title: Initial Stroke Thrombectomy Experience in New York City during the COVID-19 Pandemic

text: New York City has become the global epicenter of the coronavirus 2019 (COVID-19) pandemic. Despite a massive shift in health care resources, cerebrovascular disease continues to be a substantial burden. We review the first 10 patients undergoing thrombectomy following a series of governmental and institutional policy changes diverting resources to the care of critically ill patients with COVID-19. Ten patients with emergent large-vessel occlusion underwent thrombectomy between March 23 and April 1, 2020. Five patients tested positive for the COVID-19 virus. Successful reperfusion was achieved in 9 of 10 patients, at a median time of 37 minutes from vascular access. The postprocedural NIHSS score improved by an average of 7.7 points. Of the 5 patients positive for COVID-19, none have experienced a critical respiratory illness. We report the early incidence of COVID-19 positivity in patients with emergent large-vessel occlusion and demonstrate that thrombectomy continues to be an efficacious option, as well as safe for health care providers.


COVID-19 outbreak: Challenges for Addiction services in India


title: Analysis of Spatial Spread Relationships of Coronavirus (COVID-19) Pandemic in the World using Self Organizing Maps

text: We describe in this paper an analysis of the spatial evolution of coronavirus pandemic around the world by using a particular type of unsupervised neural network, which is called self-organizing maps. Based on the clustering abilities of self-organizing maps we are able to spatially group together countries that are similar according to their coronavirus cases, in this way being able to analyze which countries are behaving similarly and thus can benefit by using similar strategies in dealing with the spread of the virus. Publicly available datasets of coronavirus cases around the globe from the last months have been used in the analysis. Interesting conclusions have been obtained, that could be helpful in deciding the best strategies in dealing with this virus. Most of the previous papers dealing with data of the Coronavirus have viewed the problem on temporal aspect, which is also important, but this is mainly concerned with the forecast of the numeric information. However, we believe that the spatial aspect is also important, so in this view the main contribution of this paper is the use of unsupervised self-organizing maps for grouping together similar countries in their fight against the Coronavirus pandemic, and thus proposing that strategies for similar countries could be established accordingly.


title: Porcine Deltacoronavirus nsp5 Cleaves DCP1A to Decrease Its Antiviral Ability

text: Porcine deltacoronavirus (PDCoV) is an emerging swine enteropathogenic coronavirus. The nonstructural protein nsp5, also called 3C-like protease, is responsible for processing viral polyprotein precursors in coronavirus (CoV) replication. Previous studies have shown that PDCoV nsp5 cleaves the NF-κB essential modulator and the signal transducer and activator of transcription 2 to disrupt interferon (IFN) production and signaling, respectively. Whether PDCoV nsp5 also cleaves IFN-stimulated genes (ISGs), IFN-induced antiviral effector molecules, remains unclear. In this study, we screened 14 classical ISGs and found that PDCoV nsp5 cleaved the porcine mRNA-decapping enzyme 1a (pDCP1A) through its protease activity. Similar cleavage of endogenous pDCP1A was also observed in PDCoV-infected cells. PDCoV nsp5 cleaved pDCP1A at glutamine 343 (Q343) and the cleaved pDCP1A fragments, pDCP1A1-343 and pDCP1A344-580, could not inhibit PDCoV infection. Mutant pDCP1A-Q343A, which resists nsp5-mediated cleavage, exhibited a stronger ability to inhibit PDCoV infection compared with wild-type pDCP1A. Interestingly, the Q343 cleavage site is highly conserved in DCP1A homologs from other mammalian species. Further analyses demonstrated that nsp5 encoded by seven tested CoVs that can infect human or pig also cleaved pDCP1A and human DCP1A, suggesting that DCP1A maybe the common target for cleavage by nsp5 of mammalian CoVs.IMPORTANCE IFN-stimulated gene (ISG) induction through interferon (IFN) signaling is important to create an antiviral state and usually directly inhibits virus infection. The present study first demonstrated that PDCoV nsp5 can cleave mRNA-decapping enzyme 1a (DCP1A) to attenuate its antiviral activity. Furthermore, cleaving DCP1A is a common characteristic of nsp5 proteins from different coronaviruses (CoVs), which represents a common immune evasion mechanism of CoVs. Previous evidence showed that CoV nsp5 cleaves the NF-κB essential modulator and signal transducer and activator of transcription 2. Taken together, CoV nsp5 is a potent IFN antagonist because it can simultaneously target different aspects of the host IFN system, including IFN production and signaling and effector molecules.


COVID-19 and digital epidemiology


Surge capacity and updated admission criteria: response of the NHS-commissioned national respiratory extracorporeal membrane oxygenation network to the COVID-19 pandemic


title: Self-assessment of the Thai Department of Disease Control's communication for international response to COVID-19 in the early phase

text: OBJECTIVES: This study aimed to assess the Thailand Department of Disease Control's (DDC) early responses to COVID-19 in respect to communication with the international community and to identify the manner of Thailand's response during public health emergencies. METHODS: Documents and international response communication from 4-31 January 2020 were reviewed and dates of responses were collected for descriptive analysis. A questionnaire was submitted to the DDC officers responsible for international coordination. A meeting to identify responses was held to evaluate the self-assessed capacities of the Department's international communication. RESULTS: Thailand began the COVID-19 screening protocol on 3 January 2020. International correspondence subsequently occurred continually either through the ASEAN or International Health Regulations (IHR) mechanisms. The total score of communication for international response was 88.9%. For IHR reporting duties, the median duration to respond was 2.49hours. Official news was sent within a mean of 9.18hours and the English daily situation reports were always uploaded onto the official website within 24hours. CONCLUSIONS: This study provided a benchmark for international coordination and communication capacities and also identified areas for improvement during public health emergencies, such as the need to identify English-speaking spokespeople to communicate at an international level.


Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies


title: Chilblain-like lesions during COVID-19 pandemic: a serological study on a case series

text: The outbreak of chilblain-like lesions (CLL) coincidentally to the COVID-19 pandemic is a topic of great concern. SARS-CoV-2 has been hypothesized as the etiologic agent of CLL, on the basis of the temporal correlation between the "burst" of skin manifestations and the viral pandemic. However, the relationship between CLL and COVID-19 remains unclear, since authors failed to confirm the SARS-CoV-2 infection in these patients using a real-time reverse transcription polymerase chain reaction (rt-PCR) test from nasopharyngeal swabs, which seldom resulted positive. Indeed, the most recent articles on the prevalence of the SARS-CoV-2 infection in CLL reported a positive swab test in only about a fifth of these patients.


docid: wmfmgulr

title: Parenting in a time of COVID-19


Detection of Hemosiderin-Laden Macrophages in Bronchoalveolar Lavage Fluid of COVID-19 Patients: Is Perls Stain a Potential Indicator of Oxidative Alveolar Damage?


title: Phase 2 study of NAB-paclitaxel in SensiTivE and refractory relapsed small cell lung cancer (SCLC) (NABSTER TRIAL)

text: BACKGROUND: Despite sensitivity to first-line chemotherapy, most small-cell lung cancer (SCLC) patients relapse. In this setting, topotecan demonstrated modest activity with significant toxicity. Paclitaxel was also active. This study was designed to evaluate activity and safety of nab-paclitaxel in relapsed SCLC. METHODS: In this multicentre prospective Phase 2 trial, patients with refractory or sensitive SCLC progressed to first-line platinum-based chemotherapy received nab-paclitaxel 100 mg/smq on days 1, 8, 15 every 4 weeks up to six cycles, progressive disease or intolerable toxicity. Primary endpoint was investigator-assessed objective tumour response. Secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS). RESULTS: Of the 68 patients treated, partial response was 8% in the refractory cohort and 14% in the sensitive cohort. Most common toxicities of any grade were fatigue (54%), anaemia (38%), neutropenia (29%), leukopenia (26%) and diarrhoea (21%). Median PFS was similar in both refractory (1.8 months) and sensitive cohorts (1.9 months), while median OS was longer in sensitive one (6.6 versus 3.6 months). CONCLUSIONS: Although nab-paclitaxel has shown some modest anti-tumour activity in relapsed SCLC, associated with a favourable toxicity profile, the primary end-point of the study was not met. CLINICAL TRIAL REGISTRATION: Clinical Trial registration number is ClinicalTrials.gov Identifier: NCT03219762.


Understanding heterogeneity to inform the public health response to COVID-19 in Canada


title: Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS-COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management

text: BACKGROUND: The worldwide spread of a novel coronavirus disease (COVID-19) has led to a near total stop of non-urgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the self-imposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen. Defining manageable, evidence-based protocols for testing, surgical/procedural risk mitigation and clinical flow management/contamination management will be paramount for the safety of non-urgent surgical procedures. METHODS: We conducted a MEDLINE/PubMed research for all available publications on COVID-19 and surgery and COVID-19 and anesthesia. Articles and referenced literature describing possible procedural impact factors leading to exacerbation of the clinical evolution of COVID-19-positive patients were identified to perform risk stratification for elective surgery. Based on these impact factors, considerations for patient selection, choice of procedural complexity, duration of procedure, type of anesthesia, etc., are discussed in this article and translated into algorithms for surgical/anesthesia risk management and clinical management. Current recommendations and published protocols on contamination control, avoidance of cross-contamination and procedural patient flow are reviewed. A COVID-19 testing guideline protocol for patients planning to undergo elective aesthetic surgery is presented and recommendations are made regarding adaptation of current patient information/informed consent forms and patient health questionnaires. CONCLUSION: The COVID-19 crisis has led to unprecedented challenges in the acute management of the crisis, and the wave only recently seems to flatten out in some countries. The adaptation of surgical and procedural steps for a risk-minimizing management of potential COVID-19-positive patients seeking to undergo elective aesthetic procedures in the wake of that wave will present the next big challenge for the aesthetic surgery community. We propose a clinical algorithm to enhance patient safety in elective surgery in the context of COVID-19 and to minimize cross-contamination between healthcare workers and patients. New evidence-based guidelines regarding surgical risk stratification, testing, and clinical flow management/contamination management are proposed. We believe that only the continuous development and broad implementation of guidelines like the ones proposed in this paper will allow an early reintegration of all aesthetic procedures into the scope of surgical care currently performed and to prepare the elective surgical specialties better for a possible second wave of the pandemic. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.


Asthma and COVID-19: Is asthma a risk factor for severe outcomes?


Liberté, égalité, fraternité à l'épreuve du COVID-19./ [Freedom, equality, fraternity facing the COVID-19]


Intrapartum care of women with COVID-19: A practical approach


Gastrointestinal symptoms as the first, atypical indication of severe acute respiratory syndrome coronavirus 2 infection


title: Management of patients with liver derangement during the COVID-19 pandemic: an Asia-Pacific position statement

text: The COVID-19 pandemic has spread rapidly worldwide. It is common to encounter patients with COVID-19 with abnormal liver function, either in the form of hepatitis, cholestasis, or both. The clinical implications of liver derangement might be variable in different clinical scenarios. With growing evidence of its clinical significance, it would be clinically helpful to provide practice recommendations for various common clinical scenarios of liver derangement during the COVID-19 pandemic. The Asia-Pacific Working Group for Liver Derangement during the COVID-19 Pandemic was formed to systematically review the literature with special focus on the clinical management of patients who have been or who are at risk of developing liver derangement during this pandemic. Clinical scenarios covering the use of pharmacological treatment for COVID-19 in the case of liver derangement, and assessment and management of patients with chronic hepatitis B or hepatitis C, non-alcoholic fatty liver disease, liver cirrhosis, and liver transplantation during the pandemic are discussed.


title: Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient - Solano County, California, February 2020

text: On February 26, 2020, the first U.S. case of community-acquired coronavirus disease 2019 (COVID-19) was confirmed in a patient hospitalized in Solano County, California (1). The patient was initially evaluated at hospital A on February 15; at that time, COVID-19 was not suspected, as the patient denied travel or contact with symptomatic persons. During a 4-day hospitalization, the patient was managed with standard precautions and underwent multiple aerosol-generating procedures (AGPs), including nebulizer treatments, bilevel positive airway pressure (BiPAP) ventilation, endotracheal intubation, and bronchoscopy. Several days after the patient's transfer to hospital B, a real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2 returned positive. Among 121 hospital A health care personnel (HCP) who were exposed to the patient, 43 (35.5%) developed symptoms during the 14 days after exposure and were tested for SARS-CoV-2; three had positive test results and were among the first known cases of probable occupational transmission of SARS-CoV-2 to HCP in the United States. Little is known about specific risk factors for SARS-CoV-2 transmission in health care settings. To better characterize and compare exposures among HCP who did and did not develop COVID-19, standardized interviews were conducted with 37 hospital A HCP who were tested for SARS-CoV-2, including the three who had positive test results. Performing physical examinations and exposure to the patient during nebulizer treatments were more common among HCP with laboratory-confirmed COVID-19 than among those without COVID-19; HCP with COVID-19 also had exposures of longer duration to the patient. Because transmission-based precautions were not in use, no HCP wore personal protective equipment (PPE) recommended for COVID-19 patient care during contact with the index patient. Health care facilities should emphasize early recognition and isolation of patients with possible COVID-19 and use of recommended PPE to minimize unprotected, high-risk HCP exposures and protect the health care workforce.


title: Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey

text: China has been severely affected by Coronavirus Disease 2019(COVID-19) since December, 2019. We aimed to assess the mental health burden of Chinese public during the outbreak, and to explore the potential influence factors. Using a web-based cross-sectional survey, we collected data from 7,236 self-selected volunteers assessed with demographic information, COVID-19 related knowledge, generalized anxiety disorder (GAD), depressive symptoms, and sleep quality. The overall prevalence of GAD, depressive symptoms, and sleep quality of the public were 35.1%, 20.1%, and 18.2%, respectively. Younger people reported a significantly higher prevalence of GAD and depressive symptoms than older people. Compared with other occupational group, healthcare workers were more likely to have poor sleep quality. Multivariate logistic regression showed that age (< 35 years) and time spent focusing on the COVID-19 (≥ 3 hours per day) were associated with GAD, and healthcare workers were at high risk for poor sleep quality. Our study identified a major mental health burden of the public during the COVID-19 outbreak. Younger people, people spending too much time thinking about the outbreak, and healthcare workers were at high risk of mental illness. Continuous surveillance of the psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide.


Every cloud: how the COVID-19 pandemic may benefit child health


docid: lvuixxry

title: Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations

text: Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients.


title: Medications in COVID-19 patients: summarizing the current literature from an orthopaedic perspective

text: PURPOSE: The review aims to provide a summary of the current literature regarding common medications prescribed in orthopaedic surgery and their potential implications in COVID-19 patients. METHODS: A systematic review was performed using the PRISMA guidelines. All clinical studies, reviews, consensus and guidelines related to the above medications and COVID-19 were included. RESULTS: A total of 18 articles were included. The use of analgesia, anti-inflammatories, steroids, anticoagulants, antibiotics, vitamin B, vitamin C and vitamin D and their potential impact on COVID-19 patients were reported. CONCLUSION: Eight main recommendations were derived from the review. Firstly, paracetamol remains the first line of analgesia and antipyretic. Secondly, there is no need to avoid NSAIDs for COVID-19 patients. Thirdly, opioids have the potential for immunosuppression in addition to respiratory depression and, therefore, should be prescribed with care in COVID-19 patients. Fourthly, patients with conditions where steroids are proven to be efficacious can continue to receive their steroids; otherwise, systemic steroids are not recommended for COVID-19 patients. Fifthly, orthopaedic surgeons following up on COVID-19 patients who are using steroids should continue to follow them up for possible avascular necrosis. Sixthly, whenever possible, oral anticoagulation should be converted to parental heparin. Seventhly, common orthopaedic antibiotics including penicillin and clindamycin are safe to continue for COVID-19 patients. However, for COVID-19 patients, the antibiotics can potentially be switched to macrolides and tetracyclines if the organisms are sensitive. Lastly, prescription for vitamins B, C and D should continue as per usual clinical practice.


Urticarial eruption in coronavirus disease 2019 infection: a case report in Tangerang, Indonesia


Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence?


title: Novel therapeutic targets for SARS-CoV-2-induced acute lung injury: Targeting a potential IL-1ß/neutrophil extracellular traps feedback loop

text: Most COVID-19 infected individuals present with mild flu-like symptoms; however, 5-10% of cases suffer from life-threatening pneumonia and respiratory failure. The pathogenesis of SARS-CoV-2 and its pathology of associated acute lung injury (ALI), acute respiratory distress syndrome (ARDS), sepsis, coagulopathy and multiorgan failure is not known. SARS-CoV-2 is an envelope virus with S (spike), M (membrane), N (nucleocapsid) and E (envelop) proteins. In a closely related coronavirus (SARS-CoV), the transmembrane E protein exerts an important role in membrane-ionic transport through viroporins, deletion of which reduced levels of IL-1ß and a remarkably reduced lung edema compared to wild type. IL-1ß is generated by macrophages upon activation of intracellular NLRP3 (NOD-like, leucine rich repeat domains, and pyrin domain-containing protein 3), part of the functional NLRP3 inflammasome complex that detects pathogenic microorganisms and stressors, while neutrophils are enhanced by increasing levels of IL-1ß. Expiring neutrophils undergo "NETosis", producing thread-like extracellular structures termed neutrophil extracellular traps (NETs), which protect against mild infections and microbes. However, uncontrolled NET production can cause acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), coagulopathy, multiple organ failure, and autoimmune disease. Herein, we present arguments underlying our hypothesis that IL-1ß and NETs, mediated via NLRP3 inflammasomes, form a feed-forward loop leading to the excessive alveolar and endothelial damage observed in severe cases of COVID-19. Considering such assertions, we propose potential drug candidates that could be used to alleviate such pathologies. Considering that recent efforts to ascertain effective treatments of COVID-19 in severe patients has been less than successful, investigating novel avenues of treating this virus are essential.


title: Participant and Caregiver Perspectives on Clinical Research During Covid-19 Pandemic

text: BACKGROUND/OBJECTIVES: The COVID-19 pandemic has massively disrupted essential clinical research. Many regulatory organizations have rightfully advocated to temporarily halt enrollment and curtail all face-to-face interactions. Views and opinions of patients and their caregivers are seldom considered while making such decisions. The objective was to study older participants' and their caregivers' perspectives to participate in ongoing clinical research during the COVID-19 pandemic. DESIGN: Cross-sectional. SETTING: VISN-16/Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs. PARTICIPANTS: Older participants and their caregivers (N = 51) enrolled in ongoing clinical research studies. MEASUREMENTS: Questions about perceptions of safety to attend research visit, the level of panic among the general public, and medical center's preparedness in handling the pandemic. Other questions identified the source of pandemic information and the preference of a phone or in-person visit. RESULTS: Mean age was 69.3 (±9.4) years, 53% were male, 39% were caregivers, and 65% were Caucasian. Majority (78%) of the participants felt safe/very safe attending the scheduled research appointment; 63% felt that the extra screening made them feel safe/very safe; 82% felt that the medical center was prepared/very prepared for the pandemic. Participants split evenly on their preference for phone versus in-person visits. Family members and television news media were the commonly used sources of pandemic information irrespective of their education. Perceptions were influenced by gender and source of information, not by age or education. Females perceived higher level of panic compared to males (P = .02). Those relying on news media felt safer compared to those that relied on family members (P = .008). CONCLUSION: Even though informants felt that the medical center was prepared to handle the pandemic, only half the participants preferred the in-person visit. Pandemic information was obtained from family members or the television news media. Knowing patients' perspectives may help researchers be better prepared for future pandemics. J Am Geriatr Soc 68:E14-E18, 2020.


title: The COVID-19 pandemic and health inequalities

text: This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics-drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemic pandemic It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.


docid: gutwumol

title: The battle against COVID-19: mortality in Italy


title: A serological assay to detect SARS-CoV-2 seroconversion in humans

text: Here, we describe a serological enzyme-linked immunosorbent assay for the screening and identification of human SARS-CoV-2 seroconverters. This assay does not require the handling of infectious virus, can be adjusted to detect different antibody types in serum and plasma and is amenable to scaling. Serological assays are of critical importance to help define previous exposure to SARS-CoV-2 in populations, identify highly reactive human donors for convalescent plasma therapy and investigate correlates of protection.


title: Optimal Control Concerns Regarding the COVID-19 (SARS-CoV-2) Pandemic in Bahia and Santa Catarina, Brazil

text: The COVID-19 pandemic is the profoundest health crisis of the 21rst century. The SARS-CoV-2 virus arrived in Brazil around March, 2020 and its social and economical backlashes are catastrophic. In this paper, it is investigated how Model Predictive Control (MPC) could be used to plan appropriate social distancing policies to mitigate the pandemic effects in Bahia and Santa Catarina, two states of different regions, culture, and population demography in Brazil. In addition, the parameters of Susceptible-Infected-Recovered-Deceased (SIRD) models for these two states are identified using an optimization procedure. The control input to the process is a social isolation guideline passed to the population. Two MPC strategies are designed: a) a centralized MPC, which coordinates a single control policy for both states; and b) a decentralized strategy, for which one optimization is solved for each state. Simulation results are shown to illustrate and compare both control strategies. The framework serves as guidelines to deals with such pandemic phenomena.


title: Relationship between clinical types and radiological subgroups defined by latent class analysis in 2019 novel coronavirus pneumonia caused by SARS-CoV-2

text: OBJECTIVES: To investigate whether meaningful subgroups sharing the CT features of patients with COVID-19 pneumonia could be identified using latent class analysis (LCA) and explore the relationship between the LCA-derived subgroups and clinical types. METHODS: This retrospective review included 499 patients with confirmed COVID-19 pneumonia between February 11 and March 8, 2020. Subgroups sharing the CT features were identified using LCA. Univariate and multivariate logistic regression models were utilized to analyze the association between clinical types and the LCA-derived subgroups. RESULTS: Two radiological subgroups were identified using LCA. There were 228 subjects (45.69%) in class 1 and 271 subjects (54.31%) in class 2. The CT findings of class 1 were smaller pulmonary infection volume, more peripheral distribution, more GGO, more maximum lesion range ≤ 5 cm, a smaller number of lesions, less involvement of lobes, less air bronchogram, less dilatation of vessels, less hilar and mediastinal lymph node enlargement, and less pleural effusion than the CT findings of class 2. Univariate analysis demonstrated that older age, therapy, presence of fever, presence of hypertension, decreased lymphocyte count, and increased CRP levels were significant parameters associated with an increased risk for class 2. Multivariate analyses revealed that the patients with clinically severe type disease had a 1.97-fold risk of class 2 than the patients with clinically moderate-type disease. CONCLUSIONS: The demographic and clinical differences between the two radiological subgroups based on the LCA were significantly different. Two radiological subgroups were significantly associated with clinical moderate and severe types. KEY POINTS: â¢ Two radiological subgroups were identified using LCA. â¢ Older age, therapy, presence of fever, presence of hypertension, decreased lymphocyte count, and increased CRP levels were significant parameters with an increased risk for class 2 defined by LCA. â¢ Patients with clinically severe type had a 1.97-fold higher risk of class 2 defined by LCA in comparison with patients showing clinically moderate-type disease.


title: An Optimal Predictive Control Strategy for COVID-19 (SARS-CoV-2) Social Distancing Policies in Brazil

text: The global COVID-19 pandemic (SARS-CoV-2 virus) is the defining health crisis of our century. Due to the absence of vaccines and drugs that can help to fight it, the world solution to control the spread has been to consider public social distance measures that avoids the saturation of the health system. In this context, we investigate a Model Predictive Control (MPC) framework to determine the time and duration of social distancing policies. We use Brazilian data in the period from March to May of 2020. The available data regarding the number of infected individuals and deaths suffers from sub-notification due to the absence of mass tests and the relevant presence of the asymptomatic individuals. We estimate variations of the SIR model using an uncertainty-weighted Least-Squares criterion that considers both nominal and inconsistent-data conditions. Moreover, we add to our versions of the SIR model an additional dynamic state variable to mimic the response of the population to the social distancing policies determined by the government that affects the speed of COVID-19 transmission. Our control framework is within a mixed-logical formalism, since the decision variable is forcefully binary (the existence or the absence of social distance policy). A dwell-time constraint is included to avoid harsh shifting between these two states. Finally, we present simulation results to illustrate how such optimal control policy would operate. These results point out that no social distancing should be relaxed before mid August 2020. If relaxations are necessary, they should not be performed before the beginning this date and should be in small periods, no longer than 25 days. This paradigm would proceed roughly until January/2021. The second peak of infections, which has a forecast to the beginning of October, can be reduced if the periods of no-isolation days are shortened.


title: Enjeux de l'utilisation des psychotropes dans le cadre de la pandémie au SARS-Cov-2./ [Challenges for psychotropics in the context of the SARS-Cov-2 pandemic]

text: French recommendations have been proposed for psychotropics use and possible adaptations during the SARS-CoV-2 epidemic. Between uncertainties linked to the lack of data and speculations about possible benefits of psychotropics against the coronavirus, we propose here elements allowing to base the pharmacotherapeutic decisions potentially useful in Covid+ patients with psychiatric disorders.


title: Working Hard or Hardly Working? Regulatory Bottlenecks in Developing a COVID-19 Vaccine

text: Vaccine solutions rarely reach the public until after an outbreak abates; an Ebola vaccine was approved 5 years after peak outbreak and SARS, MERS, and Zika vaccines are still in clinical development. Despite massive leaps forward in rapid science, other regulatory bottlenecks are hamstringing the global effort for pandemic vaccines.


title: Morphology and numerical characteristics of epidemic curves for SARS-Cov-II using Moyal distribution

text: In this paper, it is shown that the Moyal distribution is an excelent tool to study the SARS-Cov-II (Covid-19) epidemiological associated curves and its propagation. The Moyal parameters give all the information to describe the form and the impact of the illness outbreak in the different affected countries and its global impact. We checked that the Moyal distribution can accurately fit the daily report of {\it{new confirmed cases of infected people}} (NCC) per country, in that places where the contagion is reaching their final phase, describing the beginning, the most intense phase and the descend of the contagion, simultaneously . In order to achieve the purpose of this work, it is important to work with a complete and well compilated set of the data to be used to fit the curves. Data from European countries like France, Spain, Italy Belgium, Sweden, United Kingdom, Denmark and others like USA and China, have been used. Also, the correlation between the parameters of the Moyal distribution fitting and the general public health measures imposed in each country, have been discussed. A relation between those policies and the features of the Moyal distribution, in terms of their parameters and critical points, is shown; from that, it can be seen that the knowledge of the time evolution of the epidemiological curve, their critical points, superposition properties and rates of the rising and the ending, could help to find a way to estimate the efficiency of social distancing measures, imposed in each country, and anticipate the different phases of the pandemic.


COVID-19: Importance of the Awareness of the Clinical Syndrome by Urologists


title: Needles in the 'Sheet'stack: Augmented Analytics to get Insights from Spreadsheets

text: Business intelligence (BI) tools for database analytics have come a long way and nowadays also provide ready insights or visual query explorations, e.g. QuickInsights by Microsoft Power BI, SpotIQ by ThoughtSpot, Zenvisage, etc. In this demo, we focus on providing insights by examining periodic spreadsheets of different reports (aka views), without prior knowledge of the schema of the database or reports, or data information. Such a solution is targeted at users without the familiarity with the database schema or resources to conduct analytics in the contemporary way.


England and Wales see 20â000 excess deaths in care homes


Offline: After COVID-19-is an "alternate society" possible?


docid: ibtylbut

title: Covid-19: Over 300 Italian doctors and scientists call for more testing


'We need to be alert': Scientists fear second coronavirus wave as China's lockdowns ease


Suggesting Ritonavir against COVID-19/SARS-CoV-2


title: Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana Covid-19 Patients

text: BACKGROUND: Due to the rapidly escalating number of cases and the low baseline of overall health in Louisiana, we sought to determine the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in hospitalized COVID patients in 2 major metropolitan areas with the highest prevalence of cases and exceedingly high rates of obesity and other comorbid conditions. We hypothesized that elevated NLR would be a prognostic indicator of mortality. METHODS: This was a review of a prospective registry of adult (18+ years) hospitalized SARS-CoV-2 patients from to two large urban safety net hospitals in Louisiana. Blood cell counts at days 2 and 5 were used to obtain NLR. Receiver operating characteristic (ROC) curve analysis assessed predictive capacity of NLR on mortality. Kaplan-Meier (KM) survival analysis and Cox regression models examined the effect of NLR on survival. RESULTS: The study population of 125 patients was majority African American (88.6%) and female (54.8%) with a mean age and BMI of 58.7 years and 34.2. Most (96.0%) had comorbidities of which hypertension (72.0%), obesity (66.7%), and diabetes (40.0%) were the most common. Mortality was 18.4%. NLRâ>â4.94 on day 1 predicted intubation (Pâ=â0.02). NLR above established cutoff values on hospital days 2 and 5 each significantly predicted mortality (Pâ<â0.001 and Pâ=â0.002, respectively). CONCLUSIONS: NLR is a prognostic factor for endotracheal intubation upon hospital admission and independent predictor for risk of mortality in SARS-CoV-2 patients on subsequent hospital days. Clinical research efforts should examine effects of strategies such as arginase inhibition alone and/or inhaled nitric oxide to ameliorate the effects of elevated NLR.


Basing Respiratory Management of COVID-19 on Physiological Principles


Smell and taste dysfunction in patients with COVID-19


title: Comparing COVID-19 and the 1918-19 influenza pandemics in United Kingdom

text: We compare the COVID-19 pandemic and 1918-19 influenza pandemic in United Kingdom. We found that the on-going COVID-19 wave of infection matched the major wave of the 1918-19 influenza pandemic surprisingly well, both reached similar magnitude (in term of estimated weekly new infections) and spent the same duration above 5 cases per 1000 inhabitants, for the past two months. We discussed the similar characteristics between these two pandemics.


docid: jlcxtsnq

title: Pitfalls of possible reporting of same patients with COVID-19 in dermatology journals


Chirurgische Aspekte zur Tracheostomie bei COVID-19-positiven Patienten - Stellungnahme im Auftrag der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNO-KHC) und der AG Laryngologie & Trachealerkrankungen


title: Antibodies to SARS-CoV-2 and their potential for therapeutic passive immunization

text: We review aspects of the antibody response to SARS-CoV-2, the causative agent of the COVID-19 pandemic. The topics we cover are relevant to immunotherapy with plasma from recovered patients, monoclonal antibodies against the viral S-protein, and soluble forms of the receptor for the virus, angiotensin converting enzyme 2. The development of vaccines against SARS-CoV-2, an essential public health tool, will also be informed by an understanding of the antibody response in infected patients. Although virus-neutralizing antibodies are likely to protect, antibodies could potentially trigger immunopathogenic events in SARS-CoV-2-infected patients or enhance infection. An awareness of these possibilities may benefit clinicians and the developers of antibody-based therapies and vaccines.


COVID-19: a public health approach to manage domestic violence is needed


title: Novel Immunoglobulin Domain Proteins Provide Insights into Evolution and Pathogenesis of SARS-CoV-2-Related Viruses

text: A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was recently identified as the causative agent for the coronavirus disease 2019 (COVID-19) outbreak that has generated a global health crisis. We use a combination of genomic analysis and sensitive profile-based sequence and structure analysis to understand the potential pathogenesis determinants of this virus. As a result, we identify several fast-evolving genomic regions that might be at the interface of virus-host interactions, corresponding to the receptor binding domain of the Spike protein, the three tandem Macro fold domains in ORF1a, and the uncharacterized protein ORF8. Further, we show that ORF8 and several other proteins from alpha- and beta-CoVs belong to novel families of immunoglobulin (Ig) proteins. Among them, ORF8 is distinguished by being rapidly evolving, possessing a unique insert, and having a hypervariable position among SARS-CoV-2 genomes in its predicted ligand-binding groove. We also uncover numerous Ig domain proteins from several unrelated metazoan viruses, which are distinct in sequence and structure but share comparable architectures to those of the CoV Ig domain proteins. Hence, we propose that SARS-CoV-2 ORF8 and other previously unidentified CoV Ig domain proteins fall under the umbrella of a widespread strategy of deployment of Ig domain proteins in animal viruses as pathogenicity factors that modulate host immunity. The rapid evolution of the ORF8 Ig domain proteins points to a potential evolutionary arms race between viruses and hosts, likely arising from immune pressure, and suggests a role in transmission between distinct host species.IMPORTANCE The ongoing COVID-19 pandemic strongly emphasizes the need for a more complete understanding of the biology and pathogenesis of its causative agent SARS-CoV-2. Despite intense scrutiny, several proteins encoded by the genomes of SARS-CoV-2 and other SARS-like coronaviruses remain enigmatic. Moreover, the high infectivity and severity of SARS-CoV-2 in certain individuals make wet-lab studies currently challenging. In this study, we used a series of computational strategies to identify several fast-evolving regions of SARS-CoV-2 proteins which are potentially under host immune pressure. Most notably, the hitherto-uncharacterized protein encoded by ORF8 is one of them. Using sensitive sequence and structural analysis methods, we show that ORF8 and several other proteins from alpha- and beta-coronavirus comprise novel families of immunoglobulin domain proteins, which might function as potential immune modulators to delay or attenuate the host immune response against the viruses.


Unconditional Care in Academic Emergency Departments


Focal Cerebral Arteriopathy in a COVID-19 Pediatric Patient


Using socioeconomics to counter health disparities arising from the covid-19 pandemic


Persistence of viral RNA in stool samples from patients recovering from covid-19


title: Influencia de la infección SARS-CoV-2 sobre enfermedades neurodegenerativas y neuropsiquiátricas: ¿una pandemia demorada?/ Influencia de la infección SARS-CoV-2 sobre enfermedades neurodegenerativas y neuropsiquiátricas: ¿una pandemia demorada?/ Impact of SARS-CoV-2 infection on neurodegenerative and neuropsychiatric diseases: a delayed pandemic?

text: INTRODUCTION: SARS-CoV-2 was first detected in December 2019 in the Chinese city of Wuhan and has since spread across the world. At present, the virus has infected over 1.7 million people and caused over 100 000 deaths worldwide. Research is currently focused on understanding the acute infection and developing effective treatment strategies. In view of the magnitude of the epidemic, we conducted a speculative review of possible medium- and long-term neurological consequences of SARS-CoV-2 infection, with particular emphasis on neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin, based on the available evidence on neurological symptoms of acute SARS-CoV-2 infection. DEVELOPMENT: We systematically reviewed the available evidence about the pathogenic mechanisms of SARS-CoV-2 infection, the immediate and lasting effects of the cytokine storm on the central nervous system, and the consequences of neuroinflammation for the central nervous system. CONCLUSIONS: SARS-CoV-2 is a neuroinvasive virus capable of triggering a cytokine storm, with persistent effects in specific populations. Although our hypothesis is highly speculative, the impact of SARS-CoV-2 infection on the onset and progression of neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin should be regarded as the potential cause of a delayed pandemic that may have a major public health impact in the medium to long term. Cognitive and neuropsychological function should be closely monitored in COVID-19 survivors.


An Atypical Presentation of Novel Coronavirus Disease 2019 (COVID-19)


title: Optimal quarantine strategies for COVID-19 control models

text: Optimal control problems reflecting the finding of effective quarantine strategies are considered for two control SEIR~type models describing the spread of the COVID-19 virus in the human population. The properties of the corresponding optimal controls are established analytically by applying the Pontryagin maximum principle. The optimal solutions are obtained numerically using BOCOP 2.0.5 software. The behavior of the appropriate optimal solutions and their dependence on the basic reproductive ratio and length of quarantine are discussed in detail. Necessary conclusions are made.


title: Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands

text: A potential link between mortality, D-dimer values and a prothrombotic syndrome has been reported in patients with COVID-19 infection. The National Institute for Public Health of the Netherlands asked a group of Radiology and Vascular Medicine experts to provide guidance for the imaging workup and treatment of these important complications. This report summarizes evidence for thromboembolic disease, potential diagnostic and preventive actions as well as recommendations for patients with COVID-19 infection.


The neuroinvasive potential of severe acute respiratory syndrome coronavirus 2


title: How to reduce the likelihood of coronavirus-19 (CoV-19 or SARS-CoV-2) infection and lung inflammation mediated by IL-1

text: SARS-CoV-2, also referred to as CoV-19, is an RNA virus which can cause severe acute respiratory diseases (COVID-19), with serious infection of the lower respiratory tract followed by bronchitis, pneumonia and fibrosis. The severity of the disease depends on the efficiency of the immune system which, if it is weak, cannot stem the infection and its symptoms. The new CoV-19 spreads in the population at a rate of 0.8-3% more than normal flu and mostly affects men, since immune genes are more expressed on the X chromosome. If CoV-19 would spread with a higher incidence rate (over 10%), and affect the people who live in closed communities such as islands, it would cause many more deaths. Moreover, people from the poorest classes are most at risk because of lack of health care and should be given more assistance by the competent authorities. To avoid the aggravation of CoV-19 infection, and the collapse of the health system, individuals should remain at home in quarantine for a period of approximately one month in order to limit viral transmission. In the case of a pandemic, the severe shortage of respirators and protective clothing, due to the enormous demand and insufficient production, could lead the CoV-19 to kill a large number of individuals. At present, there is no drug capable of treating CoV-19 flu, the only therapeutic remedies are those aimed at the side effects caused by the virus, such as inflammation and pulmonary fibrosis, recognized as the first causes of death. One of the COVID-19 treatments involves inhaling a mixture of gaseous hydrogen and oxygen, obtaining better results than with oxygen alone. It was also noted that individuals vaccinated for viral and/or bacterial infectious diseases were less likely to become infected. In addition, germicidal UV radiation "breaks down" the oxygen O2 which then aggregate into O3 (ozone) molecules creating the ozone layer, capable of inhibiting viral replication and improving lung respiration. All these precautions should be taken into consideration to lower the risk of infection by CoV-19. New anti-viral therapies with new drugs should also be taken into consideration. For example, microbes are known to bind TLR, inducing IL-1, a pleiotropic cytokine, highly inflammatory, mediator of fever and fibrosis. Therefore, drugs that suppress IL-1 or IL-1R, also used for the treatment of rheumatoid arthritis are to be taken into consideration to treat COVID-19. We strongly believe that all these devices described above can lead to greater survival and. therefore, reduction in mortality in patients infected with CoV-19.


docid: fkunlpoq

title: Comments on Wu et al: Possible special needs for mental online support in female and male health care workers during the COVID-19

text: In their article Wu and colleagues, similarly to other authors, present the effects of stress on medical staff during the COVID-19 pandemic as an unprecedented challenge for all communities. Their observation is within current literature trends, which identify 7 population subgroups affected by the psychosocial consequences of the COVID-19: general population affected by restrictive measures, people subjected to quarantine, positive for the virus (isolated/hospitalized), health care personnel, relatives of persons who died, and mentally ill patients. This article is protected by copyright. All rights reserved.


Comments on the publication by Yerramilli et al titled "Palliative Radiotherapy for Oncologic emergencies in the setting of COVID-19: Approaches to Balancing Risks and Benefits."


title: The Number of Confirmed Cases of Covid-19 by using Machine Learning: Methods and Challenges

text: Covid-19 is one of the biggest health challenges that the world has ever faced. Public health policy makers need the reliable prediction of the confirmed cases in future to plan medical facilities. Machine learning methods learn from the historical data and make a prediction about the event. Machine learning methods have been used to predict the number of confirmed cases of Covid-19. In this paper, we present a detailed review of these research papers. We present a taxonomy that groups them in four categories. We further present the challenges in this field. We provide suggestions to the machine learning practitioners to improve the performance of machine learning methods for the prediction of confirmed cases of Covid-19.


La chirurgie gynécologique à l'épreuve de l'infection à COVID-19. Quelles recommandations formuler ?/ [Gynecological surgery during the COVID-19 pandemic: Take home messages]


The COVID-19 Pandemic and Acute Aortic Dissections in New York: A Matter of Public Health


title: The risk of COVID-19 transmission by laparoscopic smoke may be lower than for laparotomy: a narrative review

text: BACKGROUND: Surgical smoke is a well-recognized hazard in the operating room. At the beginning of the COVID-19 pandemic, surgical societies quickly published guidelines recommending avoiding laparoscopy or to consider open surgery because of the fear of transmission of SARS-CoV-2 through surgical smoke or aerosol. This narrative review of the literature aimed to determine whether there are any differences in the creation of surgical smoke/aerosol between laparoscopy and laparotomy and if laparoscopy may be safer than laparotomy. METHODS: A literature search was performed using the Pubmed, Embase and Google scholar search engines, as well as manual search of the major journals with specific COVID-19 sections for ahead-of-print publications. RESULTS: Of 1098 identified articles, we critically appraised 50. Surgical smoke created by electrosurgical and ultrasonic devices has the same composition both in laparoscopy and laparotomy. SARS-CoV-2 has never been found in surgical smoke and there is currently no data to support its virulence if ever it could be transmitted through surgical smoke/aerosol. CONCLUSION: If laparoscopy is performed in a closed cavity enabling containment of surgical smoke/aerosol, and proper evacuation of smoke with simple measures is respected, and as long as laparoscopy is not contraindicated, we believe that this surgical approach may be safer for the operating team while the patient has the benefits of minimally invasive surgery. Evidence-based research in this field is needed for definitive determination of safety.


Refugees, asylum seekers and COVID-19: Canada needs to do more to protect at-risk refugees during the current pandemic


title: Risks Posed to Corneal Transplant Recipients by COVID-19-Affected Donors

text: The recent emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant human disease, COVID-19, will likely have a significant impact on the corneal tissue donor pool. Current recommendations from the United States and global eye bank associations call for the outright avoidance of tissues from donors recently infected with or exposed to COVID-19. This conservative recommendation is currently appropriate given the reported ocular sequelae, tear film viral detectability, and transmissibility of COVID-19. However, the rapidly increasing global prevalence and mortality of COVID-19 threatens the tenability of current tissue exclusion guidelines, and may necessitate their relaxation in the near future.


title: Desafios e oportunidades para telessaúde em tempos da pandemia pela COVID-19: uma reflexão sobre os espaços e iniciativas no contexto brasileiro./ Desafios e oportunidades para telessaúde em tempos da pandemia pela COVID-19: uma reflexão sobre os espaços e iniciativas no contexto brasileiro./ Challenges and opportunities for telehealth during the COVID-19 pandemic: ideas on spaces and initiatives in the Brazilian context

text: COVID-19 has created enormous challenges for health systems worldwide, with the rapidly growing number of deaths and critical patients with pneumonia requiring ventilatory support. Alternative methods to control the spread of the disease such as social isolation, extreme quarantine measures, and contact tracing have been used around the world. However, these measures may not be totally effective to fight COVID-19, in step with the necessary national preparations to meet the new patient care demands. A wide range of digital technologies can be used to enhance these public health strategies, and the pandemic has sparked increasing use of telehealth. This field has grown considerably in Brazil in recent years. Still, despite the intense proliferation of recommendations and rules, until the current pandemic the country still lacked a fully consolidated regulatory framework. The emergence of COVID-19 marks a key moment in the expansion of applications and use of telehealth for improving the health system's response to the current crisis. The article discusses telehealth's contribution to the fight against COVID-19 and the recent initiatives triggered in Brazil as opportunities for the consolidation of telemedicine and improvement of the Brazilian Unified National Health System. The authors conclude that telehealth offers capabilities for remote screening, care and treatment, and assists monitoring, surveillance, detection, prevention, and mitigation of the impacts on healthcare indirectly related to COVID-19. The initiatives triggered in this process can reshape the future space of telemedicine in health services in the territory.


title: Toward a translationally independent RNA-based synthetic oscillator using deactivated CRISPR-Cas

text: In synthetic circuits, CRISPR-Cas systems have been used effectively for endpoint changes from an initial state to a final state, such as in logic gates. Here, we use deactivated Cas9 (dCas9) and deactivated Cas12a (dCas12a) to construct dynamic RNA ring oscillators that cycle continuously between states over time in bacterial cells. While our dCas9 circuits using 103-nt guide RNAs showed irregular fluctuations with a wide distribution of peak-to-peak period lengths averaging approximately nine generations, a dCas12a oscillator design with 40-nt CRISPR RNAs performed much better, having a strongly repressed off-state, distinct autocorrelation function peaks, and an average peak-to-peak period length of â¼7.5 generations. Along with free-running oscillator circuits, we measure repression response times in open-loop systems with inducible RNA steps to compare with oscillator period times. We track thousands of cells for 24+ h at the single-cell level using a microfluidic device. In creating a circuit with nearly translationally independent behavior, as the RNAs control each others' transcription, we present the possibility for a synthetic oscillator generalizable across many organisms and readily linkable for transcriptional control.


docid: hjtlblxe

title: CoViD-19 and ortho and trauma surgery: The Italian experience


title: Utilization pattern and side effect profile of oral anticonceptives: A community-based cross-sectional study among Saudi women

text: BACKGROUND: The rapid change in the socio-demographic pattern and changing beliefs toward fertility and birth spacing have resulted in a notable increase in the use of oral anticonceptives in the Saudi Arabian community. However, information on the current utilization of oral anticonceptives and attitudes toward their use remains sparse. OBJECTIVE: The present study evaluated the utilization pattern of oral anticonceptives, attitude toward pill use, and incidence of side effects among Saudi women. SETTING: The study was conducted in a community setting in Jazan, Kingdom of Saudi Arabia. METHODS: Eligible Saudi women routinely using oral anticonceptive pills were invited to participate in this prospective, cross-sectional survey. Data were collected using a standardized, pretested, semi-structured questionnaire. Jazan was selected as it recorded the highest number of women using contraceptives in Saudi Arabia. MAIN OUTCOME MEASURE: The pattern of pill utilization, attitude toward pill use, and incidence of side effects. RESULTS: A total of 496 women consented to participate in this study. Most of the respondents (87.5%) were using or had used oral anticonceptives for birth control. In nearly half (49.2%) of participants, oral pills were advised by a gynaecologist, and approximately two-thirds (69.0%) were using or had used combined oral anticonceptives. Nearly two-thirds (63.1%) of respondents preferred pills over other contraception methods due to their ease of use. More than one-third (39.3%) of participants agreed that oral pills are safe. Approximately half (53.2%) of participants were aware that a missed pill must be taken immediately after recalling that a dose was missed. A total of 69.6% of participants experienced at least one side effect, of which mood swings (61.1%), weight gain or increase appetite (42.2%), decreased libido (34.1%), and nausea (31.2%) were most common. CONCLUSION: Saudi women had a high acceptance rate for oral anticonceptives as a legitimate method to prevent unintended pregnancy. This was associated with a modest degree of understanding about their risks and benefits. Pharmacists should provide up-to-date information and counsel patients about the use and side effects of oral anticonceptives.


docid: dtlnjcqm

title: Assess, adapt and act: a paediatric surgery division's initial approach in a rapidly evolving pandemic

text: PURPOSE: The COVID-19 pandemic has placed an unprecedented test on the delivery and management of healthcare services globally. This study describes the adaptive measures taken and evolving roles of the members of the paediatric surgery division in a developing country during this period. METHODS: We adopted multiple adaptive strategies including changes to stratification of surgeries, out-patient services by urgency and hospital alert status, policy writing involving multidisciplinary teams, and redeployment of manpower. Modifications were made to teaching activities and skills training to observe social distancing and mitigate reduced operative learning opportunities. Roles of academic staff were expanded to include non-surgical duties. RESULTS: The planned strategies and changes to pre COVID-19 practices were successful in ensuring minimal disruption to the delivery of essential paediatric surgical services and training. Despite the lack of established guidelines and literature outlining strategies to address the impact of this pandemic on surgical services, most of the initial measures employed were consistent with that of other surgical centres. CONCLUSION: Changes to delivery of surgical services and surgical training warrant a holistic approach and a constant re-evaluation of practices with emergence of new experiences and guidelines.


title: What Caused the Outbreak of COVID-19 in China: From the Perspective of Crisis Management

text: Since the first known case of a COVID-19 infected patient in Wuhan, China on 8 December 2019, COVID-19 has spread to more than 200 countries, causing a worldwide public health crisis. The existing literature fails to examine what caused this sudden outbreak from a crisis management perspective. This article attempts to fill this research gap through analysis of big data, officially released information and other social media sources to understand the root cause of the crisis as it relates to China's current management system and public health policy. The article draws the following conclusions: firstly, strict government control over information was the main reason for the early silencing of media announcements, which directly caused most people to be unprepared and unaware of COVID-19. Secondly, a choice between addressing a virus with an unknown magnitude and nature, and mitigating known public panic during a politically and culturally sensitive time, lead to falsehood and concealment. Thirdly, the weak autonomous management power of local public health management departments is not conducive for providing a timely response to the crisis. Finally, the privatization of many state-owned hospitals led to the unavailability of public health medical resources to serve affected patients in the Wuhan and Hubei Province. This article suggests that China should adopt a Singaporean-style public health crisis information management system to ensure information disclosure and information symmetry and should use it to monitor public health crises in real time. In addition, the central government should adopt the territorial administration model of a public health crisis and increase investment in public health in China.


Anti-CD20 and COVID-19 in multiple sclerosis and related disorders: A case series of 60 patients from Madrid, Spain


Protecting the psychological health of children through effective communication about COVID-19


title: Higher levels of IL-6 early after tocilizumab distinguish survivors from non-survivors in COVID-19 pneumonia: a possible indication for deeper targeting IL-6

text: INTRODUCTION: The most serious COVID-19 deriving from severe acute respiratory syndrome coronavirus 2 causes cytokine release storm and it is associated with worse outcomes. In COVID-19 patients, Interleukin (IL)-6 levels are significantly elevated. Blocking IL-6 preliminary resulted in the improvement of this hyperinflammatory state. It is unknown which patients could require higher doses of tocilizumab to get out of the cytokine storm. MATERIALS AND METHODS: Twenty-four patients affected by COVID-19 pneumonia were included. All the patients underwent tocilizumab 8 mg/kg intravenously and were tested for serum IL-6 24-48 hours before and 12-48 hours after tocilizumab infusion. Comparisons between survivors and non-survivors were performed. RESULTS: Eighteen patients were discharged, while six patients died, with no clinical or laboratory differences between the two groups at baseline. IL-6 was not different at baseline (p=0.41), while 24-48h post-tocilizumab IL-6 serum levels were significantly higher in non-survivors than in survivors [2398.5 (430.5-9372) pg/mL vs 290.5 (58.5-1305.5) pg/mL, p=0.022)]. Serum IL-6 post-tocilizumab showed a good predictive ability to discriminate survivors from non-survivors (AUC 0.815 95%CI 0.63-0.99, p=0.02). CONCLUSION: Repeated measurement of serum level of IL-6 early after tocilizumab may distinguish non-survivors from survivors and support the choice of deeper targeting IL-6 in COVID-19 pneumonia. This article is protected by copyright. All rights reserved.


docid: ynimjlzx

title: Letter to the Editor: Radiological approaches to COVID-19 pneumonia

text: Dear editor, We read with great interest the article titled ?Radiological approaches to COVID-19 pneumonia? by Akcay S. et al. in the latest issue of Turk J Med Sci [1]. The authors provided a review of the radiological findings of novel coronavirus disease (COVID-19) pneumonia. We would like to highlight some missing radiological findings in this article, and we want to contribute to some critical radiological findings.


Risk factors in patients with COVID-19 developing severe liver injury during hospitalisation


title: Novel design for door handle-a potential technology to reduce hand contamination in the COVID-19 pandemic

text: Coronavirus disease 2019; COVID-19; 3D printing; door handle.


COVID-19 and viral hepatitis elimination programs: Are we stepping backward?


Sex workers must not be forgotten in the COVID-19 response


docid: lvqkaymz

title: Weakly $\omega$-Categorified Models of Algebraic Theories

text: We provide the expected constructions of weakly $\omega$-categorified models (in the sense of Bressie) of the theory of groups and quandles which arise by replacing the homotopies used to give equivalence relations in the theory of fundamental groups, fundamental quandles, and knot quandles with homotopies of all orders used as arrows of categorical dimensions one and greater, and discuss other related constructions of weakly $\omega$-categorifed algebras.


Covid-19: four fifths of cases are asymptomatic, China figures indicate


PEEP levels in COVID-19 pneumonia


title: Implementation of field hospital pharmacy services during the COVID-19 pandemic

text: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.


Proposition for an international DNR symbol printable on patients' wristbands and usable in hospital, nursing and retirement homes with the aim to avoid unwanted CPR in patients with a DNR status


Imaging Publications in the COVID-19 Pandemic: Applying New Research Results to Clinical Practice


Coronavirus Disease 2019: the Pivotal Role of UK Clinical Oncology and the UK Coronavirus Cancer Monitoring Project


title: The experience of treating patients with acute myocardial infarction under the COVID-19 epidemic

text: Worldwide Coronavirus Disease 2019 (COVID-19) epidemic makes the management of acute myocardial infarction (AMI) more complicated, effective treatment without further dissemination is thus quite challenging. Recently, we successfully treated three representative AMI cases, by sharing these detailed procedures, we summarized some important issues including patient screening, reperfusion strategy selecting, personnel/catheter lab protection principle, as well as operation tactics, which may lend precious experience on AMI treating during the ongoing COVID-19 pandemic situation.


title: A Novel AI-enabled Framework to Diagnose Coronavirus COVID 19 using Smartphone Embedded Sensors: Design Study

text: Coronaviruses are a famous family of viruses that cause illness in both humans and animals. The new type of coronavirus COVID-19 was firstly discovered in Wuhan, China. However, recently, the virus has widely spread in most of the world and causing a pandemic according to the World Health Organization (WHO). Further, nowadays, all the world countries are striving to control the COVID-19. There are many mechanisms to detect coronavirus including clinical analysis of chest CT scan images and blood test results. The confirmed COVID-19 patient manifests as fever, tiredness, and dry cough. Particularly, several techniques can be used to detect the initial results of the virus such as medical detection Kits. However, such devices are incurring huge cost, taking time to install them and use. Therefore, in this paper, a new framework is proposed to detect COVID-19 using built-in smartphone sensors. The proposal provides a low-cost solution, since most of radiologists have already held smartphones for different daily-purposes. Not only that but also ordinary people can use the framework on their smartphones for the virus detection purposes. Nowadays Smartphones are powerful with existing computation-rich processors, memory space, and large number of sensors including cameras, microphone, temperature sensor, inertial sensors, proximity, colour-sensor, humidity-sensor, and wireless chipsets/sensors. The designed Artificial Intelligence (AI) enabled framework reads the smartphone sensors signal measurements to predict the grade of severity of the pneumonia as well as predicting the result of the disease.


docid: qvvjhrez

title: Safely performing neurosurgical procedures during COVID-19 pandemic

text: INTRODUCTION: The novel coronavirus disease (COVID-19) pandemic poses a substantial threat to the health of healthcare personnel on the front line of caring for COVID-19 patients. The Centers for Medicare and Medicaid Services previously announced that all non-essential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. METHODS: We share our experiences with safely performing neurosurgical procedures on confirmed and suspected COVID-19 patients, to aide other neurosurgical teams in preparing for these high-risk cases, especially for neurosurgical interventions which are essential at saving a life or preserving functioning of the central nervous system that cannot be delayed. Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed: the hospital should be equipped with negative pressure areas and multiple areas to quarantine positive patients; the operating rooms should be negative pressure or have HEPA-filtration systems in place; all healthcare personnel who immediately participate in neurosurgical interventions for confirmed and suspected COVID-19 patients should take airborne precautions and wear enhanced personal protective equipment. RESULTS: Successful management of neurosurgical emergencies without healthcare personnel infection has been achieved during this pandemic crisis. CONCLUSION: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


title: Optimizing lung cancer radiation treatment worldwide in COVID-19 outbreak

text: COVID-19 has spread around the planet, sending billions of people into lockdown as health services struggle to cope. Meanwhile in Asia, where the disease began, the spread continues, in China it seems for now to have passed its peak. Italy, Spain, France, UK, and the US have been the countries more affected in terms of deaths. The coronavirus is more dangerous to the elderly and those with certain pre-existing medical conditions which is precisely the profile of lung cancer patients. Essential cancer services should be delivered but all steps should be taken to protect patients and the health workforce from infection with COVID-19. This presents a major challenge to radiotherapy (RT) departments worldwide. An international panel with expertise in the management of lung cancer in high-volume comprehensive centres has come together to share its experience on COVID-19 preparedness to deliver optimal care in such exceptional circumstances. A comprehensive systematic review of the literature through a PubMed search was undertaken. Twelve recommendations including, among others, the consideration of shorter courses, delays, and the omission of RT for lung cancer are proposed by the panel. In summary, we recommend the screening of every single person accessing the treatment room, the consideration of hypofractionation and to delay postoperative RT for non-small cell lung cancer, to avoid twice-daily treatments and delay or deliver prophylactic cranial irradiation during radio(chemo)therapy for limited-stage small cell lung cancer, review image guided RT images for suspicious image findings, and the use of single-fraction RT for the palliative treatment of stage IV lung cancer patients. Given that lung cancer is one of the most common and severe pathologies in radiation oncology departments, the following recommendations require particularly urgent consideration. The decision-making paths strongly depend on locally available resources, and a tailored approach should be used to attend lung cancer patients during this pandemic.


Management of pediatric rheumatic patients in Kazakhstan during the coronavirus disease 2019 (COVID-19) pandemic


Convalescent plasma therapy in the treatment of COVID-19: Some considerations: Correspondence


docid: bpjlrxvs

title: Human infection challenge studies in endemic settings and/or low-income and middle-income countries: key points of ethical consensus and controversy

text: Human infection challenge studies (HCS) involve intentionally infecting research participants with pathogens (or other micro-organisms). There have been recent calls for more HCS to be conducted in low-income and middle-income countries (LMICs), where many relevant diseases are endemic. HCS in general, and HCS in LMICs in particular, raise numerous ethical issues. This paper summarises the findings of a project that explored ethical and regulatory issues related to LMIC HCS via (i) a review of relevant literature and (ii) 45 qualitative interviews with scientists and ethicists. Among other areas of consensus, we found that there was widespread agreement that LMIC HCS can be ethically acceptable, provided that they have a sound scientific rationale, are accepted by local communities and meet usual research ethics requirements. Unresolved issues include those related to (i) acceptable approaches to trade-offs between the scientific aim to produce generalisable results and the protection of participants, (iii) the sharing of benefits with LMIC populations, (iii) the acceptable limits to risks and burdens for participants, (iv) the potential for third-party risk and whether the degree of acceptable third-party risk is different in endemic settings, (v) the conditions under which (if any) it would be appropriate to recruit children for disease-causing HCS, (v) appropriate levels of payment to participants and (vi) appropriate governance of (LMIC) HCS. This paper provides preliminary analyses of these ethical considerations in order to (i) inform scientists and policymakers involved in the planning, conduct and/or governance of LMIC HCS and (ii) highlight areas warranting future research. Insofar as this article focuses on HCS in (endemic) settings where diseases are present and/or widespread, much of the analysis provided is relevant to HCS (in HICs or LMICs) involving pandemic diseases including COVID19.


title: Lived population density and the spread of COVID-19

text: We consider variations in the rate of spread of COVID-19, firstly comparing between European countries and secondly comparing between US states. We show that the population density has a small but significant effect on the rate of spread of the virus. However we show that measures of `lived population density', which capture density as perceived by a randomly chosen person, do a better job of explaining variations in the rate of spread, achieving $R^2 = 0.45$ in Europe. We show that adding further measures based on the timing of the outbreak into the regression can increase this to $R^2 = 0.58$.


docid: qrzstmwv

title: Palliative care considerations for cardiovascular clinicians in COVID-19


The Early Impact of COVID-19 Pandemic on Surgical Urologic Oncology Practice in Turkey: Multi-Institutional Experience From Different Geographic Areas


Working from home in the time of COVID-19: how to best preserve occupational health?


Working in isolation to find a cure for COVID-19


Commentary: Lung surgery in the time of COVID-19


title: COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period

text: : Little is known about surgical practice in the initial phase of coronavirus disease 2019 (COVID-19) global crisis. This is a retrospective case series of 4 surgical patients (cholecystectomy, hernia repair, gastric bypass, and hysterectomy) who developed perioperative complications in the first few weeks of COVID-19 outbreak in Tehran, Iran in the month of February 2020. COVID-19 can complicate the perioperative course with diagnostic challenge and a high potential fatality rate. In locations with widespread infections and limited resources, the risk of elective surgical procedures for index patient and community may outweigh the benefit.


title: Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals

text: The ongoing outbreak of coronavirus disease 2019 (COVID-19) has spread rapidly on a global scale. Although it is clear that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted through human respiratory droplets and direct contact, the potential for aerosol transmission is poorly understood1-3. Here we investigated the aerodynamic nature of SARS-CoV-2 by measuring viral RNA in aerosols in different areas of two Wuhan hospitals during the outbreak of COVID-19 in February and March 2020. The concentration of SARS-CoV-2 RNA in aerosols that was detected in isolation wards and ventilated patient rooms was very low, but it was higher in the toilet areas used by the patients. Levels of airborne SARS-CoV-2 RNA in the most public areas was undetectable, except in two areas that were prone to crowding; this increase was possibly due to individuals infected with SARS-CoV-2 in the crowd. We found that some medical staff areas initially had high concentrations of viral RNA with aerosol size distributions that showed peaks in the submicrometre and/or supermicrometre regions; however, these levels were reduced to undetectable levels after implementation of rigorous sanitization procedures. Although we have not established the infectivity of the virus detected in these hospital areas, we propose that SARS-CoV-2 may have the potential to be transmitted through aerosols. Our results indicate that room ventilation, open space, sanitization of protective apparel, and proper use and disinfection of toilet areas can effectively limit the concentration of SARS-CoV-2 RNA in aerosols. Future work should explore the infectivity of aerosolized virus.


title: Management of orthopaedic and traumatology patients during the Coronavirus disease (COVID-19) pandemic in northern Italy

text: PURPOSE: This article aims to share northern Italy's experience in hospital re-organization and management of clinical pathways for traumatic and orthopaedic patients in the early stages of the COVID-19 pandemic. METHODS: Authors collected regional recommendations to re-organize the healthcare system during the initial weeks of the COVID-19 pandemic in March, 2020. The specific protocols implemented in an orthopaedic hospital, selected as a regional hub for minor trauma, are analyzed and described in this article. RESULTS: Two referral centres were identified as the hubs for minor trauma to reduce the risk of overload in general hospitals. These two centres have specific features: an emergency room, specialized orthopaedic surgeons for joint diseases and trauma surgeons on-call 24/7. Patients with trauma without the need for a multi-disciplinary approach or needing non-deferrable elective orthopaedic surgery were moved to these hospitals. Authors report the internal protocols of one of these centres. All elective surgery was stopped, outpatient clinics limited to emergencies and specific pathways, ward and operating theatre dedicated to COVID-19-positive patients were implemented. An oropharyngeal swab was performed in the emergency room for all patients needing to be admitted, and patients were moved to a specific ward with single rooms to wait for the results. Specific courses were organized to demonstrate the correct use of personal protection equipment (PPE). CONCLUSION: The structure of the orthopaedic hubs, and the internal protocols proposed, could help to improve the quality of assistance for patients with musculoskeletal disorders and reduce the risk of overload in general hospitals during the COVID-19 pandemic.


The role of additive manufacturing and antimicrobial polymers in the COVID-19 pandemic


La pandemia por el nuevo coronavirus covid-19./ [The novel coronavirus covid-19 pandemic]


title: CRISP: A Probabilistic Model for Individual-Level COVID-19 Infection Risk Estimation Based on Contact Data

text: We present CRISP (COVID-19 Risk Score Prediction), a probabilistic graphical model for COVID-19 infection spread through a population based on the SEIR model where we assume access to (1) mutual contacts between pairs of individuals across time across various channels (e.g., Bluetooth contact traces), as well as (2) test outcomes at given times for infection, exposure and immunity tests. Our micro-level model keeps track of the infection state for each individual at every point in time, ranging from susceptible, exposed, infectious to recovered. We develop a Monte Carlo EM algorithm to infer contact-channel specific infection transmission probabilities. Our algorithm uses Gibbs sampling to draw samples of the latent infection status of each individual over the entire time period of analysis, given the latent infection status of all contacts and test outcome data. Experimental results with simulated data demonstrate our CRISP model can be parametrized by the reproduction factor $R_0$ and exhibits population-level infectiousness and recovery time series similar to those of the classical SEIR model. However, due to the individual contact data, this model allows fine grained control and inference for a wide range of COVID-19 mitigation and suppression policy measures. Moreover, the algorithm is able to support efficient testing in a test-trace-isolate approach to contain COVID-19 infection spread. To the best of our knowledge, this is the first model with efficient inference for COVID-19 infection spread based on individual-level contact data; most epidemic models are macro-level models that reason over entire populations. The implementation of CRISP is available in Python and C++ at https://github.com/zalandoresearch/CRISP.


"ANESTHESIA STAT" TO INTUBATE A COVID-19 PATIENT: IMPLICATIONS FOR THE ANESTHESIOLOGIST


title: A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19

text: BACKGROUND: No therapeutics have yet been proven effective for the treatment of severe illness caused by SARS-CoV-2. METHODS: We conducted a randomized, controlled, open-label trial involving hospitalized adult patients with confirmed SARS-CoV-2 infection, which causes the respiratory illness Covid-19, and an oxygen saturation (Sao2) of 94% or less while they were breathing ambient air or a ratio of the partial pressure of oxygen (Pao2) to the fraction of inspired oxygen (Fio2) of less than 300 mm Hg. Patients were randomly assigned in a 1:1 ratio to receive either lopinavir-ritonavir (400 mg and 100 mg, respectively) twice a day for 14 days, in addition to standard care, or standard care alone. The primary end point was the time to clinical improvement, defined as the time from randomization to either an improvement of two points on a seven-category ordinal scale or discharge from the hospital, whichever came first. RESULTS: A total of 199 patients with laboratory-confirmed SARS-CoV-2 infection underwent randomization; 99 were assigned to the lopinavir-ritonavir group, and 100 to the standard-care group. Treatment with lopinavir-ritonavir was not associated with a difference from standard care in the time to clinical improvement (hazard ratio for clinical improvement, 1.31; 95% confidence interval [CI], 0.95 to 1.80). Mortality at 28 days was similar in the lopinavir-ritonavir group and the standard-care group (19.2% vs. 25.0%; difference, -5.8 percentage points; 95% CI, -17.3 to 5.7). The percentages of patients with detectable viral RNA at various time points were similar. In a modified intention-to-treat analysis, lopinavir-ritonavir led to a median time to clinical improvement that was shorter by 1 day than that observed with standard care (hazard ratio, 1.39; 95% CI, 1.00 to 1.91). Gastrointestinal adverse events were more common in the lopinavir-ritonavir group, but serious adverse events were more common in the standard-care group. Lopinavir-ritonavir treatment was stopped early in 13 patients (13.8%) because of adverse events. CONCLUSIONS: In hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir-ritonavir treatment beyond standard care. Future trials in patients with severe illness may help to confirm or exclude the possibility of a treatment benefit. (Funded by Major Projects of National Science and Technology on New Drug Creation and Development and others; Chinese Clinical Trial Register number, ChiCTR2000029308.).


Severe Hypoxemia in Early COVID-19 Pneumonia


title: The Impact of Social Media on Panic During the COVID-19 Pandemic in Iraqi Kurdistan: Online Questionnaire Study

text: BACKGROUND: In the first few months of 2020, information and news reports about the coronavirus disease (COVID-19) were rapidly published and shared on social media and social networking sites. While the field of infodemiology has studied information patterns on the Web and in social media for at least 18 years, the COVID-19 pandemic has been referred to as the first social media infodemic. However, there is limited evidence about whether and how the social media infodemic has spread panic and affected the mental health of social media users. OBJECTIVE: The aim of this study is to determine how social media affects self-reported mental health and the spread of panic about COVID-19 in the Kurdistan Region of Iraq. METHODS: To carry out this study, an online questionnaire was prepared and conducted in Iraqi Kurdistan, and a total of 516 social media users were sampled. This study deployed a content analysis method for data analysis. Correspondingly, data were analyzed using SPSS software. RESULTS: Participants reported that social media has a significant impact on spreading fear and panic related to the COVID-19 outbreak in Iraqi Kurdistan, with a potential negative influence on people's mental health and psychological well-being. Facebook was the most used social media network for spreading panic about the COVID-19 outbreak in Iraq. We found a significant positive statistical correlation between self-reported social media use and the spread of panic related to COVID-19 (R=.8701). Our results showed that the majority of youths aged 18-35 years are facing psychological anxiety. CONCLUSIONS: During lockdown, people are using social media platforms to gain information about COVID-19. The nature of the impact of social media panic among people varies depending on an individual's gender, age, and level of education. Social media has played a key role in spreading anxiety about the COVID-19 outbreak in Iraqi Kurdistan.


docid: vfgwetem

title: Identifying the BLE Advertising Channel for Reliable Distance Estimation on Smartphones

text: As a response to the global COVID-19 surge in 2020, many countries have implemented lockdown or stay-at-home policies. If, however, the contact persons of every infected patient could be identified, the number of virus transmissions could be reduced, while the more incisive measures could be softened. For this purpose, contact tracing using smartphones is being considered as a promising technique. Here, smartphones emit and scan for Bluetooth Low Energy (BLE) signals for detecting devices in range. When a device is detected, its distance is estimated by evaluating its received signal strength. The main insight that is exploited for distance estimation is that the attenuation of a signal increases with the distance along which it has traveled. However, besides distance, there are multiple additional factors that impact the attenuation and hence disturb distance estimation. Among them, frequency selective hardware and signal propagation belong to the most significant ones. For example, a BLE device transmits beacons on three different frequencies (channels), while the transmit power and the receiver sensitivity depend on the frequency. As a result, the received signal strength varies for each channel, even when the distance remains constant. However, the information on which wireless channel a beacon has been received is not made available to a smartphone. Hence, this error cannot be compensated, e.g., by calibration. In this paper, we for the first time provide a solution to detect the wireless channel on which a packet has been received on a smartphone. We experimentally evaluate our proposed technique on multiple different smartphone models. Our results help to make contact tracing more robust by improving the accuracy of distance estimation.


Making the Case for "COVID-19 Prophylaxis" With Lifestyle Medicine


Psychogeriatrics in a World with COVID-19


title: Changes in Provision of Psychotherapy in the Early Weeks of the COVID-19 Lockdown in Austria

text: Reducing personal contacts is a central measure against the spreading of the novel coronavirus disease (COVID-19). This troubles mental health, but also mental health care as treatments usually take place in personal contact and switching to remote treatments might be necessary in times of COVID-19. The present study investigated the question how the provision of psychotherapy changed in the early weeks of the COVID-19 lockdown in Austria and whether there were differences between the four therapeutic orientations eligible in Austria (psychodynamic, humanistic, systemic, behavioral). Psychotherapists (N = 1547) completed an online survey. They entered their number of patients treated on average per week (in personal contact, via telephone, via Internet) in the early weeks of the COVID-19 lockdown in Austria as well as (retrospectively) in the months before. The number of patients treated on average per week in personal contact decreased (on average 81%; p < 0.001), whereas the number of patients treated on average per week via telephone and via Internet increased (on average 979% and 1561%; both p < 0.001). Yet, the decrease of psychotherapies through personal contact was not compensated for by increases of remote psychotherapies (p < 0.001). No differences between the four therapeutic orientations emerged. Results imply an undersupply of psychotherapy in the COVID-19 lockdown and that further changes are necessary to cover the increased need for timely psychotherapy in times of COVID-19.


title: A Well Infant with Coronavirus Disease 2019 (COVID-19) with High Viral Load

text: A well 6-month-old infant with coronavirus disease 2019 (COVID-19) had persistently positive nasopharyngeal swabs to day 16 of admission. This case highlights the difficulties in establishing the true incidence of COVID-19 as asymptomatic individuals can excrete the virus. These patients may play important roles in human-to-human transmission in the community.


Continuous high-dose ivermectin appears to be safe in patients with acute myelogenous leukemia and could inform clinical repurposing for COVID-19 infection


title: Build-at-home UV-C disinfection system for healthcare settings

text: Significant research has shown that UV-C exposure is an effective disinfectant for a range of bacteria and viruses, including coronaviruses. As such, a UV-C treatment in combination with a chemical wipe, such as EPA hydrogen peroxide, is a common cleaning protocol in a medical setting, and such disinfection protocols have gained in importance during the current COVID-19 pandemic due to the need to reuse PPE. However, given the substantial increase in patient volume, the quantity of materials requiring disinfection exceeds the UV-C equipment throughput capabilities at many medical facilities. Therefore, there is a need for a UV-C disinfection system that can be rapidly deployed. In response to this demand, we designed, constructed, and validated a UV-C disinfection system from readily accessible components; specifically, a plastic bin, UV-C light bulb and conventional light housing. To further improve the performance, the interior of the tub was spray-painted with chrome paint, forming a low quality-factor (Q) Fabry-Perot optical cavity. As part of this work, a set of modular design criteria which allows for flexibility in component selection without degradation of UV-C dose performance is established. This flexibility is critical given the current fluctuating availability of source materials. The disinfection capabilities of the system are validated using Bacillus cereus, a gram-positive endospore-forming bacteria.


title: Geospatial analysis of COVID-19 and otolaryngologists above age 60

text: OBJECTIVE: The 2019 novel coronavirus (COVID-19) is disproportionately impacting older individuals and healthcare workers. Otolaryngologists are especially susceptible with the elevated risk of aerosolization and corresponding high viral loads. This study utilizes a geospatial analysis to illustrate the comparative risks of older otolaryngologists across the United States during the COVID-19 pandemic. METHODS AND MATERIALS: Demographic and state population data were extracted from the State Physician Workforce Reports published by the AAMC for the year 2018. A geospatial heat map of the United States was then constructed to illustrate the location of COVID-19 confirmed case counts and the distributions of ENTs over 60 years for each state. RESULTS: In 2018, out of a total of 9578 practicing U.S. ENT surgeons, 3081 were older than 60 years (32.2%). The states with the highest proportion of ENTs over 60 were Maine, Delaware, Hawaii, and Louisiana. The states with the highest ratios of confirmed COVID-19 cases to the number of total ENTs over 60 were New York, New Jersey, Massachusetts, and Michigan. CONCLUSIONS: Based on our models, New York, New Jersey, Massachusetts, and Michigan represent states where older ENTs may be the most susceptible to developing severe complications from nosocomial transmission of COVID-19 due to a combination of high COVID-19 case volumes and a high proportion of ENTs over 60 years.


title: Cardiac Care of Patients with Cardiac Amyloidosis

text: Cardiac amyloidosis, the majority of cases of which are due to immunoglobulin light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), affects different aspects of the heart and cardiovascular system. Amyloid-induced cardiomyopathy, clinically manifesting with heart failure and electrophysiological abnormalities, has distinct characteristics compared to non-amyloid cardiomyopathies. Accordingly, specific management strategies are required. This paper will review the cardiovascular manifestations of patients with cardiac amyloidosis and their suggested treatment strategies, emphasizing the importance of multidisciplinary care.