title: Making Waves: Coronavirus detection, presence and persistence in the water environment: State of the art and knowledge needs for public health

text: The main route of transmission of the human coronaviruses (HCoVs), and presumably also of the new pandemic SARS-CoV-2, is via droplets and close contacts, however their fecal elimination also suggests the possible spread via water. A scientific literature search was thus carried out to highlight the current state of the art and knowledge gaps regarding coronavirus in water. Since 1978 only 22 studies have met the inclusion criteria, and considered heterogeneous purposes, detection methods and types of water. In vitro experiments have addressed the recovery efficiency of analytical methods, survival in different types of water and the removal efficiency of water treatments. Field studies have monitored coronaviruses in surface waters, sewage, slurry, and biosolids. Overall, at the lab scale, HCoVs or surrogates can survive for several days at 4 °C, however their persistence is lower compared with non-enveloped viruses and is strongly influenced by temperature and organic or microbial pollution. HCoVs have rarely been detected in field investigations, however may be due to the low recovery efficiency of the analytical methods. The scarcity of information on HCoV in the environment suggests that research is needed to understand the fate of these viruses in the water cycle.


Mental Health of Young Physicians in China During the Novel Coronavirus Disease 2019 Outbreak


docid: hhsqqnyk

title: Daily pool testing of nasopharyngeal self-obtained swaps of healthcare professionals with definite COVID-19 exposition


Learning to deal with dual use


RAS-Inhibition in Zeiten der COVID-19-Pandemie  aktuelle ESH-Empfehlungen : Seminar / Hypertonie./ [Hypertension and RAAS inhibition in times of COVID-19 - current recommendations of the European Society of Hypertension.]


title: ANZICS guiding principles for complex decision making during the COVID-19 pandemic

text: The global 2019 coronavirus disease (COVID-19) pandemic has led to major challenges in clinical decision making when the demand for intensive care exceeds local capacity In order to promote consistent, transparent, objective and ethical decision making, the Australian and New Zealand Intensive Care Society (ANZICS) formed a committee to urgently develop guidelines outlining key principles that should be utilised during the pandemic This guidance is intended to support the practice of intensive care specialists during the COVID-19 pandemic and to promote the development of local admission policies that should be endorsed by health care organisations and relevant local authorities


Psoriasis and psoriatic arthritis: How to manage immunosuppressants in COVID-19 days


Comment on "Chilblains-like lesions in children following suspected COVID-19 infection"


title: A 3-Dimensional-Printed Hand Model for Home-Based Acquisition of Fracture Fixation Skills Without Fluoroscopy

text: OBJECTIVE: To design a low cost ($40), realistic and fluoroscopy-free percutaneous Kirschner wire hand fracture fixation training instrument kit for home-based skill acquisition during the COVID-19 pandemic. DESIGN: A 3D-printed hand was designed from a computed tomography scan of a healthy hand. These data were used to create replaceable hand and wrist bones and reusable silicone molds for a replica of the soft tissue envelope. The model is currently being integrated into the simulation curriculum at 2 integrated plastic surgery residency programs for training in percutaneous wire fixation of hand fractures. SETTING: Brown University, Warren Alpert Medical School of Brown University. Department of Surgery, Division of Plastic and Reconstructive Surgery. Large academic quaternary referral institution. Yale University, Yale School of Medicine. Department of Surgery, Division of Plastic and Reconstructive Surgery. Large academic quaternary referral institution. PARTICIPANTS: PGY 1-4 plastic surgery residents preparing to meet ACGME Accreditation for Graduate Medical Education hand surgery specific milestones. RESULTS: A realistic and durable 3D model with interchangeable bones allows trainees to practice the key motor skills necessary for successful fixation of hand and wrist fractures with K-wires in a home-based setting. CONCLUSIONS: A low cost, realistic and durable 3D hand model with interchangeable bones allows easy integration into any home-based hand surgery curriculum. With 3D printers and programming becoming more prevalent and affordable, such models offer a means of low-cost and safe instruction of residents in fracture fixation with no harm to patients.


Emergence of SARS-like coronavirus in China: An update


Home healthcare services in communities during COVID-19: Protecting against and mitigating the pandemics in Taiwan


L'évolution du rôle de la SOGC face à la pandémie de COVID-19


title: Effect of time varying transmission rates on coupled dynamics of epidemic and awareness over multiplex network

text: In the present work, a non-linear stochastic model is presented to study the effect of time variation of transmission rates on the co-evolution of epidemics and its corresponding awareness over a two layered multiplex network. In this model, the infection transmission rate of a given node in the epidemic layer depends upon its awareness probability in the awareness layer. Similarly, the infection information transmission rate of a node in the awareness layer depends upon its infection probability in the epidemic layer. The spread of disease resulting from physical contacts is described in terms of SIS (Susceptible Infected Susceptible) process over the epidemic layer and the spread of information about the disease outbreak is described in terms of UAU (Unaware Aware Unaware) process over the virtual interaction mediated awareness layer. The time variation of the transmission rates and the resulting co-evolution of these mutually competing processes is studied in terms of a network topology depend parameter({\alpha}). Using a second order linear theory it has been shown that in the continuous time limit, the co-evolution of these processes can be described in terms of damped and driven harmonic oscillator equations. From the results of the Monte-Carlo simulation, it is shown that for the suitable choice of parameter({\alpha}), the two process can either exhibit sustained oscillatory or damped dynamics. The damped dynamics corresponds to the endemic state. Further, for the case of endemic state it is shown that the inclusion of awareness layer significantly lowers the disease transmission rate and reduces the size of epidemic. The endemic state infection probability of a given node corresponding to the damped dynamics is found to have dependence upon both the transmission rates as well as on both absolute intra-layer and relative inter-layer degree of the individual nodes.


docid: zrdztbbj

title: Satellite-based estimates of decline and rebound in China's CO$_2$ emissions during COVID-19 pandemic

text: Changes in CO$_2$ emissions during the COVID-19 pandemic have been estimated from indicators on activities like transportation and electricity generation. Here, we instead use satellite observations together with bottom-up information to track the daily dynamics of CO$_2$ emissions during the pandemic. Unlike activity data, our observation-based analysis can be independently evaluated and can provide more detailed insights into spatially-explicit changes. Specifically, we use TROPOMI observations of NO$_2$ to deduce ten-day moving averages of NO$_x$ and CO$_2$ emissions over China, differentiating emissions by sector and province. Between January and April 2020, China's CO$_2$ emissions fell by 11.5% compared to the same period in 2019, but emissions have since rebounded to pre-pandemic levels owing to the fast economic recovery in provinces where industrial activity is concentrated.


Lung cavitation due to COVID-19 pneumonia


docid: waysgnir

title: Long-term Institutional Experience with Telemedicine Services for Radiation Oncology: A Potential Model for Long-term Utilization

text: With the development of the COVID-19 pandemic, healthcare practices and radiation oncology departments have begun to incorporate telemedicine services to practice social distancing and minimize the chances of disease spread. Given the severity of this pandemic, it will likely fundamentally impact the use of these services for years to come. Our institution and radiation oncology department have used telemedicine services for many years; we would like to report on our departmental experience to guide other radiation oncology practices on its long-term use for clinical evaluation and patient care. Our institution's telemedicine program provides clinical services for a number of remote locations and represents the largest telehealth network in the world, with over 300 sites and 60,000 patient encounters a year. Specifically for our radiation oncology department, over 200 patient encounters occur via telemedicine a year. Patients report great appreciation and satisfaction with these encounters, as they eliminate the time and energy needed for travel from long distances. It has resulted in improved efficiency and cost-effectiveness as well. Based on our institutional experience, our long-term vision for telemedicine (after the COVID-19 pandemic has hopefully subsided) is as an excellent and cost-efficient tool to provide long-term follow-up for patients, especially for those who live far away in rural or underserved areas.


Chest computed tomography images of early coronavirus disease (COVID-19)


title: Covid-19 in children: A brief overview after three months experience

text: Severe Acute Respiratory Syndrome - Coronavirus - 2 (SARS-CoV-2) and its related Coronavirus Disease - 19 (COVID-19) has become a health emergency worldwide. The medical community has been concerned since the beginning of the outbreak about the potential impact of COVID-19 in children, especially in those with underlying chronic diseases. Fortunately, COVID-19 has been reported to be less severe in children than in adults. However, epidemiologic and clinical data are scarce. Children show unique features of SARS-CoV-2 involvement that may account for the low rate of infection and death in this age group. The purpose of this review is to summarize the most relevant evidence of COVID-19 in children highlighting similarities and differences with adults.


title: [Theory and practice of aging upon COVID-19 pandemic.]

text: Never before in history, aging was such a significant factor for epidemics as it is now for the current COVID-19 pandemic, which features a drastic shift of mortality towards older ages. Our analysis of data on COVID-19-related mortality in Spain, Italy, and Sweden has shown that, in the range of 30 to 90 years of age, each dependency of the logarithm of mortality upon age is linear, and all regression lines are strictly parallel to those related to the total mortality in accordance with the Gompertz law. In all cases, irrespective of the stage and place of epidemic, mortality doubling time in this age range is close to 7,5 years. The rates of being infected with the SARS-CoV-2 coronavirus and of being diagnosed due to the symptomatic manifestations of the infection are dependent on age to a far lesser degree. With account for these observations, three messages are put forth: 1) Older persons are the principal victims of both SARS-CoV-2 and measures undertaken to control its spread; 2) Older persons are not the principal driving force of SARS-CoV-2 spread; 3) Older persons can and should be engaged in combating the pandemic and its consequences; however, not via selective social distancing and other discriminative measures. People aged over 65 years constitute a significant part of the current population. They have specific interests and needs, which deserve no less respect than those of any other age group. This includes the right for the quality of life that remains sustained under the emergency conditions. Since the prospects for controlling the SARS-CoV-2 are dubious, those in charge of decisions concerning «people aged above 65¼ should mind that currently, unlike in the medieval ages, 65+ is the individual future of almost everyone.


COVID-19 and cancer: what we know so far


Chirurgie gynecologique en période COVID+  Recommandations de sortie de crise./ [Gynecologic surgery in the era of COVID-19 - Recommendations for deconfinement]


title: Personal historical perspective of HIV: part 11

text: All animal life on earth is thought to have a common origin and have common genetic mechanisms. Evolution has enabled differentiation of species. Pathogens likewise have evolved within various species and mostly come to a settled dynamic equilibrium such that co-existence results (pathogens ideally should not kill their hosts). Problems arise when pathogens jump species because the new host had not developed any resistance. These infections from related species are known as zoonoses. COVID-19 is the latest example of a virus entering another species but HIV (and various strains of influenza) were previous examples. HIV entered the human population from monkeys in Africa. These two papers outline the underlying principle of HIV and the differing epidemiologies in Africa, the USA and in Edinburgh. The underlying immunosuppression of HIV in Africa was initially hidden behind common infections and HIV first came to world awareness in focal areas of the USA as a disease seemingly limited to gay males. The epidemic of intravenous drug abuse in Edinburgh was associated with overlapping epidemics of bloodborne viruses like hepatitis B, hepatitis C and HIV.


Covid-19: emergency departments lack proper isolation facilities, senior medic warns


title: Linear Time Construction of Indexable Founder Block Graphs

text: We introduce a compact pangenome representation based on an optimal segmentation concept that aims to reconstruct founder sequences from a multiple sequence alignment (MSA). Such founder sequences have the feature that each row of the MSA is a recombination of the founders. Several linear time dynamic programming algorithms have been previously devised to optimize segmentations that induce founder blocks that then can be concatenated into a set of founder sequences. All possible concatenation orders can be expressed as a founder block graph. We observe a key property of such graphs: if the node labels (founder segments) do not repeat in the paths of the graph, such graphs can be indexed for efficient string matching. We call such graphs segment repeat-free founder block graphs. We give a linear time algorithm to construct a segment repeat-free founder block graph given an MSA. The algorithm combines techniques from the founder segmentation algorithms (Cazaux et al. SPIRE 2019) and fully-functional bidirectional Burrows-Wheeler index (Belazzougui and Cunial, CPM 2019). We derive a succinct index structure to support queries of arbitrary length in the paths of the graph. Experiments on an MSA of SAR-CoV-2 strains are reported. An MSA of size $410\times 29811$ is compacted in one minute into a segment repeat-free founder block graph of 3900 nodes and 4440 edges. The maximum length and total length of node labels is 12 and 34968, respectively. The index on the graph takes only $3\%$ of the size of the MSA.


title: Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019

text: Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), is a highly contagious disease. It firstly appeared in Wuhan, Hubei province of China in December 2019. During the next two months, it moved rapidly throughout China and spread to multiple countries through infected persons travelling by air. Most of the infected patients have mild symptoms including fever, fatigue and cough. But in severe cases, patients can progress rapidly and develop to the acute respiratory distress syndrome, septic shock, metabolic acidosis and coagulopathy. The new coronavirus was reported to spread via droplets, contact and natural aerosols from human-to-human. Therefore, high-risk aerosol-producing procedures such as endotracheal intubation may put the anesthesiologists at high risk of nosocomial infections. In fact, SARS-CoV-2 infection of anesthesiologists after endotracheal intubation for confirmed COVID-19 patients have been reported in hospitals in Wuhan. The expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted this recommendation, by which we hope to guide the performance of endotracheal intubation by frontline anesthesiologists and critical care physicians. During the airway management, enhanced droplet/airborne PPE should be applied to the health care providers. A good airway assessment before airway intervention is of vital importance. For patients with normal airway, awake intubation should be avoided and modified rapid sequence induction is strongly recommended. Sufficient muscle relaxant should be assured before intubation. For patients with difficult airway, good preparation of airway devices and detailed intubation plans should be made.


title: Triaging moderate COVID-19 and other viral pneumonias from routine blood tests

text: The COVID-19 is sweeping the world with deadly consequences. Its contagious nature and clinical similarity to other pneumonias make separating subjects contracted with COVID-19 and non-COVID-19 viral pneumonia a priority and a challenge. However, COVID-19 testing has been greatly limited by the availability and cost of existing methods, even in developed countries like the US. Intrigued by the wide availability of routine blood tests, we propose to leverage them for COVID-19 testing using the power of machine learning. Two proven-robust machine learning model families, random forests (RFs) and support vector machines (SVMs), are employed to tackle the challenge. Trained on blood data from 208 moderate COVID-19 subjects and 86 subjects with non-COVID-19 moderate viral pneumonia, the best result is obtained in an SVM-based classifier with an accuracy of 84%, a sensitivity of 88%, a specificity of 80%, and a precision of 92%. The results are found explainable from both machine learning and medical perspectives. A privacy-protected web portal is set up to help medical personnel in their practice and the trained models are released for developers to further build other applications. We hope our results can help the world fight this pandemic and welcome clinical verification of our approach on larger populations.


title: Estimating the COVID-19 infection rate: Anatomy of an inference problem

text: As a consequence of missing data on tests for infection and imperfect accuracy of tests, reported rates of cumulative population infection by the SARS CoV-2 virus are lower than actual rates of infection. Hence, reported rates of severe illness conditional on infection are higher than actual rates. Understanding the time path of the COVID-19 pandemic has been hampered by the absence of bounds on infection rates that are credible and informative. This paper explains the logical problem of bounding these rates and reports illustrative findings, using data from Illinois, New York, and Italy. We combine the data with assumptions on the infection rate in the untested population and on the accuracy of the tests that appear credible in the current context. We find that the infection rate might be substantially higher than reported. We also find that the infection fatality rate in Illinois, New York, and Italy is substantially lower than reported.


title: Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic

text: BACKGROUND: Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations. METHODS: A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category. RESULTS: Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission. CONCLUSIONS: During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols.


title: COVID-19 Special Column: Principles Behind the Technology for Detecting SARS-CoV-2, the Cause of COVID-19

text: Nationwide shortages of tests that detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and diagnose coronavirus disease 2019 (COVID-19) have led the US Food and Drug Administration (FDA) to significantly relax regulations regarding COVID-19 diagnostic testing. To date the FDA has given emergency use authorization (EUA) to 48 COVID-19 in vitro diagnostic tests and 21 high complexity molecular-based laboratory developed tests, as well as implemented policies that give broad authority to clinical laboratories and commercial manufacturers in the development, distribution, and use of COVID-19 diagnostic tests. Currently, there are 2 types of diagnostic tests available for the detection of SARS-CoV-2: (1) molecular and (2) serological tests. Molecular detection of nucleic acid (RNA or DNA) sequences relating to the suspected pathogen is indicative of an active infection with the suspected pathogen. Serological tests detect antibodies against the suspected pathogen, which are produced by an individual's immune system. A positive serological test result indicates recent exposure to the suspected pathogen but cannot be used to determine if the individual is actively infected with the pathogen or immune to reinfection. In this article, the SARS-CoV-2 diagnostic tests currently approved by the FDA under EUA are reviewed, and other diagnostic tests that researchers are developing to detect SARS-CoV-2 infection are discussed.


docid: lgrpubob

title: In reply: Regional anesthesia during the COVID-19 pandemic: a time to reconsider practices? (Letters #1 and #2)


title: Opposite Modulatory Effects of Crataegus aronia Aqueous Extract on Platelet Aggregation in Rats

text: OBJECTIVES: To reveal the mechanisms behind the dual effects of Crataegus aronia (C. aronia) aqueous extract on platelet aggregation by focusing on function, regulation, expression, and signaling of platelets P2Y12 receptors. METHODS: Adult male Wistar rats (120 ± 10 g) were classified as control received the vehicle, C. aronia (200 mg/kg), and C. aronia (2,000 mg/kg)-treated rats. After treatments for consecutive 7 days, hematological and molecular experiments were conducted to detect alterations in platelet aggregation, thromboxane B2 (THXB2) and intracellular reactive oxygen species (ROS) content; protein levels of P2Y12, p-Akt, cyclic adenosine monophosphate (cAMP), phosphorylated vasodilator-stimulated-phosphoprotein (p-VASP), nuclear factor κB (NF-κB), P-selectin, and etc. in platelets were determined by Western blot; mRNA expressions of P2Y12 and some inflammatory markers were determined by real-time polymerase chain reaction. RESULTS: At a concentration of 200 mg/kg, C. aronia inhibited platelet aggregation through multiple interconnected mechanisms including downregulation P2Y12 synthesis and expression, stimulating intracellular cAMP levels and protein levels of p-VASP, inhibiting platelets THXB2 release and protein levels of P-selectin. Also, it inhibited platelets level of ROS and of NF-κB, a major signaling pathway that stimulates the expression of P2Y12 and THXA2 synthesis. Opposite findings were seen in platelets of rats received C. aronia at a concentration of 2,000 mg/kg. Interestingly, co-administration of N-acetylcysteine prevented all hematological and molecular alterations exerted by the high dose of the extract and inhibited platelet aggregation. CONCLUSION: Oral administration of C. aronia at low dose inhibits platelet aggregation by reducing THXB2 release, expression of P-selectin and activating cAMP and Akt signaling through two major mechanisms including downregulation of P2Y12 and inhibition of ROS-induced activation of NF-κB, an effect that is observed to be in the opposite direction with its high dose.


Reactive lymphocytes in patients with COVID-19


SARS-CoV-2 Viral Load in Clinical Samples from Critically Ill Patients


title: Do COVID-19 and crude oil prices drive the US economic policy uncertainty?

text: This paper investigates the effect of the novel coronavirus and crude oil prices on the United States (US) economic policy uncertainty (EPU). Using daily data for the period January 21-March 13, 2020, our Autoregressive Distributed Lag (ARDL) model shows that the new infection cases reported at global level, and the death ratio, have no significant effect on the US EPU, whereas the oil price negative dynamics leads to increased uncertainty. However, analyzing the situation outside China, we discover that both new case announcements and the COVID-19 associated death ratio have a positive influence on the US EPU.


The COVID-19 (Coronavirus) pandemic: consequences for occupational health


docid: wqwuonap

title: Low prevalence of SARS-CoV-2 among pregnant and postpartum patients with universal screening in Seattle, Washington

text: We found a low prevalence of SARS-CoV-2 (2.7% [5/188]) among pregnant and postpartum patients after initiating universal testing. Prevalence among symptomatic patients (22.2% [4/18]) was similar to initial targeted screening approaches (19.1% [8/42]). Among 170 asymptomatic patients, two were positive or inconclusive, respectively; repeat testing at 24 hours was negative.


docid: haiuzuha

title: Demographic science aids in understanding the spread and fatality rates of COVID-19

text: Governments around the world must rapidly mobilize and make difficult policy decisions to mitigate the coronavirus disease 2019 (COVID-19) pandemic. Because deaths have been concentrated at older ages, we highlight the important role of demography, particularly, how the age structure of a population may help explain differences in fatality rates across countries and how transmission unfolds. We examine the role of age structure in deaths thus far in Italy and South Korea and illustrate how the pandemic could unfold in populations with similar population sizes but different age structures, showing a dramatically higher burden of mortality in countries with older versus younger populations. This powerful interaction of demography and current age-specific mortality for COVID-19 suggests that social distancing and other policies to slow transmission should consider the age composition of local and national contexts as well as intergenerational interactions. We also call for countries to provide case and fatality data disaggregated by age and sex to improve real-time targeted forecasting of hospitalization and critical care needs.


docid: rvrcsdmj

title: Implementation of a Reference-Scaled Average Bioequivalence Approach for Highly Variable Acetylsalicylic Acid in Fixed-Dose Combination with Clopidogrel Versus Enteric Aspirin in Chinese Subjects Under Fasting Conditions: A Phase 1, Open-Label, Randomized, Crossover Study

text: INTRODUCTION: Dual antiplatelet therapy, aspirin and a P2Y12 inhibitor, is recommended to prevent thrombotic complications of acute coronary syndrome. Clopidogrel plus acetylsalicylic acid combination is the most commonly used dual antiplatelet therapy recommended by international guidelines and in Chinese clinical practice. Poor adherence to dual antiplatelet therapy or premature interruption of dual antiplatelet therapy is an important contributor to cardiovascular mortality and lethal cardiovascular events. Clopidogrel + acetylsalicylic acid fixed-dose combination enhances adherence to dual antiplatelet therapy. Herein, we aimed to evaluate bioequivalence of acetylsalicylic acid and clopidogrel in fixed-dose combination compared with simultaneous administration of their individual formulations in healthy Chinese subjects under fasting conditions. METHODS: This was a randomized, single-center, open-label, three-sequence, three-period, two-treatment, crossover study with a washout period of 10 days conducted in healthy Chinese volunteers. Subjects were randomized to receive Co-Plavix® (test formulation- fixed-dose combination of 100 mg acetylsalicylic acid and 75 mg clopidogrel) once and reference formulations (coadministration of individual formulations of 100 mg acetylsalicylic acid and 75 mg clopidogrel) twice during the study period. Pharmacokinetic parameters were analyzed for acetylsalicylic acid, its metabolite salicylic acid, clopidogrel, and its metabolite SR26334. As acetylsalicylic acid shows high intrasubject variability, the reference-scaled average bioequivalence (RSABE) approach was implemented for acetylsalicylic acid analysis, while bioequivalence of clopidogrel was assessed using the average bioequivalence method. Point ratios and confidence intervals (CIs) for AUC, AUClast, and Cmax for acetylsalicylic acid and clopidogrel were calculated. RESULTS: In total, 171 healthy subjects were enrolled in this study. Subjects were randomized and 170 subjects were treated with test or reference formulation; 164 subjects completed the study. Regarding acetylsalicylic acid exposure, as reference within-subject standard deviation (SDW) was at least 0.294 for acetylsalicylic acid Cmax, AUClast, and AUC, the RSABE analysis method was used to assess bioequivalence for all three parameters. The point estimates were within the 0.80-1.25 range (1.19, 1.09, and 1.04, respectively), and upper one-sided 95% CIs of scaled average bioequivalence metric were at most 0 (- 0.30, - 0.14, and - 0.10, respectively). Thus, bioequivalence was demonstrated with acetylsalicylic acid. Bioequivalence was also achieved with clopidogrel as the 90% CIs for geometric mean ratios of clopidogrel Cmax, AUClast, and AUC were within the bioequivalence range (0.80-1.25). CONCLUSION: Application of the reference-scaled average bioequivalence approach to evaluate bioequivalence of acetylsalicylic acid in Chinese male and female healthy volunteers under fasting conditions demonstrated bioequivalence of test and reference formulations. TRIAL REGISTRATION: CTR20181695.


title: predCOVID-19: A Systematic Study of Clinical Predictive Models for Coronavirus Disease 2019

text: Coronavirus Disease 2019 (COVID-19) is a rapidly emerging respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the rapid human-to-human transmission of SARS-CoV-2, many healthcare systems are at risk of exceeding their healthcare capacities, in particular in terms of SARS-CoV-2 tests, hospital and intensive care unit (ICU) beds and mechanical ventilators. Predictive algorithms could potentially ease the strain on healthcare systems by identifying those who are most likely to receive a positive SARS-CoV-2 test, be hospitalised or admitted to the ICU. Here, we study clinical predictive models that estimate, using machine learning and based on routinely collected clinical data, which patients are likely to receive a positive SARS-CoV-2 test, require hospitalisation or intensive care. To evaluate the predictive performance of our models, we perform a retrospective evaluation on clinical and blood analysis data from a cohort of 5644 patients. Our experimental results indicate that our predictive models identify (i) patients that test positive for SARS-CoV-2 a priori at a sensitivity of 75% (95% CI: 67%, 81%) and a specificity of 49% (95% CI: 46%, 51%), (ii) SARS-CoV-2 positive patients that require hospitalisation with 0.92 AUC (95% CI: 0.81, 0.98), and (iii) SARS-CoV-2 positive patients that require critical care with 0.98 AUC (95% CI: 0.95, 1.00). In addition, we determine which clinical features are predictive to what degree for each of the aforementioned clinical tasks. Our results indicate that predictive models trained on routinely collected clinical data could be used to predict clinical pathways for COVID-19, and therefore help inform care and prioritise resources.


From ground-glass opacities to pulmonary emboli. A snapshot of the evolving role of a radiology unit facing the COVID-19 outbreak


Wound Healing Center: Analysis of preventive measures and new indications in a teaching hospital in central Italy during the Covid-19 emergency


A role for CT in COVID-19? What data really tell us so far


docid: yawircdf

title: Unrecognized diabetes in critically ill COVID-19 patients


A glimpse into a post-Covid vet future


Rapid Scale-Up of Telehealth During the COVID-19 Pandemic and Implications for Subspecialty Care in Rural Areas


The consequences of the COVID-19 pandemic for self-care in patients supported with a left ventricular assist device


title: Telemedicine During COVID-19 for Outpatient Sports and Musculoskeletal Medicine Physicians

text: INTRODUCTION: The global pandemic due to SARS-CoV-2 has resulted in an expansion of telemedicine. Measures of quality and barriers for rapid use by patients and physicians are not well described. OBJECTIVE: To describe results from a quality improvement initiative during a rapid adoptive phase of telemedicine during the pandemic. DESIGN: Patient and physician satisfaction with synchronous audiovisual telemedicine visits was measured during the early adoptive phase (6 April 2020-17 April 2020) within the division of sports medicine in an academic Physical Medicine and Rehabilitation (PM&R) department. Patients were invited to participate in a quality improvement initiative by completing an online survey at the end of a telemedicine visit. Physicians completed a separate survey. PRIMARY OUTCOME MEASURES: Patient measures included visit type, duration of encounter, quality, and satisfaction. Physicians reported on experiences performed telemedicine. RESULTS: Surveys were completed by 119 patients (293 telemedicine encounters, response rate 40.6%) and 14 physiatrists. Telemedicine was utilized primarily for follow-up visits (n = 74, 70.6%), and the most common duration was 15 to 29 minutes. Patients rated their telemedicine visit as "excellent" or "very good" across measures (91.6%-95.0%) including addressing concerns, communication, developing a treatment plan, convenience, and satisfaction. Value of completing a future telemedicine visit was measured at 84.9%. Most reported estimated travel time saved was in excess of 30 minutes. Rate of no-show was 2.7%. Most physicians (57.1%) had no prior experience with telemedicine visits, and most were comfortable performing these visits after completing 1 to 4 sessions (71%). Nearly all physicians (92.9%) rated their telemedicine experience as very good or excellent. The key barrier identified for telemedicine was technical issues. All physicians reported plans to perform telemedicine visits if reimbursement continues. CONCLUSIONS: In summary, rapid expansion of telemedicine during the COVID-19 pandemic was well-received by a majority of patients and physicians. This suggests feasibility in rapid expansion of telemedicine for other outpatient sports medicine practices.


title: Heightened risk of child maltreatment amid the COVID-19 pandemic can exacerbate mental health problems for the next generation

text: The spread of the COVID-19 disrupted ecological systems in which children develop, exacerbating threats to their safety and increasing their vulnerability to future psychopathology. Supports to reduce sources of stress for caregivers and protect children from threats to their safety are warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Pathogenesis of COVID-19 from the Perspective of the Damage-Response Framework

text: The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents the medical community with a significant challenge. COVID-19 is an entirely new disease with disparate clinical manifestations that are difficult to reconcile with a single pathogenic principle. Here, we explain how the flexible paradigm of the "damage-response framework" (DRF) of microbial pathogenesis can organize the varied manifestations of COVID-19 into a synthesis that accounts for differences in susceptibility of vulnerable populations as well as for differing manifestations of COVID-19 disease. By focusing on mechanisms of host damage, particularly immune-mediated damage, the DRF provides a lens to understand COVID-19 pathogenesis and to consider how potential therapies could alter the outcome of this disease.


docid: irkjiqll

title: Coronavirus: origins, signs, prevention and management of patients


title: Stability of RNA sequences derived from the coronavirus genome in human cells

text: Most viruses inhibit the innate immune system and/or the RNA degradation processes of host cells to construct an advantageous intracellular environment for their survival. Characteristic RNA sequences within RNA virus genomes or RNAs transcribed from DNA virus genomes contribute toward this inhibition. In this study, we developed a method called "Fate-seq" to comprehensively identify the RNA sequences derived from RNA and DNA viruses, contributing RNA stability in the cells. We examined the stabilization activity of 5,924 RNA fragments derived from 26 different viruses (16 RNA viruses and 10 DNA viruses) using next-generation sequencing of these RNAs fused 3' downstream of GFP reporter RNA. With the Fate-seq approach, we detected multiple virus-derived RNA sequences that stabilized GFP reporter RNA, including sequences derived from severe acute respiratory syndrome-related coronavirus (SARS-CoV). Comparative genomic analysis revealed that these RNA sequences and their predicted secondary structures are highly conserved between SARS-CoV and the novel coronavirus, SARS-CoV-2, which is responsible for the global outbreak of the coronavirus-associated disease that emerged in December 2019 (COVID-19). These sequences have the potential to enhance the stability of viral RNA genomes, thereby augmenting viral replication efficiency and virulence.


A plea for the pathogenic role of immune complexes in severe Covid-19


EP lessons by legendary quartet of "Jackman-Klein-Prystowsky-Stevenson": "A priceless opportunity" during the COVID-19 era


Challenges and Ethical Considerations for Trainees and Attending Physicians During the COVID-19 Pandemic


COVID-19, acute respiratory distress syndrome (ARDS), and hyperbaric oxygen therapy (HBOT): what is the link?


docid: ioeisvgj

title: Time-sensitive ambulatory orthopaedic soft-tissue surgery paradigms during the COVID-19 pandemic

text: PURPOSE: Timing of surgery for orthopaedic injuries continues to evolve, as an improved understanding of biology, healing, and technological advances continues to challenge historical norms. With the growing COVID-19 pandemic stretching limited healthcare resources, postponing surgery becomes an inevitable and unenviable task for most orthopaedic surgeons, and a shift in outpatient paradigms is required to mitigate poor outcomes in patients. METHODS: A scoping review of five databases on surgical timing and orthopaedic soft-tissue injuries was performed. All randomized controlled trials, longitudinal cohort studies, retrospective case series, systematic reviews, meta-analyses, and expert opinions were included for review, with 65 studies meeting the inclusion criteria. RESULTS: Better outcomes appear to be associated with early surgery for subluxations (< 1 week), recurrent dislocations (> 2 episodes), ligamentous and tendinous injuries (< 2 weeks), and bony avulsion injuries (< 3 weeks). Spinal conditions with neurological compromise should be operated on within 24 hours and spinal instability within 72 hours to reduce the risk of complications and poor outcomes. CONCLUSION: Most soft-tissue orthopaedic injuries can be managed with outpatient ambulatory surgery in a semi-elective setting. As the paradigm for outpatient surgery shifts due to technological advances and the COVID-19 pandemic, it is critical for surgeons to time their surgery appropriately to maintain the high standards of orthopaedic practice.


title: Challenges of COVID-19 pandemic for dermatology

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus responsible for the pandemic named coronavirus disease 2019 (COVID-19). The disease causes SARS with a significant morbidity and mortality. We provide a review with a focus on COVID-19 in dermatology. We discuss triage of suspected infectious patients, protection of medical doctors and nurses. We discuss the available data on cutaneous symptoms, although disease-specific symptoms have yet not been observed. COVID-19 is a challenge for the treatment of dermatologic patients, either with severe inflammatory disorders or with skin cancer. The consequences for systemic treatment are obvious but it will be most important to collect the clinical data for a better decision process. Last but not least, education in dermatology for students will not be temporarily possible in the classical settings. COVID-19, although not a skin disease, by itself has an immense impact on dermatology.


title: The association between obesity, type 2 diabetes, and hypertension with severe COVID-19 on admission among Mexicans

text: OBJECTIVE: To explore the association between obesity, type 2 diabetes, hypertension, and severe COVID-19 on admission. METHODS: In the present study, a total of 23,593 patient samples were evaluated by a laboratory from the Mexican Institute of Epidemiological Diagnosis and Reference (InDRE, for its acronym in Spanish). Of these: 18,443 were negative for COVID-19, 3,844 were positive for COVID-19, and 1,306 were positive for other respiratory viruses. Severe types of respiratory disease were defined by the presence of pneumonia and other organ failure that requires intensive care. Multivariable logistic regression models were used to explore factors associated with severe COVID-19 on admission. RESULTS: Patients who tested positive for COVID-19 had a higher proportion of obesity (17.4%), diabetes (14.5%), and hypertension (18.9%), compared to those without a confirmed diagnosis. Compared to non-obese patients, those with obesity showed a 1.43-fold higher odds of developing severe COVID-19 on admission, while subjects with diabetes and hypertension showed a 1.87-fold and 1.77-fold higher odds of developing severe COVID-19 on admission, respectively. CONCLUSION: Obesity, diabetes, and hypertension were significantly associated with severe COVID-19 on admission and the association of obesity was stronger in patients < 50 y.


COVID-19 grave con inicio como neumonía bilateral, ictus isquémico e infarto de miocardio./ COVID-19 grave con inicio como neumonía bilateral, ictus isquémico e infarto de miocardio./ Severe COVID-19 with debut as bilateral pneumonia, ischemic stroke, and acute myocardial infarction


COVID-19 pandemic: A stress test for interventional radiology


title: Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic

text: BACKGROUND: Before the COVID-19 pandemic, coronaviruses caused two noteworthy outbreaks: severe acute respiratory syndrome (SARS), starting in 2002, and Middle East respiratory syndrome (MERS), starting in 2012. We aimed to assess the psychiatric and neuropsychiatric presentations of SARS, MERS, and COVID-19. METHODS: In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases (from their inception until March 18, 2020), and medRxiv, bioRxiv, and PsyArXiv (between Jan 1, 2020, and April 10, 2020) were searched by two independent researchers for all English-language studies or preprints reporting data on the psychiatric and neuropsychiatric presentations of individuals with suspected or laboratory-confirmed coronavirus infection (SARS coronavirus, MERS coronavirus, or SARS coronavirus 2). We excluded studies limited to neurological complications without specified neuropsychiatric presentations and those investigating the indirect effects of coronavirus infections on the mental health of people who are not infected, such as those mediated through physical distancing measures such as self-isolation or quarantine. Outcomes were psychiatric signs or symptoms; symptom severity; diagnoses based on ICD-10, DSM-IV, or the Chinese Classification of Mental Disorders (third edition) or psychometric scales; quality of life; and employment. Both the systematic review and the meta-analysis stratified outcomes across illness stages (acute vs post-illness) for SARS and MERS. We used a random-effects model for the meta-analysis, and the meta-analytical effect size was prevalence for relevant outcomes, I2 statistics, and assessment of study quality. FINDINGS: 1963 studies and 87 preprints were identified by the systematic search, of which 65 peer-reviewed studies and seven preprints met inclusion criteria. The number of coronavirus cases of the included studies was 3559, ranging from 1 to 997, and the mean age of participants in studies ranged from 12·2 years (SD 4·1) to 68·0 years (single case report). Studies were from China, Hong Kong, South Korea, Canada, Saudi Arabia, France, Japan, Singapore, the UK, and the USA. Follow-up time for the post-illness studies varied between 60 days and 12 years. The systematic review revealed that during the acute illness, common symptoms among patients admitted to hospital for SARS or MERS included confusion (36 [27·9%; 95% CI 20·5-36·0] of 129 patients), depressed mood (42 [32·6%; 24·7-40·9] of 129), anxiety (46 [35·7%; 27·6-44·2] of 129), impaired memory (44 [34·1%; 26·2-42·5] of 129), and insomnia (54 [41·9%; 22·5-50·5] of 129). Steroid-induced mania and psychosis were reported in 13 (0·7%) of 1744 patients with SARS in the acute stage in one study. In the post-illness stage, depressed mood (35 [10·5%; 95% CI 7·5-14·1] of 332 patients), insomnia (34 [12·1%; 8·6-16·3] of 280), anxiety (21 [12·3%; 7·7-17·7] of 171), irritability (28 [12·8%; 8·7-17·6] of 218), memory impairment (44 [18·9%; 14·1-24·2] of 233), fatigue (61 [19·3%; 15·1-23·9] of 316), and in one study traumatic memories (55 [30·4%; 23·9-37·3] of 181) and sleep disorder (14 [100·0%; 88·0-100·0] of 14) were frequently reported. The meta-analysis indicated that in the post-illness stage the point prevalence of post-traumatic stress disorder was 32·2% (95% CI 23·7-42·0; 121 of 402 cases from four studies), that of depression was 14·9% (12·1-18·2; 77 of 517 cases from five studies), and that of anxiety disorders was 14·8% (11·1-19·4; 42 of 284 cases from three studies). 446 (76·9%; 95% CI 68·1-84·6) of 580 patients from six studies had returned to work at a mean follow-up time of 35·3 months (SD 40·1). When data for patients with COVID-19 were examined (including preprint data), there was evidence for delirium (confusion in 26 [65%] of 40 intensive care unit patients and agitation in 40 [69%] of 58 intensive care unit patients in one study, and altered consciousness in 17 [21%] of 82 patients who subsequently died in another study). At discharge, 15 (33%) of 45 patients with COVID-19 who were assessed had a dysexecutive syndrome in one study. At the time of writing, there were two reports of hypoxic encephalopathy and one report of encephalitis. 68 (94%) of the 72 studies were of either low or medium quality. INTERPRETATION: If infection with SARS-CoV-2 follows a similar course to that with SARS-CoV or MERS-CoV, most patients should recover without experiencing mental illness. SARS-CoV-2 might cause delirium in a significant proportion of patients in the acute stage. Clinicians should be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the longer term. FUNDING: Wellcome Trust, UK National Institute for Health Research (NIHR), UK Medical Research Council, NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust and University College London.


SARS coronavirus 2; how many more examples do we need before the world commits to decisive action?


title: Impact of the COVID-19 Pandemic on the Management of Head and Neck Malignancies

text: The impact of the coronavirus disease 2019 (COVID-19) pandemic on the management of head and neck cancer must be addressed. Immediate measures to reduce transmission rates and protect patients and providers take priority and necessitate some delays in care, particularly for patients with mild symptoms or less aggressive cancers. However, strict guidelines have yet to be developed, and many unintentional delays in care are to be expected based on the magnitude of the looming public health crisis. The medical complexity of head and neck cancer management may lead to prolonged delays that worsen treatment outcomes. Therefore, those caring for patients with head and neck cancer must take action to reduce these negative impacts as the country rallies to overcome the challenges posed by this pandemic.


Meat plants-a new front line in the covid-19 pandemic


Covid-19 and Immunity in Aging Populations - A New Research Agenda


title: ACE2 Expression is Increased in the Lungs of Patients with Comorbidities Associated with Severe COVID-19

text: PATIENTS: who died from COVID-19 often had comorbidities, such as hypertension, diabetes, and chronic obstructive lung disease. Although angiotensin-converting enzyme 2 (ACE2) is crucial for SARS-CoV2 to bind and enter host cells, no study has systematically assessed the ACE2 expression in the lungs of patients with these diseases. Here, we analyzed over 700 lung transcriptome samples of patients with comorbidities associated with severe COVID-19 and found that ACE2 was highly expressed in these patients, compared to control individuals. This finding suggests that patients with such comorbidities may have higher chances of developing severe COVID-19. Correlation and network analyses revealed many potential regulators of ACE2 in the human lung, including genes related to histone modifications, such as HAT1, HDAC2, and KDM5B. Our systems biology approach offers a possible explanation for increase of COVID-19 severity in patients with certain comorbidities.


title: COVID-19 Response in the Global Epicenter: Converting a New York City Level 1 Orthopedic Trauma Service into a Hybrid Orthopedic and Medicine COVID-19 Management Team

text: The SARS-COV-2 (COVID-19) pandemic has placed unprecedented challenges on the health care system in the United States with New York City at its epicenter. By the end of the 8 week (4/23/2020) since the virus's emergence in New York City, there have been 142,432 confirmed COVID-19 cases and 10,977 deaths attributed to complications from COVID-19-related illnesses. Secondary to policies enacted by the New York State government to limit spread of the virus, Orthopedic Surgery departments at hospitals around the area have witnessed an abrupt change in clinical demands. At a local level one trauma hospital in Queens, New York, Orthopedic Surgery elective cases have been cancelled, trauma consult volume has experienced a sharp decline, and both residents and attendings have been repurposed to meet the new clinical demands of this medical crisis. Our own orthopedic surgery service has adopted care for patients normally admitted to an internal medicine service in a novel Ortho-Medical COVID-19 management team. We prepared this primer to make our experience with caring for COVID-19 patents available as a reference for other surgical subspecialty services preparing to adjust the clinical focus of their hospital teams during this or future pandemics. LEVEL OF EVIDENCE:: Level V.


Effect of COVID-19 on ocular diseases and ophthalmology residency training program-A developing country's perspective


A confirmed asymptomatic carrier of 2019 novel coronavirus


Immunosuppression during the COVID-19 pandemic in neuromyelitis optica spectrum disorders patients: A new challenge


title: Towards individualised and optimalised positioning of non-ventilated COVID-19 patients: Putting the affected parts of the lung(s) on top?

text: The outbreak of COVID-19 led to an unprecedented inflow of hospitalised patients with severe acute respiratory syndrome (SARS), requiring high-flow non-invasive oxygenation, if not invasive mechanical ventilation. While the best option in terms of non-invasive systems of oxygen delivery is still a matter of debate, it also remains unclear as to whether or not the optimal in-bed positioning of patients might also help to improve their oxygen saturation levels. On the basis of three representative cases, it is possible to propose the following hypotheses: (i) how patients are positioned has a strong influence on their oxygen saturation levels; (ii) saturation-optimalised positions are patient-specific; (iii) prone positions require ergonomic devices; and (iv) saturation-optimalised positions should aim to place the most affected part(s) of the lung(s) on top. Considered together, these hypotheses have led us to recommend that COVID-19 patients should undergo a specific assessment at admission to determine their saturation-optimalised in-bed position. However, further studies are still needed to assess the benefits of such a strategy on clinical outcomes.


title: Syrian hamsters as a small animal model for SARS-CoV-2 infection and countermeasure development

text: At the end of 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2; SARS-CoV-2) was detected in Wuhan, China, that spread rapidly around the world, with severe consequences for human health and the global economy. Here, we assessed the replicative ability and pathogenesis of SARS-CoV-2 isolates in Syrian hamsters. SARS-CoV-2 isolates replicated efficiently in the lungs of hamsters, causing severe pathological lung lesions following intranasal infection. In addition, microcomputed tomographic imaging revealed severe lung injury that shared characteristics with SARS-CoV-2-infected human lung, including severe, bilateral, peripherally distributed, multilobular ground glass opacity, and regions of lung consolidation. SARS-CoV-2-infected hamsters mounted neutralizing antibody responses and were protected against subsequent rechallenge with SARS-CoV-2. Moreover, passive transfer of convalescent serum to naïve hamsters efficiently suppressed the replication of the virus in the lungs even when the serum was administrated 2 d postinfection of the serum-treated hamsters. Collectively, these findings demonstrate that this Syrian hamster model will be useful for understanding SARS-CoV-2 pathogenesis and testing vaccines and antiviral drugs.


title: Deep Convolutional Neural Networks to Diagnose COVID-19 and other Pneumonia Diseases from Posteroanterior Chest X-Rays

text: The article explores different deep convolutional neural network architectures trained and tested on posteroanterior chest X-rays of 327 patients who are healthy (152 patients), diagnosed with COVID-19 (125), and other types of pneumonia (48). In particular, this paper looks at the deep convolutional neural networks VGG16 and VGG19, InceptionResNetV2 and InceptionV3, as well as Xception, all followed by a flat multi-layer perceptron and a final 30% drop-out. The paper has found that the best performing network is VGG16 with a final $30$% drop-out trained over 3 classes (COVID-19, No Finding, Other Pneumonia). It has an internal cross-validated accuracy of $93.9(\pm3.4)$%, a COVID-19 sensitivity of $87.7(-1.9,+2)$%, and a No Finding sensitivity of $96.8(\pm0.8)$%. The respective external cross-validated values are $84.1(\pm13.5)$%, $87.7(-1.9,2)$%, and $96.8(\pm0.8)$%. The model optimizer was Adam with a 1e-4 learning rate, and categorical cross-entropy loss. It is hoped that, once this research will be put to practice in hospitals, healthcare professionals will be able in the medium to long-term to diagnosing through machine learning tools possible pneumonia, and if detected, whether it is linked to a COVID-19 infection, allowing the detection of new possible COVID-19 foyers after the end of possible"stop-and-go"lockdowns as expected by until a vaccine is found and widespread. Furthermore, in the short-term, it is hoped practitioners can compare the diagnosis from the deep convolutional neural networks with possible RT-PCR testing results, and if clashing, a Computed Tomography could be performed as they are more accurate in showing COVID-19 pneumonia.


title: A Semantic Web Framework for Automated Smart Assistants: COVID-19 Case Study

text: COVID-19 pandemic elucidated that knowledge systems will be instrumental in cases where accurate information needs to be communicated to a substantial group of people with different backgrounds and technological resources. However, several challenges and obstacles hold back the wide adoption of virtual assistants by public health departments and organizations. This paper presents the Instant Expert, an open-source semantic web framework to build and integrate voice-enabled smart assistants (i.e. chatbots) for any web platform regardless of the underlying domain and technology. The component allows non-technical domain experts to effortlessly incorporate an operational assistant with voice recognition capability into their websites. Instant Expert is capable of automatically parsing, processing, and modeling Frequently Asked Questions pages as an information resource as well as communicating with an external knowledge engine for ontology-powered inference and dynamic data utilization. The presented framework utilizes advanced web technologies to ensure reusability and reliability, and an inference engine for natural language understanding powered by deep learning and heuristic algorithms. A use case for creating an informatory assistant for COVID-19 based on the Centers for Disease Control and Prevention (CDC) data is presented to demonstrate the framework's usage and benefits.


Epidemia COVID-19: ¿debe el oftalmólogo estar alerta ante las paresias oculomotoras?/ Epidemia COVID-19: ¿debe el oftalmólogo estar alerta ante las paresias oculomotoras?/ COVID-19 epidemic: Should ophthalmologists be aware of oculomotor paresis?


title: Real-time estimation of the short-run impact of COVID-19 on economic activity using electricity market data

text: The COVID-19 pandemic has caused more than 8 million confirmed cases and 500,000 death to date. In response to this emergency, many countries have introduced a series of social-distancing measures including lockdowns and businesses' temporary shutdowns, in an attempt to curb the spread of the infection. Accordingly, the pandemic has been generating unprecedent disruption on practically every aspect of society. This paper demonstrates that high-frequency electricity market data can be used to estimate the causal, short-run impact of COVID-19 on the economy. In the current uncertain economic conditions, timeliness is essential. Unlike official statistics, which are published with a delay of a few months, with our approach one can monitor virtually every day the impact of the containment policies, the extent of the recession and measure whether the monetary and fiscal stimuli introduced to address the crisis are being effective. We illustrate our methodology on daily data for the Italian day-ahead power market. Not surprisingly, we find that the containment measures caused a significant reduction in economic activities and that the GDP at the end of in May 2020 is still about 11% lower that what it would have been without the outbreak.


docid: karnbncw

title: March/April 2020: Special COVID-19 Issue


Efficacy of MSC for steroid-refractory acute GVHD associates with MSC donor age and a defined molecular profile


Emergency Palliative Care Planning and Support in a COVID-19 Pandemic


Should interferons take front stage as an essential MS disease-modifying therapy in the era of coronavirus disease 2019?


Grundrechte in Zeiten von Corona : Zugleich Anmerkung zu BVerfG, Beschl. v. 7.4.2020  1 BvR 755/20


title: Clinical and Epidemiological Characteristics of Patients Diagnosed with Covid-19 in a Tertiary Care Center in Mexico City: a Prospective Cohort Study

text: Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.


title: Cellular Scale Imaging of Transparent Retinal Structures and Processes Using Adaptive Optics Optical Coherence Tomography

text: High-resolution retinal imaging is revolutionizing how scientists and clinicians study the retina on the cellular scale. Its exquisite sensitivity enables time-lapse optical biopsies that capture minute changes in the structure and physiological processes of cells in the living eye. This information is increasingly used to detect disease onset and monitor disease progression during early stages, raising the possibility of personalized eye care. Powerful high-resolution imaging tools have been in development for more than two decades; one that has garnered considerable interest in recent years is optical coherence tomography enhanced with adaptive optics. State-of-the-art adaptive optics optical coherence tomography (AO-OCT) makes it possible to visualize even highly transparent cells and measure some of their internal processes at all depths within the retina, permitting reconstruction of a 3D view of the living microscopic retina. In this review, we report current AO-OCT performance and its success in visualizing and quantifying these once-invisible cells in human eyes. Expected final online publication date for the Annual Review of Vision Science, Volume 6 is September 15, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.


title: Taste and smell as chemosensory dysfunctions in COVID-19 infection

text: PURPOSE: To review the literature on the presence of two clinical manifestations in patients presenting COVID-19 (SARS-CoV-2) infection: loss of taste (ageusia) and loss of smell (anosmia) METHODS: PubMed and EMBASE were searched and studies were selected starting from November, 2019 until April 2020;also, the references of the selected articles were evaluated for methodological quality RESULTS: Of the 19 studies analyzed, five were included to evaluate the presence of ageusia and/or anosmia as symptoms in patients who were tested and resulted positive for the SARS-CoV-2 virus In a total of 10,818 patients, 8,823 presented ageusia (81 6%;range 5 6%-88%) and 8,088 presented anosmia (74 8%;range 5 1-85 6%) Only one study recorded both symptoms with a percentage of 18 6% CLINICAL SIGNIFICANCE: This systematic review demonstrated significant presence of ageusia and anosmia in the patients with COVID-19 infection These symptoms may be considered as the first manifestation of the infection


Facing Covid-19 in Italy - Ethics, Logistics, and Therapeutics on the Epidemic's Front Line


Ruxolitinib for the treatment of SARS-CoV-2 induced acute respiratory distress syndrome (ARDS)


title: "Perioperative Presentation of COVID-19 Disease in a Liver Transplant Recipient"

text: In a recent issue of Hepatology, Drs. Qin and Wang report a case of a 37-year old patient with COVID-19 disease after undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). While these are interesting data on the course of COVID-19 disease in an immunosuppressed patient, we would like to highlight some particularly important issues related to management of liver disease and post-transplant care.


title: Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State

text: Importance: Hydroxychloroquine, with or without azithromycin, has been considered as a possible therapeutic agent for patients with coronavirus disease 2019 (COVID-19). However, there are limited data on efficacy and associated adverse events. Objective: To describe the association between use of hydroxychloroquine, with or without azithromycin, and clinical outcomes among hospital inpatients diagnosed with COVID-19. Design, Setting, and Participants: Retrospective multicenter cohort study of patients from a random sample of all admitted patients with laboratory-confirmed COVID-19 in 25 hospitals, representing 88.2% of patients with COVID-19 in the New York metropolitan region. Eligible patients were admitted for at least 24 hours between March 15 and 28, 2020. Medications, preexisting conditions, clinical measures on admission, outcomes, and adverse events were abstracted from medical records. The date of final follow-up was April 24, 2020. Exposures: Receipt of both hydroxychloroquine and azithromycin, hydroxychloroquine alone, azithromycin alone, or neither. Main Outcomes and Measures: Primary outcome was in-hospital mortality. Secondary outcomes were cardiac arrest and abnormal electrocardiogram findings (arrhythmia or QT prolongation). Results: Among 1438 hospitalized patients with a diagnosis of COVID-19 (858 [59.7%] male, median age, 63 years), those receiving hydroxychloroquine, azithromycin, or both were more likely than those not receiving either drug to have diabetes, respiratory rate >22/min, abnormal chest imaging findings, O2 saturation lower than 90%, and aspartate aminotransferase greater than 40 U/L. Overall in-hospital mortality was 20.3% (95% CI, 18.2%-22.4%). The probability of death for patients receiving hydroxychloroquine + azithromycin was 189/735 (25.7% [95% CI, 22.3%-28.9%]), hydroxychloroquine alone, 54/271 (19.9% [95% CI, 15.2%-24.7%]), azithromycin alone, 21/211 (10.0% [95% CI, 5.9%-14.0%]), and neither drug, 28/221 (12.7% [95% CI, 8.3%-17.1%]). In adjusted Cox proportional hazards models, compared with patients receiving neither drug, there were no significant differences in mortality for patients receiving hydroxychloroquine + azithromycin (HR, 1.35 [95% CI, 0.76-2.40]), hydroxychloroquine alone (HR, 1.08 [95% CI, 0.63-1.85]), or azithromycin alone (HR, 0.56 [95% CI, 0.26-1.21]). In logistic models, compared with patients receiving neither drug cardiac arrest was significantly more likely in patients receiving hydroxychloroquine + azithromycin (adjusted OR, 2.13 [95% CI, 1.12-4.05]), but not hydroxychloroquine alone (adjusted OR, 1.91 [95% CI, 0.96-3.81]) or azithromycin alone (adjusted OR, 0.64 [95% CI, 0.27-1.56]), . In adjusted logistic regression models, there were no significant differences in the relative likelihood of abnormal electrocardiogram findings. Conclusions and Relevance: Among patients hospitalized in metropolitan New York with COVID-19, treatment with hydroxychloroquine, azithromycin, or both, compared with neither treatment, was not significantly associated with differences in in-hospital mortality. However, the interpretation of these findings may be limited by the observational design.


Using Telehealth Cardiopulmonary Rehabilitation during the COVID-19 Pandemic


Risk factors for death from COVID-19


Optimizing the Use Of Teleneurology During the COVID-19 Pandemic


title: Presenting Features and Early Mortality from SARS-CoV-2 Infection in Cancer Patients during the Initial Stage of the COVID-19 Pandemic in Europe

text: We describe the outcomes in cancer patients during the initial outbreak of the COVID-19 in Europe from the retrospective, multi-center observational OnCovid study. We identified 204 cancer patients from eight centers in the United Kingdom, Italy, and Spain aged > 18 (mean = 69) and diagnosed with COVID-19 between February 26th and April 1st, 2020. A total of 127 (62%) were male, 184 (91%) had a diagnosis of solid malignancy, and 103 (51%) had non-metastatic disease. A total of 161 (79%) had > 1 co-morbidity. A total of 141 (69%) patients had > 1 COVID-19 complication. A total of 36 (19%) were escalated to high-dependency or intensive care. A total of 59 (29%) died, 53 (26%) were discharged, and 92 (45%) were in-hospital survivors. Mortality was higher in patients aged > 65 (36% versus 16%), in those with > 2 co-morbidities (40% versus 18%) and developing > 1 complication from COVID-19 (38% versus 4%, p = 0.004). Multi-variable analyses confirmed age > 65 and > 2 co-morbidities to predict for patient mortality independent of tumor stage, active malignancy, or anticancer therapy. During the early outbreak of SARS-CoV-2 infection in Europe co-morbid burden and advancing age predicted for adverse disease course in cancer patients. The ongoing OnCovid study will allow us to compare risks and outcomes in cancer patients between the initial and later stages of the COVID-19 pandemic.


Demographic Stability on Mechanical Turk Despite COVID-19


docid: dekljruc

title: Hospital-based use of thromboprophylaxis in patients with COVID-19


title: Automatic Detection of Influential Actors in Disinformation Networks

text: The weaponization of digital communications and social media to conduct disinformation campaigns at immense scale, speed, and reach presents new challenges to identify and counter hostile influence operations (IO). This paper presents an end-to-end framework to automate detection of disinformation narratives, networks, and influential actors. The framework integrates natural language processing, machine learning, graph analytics, and a novel network causal inference approach to quantify the impact of individual actors in spreading IO narratives. We demonstrate its capability on real-world hostile IO campaigns with Twitter datasets collected during the 2017 French presidential elections, and known IO accounts disclosed by Twitter. Our system detects IO accounts with 96% precision, 79% recall, and 96% area-under-the-PR-curve, maps out salient network communities, and discovers high-impact accounts that escape the lens of traditional impact statistics based on activity counts and network centrality. Results are corroborated with independent sources of known IO accounts from U.S. Congressional reports, investigative journalism, and IO datasets provided by Twitter.


No detection of SARS-CoV-2 in cystic fibrosis patients at the Regional (Lazio) Reference Center for CF in Italy


Focus on kidney disease among the coronavirus disease 2019 patients: A comparative perspective between China, Italy and the United States


title: Treating acute anxiety in patients with COVID-19

text: At present, there are no firm guidelines for the treatment of COVID-19-related emotional distress. The current approach is based on our knowledge of how to manage anxiety in medically ill patients, taking into consideration all associated medical comorbidities, drug-drug interactions, and the patient's specific needs and preexisting mental illness. Interventions should be implemented at the bedside to augment the patient's own resiliency in coping with these stressful events. A targeted combination of psychopharmacology (targeting acute anxiety and panic symptoms) and psychotherapy (relaxation techniques, breathing exercises, and encouragement) is recommended.


COVID-19: The Worst Days of Our Careers


title: Quantification of plasma remdesivir and its metabolite GS-441524 using liquid chromatography coupled to tandem mass spectrometry. Application to a Covid-19 treated patient

text: Objectives A method based on liquid chromatography coupled to triple quadrupole mass spectrometry detection using 50 µL of plasma was developed and fully validated for quantification of remdesivir and its active metabolites GS-441524. Methods A simple protein precipitation was carried out using 75 µL of methanol containing the internal standard (IS) remdesivir-13C6 and 5 µL ZnSO4 1 M. After separation on Kinetex® 2.6 µm Polar C18 100A LC column (100 × 2.1 mm i.d.), both compounds were detected by a mass spectrometer with electrospray ionization in positive mode. The ion transitions used were m/z 603.3 â m/z 200.0 and m/z 229.0 for remdesivir, m/z 292.2 â m/z 173.1 and m/z 147.1 for GS-441524 and m/z 609.3 â m/z 206.0 for remdesivir-13C6. Results Calibration curves were linear in the 1-5000 µg/L range for remdesivir and 5-2500 for GS-441524, with limit of detection set at 0.5 and 2 µg/L and limit of quantification at 1 and 5 µg/L, respectively. Precisions evaluated at 2.5, 400 and 4000 µg/L for remdesivir and 12.5, 125, 2000 µg/L for GS-441524 were lower than 14.7% and accuracy was in the [89.6-110.2%] range. A slight matrix effect was observed, compensated by IS. Higher stability of remdesivir and metabolite was observed on NaF-plasma. After 200 mg IV single administration, remdesivir concentration decrease rapidly with a half-life less than 1 h while GS-441524 appeared rapidly and decreased slowly until H24 with a half-life around 12 h. Conclusions This method would be useful for therapeutic drug monitoring of these compounds in Covid-19 pandemic.


A process for daily checks when using anaesthetic machines to ventilate the lungs of COVID-19 patients: the 'domino switch' technique


title: The Pandemic: Lessons for Bioethics?

text: Seeking useful ways to respond to the Covid-19 pandemic, bioethicists have been tempted to claim for themselves what Alasdair MacIntyre characterized in After Virtue as the moral fiction of managerial expertise. They have been eager to offer a wide range of policy prescriptions, presenting themselves as bureaucratic managers and suggesting an expertise that bioethics may not in fact be able to offer. This was evident, for example, in the petition published by The Hastings Center in March 2020. The pandemic could foster a more hopeful future for bioethics if it were to focus attention less on policy decisions that belong to all citizens and more on some of the most basic moral questions that life presents and with which bioethics has always dealt-including, surely, the virtues needed in order to live well in a time of pandemic.


docid: khhhtuhk

title: Why the World Bank ex-chief is on a mission to end coronavirus transmission


title: Air Quality Variation in Wuhan, Daegu, and Tokyo during the Explosive Outbreak of COVID-19 and Its Health Effects

text: This study was designed to assess the variation of the air quality actually measured from the air pollution monitoring stations (AQMS) in three cities (Wuhan, Daegu, and Tokyo), in Asian countries experiencing the explosive outbreak of COVID-19, in a short period of time. In addition, we made a new attempt to calculate the reduced DosePM2.5 (µg) at the bronchiolar (Br.) and alveolar-interstitial (AI) regions of the 10-year-old children after the city lockdown/self-reflection of each city. A comparison of the average PM2.5 of a month before and after the lockdown (Wuhan) and self-reflection (Daegu and Tokyo) clearly shows that the PM2.5 concentration was decreased by 29.9, 20.9, and 3.6% in Wuhan, Daegu and Tokyo, respectively. Wuhan, Daegu and Tokyo also recorded 53.2, 19.0, and 10.4% falls of NO2 concentration, respectively. Wuhan, which had the largest decrease of PM2.5 concentration due to COVID-19, also marked the largest reduced DosePM2.5 10-year-old children (µg) (3660 µg at Br. and 6222 µg at AI), followed by Daegu (445 µg at Br. and 1,287 µg at AI), and Tokyo (18 µg at Br. and 52 µg at AI), over two months after the city lockdown/self-reflection. Our results suggest that the city lockdown/self-reflection had the effect of lowering the concentration of PM2.5, resulting in an extension of the period it took to the acute allergic airway inflammation (AAI) for the 10-year-old children.


Tackling UK's mortality problem: covid-19 and other causes


How can I take care of you? The dermatologist meets patients' needs during the COVID-19 pandemic


COVID-19 - how a pandemic reveals that everything is connected to everything else


Covid-19: Lopinavir-ritonavir does not benefit hospitalised patients, UK trial finds


title: A cross-sectional study: Comparing the attitude and knowledge of medical and non-medical students toward 2019 novel coronavirus

text: BACKGROUND AND OBJECTIVES: Since December 2019, the rapid epidemic spread of COVID-19 in China has aroused the attention of the government and the public. The purpose of this study is to investigate the attitude and knowledge among medical students and non-medical students toward SARS-CoV-2 infection. METHODS: A web-based survey was disseminated to the students from medical colleges and comprehensive universities via the survey website (www.wjx.cn) and via WeChat. Participation in the study was voluntary with the instruction to click on the website or scan the QR code to complete the anonymous electronic questionnaire from February 5 to 7, 2020. RESULTS: The questionnaire was completed by 588 students from 20 colleges and universities in China. Of the respondents, 66.0% were medical students and 34.0% were non-medical students. 99.6 % of the students held an optimistic attitude toward the COVID-19 epidemic situation. The majority of participants had a good level of knowledge of common symptoms, transmission, and prevention of the disease. In a comparison between non-medical students with medical students, the medical students had a deeper understanding of COVID-19. In this study, we also found that female students had a better understanding of transmission and prevention than male students did. CONCLUSIONS: The majority of students who participated in the questionnaire had a positive attitude and a good perception about COVID-19.


Medical resources are scarce, but theories about their allocation are not


title: Simulation study of the effects of interstitial fluid pressure and blood flow velocity on transvascular transport of nanoparticles in tumor microenvironment

text: BACKGROUND AND OBJECTIVE: Although nanoparticle preparations have great potential in the treatment of tumors, nanoparticle preparations have not achieved the desired therapeutic effect. The reason is that the abnormal tumor microenvironment prevents nanoparticles from effective concentrating and reaching tumor area. Therefore, it's very necessary to better understand the effect of the abnormal tumor microenvironment on the transvascular transport of nanoparticles to overcome this critical problem. METHODS: In this paper, a tumor abnormal vascular-interstitial model was established, and the transvascular transport process of nanoparticles was simulated in the model by computational fluid dynamics (CFD) modeling. RESULTS: The simulation results showed that the transport efficiency of nanoparticles decreased with increasing interstitial fluid pressure (IFP), and nanoparticles could not cross the blood vessel wall when the IFP approached the blood vessel wall pressure. Interestingly, the transport efficiency of nanoparticles first increased with blood flow velocity, and then decreased with blood flow velocity. CONCLUSIONS: The results showed that with the continuous malignant development of tumors, the ability of nanoparticles to passively diffuse has almost disappeared. The enhanced permeability and retention (EPR) effect of the nanoparticles disappeared with the disappearance of the pressure gradient inside the tumor. These results provided guidance for future research on the vascular transport pathways and mechanisms of nanoparticles.


title: Radiotherapy after the easing of public restrictions during COVID-19 epidemic

text: The daily new confirmed Coronavirus disease 2019 (COVID-19) cases have decreased in some European and Asian countries. Many countries and areas have started to ease public restrictions. Here, we share our experiences and recommendations on how to conduct radiotherapy after public restrictions have eased or upon reopening. Firstly, COVID-19 nucleic acid test screening should be performed for all new admitted patients in areas with enough test capability. Secondly, radiotherapy can be conducted reference to consensus or recommendations on radiotherapy during COVID-19. Thirdly, it is not the time to consider compromising the guidance and the guidance on radiotherapy workflow and protection procedures still should be strictly followed.


COVID-19: Yin and Yang and Herd Immunity


Acute promyelocytic leukaemia lying under the mask of COVID-19-a diagnostic and therapeutic conundrum


Increased internet search interest for GI symptoms may predict COVID-19 cases in US hotspots


Discontinuation of antiviral drugs may be the reason for recovered COVID-19 patients testing positive again


docid: uoimfbeu

title: Cash, currency and COVID-19


Impact of COVID 19: perspectives from gastroenterology


Lung ultrasonography in a woman with COVID-19: This examination could be remote


docid: pynpxxol

title: Meningoencephalitis without respiratory failure in a young female patient with COVID-19 infection in Downtown Los Angeles, early April 2020


When a system breaks: queueing theory model of intensive care bed needs during the COVID-19 pandemic


What are the risks of COVID-19 infection in pregnant women?


Working in the emergency and inpatient COVID-19 special wards: A different experience for Iranian psychiatric trainees amid the outbreak


title: Overview of Upper Airway Management During Covid-19 Outbreak: Head & Neck Surgeon's Perspective

text: At the end of December, 2019, a new virus was named SARS-CoV-2 appeared in Wuhan, China the disease it causes as COVID-19 by WHO, to date having infected more than 3588773 people worldwide, as well as causing 247503 deaths (1), a human to human Transmission is thought to be predominantly by droplet spread, and direct contact with the patient or contaminated surfaces. (2). This paper aims to provide a comprehensive overview as well as to highlight essential evidence based guidelines for how Head and Neck surgeon and healthcare providers need to take into consideration during their management of the upper airway during the COVID-19 pandemic safely and effectively to avoid the spread of the virus to the health provider.


Mendelian randomization in COVID-19: Applications for cardiovascular comorbidities and beyond


title: Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units

text: Importance: The recent and ongoing coronavirus disease 2019 (COVID-19) pandemic has taken an unprecedented toll on adults critically ill with COVID-19 infection. While there is evidence that the burden of COVID-19 infection in hospitalized children is lesser than in their adult counterparts, to date, there are only limited reports describing COVID-19 in pediatric intensive care units (PICUs). Objective: To provide an early description and characterization of COVID-19 infection in North American PICUs, focusing on mode of presentation, presence of comorbidities, severity of disease, therapeutic interventions, clinical trajectory, and early outcomes. Design, Setting, and Participants: This cross-sectional study included children positive for COVID-19 admitted to 46 North American PICUs between March 14 and April 3, 2020. with follow-up to April 10, 2020. Main Outcomes and Measures: Prehospital characteristics, clinical trajectory, and hospital outcomes of children admitted to PICUs with confirmed COVID-19 infection. Results: Of the 48 children with COVID-19 admitted to participating PICUs, 25 (52%) were male, and the median (range) age was 13 (4.2-16.6) years. Forty patients (83%) had significant preexisting comorbidities; 35 (73%) presented with respiratory symptoms and 18 (38%) required invasive ventilation. Eleven patients (23%) had failure of 2 or more organ systems. Extracorporeal membrane oxygenation was required for 1 patient (2%). Targeted therapies were used in 28 patients (61%), with hydroxychloroquine being the most commonly used agent either alone (11 patients) or in combination (10 patients). At the completion of the follow-up period, 2 patients (4%) had died and 15 (31%) were still hospitalized, with 3 still requiring ventilatory support and 1 receiving extracorporeal membrane oxygenation. The median (range) PICU and hospital lengths of stay for those who had been discharged were 5 (3-9) days and 7 (4-13) days, respectively. Conclusions and Relevance: This early report describes the burden of COVID-19 infection in North American PICUs and confirms that severe illness in children is significant but far less frequent than in adults. Prehospital comorbidities appear to be an important factor in children. These preliminary observations provide an important platform for larger and more extensive studies of children with COVID-19 infection.


title: [Role of age, comorbidity and renin- angiotensin-aldosterone system in COVID-19. Effects of ACE inhibitors and angiotensin receptor blockers]

text: The review addressed the relationship of coronavirus disease 2019 (COVID-19) with functioning of the renin-angiotensin-aldosterone axis and the causes for unfavorable prognosis depending on patients' age and comorbidities. The authors discussed in detail potential effects of angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor antagonists on the risk of infection and the course of COVID-2019 as well as the effect of SARS-COV2 virus on the cardiovascular system.


Ten Weeks to Crush the Curve


title: A Systematic Review on Guidelines and Recommendations for Urology Standard of Care During the COVID-19 Pandemic

text: CONTEXT: The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge. OBJECTIVE: To summarize guidelines and recommendations on the urology standard of care during the COVID-19 pandemic. EVIDENCE ACQUISITION: Guidelines and recommendations published between November 2019 and April 17, 2020 were retrieved using MEDLINE, EMBASE, and CINAHL. This was supplemented by searching the web pages of international urology societies. Our inclusion criteria were guidelines, recommendations, or best practice statements by international urology organizations and reference centers about urological care in different phases of the COVID-19 pandemic. Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of 366 titles identified, 15 guidelines met our criteria. EVIDENCE SYNTHESIS: Of the 15 guidelines, 14 addressed emergency situations and 12 reported on assessment of elective uro-oncology procedures. There was consensus on postponing radical prostatectomy except for high-risk prostate cancer, and delaying treatment for low-grade bladder cancer, small renal masses up to T2, and stage I seminoma. According to nine guidelines that addressed endourology, obstructed or infected kidneys should be decompressed, whereas nonobstructing stones and stent removal should be rescheduled. Five guidelines/recommendations discussed laparoscopic and robotic surgery, while the remaining recommendations focused on outpatient procedures and consultations. All recommendations represented expert opinions, with three specifically endorsed by professional societies. Only the European Association of Urology guidelines provided evidence-based levels of evidence (mostly level 3 evidence). CONCLUSIONS: To make informed decisions during the COVID-19 pandemic, there are multiple national and international guidelines and recommendations for urologists to prioritize the provision of care. Differences among the guidelines were minimal. PATIENT SUMMARY: We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provide guidance on prioritizing the timing for different types of urological care.


title: Neumonía por COVID-19: hallazgos tomográficos./ [COVID-19 pneumonia: Tomographic findings]

text: Coronavirus disease (COVID-19) has spread worldwide and has become a priority health problem. We described a case of a patient with COVID-19 and the main characteristics of imaging findings.


Beware of False-Positive Results with SARS-CoV-2 Antibody Tests


Symmetric cutaneous vasculitis in COVID-19 pneumonia


An effective screening and management process in the outpatient clinic for patients requiring hospitalization during the COVID-19 pandemic


Co-infections of SARS-CoV-2 with multiple common respiratory pathogens in infected patients


title: Incidence of Venous Thromboembolism in Critically Ill Coronavirus Disease 2019 Patients Receiving Prophylactic Anticoagulation

text: OBJECTIVES: One of the defining features of the novel coronavirus disease 2019 infection has been high rates of venous thromboses. The present study aimed to describe the prevalence of venous thromboembolism in critically ill patients receiving different regimens of prophylactic anticoagulation. DESIGN: Single-center retrospective review using data from patients with confirmed severe acute respiratory syndrome coronavirus 2 requiring intubation. SETTING: Tertiary-care center in Indianapolis, IN, United States. PATIENTS: Patients hospitalized at international units Health Methodist Hospital with severe acute respiratory syndrome coronavirus 2 requiring intubation between March 23, 2020, and April 8, 2020, who underwent ultrasound evaluation for venous thrombosis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 45 patients were included. Nineteen of 45 patients (42.2%) were found to have deep venous thrombosis. Patients found to have deep venous thrombosis had no difference in time to intubation (p = 0.97) but underwent ultrasound earlier in their hospital course (p = 0.02). Sequential Organ Failure Assessment scores were similar between the groups on day of intubation and day of ultrasound (p = 0.44 and p = 0.07, respectively). D-dimers were markedly higher in patients with deep venous thrombosis, both for maximum value and value on day of ultrasound (p < 0.01 for both). Choice of prophylactic regimen was not related to presence of deep venous thrombosis (p = 0.35). Ultrasound evaluation is recommended if D-dimer is greater than 2,000 ng/mL (sensitivity 95%, specificity 46%) and empiric anticoagulation considered if D-dimer is greater than 5,500 ng/mL (sensitivity 53%, specificity 88%). CONCLUSIONS: Deep venous thrombosis is very common in critically ill patients with coronavirus disease 2019. There was no difference in incidence of deep venous thrombosis among different pharmacologic prophylaxis regimens, although our analysis is limited by small sample size. D-dimer values are elevated in the majority of these patients, but there may be thresholds at which screening ultrasound or even empiric systemic anticoagulation is indicated.


Prevalence of SARS-CoV-2 Infection in Residents of a Large Homeless Shelter in Boston


title: A study on infectivity of asymptomatic SARS-CoV-2 carriers

text: BACKGROUND: An ongoing outbreak of coronavirus disease 2019 (COVID-19) has spread around the world. It is debatable whether asymptomatic COVID-19 virus carriers are contagious. We report here a case of the asymptomatic patient and present clinical characteristics of 455 contacts, which aims to study the infectivity of asymptomatic carriers. MATERIAL AND METHODS: 455 contacts who were exposed to the asymptomatic COVID-19 virus carrier became the subjects of our research. They were divided into three groups: 35 patients, 196 family members and 224 hospital staffs. We extracted their epidemiological information, clinical records, auxiliary examination results and therapeutic schedules. RESULTS: The median contact time for patients was four days and that for family members was five days. Cardiovascular disease accounted for 25% among original diseases of patients. Apart from hospital staffs, both patients and family members were isolated medically. During the quarantine, seven patients plus one family member appeared new respiratory symptoms, where fever was the most common one. The blood counts in most contacts were within a normal range. All CT images showed no sign of COVID-19 infection. No severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections was detected in 455 contacts by nucleic acid test. CONCLUSION: In summary, all the 455 contacts were excluded from SARS-CoV-2 infection and we conclude that the infectivity of some asymptomatic SARS-CoV-2 carriers might be weak.


Promoting Better Clinical Trials and Drug Information as Public Health Interventions for the COVID-19 Emergency in Italy


title: Affine Quantization on the Half Line

text: The similarity between classical and quantum physics is large enough to make an investigation of quantization methods a worthwhile endeavour. As history has shown, Dirac's canonical quantization method works reasonably well in the case of conventional quantum mechanics over $\mathbb{R}^n$ but it may fail in non-trivial phase spaces and also suffer from ordering problem. Affine quantization is an alternative method, similar to the canonical quantization, that may offer a positive result in situations for which canonical quantization fails. In this paper we revisit the affine quantization method on the half line. We formulate and solve some simple models, the free particle and the harmonic oscillator.


docid: qkxkamdb

title: Influence of perceived threat of Covid-19 and HEXACO personality traits on toilet paper stockpiling

text: Following the fast spread of Covid-19 across Europe and North America in March 2020, many people started stockpiling commodities like toilet paper. Despite the high relevance for public authorities to adequately address stockpiling behavior, empirical studies on the psychological underpinnings of toilet paper stockpiling are still scarce. In this study, we investigated the relation between personality traits, perceived threat of Covid-19, and stockpiling of toilet paper in an online survey (N = 996) across 22 countries. Results suggest that people who felt more threatened by Covid-19 stockpiled more toilet paper. Further, a predisposition towards Emotionality predicted the perceived threat of Covid-19 and affected stockpiling behavior indirectly. Finally, Conscientiousness was related to toilet paper stockpiling, such that individuals higher in Conscientiousness tended to stockpile more toilet paper. These results emphasize the importance of clear communication by public authorities acknowledging anxiety and, at the same time, transmitting a sense of control.


Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. What are the implications for the commencement of elective surgery?


Sars-cov-2 hurricane impacting proctology outpatient clinics and proctologic emergencies. On the verge of phase 2, learning from phase 1. correspondence


title: Effect of Covid-19 pandemic on stroke admission rates in a Norwegian population

text: OBJECTIVES: There are concerns that public anxiety around Covid-19 discourages patients from seeking medical help. The aim of this study was to see how lockdown due to the pandemic affected the number of admissions of acute stroke. METHODS: All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke were identified by hospital chart review. January 3rd to March 12th was defined as before, and March 13th to April 30th as during lockdown. RESULTS: There were 21.8 admissions/week before and 15.0 admissions/week during the lockdown (p<0.01). Patients had on average higher NIHSS during the lockdown than before (5.9 vs. 4.2, p=0.041). In the multivariable logistic regression model for ischemic stroke (adjusted for sex, age, living alone and NIHSS≤5) there was an increased OR of 2.05 (95% CI 1.10-3.83, p=0.024) for not reaching hospital within 4.5 hours during the lockdown as compared to the period before the lockdown. CONCLUSION: There was a significant reduction in number of admissions for stroke and TIAs during the lockdown due to the covid-19 pandemic in Norway.


COVID-19 and generalized Myasthenia Gravis exacerbation: A case report