asia. There is evidence from different parts of the world that temperature and humidity can influence viral survival as well as the host immune response. Finally implementation of early containment measures by some South Asian countries has also contributed to a less disease burden.


How can physicians advise faith communities during the COVID-19 pandemic?


Small droplet aerosols in poorly ventilated spaces and SARS-CoV-2 transmission


title: Phylogenetic analyses of the severe acute respiratory syndrome coronavirus 2 reflected the several routes of introduction to Taiwan, the United States, and Japan

text: Worldwide Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is disrupting in the economy and anxiety of people. The public anxiety has increased the psychological burden on government and healthcare professionals, resulting in a government worker suicide in Japan. The terrified people are asking the government for border measures. However, are border measures possible for this virus? By analyzing 48 almost complete virus genome sequences, we found out that the viruses that invaded Taiwan, the United States, and Japan were introduced independently. We identified thirteen parsimony-informative sites and three groups (CTC, TCC, and TCT). Viruses found outside China did not form a monophyletic clade, opposite to previous study. These results suggest the difficulty of implementing effective border measures against this virus.


title: Psychological status of parents of hospitalized children during the COVID-19 epidemic in China

text: A series of unexplained pneumonia appeared in Wuhan, Hubei Province, China, which is highly contagious. The virus is prone to nervous and anxious psychological reactions. In the objective environment of complex and densely populated hospitals, it is a high-risk area for virus-transmitted infections and children generally have lower immunity who are more likely to develop infections. The results showed that the mental health problems of parents of hospitalized children during the epidemic were more serious, and the anxiety and depression were more obvious.


title: Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study

text: Background CT may play a central role in the diagnosis and management of COVID-19 pneumonia. Purpose To perform a longitudinal study to analyze the serial CT findings over time in patients with COVID-19 pneumonia. Materials and Methods During January 16 to February 17, 2020, 90 patients (male:female, 33:57; mean age, 45 years) with COVID-19 pneumonia were prospectively enrolled and followed up until they were discharged or died, or until the end of the study. A total of 366 CT scans were acquired and reviewed by 2 groups of radiologists for the patterns and distribution of lung abnormalities, total CT scores and number of zones involved. Those features were analyzed for temporal change. Results CT scores and number of zones involved progressed rapidly, peaked during illness days 6-11 (median: 5 and 5), and followed by persistence of high levels. The predominant pattern of abnormalities after symptom onset was ground-glass opacity (35/78 [45%] to 49/79 [62%] in different periods). The percentage of mixed pattern peaked (30/78 [38%]) on illness days 12-17, and became the second most predominant pattern thereafter. Pure ground-glass opacity was the most prevalent sub-type of ground-glass opacity after symptom onset (20/50 [40%] to 20/28 [71%]). The percentage of ground-glass opacity with irregular linear opacity peaked on illness days 6-11 (14/50 [28%)]) and became the second most prevalent subtype thereafter. The distribution of lesions was predominantly bilateral and subpleural. 66/70 (94%) patients discharged had residual disease on final CT scans (median CT scores and zones involved: 4 and 4), with ground-glass opacity (42/70 [60%]) and pure ground-glass opacity (31/42 [74%]) the most common pattern and subtype. Conclusion The extent of lung abnormalities on CT peaked during illness days 6-11. The temporal changes of the diverse CT manifestations followed a specific pattern, which might indicate the progression and recovery of the illness.