title: Rhythm blues in the time of coronavirus disease 2019 (COVID-19): how the cardiac electrophysiologist adapts to a viral pandemic in Singapore

text: Coronavirus disease 2019 (COVID-19) is a major healthcare disaster in the modern times. Healthcare services must adapt to effectively juggle between pandemic management and maintenance of business-as-usual services so that both COVID-19 and non-COVID-19 patients receive appropriate clinical care. We share our experience of significant cardiac rhythm abnormalities seen in COVID-19 patients in Singapore, how the viral pandemic has affected the cardiac electrophysiology and pacing service in a large acute care general hospital and the steps taken to alleviate the negative impact.


title: Mathematical Modeling of COVID-19 Transmission Dynamics with a Case Study of Wuhan

text: We propose a compartmental mathematical model for the spread of the COVID-19 disease with special focus on the transmissibility of super-spreaders individuals. We compute the basic reproduction number threshold, we study the local stability of the disease free equilibrium in terms of the basic reproduction number, and we investigate the sensitivity of the model with respect to the variation of each one of its parameters. Numerical simulations show the suitability of the proposed COVID-19 model for the outbreak that occurred in Wuhan, China.


Protecting our healthcare workers during the COVID-19 pandemic


Unexpected Benefits to Virtual Care During COVID-19


title: The Elabela-APJ axis: a promising therapeutic target for heart failure

text: Heart failure (HF) is a growing epidemic with high morbidity and mortality at an international scale. The apelin-APJ receptor pathway has been implicated in HF, making it a promising therapeutic target. APJ has been shown to be activated by a novel endogenous peptide ligand known as Elabela (ELA, also called Toddler or Apela), with a critical role in cardiac development and function. Activation of the ELA-APJ receptor axis exerts a wide range of physiological effects, including depressor response, positive inotropic action, diuresis, anti-inflammatory, anti-fibrotic, and anti-remodeling, leading to its cardiovascular protection. The ELA-APJ axis is essential for diverse biological processes and has been shown to regulate fluid homeostasis, myocardial contractility, vasodilation, angiogenesis, cellular differentiation, apoptosis, oxidative stress, cardiorenal fibrosis, and dysfunction. The beneficial effects of the ELA-APJ receptor system are well-established by treating hypertension, myocardial infarction, and HF. Additionally, administration of ELA protects human embryonic stem cells against apoptosis and stress-induced cell death and promotes survival and self-renewal in an APJ-independent manner (X receptor) via the phosphatidylinositol 3-kinase/Akt pathway, which may provide a new therapeutic approach for HF. Thus, targeting the ELA-APJ axis has emerged as a pre-warning biomarker and a novel therapeutic approach against progression of HF. An increased understanding of cardiovascular actions of ELA will help to develop effective interventions. This article gives an overview of the characteristics of the ELA-apelin-APJ axis and summarizes the current knowledge on its cardioprotective roles, potential mechanisms, and prospective application for acute and chronic HF.


title: Clinical characteristics and outcomes in people living with HIV hospitalized for COVID-19

text: We describe the characteristics of 31 people living with HIV (PLWH) hospitalized for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. All patients were on antiretroviral therapy and virologically suppressed at the time of admission. Clinical course and outcomes were similar to those reported in other hospitalized cohorts.


title: Pangolins Lack IFIH1/MDA5, a Cytoplasmic RNA Sensor That Initiates Innate Immune Defense Upon Coronavirus Infection

text: Zoonotic infections are an imminent threat to human health. Pangolins were recently identified as carriers and intermediate hosts of coronaviruses. Previous research has shown that infection with coronaviruses activates an innate immune response upon sensing of viral RNA by interferon-induced with helicase C domain 1 (IFIH1), also known as MDA5. Here, we performed a comparative genomics study of RNA sensor genes in three species of pangolins. DDX58/RIG-I, a sensor of cytoplasmic viral RNA and toll-like receptors (TLR) 3, 7, and 8, which bind RNA in endosomes, are conserved in pangolins. By contrast, IFIH1 a sensor of intracellular double-stranded RNA, has been inactivated by mutations in pangolins. Likewise, Z-DNA-binding protein (ZBP1), which senses both Z-DNA and Z-RNA, has been lost during the evolution of pangolins. These results suggest that the innate immune response to viruses differs significantly between pangolins and other mammals, including humans. We put forward the hypothesis that loss of IFIH1 and ZBP1 provided an evolutionary advantage by reducing inflammation-induced damage to host tissues and thereby contributed to a switch from resistance to tolerance of viral infections in pangolins.


Keeping the Wheels of the Scientific Endeavor Turning during the COVID-19 Pandemic


title: Understanding face mask use to prevent coronavirus and other illnesses: Development of a multidimensional face mask perceptions scale

text: Face masks are an avenue to curb the spread of coronavirus, but few people in Western societies wear face masks. Social scientists have rarely studied face mask wearing, leaving little guidance for methods to encourage these behaviours. In the current article, we provide an approach to address this issue by developing the 32-item and 8-dimension Face Mask Perceptions Scale (FMPS). We begin by developing an over-representative item list in a qualitative study, wherein participants' responses are used to develop items to ensure content relevance. This item list is then reduced via exploratory factor analysis in a second study, and the eight dimensions of the scale are supported. We also support the validity of the FMPS, as the scale significantly relates to both face mask wearing and health perceptions. We lastly confirm the factor structure of the FMPS in a third study via confirmatory factor analysis. From these efforts, we identify an avenue that social scientists can aid in preventing coronavirus and illness more broadly - by studying face mask perceptions and behaviours.


Prevention of skin damage caused by the protective equipment used to mitigate COVID-19


Angiotensin II infusion in COVID-19-associated vasodilatory shock: a case series


Covid-19: all non-urgent elective surgery is suspended for at least three months in England


title: In hospital verification of non CE-marked respiratory protective devices to ensure safety of healthcare staff during the COVID-19 outbreak

text: AIM: To develop a protocol to ensure the quality of respiratory protective devices for healthcare workers nursing and treating patients with possible or confirmed COVID-19 in the Catharina hospital. BACKGROUND: Due to the COVID-19 outbreak a shortage of respirators is occurring worldwide; more specifically, CE-certified FFP2 respirators. This has resulted in an increased supply to hospitals of alternative respirators of uncertain quality. Nevertheless, the quality of the respirators used by our healthcare workers must be ensured. METHOD: A protocol and criteria based on applicable standards was developed to ensure the quality of respirators. The protocol has been implemented at the Catharina hospital and includes verification of the documents accompanying the respirator, visual inspection of the respirator and a test for total inward leak of particles into respirators. FINDINGS: 67% of the respirators brands and types received in the Catharina hospital did not meet quality criteria. CONCLUSION: With a simple verification protocol the quality of the respirators can be checked and guaranteed while there is a shortage of the CE approved respirators which are normally used. With this in-hospital protocol health care workers can be equipped with safe-to-use respirators.


Resuscitating Patient Rights during the Pandemic: COVID-19 and the Risk of Resurgent Paternalism


title: Evidence Supporting a Phased Immuno-physiological Approach to COVID-19 From Prevention Through Recovery

text: This paper presents an evidence-based strategy for improving clinical outcomes in COVID-19 Recommendations are based on the phases of the disease, because optimal interventions for one phase may not be appropriate for a different phase The four phases addressed are: Prevention, Infection, Inflammation and Recovery Underlying this phased approach is recognition of emerging evidence for two different components of pathophysiology, early infection and late stage severe complications These two aspects of the disease suggest two different patterns of clinical emphasis that seem on the surface to be not entirely concordant We describe the application of therapeutic strategies and appropriate tactics that address four main stages of disease progression for COVID-19 Emerging evidence in COVID-19 suggests that the SARS-CoV-2 virus may both evade the innate immune response and kill macrophages Delayed innate immune response and a depleted population of macrophages can theoretically result in a blunted antigen presentation, delaying and diminishing activation of the adaptive immune response Thus, one clinical strategy involves supporting patient innate and adaptive immune responses early in the time course of illness, with the goal of improving the timeliness, readiness, and robustness of both the innate and adaptive immune responses At the other end of the disease pathology spectrum, risk of fatality in COVID-19 is driven by excessive and persistent upregulation of inflammatory mechanisms associated with cytokine storm Thus, the second clinical strategy is to prevent or mitigate excessive inflammatory response to prevent the cytokine storm associated with high mortality risk Clinical support for immune system pathogen clearance mechanisms involves obligate activation of immune response components that are inherently inflammatory This puts the goals of the first clinical strategy (immune activation) potentially at odds with the goals of the second strategy(mitigation of proinflammatory effects) This creates a need for discernment about the time course of the illness and with that, understanding of which components of an overall strategy to apply at each phase of the time course of the illness We review evidence from early observational studies and the existing literature on both outcomes and mechanisms of disease, to inform a phased approach to support the patient at risk for infection, with infection, with escalating inflammation during infection, and at risk of negative sequelae as they move into recovery


Commentary: Challenges to thoracic surgeons in the global coronavirus pandemic


title: Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study

text: BACKGROUND: Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. METHODS: 35â883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61â075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). FINDINGS: Seroprevalence was 5·0% (95% CI 4·7-5·4) by the point-of-care test and 4·6% (4·3-5·0) by immunoassay, with a specificity-sensitivity range of 3·7% (3·3-4·0; both tests positive) to 6·2% (5·8-6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (<3·1% by the point-of-care test). There was substantial geographical variability, with higher prevalence around Madrid (>10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1-92·1; both tests positive) to 91·8% (86·3-95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8-16·8) to 19·3% (17·7-21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1-24·9) to 35·8% (33·1-38·5). Only 19·5% (16·3-23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test. INTERPRETATION: The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave. FUNDING: Spanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System.


Back-to-work Coronavirus infection control


Latin America and Its Global Partners Toil to Procure Medical Supplies as COVID-19 Pushes the Region to Its Limit


Ground-glass opacity on chest computed tomography in a young, athletic man with coronavirus disease 2019-related pneumonia without hypoxemia


title: Targeting SARS-COV-2 non-structural protein 16: a virtual drug repurposing study

text: Non-Structural Protein 16 (nsp-16), a viral RNA methyltransferase (MTase), is one of the highly viable targets for drug discovery of coronaviruses including SARS-CoV-2. In this study, drug discovery of SARS-CoV-2 nsp-16 has been performed by a virtual drug repurposing approach. First, drug shape-based screening (among FDA approved drugs) with a known template of MTase inhibitor, sinefungin was done and best compounds with high similarity scores were selected. In addition to the selected compounds, 4 nucleoside analogs of anti-viral (Raltgravir, Maraviroc and Favipiravir) and anti-inflammatory (Prednisolone) drugs were selected for further investigations. Then, binding energies and interaction modes were found by molecular docking approaches and compouds with lower energy were selected for further investigation. After that, Molecular dynamics (MD) simulation was carried to test the potential selected compounds in a realistic environment. The results showed that Raltegravir and Maraviroc among other compounds can bind strongly to the active site of the protein compared to sinefungin, and can be potential candidates to inhibit NSP-16. Also, the MD simulation results suggested that the Maraviroc and Raltegravir are more effective drug candidates than Sinefungin for inhibiting the enzyme. It is concluded that Raltegravir and Maraviroc which may be used in the treatment of COVID-19 after Invitro and invivo studies and clinical trial for final confirmation of drug effectiveness.Communicated by Ramaswamy H. Sarma.


title: Operating room management strategy for orthopedic patients in Third Hospital of Hebei Medical University during epidemic of corona virus disease 2019/ 中华创伤杂志

text: In December 2019, the corona virus disease 2019 (COVID-19) broke out in Wuhan, Hubei Province. Although the number of newly confirmed COVID-19 cases in provinces outside of Hubei Province has declined continuously since February 4, the epidemic of COVID-19 remains serious. As companies resume work, it is still inevitable that some high-energy orthopedic trauma patients and elderly patients with low-energy fractures will need surgical treatment. The operating room, as a place for close contact between doctors, patients and nurses, increases the risk of infection and transmission. Based on the current needs of orthopedic trauma patients and the situation of the country's resistance to the epidemic of COVID-19, the authors expound the operating room management, preparation of medical materials, transfer of patients needing surgery, intraoperative protection and post-operative end disinfection in Third Hospital of Hebei Medical University so as to provide reference for prevention and control management of the operating room during the epidemic period.


P-selectin blockade in COVID-19-related ARDS


Audio Interview: Preparing for the Spread of Covid-19


title: The isolation period should be longer: Lesson from a child infected with SARS-CoV-2 in Chongqing, China

text: In December 2019, COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbroke in Wuhan, the capital city of Hubei province, China. The disease rapidly spread to other areas in China due to a huge population movement during the New Year Festival. Here, a 7-year-old child with SARS-CoV-2 infection in Chongqing, outside of Wuhan, Hubei province, was reported. This case suggested that children infected with SARS-CoV-2 are more likely to present milder manifestations than adults. The continuous positive real-time reverse transcription-polymerase chain reaction assay for SARS-CoV-2 in the child's throat swab sample indicated the isolation period for suspected child cases should be longer than 14 days.


title: Testing COVID-19 tests faces methodological challenges

text: In battling the COVID-19 pandemic, testing is essential. The detection of viral RNA allows the identification of infected persons, while the detection of antibodies may reveal a response to a previous infection. Tests for coronavirus should be rigorously evaluated in terms of their analytical and clinical performance. This poses not only logistic challenges, but also methodological ones. Some of these are generic for the diagnostic accuracy paradigm, while others are more specific for tests for viruses. Problematic for evaluations of the clinical performance of tests for viral RNA is the absence of an independent reference standard. Many studies lack rigor in terms of the recruitment of study participants. Study reports are often insufficiently informative, which makes it difficult to assess the applicability of study findings. Attempts to summarize the performance of these tests in terms of a single estimate of the clinical sensitivity fails to do justice to the identifiable sources of the large heterogeneity in mechanisms for generating false negative results.


title: Italy in a Time of Emergency and Scarce Resources: The Need for Embedding Ethical Reflection in Social and Clinical Settings

text: The COVID-19 virus is severely testing the Italian healthcare system, as the requests for intensive treatment are greater than the real capacity of the system to receive patients. Given this emergency situation, it follows that citizens are limited in their freedom of movement in order to limit infection, and that in hospitals a significant number of critical situations must be faced. This brief contribution aims to offer a reflection on the public and clinical role of the bioethicist: a figure able to promote dialogue between the world of medicine and the community, and to face ethical dilemmas even in emergent clinical settings.


Proposed Workflow for Rehabilitation in a Field Hospital Setting during the COVID-19 Pandemic


Physician Supply During the Coronavirus Disease 2019 (COVID-19) Crisis: the Role of Hazard Pay


title: How to Produce Cheap and Easy Custom-Made Sterilizable Filtering Facepiece 2/3 Masks for Healthcare Providers During Pandemic COVID-19 Emergency

text: On January 8, 2020, a novel coronavirus was officially announced as the causative pathogen of coronavirus disease (COVID-19) by the Chinese Center for Disease Control and Prevention.On February 26, COVID-19 has been recognized in 34 countries, with a total of 80,239 laboratory-confirmed patients and 2700 deaths.Protecting healthcare workers from infectious hazards is paramount to ensuring their safety in delivering health care.In addition, being able to protect healthcare workers, constituting the front-line response against high-threat respiratory pathogens, such as severe acute respiratory syndrome coronavirus 2, is important for reducing secondary transmission in healthcare-associated outbreaks.Authors present a simple, reliable, and cheap protocol to produce a custom-made sterilizable filtering facepiece 2/3 masks for healthcare providers during pandemic COVID-19 emergency.


title: Digital Ischemia in COVID-19 Patients: Case Report

text: As coronavirus 2019 (COVID-19) continues to cause an immense burden on the global health care systems, it is crucial to understand the breadth of this disease process. Recent reports identified hypercoagulability in a subset of critically ill patients and extremity ischemia in an even smaller cohort. Because abnormal coagulation parameters and extremity ischemia have been shown to correlate with poor disease prognosis, understanding how to treat these patients is crucial. To better describe the identification and management of this phenomenon, we present 2 cases of critically ill patients with COVID-19 who developed fingertip ischemia while in the intensive care unit.


Smartphone based ROP (S-ROP) screening-opportunities and challenges


Emergent Strategies for the Next Phase of COVID-19


title: A single-centre experience of intravenous thrombolysis for stroke in COVID-19 patients

text: The sudden worldwide outbreak of Coronavirus Disease 2019 (COVID-19) has certainly provided new challenges in the management of acute ischaemic stroke, and the risk-benefit ratio of intravenous thrombolysis in COVID-19 positive patients is not well known. We describe four COVID-19 patients treated with intravenous thrombolysis for acute ischaemic stroke. Although rt-PA administration is the main therapeutic strategy, our patients experienced unpredictable complications and showed atypical features: the overall mortality was very high. In conclusion, in this article, we provide information about these cases and discuss the possible explanation behind this trend.


title: ‘A completely new culture of doing research.’ Coronavirus outbreak changes how scientists communicate ;Science ;AAAS

text: On 22 January, Dave O’Connor and Tom Friedrich invited several dozen colleagues around the United States to join a new workspace on the instant messaging platform Slack The scientists, both at the Wisconsin National Primate Research Center, had seen news about a new disease emerging in China and realized researchers would need a primate model if they were going to answer some important questions about its biology “We put out a call to a bunch of investigators and basically said: ‘Hey, let’s talk,’” O’Connor says The idea is to coordinate research and make sure results are comparable, Friedrich adds (They named the Slack workspace the Wu-han Clan, a play on the hip-hop group Wu-Tang Clan ) The Wu-han Clan is just one example of how the COVID-19 outbreak is transforming how scientists communicate about fast-moving health crises A torrent of data is being released daily by preprint servers that didn’t even exist a decade ago, then dissected on platforms such as Slack and Twitter, and in the media, before formal peer review begins Journal staffers are working overtime to get manuscripts reviewed, edited, and published at record speeds The venerable New England Journal of Medicine (NEJM) posted one COVID-19 paper within 48 hours of submission Viral genomes posted on a platform named GISAID, more than 200 so far, are analyzed instantaneously by a phalanx of evolutionary biologists who share their phylogenetic trees in preprints and on social media


docid: toarzmkn

title: Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic

text: AIMS: To investigate the work stress among Chinese nurses who are supporting Wuhan in fighting against Coronavirus Disease 2019 (COVID-19) infection and to explore the relevant influencing factors. BACKGROUND: The COVID-19 epidemic has posed a major threat to public health. Nurses have always played an important role in infection prevention, infection control, isolation, containment and public health. However, available data on the work stress among these nurses are limited. METHODS: A cross-sectional survey. An online questionnaire was completed by 180 anti-epidemic nurses from Guangxi. Data collection tools, including the Chinese version of the Stress Overload Scale (SOS) and the Self-rating Anxiety Scale (SAS), were used. Descriptive single factor correlation and multiple regression analyses were used in exploring the related influencing factors. RESULTS: The SOS (39.91 ± 12.92) and SAS (32.19 ± 7.56) scores of this nurse group were positively correlated (r = 0.676, p < .05). Multiple regression analysis showed that only children, working hours per week and anxiety were the main factors affecting nurse stress (p = .000, .048, .000, respectively). CONCLUSIONS: Nurses who fight against COVID-19 were generally under pressure. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should pay attention to the work stress and the influencing factors of the nurses who are fighting against COVID-19 infection, and offer solutions to retain mental health among these nurses.


Insights from nanomedicine into chloroquine efficacy against COVID-19


COVID-19-Where Have All the STEMIs Gone?


title: SciSight: Combining faceted navigation and research group detection for COVID-19 exploratory scientific search

text: The COVID-19 pandemic has sparked unprecedented mobilization of scientists, already generating thousands of new papers that join a litany of previous biomedical work in related areas. This deluge of information makes it hard for researchers to keep track of their own research area, let alone explore new directions. Standard search engines are designed primarily for targeted search and are not geared for discovery or making connections that are not obvious from reading individual papers. In this paper, we present our ongoing work on SciSight, a novel framework for exploratory search of COVID-19 research. Based on formative interviews with scientists and a review of existing tools, we build and integrate two key capabilities: first, exploring interactions between biomedical facets (e.g., proteins, genes, drugs, diseases, patient characteristics); and second, discovering groups of researchers and how they are connected. We extract entities using a language model pre-trained on several biomedical information extraction tasks, and enrich them with data from the Microsoft Academic Graph (MAG). To find research groups automatically, we use hierarchical clustering with overlap to allow authors, as they do, to belong to multiple groups. Finally, we introduce a novel presentation of these groups based on both topical and social affinities, allowing users to drill down from groups to papers to associations between entities, and update query suggestions on the fly with the goal of facilitating exploratory navigation. SciSight has thus far served over 10K users with over 30K page views and 13% returning users. Preliminary user interviews with biomedical researchers suggest that SciSight complements current approaches and helps find new and relevant knowledge.


Telemedicine: Has the Time Really Finally Arrived?


title: Prone Positioning for Pregnant Women With Hypoxemia Due to Coronavirus Disease 2019 (COVID-19)

text: The coronavirus disease 2019 (COVID-19) pandemic has prompted expanded use of prone positioning for refractory hypoxemia. Clinical trials have demonstrated beneficial effects of early prone positioning for acute respiratory distress syndrome (ARDS), including decreased mortality. However, pregnant women were excluded from these trials. To address the need for low-cost, low-harm interventions in the face of a widespread viral syndrome wherein hypoxemia predominates, we developed an algorithm for prone positioning of both intubated and nonintubated pregnant women. This algorithm may be appropriate for a wide spectrum of hypoxemia severity among pregnant women. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is responsible for the clinical manifestations of COVID-19. This syndrome can manifest as severe pneumonia complicated by hypoxemia and ARDS. Given the current global COVID-19 pandemic, with a large number of ARDS cases, there is renewed interest in the use of prone positioning to improve oxygenation in moderate or severe hypoxemia. Among the populations who can benefit from prone positioning are pregnant women experiencing severe respiratory distress, as long as the physiologic changes and risks of pregnancy are taken into account.


title: A new threat from an old enemy: Reemergence of coronavirus (Review)

text: The new outbreak of coronavirus from December 2019 has brought attention to an old viral enemy and has raised concerns as to the ability of current protection measures and the healthcare system to handle such a threat. It has been known since the 1960s that coronaviruses can cause respiratory infections in humans; however, their epidemic potential was understood only during the past two decades. In the present review, we address current knowledge on coronaviruses from a short history to epidemiology, pathogenesis, clinical manifestation of the disease, as well as treatment and prevention strategies. Although a great amount of research and efforts have been made worldwide to prevent further outbreaks of coronavirusassociated disease, the spread and lethality of the 2019 outbreak (COVID19) is proving to be higher than previous epidemics on account of international travel density and immune naivety of the population. Only strong, joint and coordinated efforts of worldwide healthcare systems, researchers, and pharmaceutical companies and receptive national leaders will succeed in suppressing an outbreak of this scale.


title: Epidemiologic characteristics of traumatic fractures during the outbreak of coronavirus disease 2019 (COVID-19) in China: A retrospective & comparative multi-center study

text: PURPOSE: Amid the outbreak of coronavirus disease 2019 (COVID-19), effective measures have been taken in China to suggest people wearing masks and staying at home. The majority of the people stayed at home, which had an obvious impact on the occurrence of traumatic fractures. This study aimed to describe the epidemiologic characteristics of traumatic fractures during the COVID-19, and provide reference for targeted control measures for the whole world by proposing China's experiences. METHODS: This was a retrospective & comparative multi-center study with data obtained from 11 hospitals in five provinces of China. Patients were enrolled into this study, who sustained fractures from 20 January to 19 February 2020 and the same period in 2019 (based on Chinese lunar calendar). All patients were divided into two groups: epidemic group (admitted in 2020) and control group (admitted in 2019). The data of patients' demographics (age and gender), injury related data (fracture type, fractured site, osteoporosis fracture, concurrent fractures, injury mechanism, places where fracture occurred, ISS score, Gustilo-Anderson Classification for open fracture), mortality and treatment modality were compared between the two groups. RESULTS: A total of 2,489 patients with 2,590 fractures were included. In the epidemic group, there were 865 patients, including 483 (55.8%) males and 382 (44.2%) females with an average age of 53.1 ± 23.1 years (range, 1 to 105). In the control group, there were 1,624 patients, including 876 (53.9%) males and 748 (46.1%) females with an average age of 51.2 ± 21.5 years (range, 1 to 98). Patients in the epidemic group was significantly older than those in the control group (t=-2.046, P = 0.045). For epidemic group, the mostly commonly involved age group was elderly patients, whereas it was middle-aged adults for the control group (χ2 = 14.642, P = 0.002). For epidemic group, a total of 576 (66.6%) patients had their fracture occurring at home, while in the control group there was 183 (11.3%). The proportion rates of low energy injuries (79.1%, 684/865), osteoporotic fractures (32.5%, 294/906) and closed fractures (94.5%, 817/865) in the epidemic group were significantly higher when compared to the control group, respectively (34.4%, 559/1624; 26.9%, 453/1684; 91.9%, 1,493/1692; all P<0.05). The proportion rates of Gustilo-Anderson classification (5.5%, 16/865), concurrent fractures (2.3%, 20/865), and injury severity score (15.6 ± 6.7) in epidemic group were significantly lower than those in the control group, respectively (52.8%, 199/1624; 3.9%, 63/1624; 20.1 ± 8.7; all P<0.05). No positive case with COVID-19 was diagnosed in the epidemic group. The mortality rate in the epidemic group (0.46%) was similar with that in the control group (0.43%). CONCLUSIONS: Our findings confirmed the importance of the measures to restrict people's movement and wear masks in the prevention of the spread of COVID-19. The epidemiological characteristics of traumatic fractures amid the epidemic changes dramatically, and more attempts should be focused on the prevention of low energy injuries of elderly population.


Safety considerations with chloroquine, hydroxychloroquine and azithromycin in the management of SARS-CoV-2 infection


Communicating Effectively With Hospitalized Patients and Families During the COVID-19 Pandemic


Should We Be Screening for SARS-CoV-2 in IBD Patients Before Initiation of Biologic Therapy?


UK vets coping well with global pandemic


docid: aichdors

title: Os direitos humanos das crianças com deficiência durante emergências de saúde: o desafio do COVID-19


title: Production of isopropyl and butyl esters by Clostridium mono-culture and co-culture

text: Production of esters from the acetone-butanol-ethanol (ABE) fermentation by Clostridium often focuses on butyl butyrate, leaving acetone as an undesired product. Addition of butyrate is also often needed because ABE fermentation does not produce enough butyrate. Here we addressed the problems using Clostridium beijerinckii BGS1 that preferred to produce isopropanol instead of acetone, and co-culturing it with Clostridium tyrobutyricum ATCC 25,755 that produced butyrate. Unlike acetone, isopropanol could be converted into ester using lipase and acids. C. tyrobutyricum ATCC 25,755 produced acids at pH 6, while C. beijerinckii BGS1 produced mainly solvents at the same pH. When the two strains were co-cultured, more butyrate was produced, leading to a higher titer of esters than the mono-culture of C. beijerinckii BGS1. As the first study reporting the production of isopropyl butyrate from the Clostridium fermentation, this study highlighted the potential use of lipase and co-culture strategy in ester production.


Practical considerations in the anaesthetic management of patients during a COVID-19 epidemic


title: TRAF4 knockdown triggers synergistic lethality with simultaneous PARP1 inhibition in endometrial cancer

text: Endometrial cancer (EC) is one of the most common cancers among females worldwide. Advanced stage patients of EC have poor prognosis. Inevitable side effects and treatment tolerance of chemotherapy for EC remain to be addressed. Our results in this study showed that EC cells with higher tumor necrosis factor receptor-associated factor 4 (TRAF4) expression have lower sensitivity to poly ADP-ribose polymerase 1 (PARP1) inhibitors. Upon TRAF4 knockdown, the colony numbers of EC cells were markedly down-regulated, and the markers of DNA double-strand breakage were significantly up-regulated after the treatment of olaparib, a PARP1 inhibitor. TRAF4 knockdown reduced the phosphorylation of protein kinase B (Akt), promoted DNA double-strand breakage, and decreased levels of DNA repair related proteins, including phosphorylated-DNA-dependent protein kinase (p-DNA-PK) and RAD51 recombinase (RAD51). In addition, TRAF4's effect on the sensitivity of EC cells to olaparib was further found to be mainly mediated by Akt phosphorylation. Moreover, in vivo results showed that TRAF4 knockdown enhanced the sensitivity of EC to PARP1 inhibitors using a mouse xenograft model. Collectively, our data suggest that combined application of TRAF4 knockdown and PARP1 inhibition can be used as a promising strategy for synthetic lethality in EC treatment.


Xenophobia due to the coronavirus outbreak - A letter to the editor in response to "the socio-economic implications of the coronavirus pandemic (COVID-19): A review"


title: Accurate closed-form solution of the SIR epidemic model

text: An accurate closed-form solution is obtained to the SIR Epidemic Model through the use of Asymptotic Approximants (Barlow et al., 2017). The solution is created by analytically continuing the divergent power series solution such that it matches the long-time asymptotic behavior of the epidemic model. The utility of the analytical form is demonstrated through its application to the COVID-19 pandemic.


title: Stop playing with data: there is no sound evidence that Bacille Calmette-Guérin may avoid SARS-CoV-2 infection (for now)

text: Since the beginning of the COVID-19 epidemic, a possible explanation for the high heterogeneity of infection/mortality rates across involved countries was hinted in the prevalence of tuberculosis vaccination with Bacille Calmette-Guérin (BCG). A systematic review was therefore performed on May 2, 2020. A total of 13 articles were ultimately retrieved, 12 of them as preprint papers. All articles were ecological studies of low quality. Most of them did not include main confounding factors (i.e. demographic of the assessed countries, share of peo- ple residing in urban settings, etc.), and simply assessed the differences among incidence/mortality of COVID-19 with vaccination rates or by having vs. having not any vaccination policy for BCG. Even though all studies shared the very same information sources (i.e. international registries for BCG vaccination rates and open source data for COVID-19 epidemics), results were conflicting, with later studies apparently denying any true correlation between COVID-19 occurrence and BCG vaccination rates and/or policies. As a consequence, there is no sound evidence to recommend BCG vaccination for the prevention of COVID-19.


title: Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals

text: Routine care for chronic disease is an ongoing major challenge. We aimed to evaluate the global impact of COVID-19 on routine care for chronic diseases. An online survey was posted 31 March to 23 April 2020 targeted at healthcare professionals. 202 from 47 countries responded. Most reported change in routine care to virtual communication. Diabetes, chronic obstructive pulmonary disease, and hypertension were the most impacted conditions due to reduction in access to care. 80% reported the mental health of their patients worsened during COVID-19. It is important routine care continues in spite of the pandemic, to avoid a rise in non-COVID-19-related morbidity and mortality.


title: Effect of the Phytochemical Agents Against the SARS-CoV and Selected Some of them for Application to COVID-19: A Mini-Review

text: BACKGROUND: The aim of the present review is to provide basic knowledge about the treatment of Coronavirus via medicinal plants. Coronavirus (COVID-19, SARS-CoV, and MERS-CoV) as a viral pneumonia causative agent, infects thousands of people in China and worldwide. There is currently no specific medicine or vaccine available and it is considered a threat to develop effective novel drug or anti-coronavirus vaccine treatment. However, natural compounds to treat coronaviruses are the most alternative and complementary therapies due to their diverse range of biological and therapeutic properties. METHODS: We performed an open-ended, English restricted search of Scopus database, Web of Science, and Pubmed for all available literature from Jan-March, 2020, using terms related to phytochemical compounds, medicinal plants and coronavirus. RESULTS: The view on anti-coronavirus (anti-CoV) activity in the plant derived phytochemicals and medicinal plants give the strong base to develop a novel treatment of corona virus activity. Various phytochemicals and medicinal plant extracts have been revised and considered to be the potential anti-CoV agents for effective control and future drug development. We discuss some important plants (Scutellaria baicalensis, Psorothamnus arborescens, Glycyrrhiza radix, Glycyrrhiza uralensis , Lycoris radiate, Phyllanthus emblica, Camellia sinensis, Hyptis atrorubens Poit, Fraxinus sieboldiana, Erigeron breviscapus, Citri Reticulatae Pericarpium, Amaranthus tricolor, Phaseolus vulgaris, Rheum palmatum, Curcuma longa and Myrica cerifera) emerged to have broad spectrum antiviral activity. CONCLUSION: Nigella sativa has potent anti-SARS-CoV activity and it might be useful souce for developing novel antiviral therapies for coronaviruses.


Why daily death tolls have become unusually important in understanding the coronavirus pandemic


title: Correction to: Children's dental anxiety (self and proxy reported) and its association with dental behaviour in a postgraduate dental hospital

text: In the original publication of the article the third author's name "M. Kowash" was submitted as "K.


Maternal mental health in Nepal and its prioritization during COVID-19 pandemic: Missing the obvious


title: Epidemic models with varying infectivity

text: We introduce an epidemic model with varying infectivity and general exposed and infectious periods, where the infectivity of each individual is a random function of the elapsed time since infection, those function being i.i.d. for the various individuals in the population. This approach models infection-age dependent infectivity, and extends the classical SIR and SEIR models. We focus on the infectivity process (total force of infection at each time), and prove a functional law of large number (FLLN). In the deterministic limit of this LLN, the infectivity process and the susceptible process are determined by a two-dimensional deterministic integral equation. From its solutions, we then derive the exposed, infectious and recovered processes, again using integral equations. We also use these equations to derive the basic reproduction number $R_0$ during the early stage of an epidemic, in terms of the average individual infectivity function and the exponential rate of growth of the epidemic.


docid: vktdvbah

title: Characterization of acute acral skin lesions in nonhospitalized patients: A case series of 132 patients during the COVID-19 outbreak


title: Ecografía en el manejo del paciente crítico con infección por SARS-CoV-2 (COVID-19): una revisión narrativa./ Ecografía en el manejo del paciente crítico con infección por SARS-CoV-2 (COVID-19): una revisión narrativa./ Ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): narrative review

text: The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS) and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common. Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination. A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with an adapted guide to the intensive care setting. Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects cor pulmonale and shock states.


Teledermatology for acne patients: How to reduce face-to-face visits during COVID-19 pandemic


title: COVID-19 and dengue co-infection in a returning traveller

text: In march 2020, a pandemic of respiratory infection due to the SARS-CoV2 is underway, dengue fever epidemics are at the same time present in many regions of the inter-equatorial zone. We report the first cases of covid19-dengue co-infection, which occurred in Mayotte, a French island in the Indian Ocean.


title: A Phased Approach to Resuming Suspended Allergy/Immunology Clinical Services

text: In early 2020, the first US and Canadian cases of the novel severe acute respiratory syndrome coronavirus 2 infection were detected. In the ensuing months, there has been rapid spread of the infection. In March 2020, in response to the virus, state/provincial and local governments instituted shelter-in-place orders, and nonessential ambulatory care was significantly curtailed, including allergy/immunology services. With rates of new infections and fatalities potentially reaching a plateau and/or declining, restrictions on provision of routine ambulatory care are lifting, and there is a need to help guide the allergy/immunology clinician on how to reinitiate services. Given the fact that coronavirus disease 2019 will circulate within our communities for months or longer, we present a flexible, algorithmic best-practices planning approach on how to prioritize services, in 4 stratified phases of reopening according to community risk level, as well as highlight key considerations for how to safely do so. The decisions on what services to offer and how fast to proceed are left to the discretion of the individual clinician and practice, operating in accordance with state and local ordinances with respect to the level of nonessential ambulatory care that can be provided. Clear communication with staff and patients before and after all changes should be incorporated into this new paradigm on continual change, given the movement may be forward and even backward through the phases because this is an evolving situation.


title: Traditional Chinese herbal medicine for treating novel coronavirus (COVID-19) pneumonia: protocol for a systematic review and meta-analysis

text: BACKGROUND: A new type of coronavirus, novel coronavirus (COVID-19), is causing an increasing number of cases of pneumonia and was declared a Public Health Emergency of International Concern by the World Health Organization on 30 January 2020. The virus first appeared in Wuhan, China, in late December 2019, and traditional Chinese herbal medicine is being used for its treatment. This systematic review and meta-analysis will assess studies of the effects of traditional Chinese herbal medicine in COVID-19 pneumonia. METHODS: We will search electronic databases including PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang database using keywords related to COVID-19 and traditional Chinese herbal medicine. Reference lists of relevant trials and reviews will be searched. We will manually search gray literature, such as conference proceedings and academic degree dissertations, and trial registries. Two independent reviewers will screen studies (XL and DZ), extract data (YL and LG), and evaluate risk of bias (YL and DZ). Data analysis will be conducted using the Review Manager software (version 5.3.5) and R software (version 3.6.1). Statistical heterogeneity will be assessed using a standard chi-square test with a significance level of P < 0.10. Biases associated with study size (e.g., publication bias) will be investigated using funnel plots, Egger's test and Begg's test, and Trim and Fill analysis. DISCUSSION: This study will provide a high-quality synthesis of the effects of traditional Chinese herbal medicine for COVID-19. The use of traditional Chinese herbal medicine for treatment or prevention of these novel viral infections affecting the pneumonia will be investigated. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42020168004.


title: Personal protective equipment for ENT activity during COVID-19 pandemic

text: BACKGROUND: In the COVID-19 era physicians have to face with need to perform office procedures maintaining the maximum safety for both the patient and the Doctor himself. The purpose of this paper was to suggest some equipment useful to perform outpatient visits in an ENT setting. METHODS: A simple modification of the standard headlight used during an ENT visit provides the operator a better face protection without any impairment in vision and comfort. In addition, in order to perform a safer ENT examination, a droplet protective barrier has been adapted to the patient's chair. RESULTS: Both the devices have been texted with success during a period of 2 months in our ENT clinic. No cases of contamination have been registered among physicians. CONCLUSION: A simple modification to a device used in the routine ENT activity implemented its protective efficacy with low costs. On the other hand, a more structured tool permitted to obtain a more protected environment during patient examination.


title: Turkish Thoracic Society Experts Consensus Report: Recommendations for Pulmonary Function Tests During and After COVID 19 Pandemic

text: The recommendation of conducting pulmonary function tests (PFTs) from different societies during and after the coronavirus disease (COVID-19) pandemic was rated by the experts of the Turkish Thoracic Society (TTS) and presented as the TTS experts consensus report. Information about the topic has been provided.Globally, as of mid-May 2020, there have been over 4.4 million confirmed cases of COVID-19. There are two main routes of transmission of COVID-19: respiratory droplets and contact transmission. PFTs are non-invasive tests that are commonly performed in routine assessment and follow-up of patients in the pulmonology units. However, PFTs may generate aerosols and require sharing common surfaces. With regard to the high prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the community, PFTs should not be performed routinely in confirmed or suspected patients with COVID-19 during the pandemic. Because of the risk of human-to-human transmission of COVID-19, PFTs should be restricted to a small patient population with selected indications. Triage for COVID-19 should be performed prior to testing. Only essential PFTs such as spirometry, diffusion capacity of the lungs for carbon monoxide (DLCO), arterial blood gas analysis, or pulse oximetry should be performed in the selected cases. Tests should be scheduled to allow sufficient time for donning and doffing of the technical personnel with the full personal protective equipment (PPE) (gown, a filtering respirator mask, goggles or full-face shield, and disposable gloves), ventilation of the room, and application of post-test cleaning and disinfection procedures of the equipment and the testing room.


title: Innate Immunity in Coronavirus Infection ;врожденный Иммунитет При Коронавирусной Инфекции

text: Coronaviruses (CoVs) comprise a polymorphic group of respiratory viruses causing acute inflammatory diseases in domestic and agricultural animals (chicken, pig, buffalo, cat, dog) Until recently, this infection in humans was mainly observed during the autumn-winter period and characterized by a mild, often asymptomatic, course The situation changed dramatically in 2003, when SARS outbreak caused by pathogenic CoV (SARS-CoV) was recorded in China A decade later, a new CoV outbreak occurred in the form of the Middle East respiratory syndrome (MERS-CoV), whereas in December 2019, SARS-CoV-2 (COVID-19) cases were recorded, which transformed within the first months of 2020 into the pandemic In all three cases, CoV disease led to severe bronchopulmonary lesions, varying from dry, debilitating cough to acute respiratory distress syndrome (ARDS) At the same time, multiple changes in innate immunity were noted most often manifested as a pronounced inflammatory reaction in the lower respiratory tract, featured by damaged type II pneumocytes, apoptosis, hyalinization of alveolar membranes, focal or generalized pulmonary edema Destructive processes in the respiratory tract were accompanied by migration of monocytes/macrophages and granulocyte neutrophils to the inflammatory focus Such events were accompanied by production of pro-inflammatory cytokines, which magnitude could ascend up to a cytokine storm SARS-CoV is characterized by symptoms of secondary immunosuppression, manifested by the late onset of interferon production and activation of NLRP3 inflammasomes â€“ the key inflammatory factor The reason for such reaction may be accounted for by CoV arsenal containing extensive set of structural and inflammatory proteins exerting pro-inflammatory and immunosuppressive properties Delayed IFN production allowed CoV to replicate actively and freely, and when type I IFN synthesis was eventually triggered, its activity was detrimental and accompanied by an aggravated infection course Thus, SARS can surely be referred to immune-dependent infections with a marked immunopathological component The purpose of this review was to describe some mechanisms underlying formation of innate immune response to infection caused by pathogenic coronaviruses SARS-CoV, MERS-CoV and SARS-CoV-2 (COVID-19) ;ÐšÐ¾Ñ€Ð¾Ð½Ð°Ð²Ð¸Ñ€ÑƒÑÑ‹ (CoV) Ð¿Ñ€ÐµÐ´ÑÑ‚Ð°Ð²Ð»ÑÑŽÑ‚ ÑÐ¾Ð±Ð¾Ð¹ Ð¿Ð¾Ð»Ð¸Ð¼Ð¾Ñ€Ñ„Ð½ÑƒÑŽ Ð³Ñ€ÑƒÐ¿Ð¿Ñƒ Ñ€ÐµÑÐ¿Ð¸Ñ€Ð°Ñ‚Ð¾Ñ€Ð½Ñ‹Ñ… Ð²Ð¸Ñ€ÑƒÑÐ¾Ð², Ð²Ñ‹Ð·Ñ‹Ð²Ð°ÑŽÑ‰Ð¸Ñ… Ð¾ÑÑ‚Ñ€Ñ‹Ðµ Ð²Ð¾ÑÐ¿Ð°Ð»Ð¸Ñ‚ÐµÐ»ÑŒÐ½Ñ‹Ðµ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ñ Ñƒ Ð´Ð¾Ð¼Ð°ÑˆÐ½Ð¸Ñ… Ð¸ ÑÐµÐ»ÑŒÑÐºÐ¾Ñ…Ð¾Ð·ÑÐ¹ÑÑ‚Ð²ÐµÐ½Ð½Ñ‹Ñ… Ð¶Ð¸Ð²Ð¾Ñ‚Ð½Ñ‹Ñ… (ÐºÑƒÑ€Ñ‹, ÑÐ²Ð¸Ð½ÑŒÐ¸, Ð±ÑƒÐ¹Ð²Ð¾Ð»Ñ‹, ÐºÐ¾ÑˆÐºÐ¸, ÑÐ¾Ð±Ð°ÐºÐ¸) Ð£ Ð»ÑŽÐ´ÐµÐ¹ Ð¸Ð½Ñ„ÐµÐºÑ†Ð¸Ñ Ð´Ð¾ Ð½ÐµÐ´Ð°Ð²Ð½ÐµÐ³Ð¾ Ð²Ñ€ÐµÐ¼ÐµÐ½Ð¸ Ð½Ð°Ð±Ð»ÑŽÐ´Ð°Ð»Ð¾ÑÑŒ Ð¿Ñ€ÐµÐ¸Ð¼ÑƒÑ‰ÐµÑÑ‚Ð²ÐµÐ½Ð½Ð¾ Ð² Ð¾ÑÐµÐ½Ð½Ðµ-Ð·Ð¸Ð¼Ð½Ð¸Ð¹ Ð¿ÐµÑ€Ð¸Ð¾Ð´ Ð¸ Ñ…Ð°Ñ€Ð°ÐºÑ‚ÐµÑ€Ð¸Ð·Ð¾Ð²Ð°Ð»Ð°ÑÑŒ Ð»ÐµÐ³ÐºÐ¸Ð¼, Ð·Ð°Ñ‡Ð°ÑÑ‚ÑƒÑŽ Ð±ÐµÑÑÐ¸Ð¼Ð¿Ñ‚Ð¾Ð¼Ð½Ñ‹Ð¼, Ñ‚ÐµÑ‡ÐµÐ½Ð¸ÐµÐ¼ Ð¡Ð¸Ñ‚ÑƒÐ°Ñ†Ð¸Ñ Ñ€ÐµÐ·ÐºÐ¾ Ð¸Ð·Ð¼ÐµÐ½Ð¸Ð»Ð°ÑÑŒ, Ð² 2003 Ð³Ð¾Ð´Ñƒ, ÐºÐ¾Ð³Ð´Ð° Ð² ÐšÐ¸Ñ‚Ð°Ðµ Ð±Ñ‹Ð»Ð° Ð·Ð°Ñ€ÐµÐ³Ð¸ÑÑ‚Ñ€Ð¸Ñ€Ð¾Ð²Ð°Ð½Ð° Ð²ÑÐ¿Ñ‹ÑˆÐºÐ° Ð°Ñ‚Ð¸Ð¿Ð¸Ñ‡Ð½Ð¾Ð¹ Ð¿Ð½ÐµÐ²Ð¼Ð¾Ð½Ð¸Ð¸, Ð²Ñ‹Ð·Ð²Ð°Ð½Ð½Ð¾Ð¹ Ð¿Ð°Ñ‚Ð¾Ð³ÐµÐ½Ð½Ñ‹Ð¼ CoV (SARS-CoV) Ð¡Ð¿ÑƒÑÑ‚Ñ 10 Ð»ÐµÑ‚ Ð²Ð¾Ð·Ð½Ð¸ÐºÐ»Ð° Ð½Ð¾Ð²Ð°Ñ Ð²ÑÐ¿Ñ‹ÑˆÐºÐ° CoV Ð² Ð²Ð¸Ð´Ðµ Ð±Ð»Ð¸Ð¶Ð½ÐµÐ²Ð¾ÑÑ‚Ð¾Ñ‡Ð½Ð¾Ð³Ð¾ Ñ€ÐµÑÐ¿Ð¸Ñ€Ð°Ñ‚Ð¾Ñ€Ð½Ð¾Ð³Ð¾ ÑÐ¸Ð½Ð´Ñ€Ð¾Ð¼Ð° (MERS-CoV), Ð° Ð² Ð´ÐµÐºÐ°Ð±Ñ€Ðµ 2019 Ð³ Ð¾Ñ‚Ð¼ÐµÑ‡ÐµÐ½Ñ‹ ÑÐ»ÑƒÑ‡Ð°Ð¸ SARS-CoV-2 (COVID-19), Ñ‚Ñ€Ð°Ð½ÑÑ„Ð¾Ñ€Ð¼Ð¸Ñ€Ð¾Ð²Ð°Ð²ÑˆÐ¸ÐµÑÑ Ð² Ð¿ÐµÑ€Ð²Ñ‹Ðµ Ð¼ÐµÑÑÑ†Ñ‹ 2020 Ð³ Ð² Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸ÑŽ Ð’Ð¾ Ð²ÑÐµÑ… Ñ‚Ñ€ÐµÑ… ÑÐ»ÑƒÑ‡Ð°ÑÑ… Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ðµ Ñ‡Ð°ÑÑ‚Ð¾ Ð¿Ñ€Ð¸Ð²Ð¾Ð´Ð¸Ð»Ð¾ Ðº Ñ‚ÑÐ¶ÐµÐ»Ñ‹Ð¼Ð¸ Ð±Ñ€Ð¾Ð½Ñ…Ð¾Ð»ÐµÐ³Ð¾Ñ‡Ð½Ñ‹Ð¼Ð¸ Ð¿Ð¾Ñ€Ð°Ð¶ÐµÐ½Ð¸ÑÐ¼Ð¸, Ð²Ð°Ñ€ÑŒÐ¸Ñ€Ð¾Ð²Ð°Ð²ÑˆÐ¸Ð¼ Ð¾Ñ‚ ÑÑƒÑ…Ð¾Ð³Ð¾ Ð¸Ð·Ð½ÑƒÑ€Ð¸Ñ‚ÐµÐ»ÑŒÐ½Ð¾Ð³Ð¾ ÐºÐ°ÑˆÐ»Ñ Ð´Ð¾ Ð¾ÑÑ‚Ñ€Ð¾Ð³Ð¾ Ñ€ÐµÑÐ¿Ð¸Ñ€Ð°Ñ‚Ð¾Ñ€Ð½Ð¾Ð³Ð¾ Ð´Ð¸ÑÑ‚Ñ€ÐµÑÑ ÑÐ¸Ð½Ð´Ñ€Ð¾Ð¼Ð° (ÐžÐ Ð”Ð¡) ÐžÐ´Ð½Ð¾Ð²Ñ€ÐµÐ¼ÐµÐ½Ð½Ð¾ Ñ ÑÑ‚Ð¸Ð¼ Ð¾Ñ‚Ð¼ÐµÑ‡ÐµÐ½Ñ‹ Ð¼Ð½Ð¾Ð¶ÐµÑÑ‚Ð²ÐµÐ½Ð½Ñ‹Ðµ Ð¸Ð·Ð¼ÐµÐ½ÐµÐ½Ð¸Ñ Ð² ÑÐ¸ÑÑ‚ÐµÐ¼Ðµ Ð²Ñ€Ð¾Ð¶Ð´ÐµÐ½Ð½Ð¾Ð³Ð¾ Ð¸Ð¼Ð¼ÑƒÐ½Ð¸Ñ‚ÐµÑ‚Ð Ñ‡Ð°Ñ‰Ðµ Ð²ÑÐµÐ³Ð¾ Ð² Ð²Ð¸Ð´Ðµ Ð²Ñ‹Ñ€Ð°Ð¶ÐµÐ½Ð½Ð¾Ð¹ Ð²Ð¾ÑÐ¿Ð°Ð»Ð¸Ñ‚ÐµÐ»ÑŒÐ½Ð¾Ð¹ Ñ€ÐµÐ°ÐºÑ†Ð¸Ð¸ Ð² Ð½Ð¸Ð¶Ð½Ð¸Ñ… Ð´Ñ‹Ñ…Ð°Ñ‚ÐµÐ»ÑŒÐ½Ñ‹Ñ… Ð¿ÑƒÑ‚ÑÑ…, Ð¿Ñ€Ð¾ÑÐ²Ð»ÑÐ²ÑˆÐ¸ÐµÑÑ Ð¿Ð¾Ð²Ñ€ÐµÐ¶Ð´ÐµÐ½Ð¸ÐµÐ¼ Ð¿Ð½ÐµÐ²Ð¼Ð¾Ñ†Ð¸Ñ‚Ð¾Ð² II Ð¿Ð¾Ñ€ÑÐ´ÐºÐ°, ÑÐ²Ð»ÐµÐ½Ð¸ÑÐ¼Ð¸ Ð°Ð¿Ð¾Ð¿Ñ‚Ð¾Ð·Ð°, Ð³Ð¸Ð°Ð»Ð¸Ð½Ð¸Ð·Ð°Ñ†Ð¸ÐµÐ¹ Ð°Ð»ÑŒÐ²ÐµÐ¾Ð»ÑÑ€Ð½Ñ‹Ñ… Ð¼ÐµÐ¼Ð±Ñ€Ð°Ð½, Ð¾Ñ‡Ð°Ð³Ð¾Ð²Ñ‹Ð¼ Ð¸Ð»Ð¸ Ð³ÐµÐ½ÐµÑ€Ð°Ð»Ð¸Ð·Ð¾Ð²Ð°Ð½Ð½Ñ‹Ð¼ Ð¾Ñ‚ÐµÐºÐ¾Ð¼ Ð»ÐµÐ³ÐºÐ¸Ñ… Ð”ÐµÑÑ‚Ñ€ÑƒÐºÑ‚Ð¸Ð²Ð½Ñ‹Ðµ Ð¿Ñ€Ð¾Ñ†ÐµÑÑÑ‹ Ð² Ñ€ÐµÑÐ¿Ð¸Ñ€Ð°Ñ‚Ð¾Ñ€Ð½Ð¾Ð¼ Ð¾Ñ‚Ð´ÐµÐ»Ðµ ÑÐ¾Ð¿Ñ€Ð¾Ð²Ð¾Ð¶Ð´Ð°Ð»Ð¸ÑÑŒ Ð¼Ð¸Ð³Ñ€Ð°Ñ†Ð¸ÐµÐ¹ Ð² Ð¾Ñ‡Ð°Ð³ Ð²Ð¾ÑÐ¿Ð°Ð»Ð¸Ñ‚ÐµÐ»ÑŒÐ½Ñ‹Ñ… Ð¼Ð¾Ð½Ð¾Ñ†Ð¸Ñ‚Ð¾Ð²/Ð¼Ð°ÐºÑ€Ð¾Ñ„Ð°Ð³Ð¾Ð² Ð¸ Ð³Ñ€Ð°Ð½ÑƒÐ»Ð¾Ñ†Ð¸Ñ‚Ð°Ñ€Ð½Ñ‹Ñ… Ð½ÐµÐ¹Ñ‚Ñ€Ð¾Ñ„Ð¸Ð»Ð¾Ð² ÐÐ° Ñ„Ð¾Ð½Ðµ Ð¿ÐµÑ€ÐµÑ‡Ð¸ÑÐ»ÐµÐ½Ð½Ñ‹Ñ… ÑÐ²Ð»ÐµÐ½Ð¸Ð¹ Ð½Ð°Ð±Ð»ÑŽÐ´Ð°Ð»Ð°ÑÑŒ Ð²Ñ‹Ñ€Ð°Ð±Ð¾Ñ‚ÐºÐ° Ð¿Ñ€Ð¾Ð²Ð¾ÑÐ¿Ð°Ð»Ð¸Ñ‚ÐµÐ»ÑŒÐ½Ñ‹Ñ… Ñ†Ð¸Ñ‚Ð¾ÐºÐ¸Ð½Ð¾Ð², Ð¸Ð½Ñ‚ÐµÐ½ÑÐ¸Ð²Ð½Ð¾ÑÑ‚ÑŒ ÐºÐ¾Ñ‚Ð¾Ñ€Ð¾Ð¹ Ð¼Ð¾Ð¶ÐµÑ‚ Ð½Ð°Ñ€Ð°ÑÑ‚Ð°Ñ‚ÑŒ Ð´Ð¾ Ñ†Ð¸Ñ‚Ð¾ÐºÐ¸Ð½Ð¾Ð²Ð¾Ð³Ð¾ ÑˆÑ‚Ð¾Ñ€Ð¼Ð° Ð”Ð»Ñ SARS-CoV Ñ…Ð°Ñ€Ð°ÐºÑ‚ÐµÑ€Ð½Ñ‹ ÑÐ¸Ð¼Ð¿Ñ‚Ð¾Ð¼Ñ‹ Ð²Ñ‚Ð¾Ñ€Ð¸Ñ‡Ð½Ð¾Ð¹ Ð¸Ð¼Ð¼ÑƒÐ½Ð¾Ð´ÐµÐ¿Ñ€ÐµÑÑÐ¸Ð¸, Ð¿Ñ€Ð¾ÑÐ²Ð»ÑÐ²ÑˆÐ¸ÐµÑÑ Ð² Ð¿Ð¾Ð·Ð´Ð½ÐµÐ¼ Ð½Ð°Ñ‡Ð°Ð»Ðµ ÑÐ¸Ð½Ñ‚ÐµÐ·Ð° Ð¸Ð½Ñ‚ÐµÑ€Ñ„ÐµÑ€Ð¾Ð½Ð¾Ð² Ð¸ Ð°ÐºÑ‚Ð¸Ð²Ð°Ñ†Ð¸Ð¸ ÐºÐ»ÑŽÑ‡ÐµÐ²Ð¾Ð³Ð¾ Ñ„Ð°ÐºÑ‚Ð¾Ñ€Ð° Ð²Ð¾ÑÐ¿Ð°Ð»ÐµÐ½Ð¸Ñ â€“ NLRP3 Ð¸Ð½Ñ„Ð»Ð°Ð¼Ð¼Ð°ÑÐ¾Ð¼Ñ‹ ÐŸÑ€Ð¸Ñ‡Ð¸Ð½Ð¾Ð¹ Ð¿Ð¾Ð´Ð¾Ð±Ð½Ð¾Ð¹ Ñ€ÐµÐ°ÐºÑ†Ð¸Ð¸ ÑÐ²Ð»ÑÐµÑ‚ÑÑ Â«Ð²Ð¾Ð¾Ñ€ÑƒÐ¶ÐµÐ½Ð½Ð¾ÑÑ‚ÑŒÂ» CoV Ð¾Ð±ÑˆÐ¸Ñ€Ð½Ñ‹Ð¼ Ð½Ð°Ð±Ð¾Ñ€Ð¾Ð¼ ÑÑ‚Ñ€ÑƒÐºÑ‚ÑƒÑ€Ð½Ñ‹Ñ… Ð¸ Ð²Ð¾ÑÐ¿Ð°Ð»Ð¸Ñ‚ÐµÐ»ÑŒÐ½Ñ‹Ñ… Ð±ÐµÐ»ÐºÐ¾Ð², Ð¾Ð±Ð»Ð°Ð´Ð°ÑŽÑ‰Ð¸Ñ… Ð¿Ñ€Ð¾Ð²Ð¾ÑÐ¿Ð°Ð»Ð¸Ñ‚ÐµÐ»ÑŒÐ½Ñ‹Ð¼Ð¸ Ð¸ Ð¸Ð¼Ð¼ÑƒÐ½Ð¾Ð´ÐµÐ¿Ñ€ÐµÑÑÐ¸Ð²Ð½Ñ‹Ð¼Ð¸ ÑÐ²Ð¾Ð¹ÑÑ‚Ð²Ð°Ð¼Ð¸ ÐžÑ‚ÑÑ€Ð¾Ñ‡ÐµÐ½Ð½Ñ‹Ð¹ ÑÐ¸Ð½Ñ‚ÐµÐ· IFN Ð¿Ð¾Ð·Ð²Ð¾Ð»ÑÐ» Ð²Ð¸Ñ€ÑƒÑÑƒ Ð°ÐºÑ‚Ð¸Ð²Ð½Ð¾ Ð¸ Ð±ÐµÑÐ¿Ñ€ÐµÐ¿ÑÑ‚ÑÑ‚Ð²ÐµÐ½Ð½Ð¾ Ñ€ÐµÐ¿Ð»Ð¸Ñ†Ð¸Ñ€Ð¾Ð²Ð°Ñ‚ÑŒ, Ð° ÐºÐ¾Ð³Ð´Ð° Ð²ÑÐµ Ð¶Ðµ Ð¾Ñ€Ð³Ð°Ð½Ð¸Ð·Ð¼ Ð·Ð°Ð¿ÑƒÑÐºÐ°Ð» ÑÐ¸Ð½Ñ‚ÐµÐ· IFN I, ÐµÐ³Ð¾ Ð´ÐµÐ¹ÑÑ‚Ð²Ð¸Ðµ Ð¾ÐºÐ°Ð·Ñ‹Ð²Ð°Ð»Ð¾ÑÑŒ Ð²Ñ€ÐµÐ´Ð½Ñ‹Ð¼ Ð¸ ÑÐ¾Ð¿Ñ€Ð¾Ð²Ð¾Ð¶Ð´Ð°Ð»Ð¾ÑÑŒ ÑƒÑ‚ÑÐ¶ÐµÐ»ÐµÐ½Ð¸ÐµÐ¼ Ñ‚ÐµÑ‡ÐµÐ½Ð¸Ñ Ð¸Ð½Ñ„ÐµÐºÑ†Ð¸Ð¸ Ð¢Ð°ÐºÐ¸Ð¼ Ð¾Ð±Ñ€Ð°Ð·Ð¾Ð¼, SARS Ð¼Ð¾Ð¶Ð½Ð¾ Ñ Ð¿Ð¾Ð»Ð½Ñ‹Ð¼ Ð¾ÑÐ½Ð¾Ð²Ð°Ð½Ð¸ÐµÐ¼ Ð¾Ñ‚Ð½ÐµÑÑ‚Ð¸Ðº Ñ‡Ð¸ÑÐ»Ñƒ Ð¸Ð¼Ð¼ÑƒÐ½Ð¾-Ð·Ð°Ð²Ð¸ÑÐ¸Ð¼Ñ‹Ñ… Ð¸Ð½Ñ„ÐµÐºÑ†Ð¸Ð¹ Ñ Ð²Ñ‹Ñ€Ð°Ð¶ÐµÐ½Ð½Ñ‹Ð¼ Ð¸Ð¼Ð¼ÑƒÐ½Ð¾Ð¿Ð°Ñ‚Ð¾Ð»Ð¾Ð³Ð¸Ñ‡ÐµÑÐºÐ¸Ð¼ ÐºÐ¾Ð¼Ð¿Ð¾Ð½ÐµÐ½Ñ‚Ð¾Ð¼ Ð¦ÐµÐ»ÑŒ ÑÑ‚Ð¾Ð³Ð¾ Ð¾Ð±Ð·Ð¾Ñ€Ð° Ð¾Ð¿Ð¸ÑÐ°Ñ‚ÑŒ Ð½ÐµÐºÐ¾Ñ‚Ð¾Ñ€Ñ‹Ðµ Ð¼ÐµÑ…Ð°Ð½Ð¸Ð·Ð¼Ñ‹ Ñ„Ð¾Ñ€Ð¼Ð¸Ñ€Ð¾Ð²Ð°Ð½Ð¸Ñ Ð²Ñ€Ð¾Ð¶Ð´ÐµÐ½Ð½Ð¾Ð³Ð¾ Ð¸Ð¼Ð¼ÑƒÐ½Ð½Ð¾Ð³Ð¾ Ð¾Ñ‚Ð²ÐµÑ‚Ð° Ð½Ð° Ð¸Ð½Ñ„Ð¸Ñ†Ð¸Ñ€Ð¾Ð²Ð°Ð½Ð¸Ðµ Ð¿Ð°Ñ‚Ð¾Ð³ÐµÐ½Ð½Ñ‹Ð¼Ð¸ ÐºÐ¾Ñ€Ð¾Ð½Ð°Ð²Ð¸Ñ€ÑƒÑÐ°Ð¼Ð¸: SARS-CoV, MERS-CoV Ð¸ CoV-2 (COVID-19)


RCVS may relax guidance due to Covid-19


title: Sargramostim to treat patients with acute hypoxic respiratory failure due to COVID-19 (SARPAC): A structured summary of a study protocol for a randomised controlled trial

text: OBJECTIVES: The hypothesis of the proposed intervention is that Granulocyte-macrophage colony-stimulating factor (GM-CSF) has profound effects on antiviral immunity, and can provide the stimulus to restore immune homeostasis in the lung with acute lung injury post COVID-19, and can promote lung repair mechanisms, that lead to a 25% improvement in lung oxygenation parameters. Sargramostim is a man-made form of the naturally-occurring protein GM-CSF. TRIAL DESIGN: A phase 4 academic, prospective, 2 arm (1:1 ratio), randomized, open-label, controlled trial. PARTICIPANTS: Patients aged 18-80 years admitted to specialized COVID-19 wards in 5 Belgian hospitals with recent (< 2 weeks prior to randomization) confirmed COVID-19 infection and acute respiratory failure defined as a PaO2/FiO2 below 350 mmHg or SpO2 below 93% on minimal 2 L/min supplemental oxygen. Patients were excluded from the trial in case of (1) known serious allergic reactions to yeast-derived products, (2) lithium carbonate therapy, (3) mechanical ventilation prior to randomization, (4) peripheral white blood cell count above 25.000/µL and/or active myeloid malignancy, (5) high dose systemic steroid therapy (> 20 mg methylprednisolone or equivalent), (6) enrolment in another investigational study, (7) pregnant or breastfeeding or (8) ferritin levels > 2000 µg/mL. INTERVENTION AND COMPARATOR: Inhaled sargramostim 125 µg twice daily for 5 days in addition to standard care. Upon progression of disease requiring mechanical ventilation or to acute respiratory distress syndrome (ARDS) and initiation of mechanical ventilator support within the 5 day period, inhaled sargramostim will be replaced by intravenous sargramostim 125 µg/m2 body surface area once daily until the 5 day period is reached. From day 6 onwards, progressive patients in the active group will have the option to receive an additional 5 days of IV sargramostim, based on the treating physician's assessment. Intervention will be compared to standard of care. Subjects progressing to ARDS and requiring invasive mechanical ventilatory support, from day 6 onwards in the standard of care group will have the option (clinician's decision) to initiate IV sargramostim 125m µg/m2 body surface area once daily for 5 days. MAIN OUTCOMES: The primary endpoint of this intervention is measuring oxygenation after 5 days of inhaled (and intravenous) treatment through assessment of a change in pretreatment and post-treatment ratio of PaO2/FiO2 and through measurement of the P(A-a)O2 gradient (PAO2= Partial alveolar pressure of oxygen, PaO2=Partial arterial pressure of oxygen; FiO2= Fraction of inspired oxygen). RANDOMISATION: Patients will be randomized in a 1:1 ratio. Randomization will be done using REDCap (electronic IWRS system). BLINDING (MASKING): In this open-label trial neither participants, caregivers, nor those assessing the outcomes will be blinded to group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 80 patients with confirmed COVID-19 and acute hypoxic respiratory failure will be enrolled, 40 in the active and 40 in the control group. TRIAL STATUS: SARPAC protocol Version 2.0 (April 15 2020). Participant recruitment is ongoing in 5 Belgian Hospitals (i.e. University Hospital Ghent, AZ Sint-Jan Bruges, AZ Delta Roeselare, University Hospital Brussels and ZNA Middelheim Antwerp). Participant recruitment started on March 26th 2020. Given the current decline of the COVID-19 pandemic in Belgium, it is difficult to anticipate the rate of participant recruitment. TRIAL REGISTRATION: The trial was registered on Clinical Trials.gov on March 30th, 2020 (ClinicalTrials.gov Identifier: NCT04326920) - retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT04326920?term=sarpac&recrs=ab&draw=2&rank=1 and on EudraCT on March 24th, 2020 (Identifier: 2020-001254-22). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


docid: domxlzgz

title: Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases

text: Coronavirus disease 2019 (COVID-19) is a global pandemic which has caused numerous deaths worldwide. The present study investigated the roles of hypoproteinemia in the clinical outcome and liver dysfunction of COVID-19 patients. In this retrospective study, we extracted data from 2,623 clinically confirmed adult COVID-19 patients (>18 years old) between January 29, 2020 and March 6, 2020 in Tongji Hospital, Wuhan, China. The patients were divided into three groups-non-critically ill, critically ill, and death groups-in accordance with the Chinese Clinical Guideline for COVID-19. Serum albumin, low-density lipoproteins cholesterol (LDL-C), and high-density lipoproteins cholesterol (HDL-C) concentrations and inflammatory cytokines levels were measured and compared among these three groups. The median age of these 2,623 patients was 64 years old (interquartile range (IQR), 52-71). Among the patients enrolled in the study, 2,008 (76.6%) were diagnosed as non-critically ill and 615 (23.4%) were critically ill patients, including 383 (14.6%) critically ill survivors and 232 (8.8%) critically ill deaths in the hospital. Marked hypoalbuminemia occurred in 38.2%, 71.2%, and 82.4% patients in non-critically ill, critically ill, and death groups, respectively, on admission and 45.9%, 77.7%, and 95.6% of these three groups, respectively, during hospitalization. We also discovered that serum low-density lipoprotein (LDL) and HDL levels were significantly lower in critically ill and death groups compared to non-critically ill group. Meanwhile, the patients displayed dramatically elevated levels of serum inflammatory factors, while a markedly prolonged activated partial thromboplastin time (APTT) in critically ill patients reflected coagulopathy. This study suggests that COVID-19-induced cytokine storm causes hepatotoxicity and subsequently critical hypoalbuminemia, which are associated with exacerbation of disease-associated inflammatory responses and progression of the disease and ultimately leads to death for some critically ill patients.


title: Potential Immunotherapeutic Targets For Hypoxia Due to COVI-FLU

text: The world is currently embroiled in a pandemic of coronavirus disease 2019 (COVID-19), a respiratory illness caused by the novel betacoronavirus SARS-CoV-2. The severity of COVID-19 disease ranges from asymptomatic to fatal acute respiratory distress syndrome (ARDS). In few patients, the disease undergoes phenotypic differentiation between 7-14 days of acute illness, either resulting in full recovery or symptom escalation. However, the mechanism of such variation is not clear, but the facts suggest that patient's immune status, co-morbidities, and the systemic effects of the viral infection (potentially depending on the SARS-CoV-2 strain involved) play a key role. Subsequently, patients with the most severe symptoms tend to have poor outcomes, manifest severe hypoxia, and possess elevated levels of pro-inflammatory cytokines (including IL-1ß, IL-6, IFN-Î³, and TNF-α) along with elevated levels of the anti-inflammatory cytokine IL-10, marked lymphopenia, and elevated neutrophil-to-lymphocyte ratios. Based on the available evidence, we propose a mechanism wherein SARS-CoV-2 infection induces direct organ damage while also fueling an IL-6-mediated cytokine release syndrome (CRS) and hypoxia, resulting in escalating systemic inflammation, multi-organ damage, and end-organ failure. Elevated IL-6 and hypoxia together predisposes patients to pulmonary hypertension, and the presence of asymptomatic hypoxia in COVID-19 further compounds this problem. Due to the similar downstream mediators, we discuss the potential synergistic effects and systemic ramifications of SARS-CoV-2 and influenza virus during co-infection, a phenomenon we have termed "COVI-Flu." Additionally, the differences between CRS and cytokine storm are highlighted. Finally, novel management approaches, clinical trials, and therapeutic strategies toward both SARS-CoV-2 and COVI-Flu infection are discussed, highlighting host response optimization and systemic inflammation reduction.


title: Case Fatality Rate of Cancer Patients with COVID-19 in a New York Hospital System

text: Patients with cancer are presumed to be at increased risk from COVID-19 infection-related fatality due to underlying malignancy, treatment-related immunosuppression, or increased comorbidities. A total of 218 COVID-19-positive patients from March 18, 2020, to April 8, 2020, with a malignant diagnosis were identified. A total of 61 (28%) patients with cancer died from COVID-19 with a case fatality rate (CFR) of 37% (20/54) for hematologic malignancies and 25% (41/164) for solid malignancies. Six of 11 (55%) patients with lung cancer died from COVID-19 disease. Increased mortality was significantly associated with older age, multiple comorbidities, need for ICU support, and elevated levels of D-dimer, lactate dehydrogenase, and lactate in multivariate analysis. Age-adjusted CFRs in patients with cancer compared with noncancer patients at our institution and New York City reported a significant increase in case fatality for patients with cancer. These data suggest the need for proactive strategies to reduce likelihood of infection and improve early identification in this vulnerable patient population. SIGNIFICANCE: COVID-19 in patients with cancer is associated with a significantly increased risk of case fatality, suggesting the need for proactive strategies to reduce likelihood of infection and improve early identification in this vulnerable patient population.This article is highlighted in the In This Issue feature, p. 890.


docid: ehrzlemg

title: Impact of COVID-19 outbreak measures of lockdown on the Italian Carbon Footprint

text: Stringent lockdown measures implemented in Italy to mitigate the spread of COVID-19 are generating unprecedented economic impacts. However, the environmental consequences associated with the temporary shutdown and recovery of industrial and commercial activities are still not fully understood. Using the well-known carbon footprint (CF) indicator, this paper provides a comprehensive estimation of environmental effects due to the COVID-19 outbreak lockdown measures in Italy. Our aim was to quantify the CF associated with the consumption of energy by any economic activity and region in Italy during the lockdown, and then compare these environmental burdens with the CF calculated for analogous periods from 2015 to 2019 (~March and April). Complementarily, we also conducted a scenario analysis to estimate the post-lockdown CF impact in Italy. A consumption-based approach was applied according to the principles of the established Life Cycle Assessment method. The CF was therefore quantified as a sum of direct and indirect greenhouse gases (GHGs) released from domestically produced and imported energy metabolism flows, excluding the exports. Our findings indicate that the CF in the lockdown period is ~-20% lower than the mean CF calculated for the past. This means avoided GHGs in between ~5.6 and ~10.6 Mt CO2e. Results further suggest that a tendency occurs towards higher impact savings in the Northern regions, on average ~230 kt CO2e of GHGs avoided by province (against ~110-130 kt CO2e in central and Southern provinces). Not surprisingly, these are the utmost industrialized areas of Italy and have been the ones mostly affected by the outbreak. Despite our CF estimates are not free of uncertainties, our research offers quantitative insights to start understanding the magnitude generated by such an exceptional lockdown event in Italy on climate change, and to complement current scientific efforts investigating the relationships between air pollution and the spread of COVID-19.


title: Inferior vena cava filter in a patient with COVID-19 pneumonia to prevent a massive pulmonary embolism

text: COVID 19 predispose to deep vein thrombosis . We describe an early placement of inferior vena cava filter added to the therapeutic anticoagulation to prevent a massive pulmonary embolism.


title: An agent-based model to evaluate the COVID-19 transmission risks in facilities

text: The rapid spread of the coronavirus disease (COVID-19) has become a global threat affecting almost all countries in the world. As countries reach the infection peak, it is planned to return to a new normal under different coexistence conditions in order to reduce the economic effects produced by the total or partial closure of companies, universities, shops, etc. Under such circumstances, the use of mathematical models to evaluate the transmission risk of COVID-19 in various facilities represents an important tool in assisting authorities to make informed decisions. On the other hand, agent-based modeling is a relatively new approach to model complex systems composed of agents whose behavior is described using simple rules. Different from classical mathematical models (which consider a homogenous population), agent-based approaches model individuals with distinct characteristics and provide more realistic results. In this paper, an agent-based model to evaluate the COVID-19 transmission risks in facilities is presented. The proposed scheme has been designed to simulate the spatiotemporal transmission process. In the model, simulated agents make decisions depending on the programmed rules. Such rules correspond to spatial patterns and infection conditions under which agents interact to characterize the transmission process. The model also includes an individual profile for each agent, which defines its main social characteristics and health conditions used during its interactions. In general, this profile partially determines the behavior of the agent during its interactions with other individuals. Several hypothetical scenarios have been considered to show the performance of the proposed model. Experimental results have demonstrated that the simulations provide useful information to produce strategies for reducing the transmission risks of COVID-19 within the facilities.


Role of Data Registries in the Time of COVID-19


Covid-19: countermeasure for N95 mask-induced pressure sore


Dwindling blood reserves: An ominous downside of COVID-19 pandemic


title: [Therapy of coronavirus disease 2019 induced acute respiratory distress syndrome is different from traditional acute respiratory distress syndrome]

text: Coronavirus disease 2019 (COVID-19) has become a global public health emergency threatening people's lives around the world. Although the acute respiratory distress syndrome (ARDS) induced by COVID-19 is similar to the ARDS caused by other diseases in terms of pathophysiological basis and clinical manifestations, they are also different in many aspects, which lead to different clinical therapies. Therefore, understanding the differences and similarities of ARDS induced by COVID-19 and other diseases currently are the basis for clinicians to make decisions for the treatment of COVID-19 induced ARDS.


title: Qualitative and quantitative evaluation of COVID-19 outbreak severity with the use of meta-projections based on Richards' curve parameters

text: Researchers have shown that even simple empirical models stemming from biological growth modeling have the potential to provide useful information on the development and severity of ongoing epidemics since they can be employed as tools for carrying out projections on the size of the affected population, timing of turning points, as well as best- and worst-case scenarios. Nevertheless, they commonly exhibit considerable sensitivity to some input parameters' variance which results in large fluctuations in the generated projections, thus rendering predictions difficult and even risky. In this work we examine a novel meta-projections-based approach which allows us to evaluate the model's current trends and assess whether generated projections are at a transient or stable state. Meta-projections can be extracted from graphs of successive estimations of model's parameters and resulting projections, over a sequence of days being gradually added to the employed model. In other words, projections are carried out on truncated time series of cumulative numbers of confirmed cases with increased lengths at each successive evaluation. This allows us to trace the values of model parameters over a certain period of time and examine their trends which may converge to specific values for settled-growth cases or exhibit a changing or even an erratic behavior for cases that undergo epidemiological transitions and/or are inappropriately described by the current model instance(s). We have computed meta-projections and compared our findings for countries at different stages of the epidemic with stable or unstable behaviors and increasing or decreasing numbers of confirmed cases. Our results indicate that meta-projections can aid researchers in assessing the appropriateness of their relevant models and in effect decrease the uncertainty in their estimations of an epidemic's severity and development.


COVID-19, China, the World Health Organization, and the Limits of International Health Diplomacy


Radiotherapy and Systemic Treatment for Non-melanoma Skin Cancer in the COVID-19 Pandemic


COVID-19 should be a novel indication for fertility preservation


docid: pdhkkdwt

title: Administration of end-of-life drugs by family caregivers during covid-19 pandemic


title: Clinical course and treatment efficacy of COVID-19 near Hubei Province, China: A multicentre, retrospective study

text: Currently, COVID-19 has been reported in nearly all countries globally. To date, little is known about the viral shedding duration, clinical course and treatment efficacy of COVID-19 near Hubei Province, China. This multicentre, retrospective study was performed in 12 hospitals in Henan and Shaanxi Provinces from 20 January to 8 February 2020. Clinical outcomes were followed up until 26 March 2020. The viral shedding duration, full clinical course and treatment efficacy were analysed in different subgroups of patients. A total of 149 COVID-19 patients were enrolled. The median age was 42 years, and 61.1% (91) were males. Of them, 133 (89.3%) had fever, 131 of 144 (91%) had pneumonia, 27 (18.1%) required intensive care unit (ICU) management, 3 (2%) were pregnant, and 3 (2%) died. Two premature newborns were negative for SARS-CoV-2. In total, the median SARS-CoV-2 shedding period and clinical course were 12 (IQR: 9-17; mean: 13.4, 95% CI: 12.5, 14.2) and 20 (IQR: 16-24; mean: 21.2, 95% CI: 20.1, 22.3) days, respectively, and ICU patients had longer median viral shedding periods (21 [17-24] versus 11 [9-15]) and clinical courses (30 [22-33] vs. 19 [15.8-22]) than non-ICU patients (both p < .0001). SARS-CoV-2 clearances occurred at least 2 days before fatality in 3 non-survivors. Current treatment with any anti-viral agent or combination did not present the benefit of shortening viral shedding period and clinical course (all p > .05) in real-life settings. In conclusion, the viral shedding duration and clinical course in Henan and Shaanxi Provinces were shorter than those in Hubei Province, and current anti-viral therapies were ineffective for shortening viral shedding duration and clinical course in real-world settings. These findings expand our knowledge of the SARS-CoV-2 infection and may be helpful for management of the epidemic outbreak of COVID-19 worldwide. Further studies concerning effective anti-viral agents and vaccines are urgently needed.


To compare the incomparable: COVID-19 pneumonia and high-altitude disease


Interleukin-6 receptor antagonist therapy to treat SARS-CoV-2 driven inflammatory syndrome in a kidney transplant recipient


Food insecurity will be the sting in the tail of COVID-19


Treatment of COVID-19: old tricks for new challenges


Low ADAMTS 13 plasma levels are predictors of mortality in COVID-19 patients


Prevalence and predictors of PTSD during the COVID-19 pandemic: Findings from a Tunisian community sample


COVID-19: The Uninvited Guest in the Intensive Care Unit - Implications for Pharmacotherapy


title: Quantifying human mobility behavior changes in response to non-pharmaceutical interventions during the COVID-19 outbreak in the United States

text: Ever since the first case of the novel coronavirus disease (COVID-19) was confirmed in Wuhan, China, social distancing has been promoted worldwide, including the United States. It is one of the major community mitigation strategies, also known as non-pharmaceutical interventions. However, our understanding is remaining limited in how people practice social distancing. In this study, we construct a Social Distancing Index (SDI) to evaluate people's mobility pattern changes along with the spread of COVID-19. We utilize an integrated dataset of mobile device location data for the contiguous United States plus Alaska and Hawaii over a 100-day period from January 1, 2020 to April 9, 2020. The major findings are: 1) the declaration of the national emergency concerning the COVID-19 outbreak greatly encouraged social distancing and the mandatory stay-at-home orders in most states further strengthened the practice; 2) the states with more confirmed cases have taken more active and timely responses in practicing social distancing; 3) people in the states with fewer confirmed cases did not pay much attention to maintaining social distancing and some states, e.g., Wyoming, North Dakota, and Montana, already began to practice less social distancing despite the high increasing speed of confirmed cases; 4) some counties with the highest infection rates are not performing much social distancing, e.g., Randolph County and Dougherty County in Georgia, and some counties began to practice less social distancing right after the increasing speed of confirmed cases went down, e.g., in Blaine County, Idaho, which may be dangerous as well.


Impact of COVID-19 outbreak on rehabilitation services and Physical and Rehabilitation Medicine (PRM) physicians' activities in Italy. An official document of the Italian PRM Society (SIMFER)


title: Fibrinolysis Shutdown Correlation with Thromboembolic Events in Severe COVID-19 Infection

text: BACKGROUND: COVID-19 predisposes patients to a prothrombotic state with demonstrated microvascular involvement. The degree of hypercoagulability appears to correlate with outcomes; however, optimal criteria to assess for the highest-risk patients for thrombotic events remain unclear; we hypothesized that deranged thromboelastography measurements of coagulation would correlate with thromboembolic events. STUDY DESIGN: Patients admitted to an ICU with COVID-19 diagnoses who had thromboelastography analyses performed were studied. Conventional coagulation assays, d-dimer levels, and viscoelastic measurements were analyzed using a receiver operating characteristic curve to predict thromboembolic outcomes and new-onset renal failure. RESULTS: Forty-four patients with COVID-19 were included in the analysis. Derangements in coagulation laboratory values, including elevated d-dimer, fibrinogen, prothrombin time, and partial thromboplastin time, were confirmed; viscoelastic measurements showed an elevated maximum amplitude and low lysis of clot at 30 minutes. A complete lack of lysis of clot at 30 minutes was seen in 57% of patients and predicted venous thromboembolic events with an area under the receiver operating characteristic curve of 0.742 (p = 0.021). A d-dimer cutoff of 2,600 ng/mL predicted need for dialysis with an area under the receiver operating characteristic curve of 0.779 (p = 0.005). Overall, patients with no lysis of clot at 30 minutes and a d-dimer > 2,600 ng/mL had a venous thromboembolic event rate of 50% compared with 0% for patients with neither risk factor (p = 0.008), and had a hemodialysis rate of 80% compared with 14% (p = 0.004). CONCLUSIONS: Fibrinolysis shutdown, as evidenced by elevated d-dimer and complete failure of clot lysis at 30 minutes on thromboelastography predicts thromboembolic events and need for hemodialysis in critically ill patients with COVID-19. Additional clinical trials are required to ascertain the need for early therapeutic anticoagulation or fibrinolytic therapy to address this state of fibrinolysis shutdown.


title: Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists

text: Coronavirus disease 2019 (COVID-19) has become a pandemic disease globally. Although COVID-19 directly invades lungs, it also involves the nervous system. Therefore, patients with nervous system involvement as the presenting symptoms in the early stage of infection may easily be misdiagnosed and their treatment delayed. They become silent contagious sources or 'virus spreaders'. In order to help neurologists to better understand the occurrence, development and prognosis, we have developed this consensus of prevention and management of COVID-19. It can also assist other healthcare providers to be familiar with and recognise COVID-19 in their evaluation of patients in the clinic and hospital environment.


Early advice on managing children with cancer during the COVID-19 pandemic and a call for sharing experiences


A report of three COVID-19 cases with prolonged viral RNA detection in anal swabs


Patients with COVID-19: are current isolation guidelines effective enough?


Access to lifesaving medical resources for African countries: COVID-19 testing and response, ethics, and politics


Response to 'Is there a future for hydroxychloroquine/chloroquine in prevention of SARS-CoV-2 infection (COVID-19)?' by Moiseev et al


title: The impact of the COVID-19 pandemic on renal transplantation in the UK

text: COVID-19 is impacting provision of renal transplantation in the UK with a reduction in clinical activity. Publicly available Renal Registry and NHS Blood and Transplant reports were analysed to model the number of missed transplant opportunities, waiting list size and change in dialysis population over a six-month period starting 5 March 2020. An estimated 1,670 kidney transplant opportunities may be lost, which will lead to 6,317 active patients on the kidney-alone waiting list, compared to 4,649 based on usual activity estimates. This will result in 1,324 additional patients on dialysis who would otherwise have been transplanted. COVID-19 will lead to a marked loss of transplant opportunities and a significantly larger national waiting list. The existing strain on dialysis capacity will be exacerbated as patients remain on dialysis as the only available form of renal replacement therapy. These findings will help inform policy and service specific strategies.


title: Similarities and differences in COVID-19 awareness, concern, and symptoms by race and ethnicity in the United States: A cross-sectional survey

text: BACKGROUND: Existing health disparities based on race and ethnicity in the United States are contributing to disparities in morbidity and mortality in the COVID-19 pandemic. We conducted an online survey of American adults to assess similarities and differences by race and ethnicity groups with respect to COVID-19 symptoms, estimates of the extent of the pandemic, knowledge of control measures, and stigma. OBJECTIVE: Describe similarities and differences in COVID-19 symptoms, knowledge, and beliefs by race and ethnicity among adults in the US. METHODS: We conducted a cross-sectional survey from March 27, 2020 through April 1, 2020. Participants were recruited on social media platforms and completed the survey on a secure, online survey platform. We used chi square tests to compare characteristics related to COVID-19 by race and ethnicity. Statistical tests were corrected using the Holm Bonferroni correction to account for multiple comparisons. RESULTS: A total of 1,435 (3.6% Asian, 11.0% non-Hispanic Black, 38.2% Hispanic, 40.9% non-Hispanic white, and 6.3% other or multiple races) participants completed the survey. Only one symptom (sore throat) was found to be different based on race and ethnicity (p = 0.003), which was less frequently reported by Asian (5.8%), non-Hispanic Black (5.7%), and other/multiple race (8.9%) participants compared to those who were Hispanic (18.1%) or non-Hispanic white (16.2%). Non-Hispanic white and Asian participants were more likely to estimate that the number of current cases was at least 100,000 (p = 0.004) and were more likely to answer all 14 COVID-19 knowledge scale questions correctly (Asian, 25.0%; non-Hispanic White, 30.7%) compared to Hispanic (19.7%) and non-Hispanic Black (15.8%) participants. CONCLUSIONS: We observed differences with respect to knowledge of appropriate methods to prevent infection by the novel coronavirus that causes COVID-19. Deficits in knowledge of proper control methods might further exacerbate existing race/ethnicity disparities. Additional research is needed to identify trusted sources of information in Hispanic and non-Hispanic Black communities and effective messaging to disseminate correct COVID-19 prevention and treatment information.


Midwives in a pandemic: A call for solidarity and compassion


title: La farmacotecnia hospitalaria frente a la COVID-19./ Hospital Pharmacy Compounding against COVID-19 pandemic

text: As in other areas of the health system, COVID-19 has had a dramatic impact on hospital compounding. This area has faced numerous challenges, including the shortage of frequent-use products (hydroalcoholic solutions, lopinavir/ritonavir suspension), the use of new preparations for SARS-CoV-2 (tocilizumab, remdesivir), or requests from overwhelmed wards unable to assume the safe preparation of a high volume of medications (intravenous solutions). The demand for all types of preparations (topic and oral medications, intravenous solutions) has increased dramatically. This increase has highlighted the shortage of resources allocated to this area, which has made it difficult to meet the high demand for preparations. In addition, the pandemic has revealed the scarcity of research on such basic aspects as agent stability and drug compatibility. One of the most relevant conclusions drawn from the COVID-19 pandemic is that the basic areas of hospital pharmacy, along with other, must be maintained and reinforced, as these are the areas that make us essential.


Blood transfusion during the COVID-19 outbreak


docid: haedyvka

title: [Understanding and suggestion on prevention and control of COVID-19 infection in hematological wards]


title: Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Shenzhen, China, 2020

text: Since early January 2020, after the outbreak of coronavirus infection in Wuhan, China, ≈365 confirmed cases have been reported in Shenzhen, China. The mode of community and intrafamily transmission is threatening residents in Shenzhen. Strategies to strengthen prevention and interruption of these transmissions should be urgently addressed.


Psychophysical olfactory testing in COVID-19: is smell function really impaired in nearly all patients?


title: [Visualization analysis on treatment of coronavirus based on knowledge graph]

text: OBJECTIVE: To discuss the research progress in the field of coronavirus (CoVs) treatment based on the visualization analysis of knowledge graph. METHODS: The related literatures in the field of CoVs treatment were retrieved from the establishment of Web of Science core collection database to February 15th, 2020, and the literature analysis tool of Web of Science database was used to count the annual trend of published literatures. The VOSviewer software was used to analyze the relationship among countries, institutions, authors, clustering and density of subject words. The HistCite software was used to screen important documents and to draw the evolution process of hot spots. The CiteSpace software was used to analyze the breakout points of subject words, so as to find the front and hot spots in this field. RESULTS: A total of 1 747 data were retrieved, with the exception of 17 duplicate data, and 1 730 data were retained for visualization analysis. In terms of literature volume, the literatures on CoVs therapy rose after 2003 and 2012, and the number of published literatures had remained high since 2014. In terms of countries, the main countries that carried out the research on the treatment of CoVs were the United States (n = 613), China (n = 582), Germany (n = 122), Canada (n = 99), etc., and the cooperation among countries was close. In terms of institutions, the number of papers issued by Chinese Academy of Sciences in the field of CoVs treatment ranked first (n = 82), followed by University of Hong Kong of China (n = 74) and Chinese University of Hong Kong of China (n = 58), followed by National Institute of Allergy and Infectious Diseases (n = 37), and the cooperation among various institutions was close. In terms of literature authors, there were two high-yielding authors in the United States [Ralph S. Baric (n = 21) and Kuochen Chou (n = 17)], two Chinese authors [Yuen Kwok-yung (n = 17) and Jiang Shibo (n = 16)] and one Dutch author [Eric J. Snijder (n = 17)]. In terms of the cluster analysis of authors, the authors were closely related in reverse genetics, respiratory infection, receptor binding domain, etc., and the 15 top-cited papers came mainly from China, the United States, Netherlands and other countries, and the literature content represented the frontiers and hot spots in different periods. The treatment hot spots focused on preventing virus adsorption, inhibiting the virus gene nucleic acid replication, transcription and translation. The main subject words were divided into three main categories, namely, CoVs epidemiology, basic research and drug development, in which basic research and drug development were strongly correlated. In the subject words breakthrough analysis, there were time-related breakthrough points in 1991, 1996 and 2002, and the "diagnosis" and "sequence" were continuous hot spots. CONCLUSIONS: Through the visualization analysis of knowledge graph, the development trend and hot spots of CoVs therapy research could be well observed. In this study, the degree of attention in the field of CoVs treatment showed periodic changes, related to the outbreak of new CoVs, and the country, institutions and the author were closely related. The treatment hot spots focused on preventing virus adsorption, inhibiting the virus gene nucleic acid replication, transcription and translation in order to develop new targets of drug.


title: First detection of SARS-CoV-2 in untreated wastewaters in Italy

text: Several studies have demonstrated the advantages of environmental surveillance through the monitoring of sewage for the assessment of viruses circulating in a given community (wastewater-based epidemiology, WBE). During the COVID-19 public health emergency, many reports have described the presence of SARS-CoV-2 RNA in stools from COVID-19 patients, and a few studies reported the occurrence of SARS-CoV-2 in wastewaters worldwide. Italy is among the world's worst-affected countries in the COVID-19 pandemic, but so far there are no studies assessing the presence of SARS-CoV-2 in Italian wastewaters. To this aim, twelve influent sewage samples, collected between February and April 2020 from Wastewater Treatment Plants in Milan and Rome, were tested adapting, for concentration, the standard WHO procedure for Poliovirus surveillance. Molecular analysis was undertaken with three nested protocols, including a newly designed SARS-CoV-2 specific primer set. SARS-CoV-2 RNA detection was accomplished in volumes of 250 ml of wastewaters collected in areas of high (Milan) and low (Rome) epidemic circulation, according to clinical data. Overall, 6 out of 12 samples were positive. One of the positive results was obtained in a Milan wastewater sample collected a few days after the first notified Italian case of autochthonous SARS-CoV-2. The study confirms that WBE has the potential to be applied to SARS-CoV-2 as a sensitive tool to study spatial and temporal trends of virus circulation in the population.


The great pandemic of 2020: A defining moment for Heart Rhythm Societies and their members


Resource poor countries ought to focus on early detection and containment of novel corona virus at the point of entry


Meeting the Care Needs of Older Adults Isolated at Home During the COVID-19 Pandemic


Potential risk of the kidney vulnerable to novel coronavirus 2019 infection


title: A commentary on potential associations between narcissism and trauma-related outcomes during the coronavirus pandemic

text: The coronavirus (COVID-19) pandemic has been accompanied by a variety of potentially stressful or traumatic experiences that people may face in daily life (e.g., repeated exposure to morbidity or mortality reports across media platforms, social isolation, contracting COVID-19, supply shortages, lost income, death of a loved one). As such, it is important to consider individual differences that may increase one's risk for developing stress-related disorders (e.g., posttraumatic stress disorder) or put the health of other people at risk. Individual differences in narcissism-a multifaceted aspect of personality-may be worth examining in association with social health behaviors, stress, and trauma-related outcomes during the current and future pandemics. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


The health equity in all policies (HEiAP) approach before and beyond the Covid-19 pandemic in the Italian context


title: Clinical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States

text: Data on the detailed clinical progression of COVID-19 in conjunction with epidemiological and virological characteristics are limited. In this case series, we describe the first 12 US patients confirmed to have COVID-19 from 20 January to 5 February 2020, including 4 patients described previously1-3. Respiratory, stool, serum and urine specimens were submitted for SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) testing, viral culture and whole genome sequencing. Median age was 53 years (range: 21-68); 8 patients were male. Common symptoms at illness onset were cough (n = 8) and fever (n = 7). Patients had mild to moderately severe illness; seven were hospitalized and demonstrated clinical or laboratory signs of worsening during the second week of illness. No patients required mechanical ventilation and all recovered. All had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2-3 weeks after illness onset. Lowest real-time PCR with reverse transcription cycle threshold values in the upper respiratory tract were often detected in the first week and SARS-CoV-2 was cultured from early respiratory specimens. These data provide insight into the natural history of SARS-CoV-2. Although infectiousness is unclear, highest viral RNA levels were identified in the first week of illness. Clinicians should anticipate that some patients may worsen in the second week of illness.


Hidroxicloroquina en el tratamiento del COVID-19: como utilizarla a la espera de evidencia científica concluyente./ [Hydroxychloroquine in the treatment of COVID-19: how to use it waiting for conclusive scientific evidence]


How to face cancer treatment in the COVID-19 era


Lack of viral transmission to preterm newborn from a COVID-19 positive breastfeeding mother at 11 days postpartum