docid: upzjqnfk

title: Role and Management of a Head and Neck Department during the COVID-19 Outbreak in Lombardy

text: The recent Italian outbreak of coronavirus disease 2019 led to an unprecedented burden on our health care system. Despite head and neck-otolaryngology not being a front-line specialty in dealing with this disease, our department had to face several specific issues. Despite a massive reallocation of resources in the hospital, we managed to keep the service active, improving safety measures for our personnel, specifically during common otolaryngologic maneuvers known to produce aerosols. Furthermore, we strived to maintain our teaching role, giving residents an inclusive role in managing the response to the emergency state, and we progressively integrated our inactive specialists into other service rotations to relieve front-line colleagues' burden. Specific issues and management decisions are discussed in detail in the article.


title: Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient during COVID-19 Pandemic: Expert Review and Recommendation

text: Critically ill COVID-19 patients are generally admitted to the ICU for respiratory insufficiency which can evolve into a multiple-organ dysfunction syndrome requiring extracorporeal organ support. Ongoing advances in technology and science and progress in information technology support the development of integrated multi-organ support platforms for personalized treatment according to the changing needs of the patient. Based on pathophysiological derangements observed in COVID-19 patients, a rationale emerges for sequential extracorporeal therapies designed to remove inflammatory mediators and support different organ systems. In the absence of vaccines or direct therapy for COVID-19, extracorporeal therapies could represent an option to prevent organ failure and improve survival. The enormous demand in care for COVID-19 patients requires an immediate response from the scientific community. Thus, a detailed review of the available technology is provided by experts followed by a series of recommendation based on current experience and opinions, while waiting for generation of robust evidence from trials.


title: The Science Underlying COVID-19: Implications for the Cardiovascular System

text: The coronavirus disease 2019 (COVID-19) pandemic has affected health and economy worldwide on an unprecedented scale. Patients have diverse clinical outcomes, but those with preexisting cardiovascular disease, hypertension, and related conditions incur disproportionately worse outcome. The high infectivity of severe acute respiratory syndrome coronavirus 2 is in part related to new mutations in the receptor binding domain, and acquisition of a furin cleavage site in the S-spike protein. The continued viral shedding in the asymptomatic and presymptomatic individuals enhances its community transmission. The virus uses the angiotensin converting enzyme 2 receptor for internalization, aided by transmembrane protease serine 2 protease. The tissue localization of the receptors correlates with COVID-19 presenting symptoms and organ dysfunction. Virus-induced angiotensin converting enzyme 2 downregulation may attenuate its function, diminish its anti-inflammatory role, and heighten angiotensin II effects in the predisposed patients. Lymphopenia occurs early and is prognostic, potentially associated with reduction of the CD4+ and some CD8+ T cells. This leads to imbalance of the innate/acquired immune response, delayed viral clearance, and hyperstimulated macrophages and neutrophils. Appropriate type I interferon pathway activation is critical for virus attenuation and balanced immune response. Persistent immune activation in predisposed patients, such as elderly adults and those with cardiovascular risk, can lead to hemophagocytosis-like syndrome, with uncontrolled amplification of cytokine production, leading to multiorgan failure and death. In addition to the airways and lungs, the cardiovascular system is often involved in COVID-19 early, reflected in the release of highly sensitive troponin and natriuretic peptides, which are all extremely prognostic, in particular, in those showing continued rise, along with cytokines such as interleukin-6. Inflammation in the vascular system can result in diffuse microangiopathy with thrombosis. Inflammation in the myocardium can result in myocarditis, heart failure, cardiac arrhythmias, acute coronary syndrome, rapid deterioration, and sudden death. Aggressive support based on early prognostic indicators with expectant management can potentially improve recovery. Appropriate treatment for heart failure, arrhythmias, acute coronary syndrome, and thrombosis remain important. Specific evidence-based treatment strategies for COVID-19 will emerge with ongoing global collaboration on multiple approaches being evaluated. To protect the wider population, antibody testing and effective vaccine will be needed to make COVID-19 history.


Covid-19: Én verden, én helse./ Covid-19: Én verden, én helse./ COVID-19: One world, one health


Tracking online heroisation and blame in epidemics


docid: lkcbhdqg

title: The five 'W' of cognitive telerehabilitation in the Covid-19 era


title: Can China's 'standard of care' for COVID-19 be replicated in Europe?

text: The Director-General of the WHO has suggested that China's approach to the COVID-19 crisis could be the standard of care for global epidemics. However, as remarkable as the Chinese strategy might be, it cannot be replicated in other countries and certainly not in Europe. In Europe, there is a distribution of power between the European Union and its member states. In contrast, China's political power is concentrated in the central government. This enables it to take immediate measures that affect the entire country, such as massive quarantines or closing borders. Moreover, the Chinese legal framework includes restrictions on privacy and other human rights that are unknown in Europe. In addition, China has the technological power to easily impose such restrictions. In most European countries, that would be science fiction. These conditions have enabled China to combat epidemics like no other country can. However, the WHO might have been overoptimistic. The Chinese standard of care for treating COVID-19 also raises problematic issues for human rights, and the real consequences of these actions remain to be seen.


Diabetiker auch in Zeiten von Corona gut versorgen : Editorial


Telecardiología en tiempos de la pandemia COVID-19./ [Telecardiology in times of the COVID-19 pandemic]


title: A simulation approach to measure critical safety behaviors when evaluating training methods for respirator education in healthcare workers

text: BACKGROUND: The N95 respirator is the most common safety tool used in hospitals to protect health care workers (HCW) from inhaling airborne particles. Focusing on HCW behavior related to respirator use is an effective route to improve HCW safety and respiratory health. METHODS: Participants were asked to perform the donning and doffing of an N95 respirator to camera. Then they were randomized to a video alone or a reflective practice intervention. After the intervention they repeated the donning and doffing to camera. A critical safety behavior scoring tool (CSBST) was developed to compare the performance of the participants over time at pretest, post-test and 1 month later for follow-up. RESULTS: The reflective practice intervention group was found to have significantly higher scores on the CSBST at post-test and follow-up than the video alone group. In the reflective practice intervention group, the participants perceived they were better at performing the N95 donning and doffing than the experts scored them. CONCLUSIONS: The CSBST is a tool to measure the performance of HCWs on a specific targeted safety behaviors. The addition of a reflective practice intervention may result in a measurable and sustained improvement in the safety behaviors demonstrated when using the N95 respirator.


Rapid COVID-19-related Clinical Adaptations and Unanticipated Risks


docid: spteqcya

title: Partha Kar: To tackle racism, the NHS needs policies with teeth


Laryngeal oedema associated with COVID-19 complicating airway management


Resources during covid-19


What led to the UK's COVID-19 death toll? - An insight into the mistakes made and the current situation


title: Preventing Facial Pressure Injury for Health Care Providers Adhering to COVID-19 Personal Protective Equipment Requirements

text: OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath a N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask's seal. METHODS: Since February 21, 2020, staff in high risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when doing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital's Pressure Injury Prevention Committee explored and created a stepwise process to protect the skin under these masks. This procedure was developed over time and tested to make sure that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes who became part of this evidence generation project. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. An added advantage was increased comfort with less friction as self-reported by the staff. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method by which staff could apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.


title: Back to school: Safe for children with underlying medical conditions

text: As schools reopen as a result of low community transmission rates of COVID-19, parents and teachers will have understandable concerns about the risks to students and staff.


Travel rush during Chinese Spring Festival and the 2019-nCoV


title: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): An overview of viral structure and host response

text: BACKGROUND AND AIM: As a result of its rapid spread in various countries around the world, on March 11, 2020, WHO issued an announcement of the change in coronavirus disease 2019 status from epidemic to pandemic disease. The virus that causes this disease is indicated originating from animals traded in a live animal market in Wuhan, China. Severe Acute Respiratory Syndrome Coronavirus 2 can attack lung cells because there are many conserved receptor entries, namely Angiotensin Converting Enzyme-2. The presence of this virus in host cells will initiate various protective responses leading to pneumonia and Acute Respiratory Distress Syndrome. This review aimed to provide an overview related to this virus and examine the body's responses and possible therapies. METHOD: We searched PubMed databases for Severe Acute Respiratory Syndrome Coronavirus-2, Middle East respiratory syndrome-related coronavirus and Severe Acute Respiratory Syndrome Coronavirus. Full texts were retrieved, analyzed and developed into an easy-to-understand review. RESULTS: We provide a complete review related to structure, origin, and how the body responds to this virus infection and explain the possibility of an immune system over-reaction or cytokine storm. We also include an explanation of how this virus creates modes of avoidance to evade immune system attacks. We further explain the therapeutic approaches that can be taken in the treatment and prevention of this viral infection. CONCLUSION: In summary, based on the structural and immune-evasion system of coronavirus, we suggest several approaches to treat the disease.


title: A Review of SARS-CoV-2 and the Ongoing Clinical Trials

text: The sudden outbreak of 2019 novel coronavirus (2019-nCoV, later named SARS-CoV-2) in Wuhan, China, which rapidly grew into a global pandemic, marked the third introduction of a virulent coronavirus into the human society, affecting not only the healthcare system, but also the global economy. Although our understanding of coronaviruses has undergone a huge leap after two precedents, the effective approaches to treatment and epidemiological control are still lacking. In this article, we present a succinct overview of the epidemiology, clinical features, and molecular characteristics of SARS-CoV-2. We summarize the current epidemiological and clinical data from the initial Wuhan studies, and emphasize several features of SARS-CoV-2, which differentiate it from SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), such as high variability of disease presentation. We systematize the current clinical trials that have been rapidly initiated after the outbreak of COVID-19 pandemic. Whereas the trials on SARS-CoV-2 genome-based specific vaccines and therapeutic antibodies are currently being tested, this solution is more long-term, as they require thorough testing of their safety. On the other hand, the repurposing of the existing therapeutic agents previously designed for other virus infections and pathologies happens to be the only practical approach as a rapid response measure to the emergent pandemic, as most of these agents have already been tested for their safety. These agents can be divided into two broad categories, those that can directly target the virus replication cycle, and those based on immunotherapy approaches either aimed to boost innate antiviral immune responses or alleviate damage induced by dysregulated inflammatory responses. The initial clinical studies revealed the promising therapeutic potential of several of such drugs, including favipiravir, a broad-spectrum antiviral drug that interferes with the viral replication, and hydroxychloroquine, the repurposed antimalarial drug that interferes with the virus endosomal entry pathway. We speculate that the current pandemic emergency will be a trigger for more systematic drug repurposing design approaches based on big data analysis.


What could be the better choice between ACE inhibitors and AT1R antagonists in coronavirus disease 2019 (COVID-19) patients?


title: Transforming ophthalmic education into virtual learning during COVID-19 pandemic: a global perspective

text: OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has imposed measures of social distancing and barriers in delivery of "in person" education. Institutions, involved in training the next generation of ophthalmologists, are using alternative teaching methods to maintain the standard of education. METHODS: We conducted a worldwide survey among physicians, who are actively involved in Ophthalmology-related education, between 3 and 14 April 2020. The expert survey, developed on the basis of literature search and focus group discussions, comprised 23 questions addressing the use of e-learning in Ophthalmology during the COVID-19 pandemic. RESULTS: A total of 321 participants from both academic and non-academic institutions worldwide, with variable practice experience and expertise, completed the survey. Before the pandemic, the majority of participants used traditional training modalities, including lectures, grand rounds and journal clubs, and 48% did not use any e-learning. There was a statistically significant increase in the use of all e-learning alternatives during the pandemic (p < 0.001), associated mainly with the availability of e-learning facilities (p < 0.001) and the academic character of institutions (p < 0.001). Zoom® was recognized as the mostly used platform for virtual teaching. Although theoretical teaching may take place, the surgical training of residents/fellows was dramatically reduced. The latter was significantly associated with participants' perspectives about teaching practices (p < 0.001). CONCLUSION: COVID-19 pandemic imposed great challenges in the educational field of Ophthalmology. The experience related to virtual training in Ophthalmology, gained during the pandemic, may change the traditional teaching practices in the world and provide new educational opportunities.


title: Case series of six kidney transplanted patients with COVID-19 pneumonia treated with tocilizumab

text: Few reports described the outcome of kidney transplanted patients (KTs) affected by COVID-19 treated with interleukin-6 receptor inhibitor tocilizumab (TCZ). We report our case series of 6 KTs with COVID-19 pneumonia who received TCZ: All were of male gender, with a mean age of 55.5 ± 8.4 years, a median time from transplantation of 3611 days (1465-5757); 5/6 had cardiovascular comorbidities, 1/6 had diabetes, and 3/6 have one or more previous KTs. Four out of six patients died, at an average time of 9.75 ± 2.4 days after tocilizumab administration, 3/6 due to a coexistent septic shock. Two patients improved after TCZ and were discharged at 20 and 21 days, respectively; in both patient, a significant increase of total lymphocyte count was observed. In conclusion, KTs, where the role of peculiar factors such as chronic immunosuppression is still undetermined, represent a high-risk group with significant COVID-19-associated mortality. The evaluation of the TCZ effect in COVID-19 pneumonia requires controlled studies (ideally RCTs) in this specific population.


text: Few reports described the outcome of kidney transplanted patients (KTs) affected by COVID-19 treated with interleukin-6 receptor inhibitor Tocilizumab (TCZ). We report our case series of 6 KTs with COVID-19 pneumonia who received TCZ: all were of male gender, with a mean age of 55.5±8.4 years, a median time from transplantation of 3611 days (1465-5757); 5/6 had cardiovascular comorbidities, 1/6 had diabetes and 3/6 have one or more previous KTs. Four out of six patients died, at an average time of 9.75±2.4 days after tocilizumab administration, 3/6 due to a coexistent septic shock. Two patients improved after TCZ and were discharged at 20 and 21 days respectively; in both patient a significant increase of total lymphocyte count was observed. In conclusion KTs, where the role of peculiar factors such as chronic immunosuppression is still undetermined, represent a high-risk group with significant COVID-19 associated mortality. The evaluation of the TCZ effect in COVID-19 pneumonia requires controlled studies (ideally RCTs) in this specific population.


SARS-CoV, Mers-CoV and COVID-19: what differences from a dermatological viewpoint?


title: A Second Pandemic? Perspective on Information Overload in the COVID-19 Era

text: The outbreak of COVID-19 has affected the globe in previously unimaginable ways, with far-reaching economic and social implications. It has also led to an outpouring of daily, ever-changing information. To assess the amount of data that were emerging, a PubMed search related to COVID-19 was performed. Nearly 8000 articles have been published since the virus was defined 4 months ago. This number has grown exponentially every month, potentially hindering our ability to discern what is scientifically important. Unlike previous global pandemics, we exist in a world of instantaneous access. Information, accurate or otherwise, is flowing from one side of the world to the other via word of mouth, social media, news, and medical journals. Changes in practice guidelines should be based on high-quality, well-powered research. Our job as health care providers is to mitigate misinformation and provide reassurance to prevent a second pandemic of misinformation.


title: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19

text: BACKGROUND: Coronavirus disease 2019 (Covid-19) may disproportionately affect people with cardiovascular disease. Concern has been aroused regarding a potential harmful effect of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in this clinical context. METHODS: Using an observational database from 169 hospitals in Asia, Europe, and North America, we evaluated the relationship of cardiovascular disease and drug therapy with in-hospital death among hospitalized patients with Covid-19 who were admitted between December 20, 2019, and March 15, 2020, and were recorded in the Surgical Outcomes Collaborative registry as having either died in the hospital or survived to discharge as of March 28, 2020. RESULTS: Of the 8910 patients with Covid-19 for whom discharge status was available at the time of the analysis, a total of 515 died in the hospital (5.8%) and 8395 survived to discharge. The factors we found to be independently associated with an increased risk of in-hospital death were an age greater than 65 years (mortality of 10.0%, vs. 4.9% among those ≤65 years of age; odds ratio, 1.93; 95% confidence interval [CI], 1.60 to 2.41), coronary artery disease (10.2%, vs. 5.2% among those without disease; odds ratio, 2.70; 95% CI, 2.08 to 3.51), heart failure (15.3%, vs. 5.6% among those without heart failure; odds ratio, 2.48; 95% CI, 1.62 to 3.79), cardiac arrhythmia (11.5%, vs. 5.6% among those without arrhythmia; odds ratio, 1.95; 95% CI, 1.33 to 2.86), chronic obstructive pulmonary disease (14.2%, vs. 5.6% among those without disease; odds ratio, 2.96; 95% CI, 2.00 to 4.40), and current smoking (9.4%, vs. 5.6% among former smokers or nonsmokers; odds ratio, 1.79; 95% CI, 1.29 to 2.47). No increased risk of in-hospital death was found to be associated with the use of ACE inhibitors (2.1% vs. 6.1%; odds ratio, 0.33; 95% CI, 0.20 to 0.54) or the use of ARBs (6.8% vs. 5.7%; odds ratio, 1.23; 95% CI, 0.87 to 1.74). CONCLUSIONS: Our study confirmed previous observations suggesting that underlying cardiovascular disease is associated with an increased risk of in-hospital death among patients hospitalized with Covid-19. Our results did not confirm previous concerns regarding a potential harmful association of ACE inhibitors or ARBs with in-hospital death in this clinical context. (Funded by the William Harvey Distinguished Chair in Advanced Cardiovascular Medicine at Brigham and Women's Hospital.).


title: Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study

text: BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is leading to social (physical) distancing policies worldwide, including in the USA. Some of the first actions taken by governments are the closing of schools. The evidence that mandatory school closures reduce the number of cases and, ultimately, mortality comes from experience with influenza or from models that do not include the effect of school closure on the health-care labour force. The potential benefits from school closures need to be weighed against costs of health-care worker absenteeism associated with additional child-care obligations. In this study, we aimed to measure child-care obligations for US health-care workers arising from school closures when these are used as a social distancing measure. We then assessed how important the contribution of health-care workers would have to be in reducing mortality for their absenteeism due to child-care obligations to undo the benefits of school closures in reducing the number of cases. METHODS: For this modelling analysis, we used data from the monthly releases of the US Current Population Survey to characterise the family structure and probable within-household child-care options of US health-care workers. We accounted for the occupation within the health-care sector, state, and household structure to identify the segments of the health-care workforce that are most exposed to child-care obligations from school closures. We used these estimates to identify the critical level at which the importance of health-care labour supply in increasing the survival probability of a patient with COVID-19 would undo the benefits of school closures and ultimately increase cumulative mortality. FINDINGS: Between January, 2018, and January, 2020, the US Current Population Survey included information on more than 3·1 million individuals across 1·3 million households. We found that the US health-care sector has some of the highest child-care obligations in the USA, with 28·8% (95% CI 28·5-29·1) of the health-care workforce needing to provide care for children aged 3-12 years. Assuming non-working adults or a sibling aged 13 years or older can provide child care, 15·0% (14·8-15·2) of the health-care workforce would still be in need of child care during a school closure. We observed substantial variation within the health-care system. We estimated that, combined with reasonable parameters for COVID-19 such as a 15·0% case reduction from school closings and 2·0% baseline mortality rate, a 15·0% decrease in the health-care labour force would need to decrease the survival probability per percent health-care worker lost by 17·6% for a school closure to increase cumulative mortality. Our model estimates that if the infection mortality rate of COVID-19 increases from 2·00% to 2·35% when the health-care workforce declines by 15·0%, school closures could lead to a greater number of deaths than they prevent. INTERPRETATION: School closures come with many trade-offs, and can create unintended child-care obligations. Our results suggest that the potential contagion prevention from school closures needs to be carefully weighted with the potential loss of health-care workers from the standpoint of reducing cumulative mortality due to COVID-19, in the absence of mitigating measures. FUNDING: None.


COVID-19 Pandemic Disrupts HIV Continuum of Care and Prevention: Implications for Research and Practice Concerning Community-Based Organizations and Frontline Providers


COVID-19: Timing is Important


What the World Can Learn from China's Experience With Coronavirus : Lessons from a Pandemics 'Ground Zero


Response to: Sore throat in COVID-19: comment on "Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: A single arm meta-analysis"


Severe COVID-19 in the young and healthy: monogenic inborn errors of immunity?


Population Trends in Rates of Percutaneous Coronary Revascularization for Acute Coronary Syndromes Associated With the COVID-19 Outbreak


title: Factors affecting the chemical composition of precipitation in Syria

text: Concentrations of the major ions (Ca2+, Mg2+, Na+, K+, NH4+, Cl-, HCO3-, SO42- and NO3-), pH and electrical conductivity (EC) values in the rainwater (RW) samples at 16 stations in Syria were determined for characterizing the principal factors affecting the chemical composition of precipitation (P) in this country. Collection of the RW samples was made on a monthly basis during the period (1989-2006). The volume-weighted mean (VWM) values calculated for the different parameters at all stations show VWM values of 6.84 and 96 µS/cm for pH and EC, respectively. The ionic trend of the VWM concentrations (µeq/L) in the RW samples of entire dataset follows the descending order: Ca2+ ≥ HCO3- > SO42- > Mg2+ > Cl- > Na+ > NO3- > K+ > NH4+. The lowest pH and EC values were found for the southern mountainous stations, while the highest were reported for the interior inland stations, depending on the amount of carbonate dust present in the atmosphere. The major part of the RW salinity (> 70%) was due to Ca2+, HCO3- and SO42- concentrations. The highest concentrations of Na+ and Cl- were found for the Tartous coastal station, where the Na+/Cl- ratio (0.84 ± 0.16) was remarkably very close to that of the Mediterranean Sea (MS) value (0.86), implying thus the sea spray effect. The highest NO3- concentrations (≈ 8-9 mg/L), with relatively high SO42-/NO3- ratios (> 2 ± 1), were found for the major cities (Damascus, Homs and Aleppo), implying hence the influence of intensive traffics and urban pollutions. The pH parameter was moderately linked with Ca2+ and HCO3- (R2 ≈ 0.36), while EC was correlated with all ions, except NH4+. This later ion was weakly correlated with NO3- (R2 ≈ 0.23). Strong correlations were found between Ca2+ and SO42- (R2 ≈ 0.80) and between Cl- and Na+ (R2 ≈ 0.95). Ca2+ and Mg2+ ions were the most responsible for neutralizing the RW acidity. The role of K+ and NH4+ as acidity neutralizers was small. By using the principal component analysis (PCA), five major factors, explaining ≈ 87% of the total variance, were suggested for the possible sources affecting the chemical composition of RW in this country. The factors are (1) crustal natural materials, (2) sea salts, (3) fossil fuel combustion, (4) rural activity, and (5) biomass burning.


When Life is Put on Hold, How Do We Hold on to Life? Challenges and Opportunities in Developmental and Behavioral Pediatrics During COVID-19


docid: jqssxgag

title: Urology surgical activity and COVID-19: Risk assessment at the epidemic peak the parisian multicenter experience

text: OBJECTIVES: To evaluate the risk of contracting severe COVID-19, defined as COVID-19 specific intensive care unit (ICU) admission or death, for patients undergoing urological surgery during the epidemic. To define consequences of receiving surgery for COVID-19 patients. PATIENTS AND METHODS: This is a multicenter observational cohort study. Every patient receiving a urological procedure in Paris academic urological centers during the 4 initial weeks of surgical restrictions were included. Their status was updated minimum 3 weeks after the procedure. The main outcomes were the COVID-19 specific ICU admission and death. Statistics were mostly descriptive. The Post-operative COVID-19 confirmed group was compared with non-COVID patients using Chi-square tests for categorical and Wilcoxon test tests for continuous variables. RESULTS: During the 4-week period, 552 patients received surgery within 8 centers. At follow-up, 57 (10%) patients were lost. Among the 11 preoperative COVID-19 cases, one remained in ICU, no new admission, and no death. For the non-COVID patients, 57 (12%) developed COVID-related symptoms; only one case (0.2%) required COVID-19 specific ICU and 3 (0.6%) patients died of COVID-19 after surgery. CONCLUSIONS: Performing urological surgery during the COVID-19 epidemic peak has a limited impact on ICU admissions but presents a real (0.6%) risk of specific mortality. Surgical activities should be maintained according to this risk.


title: A snapshot of the ongoing clinical research on COVID-19

text: The pandemic of coronavirus disease 2019 (COVID-19) presents an unprecedented challenge to rapidly develop new diagnostic, preventive and therapeutic strategies. Currently, thousands of new COVID-19 patients are quickly enrolled in clinical studies. We aimed to investigate the characteristics of the COVID-19 studies registered in ClinicalTrials.gov and report the extent to which they have incorporated features that are desirable for generating high-quality evidence. On April 28, 2020, a total of 945 studies on COVID-19 have been registered in ClinicalTrials.gov; 586 studies are interventional (62.0%), the most frequent allocation scheme is the parallel group assignment (437; 74.6%), they are open-label and the most common primary purpose is the research on treatment. Too many of the ongoing interventional studies have a small expected sample size and may not generate credible evidence at completion. This might lead to a delayed recognition of effective therapies that are urgently needed, and a waste of time and resources. In the COVID-19 pandemic era, it is crucial that the adoption of new diagnostic, preventive and therapeutic strategies is based upon evidence coming from well-designed, adequately powered and carefully conducted clinical trials.


Extraordinary diseases require extraordinary solutions


Predictors of refractory Coronavirus disease (COVID-19) pneumonia


title: Potential Novel Role of COVID-19 in Alzheimer's Disease and Preventative Mitigation Strategies

text: There are a number of potential implications for the field of Alzheimer's disease (AD) stemming from the global spread of SARS-CoV-2. Neuroinflammation is known to be a prominent feature of neurodegeneration and plays a major role in AD pathology. Immune response and excessive inflammation in COVID-19 may also accelerate the progression of brain inflammatory neurodegeneration, and elderly individuals are more susceptible to severe outcomes after SARS-CoV-2 infection. Individuals with type 2 diabetes (T2D) are at an increased risk for AD as well as severe outcomes after SARS-CoV-2 infection. Genetic and socioeconomic factors influencing the rates of T2D, AD, and COVID-19 severity may create an exceptionally high-risk profile for certain demographics such as African Americans and Hispanic Americans. Type I interferon response plays an important role in both host response to viral infection, as well as AD pathology and may be a sensible therapeutic target in both AD and COVID-19.


COVID-19 and endoscopy: implications for healthcare and digestive cancer screening


title: PriLok: Citizen-protecting distributed epidemic tracing

text: Contact tracing is an important instrument for national health services to fight epidemics. As part of the COVID-19 situation, many proposals have been made for scaling up contract tracing capacities with the help of smartphone applications, an important but highly critical endeavor due to the privacy risks involved in such solutions. Extending our previously expressed concern, we clearly articulate in this article, the functional and non-functional requirements that any solution has to meet, when striving to serve, not mere collections of individuals, but the whole of a nation, as required in face of such potentially dangerous epidemics. We present a critical information infrastructure, PriLock, a fully-open preliminary architecture proposal and design draft for privacy preserving contact tracing, which we believe can be constructed in a way to fulfill the former requirements. Our architecture leverages the existing regulated mobile communication infrastructure and builds upon the concept of"checks and balances", requiring a majority of independent players to agree to effect any operation on it, thus preventing abuse of the highly sensitive information that must be collected and processed for efficient contact tracing. This is enforced with a largely decentralised layout and highly resilient state-of-the-art technology, which we explain in the paper, finishing by giving a security, dependability and resilience analysis, showing how it meets the defined requirements, even while the infrastructure is under attack.


title: Immune response in children with COVID-19 is characterized by lower levels of T cell activation than infected adults

text: XX XXX This article is protected by copyright. All rights reserved.


COVID-19 pandemic: Ophthalmic practice and precautions in a tertiary eye hospital in Iran


Tracking COVID-19 responsibly


title: The Society for Immunotherapy of Cancer perspective on regulation of interleukin-6 signaling in COVID-19-related systemic inflammatory response

text: The pandemic caused by the novel coronavirus SARS-CoV-2 has placed an unprecedented burden on healthcare systems around the world. In patients who experience severe disease, acute respiratory distress is often accompanied by a pathological immune reaction, sometimes referred to as 'cytokine storm'. One hallmark feature of the profound inflammatory state seen in patients with COVID-19 who succumb to pneumonia and hypoxia is marked elevation of serum cytokines, especially interferon gamma, tumor necrosis factor alpha, interleukin 17 (IL-17), interleukin 8 (IL-8) and interleukin 6 (IL-6). Initial experience from the outbreaks in Italy, China and the USA has anecdotally demonstrated improved outcomes for critically ill patients with COVID-19 with the administration of cytokine-modulatory therapies, especially anti-IL-6 agents. Although ongoing trials are investigating anti-IL-6 therapies, access to these therapies is a concern, especially as the numbers of cases worldwide continue to climb. An immunology-informed approach may help identify alternative agents to modulate the pathological inflammation seen in patients with COVID-19. Drawing on extensive experience administering these and other immune-modulating therapies, the Society for Immunotherapy of Cancer offers this perspective on potential alternatives to anti-IL-6 that may also warrant consideration for management of the systemic inflammatory response and pulmonary compromise that can be seen in patients with severe COVID-19.


title: Operational Strategies to Prevent Coronavirus Disease 2019 (COVID-19) Spread in Radiology: Experience From a Singapore Radiology Department After Severe Acute Respiratory Syndrome

text: As coronavirus disease 2019 (COVID-19) infection spreads globally, the demand for chest imaging will inevitably rise with an accompanying increase in risk of disease transmission to frontline radiology staff. Radiology departments should implement strict infection control measures and robust operational plans to minimize disease transmission and mitigate potential impact of possible staff infection. In this article, the authors share several operational guidelines and strategies implemented in our practice to reduce spread of COVID-19 and maintain clinical and educational needs of a teaching hospital.


title: A cutting-edge immunoinformatics approach for design of multi-epitope oral vaccine against dreadful human malaria

text: Human malaria is a pathogenic disease mainly caused by Plasmodium falciparum, which was responsible for about 405,000 deaths globally in the year 2018. To date, several vaccine candidates have been evaluated for prevention, which failed to produce optimal output at various preclinical/clinical stages. This study is based on designing of polypeptide vaccines (PVs) against human malaria that cover almost all stages of life-cycle of Plasmodium and for the same 5 genome derived predicted antigenic proteins (GDPAP) have been used. For the development of a multi-immune inducer, 15 PVs were initially designed using T-cell epitope ensemble, which covered >99% human population as well as linear B-cell epitopes with or without adjuvants. The immune simulation of PVs showed higher levels of T-cell and B-cell activities compared to positive and negative vaccine controls. Furthermore, in silico cloning of PVs and codon optimization followed by enhanced expression within Lactococcus lactis host system was also explored. Although, the study has sound theoretical and in silico findings, the in vitro/in vivo evaluation seems imperative to warrant the immunogenicity and safety of PVs towards management of P. falciparum infection in the future.


Food frights: COVID-19 and the specter of hunger


Atypical Presentation of Covid-19 in an Older Adult With Severe Alzheimer Disease


title: RE: ISTH interim guidance to recognition and management of coagulopathy in COVID-19

text: The unrelenting acceleration of COVID-19 infections due to SARS-CoV-2 is unquestionably the greatest medical challenge of our professional careers. The Scientific and Standardisation Committee (SSC) on disseminated intravascular coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH) is to be commended for the rapid publication of guidance for clinicians worldwide to assist in management of the coagulopathy widely reported to be associated with severe COVID-19 infection. However, we would like to offer constructive feedback as to how the SSC's interim guidance1 might be improved.


title: Characterisation of COVID-19 Pandemic in Paediatric Age Group: A Systematic Review and Meta-Analysis

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) is a pandemic first originated in Wuhan the capital of Hubei province, China in December 2019 and then spread globally. It is caused by SARS-CoV-2. Until 1st April 2020, the number of cases worldwide was recorded to be 823,626 with 40,598 deaths. Most of the reported cases were adults with few cases described in children and neonates. OBJECTIVES: We performed a systematic review and meta-analysis to analyse the disease characterisation in paediatric age group including the possibility of vertical transmission to the neonates. METHODS: Articles published up to 2nd April 2020 in PubMed and google Scholar were considered for this study. FINDINGS: The most frequently reported symptoms were cough 49% (95% CI: 42 - 55%) and fever 47% (95% CI: 41- 53%). Lymphopenia and increased Procalcitonin were recorded in (21%, 95% CI: 12 - 30%) and (28%, 95% CI: 18 - 37%) respectively. No sex difference for COVID-19 was found in paediatric age group (pâ¯=â¯0.7). Case fatality rate was 0%. Four out of 58 neonates (6.8%) born to COVID-19 confirmed mothers tested positive for the disease. CONCLUSION: The disease trajectory in Paediatric patients has good prognosis compared to adults. Intensive care unit and death are rare. Vertical transmission and virus shedding in breast milk are yet to be established.


title: Preventing transmission among operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other personal protective equipment

text: The COVID-19 pandemic is highly challenging for the operating room staff and healthcare workers in emergency departments. SARS-CoV-2 is a positive-sense single-stranded RNA beta-coronavirus that primarily targets the human respiratory system, with fever, cough, myalgia, and pneumonia as the most common manifestations. However, since SARS-CoV-2 RNA was detected in stool specimens much more attention has been paid to gastrointestinal symptoms such as loss of appetite, nausea, and diarrhea. Furthermore, the expression of ACE-2 receptors in absorptive enterocytes from ileum and colon suggests that these organs should also be considered as a potential high risk for SARS-CoV-2 infection. During aerosol-generating medical procedures (AGMP; e.g. intubating and extubating patients or any surgical procedures), the production of both airborne particles and droplets may increase the risk of infection. In this situation, the surgical staff is strongly recommended to wear personal protective equipment (PPE). A transparent plastic cube, the so-called "Aerosol Box" (AB), has been recently designed to lend further protection against droplets and aerosol exposure during the AGMP.


title: A search for medications to treat COVID-19 via in silico molecular docking models of the SARS-CoV-2 spike glycoprotein and 3CL protease

text: BACKGROUND: The COVID-19 has now been declared a global pandemic by the World Health Organization. There is an emergent need to search for possible medications. METHOD: Utilization of the available sequence information, homology modeling, and in slico docking a number of available medications might prove to be effective in inhibiting the SARS-CoV-2 two main drug targets, the spike glycoprotein, and the 3CL protease. RESULTS: Several compounds were determined from the in silico docking models that might prove to be effective inhibitors for SARS-CoV-2. Several antiviral medications: Zanamivir, Indinavir, Saquinavir, and Remdesivir show potential as and 3CLPRO main proteinase inhibitors and as a treatment for COVID-19. CONCLUSION: Zanamivir, Indinavir, Saquinavir, and Remdesivir are among the exciting hits on the 3CLPRO main proteinase. It is also exciting to uncover that Flavin Adenine Dinucleotide (FAD) Adeflavin, B2 deficiency medicine, and Coenzyme A, a coenzyme, may also be potentially used for the treatment of SARS-CoV-2 infections. The use of these off-label medications may be beneficial in the treatment of the COVID-19.


Covid-19./ Covid-19


title: Improving Hand Hygiene Adherence in Healthcare Workers Before Patient Contact: A Multimodal Intervention in Four Tertiary Care Hospitals in Japan

text: BACKGROUND: Hand hygiene is key to preventing healthcare-associated infection and the spread of respiratory viruses like the novel coronavirus that causes COVID-19. Unfortunately, hand hygiene adherence of healthcare workers (HCWs) in Japan is suboptimal according to previous studies. OBJECTIVES: Our objectives were to evaluate hand hygiene adherence among physicians and nurses before touching hospitalized patients and to evaluate changes in hand hygiene adherence after a multimodal intervention was implemented. DESIGN, SETTING, AND PARTICIPANTS: We conducted a pre- and postintervention study with HCWs at four tertiary hospitals in Niigata, Japan. Hand hygiene observations were conducted from June to August 2018 (preintervention) and February to March 2019 (postintervention). INTERVENTION: The multimodal hand hygiene intervention recommended by the World Health Organization was tailored to each hospital and implemented from September 2018 to February 2019. MAIN OUTCOMES AND MEASURES: We observed hand hygiene adherence before touching patients in each hospital and compared rates before and after intervention. Intervention components were also evaluated. RESULTS: There were 2,018 patient observations preintervention and 1,630 postintervention. Overall, hand hygiene adherence improved from 453 of 2,018 preintervention observations (22.4%) to 548 of 1,630 postintervention observations (33.6%; P < .001). Rates improved more among nurses (13.9 percentage points) than among doctors (5.7 percentage points). Improvement varied among the hospitals: Hospital B (18.4 percentage points) was highest, followed by Hospitals D (11.4 percentage points), C (11.3 percentage points), and Hospital A (6.5 percentage points). CONCLUSIONS: A multimodal intervention improved hand hygiene adherence rates in physicians and nurses in Niigata, Japan; however, further improvement is necessary. Given the current suboptimal hand hygiene adherence rates in Japanese hospitals, the spread of COVID-19 within the hospital setting is a concern.


title: Guidance for Healthcare Providers Managing COVID-19 in Rural and Underserved Areas

text: Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has ravaged many urban and high-density areas in the USA. However, rural areas (despite their low population density) may be especially vulnerable to poor outcomes from COVID-19, owing to limited healthcare infrastructure, long distances to advanced health care, and population characteristics (e.g., high tobacco use, hypertension, obesity, older age). A panel of experts who are actively engaged in treating and managing COVID-19 at a rural academic center was convened to address this topic. In this commentary, we provide readers with some specific issues faced by rural healthcare providers and offer guidance in overcoming these challenges. This guidance includes alternative ventilator strategies, personal protective equipment (PPE), and common therapeutic options.


Amendment to the law to curb violence against doctors during the coronavirus disease 2019 crisis in India


Histologic features of long-lasting chilblain-like lesions in a paediatric COVID-19 patient


Strategies to control COVID-19 and future pandemics in Africa and around the globe


Response to: Management of Traumatic Spinal Fracture in the Coronavirus Disease 2019 Situation


title: Feasibility of Tocilizumab in ICU patients with COVID-19

text: Severe COVID-19 causes cytokine release syndrome and is associated with high mortality. In this retrospective case series, all patients diagnosed with COVID-19 by semi quantitative RT-PCR and hyperinflammatory markers were treated with tocilizumab. The use of tocilizumab was associated with rapid apyrexia, improvement of respiratory, biological parameters and short length of hospitalization (11 days). Moreover, no adverse effect attributed to the treatment was noticed. Tocilizumab seems to be a promising and safe therapy in severe patients. This article is protected by copyright. All rights reserved.


Covid-19: Children with conditions managed in primary care may not need to shield


Prothrombotic phenotype in COVID-19 severe patients


title: COVID-19: Uncharted waters

text: 'Uncharted waters' is perhaps an understatement of where we are headed at this time. The situation is fluid, with government regulations for our society changing rapidly.


COVID-19 pandemic: an opportunity to assess the utility of telemedicine in patients with rheumatic diseases


title: Potential inhibitors of coronavirus 3-chymotrypsin-like protease (3CLpro): an in silico screening of alkaloids and terpenoids from African medicinal plants

text: The novel coronavirus disease 2019 (COVID-19) caused by SARS-COV-2 has raised myriad of global concerns. There is currently no FDA approved antiviral strategy to alleviate the disease burden. The conserved 3-chymotrypsin-like protease (3CLpro), which controls coronavirus replication is a promising drug target for combating the coronavirus infection. This study screens some African plants derived alkaloids and terpenoids as potential inhibitors of coronavirus 3CLpro using in silico approach. Bioactive alkaloids (62) and terpenoids (100) of plants native to Africa were docked to the 3CLpro of the novel SARS-CoV-2. The top twenty alkaloids and terpenoids with high binding affinities to the SARS-CoV-2 3CLpro were further docked to the 3CLpro of SARS-CoV and MERS-CoV. The docking scores were compared with 3CLpro-referenced inhibitors (Lopinavir and Ritonavir). The top docked compounds were further subjected to ADEM/Tox and Lipinski filtering analyses for drug-likeness prediction analysis. This ligand-protein interaction study revealed that more than half of the top twenty alkaloids and terpenoids interacted favourably with the coronaviruses 3CLpro, and had binding affinities that surpassed that of lopinavir and ritonavir. Also, a highly defined hit-list of seven compounds (10-Hydroxyusambarensine, Cryptoquindoline, 6-Oxoisoiguesterin, 22-Hydroxyhopan-3-one, Cryptospirolepine, Isoiguesterin and 20-Epibryonolic acid) were identified. Furthermore, four non-toxic, druggable plant derived alkaloids (10-Hydroxyusambarensine, and Cryptoquindoline) and terpenoids (6-Oxoisoiguesterin and 22-Hydroxyhopan-3-one), that bind to the receptor-binding site and catalytic dyad of SARS-CoV-2 3CLpro were identified from the predictive ADME/tox and Lipinski filter analysis. However, further experimental analyses are required for developing these possible leads into natural anti-COVID-19 therapeutic agents for combating the pandemic.Communicated by Ramaswamy H. Sarma.


SARS-CoV-2 and enhancing antibodies


title: Recommendations for the Care of Pediatric Orthopaedic Patients During the COVID-19 Pandemic

text: The COVID-19 pandemic has necessitated modifications to pediatric orthopaedic practice to protect patients, families, and healthcare workers and to minimize viral transmission. It is critical to balance the benefits of alterations to current practice to reduce the chances of COVID-19 infection, with the potential long-term impact on patients. Early experiences of the pandemic from orthopaedic surgeons in China, Singapore, and Italy have provided the opportunity to take proactive and preventive measures to protect all involved in pediatric orthopaedic care. These guidelines, based on expert opinion and best available evidence, provide a framework for the management of pediatric orthopaedic patients during the COVID-19 pandemic. General principles include limiting procedures to urgent cases such as traumatic injuries and deferring outpatient visits during the acute phase of the pandemic. Nonsurgical methods should be considered where possible. For patients with developmental or chronic orthopaedic conditions, it may be possible to delay treatment for 2 to 4 months without substantial detrimental long-term impact.


title: Distribution of COVID-19 Morbidity Rate in Association with Social and Economic Factors in Wuhan, China: Implications for Urban Development

text: Social and economic factors relate to the prevention and control of infectious diseases. The purpose of this paper was to assess the distribution of COVID-19 morbidity rate in association with social and economic factors and discuss the implications for urban development that help to control infectious diseases. This study was a cross-sectional study. In this study, social and economic factors were classified into three dimensions: built environment, economic activities, and public service status. The method applied in this study was the spatial regression analysis. In the 13 districts in Wuhan, the spatial regression analysis was applied. The results showed that: 1) increasing population density, construction land area proportion, value-added of tertiary industry per unit of land area, total retail sales of consumer goods per unit of land area, public green space density, aged population density were associated with an increased COVID-19 morbidity rate due to the positive characteristics of estimated coefficients of these variables. 2) increasing average building scale, GDP per unit of land area, and hospital density were associated with a decreased COVID-19 morbidity rate due to the negative characteristics of estimated coefficients of these variables. It was concluded that it is possible to control infectious diseases, such as COVID-19, by adjusting social and economic factors. We should guide urban development to improve human health.


title: Disease spreading with social distancing: a prevention strategy in disordered multiplex networks

text: The continue emerging of diseases that have the potential to become threats at local and global scales, such as influenza A(H1N1), SARS, MERS, and COVID-19, makes it relevant to keep designing models of disease propagation and strategies to prevent or mitigate their effects in populations. Since isolated systems are very rare to find in any context, specially in human contact networks, here we examine the susceptible-infected-recovered model of disease spreading in a multiplex network formed by two distinct networks or layers that are interconnected through a fraction $q$ of shared individuals. We model the interactions between individuals in each layer through a weighted network, because person-to-person interactions are diverse (or disordered); weights represent the contact times of these interactions and we use a distribution of contact times to assign an individual disorder to each layer. Using branching theory supported by simulations, we study a social distancing strategy where we reduce the average contact time in one layer (or in both of them, if necessary). We find a set of disorder parameters - associated with average contact times - that prevents a disease from becoming an epidemic. When the disease is very likely to spread, the system is always in an epidemic phase, regardless of the disorder parameters and the fraction of shared nodes. However we find that it is still possible to protect a giant component of susceptible individuals, which is crucial to keep the functionality of the system composed by the two interconnected layers.


COVID-19: learning from experience


An update on COVID-19 for the radiologist - A British society of Thoracic Imaging statement


Key clinical research priorities for the pediatric community during the COVID-19 pandemic


Coronavirus disease-2019 in pregnancy with neurological manifestations versus pregnancy with eclampsia: Need for liberal testing to rule out the masquerades


docid: euozpliw

title: [Expert consensus on Corona Virus Disease 2019 with special blood purification technology]

text: The outbreak of Corona Virus Disease 2019 (COVID-19) has spread to more than 70 countries worldwide and there was a higher mortality in those who developed serious illness.Cytokine storm syndrome is an important pathophysiological basis for COVID-19 patients developing into severe or critical conditions. It was indicated in the diagnosis and treatment scheme, by the National Health Commission of the People's Republic of China, that blood purifications such as plasma exchange, plasma adsorption, hemoperfusion, hemofiltration and plasmafiltration could be considered for use in the critical patients with cytokine storm syndrome. This expert consensus, proposed by the Chinese Society of Nephrology and the Nephrology Committee of Chinese Research Hospital Association, is to guide and standardize the clinical application of blood purifications in the treatment of severe or critical patients with COVID-19.


title: Capability, opportunity, and motivation to enact hygienic practices in the early stages of the COVID-19 outbreak in the United Kingdom

text: OBJECTIVES: The COVID-19 pandemic is one of the greatest global health threats facing humanity in recent memory. This study aimed to explore influences on hygienic practices, a set of key transmission behaviours, in relation to the Capability, Opportunity, Motivation-Behaviour (COM-B) model of behaviour change (Michie et al., 2011). DESIGN: Data from the first wave of a longitudinal survey study were used, launched in the early stages of the UK COVID-19 pandemic. METHODS: Participants were 2025 adults aged 18 and older, representative of the UK population, recruited by a survey company from a panel of research participants. Participants self-reported motivation, capability, and opportunity to enact hygienic practices during the COVID-19 outbreak. RESULTS: Using regression models, we found that all three COM-B components significantly predicted good hygienic practices, with motivation having the greatest influence on behaviour. Breaking this down further, the subscales psychological capability, social opportunity, and reflective motivation positively influenced behaviour. Reflective motivation was largely driving behaviour, with those highest in reflective motivation scoring 51% more on the measure of hygienic practices compared with those with the lowest scores. CONCLUSIONS: Our findings have clear implications for the design of behaviour change interventions to promote hygienic practices. Interventions should focus on increasing and maintaining motivation to act and include elements that promote and maintain social support and knowledge of COVID-19 transmission. Groups in particular need of targeting for interventions to increase hygienic practices are males and those living in cities and suburbs.


Comment on: "Acral findings during the COVID-19 outbreak: Chilblain-like lesions should be preferred to acro-ischemic lesions"


title: A complication of coronavirus disease 2019: delirium

text: COVID-19 is predominantly a respiratory disease. However, some cases exhibit other features including Central Nervous System symptoms. In the older adult, COVID-19 may present with atypical symptoms, including delirium and its complications. The objective of this study is to describe the relationship between the new type of coronavirus infection and delirium. Systematic research (Cochrane Library and PubMed) was carried out (only upper time limit: April 2020). Publications found through this indexed search were reviewed and manually screened to identify relevant studies. Search terms used included "COVID-19, Delirium, Dementia, Intensive Care Unit". We manually added articles identified through other sources (i.e., key journals). Older people are at the greatest risk from COVID-19. If infected, they may present delirium. Moreover, it is not exclusive to older people. Delirium is not inevitable; rather, it is preventable. Delirium prevention programs are even more crucial in the era of COVID-19 and cannot be allowed to wither despite the challenges of integrating delirium prevention with COVID-19 care. An acute change in condition, behaviour, or mental status should prompt a delirium screen. As regards the treatment, it is advisable to use non-pharmacological interventions first where possible. Medication may be needed for patients with agitation where there is intractable distress or high risk to self/others.


Letter to the Editor regarding 'Medical Student Concerns Relating to Neurosurgery EducationDuring COVID-19' : an African experience


title: Clinics in Diagnostic Imaging: COVID-19 atypical pneumonia

text: A 53-year-old man presented with high fever and a non-productive cough but had no recent travel history. He deteriorated clinically very rapidly and was intubated. The endotracheal tube microbiological culture isolated Klebsiella pneumoniae. On chest computed tomography, the presence of mixed ground-glass airspace opacities, patchy consolidation and a 'crazy paving' appearance was atypical for Klebsiella infection. As there was also a lack of cavitating nodules, lymphadenopathy and pleural effusion, atypical pneumonia due to COVID-19 was diagnosed. The patient tested positive for COVID-19. He was isolated and subsequently recovered.


docid: enljgkis

title: Clinical and epidemiological features of COVID-19 family clusters in Beijing, China

text: BACKGROUND: Since its discovery, SARS-CoV-2 has been spread throughout China before becoming a global pandemic. In Beijing, family clusters are the main mode of human-human transmission accounting for 57.6% of the total confirmed cases. METHOD: We present the epidemiological and clinical features of the clusters of three large and one small families. RESULT: Our results revealed that SARS-CoV-2 is transmitted quickly through contact with index case, and a total of 22/24 infections were observed. Among those infected, 20/22 had mild symptoms and only two had moderate to severe clinical manifestations. Children in the families generally showed milder symptoms. The incubation period varied from 2 to 13 days, and the shedding of virus from the upper respiratory tract lasted from 5 to over 30 days. A prolonged period of virus shedding (>30 days) in upper respiratory tract was observed in 6/24 cases. CONCLUSION: SARS-CoV-2 is transmitted quickly in the form of family clusters. While the infection rate is high within the cluster, the disease manifestations, latent period, and virus shedding period varied greatly. We therefore recommend rigorously testing contacts even during the no-symptom phase and consider whether viral shedding has ceased before stopping isolation measures for an individual.


title: COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

text: BACKGROUND: To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. METHODS: This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network-the Paediatric Tuberculosis Network European Trials Group (ptbnet)-that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. FINDINGS: 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5-12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2-11, range 1-34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72-14·87; p=0·0035), male sex (2·12, 1·06-4·21; p=0·033), pre-existing medical conditions (3·27, 1·67-6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16-21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir-ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20-1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. INTERPRETATION: COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. FUNDING: ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.


title: History repeating. The plague of 1630 in Milan and the COVID-19 pandemia

text: In western democracies, individual behaviour will be crucial to control the spread of COVID-19, as well as government actions [1] that unfortunately, except China, South Korea and Italy, followed by others, seems to be generally unconvinced and, speculatively, late. Indeed human history has been marked by epidemics/pandemics which have affected, more or less, large geographical areas [2]. Italy, as well as the rest of Europe, has often been affected by these phenomena and, Lombardy, due to his position, was, as today by COVID-19, severely stroked in Italy that is, after China, the second most affected country [3]. This is also linked to the position of Lombardy and its capital, Milan, but this is beyond this brief comment. There are several differences between the past plagues and the actual COVID-19 pandemic and these must be sought in the increased ability to transmit diseases at-distance through the mobility of humans and goods [4], and in the catastrophic consequences of the breakdown of ecosystems, as told, a few years ago, by David Quammen in the book Spillover [5].


title: Respiratory Muscle Performance Screening for Infectious Disease Management Following COVID-19: A Highly Pressurized Situation

text: The 2019-2020 coronavirus pandemic elucidated how a single highly infectious virus can overburden health care systems of even highly economically developed nations. A leading contributor to these concerning outcomes is a lack of available intensive care unit (ICU) beds and mechanical ventilation support. Poorer health is associated with a higher risk for severe respiratory complications from the coronavirus. We hypothesize that impaired respiratory muscle performance is an underappreciated factor contributing to poor outcomes unfolding during the coronavirus pandemic. Although impaired respiratory muscle performance is considered to be rare, it is more frequently encountered in patients with poorer health, in particular obesity. However, measures of respiratory muscle performance are not routinely performed in clinical practice, including those with symptoms such as dyspnea. The purpose of this article is to discuss the potential role of respiratory muscle performance from the perspective of the coronavirus pandemic. We also provide a theoretical patient management model to screen for impaired respiratory muscle performance and intervention, if identified, with the goal of unburdening health care systems during future pandemic crises.


Organ procurement and transplantation during the COVID-19 pandemic


Practice of novel method of bedside postpyloric tube placement in patients with coronavirus disease 2019


title: COVID-19 : physiopathologie d'une maladie à plusieurs visages./ [COVID-19: Pathogenesis of a multi-faceted disease]

text: SARS-CoV-2 infection, named COVID-19, can lead to a dysregulated immune response and abnormal coagulation responsible for a viral sepsis. In this review, we specify physiopathological mechanisms of each phase of COVID-19 - viral, immune and pro-thrombotic - notably because they involve different treatment. Finally, we specify the physiopathological mechanisms of organ injury.


title: New regulatory strategies to manage medicines shortages in Europe

text: Medicine shortages have been spreading in European countries. In many cases, the unavailability of medicinal products has a substantial impact on the capability of National Healthcare Systems in ensuring the continuity of care. Shortages originate from multifactorial causes. In particular, they can be due to supply-related factors (e.g., manufacturing issues, regulatory issues, logistics, distribution) and demand-related ones (e.g., fluctuating drug demand, parallel market, tendering, price and reimbursement policies). However, some extraordinary geopolitical events (e.g., Brexit) may also affect medicines' availability. The capability of European Regulatory Authorities and other stakeholders, which are involved in the pharmaceutical distribution chain and the healthcare assistance services, to define suitable problem-solving strategies has been limited for years by the fragmentation of the European regulatory framework, starting from the lack of a univocal definition of a medicine shortage. Only in 2019, the EMA and HMA joint task force released the first harmonized "shortage" definition in the European Economic Area (EEA) and guidance on public communication. This manuscript aims to review the current European regulatory framework on medicine shortages. To support the activities of regulators, manufacturers and other healthcare professionals, an algorithm was also proposed to be used as a harmonized procedure to determine the shortage/unavailability impact on public health and to rationalize the problem-solving strategies adopted in all different settings.


Detroit under siege, the enemy within: The impact of the COVID-19 collision


Potential Impact of Delay in Cancer Screening due to COVID-19


title: A Fast Algorithm for Geodesic Active Contours with Applications to Medical Image Segmentation

text: The geodesic active contour model (GAC) is a commonly used segmentation model for medical image segmentation. The level set method (LSM) is the most popular approach for solving the model, via implicitly representing the contour by a level set function. However, the LSM suffers from high computation burden and numerical instability, requiring additional regularization terms or re-initialization techniques. In this paper, we use characteristic functions to implicitly approximate the contours, propose a new representation to the GAC and derive an efficient algorithm termed as the iterative convolution-thresholding method (ICTM). Compared to the LSM, the ICTM is simpler and much more efficient and stable. In addition, the ICTM enjoys most desired features (e.g., topological changes) of the level set-based methods. Extensive experiments, on 2D synthetic, 2D ultrasound, 3D CT, and 3D MR images for nodule, organ and lesion segmentation, demonstrate that the ICTM not only obtains comparable or even better segmentation results (compared to the LSM) but also achieves dozens or hundreds of times acceleration.


People experiencing homelessness urgently need to be recognised as a high risk group for COVID-19


Differential Diagnosis and Clinical Management of a Case of COVID-19 in a Patient With Stage III Lung Cancer Treated With Radio-chemotherapy and Durvalumab


The determination of release from isolation of COVID-19 patients requires ultra-high sensitivity nucleic acid test technology


title: COVID-19. Immunothrombosis and the gastrointestinal tract

text: Mönkemüller et al. brilliantly describe the pathogenesis of SARS-CoV-2 (COVID-19) in the gastrointestinal tract. Their findings highlight the local and systemic inflammatory response generated by the coronavirus. After having the opportunity to observe three cases of severe colonic ischemia and elevation of D-dimer levels in patients with COVID-19 and severe acute respiratory distress syndrome (SARS) due to SARS-CoV-2, we would like to highlight the thromboembolic complications in COVID-19, which are related to those reported by Mönkemüller and which have been mentioned by other authors.


docid: cucmysqn

title: In silico evaluation of marine fish proteins as nutritional supplements for COVID-19 patients

text: To date, no specific drug has been discovered for the treatment of COVID-19 and hence, people are in a state of anxiety. Thus, there is an urgent need to search for various possible strategies including nutritional supplementation. In this study, we have tried to provide a reference for protein supplementation. Specifically, 20 marine fish proteins were subjected to in silico hydrolysis by gastrointestinal enzymes, and a large number of active peptides were generated. Then, the binding abilities of these peptides to SARS-CoV-2 main protease and monoamine oxidase A were assessed. The results showed that NADH dehydrogenase could be a good protein source in generating potent binders to the two enzymes, followed by cytochrome b. In addition, some high-affinity oligopeptides (VIQY, ICIY, PISQF, VISAW, AIPAW, and PVSQF) were identified as dual binders to the two enzymes. In summary, the supplementation of some fish proteins can be helpful for COVID-19 patients; the identified oligopeptides can be used as the lead compounds to design potential inhibitors against COVID-19 and anxiety.


title: Zoonotic risks of pathogens from sheep and their milk borne transmission

text: Sheep were domesticated around 9000 BC in the Middle East, and since then milk from sheep gradually became very popular, not only for drinking but also for making cheeses and other dairy products. Nowadays, these dairy products are also important for people with an allergy to cow milk, and these products are an essential part of the local daily diet in regions of the world that are not suitable for cows and goats. Consumption of raw milk and raw milk products has a zoonotic risk, and with regard to sheep, the main pathogens associated with such dairy products are: Brucella melitensis, Campylobacter spp., Listeria spp., Salmonella spp., Shiga-toxin producing Escherichia coli, Staphylococcus aureus, tick borne encephalitis virus, and Toxoplasma gondii. Especially, young children, elderly people, pregnant women and immunocompromised (YOPI) persons, and those suffering from disease should be aware of the risk of consuming raw milk and raw milk products. This latter risk can be reduced by proper flock health management, prevention of contamination during milking, adequate milk processing, transport, and refrigerated storage. Only processes equaling pasteurization sufficiently reduce zoonotic risks from milk and milk products, but proper cooling is essential and recontamination must be prevented. Therefore, strict hygiene practices throughout the production process and supply chain especially for raw milk and raw dairy products, should be applied. Small scale production systems pose a greater risk compared to industrialized production systems because of a less protocolized and controlled production process. This manuscript describes zoonotic risks of pathogens from sheep and their milk borne transmission. Additionally, routes of contamination, possibilities for multiplication, and prevention measures thereof are described. We summarize some major human outbreaks caused by consumption of sheep milk and products made thereof, and finally discuss their implications.


title: Molecular Investigation of SARS-CoV-2 Proteins and Their Interactions with Antiviral Drugs

text: A new Coronavirus strain, named SARS-CoV-2, suddenly emerged in early December 2019. SARS-CoV-2 resulted in being dramatically infectious, with thousands of people infected. In this scenario, and without effective vaccines available, the importance of an immediate tool to support patients and against viral diffusion becomes evident. In this study, we exploit the molecular docking approach to analyze the affinity between different viral proteins and several inhibitors, originally developed for other viral infections. Our data show that, in some cases, a relevant binding can be detected. These findings support the hypothesis to develop new antiviral agents against COVID-19, on the basis of already established therapies.


Editorial. COVID-19 and spinal surgery


Hyperglycemia, Hypertriglyceridemia, and Acute Pancreatitis in COVID-19 Infection: Clinical Implications


title: Hiding in Plain Sight: an Approach to Treating Patients with Severe COVID-19 Infection

text: Patients with COVID-19 infection are at risk of acute respiratory disease syndrome (ARDS) and death. The tissue receptor for COVID-19 is ACE2, and higher levels of ACE2 can protect against ARDS. Angiotensin receptor blockers and statins upregulate ACE2. Clinical trials are needed to determine whether this drug combination might be used to treat patients with severe COVID-19 infection.


title: Viral Etiology and Outcome of Severe Lower Respiratory Tract Infections among Critically Ill Children Admitted to the Picu

text: OBJECTIVE: To determine the viral etiology of severe lower respiratory tract infections (LRTIs), their clinical significance and prognosis among critically ill children. DESIGN: A prospective descriptive study was carried out. SETTING: Pediatric Intensive Care Unit (PICU) of Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey. PATIENTS: A total of 115 patients hospitalized in the PICU were evaluated for inclusion in the study. Children with underlying comorbidities and those who did not require mechanical ventilation were excluded. MAIN VARIABLES OF INTEREST: Demographic, clinical, laboratory test and radiographic data were recorded. RESULTS: A total of 63 patients were eligible for the study. The most common diagnosis was bronchiolitis (57.1%). Respiratory syncytial virus (RSV) was the most frequent causal virus (36.5%). The most common complication was acute respiratory distress syndrome (ARDS) (28.6%). Multiple viral infection was identified in 20.6% of the patients, the most common in this subgroup being rhinovirus. Patients with bocavirus infection had a higher likelihood of needing invasive mechanical ventilation (IMV) at presentation. Children who died were likely to be < 12 months old, have ARDS, hepatitis, pneumomediastinum, multiple viral infection, and required IMV support with an increased duration of MV. Additionally, they were found to have a high Pediatric Risk of Mortality III score, Predicted Death Rate and increased need for inotropic support at admission. CONCLUSIONS: Our study showed critically ill children with LRTI without known risk factors to have high mortality when aged < 12 months, in the presence of multiple agents and when certain complications (ARDS, hepatitis) and X-ray findings were identified.


title: Comparative analysis of protein synthesis rate in COVID-19 with other human coronaviruses

text: The genetic code contains information that impacts the efficiency and rate of translation. Translation elongation plays a crucial role in determining the composition of the proteome, errors within a protein contributes towards disease processes. It is important to analyze the novel coronavirus (2019-nCoV) at the codon level to find similarities and variations in hosts to compare with other human coronavirus (CoVs). This requires a comparative and comprehensive study of various human and zoonotic nature CoVs relating to codon usage bias, relative synonymous codon usage (RSCU), proportions of slow codons, and slow di-codons, the effective number of codons (ENC), mutation bias, codon adaptation index (CAI), and codon frequencies. In this work, seven different CoVs were analyzed to determine the protein synthesis rate and the adaptation of these viruses to the host cell. The result reveals that the proportions of slow codons and slow di-codons in human host of 2019-nCoV and SARS-CoV found to be similar and very less compared to the other five coronavirus types, which suggest that the 2019-nCoV and SARS-CoV have faster protein synthesis rate. Zoonotic CoVs have high RSCU and codon adaptation index than human CoVs which implies the high translation rate in zoonotic viruses. All CoVs have more AT% than GC% in genetic codon compositions. The average ENC values of seven CoVs ranged between 38.36 and 49.55, which implies the CoVs are highly conserved and are easily adapted to host cells. The mutation rate of 2019-nCoV is comparatively less than MERS-CoV and NL63 that shows an evidence for genetic diversity. Host-specific codon composition analysis portrays the relation between viral host sequences and the capability of novel virus replication in host cells. Moreover, the analysis provides useful measures for evaluating a virus-host adaptation, transmission potential of novel viruses, and thus contributes to the strategies of anti-viral drug design.


title: Simulated Assessment of Pharmacokinetically Guided Dosing for Investigational Treatments of Pediatric Patients With Coronavirus Disease 2019

text: Importance: Children of all ages appear susceptible to severe acute respiratory syndrome coronavirus 2 infection. To support pediatric clinical studies for investigational treatments of coronavirus disease 2019 (COVID-19), pediatric-specific dosing is required. Objective: To define pediatric-specific dosing regimens for hydroxychloroquine and remdesivir for COVID-19 treatment. Design, Setting, and Participants: Pharmacokinetic modeling and simulation were used to extrapolate investigated adult dosages toward children (March 2020-April 2020). Physiologically based pharmacokinetic modeling was used to inform pediatric dosing for hydroxychloroquine. For remdesivir, pediatric dosages were derived using allometric-scaling with age-dependent exponents. Dosing simulations were conducted using simulated pediatric and adult participants based on the demographics of a white US population. Interventions: Simulated drug exposures following a 5-day course of hydroxychloroquine (400 mg every 12 hours × 2 doses followed by 200 mg every 12 hours × 8 doses) and a single 200-mg intravenous dose of remdesivir were computed for simulated adult participants. A simulation-based dose-ranging study was conducted in simulated children exploring different absolute and weight-normalized dosing strategies. Main Outcomes and Measures: The primary outcome for hydroxychloroquine was average unbound plasma concentrations for 5 treatment days. Additionally, unbound interstitial lung concentrations were simulated. For remdesivir, the primary outcome was plasma exposure (area under the curve, 0 to infinity) following single-dose administration. Results: For hydroxychloroquine, the physiologically based pharmacokinetic model analysis included 500 and 600 simulated white adult and pediatric participants, respectively, and supported weight-normalized dosing for children weighing less than 50 kg. Geometric mean-simulated average unbound plasma concentration values among children within different developmental age groups (32-35 ng/mL) were congruent to adults (32 ng/mL). Simulated unbound hydroxychloroquine concentrations in lung interstitial fluid mirrored those in unbound plasma and were notably lower than in vitro concentrations needed to mediate antiviral activity. For remdesivir, the analysis included 1000 and 6000 simulated adult and pediatric participants, respectively. The proposed pediatric dosing strategy supported weight-normalized dosing for participants weighing less than 60 kg. Geometric mean-simulated plasma area under the time curve 0 to infinity values among children within different developmental age-groups (4315-5027 ng × h/mL) were similar to adults (4398 ng × h/mL). Conclusions and Relevance: This analysis provides pediatric-specific dosing suggestions for hydroxychloroquine and remdesivir and raises concerns regarding hydroxychloroquine use for COVID-19 treatment because concentrations were less than those needed to mediate an antiviral effect.


docid: rlvapbpj

title: Pedagogy in the time of COVID-19


SARS-CoV-2 and Bats: From Flight to Fighting COVID-19


title: The timeline and risk factors of clinical progression of COVID-19 in Shenzhen, China

text: BACKGROUND: The novel coronavirus disease 2019 (COVID-19) broke out globally. Early prediction of the clinical progression was essential but still unclear. We aimed to evaluate the timeline of COVID-19 development and analyze risk factors of disease progression. METHODS: In this retrospective study, we included 333 patients with laboratory-confirmed COVID-19 infection hospitalized in the Third People's Hospital of Shenzhen from 10 January to 10 February 2020. Epidemiological feature, clinical records, laboratory and radiology manifestations were collected and analyzed. 323 patients with mild-moderate symptoms on admission were observed to determine whether they exacerbated to severe-critically ill conditions (progressive group) or not (stable group). We used logistic regression to identify the risk factors associated with clinical progression. RESULTS: Of all the 333 patients, 70 (21.0%) patients progressed into severe-critically ill conditions during hospitalization and assigned to the progressive group, 253 (76.0%) patients belonged to the stable group, another 10 patients were severe before admission. we found that the clinical features of aged over 40 (3.80 [1.72, 8.52]), males (2.21 [1.20, 4.07]), with comorbidities (1.78 [1.13, 2.81]) certain exposure history (0.38 [0.20, 0.71]), abnormal radiology manifestations (3.56 [1.13, 11.40]), low level of T lymphocytes (0.99 [0.997, 0.999]), high level of NLR (0.99 [0.97, 1.01]), IL-6 (1.05 [1.03, 1.07]) and CRP (1.67 [1.12, 2.47]) were the risk factors of disease progression by logistic regression. CONCLUSIONS: The potential risk factors of males, older age, with comorbidities, low T lymphocyte level and high level of NLR, CRP, IL-6 can help to predict clinical progression of COVID-19 at an early stage.


Corona-steps for tracheotomy in COVID-19 patients: A staff-safe method for airway management


COVID-19 Response in Mid-Missouri


title: Global guidance for surgical care during the COVID-19 pandemic

text: BACKGROUND: Surgeons urgently need guidance on how to deliver surgical services safely and effectively during the COVID-19 pandemic. The aim was to identify the key domains that should be considered when developing pandemic preparedness plans for surgical services. METHODS: A scoping search was conducted to identify published articles relating to management of surgical patients during pandemics. Key informant interviews were conducted with surgeons and anaesthetists with direct experience of working during infectious disease outbreaks, in order to identify key challenges and solutions to delivering effective surgical services during the COVID-19 pandemic. RESULTS: Thirteen articles were identified from the scoping search, and surgeons and anaesthetists representing 11 territories were interviewed. To mount an effective response to COVID-19, a pandemic response plan for surgical services should be developed in advance. Key domains that should be included are: provision of staff training (such as patient transfers, donning and doffing personal protection equipment, recognizing and managing COVID-19 infection); support for the overall hospital response to COVID-19 (reduction in non-urgent activities such as clinics, endoscopy, non-urgent elective surgery); establishment of a team-based approach for running emergency services; and recognition and management of COVID-19 infection in patients treated as an emergency and those who have had surgery. A backlog of procedures after the end of the COVID-19 pandemic is inevitable, and hospitals should plan how to address this effectively to ensure that patients having elective treatment have the best possible outcomes. CONCLUSION: Hospitals should prepare detailed context-specific pandemic preparedness plans addressing the identified domains. Specific guidance should be updated continuously to reflect emerging evidence during the COVID-19 pandemic.


The insidious threat of jamu and unregulated traditional medicines in the COVID-19 era


Does intranasal naloxone administration increase the risk of 2019 coronavirus disease transmission?


title: Evidence Supporting Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 While Presymptomatic or Asymptomatic

text: Recent epidemiologic, virologic, and modeling reports support the possibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from persons who are presymptomatic (SARS-CoV-2 detected before symptom onset) or asymptomatic (SARS-CoV-2 detected but symptoms never develop). SARS-CoV-2 transmission in the absence of symptoms reinforces the value of measures that prevent the spread of SARS-CoV-2 by infected persons who may not exhibit illness despite being infectious. Critical knowledge gaps include the relative incidence of asymptomatic and symptomatic SARS-CoV-2 infection, the public health interventions that prevent asymptomatic transmission, and the question of whether asymptomatic SARS-CoV-2 infection confers protective immunity.


title: Understanding the Socio-Economic Disruption in the United States during COVID-19's Early Days

text: In this paper, we collect and study Twitter communications to understand the socio-economic impact of COVID-19 in the United States during the early days of the pandemic. Our analysis reveals that COVID-19 gripped the nation during this time as is evidenced by the significant number of trending hashtags. With infections soaring rapidly, users took to Twitter asking people to self isolate and quarantine themselves. Users also demanded closure of schools, bars, and restaurants as well as lockdown of cities and states. The communications reveal the ensuing panic buying and the unavailability of some essential goods, in particular toilet paper. We also observe users express their frustration in their communications as the virus spread continued. We methodically collect a total of 530,206 tweets by identifying and tracking trending COVID-related hashtags. We then group the hashtags into six main categories, namely 1) General COVID, 2) Quarantine, 3) Panic Buying, 4) School Closures, 5) Lockdowns, and 6) Frustration and Hope, and study the temporal evolution of tweets in these hashtags. We conduct a linguistic analysis of words common to all the hashtag groups and specific to each hashtag group. Our preliminary study presents a succinct and aggregated picture of people's response to the pandemic and lays the groundwork for future fine-grained linguistic and behavioral analysis.


Management of elective aortic valve replacement over the long term in the era of COVID-19


Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic


title: Informations relatives aux psychotropes et à leurs adaptations éventuelles pour les patients souffrant de troubles psychiques en France pendant l'épidémie à SARS-CoV-2./ [Informations on psychotropics and their adaptations for patients suffering from mental disorders in France during the SARS-CoV-2 epidemic]

text: The 2019-20 coronavirus pandemic (SARS-CoV-2; severe acute respiratory syndrome coronavirus 2) has dramatic consequences on populations in terms of morbidity and mortality and in social terms, the general confinement of almost half of the world's population being a situation unprecedented in history, which is difficult today to measure the impact at the individual and collective levels. More specifically, it affects people with various risk factors, which are more frequent in patients suffering from psychiatric disorders. Psychiatrists need to know: (i) how to identify, the risks associated with the prescription of psychotropic drugs and which can prove to be counterproductive in their association with COVID-19 (coronavirus disease 2019), (ii) how to assess in terms of benefit/risk ratio, the implication of any hasty and brutal modification on psychotropic drugs that can induce confusion for a differential diagnosis with the evolution of COVID-19. We carried out a review of the literature aimed at assessing the specific benefit/risk ratio of psychotropic treatments in patients suffering from COVID-19. Clinically, symptoms suggestive of COVID-19 (fever, cough, dyspnea, digestive signs) can be caused by various psychotropic drugs and require vigilance to avoid false negatives and false positives. In infected patients, psychotropic drugs should be used with caution, especially in the elderly, considering the pulmonary risk. Lithium and Clozapine, which are the reference drugs in bipolar disorder and resistant schizophrenia, warrant specific attention. For these two treatments the possibility of a reduction in the dosage - in case of minimal infectious signs and in a situation, which does not allow rapid control - should ideally be considered taking into account the clinical response (even biological; plasma concentrations) observed in the face of previous dose reductions. Tobacco is well identified for its effects as an inducer of CYP1A2 enzyme. In a COVID+ patient, the consequences of an abrupt cessation of smoking, particularly related with the appearance of respiratory symptoms (cough, dyspnea), must therefore be anticipated for patients receiving psychotropics metabolized by CYP1A2. Plasma concentrations of these drugs are expected to decrease and can be related to an increase risk of relapse. The symptomatic treatments used in COVID-19 have frequent interactions with the most used psychotropics. If there is no curative treatment for infection to SARS-CoV-2, the interactions of the various molecules currently tested with several classes of psychotropic drugs (antidepressants, antipsychotics) are important to consider because of the risk of changes in cardiac conduction. Specific knowledge on COVID-19 remains poor today, but we must recommend rigor in this context in the use of psychotropic drugs, to avoid adding, in patients suffering from psychiatric disorders, potentially vulnerable in the epidemic context, an iatrogenic risk or loss of efficiency.


COVID-19 Ventilatory Phenotypes and Obesity: Is There a Relationship?


The first case of COVID-19 infection in a 75-day-old infant in Jahrom City, south of Iran


title: Imaging & other potential predictors of deterioration in COVID-19

text: This case report describes a young patient with COVID-19 who is initially diagnosed with CT chest imaging. Upon admission to the hospital, his clinical condition deteriorates requiring ventilatory support. We explore the value of imaging and other potential predictors of deterioration.


Offline: COVID-19 and the ethics of memory


docid: salohtex

title: Contact lens wear during the COVID-19 pandemic


docid: jfjpklpx

title: MEN2-related pheochromocytoma: current state of knowledge, specific characteristics in MEN2B, and perspectives

text: Multiple endocrine neoplasia type 2 (MEN2) is a rare hereditary syndrome due to mutations of the proto-oncogene REarranged during Transfection (RET), defined by the association of medullary thyroid carcinoma (MTC) in almost 100% cases, and pheochromocytoma in roughly 50% (primary hyperparathyroidism can be seen in 10-20% of patients with MEN2A). Early thyroidectomy and the efficacy of novel tyrosine kinase inhibitors modified the natural history of MTC, with possibilities of cure or long-term control. The second main compound, pheochromocytoma, is reported with a variable penetrance, from 10 to 80% cases, depending on the mutation of RET. Pheochromocytoma constitutes the main disease to screen in patients with RET mutations. Pheochromocytoma clinical and biochemical diagnosis, as well as the way to treat it are thus crucial. This review will thus focus on the epidemiological specificities of MEN2-related pheochromocytoma, the genotype/phenotype relationship, the modern imaging modalities necessary to confirm the diagnosis in this hereditary context, as well as the optimal management and the possibilities of adrenal sparing surgery. Additional information will include the natural history of MEN2B-pheochromocytoma, the rare cases of malignant pheochromocytoma, and the factors that could modify the penetrance between individuals carrying the same mutation, especially in the same family.


title: COVID-19 Delays Cancer Screenings

text: In recent months, the COVID-19 pandemic has caused many institutions to pause routine cancer screenings-delays that may not be problematic for patients but can create challenges for healthcare providers.


title: Rigidity of the Outer Shell Predicted by a Protein Intrinsic Disorder Model Sheds Light on the COVID-19 (Wuhan-2019-nCoV) Infectivity

text: The world is currently witnessing an outbreak of a new coronavirus spreading quickly across China and affecting at least 24 other countries With almost 65,000 infected, a worldwide death toll of at least 1370 (as of 14 February 2020), and with the potential to affect up to two-thirds of the world population, COVID-19 is considered by the World Health Organization (WHO) to be a global health emergency The speed of spread and infectivity of COVID-19 (also known as Wuhan-2019-nCoV) are dramatically exceeding those of the Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV) In fact, since September 2012, the WHO has been notified of 2494 laboratory-confirmed cases of infection with MERS-CoV, whereas the 2002–2003 epidemic of SARS affected 26 countries and resulted in more than 8000 cases Therefore, although SARS, MERS, and COVID-19 are all the result of coronaviral infections, the causes of the coronaviruses differ dramatically in their transmissibility It is likely that these differences in infectivity of coronaviruses can be attributed to the differences in the rigidity of their shells which can be evaluated using computational tools for predicting intrinsic disorder predisposition of the corresponding viral proteins


docid: fszmowhw

title: How well prepared are dermatologists redeployed to COVID-19 wards?


How China is planning to go to Mars amid the coronavirus outbreak