title: Weakly-Supervised Segmentation for Disease Localization in Chest X-Ray Images

text: Deep Convolutional Neural Networks have proven effective in solving the task of semantic segmentation. However, their efficiency heavily relies on the pixel-level annotations that are expensive to get and often require domain expertise, especially in medical imaging. Weakly supervised semantic segmentation helps to overcome these issues and also provides explainable deep learning models. In this paper, we propose a novel approach to the semantic segmentation of medical chest X-ray images with only image-level class labels as supervision. We improve the disease localization accuracy by combining three approaches as consecutive steps. First, we generate pseudo segmentation labels of abnormal regions in the training images through a supervised classification model enhanced with a regularization procedure. The obtained activation maps are then post-processed and propagated into a second classification model-Inter-pixel Relation Network, which improves the boundaries between different object classes. Finally, the resulting pseudo-labels are used to train a proposed fully supervised segmentation model. We analyze the robustness of the presented method and test its performance on two distinct datasets: PASCAL VOC 2012 and SIIM-ACR Pneumothorax. We achieve significant results in the segmentation on both datasets using only image-level annotations. We show that this approach is applicable to chest X-rays for detecting an anomalous volume of air in the pleural space between the lung and the chest wall. Our code has been made publicly available.


title: Association of COVID-19 pandemic with meteorological parameters over Singapore

text: Meteorological parameters are the critical factors affecting the transmission of infectious diseases such as Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS), and influenza. Consequently, infectious disease incidence rates are likely to be influenced by the weather change. This study investigates the role of Singapore's hot tropical weather in COVID-19 transmission by exploring the association between meteorological parameters and the COVID-19 pandemic cases in Singapore. This study uses the secondary data of COVID-19 daily cases from the webpage of Ministry of Health (MOH), Singapore. Spearman and Kendall rank correlation tests were used to investigate the correlation between COVID-19 and meteorological parameters. Temperature, dew point, relative humidity, absolute humidity, and water vapor showed positive significant correlation with COVID-19 pandemic. These results will help the epidemiologists to understand the behavior of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus against meteorological variables. This study finding would be also a useful supplement to help the local healthcare policymakers, Center for Disease Control (CDC), and the World Health Organization (WHO) in the process of strategy making to combat COVID-19 in Singapore.


COVID-19 in Patients with Kidney Disease


title: New insights in equine steroidogenesis: an in-depth look at steroid signaling in the placenta

text: Steroid production varies widely among species, with these differences becoming more pronounced during pregnancy. As a result, each species has its own distinct pattern of steroids, steroidogenic enzymes, receptors, and transporters to support its individual physiological requirements. Although the circulating steroid profile is well characterized during equine pregnancy, there is much yet to be explored regarding the factors that support steroidogenesis and steroid signaling. To obtain a holistic view of steroid-related transcripts, we sequenced chorioallantois (45 days, 4 months, 6 months, 10 months, 11 months, and post-partum) and endometrium (4 months, 6 months, 10 months, 11 months, and diestrus) throughout gestation, then looked in-depth at transcripts related to steroid synthesis, conjugation, transportation, and signaling. Key findings include: 1) differential expression of HSD17B isoforms among tissues (HSD17B1 high in the chorioallantois, while HSD17B2 is the dominant form in the endometrium) 2) a novel isoform with homology to SULT1A1 is the predominant sulfotransferase transcript in the chorioallantois; and 3) nuclear estrogen (ESR1, ESR2) and progesterone (PGR) expression is minimal to nonexistant in the chorioallantois and pregnant endometrium. Additionally, several hypotheses have been formed, including the possibility that the 45-day chorioallantois is able to synthesize steroids de novo from acetate and that horses utilize glucuronidation to clear estrogens from the endometrium during estrous, but not during pregnancy. In summary, these findings represent an in-depth look at equine steroid-related transcripts through gestation, providing novel hypotheses and future directions for equine endocrine research.


title: How the COVID-19 pandemic changed the Plastic Surgery activity in a regional referral center in Northern Italy

text: The Covid 19 epidemic has modified the way that plastic surgeons can treat their patients. At our hospital all elective surgery was canceled and only the more severe cases were admitted. The outpatient department activity has been reduced also. We present the number and diagnoses of patients, treated as in- and out-patients, during seven weeks from the onset of the epidemic, comparing our activity from the lockdown of elective surgery with the numbers and diagnoses observed during the same weeks of last year. Finally we underline the importance of using telemedicine and web-based tools to transmit images of lesions that need the surgeon's evaluation, and can be used by the patient to keep in touch with a doctor during the distressing time of delay of the expected procedure.


title: [Psychiatry in the time of pandemic : forging new ways without getting lost]

text: Coronavirus pandemic challenges mental health care providers in different ways At an individual level, they have to adapt their clinical practice and consider specific issues of teleconsultations to address patient's needs At a population level, dedicated interventions (e g hotlines, health professionals' support) have to strike a balance between « pathologizing » people's reactions and trivializing the psychological effects of a pandemic Finally, psychiatric leaders must be able to advise decision-makers on mental-health policy and communication


docid: wrpsqqrm

title: Psychiatry in the time of pandemic : forging new ways without getting lost/ La psychiatrie face a la pandemie : se reinventer sans se perdre

text: Coronavirus pandemic challenges mental health care providers in different ways At an individual level, they have to adapt their clinical practice and consider specific issues of teleconsultations to address patient's needs At a population level, dedicated interventions (e g hotlines, health professionals' support) have to strike a balance between pathologizing people's reactions and trivializing the psychological effects of a pandemic Finally, psychiatric leaders must be able to advise decision-makers on mental-health policy and communication La pandemie de coronavirus oblige les soignants en sante mentale a reinventer leur maniere de travailler et a penser de nouveaux cadres therapeutiques, les patients reagissant de maniere singuliere a cette situation extraordinaire Sur un plan populationnel, les interventions envisagees (e g hotlines, soutien aux professionnels et aux equipes) doivent trouver un equilibre entre une psychiatrisation des vecus dordre existentiel et une banalisation des effets psychologiques dune pandemie Sur les plans institutionnel et politique, la psychiatrie peut conseiller les decideurs quant aux impacts psychologiques et a la communication


title: ä¸å½éåå²æ åä¾ä¸¾æªæ§å¶2019å ç¶ç æ¯ç æµè¡./ ä¸å½éåå²æ åä¾ä¸¾æªæ§å¶2019å ç¶ç æ¯ç æµè¡./ Unprecedented action has been taken to contain the epidemic of coronavirus disease 2019 in China

text: The current outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, has posed significant threats to international health. By Feb. 20, 2020, 74 576 cases have been confirmed and over 2 118 deaths have reported in the Chinese mainland. Chinese administrations have carried out immediate and prompt measures to stop the spread of the virus. Wuhan city has been shut down since Jan. 23, and more than 30 thousand medical workers have been recruited to Hubei province. Two temporary hospitals were constructed to treat severe pneumonia patients, and 15 mobile cabin hospitals were built to treat mild pneumonia cases. Significant improvement regarding the pathogenesis, epidemiology, and diagnosis and therapy for the COVID-19 has been achieved to stop the spread of the epidemics.


title: Twin public health emergencies: Covid-19 and domestic violence

text: While a virus is hardly "choosy" in finding a host, the consequences of government responses to a pandemic, such as to Covid-19, have deep implications for those already-marginalised, such as women and girls. In the absence of a systematic database examining the details of the impact, this comment synthesises existing opinions, reviews and the limited available data to show how, not only the outbreak, but particularly our response to it, are increasing the incidence of domestic violence (DV) across the globe, including in India. Despite tackling a much higher Covid caseload and mortality rate than India has, countries such as France and Spain have prioritised responding to DV in their respective societies, working out contingent mitigation mechanisms. Admittedly, low resource settings (LRS) such as India, have a bevy of additional infrastructure and budgetary challenges; but would that imply we do not respond to DV? This comment argues that in reality we have two public health emergencies to confront, the Covid-19 and domestic violence. It builds on the author's observations in the course of working on DV in an LRS context in India, and concludes with a set of recommendations on better responding to DV during Covid/lockdown times. Keywords Domestic violence, gender-based violence, Covid-19, lockdown, pandemic, low resource settings.


Letter to the Editor: How is COVID-19 Going to Affect Education in Neurosurgery? A Step Toward a New Era of Educational Training


title: Three cases of novel coronavirus pneumonia with viral nucleic acids still positive in stool after throat swab detection turned negative/ 中华消化杂志

text: The novel coronavirus pneumonia (NCP) has spread from Wuhan to all parts of China since December 2019, and the prevention and control of NCP is a top priority for medical staff. Now report three cases of NCP patients, whose viral nucleic acids still positive in stool after throat swab detection turned negative. In view of the highly homologous and similar clinical manifestations between the 2019 novel coronavirus (2019-nCoV) and the severe acute respiratory syndrome(SARS) related coronaviruses, it is recommended to attach great importance to the detection of the viral nucleic acids in stool, with the reference of SARS prevention and control experience. In order to minimize the risks of gastrointestinal spread, the detection of 2019-nCoV nucleic acids in stool may be recommended as the reference standard of disisolation and discharge.


docid: ojlrtebu

title: Novel coronavirus SARS-CoV-2 and COVID-19. Practice recommendations for obstetric anaesthesia: what we have learned thus far

text: SARS-CoV-2 is a novel coronavirus causing a global pandemic of a severe respiratory illness known as COVID-19. To date, globally, over 30,000 people have died from this emerging disease. As clinicians and healthcare systems around the world are rapidly adapting to manage patients with COVID-19, limited data are emerging from different patient populations to support best-practice and improve outcomes. In this review, we present a summary of emerging data in the obstetric population and offer obstetric and anaesthetic clinicians around the world a set of evidence-driven, practice-based recommendations for the anaesthetic management of pregnant women with suspected or confirmed COVID-19.


title: The role of the family physician in the fight against Coronavirus disease 2019 in Nigeria

text: The Coronavirus disease 2019 (COVID-19) pandemic has been ravaging Nigeria and the world with increasing morbidity and mortality. Despite efforts by the Nigerian government implemented through the Nigerian Centre for Disease Control (NCDC) to reduce the scourge of the disease through public enlightenment and regular updates, the number of new cases and mortalities from COVID-19 are still increasing. Family physicians (FPs) who are the first contact of care for most patients accessing private and public health facilities in Nigeria have been working tirelessly to reduce the scourge of the pandemic in Nigeria. They continuously update themselves through regular webinars and online resources and guidelines provided by the Society of Family Physicians of Nigeria (SOFPON). Measures adopted by FPs across the country in the fight against the scourge include triaging patients as they present to the family medicine clinics; health education and enlightenment of the populace; and ensuring social distancing, regular handwashing and compulsory use of face mask by both physicians and patients during clinical consultations. Other measures include incorporating family-focused behavioural interventions in their practice, home-based care to reduce the number of persons visiting the hospital, telemedicine and Hospice and palliative care services to the elderly and terminally ill. In conclusion, FPs in Nigeria are helping to reduce the scourge of COVID-19 through patient education and innovative healthcare delivery that does not put patients at increased risk of the disease whilst promptly recognising potential COVID-19 patients and referring them for early diagnosis and treatment.


Correction to Lancet Public Health 2019; published online April 24. https://doi.org/10.1016/S2468-2667(20)30095-5


Life in the pandemic: Some reflections on nursing in the context of COVID-19


The Implications of COVID-19 for the Mental Health Care of Older Adults: Insights from Emergency Department Social Workers


title: Cross-Sectional Study on Awareness and Knowledge of COVID-19 Among Senior pharmacy Students

text: Extraordinary actions have been implemented in an effort to control the rapid spread of the ongoing COVID-19 epidemic in Egypt. People's adherence to control measures is influenced by their knowledge, attitudes and practices towards the disease. Therefore, in the present study we assessed pharmacy senior students' knowledge, attitudes and practices towards the COVID-19 pandemic. An online questionnaire was created and it consisted of 12 questions testing their knowledge about COVID-19 clinical characteristics, transmission routes and prevention and control steps. Among senior pharmacy students (n = 238), 70% were females and 63% were living in greater Cairo. Their main source of information included social media (70%), published articles (48%) and television (48%). The overall correct knowledge score was 83%. Most of the students displayed a good COVID-19 knowledge level (72.5% of the students). The students were least informed when trying to answer questions about hyper-coagulation, as a major cause for death in patients with severe COVID-19, and about the timings on the necessity to wear masks. Assessment of students' attitudes and practices towards COVID-19 reflected that 87% of them were confident that health care teams and scientists could win the fight against the virus. In addition, 72% of students agreed that COVID-19 will be controlled successfully. The greater the students' knowledge, the more confident they felt that COVID-19 will be controlled successfully (OR 2.2, 95% confidence interval [CI] 1.03-4.72). Good behavioral practice towards COVID-19 control was confirmed when 87% of students answered that they didn't go out to any crowded place. Females were 3.6 times (95% confidence interval [CI] 1.03-3.11) more likely to avoid going out than males. Bad behavioral practice became evident when approximately 50% of students admitted that they did not wear masks when they left their house. Therefore, more efforts should be taken to protect future pharmacists from this pandemic.


title: Medical genetics education in the midst of the COVID-19 pandemic: Shared resources

text: In the midst of the COVID-19 pandemic, it is appropriate that our focus is on patient care and preparation. However, the genetics community is well poised to fill in the educational gap created by medical students transitioning to limiting patient contact, creation of telemedicine patient care, and online learning modules. Our history of agility in learning and teaching is now only inhibited by the time constraints of current clinical demands on the genetics community. This publication is designed to offer ideas and resources for quickly transitioning our education to meet the current demands in the time of a pandemic. Not only will this allow us to continue our strong history of education, it will enhance our strong commitment to using modern educational techniques and tools to address the genetics workforce issues that have defined the recent past. We have the opportunity to aggressively educate for trainees that now have the capacity to learn, and to lead the way in showing how the genetics community rallies together no matter the challenge.


docid: vabsinmd

title: Reversing immunosenescence for prevention of COVID-19


Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak


The Use of Point-of-Care Lung Ultrasound and Echocardiography in the Management of Coronavirus Disease 2019 (COVID-19)


title: [Suggestions for prevention of 2019 novel coronavirus infection in otolaryngology head and neck surgery medical staff]

text: The epidemic of the 2019 Novel Coronavirus (2019-nCoV) infection has presented as a grim and complex situation recently. More than 11,000 cases of 2019-nCoV infection has been confirmed in China until February 1st 2020, which are causing great impact to economy and society, and seriously interfering with ordinary medical practice of otolaryngology and head and neck surgery. This advice guideline discusses the medical protection measures required in the outpatient clinic as well as in operation ward in otolaryngology head and neck department, which aims to protect medical staff from 2019-nCoV infection.


Chest Radiograph Findings in Asymptomatic and Minimally Symptomatic Quarantined Patients in Codogno, Italy during COVID-19 Pandemic


docid: juxjvysu

title: Important considerations regarding the future management of coronavirus (COVID-19)


When a nephrology ward becomes a COVID-19 ward: the Cremona experience


title: Description of Covid-19 Cases in Brazil and Italy

text: The emergence of Covid-19 started in China and has rapidly spread across the globe, notably in Italy and more recently to Brazil. This is a very worrying situation for the affected countries. This Brief Communication aims to describe and correlate the number of confirmed cases and deaths of Covid-19 in Brazil and Italy. This is a descriptive and retrospective study that used data collated on the World Health Organization (WHO) online platform between 21 January and 19 April 2020. After analyzing the data, it was observed that the number of confirmed cases and deaths in Brazil is lower than that in Italy. There are certain factors in Brazil which see it in a lower risk position than Italy; however, despite the current slow spread of the virus, the situation in Brazil is difficult to predict.


docid: sgyocdjw

title: Dear Dermatoethicist: Medical Student Dermatology Rotations in the Context of COVID-19


title: A Survey of COVID-19 Preparedness Among Hospitals in Idaho

text: BACKGROUND: SARS-CoV-2 has been implicated in the largest recorded coronavirus outbreak to date. Initially, most COVID-19 cases were in China, but the virus has spread to more than 184 countries worldwide, and the United States currently has more cases than any other country. OBJECTIVE: With person-to-person spread expanding in the United States, we describe hospital preparedness for managing suspected and confirmed COVID-19 patients. DESIGN: Cross-sectional survey focused on various elements of respiratory disease preparedness. SETTING: Critical access hospitals (CAHs) and acute-care hospitals (ACHs) in Idaho. METHODS: The electronic survey was sent to infection preventionists (IPs) and nurse administrators in 44 hospitals in Idaho. RESULTS: Overall, 32 (73%) hospitals responded to the survey. Participating facilities reported their preparedness with respect to existing, formalized structures for managing infectious disease incidents-specifically COVID-19-as well as availability of resources, such as isolation rooms and personal protective equipment, for safely managing suspected and confirmed COVID-19 cases. CONCLUSIONS: Hospitals covered by the survey had varying levels of preparedness for managing COVID-19 cases, with differences across the various categories of interest in this study. Although the study reveals strengths, including in application of emergency management and infection control frameworks, it also suggests that other areas, such as consistent implementation of federal guidelines and requirements for infection prevention, are potential areas for strengthening preparedness for SARS-CoV-2 and other respiratory pathogens with pandemic potential.


Editorial Concern-Possible Reporting of the Same Patients With COVID-19 in Different Reports


title: Incidence of novel coronavirus (2019-nCoV) infection among people under home quarantine in Shenzhen, China

text: BACKGROUND: Since the outbreak of 2019-nCoV in December, Chinese government has implemented various measures including travel bans, centralized treatments, and home quarantines to slowing the transmission across the country. In this study, we aimed to estimate the incidence of 2019-nCoV infection among people under home quarantine in Shenzhen, China. METHODS: We used a stratified multistage random sampling method to recruit participants and collected demographic information and laboratory results of people under home quarantine. We conducted descriptive analysis to estimate the basic characteristics and to calculate the incidence in out study population. RESULTS: A total of 2004 people under home quarantine participated in this study, of which 1637 participants finished the questionnaire with a response rate of 81.7%. Mean age of the participants was 33.7 years, ranging from 0.3 to 80.2 years. Of people who provided clear travel history, 129 people have traveled to Wuhan city and 1,046 people have traveled to other cities in Hubei province within 14 days before the home quarantine. Few (less than 1%) participants reported contact history with confirmed or suspected cases during their trip and most of these arrived at Shenzhen between Jan 24, 2020 to Jan 27, 2020. The incidence of COVID-19 in the sample was 1.5 (95% CI: 0.31-4.37). CONCLUSION: Home quarantine has been effective in preventing the early transmission of COVID-19, but that more needs to be done to improve early detection of COVID-19 infection.


Letter: Considerations for Performing Emergent Neurointerventional Procedures in a COVID-19 Environment


Potential implications of novel coronavirus disease (COVID-19) related gastrointestinal symptoms for abdominal imaging


Medical misinformation in mass and social media: An urgent call for action, especially during epidemics


title: Dengue Fever, COVID-19 (SARS-CoV-2), and Antibody-Dependent Enhancement (ADE): A Perspective

text: SARS-CoV-2 pandemic and recurrent dengue epidemics in tropical countries have turned into a global health threat. While both virus-caused infections may only reveal light symptoms, they can also cause severe diseases. Here, we review the possible antibody-dependent enhancement (ADE) occurrence, known for dengue infections, when there is a second infection with a different virus strain. Consequently, preexisting antibodies do not neutralize infection, but enhance it, possibly by triggering FcÎ³ receptor-mediated virus uptake. No clinical data exist indicating such mechanism for SARS-CoV-2, but previous coronavirus infections or infection of SARS-CoV-2 convalescent with different SARS-CoV-2 strains could promote ADE, as experimentally shown for antibodies against the MERS-CoV or SARS-CoV spike S protein. © 2020 International Society for Advancement of Cytometry.


The doctors navigating covid-19 with no internet


The impact of SARS-CoV-2 on surgical education - challenges and potential solutions


docid: yzbiidhf

title: Impact of gender on extent of lung injury in COVID-19


title: Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis

text: INTRODUCTION: An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 in China leading to a Public Health Emergency of International Concern (PHEIC). Clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews on COVID-19 have been published to date. METHODS: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies and also case reports, were included, and analyzed separately. We performed a random-effects model meta-analysis to calculate pooled prevalences and 95% confidence intervals (95%CI). RESULTS: 660 articles were retrieved for the time frame (1/1/2020-2/23/2020). After screening, 27 articles were selected for full-text assessment, 19 being finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 95%CI 40.8-74.4%) and dyspnea (45.6%, 95%CI 10.9-80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), 32.8% presented with acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock. Some 13.9% (95%CI 6.2-21.5%) of hospitalized patients had fatal outcomes (case fatality rate, CFR). CONCLUSION: COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and hospitalization was associated with a CFR of >13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure and facilities to treat severe COVID-19.


Contribution of Interventional Radiology to the Management of COVID-19 patient


docid: txqkjshh

title: With the current COVID pandemic: should we use single-use flexible bronchoscopes instead of conventional bronchoscopes?


title: Universal vote-by-mail has no impact on partisan turnout or vote share

text: In response to coronavirus disease 2019 (COVID-19), many scholars and policy makers are urging the United States to expand voting-by-mail programs to safeguard the electoral process. What are the effects of vote-by-mail? In this paper, we provide a comprehensive design-based analysis of the effect of universal vote-by-mail-a policy under which every voter is mailed a ballot in advance of the election-on electoral outcomes. We collect data from 1996 to 2018 on all three US states that implemented universal vote-by-mail in a staggered fashion across counties, allowing us to use a difference-in-differences design at the county level to estimate causal effects. We find that 1) universal vote-by-mail does not appear to affect either party's share of turnout, 2) universal vote-by-mail does not appear to increase either party's vote share, and 3) universal vote-by-mail modestly increases overall average turnout rates, in line with previous estimates. All three conclusions support the conventional wisdom of election administration experts and contradict many popular claims in the media.


Nursing education in a pandemic: Academic challenges in response to COVID-19


title: The prospects for the SARS-CoV-2 pandemic in Africa

text: On December 31, 2019, the Chinese government officially announced the identification of a new type of coronavirus (SARS-CoV-2) as the etiological cause of a severe acute respiratory syndrome in Wuhan city, Hubei Province. Over the next weeks, SARS-CoV-2 caused a global pandemic as officially declared by the WHO on March 11, 2020, with confirmed cases and deaths in more than 166 countries. We are experiencing a worldwide phenomenon of unprecedented social and economic consequences. Since the beginning of the COVID-19 outbreak, there have been fears that the epidemic could strongly impact weaker healthcare systems in poor-resource settings, especially in Sub-Saharan Africa (SSA). The 2 million Chinese nationals that live and work in Africa could potentially contribute to the spread of COVID-19 on the continent.


"Reversed halo sign" on 3D CT in COVID-19


docid: tmbpijna

title: Liver injury in severe COVID-19 infection: current insights and challenges

text: INTRODUCTION: The outbreak of COVID-19 is a serious health threat worldwide. Different degrees of liver injury or liver dysfunctions have been reported in patients with COVID-19 infection. However, currently, it remains unclear to what extent liver diseases should be considered as significant risk factors for the severity and mortality of COVID-19. Moreover, the mechanisms involved in liver injury in severe COVID-19 infection are not yet well understood. AREA COVERED: This review summarizes the current evidence on liver function abnormalities in COVID-19 patients and the effects of pre-existing liver disease on the disease severity. This review also illustrates the possible underlying mechanisms linking COVID-19 to liver injury, as well as provides recommendations to prevent liver damage in COVID-19 infection. EXPERT OPINION: The elevated levels of ALT, AST, GGT and bilirubin are common in more severe patients than non-severe or mild COVID-19 patients. Patients with pre-existing medical conditions including chronic hepatic diseases are at higher risk for severe illness from COVID-19 infection. The drug's effects, possible viral inclusion in liver cells, systemic inflammation and hypoxia are potential causes of liver injury in severe COVID-19. Nevertheless, further studies are needed focusing on the pre-existing hepatic diseases on prevention, treatment and outcome of COVID-19.


title: Zooming Toward a Telehealth Solution for Vulnerable Children with Obesity During Coronavirus Disease 2019

text: Health inequities exist throughout the life course, resulting in racial/ethnic and socioeconomic disparities in obesity and obesity-related health complications. Obesity and its comorbidities appear to be linked to coronavirus disease 2019 (COVID-19) mortality. Approaches to reduce obesity in the time of COVID-19 closures are urgently needed and should start early in life. In New York City, a telehealth pediatric weight-management collaborative spanning NewYork-Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine was developed during COVID-19 with show rates from 76% to 89%. To stave off the impending exacerbation of health disparities related to obesity risk factors in the aftermath of the COVID-19 pandemic, effective interventions that can be delivered remotely are urgently needed among vulnerable children with obesity. Challenges in digital technology access, social and linguistic differences, privacy security, and reimbursement must be overcome to realize the full potential of telehealth for pediatric weight management among low-income and racial/ethnic-minority children.


Correction to Lancet Psychiatry 2020; 7: 463


title: PACT: Privacy Sensitive Protocols and Mechanisms for Mobile Contact Tracing

text: The global health threat from COVID-19 has been controlled in a number of instances by large-scale testing and contact tracing efforts. We created this document to suggest three functionalities on how we might best harness computing technologies to supporting the goals of public health organizations in minimizing morbidity and mortality associated with the spread of COVID-19, while protecting the civil liberties of individuals. In particular, this work advocates for a third-party free approach to assisted mobile contact tracing, because such an approach mitigates the security and privacy risks of requiring a trusted third party. We also explicitly consider the inferential risks involved in any contract tracing system, where any alert to a user could itself give rise to de-anonymizing information. More generally, we hope to participate in bringing together colleagues in industry, academia, and civil society to discuss and converge on ideas around a critical issue rising with attempts to mitigate the COVID-19 pandemic.


COVID-19 pandemic: The experience of a multiple sclerosis centre in Chile


How to Obtain a Nasopharyngeal Swab Specimen


docid: roobzvha

title: Olfactory and taste disorder: The first and only sign in a patient with SARS-CoV-2 pneumonia


Documenting COVID-19 at the National Library of Scotland


Emergency tracheostomy during COVID 19 pandemic in a head and neck surgical oncology unit


Covid-19 has changed how we teach students


title: Understanding the possible origin and genotyping of first Bangladeshi SARS-CoV-2 strain

text: The novel coronavirus, SARS-CoV-2, causes the unfathomable pandemic in the history of humankind. Bangladesh is also a victim of this critical situation. To investigate the genomic features of the pathogen, the first complete genome of the virus has very recently been published. Therefore, the long awaiting questions regarding the possible origin and typing of the strain(s) can now be answered. Here, we endeavor to mainly discuss the published reports or online-accessed data (results) regarding those issues and presented a comprehensive picture of the typing of the virus alongside the probable origin of the sub-clade containing Bangladeshi strain. Our observation suggested that this strain might have originated from the United Kingdom (UK) or other European countries epidemiologically linked to the UK. According to different genotyping classification schemes, this strain belongs to A2a clade under G major clade, is of B and/or L type, and is a SARS-CoV-2a sub-strain. In the forwarding days, randomized genome data will certainly voluminate in Bangladesh, however because of globalization and immigrant movements, we urgently need a mass regional sequencing approach targeting the partial or complete genome that can link the epidemiological data and may help in further clinical interventions. This article is protected by copyright. All rights reserved.


title: Contact network models matching the dynamics of the COVID-19 spreading

text: We study the epidemic spreading on spatial networks where the probability that two nodes are connected decays with their distance as a power law. As the exponent of the distance dependence grows, the model networks smoothly transition from the random network limit to the regular lattice limit. We show that despite keeping the average number of contacts constant, the increasing exponent hampers the epidemic spreading by making long-distance connections less frequent. The spreading dynamics is also influenced by the exponent value and changes from exponential growth to power-law growth. The observed power-law growth is compatible with recent analyses of the COVID-19 spreading in numerous countries.


The Landmark Series: Multimodality Therapy for Stage 3A Non-small Cell Lung Cancer


title: Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China

text: Importance: Severe acute respiratory syndrome coronavirus 2 has caused a global outbreak of coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 binds angiotensin-converting enzyme 2 of the rennin-angiotensin system, resulting in hypokalemia. Objective: To investigate the prevalence, causes, and clinical implications of hypokalemia, including its possible association with treatment outcomes, among patients with COVID-19. Design, Setting, and Participants: This cohort study was conducted at Wenzhou Central Hospital and Sixth People's Hospital of Wenzhou, Wenzhou, China, from January 11, 2020, to February 15, 2020. Participants included patients who received a diagnosis of COVID-19 according to the criteria issued by the Chinese Health Bureau and were admitted to the hospital. The patients were classified as having severe hypokalemia (plasma potassium <3 mmol/L), hypokalemia (plasma potassium 3-3.5 mmol/L), and normokalemia (plasma potassium >3.5 mmol/L). The clinical features, therapy, and outcomes were compared between the 3 groups. Data analysis was conducted in March 2020. Interventions: The patients were given general support and antiviral therapy. Their epidemiological and clinical features were collected. Main Outcomes and Measures: The prevalence of hypokalemia and response to treatment with potassium supplements were measured by analyzing plasma and urine potassium levels. Results: One hundred seventy-five patients (87 female patients [50%]; mean [SD] age, 45 [14] years) were classified as having severe hypokalemia (31 patients [18%]), hypokalemia (64 patients [37%]), and normokalemia (80 patients [46%]). Patients with severe hypokalemia had statistically significantly higher body temperature (mean [SD], 37.6 °C [0.9 °C]) than the patients with hypokalemia (mean [SD], 37.2 °C [0.7 °C]; difference, 0.4 °C; 95% CI, 0.2-0.6 °C; P = .02) and the patients with normokalemia (mean [SD], 37.1 °C [0.8 °C]; difference, 0.5 °C; 95% CI, 0.3-0.7 °C; P = .005). Patients with higher levels of hypokalemia also had higher creatine kinase levels (severe hypokalemia, mean [SD], 200 [257] U/L [median, 113 U/L; interquartile range {IQR}, 61-242 U/L]; hypokalemia, mean [SD], 97 [85] U/L; and normokalemia, mean [SD], 82 [57] U/L), higher creatine kinase-MB fraction (severe hypokalemia, mean [SD], 32 [39] U/L [median, 14 U/L; IQR, 11-36 U/L]; hypokalemia, mean [SD], 18 [15] U/L; and normokalemia, mean [SD], 15 [8] U/L), higher lactate dehydrogenase levels (mean [SD], severe hypokalemia, 256 [88] U/L; hypokalemia, 212 [59] U/L; and normokalemia, 199 [61] U/L), and higher C-reactive protein levels (severe hypokalemia, mean [SD], 29 [23] mg/L; hypokalemia, mean [SD], 18 [20] mg/L [median, 12, mg/L; IQR, 4-25 mg/L]; and normokalemia, mean [SD], 15 [18] mg/L [median, 6 U/L; IQR, 3-17 U/L]). Of 40 severely and critically ill patients, 34 (85%) had hypokalemia. Patients with severe hypokalemia were given potassium at a dose of 40 mEq per day, for a total mean (SD) of 453 (53) mEq potassium chloride, during the hospital stay. The patients responded well to potassium supplements as they recovered. Conclusions and Relevance: The correction of hypokalemia is challenging because of continuous renal potassium loss resulting from the degradation of angiotensin-converting enzyme 2. The high prevalence of hypokalemia among patients with COVID-19 suggests the presence of disordered rennin-angiotensin system activity, which increases as a result of reduced counteractivity of angiotensin-converting enzyme 2, which is bound by severe acute respiratory syndrome coronavirus 2.


title: Mathematical Models for Describing and Predicting the COVID-19 Pandemic Crisis

text: The present article studies the extension of two deterministic models for describing the novel coronavirus pandemic crisis, the SIR model and the SEIR model. The models were studied and compared to real data in order to support the validity of each description and extract important information regarding the pandemic, such as the basic reproductive number R0, which might provide useful information concerning the rate of increase of the pandemic predicted by each model. We next proceed to making predictions and comparing more complex models derived from the SEIR model with the SIRD model, in order to find the most suitable one for describing and predicting the pandemic crisis. Aiming to answer the question if the simple SIRD model is able to make reliable predictions and deliver suitable information compared to more complex models.


title: COVID-19 and the Role of Neurosurgeons in Nepal

text: BACKGROUND: Despite the panic and chaos that coronavirus disease 2019 (COVID-19) has generated in over 200 countries, the role of neurosurgeons has never been more relevant and challenging. The health system in Nepal was never geared to face an onslaught of an infectious disease. METHODS: At Kathmandu Medical College Teaching Hospital, we designated a separate complex for housing COVID-19 suspects to prevent the unaffected from getting exposed. In a few hospitals, existing neurosurgical and medical intensive care units have been converted to isolation intensive care units. A separate roster of doctors, nurses, and allied staff has been drafted to care for these patients to avoid contamination and allow effective quarantine of the staff involved in care. RESULTS: At the directive of the government, all neurosurgical centers postponed routine cases and some have closed their outpatient departments because of the lack of protective gear. All neurosurgical centers have seen drastic reductions in cases. CONCLUSIONS: In these challenging times, we neurosurgeons, who are naturally primed and trained to respond and take on challenges in difficult situations, have the ideal opportunity to shine and make a true difference during this pandemic and beyond and be "5-star doctors."


title: How we treat patients with brain tumour during the COVID-19 pandemic

text: The COVID-19 pandemic has created major insecurities regarding whether we can and should maintain the current standards of diagnosis and treatment and access to care for patients with cancer. This is particularly true in the field of neuro-oncology, where the perceived benefit of therapeutic interventions is often low, although this notion is partially incorrect. We acknowledge that the recommendations for care of patients with cancer have become a moving target and that all recommendations are subject to modification based on national and institutional regulations. Still, some important considerations and proposals may apply broadly. First, it is important to note that old age and cardiovascular and pulmonary co-morbidities are the major risk factors for experiencing a severe course of and for dying of COVID-19, not chronic immunosuppression and cancer. Second, many of the considerations on how we should adapt clinical practice in neuro-oncology in view of COVID-19 that are now dominating discussions at local tumour boards, as well as on the institutional level and within societies of neuro-oncology, are not novel but have been valid before and only now have become a priority. More than ever, it seems to be mandatory to adhere to evidence-based medicine and not to prescribe potentially toxic, notably immunsuppresssive systemic therapy where evidence for efficacy is low. Furthermore, it is more obvious now that oncologists must not miss the right time for advance care planning, that is, supporting patients in understanding and sharing their personal values, life goals and preferences regarding future medical care. The major psychological impact of transforming oncology care to teleconferences and videoconferences and of the important strict recommendation of social distancing must not be overlooked in a patient population that is characterised by significant prevalence of cognitive decline and by the general perception that their life span may not exceed the life span of the COVID-19 pandemic.


Corrigendum to "Traditional Chinese medicine for COVID-19 treatment" [Pharmacol. Res. 155 (2020) 104743]


Can the SARS-CoV-2 PCR Cycle Threshold Value and Time from Symptom Onset to Testing Predict Infectivity?


title: Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020

text: Importance: Efforts to track the severity and public health impact of coronavirus disease 2019 (COVID-19) in the United States have been hampered by state-level differences in diagnostic test availability, differing strategies for prioritization of individuals for testing, and delays between testing and reporting. Evaluating unexplained increases in deaths due to all causes or attributed to nonspecific outcomes, such as pneumonia and influenza, can provide a more complete picture of the burden of COVID-19. Objective: To estimate the burden of all deaths related to COVID-19 in the United States from March to May 2020. Design, Setting, and Population: This observational study evaluated the numbers of US deaths from any cause and deaths from pneumonia, influenza, and/or COVID-19 from March 1 through May 30, 2020, using public data of the entire US population from the National Center for Health Statistics (NCHS). These numbers were compared with those from the same period of previous years. All data analyzed were accessed on June 12, 2020. Main Outcomes and Measures: Increases in weekly deaths due to any cause or deaths due to pneumonia/influenza/COVID-19 above a baseline, which was adjusted for time of year, influenza activity, and reporting delays. These estimates were compared with reported deaths attributed to COVID-19 and with testing data. Results: There were approximately 781â¯000 total deaths in the United States from March 1 to May 30, 2020, representing 122â¯300 (95% prediction interval, 116â¯800-127â¯000) more deaths than would typically be expected at that time of year. There were 95â¯235 reported deaths officially attributed to COVID-19 from March 1 to May 30, 2020. The number of excess all-cause deaths was 28% higher than the official tally of COVID-19-reported deaths during that period. In several states, these deaths occurred before increases in the availability of COVID-19 diagnostic tests and were not counted in official COVID-19 death records. There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths. Conclusions and Relevance: Excess deaths provide an estimate of the full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus. The mortality burden and the completeness of the tallies vary markedly between states.


COVID-19 Related Liver Injury: Call for International Consensus


title: Social media influence in the COVID-19 Pandemic

text: Never before in human history has it been possible to communicate so quickly during a pandemic, social media platforms have been a key piece for the dissemination of information; however, there are multiple advantages and disadvantages that must be considered. Responsible use of these tools can help quickly disseminate important new information, relevant new scientific findings, share diagnostic, treatment, and follow-up protocols, as well as compare different approaches globally, removing geographic boundaries for the first time in history. In order to use these tools in a responsible and useful way, it is recommended to follow some basic guidelines when sharing information on social networks in the COVID-19 era. In this paper, we summarize the most relevant information on the influence, and advantages, and disadvantages of the use of social networks during the COVID-19 pandemic.


The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States


The Lebanese Society of Medical Oncology (LSMO) statement on the care of patients with cancer during the COVID-19 pandemic


Tetralogy of Fallot palliation in a COVID-19 positive neonate


title: Detection and Estimation of Local Signals

text: We study the maximum score statistic to detect and estimate local signals in the form of change-points in the level, slope, or other property of a sequence of observations, and to segment the sequence when there appear to be multiple changes. We find that when observations are serially dependent, the change-points can lead to upwardly biased estimates of autocorrelations, resulting in a sometimes serious loss of power. Examples involving temperature variations, the level of atmospheric greenhouse gases, suicide rates and daily incidence of COVID-19 illustrate the general theory.


Pharmacological Management of Obese Patients with Type 2 Diabetes amid COVID-19 Pandemic


docid: dkiyjjje

title: The systemic sclerosis patient in the COVID-19 era: the challenging crossroad between immunosuppression, differential diagnosis and long-term psychological distress

text: COVID-19 is a world health emergency which may inevitably affect the management of a complex autoimmune disease such as systemic sclerosis (SSc). Several SSc patients are frail and, in this pandemic, need a careful protection. The COVID-19 infection might complicate the clinical scenario of interstitial lung disease (ILD) in SSc because it determines a severe pneumonia characterized by radiological features similar to SSc-ILD. The striking CT similarities between the 2 diseases make it difficult to distinguish a worsening of SSc-ILD from COVID-19-ILD superinfection. Moreover, other aspects, like isolation during lock down, may cause a significant psychological stress which will pile up on the already difficult contact with the patients for a routine check-up. Moreover, the drug shortage is a real problem in these times. For these reasons, the rheumatologist in daily clinical practice should carefully differentiate the possible COVID-19 infection in order to optimize the patient management. Therefore, the challenge in everyday life will be to achieve in due time the differential diagnosis as well as the long-term psychological impact.Key Pointsâ¢ SSc patients should be encouraged to continue their chronic therapy; in case of immunosuppressive therapy it must be discontinued for safety in case of COVID-19 infection.â¢ Psychological support must be guaranteed to every SSc patients.â¢ COVID-19 pneuminia is hard to distinguish from an interstitial lung disease due to SSc lung involvment.â¢ Data sharing is fundamental for an optimal managment of SSc patients during COVID-19 pandemia.


The "virtual wards" supporting patients with covid-19 in the community


title: O impacto real da doença do coronavirus 2019 (covid-19) no desfecho da gestação./ The Real Impact of the Coronavirus Disease 2019 (covid-19) on the Pregnancy Outcome

text: The COVID-19 outbreak is increasing around the world in the number of cases, deaths, and affected countries. Currently, the knowledge regarding the clinical impact of COVID-19 on maternal, fetal, and placental aspects of pregnancy is minimal. Although the elderly and men were the most affected population, in previous situations, such as the 2009 H1N1 influenza pandemic and the Ebola epidemic, pregnant women were more likely to develop complications than nonpregnant women. There are unanswered questions specific to pregnant women, such as whether pregnant women are more severely affected and whether intrauterine transmission occurs. Additional information is needed to inform key decisions, such as whether pregnant health care workers should receive special consideration, whether to separate infected mothers and their newborns, and whether it is safe for infected women to breastfeed.


Occam's Razor, Stroke and COVID-19


title: Effect of COVID-19 related lockdown on ophthalmic practice and patient care in India: Results of a survey

text: Purpose: In early 2020, the World Health Organization declared the outbreak of the disease COVID-19, caused by a new variant of coronavirus 2019-nCoV as a global pandemic. The government of India ordered a nationwide lockdown for 21 days, limiting movement of people as a preventive measure. This survey was designed and conducted during the lockdown period to assess its effect on ophthalmic practice and patient care in India. Methods: An online survey was sent across to practicing Indian ophthalmologists across through various social media platforms. All valid responses were tabulated and analyzed. Results: A total of 1260 ophthalmologists responded to the survey. Most of the respondents (775/1260; 61.5%) were in private practice and 14.8% (187/1260) were affiliated to ophthalmic institutes. At the time of taking the survey, 72.5% of the respondents (913/1260) were not seeing any patients due to the lockdown. Of those who were still examining patients, 82.9% (287/347) were only seeing emergency cases, based on their own clinical judgement. The proportion of ophthalmologists in ophthalmic institutes, government and municipal hospitals (126/253;49.8%) who were still seeing patients was significantly higher (P < 0.0001) than those in private practice (174/775;22.4%). Apart from emergencies such as trauma, retinal detachment, and endophthalmitis (81.8%), other surgeries that were still being performed included intravitreal injections (9.1%) and cataract surgeries (5.9%). Approximately, 77.5% (976/1260) of the respondents had begun telephonic/e-mail/video consultations or consultations over social media applications since the lockdown began. In addition, 59.1% (745/1260) felt that ophthalmologists were potentially at a higher risk of contracting COVID-19 compared to other specialties while examining patients. When asked about the resumption of practice upon easing off of the restrictions, 57.8% (728/1260) of the respondents said they were unsure of when to resume elective surgeries; furthermore, 62.8% (791/1260) were unsure about the preferred screening strategy or precautionary approach prior to resuming surgeries and were awaiting guidelines. Conclusion: Our survey shows that majority of ophthalmologists in India were not seeing patients during the COVID-19 lockdown, with near-total cessation of elective surgeries. Emergency services were still being attended to by 27.5% of ophthalmologists who responded. A large proportions of ophthalmologists had switched over to telephonic advice or other forms of telemedicine to assist patients. Most of the responding ophthalmologists were unclear about when and how to resume surgeries upon easing off of the COVID-19 related restrictions. Regulatory bodies should take note of this and issue appropriate guidelines regarding the same.


Imágenes quísticas pulmonares en paciente con infección por SARS-CoV-2./ Imágenes quísticas pulmonares en paciente con infección por SARS-CoV-2./ Lung cysts in a patient with SARS-CoV-2


Options for Personal Protective Equipment During the SARS-CoV-2 Pandemic Used in New Orleans, Louisiana


docid: wngybixl

title: An overdose surge will compound the COVID-19 pandemic if urgent action is not taken


Did the hesitancy in declaring COVID-19 a pandemic reflect a need to redefine the term?


How to recover during and from a pandemic


title: COVID-19 and Stroke: Casual or Causal Role?

text: BACKGROUND: The COVID-19 outbreak is currently the major public health concern worldwide. This infection, caused by the novel coronavirus Sars Cov2, primarily affects respiratory system, but there is increasing evidence of neurologic involvement and cerebrovascular accidents. CASE REPORT: We present a case of stroke in a 62-year-old COVID-19-positive patient, with multiple vascular risk factors. The patient arrived 1 h after onset of symptoms, was treated with recombinant tissue plasminogen activator (rtPA) with improvement of neurologic deficits, and later developed right foot arterial ischemia (recanalized by balloon catheter angioplasty) and left arm superficial venous thrombosis. A control computed tomography (CT) scan 7 days after onset showed hemorrhagic transformation of ischemic lesion without mass effect. However, respiratory and neurologic conditions improved so that the patient was discharged to rehabilitation. DISCUSSION: Until now, few cases of stroke in COVID-19 have been described, mainly in severe forms. This patient had ischemic injuries in different sites as well as venous thrombosis; hence, we speculate that Sars Cov2 could have a direct role in promoting vascular accidents since its receptor ACE2 is a surface protein also expressed by endothelial cells. This case suggests that COVID-19 can favor strokes and in general vascular complications, even in milder cases, and the presence of preexisting risk factors could play a determinant role.


We Asked the Experts: Covid-19 Outbreak: Is There Still a Place for Scheduled Surgery? "Reflection from Pathophysiological Data"


title: The most eagerly awaited summer of the Anthropocene: A perspective of SARS-CoV-2 decay and seasonal change

text: To date, the world perhaps has never waited for the summer so impatiently in the entire Anthropocene, owing to the debate whether increasing temperature and humidity will decrease the environmental endurance of SARS-CoV-2. We present the perspective on the seasonal change on SARS-CoV-2 decay and COVID-19 spread. Our arguments are based on: i) structural similarity of coronavirus with several enteric viruses, and its vulnerability; ii) reports related to decay of those similar transmissible gastroenteritis viruses (TGEV) like norovirus and iii) improvement in the human immunity during summer with respect to winter. We present reasons why we can be optimistic about the slowdown of corona in the upcoming summer.


title: Involvement of the Nervous System in SARS-CoV-2 Infection

text: As a severe and highly contagious infectious disease, coronavirus disease 2019 (COVID-19) has caused a global pandemic. Several case reports have demonstrated that the respiratory system is the main target in patients with COVID-19, but the disease is not limited to the respiratory system. Case analysis indicated that the nervous system can be invaded by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and that 36.4% of COVID-19 patients had neurological symptoms. Importantly, the involvement of the CNS may be associated with poor prognosis and disease worsening. Here, we discussed the symptoms and evidence of nervous system involvement (directly and indirectly) caused by SARS-CoV-2 infection and possible mechanisms. CNS symptoms could be a potential indicator of poor prognosis; therefore, the prevention and treatment of CNS symptoms are also crucial for the recovery of COVID-19 patients.


title: Corona Virus Disease 2019 and Paediatric Inflammatory Bowel Diseases: Global Experience and Provisional Guidance (March 2020) from the Paediatric IBD Porto Group of European Society of Paediatric Gastroenterology, Hepatology, and Nutrition

text: INTRODUCTION: With the current coronavirus disease 2019 (COVID-19) pandemic, concerns have been raised about the risk to children with inflammatory bowel diseases (IBD). We aimed to collate global experience and provide provisional guidance for managing paediatric IBD (PIBD) in the era of COVID-19. METHODS: An electronic reporting system of children with IBD infected with SARS-CoV-2 has been circulated among 102 PIBD centres affiliated with the Porto and Interest-group of ESPGHAN. A survey has been completed by major PIBD centres in China and South-Korea to explore management during the pandemic. A third survey collected current practice of PIBD treatment. Finally, guidance points for practice have been formulated and voted upon by 37 PIBD authors and Porto group members. RESULTS: Eight PIBD children had COVID-19 globally, all with mild infection without needing hospitalization despite treatment with immunomodulators and/or biologics. No cases have been reported in China and South Korea but biologic treatment has been delayed in 79 children, of whom 17 (22%) had exacerbation of their IBD. Among the Porto group members, face-to-face appointments were often replaced by remote consultations but almost all did not change current IBD treatment. Ten guidance points for clinicians caring for PIBD patients in epidemic areas have been endorsed with consensus rate of 92% to 100%. CONCLUSIONS: Preliminary data for PIBD patients during COVID-19 outbreak are reassuring. Standard IBD treatments including biologics should continue at present through the pandemic, especially in children who generally have more severe IBD course on one hand, and milder SARS-CoV-2 infection on the other.


The true historical origin of convalescent plasma therapy


title: Significance of super spreader events in COVID-19

text: The number of secondary cases from each primary case determines how fast an epidemic grows. It is known that all cases do not spread the infection equally; super spreaders play an important role as they contribute disproportionately to a much larger number of cases including in the ongoing COVID-19 pandemic. Super spreaders have been reported for more than a century, but limited information is available in scientific literature. An epidemic containment strategy needs to include early identification of super spreaders to limit an explosive growth. Super spreaders tend to get stigmatized, resulting in late reporting and hiding of cases. It is important for program managers to be sensitive to the manner in which related information is shared with media and general public.


Summary of the coronavirus disease 2019 (COVID-19) update from the 2020 Conference on Retroviruses and Opportunistic Infections, 8-11 March 2020, Boston, USA


Electroconvulsive Therapy During COVID-19: An Essential Medical Procedure-Maintaining Service Viability and Accessibility


title: A density functional study on the formaldehyde recognition by Al-doped ZnO nanosheet

text: Experimental works have shown that doping ZnO nanosheets by the Al atom meaningfully increases their sensitivity toward HCHO gas. Here, we applied density functional theory calculations to study the Al-doping effect on the sensitivity of a ZnO nanosheet to HCHO gas, explaining the experimental results. We found that the pristine ZnO nanosheet weakly interacts with the HCHO with adsorption energy (Ead) of -9.3 kcal/mol, and the sensing response (S) value of 2.2 at 623 K. After the Al-doping process, the Ead and S values increase to -40.7 kcal/mol and 83.9, respectively, indicating an excellent agreement with the experimental results. We showed a relation between the HOMO-LUMO gap and the S value, confirming with the experimental results. Also, the proposed Al-doped ZnO nanosheet shows a good selectivity to HCHO gas at the presence of H2, NH3, C2H5OH, CO, and CH4 gases. A short recovery time of 18 s is predicted for Al-ZnO-based sensor which is comparable with the experimental value of 26 s. Finally, we conclude that the Al-doping makes the ZnO nanosheet a promising HCHO gas sensor with a high sensitivity, an excellent selectivity, and short recovery time.


docid: zkavsvoh

title: Physicochemical properties of SARS-CoV-2 for drug targeting, virus inactivation and attenuation, vaccine formulation and quality control

text: The material properties of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its proteins are discussed. We review the viral structure, size, rigidity, lipophilicity, isoelectric point, buoyant density and centrifugation conditions, stability against pH, temperature, UV light, gamma radiation, and susceptibility to various chemical agents including solvents and detergents. Possible inactivation, downstream, and formulation conditions are given including suitable buffers and some first ideas for quality-control methods. This information supports vaccine development and discussion with competent authorities during vaccine approval and is certainly related to drug-targeting strategies and hygienics. Several instructive tables are given, including the pI and grand average of hydropathicity (GRAVY) of SARS-CoV-1 and -2 proteins in comparison. SARS-CoV-1 and SARS-CoV-2 are similar in many regards, so information can often be derived. Both are unusually stable, but sensitive at their lipophilic membranes. However, since seemingly small differences can have strong effects, for example, on immunologically relevant epitope settings, unevaluated knowledge transfer from SARS-CoV-1 to SARS-CoV-2 cannot be advised. Published knowledge regarding downstream processes, formulations and quality assuring methods is, as yet, limited. However, standard approaches employed for other viruses and vaccines seem to be feasible including virus inactivation, centrifugation conditions, and the use of adjuvants.


docid: gsjajbmg

title: Terminal complement inhibition dampens the inflammation during COVID-19


COVID-19 and diabetes: Is metformin a friend or foe?


A new approach to modeling the fade-out threshold of coronavirus disease


title: Promoting attachment between parents and neonates despite the COVID-19 pandemic

text: Social distancing is the only option available during the COVID-19 pandemic until a vaccine is developed. However, this is having a major impact on human relationships and bonding between parents and neonates is a major concern. Separation during this health emergency could have lifelong consequences for offspring and there are even greater concerns if newborn infants are sick or vulnerable and need intensive care. We look at how bonding can be safely supported and maintained without risking infecting neonates, by comparing the international guidelines and proposing safe actions within those frameworks.


H(ome)bA1c testing and telemedicine: High satisfaction of people with diabetes for diabetes management during COVID-19 lockdown


title: [Optimization of a fluorescent qPCR detection for RNA of SARS-CoV-2]

text: We optimized a fluorescent quantitative polymerase chain reaction (qPCR) assay system for rapid and real time detection of SARS-CoV-2 RNA. The results show that the lowest dilution of RNA samples used for the detection of SARS-CoV-2 RNA could reach 1/10 000 (the initial value is set as 10 ng/µL). Moreover, the cycle threshold (Ct) for samples of clinically diagnosed COVID-19 was lower than 35 or 40. The sensitivity of this method was satisfactory. The results were consistent with those of the COVID-19 detection kit on the market under the same conditions, but the number of cycles required was shortened by about 2. Therefore, the optimized assay developed in this study can be used in screening and early clinical diagnosis. Our work provides a tool to facilitate rapid clinical diagnosis of COVID-19.


docid: dnrzulkh

title: Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy


Lockdown


title: Atrial Arrhythmias in a Patient Presenting With Coronavirus Disease-2019 (COVID-19) Infection

text: The coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that has significant potential cardiovascular implications for patients. These include myocarditis, acute coronary syndromes, cardiac arrhythmias, cardiomyopathies with heart failure and cardiogenic shock, and venous thromboembolic events. We describe a Caribbean-Black gentleman with COVID-19 infection presenting with atrial arrhythmias, namely, atrial flutter and atrial fibrillation, which resolved with rate and rhythm control strategies, and supportive care.


title: Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy

text: Objective: Describe characteristics, daily care and outcomes of patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). Design: Case series of 73 patients. Setting: Large tertiary hospital in Milan. Participants: Mechanically ventilated patients with confirmed COVID-19 admitted to the intensive care unit (ICU) between 20 February and 2 April 2020. Main outcome measures: Demographic and daily clinical data were collected to identify predictors of early mortality. Results: Of the 73 patients included in the study, most were male (83.6%), the median age was 61 years (interquartile range [IQR], 54-69 years), and hypertension affected 52.9% of patients. Lymphocytopenia (median, 0.77 x 103 per mm3 ; IQR, 0.58-1.00 x 103 per mm3), hyperinflammation with C-reactive protein (median, 184.5 mg/dL; IQR, 108.2-269.1 mg/dL) and pro-coagulant status with D-dimer (median, 10.1 µg/m; IQR, 5.0-23.8 µg/m) were present. Median tidal volume was 6.7 mL/kg (IQR, 6.0-7.5 mL/kg), and median positive end-expiratory pressure was 12 cmH2O (IQR, 10-14 cmH2O). In the first 3 days, prone positioning (12-16 h) was used in 63.8% of patients and extracorporeal membrane oxygenation in five patients (6.8%). After a median follow-up of 19.0 days (IQR, 15.0-27.0 days), 17 patients (23.3%) had died, 23 (31.5%) had been discharged from the ICU, and 33 (45.2%) were receiving invasive mechanical ventilation in the ICU. Older age (odds ratio [OR], 1.12; 95% CI, 1.04-1.22; P = 0.004) and hypertension (OR, 6.15; 95% CI, 1.75-29.11; P = 0.009) were associated with mortality, while early improvement in arterial partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) ratio was associated with being discharged alive from the ICU (P = 0.002 for interaction). Conclusions: Despite multiple advanced critical care interventions, COVID-19 ARDS was associated with prolonged ventilation and high short term mortality. Older age and pre-admission hypertension were key mortality risk factors. Trial registration: ClinicalTrials.gov identifier: NCT04318366.


docid: lnfebjjo

title: COVIDiagnosis-Net: Deep Bayes-SqueezeNet based diagnosis of the coronavirus disease 2019 (COVID-19) from X-ray images

text: The Coronavirus Disease 2019 (COVID-19) outbreak has a tremendous impact on global health and the daily life of people still living in more than two hundred countries. The crucial action to gain the force in the fight of COVID-19 is to have powerful monitoring of the site forming infected patients. Most of the initial tests rely on detecting the genetic material of the coronavirus, and they have a poor detection rate with the time-consuming operation. In the ongoing process, radiological imaging is also preferred where chest X-rays are highlighted in the diagnosis. Early studies express the patients with an abnormality in chest X-rays pointing to the presence of the COVID-19. On this motivation, there are several studies cover the deep learning-based solutions to detect the COVID-19 using chest X-rays. A part of the existing studies use non-public datasets, others perform on complicated Artificial Intelligent (AI) structures. In our study, we demonstrate an AI-based structure to outperform the existing studies. The SqueezeNet that comes forward with its light network design is tuned for the COVID-19 diagnosis with Bayesian optimization additive. Fine-tuned hyperparameters and augmented dataset make the proposed network perform much better than existing network designs and to obtain a higher COVID-19 diagnosis accuracy.


title: Recreational waters - A potential transmission route for SARS-CoV-2 to humans?

text: Coronavirus disease 2019 (COVID-19), the respiratory illness caused by the novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has lead to high morbidity and mortality rates worldwide, has been causing major public health concerns since first detected in late 2019. Following identification of novel pathogens, questions in relation to dissemination of the pathogen and transmission routes begin to emerge. This rapidly spreading SARS-CoV-2 virus has been detected in both faecal and wastewater samples across the globe, highlighting the potential for faecal-oral transmission of the virus. As a result, concerns regarding the transmission of the virus in the environment and the risk associated with contracting the virus in recreational waters, particularly where inadequately treated wastewater is discharged, have been emerging in recent weeks. This paper highlights the need for further research to be carried out to investigate the presence, infectivity and viability of this newly identified SARS-CoV-2 virus in wastewater effluent and receiving recreational waters.


Share mobile and social-media data to curb COVID-19


Letter to Editor: Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control


Outpatient Inhaled Nitric Oxide in a Patient with Vasoreactive Idiopathic Pulmonary Arterial Hypertension and COVID-19 Infection


Should biologics for psoriasis be interrupted in the era of COVID-19?


docid: veckwubt

title: Home quarantine or centralized quarantine, which is more conducive to fighting COVID-19 pandemic?


docid: ddqxzcnt

title: Model informed dosing of Hydroxycholoroquine in COVID-19 patients: Learnings from the recent experience, remaining uncertainties and Gaps

text: AIMS: In the absence of a commonly agreed dosing protocol based on pharmacokinetic considerations, the dose and treatment duration for hydroxychloroquine (HCQ) COVID-19 disease currently vary across national guidelines and clinical study protocols. We have used a model-based approach to explore the relative impact of alternative dosing regimens proposed in different dosing protocols for hydroxychloroquine in COVID-19. METHODS: We compared different PK exposures using Monte Carlo simulations based on a previously published population pharmacokinetic model in patients with rheumatoid arthritis, externally validated using both independent data in lupus erythematous patients and recent data in French COVID-19 patients. Clinical efficacy and safety information from COVID-19 patients treated with HCQ were used to contextualize and assess the actual clinical value of the model predictions. RESULTS: Literature and observed clinical data confirm the variability in clinical responses in COVID-19 when treated with the same fixed doses. Confounding factors were identified that should be taken into account for dose recommendation. For 80% of patients, doses higher than 800mg day on D1 followed by 600mg daily on following days might not be needed for being cured. Limited adverse drug reactions have been reported so far for this dosing regimen, most often confounded by co-medications, comorbidities or underlying COVID-19 disease effects. CONCLUSION: Our results were clear indicating the unmet need for characterization of target PK exposures to inform HCQ dosing optimization in COVID-19. Dosing optimization for HCQ in COVID-19 is still an unmet need. Efforts in this sense are a prerequisite for best the benefit/risk balance.


title: Detection and analysis of clinical features of patients with different COVID-19 types

text: OBJECTIVE: This study was designed to investigate the change of various indexes in patients with different types of coronavirus disease 2019 (COVID-19). METHODS: 75 COVID-19 patients were collected from the First Affiliated Hospital, Zhejiang University School of Medicine, and they were classified into moderate, severe and critically severe types according to the disease severity. The basic information, blood routine, pneumonia-related blood indexes, immune-related indexes along with liver, kidney and myocardial indexes in patients with different types were analyzed. RESULTS: The analysis of immune-related indexes showed that the proportions of critically severe patients with abnormal IL-2 and IL-4 were higher than those of severe and moderate patients. In addition, the proportion of patients with abnormal total cholesterol increased as the severity of disease increased, and the proportion in critically severe patients was significantly higher than that in moderate patients. CONCLUSIONS: The patients with a more severe COVID-19 are older and more likely to have a history of hypertension. With the progression of COVID-19, the abnormal proportion of total white blood cell, neutrophils, lymphocytes, IL-2, IL-4 and total cholesterol increased. The change of these indexes in patients with different COVID-19 types could provide reference for the disease severity identification and diagnosis of COVID-19. In addition, the change in the total cholesterol level suggested that COVID-19 would induce some liver function damage in patients. This article is protected by copyright. All rights reserved.


Sensibilità, specificità, valore predittivo nei test sierologici per Covid-19./ [Sensitivity, specificity, predictive values in serological Covid-19 tests]


Special Issues on Using the Montreal Cognitive Assessment for telemedicine Assessment During COVID-19


Hemoglobin value may be decreased in patients with severe coronavirus disease 2019


Acute myocardial injury: a novel clinical pattern in children with COVID-19


title: Gravity: a blockchain-agnostic cross-chain communication and data oracles protocol

text: This paper intends to propose the architecture of a blockchain-agnostic protocol designed for communication of blockchains amongst each other (i.e. cross-chain), and for blockchains with the outside world (i.e. data oracles). The expansive growth of cutting-edge technology in the blockchain industry outlines the need and opportunity for addressing oracle consensus in a manner both technologically and economically efficient as well as futureproof. Blockchain-agnosticism is inherently limited if proposing a technological solution involves adding one more architectural layer. As such, Gravity protocol is designed to be a truly blockchain-agnostic protocol. By ensuring parity through direct integration and by leveraging the stability and security of the respective interconnected ecosystems, Gravity circumvents the need for a dedicated, public blockchain and a native token. Ultimately, Gravity protocol intends to address scalability challenges by providing a solid infrastructure for the creation of gateways, cross-chain applications, and sidechains. This paper introduces and defines the concept of Oracle Consensus and its implementation in the Gravity protocol named the Pulse Consensus algorithm. The proposed consensus architecture allows Gravity to be considered a singular decentralized blockchain-agnostic oracle.


The occurrence of diarrhea in COVID-19 patients


COVID-19 and involuntary hospitalisation: navigating the challenge


title: Features and applications of Ent35-MccV hybrid bacteriocin: current state and perspectives

text: Bacteriocins are peptides of ribosomal synthesis that are active against bacteria related to the producing strain. They have been widely used in the food industry as biopreservatives. The generation of hybrid peptides by combining the genes that encode two different bacteriocins has made it possible to study the mechanisms of action of the bacteriocins that compose them and also develop new peptides with improved biotechnological applications. Hybrid bacteriocins may be obtained in several ways. In our laboratory, by combining enterocin CRL35 and microcin V (Ent35-MccV), we obtained a broad-spectrum peptide that is active against both Gram-positive and Gram-negative bacteria. Ent35-MccV is sensitive to the action of intestinal proteases and is heat resistant, which makes it a good candidate for use as a biopreservative. For this reason, the peptide was tested in skim milk and beef burgers as food models. We also obtained more potent variants of the hybrid by modifying the central amino acid of the hinge region that connects the two bacteriocins. This review also discusses future applications and perspectives regarding the Ent35-MccV and other hybrid peptides.Key Pointsâ¢ Ent35-MccV is a new broad-spectrum bacteriocin.â¢ The mechanism of action of bacteriocins can be studied using hybrid peptides.â¢ Genetic engineering allows obtaining improved bacteriocin derivatives.â¢ Hybrid peptides can be used in the food, pharmaceutical, and veterinary applications.


title: General Anesthesia Recommendations for Electroconvulsive Therapy During the Coronavirus Disease 2019 Pandemic

text: BACKGROUND: Coronavirus disease 2019 is an infectious viral disease first identified in December 2019 in Wuhan, China, and very rapidly spread globally resulting in a pandemic. Common symptoms include fever, cough, and shortness of breath. Although the majority of patients recover, there are still a significant number of patients who progress to respiratory failure, multiorgan failure, and death. The virus is mainly spread during close contact and by small droplets produced by coughing, sneezing, or talking. Because of the highly contagious element and easy spread in a communal living arrangement that exists within an inpatient psychiatric hospitals, the following guidelines were established to improve patient and staff safety while still maintaining efficiency and capability to provide this needed treatment to a subgroup of patients. OBJECTIVE: The objective of this study was to devise a safe and efficient methodology to deliver potential lifesaving electroconvulsive therapy to inpatients during the coronavirus disease 2019 pandemic.


title: Headaches During COVID-19: My Clinical Case and Review of the Literature

text: OBJECTIVE: To analyze headaches related to COVID-19 based on personal case experience. BACKGROUND: COVID-19 is an infection caused by the new coronavirus SARS-CoV-2. The first reported case happened in Wuhan on December 1, 2019. At present, at least 1.8 million people are infected around the world and almost 110,000 people have died. Many studies have analyzed the clinical picture of COVID-19, but they are focused on respiratory symptoms and headache is generically treated. METHODS: I describe and discuss my headaches during my COVID-19 and I review the MEDLINE literature about headaches and COVID-19. RESULTS: More than 41,000 COVID-19 patients have been included in clinical studies and headache was present in 8%-12% of them. However, no headache characterization was made in these studies. As a headache expert and based on my own personal clinical case, headaches related to COVID-19 can be classified in the 2 phases of the disease. Acute headache attributed to systemic viral infection, primary cough headache, tension-type headache and headache attributed to heterophoria can appear in the first phase (the influenza-like phase); and headache attributed to hypoxia and a new headache, difficult to fit into the ICHD3, can appear if the second phase (the cytokine storm phase) occurs. CONCLUSIONS: Several headaches can appear during COVID-19 infection. All of them are headaches specified in the ICHD3, except 1 that occurs from the 7th day after the clinical onset. This headache is probably related to the cytokine storm that some patients suffer and it could be framed under the ICHD3 headache of Headache attributed to other non-infectious inflammatory intracranial disease. Although the reported prevalence of headaches as a symptom of COVID-19 infection is low, this experience shows that, very probably, it is underestimated.


Medical student involvement in the COVID-19 response


Don't judge too RAShly: the multifaceted role of the renin-angiotensin system and its therapeutic potential in COVID-19


docid: ybfifsid

title: Impact of COVID-19 Behavioral Inertia on Reopening Strategies for New York City Transit

text: The COVID-19 pandemic has affected travel behaviors and transportation system operations, and cities are grappling with what policies can be effective for a phased reopening shaped by social distancing. A baseline model was previously developed and calibrated for pre-COVID conditions as MATSim-NYC. A new COVID model is calibrated that represents travel behavior during the COVID-19 pandemic by recalibrating the population agendas to include work-from-home and re-estimating the mode choice model for MATSim-NYC to fit observed traffic and transit ridership data. Assuming the change in behavior exhibits inertia during reopening, we analyze the increase in car traffic due to the phased reopen plan guided by the state government of New York. Four reopening phases and two reopening scenarios (with and without transit capacity restrictions) are analyzed. A Phase 4 reopening with 100% transit capacity may only see as much as 73% of pre-COVID ridership and an increase in the number of car trips by as much as 142% of pre-pandemic levels. Limiting transit capacity to 50% would decrease transit ridership further from 73% to 64% while increasing car trips to as much as 143% of pre-pandemic levels. While the increase appears small, the impact on consumer surplus is disproportionately large due to already increased traffic congestion. Many of the trips also get shifted to other modes like micromobility. The findings imply that a transit capacity restriction policy during reopening needs to be accompanied by (1) support for micromobility modes, particularly in non-Manhattan boroughs, and (2) congestion alleviation policies that focus on reducing traffic in Manhattan, such as cordon-based pricing.


title: Empfehlungen zur Unterstützung von belasteten, schwerstkranken, sterbenden und trauernden Menschen in der Corona-Pandemie aus palliativmedizinischer Perspektive : Empfehlungen der Deutschen Gesellschaft für Palliativmedizin (DGP), der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), des Bundesverbands Trauerbegleitung (BVT), der Arbeitsgemeinschaft für Psychoonkologie in der Deutschen Krebsgesellschaft, der Deutschen Vereinigung für Soziale Arbeit im Gesundheitswesen (DVSG) und der Deutschen Gesellschaft für Systemische Therapie, Beratung und Familientherapie (DGSF)./ [Recommendations for the support of suffering, severely ill, dying or grieving persons in the corona pandemic from a palliative care perspective : Recommendations of the German Society for Palliative Medicine (DGP), the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI), the Federal Association for Grief Counseling (BVT), the Working Group for Psycho-oncology in the German Cancer Society, the German Association for Social Work in the Healthcare System (DVSG) and the German Association for Systemic Therapy, Counseling and Family Therapy (DGSF)]

text: The corona pandemic has led to a number of restrictions and prohibitions, which in turn place large psychosocial or spiritual burdens on patients with COVID-19, their families and relatives and the treating personnel in the healthcare system. Patients with COVID-19 are not allowed to receive visitors and many hospitals and nursing homes have completely banned visitors. Many support services have been reduced or stopped completely. Necessary treatment interventions for other patients with critical and life-limiting diseases have been delayed or suspended in order to free resources for the expected COVID-19 patients; however, these people need to feel social connectedness with their relatives. Palliative care patients should be exempted from any ban on visitors. Families should be able to visit dying patients even on intensive care units or isolation wards, using adequate protective equipment. Alternative options, such as video telephone calls or via social media should be explored for patients in isolation. Families should also be enabled to say goodbye to the deceased with adequate protective equipment or should be offered alternative real or virtual options for remembrance and commemoration. Health care professionals coping with the exceptional stress should be continuously supported. This requires clear communication and leadership structures, communication training, psychosocial support, but most of all optimal framework conditions for the clinical work.


Thinking Globally, Acting Locally - The U.S. Response to Covid-19


Challenges in the management of critical ill COVID-19 patients with pressure ulcer


Correction to Lancet Respir Med 2020; 8: 506-17


title: Management of patients with COPD during the COVID-19 pandemic

text: Patients with COPD have an increased risk for severity of COVID-19. Flu-like symptoms with dyspnea may distinguish COVID-19 infection from dyspnea due to a COPD-related exacerbation. Management of COPD with COVID-19 warrants standard-of-care treatment with antimicrobial agents and corticosteroids, though limiting the dose and duration of steroids use may be warranted due to the risk of increased viral shedding. Modalities to treat acute respiratory failure can be used with some caveats. Patients with COPD and COVID-19 infection who treat their illness at home should self-isolate, use nebulizers in ways that avoid viral aerosolization, and frequently disinfect room surfaces.


These methods from psychiatry can help you beat stress during the coronavirus pandemic


title: Quantifying Susceptibility to Spear Phishing in a High School Environment Using Signal Detection Theory

text: Spear phishing is a deceptive attack that uses social engineering to obtain confidential information through targeted victimization. It is distinguished by its use of social cues and personalized information to target specific victims. Previous work on resilience to spear phishing has focused on convenience samples, with a disproportionate focus on students. In contrast, here, we report on an evaluation of a high school community. We engaged 57 high school students and faculty members (12 high school students, 45 staff members) as participants in research utilizing signal detection theory (SDT). Through scenario-based analysis, participants tasked with distinguishing phishing emails from authentic emails. The results revealed an overconfidence bias in self-detection from the participants, regardless of their technical background. These findings are critical for evaluating the decision-making of underrepresented populations and protecting people from potential spear phishing attacks by examining human susceptibility.


title: Are patients with inflammatory bowel disease at increased risk for Covid-19 infection?

text: Crohn's disease (CD)] and ulcerative colitis (UC), the main inflammatory bowel diseases (IBD) in human beings, are chronic, immune-inflammatory diseases, whose pathogenesis implicates a complex interaction between environmental factors and genetic susceptibility. These disabling conditions affect millions of individuals and, together with the drugs used to treat them, can put patients at risk of developing complications and other conditions. This is particularly relevant nowadays, as coronavirus disease (Covid-19) has rapidly spread from China to countries where IBD are more prevalent and there is convincing evidence that Covid-19-mediated morbidity and mortality are higher in subjects with comorbidities. The primary objectives of this Viewpoint are to provide a focused overview of the factors and mechanisms by which the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the cells and to illustrate the link between such determinants and the intestinal inflammation. We also provide clues about the reasons why the overall IBD population might have no increased risk to be infected with SARS-CoV-2 and highlight the potential of cytokine blockers, used to treat IBD patients, to prevent Covid-driven pneumonia.


title: Clinical significance of nutritional risk screening for older adult patients with COVID-19

text: OBJECTIVES: The aim of this study was to assess the nutritional risks among older patients with COVID-19 and their associated clinical outcomes using four nutritional risk screening (NRS) tools: Nutrition Risk Screening 2002 (NRS 2002), Malnutrition Universal Screening Tool (MUST), Mini Nutrition Assessment Shortcut (MNA-sf), and Nutrition Risk Index (NRI). METHODS: We retrospectively analyzed the data of patients with COVID-19 older than 65 years who were treated in our hospital from January 28, 2020 to March 5, 2020, and explored the relationship between nutritional risk and clinical outcomes. RESULTS: A total of 141 patients with COVID-19 (46 common COVID-19, 73 severe COVID-19, and 22 extremely severe COVID-19) were enrolled in the study. NRS 2002 identified 85.8% of patients as having risk, with being identified 41.1% by MUST, 77.3% by MNA-sf, and 71.6% by NRI. The agreement strength was moderate between NRS 2002 and MNA-sf, NRI, fair between MUST and MNA-sf, NRI, fair between MNA-sf and NRI, poor between NRS 2002 and MUST (P < 0.01). After adjustment for confounding factors in multivariate regression analysis, patients in the risk group had significantly longer LOS, higher hospital expenses (except MNA-sf), poor appetite, heavier disease severity, and more weight change(kg) than normal patients by using NRS 2002, MNA-sf, and NRI(P < 0.05). CONCLUSIONS: The NRS 2002, MNA-sf, and NRI are useful and practical tools with respect to screening for patients with COVID-19 who are at nutritional risk, as well as in need of additional nutritional intervention.


title: Potential COVID-19 therapeutics from a rare disease: weaponizing lipid dysregulation to combat viral infectivity

text: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV)-2 has resulted in the death of more than 328,000 persons worldwide in the first 5 months of 2020. Herculean efforts to rapidly design and produce vaccines and other antiviral interventions are ongoing. However, newly evolving viral mutations, the prospect of only temporary immunity, and a long path to regulatory approval pose significant challenges and call for a common, readily available, and inexpensive treatment. Strategic drug repurposing combined with rapid testing of established molecular targets could provide a pause in disease progression. SARS-CoV-2 shares extensive structural and functional conservation with SARS-CoV-1, including engagement of the same host cell receptor (angiotensin-converting enzyme 2) localized in cholesterol-rich microdomains. These lipid-enveloped viruses encounter the endosomal/lysosomal host compartment in a critical step of infection and maturation. Niemann-Pick type C (NP-C) disease is a rare monogenic neurodegenerative disease caused by deficient efflux of lipids from the late endosome/lysosome (LE/L). The NP-C disease-causing gene (NPC1) has been strongly associated with viral infection, both as a filovirus receptor (e.g., Ebola) and through LE/L lipid trafficking. This suggests that NPC1 inhibitors or NP-C disease mimetics could serve as anti-SARS-CoV-2 agents. Fortunately, there are such clinically approved molecules that elicit antiviral activity in preclinical studies, without causing NP-C disease. Inhibition of NPC1 may impair viral SARS-CoV-2 infectivity via several lipid-dependent mechanisms, which disturb the microenvironment optimum for viral infectivity. We suggest that known mechanistic information on NPC1 could be utilized to identify existing and future drugs to treat COVID-19.


title: Ability of the immune system to fight viruses highlighted by cytometry and TCR clonotype assessments: lessons taken prior to COVID-19 virus pandemic outbreak

text: The intriguing aspects of SARS-CoV-2 virus are the high rate of spread and rapid progression of pneumonitis. Confronted with thousands of deaths daily worldwide, we have to build quickly the rationale behind the treatment, taking advantage from past analogues. When a new virus strikes, T-cell receptor (TCR) gamma/delta cells are in the first line of defence, activated by stress molecules and recognising some epitopes in a process that is major histocompatibility complex (MHC) independent but still specific, e.g. cytomegalovirus (CMV), as well as participating in the regulatory mechanism - both characteristics are useful in fighting SARS-CoV-2. The fatalities are mostly due to pneumonitis, in the course of which an overwhelming inflammatory process impairs blood oxygenation, calling for artificial ventilation. In fatal COVID-19 cases the balance between the immune response and the inflammatory outcome fails, due to which the patients at risk, mostly aged, have higher levels of anti-SARS-CoV-2 antibodies and an enhanced inflammatory process in the lung. Apparently there is no feedback control over the antibody production. The investigational use of convalescent plasma, providing antibodies taken from patients who have recovered, was shown to be effective, likely through exerting idiotype associated negative control of antibody production. Similarly, the use of mesenchymal stem cells (MSC) may assist the body regulatory mechanisms, knowing the anti-inflammatory potential of these cells. The use of these two immunotherapeutic tools is understandable on the grounds of basic immunology, whose knowledge may direct the medical community in efforts to fight the virus.


Predictive factors of poor outcomes in the COVID-19 epidemic: Consider the inflammatory response


docid: jblqeitv

title: TRPV4 antagonism prevents mechanically-induced myotonia

text: OBJECTIVE: Myotonia is caused by involuntary firing of skeletal muscle action potentials and causes debilitating stiffness. Current treatments are insufficiently efficacious and associated with side effects. Myotonia can be triggered by voluntary movement (electrically-induced myotonia) or percussion (mechanically-induced myotonia). Whether distinct molecular mechanisms underlie these triggers is unknown. Our goal was to identify ion channels involved in mechanically-induced myotonia and to evaluate block of the channels involved as a novel approach to therapy. METHODS: We developed a novel system to enable study of mechanically-induced myotonia using both genetic and pharmacologic mouse models of myotonia congenita. We extended ex vivo studies of excitability to in vivo studies of muscle stiffness. RESULTS: As previous work suggests activation of transient receptor potential vanilloid 4 (TRPV4) channels by mechanical stimuli in muscle, we examined the role of this cation channel. Mechanically-induced myotonia was markedly suppressed in TRPV4-null muscles and in muscles treated with TRPV4 small molecule antagonists. The suppression of mechanically-induced myotonia occurred without altering intrinsic muscle excitability such that myotonia triggered by firing of action potentials (electrically-induced myotonia) was unaffected. When injected intraperitoneally, TRPV4 antagonists lessened the severity of myotonia in vivo by approximately 80%. INTERPRETATION: These data demonstrate for the first time that there are distinct molecular mechanisms triggering electrically- and mechanically-induced myotonia. Our data indicates that activation of TRPV4 during muscle contraction plays an important role in triggering myotonia in vivo. Elimination of mechanically-induced myotonia by TRPV4 inhibition offers a new approach to treating myotonia. This article is protected by copyright. All rights reserved.