title: Clinical Characteristics and Outcomes of COVID-19 in Solid Organ Transplant Recipients: A Case-Control Study

text: Solid organ transplant recipients (SOTr) with COVID-19 are expected to have poorer outcomes compared to non-transplant patients due to immunosuppression and comorbidities. The clinical characteristics of 47 SOTr (38 kidneys and 9 non-kidney organs) were compared to 100 consecutive hospitalized non-transplant controls. 12/47 SOTr managed as outpatients were subsequently excluded from the outcome analyses to avoid potential selection bias. Chronic kidney disease (89% vs. 57% p=0.0007), diabetes (66% vs. 33% p=0.0007), and hypertension (94% vs. 72% p=0.006) were more common in the 35 hospitalized SOTr compared to controls. Diarrhea (54% vs. 17%, p<0.0001) was more frequent in SOTr. Primary composite outcome (escalation to ICU, mechanical ventilation, or in-hospital all-cause mortality) was comparable between SOTr and controls (40% vs. 48%, OR 0.72 CI [0.33-1.58] p=0.42), despite more comorbidities in SOTr. Acute kidney injury (AKI) requiring renal replacement therapy occurred in 20% of SOTr compared to 4% of controls (OR 6 CI [1.64-22] p=0.007). Multivariate analysis demonstrated that increasing age and clinical severity was associated with mortality. Transplant status itself was not associated with mortality.


Ebola: DRC's 10th outbreak is declared over


Ramadan under covid-19-pandemien


Actualización del diagnóstico de hiperglucemia gestacional durante la pandemia COVID-19./ Actualización del diagnóstico de hiperglucemia gestacional durante la pandemia COVID-19./ Update of the hyperglycemia Gestational diagnosis during the COVID-19 pandemic


title: Short-Term Effects of Ambient Ozone, PM2.5, and Meteorological Factors on COVID-19 Confirmed Cases and Deaths in Queens, New York

text: The outbreak of coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, has been rapidly increasing in the United States. Boroughs of New York City, including Queens county, turn out to be the epicenters of this infection. According to the data provided by the New York State Department of Health, most of the cases of new COVID-19 infections in New York City have been found in the Queens county where 42,023 people have tested positive, and 3221 people have died as of 20 April 2020. Person-to-person transmission and travels were implicated in the initial spread of the outbreaks, but factors related to the late phase of rapidly spreading outbreaks in March and April are still uncertain. A few previous studies have explored the links between air pollution and COVID-19 infections, but more data is needed to understand the effects of short-term exposures of air pollutants and meteorological factors on the spread of COVID-19 infections, particularly in the U.S. disease epicenters. In this study, we have focused on ozone and PM2.5, two major air pollutants in New York City, which were previously found to be associated with respiratory viral infections. The aim of our regression modeling was to explore the associations among ozone, PM2.5, daily meteorological variables (wind speed, temperature, relative humidity, absolute humidity, cloud percentages, and precipitation levels), and COVID-19 confirmed new cases and new deaths in Queens county, New York during March and April 2020. The results from these analyses showed that daily average temperature, daily maximum eight-hour ozone concentration, average relative humidity, and cloud percentages were significantly and positively associated with new confirmed cases related to COVID-19; none of these variables showed significant associations with new deaths related to COVID-19. The findings indicate that short-term exposures to ozone and other meteorological factors can influence COVID-19 transmission and initiation of the disease, but disease aggravation and mortality depend on other factors.


title: Susceptibility of ferrets, cats, dogs, and other domesticated animals to SARS-coronavirus 2

text: Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) causes the infectious disease COVID-19 (coronavirus disease 2019), which was first reported in Wuhan, China, in December 2019. Despite extensive efforts to control the disease, COVID-19 has now spread to more than 100 countries and caused a global pandemic. SARS-CoV-2 is thought to have originated in bats; however, the intermediate animal sources of the virus are unknown. In this study, we investigated the susceptibility of ferrets and animals in close contact with humans to SARS-CoV-2. We found that SARS-CoV-2 replicates poorly in dogs, pigs, chickens, and ducks, but ferrets and cats are permissive to infection. Additionally, cats are susceptible to airborne transmission. Our study provides insights into the animal models for SARS-CoV-2 and animal management for COVID-19 control.


Preparing hospitals for coronavirus (COVID-19)


title: Welche Bedeutung hat die Bindehaut als möglicher Übertragungsweg für eine SARS-CoV-2-Infektion?/ [What is the importance of the conjunctiva as a potential transmission pathway for SARS-CoV-2 infections?]

text: Recent studies have described conjunctivitis in approximately 1% of COVID-19 patients and speculated that SARS-CoV2 can be transmitted via the conjunctiva. In this article we recapitulate the molecular mechanisms of host cell entry of SARS-CoV2 and discuss the current evidence for a potential conjunctival transmission of SARS-CoV2. The current body of evidence indicates that SARS-CoV2 requires the membrane-bound angiotensin-converting enzyme 2 (ACE2) and the membrane-bound serine protease TMPRSS2 to enter cells. Recent studies suggest that COVID-19 patients rarely exhibit viral RNA in tear film and conjunctival smears and that, ACE2 and TMPRSS2 are only expressed in very small amounts in the conjunctiva, making conjunctival infection with SARS-CoV2 via these mediators unlikely. Nevertheless, we consider the current evidence to be still too limited to provide a conclusive statement and recommend appropriate protective measures for healthcare personnel who are in close contact with suspected and confirmed COVID-19 patients.


title: Psychometric properties of the Turkish version of the Bullying and Cyber Bullying Scale for Adolescents (BCS-A)

text: This study aimed to examine the psychometric properties of Bullying and Cyber-bullying Scale for Adolescents (BCS-A). The sample of the study was consisted of 600 adolescents, aged between 12 and 18 years. The data were collected with the Adolescent Identifier Form and Bullying and Cyber Bullying Scale for Adolescents (BCS-A). BCS-A was suitable for Turkish language, Content Validity Ratio (CVR) values were above 0.733. In the victimization subscale, all factor loads were above 0.630 and in the bullying subscale, all factor loads were above 0.679. The Cronbach's Alpha values for the victimization subscale ranged between 0.606 and 0.806, and the perpetration subscale ranged between 0.616 and 0.815. There was no difference between the pre- and post-test values and Intraclass Correlation Coefficients (ICC) values were 0.559 and above. BCS-A was found to be a valid and reliable instrument for determining bullying and cyber bullying among adolescents aged between 12 and 18 years. In conclusion, the scale may be suggested to be used as an assessment tool in new studies to determine bullying and cyber bullying among adolescents aged between 12 and 18 years.


COVID-19 and breast cancer: Impact on patients and breast care centers


Caring for the Psychological Well-Being of Healthcare Professionals in the Covid-19 Pandemic Crisis


title: A COVID-19 epidemic model with latency period

text: At the beginning of a COVID-19 infection, there is a period of time known as the exposed or latency period, before an infected person is capable of transmitting the infection to another person. We develop two differential equations models to account for this period. The first is a model that incorporates infected persons in the exposed class, before transmission is possible. The second is a model that incorporates a time delay in infected persons, before transmission is possible. We apply both models to the COVID-19 epidemic in China. We estimate the epidemiological parameters in the models, such as the transmission rate and the basic reproductive number, using data of reported cases. We thus evaluate the role of the exposed or latency period in the dynamics of a COVID-19 epidemic.


title: Validation and verification of the Abbott RealTime SARS-CoV-2 assay analytical and clinical performance

text: BACKGROUND: High-throughput assays for the SARS-CoV-2 virus are critical to increasing test capacity and slowing the spread of COVID-19. Abbott Molecular developed and received emergency use authorization (EUA) to deploy the new RealTime SARS-CoV-2 assay, run on the automated m2000sp/rt system. OBJECTIVE: To evaluate analytical and clinical performance of the RealTime SARS-CoV-2 assay compared to the SARS-CoV-2 CDC-based laboratory developed test (LDT) in clinical use by the University of Washington Clinical Virology Laboratory (UW Virology). METHODS: RealTime SARS-CoV-2 assay limit of detection (LOD) was evaluated by testing two dilution panels of 60 replicates each. Cross-reactivity was evaluated by testing 24 clinical samples positive for various nonâSARS-CoV-2 respiratory viruses. Clinical performance was evaluated using 30 positive and 30 negative SARS-CoV-2 clinical samples previously tested using the UW Virology SARS-CoV-2 LDT. RESULTS: Exceeding the 100 copies/mL LOD reported in the RealTime SARS-CoV-2 assay EUA product insert, 19 of 20 replicates were detected at 50 copies/mL and 16 of 20 replicates were detected at 25 copies/mL. All clinical samples positive for 24 nonâSARS-CoV-2 respiratory viruses were SARS-CoV-2 negative on the RealTime SARS-CoV-2 assay. The assay had high sensitivity (93%) and specificity (100%) for detecting SARS-CoV-2 in clinical samples. Two positive samples that tested negative with the RealTime SARS-CoV-2 assay had cycle numbers of 35.94 or greater and required dilution prior to testing. One of these samples was also inconclusive on the SARS-CoV-2 LDT. CONCLUSION: The RealTime SARS-CoV-2 assay is acceptable for clinical use. With the high-throughput, fully automated m2000 system, this assay will accelerate the pace of SARS-CoV-2 testing.


title: Alterations in Fecal Fungal Microbiome of Patients With COVID-19 During Time of Hospitalization until Discharge

text: BACKGROUD & AIMS: SARS-CoV-2 infects intestinal cells, and might affect the intestinal microbiota. We investigated changes in the fecal fungal microbiomes (mycobiome) of patients with SARS-CoV-2 infection during hospitalization and upon recovery. METHODS: We performed deep shotgun metagenomic sequencing analysis of fecal samples from 30 patients with COVID-19 in Hong Kong, from February 5 through May 12, 2020. Fecal samples were collected 2 to 3 times per week from time of hospitalization until discharge. We compared fecal mycobiome compositions of patients with COVID-19 with those from 9 subjects with community-acquired pneumonia and 30 healthy individuals (controls). We assessed fecal mycobiome profiles throughout time of hospitalization until clearance of SARS-CoV-2 from nasopharyngeal samples. RESULTS: Patients with COVID-19 had significant alterations in their fecal mycobiomes compared with controls, characterized by enrichment of Candia albicans and a highly heterogeneous mycobiome configuration, at time of hospitalization. Although fecal mycobiomes of 22 patients with COVID-19 did not differ significantly from those of controls during times of hospitalization, 8 of 30 patients with COVID-19 had continued significant differences in fecal mycobiome composition, through the last sample collected. The diversity of the fecal mycobiome of the last sample collected from patients with COVID-19 was 2.5-fold higher than that of controls (P<.05). Samples collected at all timepoints from patients with COVID-19 had increased proportions of opportunistic fungal pathogens, Candida albicans, Candida auris, and Aspergillus flavus compared with controls. Two respiratory-associated fungal pathogens, Aspergillus flavus and Aspergillus niger, were detected in fecal samples from a subset of patients with COVID-19, even after clearance of SARS-CoV-2 from nasopharyngeal samples and resolution of respiratory symptoms. CONCLUSIONS: In a pilot study, we found heterogeneous configurations of the fecal mycobiome, with enrichment of fungal pathogens from the genera Candida and Aspergillus, during hospitalization of 30 patients with COVID-19 compared with controls. Unstable gut mycobiomes and prolonged dysbiosis persisted in a subset of patients with COVID-19 up to 12 days after nasopharyngeal clearance of SARS-CoV-2. Studies are needed to determine whether alterations in intestinal fungi contribute to or result from SARS-CoV-2 infection, and the effects of these changes in disease progression.


title: Natural experiment concept to accelerate the Re-purposing of existing therapeutics for Covid-19

text: One of the many questions with respect to controlling the novel coronavirus pandemic is whether existing drugs can be re-purposed (re-positioned) for the prevention or treatment of Covid-19 - or for any future epidemic. The usefulness of existing approaches for re-purposing range from computational modeling to clinical trials. These are often time-consuming, resource intensive, and prone to failure. Proposed here is a new but simple concept that would capitalize on the opportunity presented by the on-going natural experiment involving the collection of data from epidemiological surveillance screening and diagnostic testing for clinical treatment. The objective would be to also collect for each Covid-19 case the patient's prior usage of existing therapeutic drugs. These drug usage data would be collected for several major test groups - those who test positive for active SARS-CoV-2 infection (using molecular methods) and those who test negative for current infection but also test positive for past infection (using serologic antibody tests). Patients from each of these groups would also be categorized with respect to where they resided on the spectrum of morbidities (from no or mild symptomology to severe). By comparing the distribution of normalized usage data for each drug within each group, drugs that are more associated with particular test groups could be revealed as having potential prophylactic, therapeutic, or contraindicated effects with respect to disease progression. These drugs could then be selected as candidates for further evaluation in fighting Covid-19. Also summarized are some of the numerous attributes, advantages, and limitations of the proposed concept, all pointing to the need for further discussion and evaluation.


title: Lessons after the early management of the COVID-19 outbreak in a pediatric transplant and hemato-oncology center embedded within a COVID-19 dedicated hospital in Lombardia, Italy. Estote parati

text: Italy is the second exposed country worldwide, after China, and Lombardia is the most affected region in Italy, with more than half of the national cases, with 13% of whom being healthcare professionals. The Clinica Pediatrica Università degli Studi di Milano Bicocca is a general pediatric and hematology oncology and transplant center embedded within the designated COVID-19 general Hospital San Gerardo in Monza, located in Lombardia, Italy. Preventive and control measures specifically undertaken to cope with the emergency within hemato-oncology, transplant, and outpatient unit in the pediatric department have been described. Preliminary COVID-19 experiences with the first Italian pediatric hemato-oncology patients are reported. The few available data regarding pediatrics and specifically hemato-oncological patients are discussed. The purpose of this report is to share pediatric hemato-oncology issues encountered in the first few weeks of the COVID-19 outbreak in Italy and to alert healthcare professionals worldwide to be prepared accordingly.


title: Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single-centre, observational cohort study

text: BACKGROUND: The safety of performing spinal anaesthesia for both patients and anaesthetists alike in the presence of active infection with the novel coronavirus disease 2019 (COVID-19) is unclear. Here, we report the clinical characteristics and outcomes for both patients with COVID-19 and the anaesthetists who provided their spinal anaesthesia. METHODS: Forty-nine patients with radiologically confirmed COVID-19 for Caesarean section or lower-limb surgery undergoing spinal anaesthesia in Zhongnan Hospital, Wuhan, China participated in this retrospective study. Clinical characteristics and perioperative outcomes were recorded. For anaesthesiologists exposed to patients with COVID-19 by providing spinal anaesthesia, the level of personal protective equipment (PPE) used, clinical outcomes (pulmonary CT scans), and confirmed COVID-19 transmission rates (polymerase chain reaction [PCR]) were reviewed. RESULTS: Forty-nine patients with COVID-19 requiring supplementary oxygen before surgery had spinal anaesthesia (ropivacaine 0.75%), chiefly for Caesarean section (45/49 [91%]). Spinal anaesthesia was not associated with cardiorespiratory compromise intraoperatively. No patients subsequently developed severe pneumonia. Of 44 anaesthetists, 37 (84.1%) provided spinal anaesthesia using Level 3 PPE. Coronavirus disease 2019 infection was subsequently confirmed by PCR in 5/44 (11.4%) anaesthetists. One (2.7%) of 37 anaesthetists who wore Level 3 PPE developed PCR-confirmed COVID-19 compared with 4/7 (57.1%) anaesthetists who had Level 1 protection in the operating theatre (relative risk reduction: 95.3% [95% confidence intervals: 63.7-99.4]; P<0.01). CONCLUSIONS: Spinal anaesthesia was delivered safely in patients with active COVID-19 infection, the majority of whom had Caesarean sections. Level 3 PPE appears to reduce the risk of transmission to anaesthetists who are exposed to mildly symptomatic surgical patients.


title: Heterogeneity in reporting venous thromboembolic phenotypes in COVID-19: Methodological issues and clinical implications

text: COVID-19 is associated with increased risk of venous thromboembolic events (VTE). However, there is significant heterogeneity in the thromboembolic phenotypes of COVID-19 patients (deep vein thrombosis, pulmonary embolism/thrombosis). The latter might be partly attributed to the variation in VTE risk factors in COVID-19 patients including: (i) patients' characteristics; (ii) hospitalization conditions and interventions; (iii) SARS-Cov-2 specific factors (coagulopathy, endothelial injury/microthrombosis). Furthermore, there is methodological heterogeneity in relation to the assessment of VTE (indications for screening, diagnostic methodology, etc). Physicians should be aware of the increased VTE risk, strongly consider VTE screening, and use thromboprophylaxis in all hospitalized patients.


title: Teaching Adequate Prehospital Use of Personal Protective Equipment During the COVID-19 Pandemic: Development of a Gamified e-Learning Module

text: BACKGROUND: The coronavirus disease (COVID-19) pandemic has led to increased use of personal protective equipment (PPE). Adequate use of this equipment is more critical than ever because the risk of shortages must be balanced against the need to effectively protect health care workers, including prehospital personnel. Specific training is therefore necessary; however, the need for social distancing has markedly disrupted the delivery of continuing education courses. Electronic learning (e-learning) may provide significant advantages because it requires neither the physical presence of learners nor the repetitive use of equipment for demonstration. OBJECTIVE: Inclusion of game mechanics, or "gamification," has been shown to increase knowledge and skill acquisition. The objective of this research was to develop a gamified e-learning module to interactively deliver concepts and information regarding the correct choice and handling of PPE. METHODS: The SERES framework was used to define and describe the development process, including scientific and design foundations. After we defined the target audience and learning objectives by interviewing the stakeholders, we searched the scientific literature to establish relevant theoretical bases. The learning contents were validated by infection control and prehospital experts. Learning mechanics were then determined according to the learning objectives, and the content that could benefit from the inclusion of game mechanics was identified. RESULTS: The literature search resulted in the selection and inclusion of 12 articles. In addition to gamification, pretesting, feedback, avoiding content skipping, and demonstrations using embedded videos were used as learning mechanics. Gamification was used to enhance the interactivity of the PPE donning and doffing sequences, which presented the greatest learning challenges. The module was developed with Articulate Storyline 3 to ensure that it would be compatible with a wide array of devices, as this software generates HTML5-compatible output that can be accessed on smartphones, tablets, and regular computers as long as a recent browser is available. CONCLUSIONS: A gamified e-learning module designed to promote better knowledge and understanding of PPE use among prehospital health care workers was created by following the SERES framework. The impact of this module should now be assessed by means of a randomized controlled trial.


Do Not Minimize the Impact of Cellular Immunity in the Development of Vaccines and Therapeutics for COVID-19


docid: dpombnhn

title: Cognitive Frailty as a Risk Factor for Incident Disability During Late Life: A 24-Month Follow-Up Longitudinal Study

text: OBJECTIVES: Association between cognitive frailty as identified by a new operational definition and incident disability in the community setting remains unclear. This will be the catalyst for preventive interventions designed to treat adverse health problems among elderlies. DESIGN: A 24-month follow-up longitudinal study on a community-based cohort. SETTING: Community-setting. PARTICIPANTS: Participants included a total of 9,936 older adults aged 65 years or older. MEASUREMENTS: Frailty was characterized as slow walking speed or/and muscle weakness represented by grip strength. Cognitive function was assessed according to several tests. Cognitive impairment was defined below the age-education reference threshold. Participants were categorized into the four groups: robust, cognitive impairment alone, frailty alone, and cognitive frailty (both frail and cognitive impairment). Incident disability data was extracted from the Japanese Long-Term Care system. RESULTS: The prevalence of cognitive frailty was 11.2%. The cumulative incidence rates of incident disability in each group were also estimated (robust, 9.6/1,000 person-years (95% CI 7.9 to 11.7); cognitive impairment, 21.3/1,000 person years (95% CI 16.3 to 27.7); frailty, 45.4/1,000 person years (95% CI 39.5 to 52.3); and cognitive frailty, 79.9/1,000 person years (95% CI 68.6 to 93.1)). Adjusted Cox proportional hazard model revealed that the cognitive frailty group had the highest hazard ratio (HR 3.86, 95%CI 2.95 - 5.05, P < 0.001). CONCLUSIONS: A proper operational definition was developed to determine cognitive frailty among elderlies. Cognitive frailty is more associated with incident disability in community-setting than cognitive impairment or physical frailty alone.


title: Pulmonary embolism: A complication of COVID 19 infection

text: The Coronavirus Disease 2019 (COVID 19) has been reported in almost every country in the world. Although a large proportion of infected individuals develop only mild symptoms or are asymptomatic, the spectrum of the disease among others has been widely variable in severity. Additionally, many infected individuals were found to have coagulation markers abnormalities. This is especially true among those progressing to severe pneumonia and multi-organ failure. While the incidence of venous thromboembolic (VTE) disease has been recently noted to be elevated among critically ill patients, the incidence among ambulatory and non-critically ill patients is not yet clearly defined. Herein, we present six patients who didn't have any hypercoagulable risk factors yet presented with pulmonary embolism in association with COVID 19 infection. Furthermore, we discuss the possible underlying mechanisms of hypercoagulability and highlight the possibility of underdiagnosing pulmonary embolism in the setting of overlapping symptoms, decreased utilization of imaging secondary to associated risks, and increased turnover times. In addition, we emphasize the role of extended thromboprophylaxis in discharged patients.


title: Age Related Morbidity and Mortality among Patients with COVID-19

text: On March 11, 2020, the World Health Organization declared coronavirus disease (COVID-19), caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic During the COVID-19 pandemic, an age-associated vulnerability in the burden of disease has been uncovered Understanding the spectrum of illness and the pathogenic mechanism of the disease in a vulnerable population is critical, especially during the pandemic Herein, we reviewed published COVID-19 epidemiology data from several countries to identify any consistent trends in the relationship between age and COVID-19-associated morbidity or mortality We also reviewed the literature for studies explaining the difference in the host response to SARS-CoV-2 infection according to age The insights from these data will be useful in determining the treatment policies and preventive measures of COVID-19


title: COVID-19 mortality rates in the European Union, Switzerland, and the UK: effect of timeliness, lockdown rigidity, and population density

text: BACKGROUND: To date the European experience with COVID-19 mortality has been different to the observed in China and Asia. We aimed to forecast mortality trends in the 27 countries of the European Union (EU), plus Switzerland and the United Kingdom (UK), where lockdown dates and confinement interventions have been heterogeneous, and to explore its determinants. METHODS: We have adapted our predictive model of COVID-19-related mortality, which rested on the observed mortality within the first weeks of the outbreak and the date of the respective lockdown in each country. It was applied in a training set of three countries (Italy, Germany and Spain), and then applied to the EU plus the UK and Switzerland. In addition, we explored the effects of timeliness and rigidity of the lockdown (on a five-step scale) and population density in our forecasts. We report r2, and percent variation of expected versus observed deaths, all following TRIPOD guidance. RESULTS: We identified a homogeneous distribution of deaths, and found a median of 24 days after lockdown adoption to reach the maximum daily deaths. Strikingly, cumulative deaths up to April 25th, 2020 observed in Europe separated countries in three waves, according to the time lockdown measures were adopted following the onset of the outbreak: after a week, within a week, or even prior to the outbreak (r2=0.876). In contrast, no correlation neither with lockdown rigidity nor population density were observed. CONCLUSIONS: The European experience confirms that early, effective interventions of 86 lockdown are fundamental to minimizing the COVID-19 death toll.


Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy


Challenges in oral radiology teaching during COVID-19 pandemic


Role of immunosuppressive therapy in rheumatic diseases concurrent with COVID-19


title: Combating COVID-19 Pandemic in Nepal: Ethical Challenges in an Outbreak

text: Pandemic outbreak of COVID-19 is the largest of its kind of this century. All countries throughout the globe are trying their best to contain the disease and eliminate at the earliest. Efforts are continuing to improve the outcome of the infection in terms of minimizing the morbidity and mortality. As a public health strategy every state has the responsibility of protecting the health of the community and such measures includes the preventive measures like social distancing or even lockdown of the state as a whole restricting the movement of the people, diagnostic measures like testing the suspects, contact tracing and isolation of the patients. Treatment of the infected requires decisions in resource constraint situation particularly ICU beds and ventilators. In the meantime, protecting doctors, nurses, other health workers as well as frontline workers need personal protective equipment which is a scarce commodity. While doing so there might be a compromise in the individual autonomy, privacy, confidentiality, and social justice for the beneficence for the larger community. This is an attempt to explore the ethical quandaries in relation to combating COVID-19 in Nepal by relating the issues with the principles of biomedical ethics.


title: Managing People with Diabetes Fasting for Ramadan During the COVID-19 Pandemic: A South Asian Health Foundation Update

text: The month of Ramadan forms one of the five pillars of the Muslim faith. Adult Muslims are obligated to keep daily fasts from dawn to sunset, with exceptions. This year Ramadan is due to begin on 23 April 2020 and the longest fast in the UK will be approximately 18 hours in length. In addition, due to the often high-calorie meals eaten to break the fast, Ramadan should be seen as a cycle of fasting and feasting. Ramadan fasting can impact those with diabetes, increasing the risk of hypoglycaemia, hyperglycaemia and dehydration. This year, Ramadan will occur during the global COVID-19 pandemic. Reports show that diabetes appears to be a risk factor for more severe disease with COVID-19. In addition, the UK experience has shown diabetes and COVID-19 is associated with dehydration, starvation ketosis, diabetic ketoacidosis and hyperosmolar hyperglycaemic state. This makes fasting in Ramadan particularly challenging for those Muslims with diabetes. Here, we discuss the implications of fasting in Ramadan during the COVID-19 pandemic and make recommendations for those with diabetes who wish to fast.


title: Severe COVID-19 infection in pregnancy requiring intubation without preterm delivery: A case report

text: Background: Coronavirus-2019 (COVID-19) is a global health crisis, but there is limited guidance for the critical care management of pregnant patients experiencing respiratory collapse. We describe our management of a peri-viable pregnant patient requiring intubation; discussion includes pharmacologic interventions, mechanical ventilation adjustments, and consideration of fetal interventions, including delivery timing. Case: A 36-year-old, gravida 2, para 1 woman positive for COVID-19 at 23â¯weeks of gestation with severe disease required admission to the intensive care unit and intubation. She completed 5â¯days of hydroxychloroquine and 7â¯days of prednisone. She was successfully intubated after 8â¯days and discharged home in a stable condition without preterm delivery on hospital day 11. Conclusion: Fortunately, the patient responded to aggressive respiratory support with intubation and mechanical ventilation early upon presentation. It is unclear whether our institution's empiric use of hydroxychloroquine and prednisone facilitated her recovery. We hope that our report helps other institutions navigate the complex care surrounding pregnant patients with severe COVID-19 pneumonia requiring intensive care.


Workplace Safety and Health Guidance in Response to the Outbreak of Severe Pneumonia with Novel Pathogens (2019-nCoV)


title: Could SARS-CoV-2 affect male fertility?

text: We performed this systematic review to evaluate the possibility of an impact of SARS-CoV-2 infection on male fertility. SARS-CoV-2 enters the cells with the help of ACE2; therefore, testicular expression of ACE2 was analysed from transcriptome sequencing studies and our unpublished data. Literature suggested that SARS-CoV-1 (2002-2004 SARS) had a significant adverse impact on testicular architecture, suggesting a high possibility of the impact of SARS-CoV-2 as well. Out of two studies on semen samples from COVID-19 affected patients, one reported the presence of SARS-CoV-2 in the semen samples while the other denied it, raising conflict about its presence in the semen samples and the possibility of sexual transmission. Our transcriptome sequencing studies on rat testicular germ cells showed ACE expression in rat testicular germ cells. We also found ACE2 expression in transcriptome sequencing data for human spermatozoa, corroborating its presence in the testicular germ cells. Transcriptome sequencing data from literature search revealed ACE2 expression in the germ, Sertoli and Leydig cells. The presence of ACE2 on almost all testicular cells and the report of a significant impact of previous SARS coronavirus on testes suggest that SARS-CoV-2 is highly likely to affect testicular tissue, semen parameters and male fertility.


title: Alcohol Consumption Reported during the COVID-19 Pandemic: The Initial Stage

text: Physical health is not the only area affected by the outbreak of the SARS-CoV-2 virus pandemic. There are also other consequences that have globally affected many millions at other levels, namely: Societal, political, economic, and cultural. This study aims to survey alcohol drinking throughout the pandemic so as to investigate those factors considered most relevant; i.e., sociodemographic and clinical. A longitudinal study was designed. The first (or initial) stage was completed between April 10-20 2020 on 443 subjects during the enforcement of the "Lockdown" in Poland. The second stage will be due in June 2020. As well as an in-house questionnaire, the study used: The Alcohol Use Disorder Identification Test (AUDIT), General Health Questionnaire (GHQ-28), Perceived Stress Scale (PSS-10), and the Brief COPE Inventory (Mini COPE). Alcohol was the most commonly used psychoactive substance (73%) identified. More than 30% changed their drinking habits because of the pandemic, with 16% actually drinking less, whilst 14% did so more. The former group was significantly younger than the latter. Amongst the stress-related coping strategies, it was found that current alcohol drinkers were significantly less able to find anything positive about the pandemic situation (positive reframing) and were mentally less able to cope. Those drinking more now were found to have been drinking more intensively before the pandemic started.


[Drug interaction monitoring of lopinavir/ritonavir in COVID-19 patients with cancer]


title: Participants' Experiences of the 2018-2019 Government Shutdown and Subsequent Supplemental Nutrition Assistance Program (SNAP) Benefit Disruption Can Inform Future Policy

text: The federal government shutdown from 22 December 2018 to 25 January 2019 created an unprecedented disruption in Supplemental Nutrition Assistance Program (SNAP) benefits. We conducted a cross-sectional qualitative study to begin to capture how the disruption affected food security and wellbeing among a small sample of California SNAP participants. We collected data from 26 low-income adults in four focus groups in four diverse California counties. We found that participants routinely struggle to secure an adequate and healthy diet in the context of high costs of living, the shutdown and benefit disruption added to participants' stress and uncertainty and exacerbated food insecurity, and it diminished some participants' faith in government. Participants reported that, while having additional benefits in January felt like a relief from typical end-of-month deprivation, the subsequent extended gap between benefit distributions and a lack of clarity about future benefits caused cascading effects as participants later had to divert money from other expenses to buy food and faced added uncertainty about future economic stability. Additionally, the shutdown highlighted challenges related to the availability, timing, and tone of communications between participants and SNAP agencies. Participants recommended that SNAP adjust benefit and eligibility levels to better address costs of living, improve customer service, and avoid future disruptions.


title: Collective trauma and community support: Lessons from Detroit

text: The COVID-19 crisis can be defined as a collective trauma, which contributes to an upheaval of community connection and functioning. The current pandemic has also illuminated disparities in mental health supports. In this commentary, we highlight one community organization, located in metro Detroit, that has responded to the trauma by bolstering resources and supports for residents, many of whom are ethnoracial minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: A commentary on the Nigerian response to the COVID-19 pandemic

text: In this commentary, we review the emergence of the COVID-19 pandemic in Nigeria and how aspects of the socioeconomic context and responses from the government and general public may contribute to its persistence. We also suggest mechanisms for the adverse mental health impacts of the pandemic and highlight the need for data and strengthening social infrastructure. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) present intraperitoneally in patients with coronavirus disease 2019 (COVID-19) infection undergoing emergency operations?


Spontaneous Pneumomediastinum: A Probable Unusual Complication of Coronavirus Disease 2019 (COVID-19) Pneumonia


How COVID-19 Rapidly Transformed Clinical Practice at the Harold Schnitzer Diabetes Health Center Now and for the Future


title: A Novel Approach for a Novel Pathogen: using a home assessment team to evaluate patients for 2019 novel coronavirus (SARS-CoV-2)

text: Thousands of people in the United States have required testing for SARS-CoV-2. Evaluation for a special pathogen is resource intensive. We report an innovative approach to home assessment that, in collaboration with public health, enables safe evaluation and specimen collection outside the healthcare setting, avoiding unnecessary exposures and resource utilization.


title: A Novel Approach for a Novel Pathogen: using a home assessment team to evaluate patients for 2019 novel coronavirus (SARS-CoV-2) ;Clinical Infectious Diseases ;Oxford Academic

text: Thousands of people in the United States have required testing for SARS-CoV-2 Evaluation for a special pathogen is resource intensive We report an innovative approach to home assessment that, in collaboration with public health, enables safe evaluation and specimen collection outside the healthcare setting, avoiding unnecessary exposures and resource utilization


title: Cardiovascular complications in COVID-19

text: BACKGROUND: The coronavirus disease of 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While systemic inflammation and pulmonary complications can result in significant morbidity and mortality, cardiovascular complications may also occur. OBJECTIVE: This brief report evaluates cardiovascular complications in the setting of COVID-19 infection. DISCUSSION: The current COVID-19 pandemic has resulted in over one million infected worldwide and thousands of death. The virus binds and enters through angiotensin-converting enzyme 2 (ACE2). COVID-19 can result in systemic inflammation, multiorgan dysfunction, and critical illness. The cardiovascular system is also affected, with complications including myocardial injury, myocarditis, acute myocardial infarction, heart failure, dysrhythmias, and venous thromboembolic events. Current therapies for COVID-19 may interact with cardiovascular medications. CONCLUSIONS: Emergency clinicians should be aware of these cardiovascular complications when evaluating and managing the patient with COVID-19.


title: Using psychoneuroimmunity against COVID-19

text: The worldwide outbreak of coronavirus disease 2019 (COVID-19) raises concerns of widespread panic and anxiety in individuals subjected to the real or perceived threat of the virus. Compared to general populations, patients who are institutionalized in a closed unit are also very vulnerable to COVID-19 infection and complications. This crisis touched on difficult issues of not only psychiatric care and ethics, but also psychological impacts to psychiatric care givers. In this Viewpoint, we address both physical and biopsychosocial aspects of this infection, as well as the psychoneuroimmunity of preventive strategies of healthy lifestyle, regular exercise, balanced nutrition, quality sleep and a strong connection with people. Social distancing and wearing masks might help us from pathogen exposure, yet such these measures also prevent us from expressing compassion and friendliness. Therefore, all forms of psychological support should be routinely implemented not only to consider psychological resilience but also to enhance psychoneuroimmunity against COVID-19.


No association of COVID-19 transmission with temperature or UV radiation in Chinese cities


title: The impact of COVID-19 on the undergraduate medical curriculum

text: The coronavirus pandemic has impacted medical education globally. As universities seek to deliver medical education through new methods of modalities, this continuing of education ensures the learning of the future workforce of the NHS. Novel ways of online teaching should be considered in new medical curricula development, as well as methods of delivering practical skills for medical students online.


Dangerous interactions of gastrointestinal drugs with experimental treatments for COVID-19


COVID-19, radiotherapy and cancer


COVID-19 and obesity: links and risks


SARS-CoV-2 infection anxieties and general population restrictions delay diagnosis and treatment of acute haematological malignancies


Will Community Health Centers Survive COVID-19?


title: Autoimmune diseases in the context of pandemic COVID-19/ Maladies autoimmunes dans le contexte de la pandemie COVID-19

text: Patient suffering from autoimmune diseases (AID) typically have an increased risk of infection, which is attributed to the disease itself, but also to immunosuppressive drugs (IS) and comorbidities During the current COVID-19 outbreak, the way to manage these diseases remains elusive Limited data is currently available on AID and IS in the context of this new coronavirus infection To date, there is no evidence to support an increase in complications of COVID-19 in these patients In addition, certain drugs that are commonly used to treat AID could be part of the therapeutic arsenal used in COVID-19 The purpose of this article is to review the unique aspects of patients with AID during the COVID-19 outbreak Les patients atteints de maladies autoimmunes (MAI) presentent classiquement un risque accru dinfections, qui est attribue a la maladie en tant que telle, mais aussi aux traitements immunosuppresseurs (IS) et aux comorbidites Durant lepidemie COVID-19, lattitude a adopter par rapport a ces maladies et a leur traitement reste incertaine En effet, les donnees concernant les MAI et lIS dans le cadre de cette nouvelle infection a coronavirus restent encore tres limitees A lheure actuelle, il ny a pas devidence indiquant une augmentation des complications severes en lien avec le COVID-19 chez ces patients De plus, certains medicaments utilises pour traiter les MAI pourraient faire partie de larsenal therapeutique utilise en cas dinfection par le COVID-19 Cet article passe en revue les aspects particuliers des patients souffrant de MAI durant lepidemie COVID-19


title: [Autoimmune diseases in the context of pandemic COVID-19]

text: Patient suffering from autoimmune diseases (AID) typically have an increased risk of infection, which is attributed to the disease itself, but also to immunosuppressive drugs (IS) and comorbidities During the current COVID-19 outbreak, the way to manage these diseases remains elusive Limited data is currently available on AID and IS in the context of this new coronavirus infection To date, there is no evidence to support an increase in complications of COVID-19 in these patients In addition, certain drugs that are commonly used to treat AID could be part of the therapeutic arsenal used in COVID-19 The purpose of this article is to review the unique aspects of patients with AID during the COVID-19 outbreak


[Sårbare patienter i almen praksis under COVID-19]


The COVID-19 outbreak and the angiotensin-converting enzyme 2: too little or too much?


Covid-19: Test and trace system is not fit for purpose, says Independent SAGE


title: CO-RADS - A categorical CT assessment scheme for patients with suspected COVID-19: definition and evaluation

text: Purpose To introduce the COVID-19 Reporting and Data System (CO-RADS) for standardized assessment of pulmonary involvement of COVID-19 on non-enhanced chest CT and report its initial interobserver agreement and performance. Methods The Dutch Radiological Society (NVvR) developed CO-RADS based on other efforts for standardization, such as Lung-RADS or BI-RADS. CO-RADS assesses the suspicion for pulmonary involvement of COVID-19 on a scale from 1 (very low) to 5 (very high). The system is meant to be used in patients presenting with moderate to severe symptoms of COVID-19. The system was evaluated using 105 chest CTs of patients admitted to the hospital with clinical suspicion of COVID-19 in whom RT-PCR was performed (62 +/- 16 years, 61 men, 53 with positive RT-PCR). Eight observers assessed the scans using CO-RADS. Fleiss' kappa was calculated, and scores of individual observers were compared to the median of the remaining seven observers. The resulting area under the receiver operating characteristics curve (AUC) was compared to results from RT-PCR and clinical diagnosis of COVID-19. Results There was absolute agreement among observers in 573 (68.2%) of 840 observations. Fleiss' kappa was 0.47 (95% confidence interval (CI) 0.45-0.47), with the highest kappa for CO-RADS categories 1 (0.58, 95% CI 0.54-0.62) and 5 (0.68, 95% CI 0.65-0.72). The average AUC was 0.91 (95% CI 0.85-0.97) for predicting RT-PCR outcome and 0.95 (95% CI 0.91-0.99) for clinical diagnosis. The false negative rate for CO-RADS 1 was 9/161 (5.6%, 95% CI 1.0-10%), and the false positive rate for CO-RADS 5 was 1/286 (0.3%, 95% CI 0-1.0%). Conclusions CO-RADS is a categorical assessment scheme for pulmonary involvement of COVID-19 on non-enhanced chest CT providing very good performance for predicting COVID-19 in patients with moderate to severe symptoms and has a substantial interobserver agreement, especially for categories 1 and 5.


Mental health during the coronavirus disease 2019 (Covid-19) pandemic: more is still to be done


title: Meditsinskaya reabilitatsiya patsientov s pnevmoniyami, assotsiirovannymi s novoi koronavirusnoi infektsiei COVID-19./ [Medical rehabilitation of patients with pneumonia associated with the new COVID-19 coronavirus infection]

text: Effective medical rehabilitation of patients with pneumonia caused by the new SARS-CoV-2 coronavirus is critical for the recovery and optimization of emergency and specialty care outcomes. In this regard, it is relevant to develop a scientifically based medical rehabilitation program for patients with the coronavirus infectious disease COVID-19, whose composition and structure includes methods and tools that have proven effectiveness. AIM: To develop evidence-based approaches to medical rehabilitation for patients with pneumonia associated with the new COVID-19 coronavirus infection. RESULTS: The clinical effects and suggested mechanisms of action of rehabilitation technologies in patients with pneumonia, including those associated with the new COVID-19 coronavirus infection, are considered in Detail. The most studied of the physical methods that have a proven effect are physical exercises, breathing exercises, the complex effect of factors of resort therapy, hydrotherapy, which affect the main clinical manifestations of the underlying disease, astheno-neurotic syndrome and increasing immunity. Clinical recommendations for medical rehabilitation are proposed and its promising methods are considered. CONCLUSION: Regular generalization and analysis of high-quality randomized controlled clinical trials to evaluate various physical methods of treatment of patients with pneumonia associated with the new COVID-19 coronavirus infection is Necessary, which serve as a basis for the development of future valid clinical recommendations. Timely and adequate specialized medical rehabilitation care is critical to maintaining the health, reducing disability and mortality of patients with pneumonia associated with the new COVID-19 coronavirus infection.


title: Impact of city lockdown on the air quality of COVID-19-hit of Wuhan city

text: A series of strict lockdown measures were implemented in the areas of China worst affected by coronavirus disease 19, including Wuhan, to prevent the disease spreading. The lockdown had a substantial environmental impact, because traffic pollution and industrial emissions are important factors affecting air quality and public health in the region. After the lockdown, the average monthly air quality index (AQI) in Wuhan was 59.7, which is 33.9% lower than that before the lockdown (January 23, 2020) and 47.5% lower than that during the corresponding period (113.6) from 2015 to 2019. Compared with the conditions before the lockdown, fine particulate matter (PM2.5) decreased by 36.9% and remained the main pollutant. Nitrogen dioxide (NO2) showed the largest decrease of approximately 53.3%, and ozone (O3) increased by 116.6%. The proportions of fixed-source emissions and transported external-source emissions in this area increased. After the lockdown, O3 pollution was highly negatively correlated with the NO2 concentration, and the radiation increase caused by the PM2.5 reduction was not the main reason for the increase in O3. This indicates that the generation of secondary pollutants is influenced by multiple factors and is not only governed by emission reduction.


title: [Covid-19 diagnosis : clinical recommendations and performance of nasopharyngeal swab-PCR]

text: The Covid-19 pandemic imposes new diagnostic strategies in order to optimize the medical care of our patients The current biblio-graphy, although of low quality, shows a sensitivity of 56 to 83 % for the Covid-19 PCR Even though one negative test can exclude a Covid-19 in the majority of cases, the NPV (Negative Predictive Value) decreases with increasing prevalence (pre-test probability) This finding suggests the need for strict auto-isolation of patients until the resolution of their symptoms For patients that present with typical symptoms, who have a presumed Covid-19 prevalence of -40-50 %, a negative test should be interpreted with caution and a repeat test may be needed


title: Standardized adult-gerontology acute care nurse practitioner point-of-care ultrasound training: A new perspective in the age of a pandemic

text: Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (GACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPPs.


docid: uivgpvvj

title: Chirurgie endocrinienne au cours et au décours de l'épidémie de COVID-19: Recommandations de l'AFCE./ [Endocrine surgery during and after the COVID-19 epidemic: guidelines from AFCE]

text: The Covid-19 pandemic commands a major reorganization of the entire French healthcare system. In France, general rules have been issued nationally and implemented by each healthcare center, both public and private, throughout France. Guidelines drafted by an expert group led by the French-speaking Association of Endocrine Surgery (AFCE) propose specific surgical management principles for thyroid, parathyroid, endocrine pancreas and adrenal surgery during and after the Covid-19 epidemic.


title: Research progress on nucleic acid detection in Novel Coronavirus Pneumonia/ 中华检验医学杂志

text: The prevention and control of Novel Coronavirus Pneumonia caused by Novel Coronavirus is at a critical period. Nucleic acid detection, as the definite diagnosis tool, plays an important role in rapid diagnosis, therapeutic efficacy, epidemic prevention and control. However, the disease is outbreak, and the time of nucleic acid detection in clinical application is short. So the insufficient method verification and clinical evaluation has been made. "False negative" is observed in clinical practice, and the result of nucleic acid detection is not matched with the clinical diagnosis. Therefore, it is urgent to optimize the current methods and improve detection sensitivity. Based on latest studies of Novel Coronavirus, this article reviews the current status and application prospects of nucleic acid detection. Also, this article provides references for clinicians and researchers.


Coronavirus SARS-CoV-2: filtering fact from fiction in the infodemic: Q&A with virologist Professor Urs Greber


title: T-Basis: a Compact Representation for Neural Networks

text: We introduce T-Basis, a novel concept for a compact representation of a set of tensors, each of an arbitrary shape, which is often seen in Neural Networks. Each of the tensors in the set is modeled using Tensor Rings, though the concept applies to other Tensor Networks. Owing its name to the T-shape of nodes in diagram notation of Tensor Rings, T-Basis is simply a list of equally shaped three-dimensional tensors, used to represent Tensor Ring nodes. Such representation allows us to parameterize the tensor set with a small number of parameters (coefficients of the T-Basis tensors), scaling logarithmically with each tensor's size in the set and linearly with the dimensionality of T-Basis. We evaluate the proposed approach on the task of neural network compression and demonstrate that it reaches high compression rates at acceptable performance drops. Finally, we analyze memory and operation requirements of the compressed networks and conclude that T-Basis networks are equally well suited for training and inference in resource-constrained environments and usage on the edge devices.


title: Learning the Compositional Visual Coherence for Complementary Recommendations

text: Complementary recommendations, which aim at providing users product suggestions that are supplementary and compatible with their obtained items, have become a hot topic in both academia and industry in recent years. %However, it is challenging due to its complexity and subjectivity. Existing work mainly focused on modeling the co-purchased relations between two items, but the compositional associations of item collections are largely unexplored. Actually, when a user chooses the complementary items for the purchased products, it is intuitive that she will consider the visual semantic coherence (such as color collocations, texture compatibilities) in addition to global impressions. Towards this end, in this paper, we propose a novel Content Attentive Neural Network (CANN) to model the comprehensive compositional coherence on both global contents and semantic contents. Specifically, we first propose a \textit{Global Coherence Learning} (GCL) module based on multi-heads attention to model the global compositional coherence. Then, we generate the semantic-focal representations from different semantic regions and design a \textit{Focal Coherence Learning} (FCL) module to learn the focal compositional coherence from different semantic-focal representations. Finally, we optimize the CANN in a novel compositional optimization strategy. Extensive experiments on the large-scale real-world data clearly demonstrate the effectiveness of CANN compared with several state-of-the-art methods.


title: Contraception during Coronavirus-Covid 19 pandemia. Recommendations of the Board of the Italian Society of Contraception

text: Purpose: The Italian Society of Contraception identified as one of its priorities the need to give recommendations on management of contraception during Coronavirus-Covid 19 pandemiaMaterials and methods: A concise communication was produced which summarises in an easy-to-read format suitable for clinicians the management of the different contraceptives mostly used. Information how to manage contraception in different conditions is presented.Results: Women may, in general, continue to use either intrauterine and or hormonal contraceptives. The use of condom should be added to any hormonal contraceptive, when the contraceptive efficacy is reduced or when women stop the contraceptive method.Conclusion: At the present time, during the Coronavirus-Covid 19 pandemia, no data contraindicate the use of intrauterine or hormonal contraceptives. Conversely the use of an appropriate contraception is advocate to prevent unintended pregnancies.


title: In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

text: BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) first broke out in Wuhan (China) and subsequently spread worldwide. Chloroquine has been sporadically used in treating SARS-CoV-2 infection. Hydroxychloroquine shares the same mechanism of action as chloroquine, but its more tolerable safety profile makes it the preferred drug to treat malaria and autoimmune conditions. We propose that the immunomodulatory effect of hydroxychloroquine also may be useful in controlling the cytokine storm that occurs late-phase in critically ill SARS-CoV-2 infected patients. Currently, there is no evidence to support the use of hydroxychloroquine in SARS-CoV-2 infection. METHODS: The pharmacological activity of chloroquine and hydroxychloroquine was tested using SARS-CoV-2 infected Vero cells. Physiologically-based pharmacokinetic models (PBPK) were implemented for both drugs separately by integrating their in vitro data. Using the PBPK models, hydroxychloroquine concentrations in lung fluid were simulated under 5 different dosing regimens to explore the most effective regimen whilst considering the drug's safety profile. RESULTS: Hydroxychloroquine (EC50=0.72 µM) was found to be more potent than chloroquine (EC50=5.47 µM) in vitro. Based on PBPK models results, a loading dose of 400 mg twice daily of hydroxychloroquine sulfate given orally, followed by a maintenance dose of 200 mg given twice daily for 4 days is recommended for SARS-CoV-2 infection, as it reached three times the potency of chloroquine phosphate when given 500 mg twice daily 5 days in advance. CONCLUSIONS: Hydroxychloroquine was found to be more potent than chloroquine to inhibit SARS-CoV-2 in vitro.


Anaesthetic management of patients with COVID-19: infection prevention and control measures in the operating theatre. Comment on Br J Anaesth doi:10.1016/j.bja.2020.04.014


Pausing cancer screening during the severe acute respiratory syndrome coronavirus 2pandemic: Should we revisit the recommendations?


title: Clinical and laboratory predictors of in-hospital mortality in patients with COVID-19: a cohort study in Wuhan, China

text: BACKGROUND: This study aimed to develop mortality-prediction models for patients with Coronavirus disease 2019 (COVID-19). METHODS: The training cohort were consecutive patients with COVID-19 in the First People's Hospital of Jiangxia District in Wuhan from January 7, 2020 to February 11, 2020. We selected baseline clinical and laboratory data through the stepwise Akaike information criterion and ensemble XGBoost model to build mortality-prediction models. We then validated these models by randomly collecting COVID-19 patients in the Infection department of Union Hospital in Wuhan from January 1, 2020, to February 20, 2020. RESULTS: 296 patients with COVID-19 were enrolled in the training cohort, 19 of whom died during hospitalization and 277 were discharged from the hospital. The clinical model developed with age, history of hypertension and coronary heart disease showed AUC of 0.88 (95% CI, 0.80-0.95); threshold, -2.6551; sensitivity, 92.31%; specificity, 77.44% and negative predictive value (NPV), 99.34%. The laboratory model developed with age, high-sensitivity C-reactive protein (hsCRP), peripheral capillary oxygen saturation (SpO2), neutrophil and lymphocyte count, D-dimer, aspartate aminotransferase (AST) and glomerular filtration rate (GFR) had a significantly stronger discriminatory power than the clinical model (p=0.0157), with AUC of 0.98 (95% CI, 0.92-0.99); threshold, -2.998; sensitivity, 100.00%; specificity, 92.82% and NPV, 100.00%. In the subsequent validation cohort (N=44), the AUCs (95% CI) were 0.83 (0.68, 0.93) and 0.88 (0.75, 0.96) for clinical model and laboratory model, respectively. CONCLUSIONS: We developed two predictive models for the in-hospital mortality of patients with COVID-19 in Wuhan and validated in patients from another center.


Can Colchicine as an Old Anti-Inflammatory Agent Be Effective in COVID-19?


title: Cancer care during the spread of coronavirus disease 2019 (COVID-19) in Italy: young oncologists' perspective

text: Click here to listen to the Podcast.


Crushing lopinavir-ritonavir tablets may decrease the efficacy of therapy in COVID-19 patients


Re: The Magnetic Resonance Imaging in Active Surveillance (MRIAS) Trial: Use of Baseline Multiparametric Magnetic Resonance Imaging and Saturation Biopsy to Reduce the Frequency of Surveillance Prostate Biopsies


Patient perspective: Roger Boyes


title: Can Bioactive Lipids Inactivate Coronavirus (COVID-19)?

text: SARS-CoV-2, SARS and MERS are all enveloped viruses that can cause acute respiratory syndrome. Arachidonic acid (AA) and other unsaturated fatty acids (especially eicosapentaenoic acd, EPA and docosahexaenoic acid DHA) are known to inactivate enveloped viruses and inhibit proliferation of various microbial organisms. The pro-inflammatory metabolites of AA and EPA such as prostaglandins, leukotrienes and thromboxanes induce inflammation whereas lipoxins, resolvins, protectins and maresins derived from AA, EPA and DHA not only suppress inflammation but also enhance would healing and augment phagocytosis of macrophages and other immunocytes and decrease microbial load. In view of these actions, it is suggested that AA and other unsaturated fatty acids and their metabolites may serve as endogenous anti-viral compounds and their deficiency may render humans susceptible to SARS-CoV-2, SARS and MERS and other similar viruses' infections. Hence, oral or intravenous administration of AA and other unsaturated fatty acids may aid in enhancing resistance and recovery from SARS-CoV-2, SARS and MERS infections.


docid: tswojeuv

title: COVID-19-A Novel Zoonotic Disease: A Review of the Disease, the Virus, and Public Health Measures

text: A cluster of cases of pneumonia of unknown etiology emerged in Wuhan, China, at the end of December 2019. The cluster was largely associated with a seafood and animal market. A novel Betacoronavirus was quickly identified as the causative agent, and it is shown to be related genetically to SARS-CoV and other bat-borne SARS-related Betacoronaviruses. The number of cases increased rapidly and spread to other provinces in China, as well as to another 4 countries. To help control the spread of the virus, a "cordon sanitaire" was instituted for Wuhan on January 23, 2020, and subsequently extended to other cities in Hubei Province, and the outbreak declared a Public Health Emergency of International Concern by the Director General of the World Health Organization on January 30, 2020. The virus was named SARS-CoV-2 by the International Committee for the Taxonomy of Viruses, and the disease it causes was named COVID-19 by the World Health Organization. This article described the evolution of the outbreak, and the known properties of the novel virus, SARS-CoV-2 and the clinical disease it causes, and the major public health measures being used to help control it's spread. These measures include social distancing, intensive surveillance and quarantining of cases, contact tracing and isolation, cancellation of mass gatherings, and community containment. The virus is the third zoonotic coronavirus, after SARS-CoV and MERS-CoV, but appears to be the only one with pandemic potential. However, a number of important properties of the virus are still not well understood, and there is an urgent need to learn more about its transmission dynamics, its spectrum of clinical severity, its wildlife origin, and its genetic stability. In addition, more research is needed on possible interventions, particularly therapeutic and vaccines.


title: Optimizing high-yield production of SARS-CoV-2 soluble spike trimers for serology assays

text: The SARS-CoV-2 spike trimer is the primary antigen for several serology assays critical to determining the extent of SARS-CoV-2 exposure in the population. Until stable cell lines are developed to increase the titer of this secreted protein in mammalian cell culture, the low yield of spike protein produced from transient transfection of HEK293 cells will be a limiting factor for these assays. To improve the yield of spike protein and support the high demand for antigens in serology assays, we investigated several recombinant protein expression variables by altering the incubation temperature, harvest time, chromatography strategy, and final protein manipulation. Through this investigation, we developed a simplified and robust purification strategy that consistently yields 5 mg of protein per liter of expression culture for two commonly used forms of the SARS-CoV-2 spike protein. We show that these proteins form well-behaved stable trimers and are consistently functional in serology assays across multiple protein production lots.


Exercise as medicine for COVID-19: An ACE in the hole?


Severe acute respiratory syndrome coronavirus 2 detection in the female lower genital tract


title: Cultural orientation, power, belief in conspiracy theories, and intentions to reduce the spread of COVID-19

text: The current study investigated cultural and psychological factors associated with intentions to reduce the spread of COVID-19. Participants (n = 704) completed measures of individualism-collectivism, belief in conspiracy theories about COVID-19, feelings of powerlessness, and intentions to engage in behaviours that reduce the spread of COVID-19. Results revealed that vertical individualism negatively predicted intentions to engage in social distancing, directly and indirectly through both belief in COVID-19 conspiracy theories and feelings of powerlessness. Vertical collectivism positively predicted social distancing intentions directly. Horizontal collectivism positively predicted social distancing intentions indirectly through feelings of powerlessness. Finally, horizontal collectivism positively predicted hygiene-related intentions both directly and indirectly through lower feelings of powerlessness. These findings suggest that promoting collectivism may be a way to increase engagement with efforts to reduce the spread of COVID-19. They also highlight the importance of examining the interplay between culture and both personal feelings (powerlessness) and information consumption (conspiracy theories) during times of crisis.


COVID-19 travel restrictions and the International Health Regulations (2005)


title: Pediatric COVID-19: Systematic review of the literature

text: OBJECTIVES: There is limited data regarding the demographics and clinical features of SARS-CoV-2 infection in children. This information is especially important as pneumonia is the single leading cause of death in children worldwide. This Systematic Review aims to elucidate a better understanding of the global impact of COVID-19 on the pediatric population. METHODS: A systematic review of the literature was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to gain insight into pediatric COVID-19 epidemiology. Specifically, Pubmed and Google Scholar databases were searched to identify any relevant article with a focus on Pediatric Covid 19, Pediatric Covid-19, Pediatric SARS-COV-2, and Pediatric Coronavirus 19. References within the included articles were reviewed. All articles that met criteria where analyzed for demographics, clinical, laboratory, radiographic, treatment and outcomes data. RESULTS: Ten studies including two case series and 8 retrospective chart reviews, altogether describing a total of 2914 pediatric patients with COVID-19 were included in this systematic review. Of the patients whose data was available, 56% were male, the age range was 1â¯day to 17â¯years, 79% were reported to have no comorbidities, and of the 21% with comorbidities, the most common were asthma, immunosupression, and cardiovascular disease. Of pediatric patients that were tested and positive for an infection with SARS-CoV-2, patients were asymptomatic, 14.9% of the time. Patients presented with cough (48%), fever (47%) and sore throat/pharyngitis (28.6%), more commonly than with upper respiratory symptoms/rhinorrhea/sneezing/nasal congestion (13.7%), vomiting/nausea (7.8%) and diarrhea (10.1%). Median lab values including those for WBC, lymphocyte count and CRP, were within the reference ranges with the exception of procalcitonin levels, which were slightly elevated in children with COVID-19 (median procalcitonin levels ranged from 0.07 to 0.5â¯ng/mL. Computed tomography (CT) results suggest that unilateral CT imaging findings are present 36% of cases while 64% of pediatric patients with COVID-19 had bilateral findings. Of the studies with age specific hospitalization data available, 27.0% of patients hospitalized were infants under 1â¯year of age. Various treatment regimens including interferon, antivirals, and hydroxychloroquine therapies have been trialed on the pediatric population but there are currently no studies showing efficacy of one regimen over the other. The mortality rate of children that were hospitalized with COVID-19 was 0.0018%. CONCLUSION: In contrast to adults, most infected children appear to have a milder course and have better outcomes overall. Additional care may be needed for children with comorbidities and younger children. This review also suggests that unilateral CT chest imaging findings were seen in 36.4% pediatric COVID-19 patients. This is particularly concerning as the work-up of pediatric patients with cough may warrant a bronchoscopy to evaluate for airway foreign bodies. Extra precautions need to be taken with personal protective equipment for these cases, as aerosolizing procedures may be a method of viral transmission. LEVEL OF EVIDENCE: 4 (Systematic Review).


title: Clinical Characteristics of Hematological Patients Concomitant with COVID-19

text: The rapid spread of COVID-19 represented the most serious issue to public health globally. Hematological patients as immunocompromised hosts are vulnerable to SARS-CoV-2 infection. There is rare information available regarding the clinical features of hematological patients concomitant with COVID-19. In this study, 9 concomitant patients were analyzed for their clinical manifestations, the laboratory data, radiological findings and immunologic features. The median age was 50 years (range, 17-68) and 6 patients were male. 7 patients were infected via hospital-associated transmission and other 2 via community-associated transmission. Onset of COVID-19 in all patients occurred during routine treatments for their hematological diseases. 8 patients were classified as moderate and 1 patient as critically ill COVID-19. 4 patients died, 1 from leukemia progression, 2 from life-threatening secondary infection and the other one from respiratory failure caused by COVID-19. Abruptly elevated level of cytokines was often correlated with progressive hematological disease or concurrent bacterial infections. 2 patients had the atypical CT imaging findings of COVID-19. The median interval from the first CT scan imaging to improvement in survivors was 40 days (range 14-51 days). 4 out of 5 survivors had negative serological tests one month after symptoms onset. Positive viral load in 4 survivors lasted longer than 45 days. Our result indicated concomitant patients formed a distinct subgroup characterized by atypical clinical features, defective viral clearance and lower level of SARS-CoV-2-specific antibodies. Targeted therapies that impair host humoral immunity should be avoided. These findings will be helpful to tailor appropriate management for the concomitant patients.


docid: ybwxrlji

title: Psoriatic arthritis and COVID-19 pandemic: Consequences in medical treatment?

text: The COVID-19 pandemic has a strong negative impact on human society worldwide. Patients with immune-mediated disease may be prone to an increased risk of infection and/or more severe course. We review the available data for patients with psoriatic arthritis (PSA) and systemic treatments. Current treatment options are summarized. Based upon the experience with COVID-19, the following problems are addressed: (a) Can systemic treatment reduce comorbidities of PsA that are also comorbidities for COVID-19? Does systemic medical treatment pose an increased risk of infection with SARS-CoV-2? Does systemic drug therapy have an impact on the risk of pulmonary fibrosis-a factor with strong negative impact on COVID-19 outcome? Small molecules, inhibitors of tumor necrosis factor alfa, interleukin, and JAK inhibitors are considered. The data are inhomogeneous for the multiple drugs used in PsA. Although the risk for severe upper airway tract infections during clinical controlled trials was mostly in the range of placebo, these data have been obtained before the COVID-19 pandemic and should be interpreted with caution. Some biologics demonstrated an antifibrotic activity in vitro and in animal disease models. None of the biologics is indicated during an active infection with fever. In nonsymptomatic PsA patients, systemic drug therapy can be continued.


SARS-CoV-2: is the liver merely a bystander to severe disease?


Virtual Nation: Telemedicine's Breakout Moment


title: Demand for Health Information on COVID-19 among Vietnamese

text: Due to the rapid spread of coronavirus, Vietnam introduced its first national partial lockdown on April 1st, 2020. The public relied on online sources, whether through official websites or phone-based applications, to acquire up-to-date health information, provide accurate instructions, and limit misinformation. This study aims to provide insight regarding the current level of awareness of the pandemic, and to identify associated factors in Vietnamese participants to recommend necessary interventions. A cross-sectional study was conducted using a web-based survey during the first week of the lockdown period. There were 341 observations collected using a snowball sampling technique. A Tobit multivariable regression model was used to identify factors associated with the demand for each category of health information. The most requested information was the latest updated news on the epidemic, followed by information about disease symptoms and updated news on the outbreak. The prevalence of diverse socioeconomic, demographic, and ethnic factors in Vietnam requires consideration of the specific health information needs of unique groups. Identifying group-specific demands would be helpful to provide proper information to fulfill each population group's needs.


title: Perspectives on Cardiopulmonary Critical Care for COVID-19 Patients: From Members of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation

text: The coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), marks a global event that will permanently reshape implementation of intensive care medicine. As of June 4, 2020, there are 6,606,455 reported cases of COVID-19 including 388,556 fatalities spanning 215 countries and territories, although epidemiological data remain incomplete. Early autopsy reports emphasize proximal airway and distal airspace involvement, including alveolar epithelial inflammation and capillary thickening.


Hyper-inflammatory Syndrome in a Child With COVID-19 Treated Successfully With Intravenous Immunoglobulin and Tocilizumab


title: Nutritional and Metabolic Support and the Treatment Strategy of Severe Corona Virus Disease 2019 (COVID-19)/ 中华急诊医学杂志

text: The digestive tract is a target organ attacked by COVID-19. It is also the earliest affected organ other than the lung and must bear side effects from the anti-virus chemotherapy such as LPV/r. In this article, we aim to provide practical recommendations for a nutritional and metabolic management strategy for severe corona virus disease-19 (COVID-19) patients. These recommendations are based on the newest pathophysiological findings on the risk factors of malnutrition for COVID-19. We also systematically retrieve literatures on nutritional therapy for acute lung injuries from international and Chinese databases according to evidence-based principles. Our suggestions are: 1) Physicians should be mindful of gut injury when they focus on respiratory support, by monitoring and managing the nutritional status; 2) Periodical and dynamic nutritional risk evaluation is needed; 3) For severe patients, the feeding target of calorie and protein should be down-regulated; 4)The using of ω-3 fatty acids products should be in accordance with pharmacological indications; the forms and dosage should be determined individually.


title: Eicosanoids: the Overlooked Storm in COVID-19?

text: Severe coronavirus-19 (COVID-19) symptoms, including systemic inflammatory response and multi-system organ failure, are now affecting thousands of infected patients and causing widespread mortality. Coronavirus infection causes tissue damage, which triggers the endoplasmic reticulum (ER) stress response and subsequent eicosanoid and cytokine storms. While pro-inflammatory eicosanoids including prostaglandins, thromboxanes, and leukotrienes are critical mediators of physiological processes such as inflammation, fever, allergy, and pain, their role in COVID-19 are poorly characterized. Arachidonic acid derived epoxyeicosatrienoic acids (EETs) could alleviate the systemic hyper-inflammatory response in COVID-19 infection by modulating ER stress and stimulating the resolution of inflammation. Soluble epoxide hydrolase (sEH) inhibitors, which increase endogenous EET levels, exhibit potent anti-inflammatory activity and inhibit various pathologic processes in preclinical disease models including pulmonary fibrosis, thrombosis, and acute respiratory distress syndrome. Therefore, targeting eicosanoids and sEH could be a novel therapeutic approach in combating COVID-19. In this review, we discuss the predominant role of eicosanoids in regulating the inflammatory cascade and propose the potential application of sEH inhibitors in alleviating COVID-19 symptoms. We also discuss the host-protective action of omega-3 fatty acid-derived epoxyeicosanoids and specialized pro-resolving mediators (SPMs) in regulating anti-inflammation and anti-viral response. Future studies determining the eicosanoid profile in COVID-19 patient or preclinical model are pivotal in providing the novel insight of coronavirus-host interaction and inflammation modulation.


SARS-CoV-2 Infection in Hospitalized Patients with Kidney Disease


Underutilization of health care for strokes during the COVID-19 outbreak


title: The overall mortality caused by COVID-19 in the European region is highly associated with demographic composition: A spatial regression-based approach

text: The demographic factors have a substantial impact on the overall casualties caused by the COVID-19. In this study, the spatial association between the key demographic variables and COVID-19 cases and deaths were analyzed using the spatial regression models. Total 13 (for COVID-19 case factor) and 8 (for COVID-19 death factor) key variables were considered for the modelling. Total five spatial regression models such as Geographically weighted regression (GWR), Spatial Error Model (SEM), Spatial Lag Model (SLM), Spatial Error_Lag model (SEM_SLM), and Ordinary Least Square (OLS) were performed for the spatial modelling and mapping of model estimates. The local R2 values, which suggesting the influences of the selected demographic variables on overall casualties caused by COVID-19, was found highest in Italy and the UK. The moderate local R2 was observed for France, Belgium, Netherlands, Ireland, Denmark, Norway, Sweden, Poland, Slovakia, and Romania. The lowest local R2 value for COVID-19 cases was accounted for Latvia and Lithuania. Among the 13 variables, the highest local R2 was calculated for total population (R2 = 0.92), followed by death crude death rate (R2 = 0.9), long time illness (R2 = 0.84), population with age>80 (R2 = 0.59), employment (R2 = 0.46), life expectancy at 65 (R2 = 0.34), crude birth rate (R2 = 0.31), life expectancy (R2 = 0.31), Population with age 65-80 (R2 = 0.29), Population with age 15-24 (R2 = 0.27), Population with age 25-49 (R2 = 0.27), Population with age 0-14 (R2 = 0.23), and Population with age 50-65 (R2 = 0.23), respectively.


title: A role for human leucocyte antigens in the susceptibility to SARS-Cov-2 infection observed in transplant patients

text: We analysed data from 80 patients who tested positive for SARS-CoV-2 RNA who had previously been HLA typed to support transplantation. Data were combined from two adjacent centres in Manchester and Leeds to achieve a sufficient number for early analysis. HLA frequencies observed were compared against two control populations: first, against published frequencies in a UK deceased donor population (n = 10,000) representing the target population of the virus, and second, using a cohort of individuals from the combined transplant waiting lists of both centres (n = 308), representing a comparator group of unaffected individuals of the same demographic. We report a significant HLA association with HLA- DQB1*06 (53% vs. 36%; p < .012; OR 1.96; 95% CI 1.94-3.22) and infection. A bias towards an increased representation of HLA-A*26, HLA-DRB1*15, HLA-DRB1*10 and DRB1*11 was also noted but these were either only significant using the UK donor controls, or did not remain significant after correction for multiple tests. Likewise, HLA-A*02, HLA-B*44 and HLA-C*05 may exert a protective effect, but these associations did not remain significant after correction for multiple tests. This is relevant information for the clinical management of patients in the setting of the current SARS-CoV-2 pandemic and potentially in risk-assessing staff interactions with infected patients.


docid: vuwphmoz

title: Impact of the COVID-19 Pandemic on Fundamental Physics Research

text: The outbreak and pandemic of the COVID-19 has dramatically changed the world in almost every aspect. Its impact on the community of high energy physics is also apparent. In this analysis we show that social distancing has greatly changed the working style of the physics community. In the field of high energy physics the online communications and video conferences are becoming daily routine arrangements. However, such a change of working styles may need some time to get used to. The influence can be seen by scientific outcomes harvested from arXiv, INSPIRE databases and JHEP, PRD official websites.


Safety of dupilumab in atopic patients during COVID-19 outbreak


title: Dying individuals and suffering populations: applying a population-level bioethics lens to palliative care in humanitarian contexts: before, during and after the COVID-19 pandemic

text: BACKGROUND: Humanitarian crises and emergencies, events often marked by high mortality, have until recently excluded palliative care-a specialty focusing on supporting people with serious or terminal illness or those nearing death. In the COVID-19 pandemic, palliative care has received unprecedented levels of societal attention. Unfortunately, this has not been enough to prevent patients dying alone, relatives not being able to say goodbye and palliative care being used instead of intensive care due to resource limitations. Yet global guidance was available. In 2018, the WHO released a guide on 'Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises'-the first guidance on the topic by an international body. AIMS: This paper argues that while a landmark document, the WHO guide took a narrowly clinical bioethics perspective and missed crucial moral dilemmas. We argue for adding a population-level bioethics lens, which draws forth complex moral dilemmas arising from the fact that groups having differential innate and acquired resources in the context of social and historical determinants of health. We discuss dilemmas concerning: limitations of material and human resources; patient prioritisation; euthanasia; and legacy inequalities, discrimination and power imbalances. IMPLICATIONS: In parts of the world where opportunity for preparation still exists, and as countries emerge from COVID-19, planners must consider care for the dying. Immediate steps to support better resolutions to ethical dilemmas of the provision of palliative care in humanitarian and emergency contexts will require honest debate; concerted research effort; and international, national and local ethical guidance.


Hypoalbuminaemia in COVID-19 infection: A predictor of severity or a potential therapeutic target?


COVID-19 pandemics and oral health care for older adults


Betting on Pandemic


Renal dysfunction in hospitalised children with COVID-19


title: COVID-19: Media coverage and financial markets behavior-A sectoral inquiry

text: We analyze the relationship between sentiment generated by coronavirus-related news with volatility of equity markets. The ongoing coronavirus outbreak (COVID-19) resulted in unprecedented news coverage and outpouring of opinions in this age of swift propagation of information. Ensuing uncertainty in financial markets leads to heightened volatility in prices. We find that overwhelming panic generated by the news outlets are associated with increasing volatility in the equity markets. Our results for individual economic sectors demonstrate that panic-laden news contributed to a greater extent to volatility in the sectors perceived to be most affected by coronavirus outbreak.


docid: jowrpwbs

title: Intramural Hematoma as Unexpected Complication of COVID-19 Infection

text: Novel coronavirus disease-2019 (COVID-19) is an ominous infectious disease that seems capable to attack any organ system, leading in the most severe cases to patient death. COVID-19 has been associated with multiple cardiovascular complications of inflammatory and immune origin, leading to a wide spectrum of vascular damage, myocardial injury, stroke, and pulmonary obstruction. We report the case of a patient with COVID-19 infection who developed an acute aortic syndrome with the characteristics of aortic intramural hematoma.


title: Contemporary and Future Concepts on Hypertension in African Americans: COVID-19 and Beyond

text: BACKGROUND: Cardiovascular disease related mortality is the leading cause of death in the United States, with hypertension being the most prevalent and potent risk factor. For decades hypertension has disproportionately affected African Americans, who also have a higher burden of associated comorbidities including diabetes and heart failure. METHODS: Current literature including guideline reports and newer studies on hypertension in African Americans in PubMed were reviewed. We also reviewed newer publications on the relationship between COVID-19 and cardiovascular disease. FINDINGS: While APOL1 has been theorized in the epidemiology of hypertension, the increased prevalence and associated risks are primarily due to environmental and lifestyle factors. These factors include poor diet, adverse lifestyle, and social determinants. Hypertension control can be achieved by lifestyle modifications such as low sodium diet, weight loss, and adequate physical activity. When lifestyle modifications alone do not adequately control hypertension, a common occurrence among African Americans who suffer with greater prevalence of resistant hypertension, pharmacological intervention is indicated. The efficacy of renal denervation, and the use of sodium-glucose cotransporter 2 and aminopeptidase A inhibitors, have been studied for treatment of resistant hypertension. Furthermore, the recent COVID-19 crisis has been particularly devastating among African Americans who demonstrate increased incidence and poorer health outcomes related to the disease. CONCLUSION: The disparities in outcomes, which are largely attributable to a greater prevalence of comorbidities such as hypertension and obesity, in addition to adverse environmental and socioeconomic factors, highlight the necessity of specialized clinical approaches and programs for African Americans to address longstanding barriers to equitable care.


title: Cardiovascular Safety of Potential Drugs for the Treatment of Coronavirus Disease 2019

text: Coronavirus disease 2019 (COVID-19) has become a global pandemic. It is still uncontrolled in most countries and no therapies are currently available. Various drugs are under investigation for its treatment. The disease is known to have worse outcomes in patients who have underlying cardiovascular disease. Chloroquine/hydroxychloroquine, azithromycin, remdesivir and lopinavir/ritonavir are currently being studied in trials and show some promise. Conduction disorders, heart failure, and mortality have been reported with the use of these drugs. It is important to have knowledge of potential cardiotoxic effects of these drugs before using them for COVID-19 patients for better allocation of healthcare resources and improvement in clinical outcomes.


title: Epidemic of COVID-19 in China and associated Psychological Problems

text: The world is experiencing pandemic of the COVID-19 now, a RNA virus that spread out from Wuhan, China. Two countries, China first and later Italy, have gone to full lock down due to rapid spread of this virus. Till to date, no epidemiological data on mental health problems due to outbreak of the COVID-19 and mass isolation were not available. To meet this need, the present study was undertaken to assess the mental health status of Chinese people. An online survey was conducted on a sample of 1074 Chinese people, majority of whom from Hubei province. Lack of adequate opportunities to conduct face to face interview, anxiety, depression, mental well-being and alcohol consumption behavior were assessed via self-reported measures. Results showed higher rate of anxiety, depression, hazardous and harmful alcohol use, and lower mental wellbeing than usual ratio. Results also revealed that young people aged 21-40 years are in more vulnerable position in terms of their mental health conditions and alcohol use. To address mental health crisis during this epidemic, it is high time to implement multi-faceted approach (i.e. forming multidisciplinary mental health team, providing psychiatric treatments and other mental health services, utilizing online counseling platforms, rehabilitation program, ensuring certain care for vulnerable groups, etc.).


title: Clinical characteristics of 194 cases of COVID-19 in Huanggang and Taian, China

text: PURPOSE: We aimed to report the clinical characteristics of 194 cases coronavirus disease-19 (COVID-19) in Huanggang, Hubei and Taian, Shandong. METHODS: We retrospectively investigated the clinical, laboratory characteristics and CT imaging of confirmed cases of COVID-19 from January 22 to February 28, 2020 in Huanggang Central Hospital and The Second Affiliated Hospital of Shandong First Medical University. Real time PCR was used to detect the new coronavirus in respiratory samples. Immunohistochemical staining was used to detect the expressions of ACE2 in tissues. RESULTS: Among the 194 patients infected with COVID-19, 108 patients were male, with a median age of 48.3 years. The average preclinical period was 7.44 day. Except for 37 severe or critically ill patients, the rest of the 157 patients exhibited mild or moderate symptoms. 190 (97.94%) patients were confirmed during the three times nucleic acid test. The main clinical symptom of the patients were fever, sore throat and cough, which accounted for 146 cases (75.26%), 98 (50.52%) and 86 cases (44.33%), respectively. 30 patients (15.46%) showed liver dysfunction. Imaging examination showed that 141 patients (72.68%) showed abnormal density shadow, while 53 cases (27.32%) had no obvious abnormality in the parenchyma of both lungs. Up to now, 109 cases have been discharged from the hospital, and 9 patients died. The ACE2 expression levels were up-regulated in patients of severe type and critically ill type. CONCLUSION: Clinical symptoms, laboratory tests and CT imaging should be combined for comprehensive analysis to diagnose COVID-19. ACE2 may be the receptor of COVID-19.


docid: oayjeens

title: Interim Guidelines on Antiviral Therapy for COVID-19

text: Since the first case was reported in Wuhan, Hubei Province, China on December 12, 2019, Coronavirus disease 2019 (COVID-19) has spread widely to other countries since January 2020. As of April 16, 2020, 10635 confirmed cases have been reported, with 230 deaths in Korea. COVID-19 patients may be asymptomatic or show various clinical manifestations, including acute symptoms such as fever, fatigue, sore throat; pneumonia presenting as acute respiratory distress syndrome; and multiple organ failure. As COVID-19 has such varied clinical manifestations and case fatality rates, no standard antiviral therapy regimen has been established other than supportive therapy. In the present guideline, we aim to introduce potentially helpful antiviral and other drug therapies based on in vivo and in vitro research and clinical experiences from many countries.


Managing locally advanced adenoid cystic carcinoma of the head and neck during the COVID-19 pandemic crisis: Is this the right time for particle therapy?


title: Markets for Efficient Public Good Allocation

text: Public goods are often either over-consumed in the absence of regulatory mechanisms, or remain completely unused, as in the case of the Covid-19 pandemic, where social distance constraints are enforced to limit the number of people who can share public spaces. In this work, we plug this gap through market based mechanisms designed to efficiently allocate capacity constrained public goods. To design these mechanisms, we leverage the theory of Fisher markets, wherein each agent in the economy is endowed with an artificial currency budget that they can spend to avail public goods. While Fisher markets provide a strong methodological backbone to model resource allocation problems, their applicability is limited to settings involving two types of constraints - budgets of individual buyers and capacities of goods. The presence of additional physical constraints that arise in public goods allocation problems motivates the need for modifications to the Fisher market framework to account for these more general set of constraints. In our market mechanism, we specifically modify the Fisher market social optimization problem through a perturbation of the budgets of agents. The budget perturbations are set based on the dual variables of the additional physical constraints such that the KKT conditions of the newly defined social and individual optimization problems are equivalent. This establishes that our mechanism sets market clearing prices such that each agent obtains their maximum possible utilities subject to their constraints. Finally, to compute the perturbation constants we present a fixed point scheme, establish the existence of a unique fixed point and present numerical experiments to illustrate convergence guarantees. Thus, our mechanism, both theoretically and computationally, overcomes a fundamental limitation of Fisher markets, which only consider capacity and budget constraints.


title: Preliminary pragmatic lessons from the SARS-CoV-2 pandemic in France

text: The first wave of the SARS-CoV-2 pandemic required an unprecedented and historic increase in critical care capacity on a global scale in France. Authors and members from the ACUTE and REANIMATION committees of the French Society of Anaesthesia and Intensive Care (SFAR) wished to share experience and insights gained during the first weeks of this pandemic. These were summarised following the World Health Organization Response Checklist and detailed according to the subsequent subheadings: 1. Command and Control, 2. Communication, 3. Safety and Security, 4. Triage, 5. Surge Capacity, 6. Continuity of essential services, 7. Human resources, 8. Logistics and supply management, 9. Training/Preparation, 10. Psychological comfort for patients and next of kin, 11. Learning and 12. Post disaster recovery. These experience-based recommendations, consensual across all members from both committees of our national society, establish a practical framework for medical teams, either spared by the first wave of severe COVID patients or preparing for the second one.


How urinary stone emergencies changed in the time of COVID-19?