Dispositivo de oxigenación con reservorio y PEEP (DORPEEP) en pacientes con dificultad respiratoria aguda por COVID-19./ Dispositivo de oxigenación con reservorio y PEEP (DORPEEP) en pacientes con dificultad respiratoria aguda por COVID-19./ Oxygenation device with reservoir and PEEP (ODRPEEP) in patients with acute respiratory distress due to COVID-19


title: [Strategies for vaccine development of COVID-19]

text: An epidemic of acute respiratory syndrome in humans, which appeared in Wuhan, China in December 2019, was caused by a novel coronavirus (SARS-CoV-2). This disease was named as "Coronavirus Disease 2019" (COVID-19). SARS-CoV-2 was first identified as an etiological pathogen of COVID-19, belonging to the species of severe acute respiratory syndrome-related coronaviruses (SARSr-CoV). The speed of both the geographical transmission and the sudden increase in numbers of cases is much faster than SARS and Middle East respiratory syndrome (MERS). COVID-19 is the first global pandemic caused by a coronavirus, which outbreaks in 211 countries/territories/areas. The vaccine against COVID-19, regarded as an effective prophylactic strategy for control and prevention, is being developed in about 90 institutions worldwide. The experiences and lessons encountered in the previous SARS and MERS vaccine research can be used for reference in the development of COVID-19 vaccine. The present paper hopes to provide some insights for COVID-19 vaccines researchers.


title: Rehabilitation Medicine Response to the COVID-19 Pandemic

text: The COVID-19 pandemic has spread across the globe at a rapid rate, affecting large numbers of individuals in different countries with varying healthcare systems and infrastructure. In the United States, New York City has been the epicenter of the COVID-19 outbreak, and the peak impact in this region has come earlier in this location than most other parts of the country. We report our experience preparing for this pandemic in a New York City academic medical center and its regional healthcare system, the issues confronted during the rise and peak of the number of cases, and the plans for the postpeak recovery and adjustment to the new reality of providing rehabilitation in an environment where COVID-19 remains prevalent.


The use of high-flow nasal oxygen in COVID-19


title: 2020 UK Lockdown Cyber Narratives: the Secure, the Insecure and the Worrying

text: On the 23rd March 2020, the UK entered a period of lockdown in the face of a deadly pandemic. While some were unable to work from home, many organisations were forced to move their activities online. Here, we discuss the technologies they used, from a privacy and security perspective. We also mention the communication failures that have exacerbated uncertainty and anxiety during the crisis. An organisation could be driven to move their activities online by a range of disasters, of which a global pandemic is only one. We seek, in this paper, to highlight the need for organisations to have contingency plans in place for this kind of eventuality. The insecure usages and poor communications we highlight are a symptom of a lack of advance pre-pandemic planning. We hope that this paper will help organisations to plan more effectively for the future.


title: Chilblain-like lesions in pediatrics dermatological outpatients during the COVID-19 outbreak

text: In Spain, with full confinement measures and coinciding with the pandemic, pediatricians and dermatologists have received, through teledermatology/teleconsultation and social networks, a barrage of diverse images, which have subsequently allowed us to approach some of them by direct physical examination of early and late skin manifestations associated with SARS-Cov-2 infection. We designed a retrospective, cross-sectional study to evaluate the dermatological care of all those patients under the age of 16 who consulted, in person or telematically, for acral lesions (chilblain-like or erythema multiforme-like) in the context of the Coronavirus disease (COVID-19) pandemic, since 15 March 2020 to 24 April 2020, both included in the health area of the Hospital Universitario San Cecilio de Granada. Of all the patients collected, 18 (66%) were male and the overall mean age was 14.44 years. All lacked a personal history of interest and denied previous episodes of chilblains or Raynaud's phenomenon/disease. The clinic was limited to purpuric lesions located on acral regions distributed on hands and feet. Dermatologists and pediatricians should be aware of the lesions associated with COVID-19 infection and their possible complications. It remains to be identified if there are different dermatological patterns in the pediatric and adult population.


Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study


Diagnosed With COVID-19, Nope Just Cabin Fever: The Fundamentals of Staying at Home


title: Rationeel gebruik van ademhalingsbeschermingsmaskers./ [Rational use of respiratory protective equipment: advice for health care professionals in time of COVID-19]

text: The current COVID-19 pandemic has led to a worldwide shortage of respiratory protective equipment. In order to offer maximum protection against infection for all healthcare workers, we need to optimise our use of the available equipment. This article provides practical advice on which type of mask is indicated in what specific situation, what requirements the mask should meet and how to optimise the local workflow, including the re-use of masks after decontamination.


title: The right to know: ethical implications of antibody testing for healthcare workers and overlooked societal implications

text: After the initial surge in cases of coronavirus (COVID-19), the outbreak has been managed differently in different countries. In the USA, it has been managed in many different ways between states, cities and even counties. This disparity is slowly becoming more and more pronounced with the advent of antibody testing. Although many argue over the potential merits of antibody testing as an immunity passport to allow the economy to restart, there are other implications that stand at the heart of the bioethical debate that are often overlooked. Particularly with COVID-19, there are many uncertainties and the discourse alone of antibodies presumes misinformation that may outweigh the epidemiological benefits of antibody testing. Although this paper does not seek to eliminate antibody testing, it does highlight the need for appropriate counselling both on a personal level with each patient but on a more global level. This moral standard of appropriate education is key to allowing the continued autonomy needed during this pandemic.


COVID-19, anxiety, sleep disturbances and suicide


title: Psychiatric Rehabilitation Journal in the era of COVID-19

text: The global health crisis caused by the coronavirus pandemic (COVID-19) has brought about previously unimaginable changes to all of health care, including the field of psychiatric rehabilitation. Given these dramatic changes, we pose this editorial to contemplate our mission and how we can best serve the field. We raise questions about how psychiatric rehabilitation will evolve and restate our steadfast commitment to publishing impactful research that shapes the field. We also remain hopeful, knowing psychiatric rehabilitation practitioners, researchers, and participants are pragmatic, persistent, and resilient, and will find opportunities for creativity and innovation even during this difficult time. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


The possible beneficial adjuvant effect of influenza vaccine to minimize the severity of COVID-19


docid: cejvoacq

title: Neurotropism of SARS-CoV 2: Mechanisms and manifestations


COVID-19 and beyond


What next for the coronavirus response?


Clinical Implications of Universal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Testing in Pregnancy


title: [Challenges and countermeasures on Chinese malaria elimination programme during the coronavirus disease 2019 (COVID-19) outbreak]

text: Since the end of 2019, the coronavirus disease 2019 (COVID-19) has been extensively epidemic in China, which not only seriously threatens the safety and health of Chinese people, but also challenges the management of other infectious diseases. Currently, there are still approximately three thousand malaria cases imported into China every year. If the diagnosis and treatment of malaria cases as well as the investigation and response of the epidemic foci are not carried out timely, it may endanger patients'lives and cause the possible of secondary transmission, which threatens the achievements of malaria elimination in China. Due to the extensive spread and high transmission ability of the COVID-19, there is a possibility of virus infections among malaria cases during the medical care-seeking behaviors and among healthcare professionals during clinical diagnosis and treatment, sample collection and testing and epidemiological surveys. This paper analyzes the challenges of the COVID-19 for Chinese malaria elimination programme, and proposes the countermeasures in response to the COVID-19 outbreak, so as to provide the reference for healthcare professionals.


Vets can help government tackle Covid-19


title: Molecular analysis of Spiophanes bombyx complex (Annelida: Spionidae) with description of a new species

text: Spiophanes bombyx (Claparède, 1870) from the Gulf of Naples, Tyrrhenian Sea, Italy, was the first described Spiophanes with fronto-lateral horns on the prostomium. It was also considered the only horned species occurring in European waters. Our sequence data of five gene fragments suggest the presence of two horned sibling Spiophanes species in northern Europe: S. cf. bombyx in the North and the Norwegian seas, and S. cf. convexus in Brittany, northern France, and Bay of Biscay, northern Spain. Spiophanes cf. bombyx worms are genetically close to a single examined specimen of S. bombyx from Venice Lagoon, Italy but their conspecificity should be verified by further study. Our sequence data show that horned Spiophanes from the North Pacific are genetically distant from horned European species, and that S. uschakowi Zachs, 1933, originally described from the Sea of Japan (East Sea) is a valid species. The data also suggest the presence of two horned sibling Spiophanes species in the North East Pacific: S. hakaiensis Radashevsky & Pankova, n. sp. distributed from Alaska south to about Point Conception, and S. norrisi Meißner & Blank, 2009, distributed from San Francisco Bay south to Baja California Sur, Mexico. Spiophanes from South America, morphologically similar to S. norrisi, are suggested to belong to a new species. Molecular data also suggest the presence of two sibling species among the worms from northern Europe identified by morphology as S. kroyeri Grube, 1860. Worms from the Barents Sea and northern part of the North Sea are tentatively referred to as S. cf. kroyeri; worms from the northern and central parts of the North Sea and from the Bay of Biscay, northern Spain, are tentatively referred to as S. cf. cirrata M. Sars in G.O. Sars, 1872. Sequence data also show that S. duplex from California is genetically different from morphologically similar worms from South America. The South American worms are referred to resurrected S. soederstroemi Hartman, 1953 which was originally described from off Rio Grande do Sul, Brazil, and then considered as a junior synonym of S. duplex. Analysis of divergence times of Spiophanes lineages suggested that the origin of the most recent common ancestor of horned Spiophanes with metameric nuchal organs was around 11.1 mya (95% HPD: 5.1-19.0 mya) and that the divergence of the North Atlantic and North Pacific lineages was around 7.9 mya (95% HPD: 4.1-13.3 mya). The North Atlantic lineage was estimated to have diverged 4.8 mya (95% HPD: 2.2-8.6 mya), resulting in the origin of S. cf. bombyx and S. cf. convexus. The North Pacific lineage was estimated to have diverged first by the isolation and speciation of S. norrisi 1.7 mya (95% HPD: 2.3-1.0 mya), and then by the isolation and speciation of S. uschakowi and S. hakaiensis n. sp. 1.3 mya (95% HPD: 2.0-0.7 mya). The estimates place the divergences soon after maximum glacial period in the North Pacific (2.4-3.0 mya).


title: Aflatoxin and ochratoxin A residues in supplementary foods used for wild birds

text: Provision of supplementary food for garden birds is practiced on a large scale in multiple countries. While this resource has benefits for wild bird populations, concern has been expressed regarding the potential for contamination of foodstuffs by mycotoxins, and the implications this might have for wildlife health. We investigated whether aflatoxin (AF) and ochratoxin A (OA) residues are present in foodstuffs sold for wild bird consumption at point of sale in Great Britain using high pressure liquid chromatography analyses. The hypothesis that production of these mycotoxins occurs in British climatic conditions, or under storage conditions after the point of sale, was tested under experimental conditions but was not proved by our study. While the majority of peanut samples were negative for AF residues, 10% (10/98) of samples at point of sale and 11% (13/119) of those across the storage and climate exposure treatment replicates contained AFB1 that exceeded the maximum permitted limit of 20 µg/kg. No significant difference was found in the detection of either mycotoxin between branded and non-branded products. The clinical significance, if any, of exposure of wild birds to mycotoxins requires further investigation. Nevertheless, the precautionary principle should be adopted and best practice steps to reduce the likelihood of wild bird exposure to mycotoxins are recommended.


title: Evaluation of the potential incidence of COVID-19 and effectiveness of containment measures in Spain: a data-driven approach

text: BACKGROUND: We are currently experiencing an unprecedented challenge, managing and containing an outbreak of a new coronavirus disease known as COVID-19. While China-where the outbreak started-seems to have been able to contain the growth of the epidemic, different outbreaks are nowadays present in multiple countries. Nonetheless, authorities have taken action and implemented containment measures, even if not everything is known. METHODS: To facilitate this task, we have studied the effect of different containment strategies that can be put into effect. Our work referred initially to the situation in Spain as of February 28, 2020, where a few dozens of cases had been detected, but has been updated to match the current situation as of 13 April. We implemented an SEIR metapopulation model that allows tracing explicitly the spatial spread of the disease through data-driven stochastic simulations. RESULTS: Our results are in line with the most recent recommendations from the World Health Organization, namely, that the best strategy is the early detection and isolation of individuals with symptoms, followed by interventions and public recommendations aimed at reducing the transmissibility of the disease, which, although might not be sufficient for disease eradication, would produce as a second order effect a delay of several days in the raise of the number of infected cases. CONCLUSIONS: Many quantitative aspects of the natural history of the disease are still unknown, such as the amount of possible asymptomatic spreading or the role of age in both the susceptibility and mortality of the disease. However, preparedness plans and mitigation interventions should be ready for quick and efficacious deployment globally. The scenarios evaluated here through data-driven simulations indicate that measures aimed at reducing individuals' flow are much less effective than others intended for early case identification and isolation. Therefore, resources should be directed towards detecting as many and as fast as possible the new cases and isolate them.


title: [Standard procedures in dialysis during the Covid-19 epidemic]

text: Scope: The aim of this document has been to define standard procedures for dealing with dialysis patients once the first cases of novel Coronavirus 2019-nCoV (Covid-19) were confirmed among the Italian population. Applicability: These procedures, that refer exclusively to the hospital's dialysis rooms, are currently implemented at the ASST Santi Paolo e Carlo in Milan and two smaller centers in the Milan area. Description: We describe the preemptive measures adopted by the staff at our dialysis unit since 24/02/2020, in order to slow down the transmission of Covid-19. They have allowed us to adopt a uniform approach towards all patients, streamlining the way we identify and deal with suspected, likely and confirmed Coronavirus infections. To start with, all patients coming to the hospital for their dialytic session have been treated as potentially infectious and everybody has been following closely the standard protocols regarding personal protective equipment (PPE).


Positive outcome in a patient with coronavirus disease 2019 and common variable immunodeficiency after intravenous immunoglobulin


title: COVID-19 Public Opinion and Emotion Monitoring System Based on Time Series Thermal New Word Mining

text: With the spread and development of new epidemics, it is of great reference value to identify the changing trends of epidemics in public emotions. We designed and implemented the COVID-19 public opinion monitoring system based on time series thermal new word mining. A new word structure discovery scheme based on the timing explosion of network topics and a Chinese sentiment analysis method for the COVID-19 public opinion environment is proposed. Establish a"Scrapy-Redis-Bloomfilter"distributed crawler framework to collect data. The system can judge the positive and negative emotions of the reviewer based on the comments, and can also reflect the depth of the seven emotions such as Hopeful, Happy, and Depressed. Finally, we improved the sentiment discriminant model of this system and compared the sentiment discriminant error of COVID-19 related comments with the Jiagu deep learning model. The results show that our model has better generalization ability and smaller discriminant error. We designed a large data visualization screen, which can clearly show the trend of public emotions, the proportion of various emotion categories, keywords, hot topics, etc., and fully and intuitively reflect the development of public opinion.


Rapid Implementation of Telehealth in Hospital Psychiatry in Response to COVID-19


title: Unexpected Biliopancreatic Limb Obstruction after Gastric Bypass Revision

text: INTRODUCTION: Biliopancreatic limb obstruction is a surgical emergency in patients who have undergone gastric bypass surgery. This case report presents an unexpected cause of biliopancreatic limb obstruction and the importance of prompt intervention. MATERIAL AND METHODS: A 37-year-old woman presented with complaints of weight regain (BMI increased from 27 to 33.3 kg/m2) and bile reflux and was found to have marginal ulcers on endoscopy. She had undergone loop gastric bypass with Braun anastomosis in 2009 at another center for morbid obesity (BMI = 43 kg/m2). Roux-en-Y gastric bypass (RYGB) was created after the separation of gastro-jejunostomy (GJ) and jejuno-jejunostomy (JJ). On the fifth postoperative day, the patient was readmitted with signs of peritonitis. Urgent relaparoscopy showed Biliopancreatic limb (BP) obstruction. It was then and that we understood intraoperatively the uncut Roux-en-Y caused stricture between the previous GJ and JJ staple lines. Side-to-side jejuno-jejunostomy between the proximal dilated and the distal collapsed biliopancreatic limb was performed. RESULT: The patient recovered uneventfully and was discharged after drain removal. CONCLUSION: Biliopancreatic limb obstruction requires prompt decision for relaparoscopy. Timely intervention is necessary to prevent postoperative morbidity. Reviewing the operative video or notes of the primary surgery can minimize the chance of mismanagement during revision surgery.


docid: llutcrwq

title: COVID-19: a catalyst for flexibility and creativity in neurology


Letter to the Editor: "Our Response to COVID-19 as Endocrinologists and Diabetologists"


title: Model studies on the COVID-19 pandemic in Sweden

text: We study the increases of infections and deaths in Sweden caused by COVID-19 with several different models: Firstly an analytical susceptible-infected (SI) model and the standard susceptible-infected-recovered (SIR) model. Then within the SIR framework we study the susceptible-infected-deceased (SID) correlations. All models reproduce well the number of infected cases and give similar predictions. What causes us deep concern is the large number of deaths projected by the SI and SID models. Our analysis shows that, irrespective of the possible uncertainty of our model prediction, the next few days can be critical for determining the future evolution of the death cases (Updated April 02).


D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis


title: Metagenomic Analysis Reveals Clinical SARS-CoV-2 Infection and Bacterial or Viral Superinfection and Colonization

text: BACKGROUND: More than 2 months separated the initial description of SARS-CoV-2 and discovery of its widespread dissemination in the United States. Despite this lengthy interval, implementation of specific quantitative reverse transcription (qRT)-PCR-based SARS-CoV-2 tests in the US has been slow, and testing is still not widely available. Metagenomic sequencing offers the promise of unbiased detection of emerging pathogens, without requiring prior knowledge of the identity of the responsible agent or its genomic sequence. METHODS: To evaluate metagenomic approaches in the context of the current SARS-CoV-2 epidemic, laboratory-confirmed positive and negative samples from Seattle, WA were evaluated by metagenomic sequencing, with comparison to a 2019 reference genomic database created before the emergence of SARS-CoV-2. RESULTS: Within 36 h our results showed clear identification of a novel human Betacoronavirus, closely related to known Betacoronaviruses of bats, in laboratory-proven cases of SARS-CoV-2. A subset of samples also showed superinfection or colonization with human parainfluenza virus 3 or Moraxella species, highlighting the need to test directly for SARS-CoV-2 as opposed to ruling out an infection using a viral respiratory panel. Samples negative for SARS-CoV-2 by RT-PCR were also negative by metagenomic analysis, and positive for Rhinovirus A and C. Unlike targeted SARS-CoV-2 qRT-PCR testing, metagenomic analysis of these SARS-CoV-2 negative samples identified candidate etiological agents for the patients' respiratory symptoms. CONCLUSION: Taken together, these results demonstrate the value of metagenomic analysis in the monitoring and response to this and future viral pandemics.


The halo sign as a chest computed tomography finding of COVID-19


title: Methylation Pathways and SARS-CoV-2 Lung Infiltration and Cell Membrane-Virus Fusion Are Both Subject to Epigenetics

text: The recent pandemic SARS-CoV-2 outbreak affects all kinds of individuals worldwide. The health, social, and economic impacts of the pandemic are dramatic, and vaccines or specific treatment options are not yet available. The only approaches that we currently have available to stop the epidemic are those of classical epidemic control, such as case isolation, contact tracing and quarantine, physical distancing, and hygiene measures. It is therefore essential to find further preventive measures and possible interventions that can slow down the number of infected individuals and decrease the severity of disease when affected by SARS-CoV-2. It seems that epigenetic mechanisms are an important part of the pathophysiology and illness severity of COVID-19. These mechanisms have been identified in SARS-CoV-2 but also in other viral infections. If and when these mechanisms are confirmed, then epigenetic interventions influencing DNA methylation could be indicated as primary and/or secondary preventive options.


title: Navigating the Clean Energy Transition in the COVID-19 Crisis

text: Bjarne Steffen is a senior researcher at ETH Zurich's Energy Politics Group. His research addresses policies related to energy innovation and the role of finance in the energy transition. He previously worked at MIT's Center for Energy and Environmental Policy Research, the World Economic Forum, and a strategy consultancy. Bjarne holds a Master's in economics from the University of Mannheim and a PhD in energy economics from the University of Duisburg-Essen. Florian Egli is a PhD candidate at ETH Zurich's Energy Politics Group. His research focuses on the role of finance in the energy transition and climate finance more generally. He is a World Economic Forum Global Shaper, is associated with the think tank foraus as its former vice president, and held a Mercator Fellowship on International Affairs in 2015 and 2016. Florian holds a Master's in International Economics from the Graduate Institute of International and Development Studies (IHEID) in Geneva. Michael Pahle is head of the working group "Climate and Energy Policy" at the Potsdam-Institute for Climate Impact Research. His research focuses on carbon pricing and power market design. He holds a Master's in Physics from Potsdam University and a PhD in economics from TU Berlin. Tobias S. Schmidt is Assistant Professor and the head of ETH Zurich's Energy Politics Group, an interdisciplinary group analyzing the interaction of energy policy and its underlying politics with technological change in the energy sector. His research covers both developed and developing countries. Tobias holds a Bachelor's and Master's of Science in electrical engineering (energy focus) from the Technical University Munich and a PhD from ETH Zurich in management, technology, and economics.


title: SARS-CoV-2 infection protects against rechallenge in rhesus macaques

text: An understanding of protective immunity to SARS-CoV-2 is critical for vaccine and public health strategies aimed at ending the global COVID-19 pandemic. A key unanswered question is whether infection with SARS-CoV-2 results in protective immunity against re-exposure. We developed a rhesus macaque model of SARS-CoV-2 infection and observed that macaques had high viral loads in the upper and lower respiratory tract, humoral and cellular immune responses, and pathologic evidence of viral pneumonia. Following initial viral clearance, animals were rechallenged with SARS-CoV-2 and showed 5 log10 reductions in median viral loads in bronchoalveolar lavage and nasal mucosa compared with primary infection. Anamnestic immune responses following rechallenge suggested that protection was mediated by immunologic control. These data show that SARS-CoV-2 infection induced protective immunity against re-exposure in nonhuman primates.


Myocarditis detected after COVID-19 recovery


Required COVID Mandatories


title: C19-TraNet: an empirical, global index-case transmission network of SARS-CoV-2

text: Originating in Wuhan, the novel coronavirus, severe acute respiratory syndrome 2 (SARS-CoV-2), has astonished health-care systems across globe due to its rapid and simultaneous spread to the neighboring and distantly located countries. To gain the systems level understanding of the role of global transmission routes in the COVID-19 spread, in this study, we have developed the first, empirical, global, index-case transmission network of SARS-CoV-2 termed as C19-TraNet. We manually curated the travel history of country wise index-cases using government press releases, their official social media handles and online news reports to construct this C19-TraNet that is a spatio-temporal, sparse, growing network comprising of 187 nodes and 199 edges and follows a power-law degree distribution. To model the growing C19-TraNet, a novel stochastic scale free (SSF) algorithm is proposed that accounts for stochastic addition of both nodes as well as edges at each time step. A peculiar connectivity pattern in C19-TraNet is observed, characterized by a fourth degree polynomial growth curve, that significantly diverges from the average random connectivity pattern obtained from an ensemble of its 1,000 SSF realizations. Partitioning the C19-TraNet, using edge betweenness, it is found that most of the large communities are comprised of a heterogeneous mixture of countries belonging to different world regions suggesting that there are no spatial constraints on the spread of disease. This work characterizes the superspreaders that have very quickly transported the virus, through multiple transmission routes, to long range geographical locations alongwith their local neighborhoods.


title: Role of Telehealth in the Management of COVID-19: Lessons Learned from Previous SARS, MERS, and Ebola Outbreaks

text: Concerns about the prevention and management of COVID-19 are on the rise, as it is crucial in contagious epidemics that travel and transfer of the patients be minimal for diagnosis, treatment, and follow-ups. Telemedicine or telehealth can play an important role, especially with previous successful experiences in the management of acute infectious respiratory epidemics such as SARS and MERS. In order to better control the rapid spread of coronavirus and manage the COVID-19 crisis, both developed and developing countries can improve the efficiency of their health system by replacing a proportion of face-to-face clinical encounters with telehealth. Recent technological advancement facilitates this reform, but there is a need for national or state-wide rules and regulations to be adapted accordingly.


title: Implementation of Remote Clinics in urology practice during the COVID-19 era: What have we learned?/ Implementacion de la teleconsulta en la practica urologica durante la era Covid-19: que hemos aprendido?

text: The COVID-19 pandemic has requiredd rastic measures for an attempt in controlling its spread Health resources and facilities are being destined for the treatment of critically ill infected patients During the past weeks, we, as urologists have faced increasingly difficult changes in practice, as out patient activity andelective surgeries must be postponed in order to save resources and limit the mobilization of patients and faculty During this conflictive situation, telehealth medicine can provide adequate support using technological tools and trying to simulate face-to-face consults with the use of video or telephone calls However, many out patient clinics and facilities are not ready yet for telehealth as their experience in this area is low The benefits for telemedicine in urology are continuing urologic outpatient follow-up, providing recommendations and prescriptions, and the triage of patients who will need urgent procedures Urology residency training has suffered an abrupt disruption nowadays as outpatient, surgical and academic meetings are cancelled In this scenario, virtual strategies and "smart learning" activities are being used to continue education We provide a review of the latest published literature regarding the use of telehealth medicine or telemedicine for the modern urology practice, along side our recommendations and conclusions La actual pandemia por COVID-19 ha requeridola implementacion de medidas drasticas para frenar su avance Las instalaciones y recursos sanitarios se estan destinando de forma total o parcial para la atencion de pacientes criticos Los urologos, nos hemos encontrado durante las semanas pasadas con cambios importantes que dificultan nuestra practica clinica diaria Las actividades ambulatorias como consultas externas y procedimientos ambulatorios, asi como las intervenciones quirurgicas, han tenido que ser suspendidas o retrasadas Mientras dure esta situacion, la actividad medica telematica puede proveer un soporte adecuado utilizando herramientas tecnologicas y tratando de simular las consultas medicas con video llamadas o llamadas por telefono Pero muchos servicios y departamentos medico-quirurgicos no se encuentran listos para implementar una practica de consultas telematicas a gran escala porque su experiencia es escasa Los beneficios de la telemedicina en urologia son permitir el seguimiento de pacientes, dar recomendaciones, prescribir medicamentos, y realizar un triaje de que pacientes precisan una atencion presencial en urgencias Los programas de formacion de residentes de urologia tambien han sufrido una interrupcion importante de sus actividades cotidianas, ya que se han suspendido consultas, cirugias y actividad academica En esta situacion, el uso de recursos virtuales y el aprendizaje inteligente se estan utilizando para mantener la docencia El objetivo de este articulo es proporcionar una revision de la mas reciente literatura acerca del uso de telemedicina en la practica urologica moderna, con nuestras recomendaciones y conclusiones


title: [Implementation of Remote Clinics in urology practice during the COVID-19 era: What have we learned?]

text: The COVID-19 pandemic has requiredd rastic measures for an attempt in controlling its spread Health resources and facilities are being destined for the treatment of critically ill infected patients During the past weeks, we, as urologists have faced increasingly difficult changes in practice, as out patient activity and elective surgeries must be postponed in order to save resources and limit the mobilization of patients and faculty During this conflictive situation, telehealth medicine can provide adequate support using technological tools and trying to simulate face-to-face consults with the use of video or telephone calls However, many out patient clinics and facilities are not ready yet for telehealth as their experience in this area is low The benefits for telemedicine in urology are continuing urologic outpatient follow-up, providing recommendations and prescriptions, and the triage of patients who will need urgent procedures Urology residency training has suffered an abrupt disruption nowadays as outpatient, surgical and academic meetings are cancelled In this scenario, virtual strategies and "smart learning" activities are being used to continue education We provide a review of the latest published literature regarding the use of telehealth medicine or telemedicine for the modern urology practice, along side our recommendations and conclusions


title: COVID-19-Related Severe Hypercoagulability in Patients Admitted to Intensive Care Unit for Acute Respiratory Failure

text: In late December 2019 an outbreak of a novel coronavirus (SARS-CoV-2) causing severe pneumonia (COVID-19) was reported in Wuhan, Hubei Province, China. A common finding in most COVID-19 patients is high D-dimer levels which are associated with a worse prognosis. We aimed to evaluate coagulation abnormalities via traditional tests and whole blood thromboelastometry profiles in a group of 22 (mean age 67 ± 8 years, M:F 20:2) consecutive patients admitted to the Intensive Care Unit of Padova University Hospital for acute respiratory failure due to COVID-19. Cases showed significantly higher fibrinogen and D-dimer plasma levels versus healthy controls (p < 0.0001 in both comparisons). Interestingly enough, markedly hypercoagulable thromboelastometry profiles were observed in COVID-19 patients, as reflected by shorter Clot Formation Time (CFT) in INTEM (p = 0.0002) and EXTEM (p = 0.01) and higher Maximum Clot Firmness (MCF) in INTEM, EXTEM and FIBTEM (p < 0.001 in all comparisons). In conclusion, COVID-19 patients with acute respiratory failure present a severe hypercoagulability rather than consumptive coagulopathy. Fibrin formation and polymerization may predispose to thrombosis and correlate with a worse outcome.


Rare CT manifestions of an asymptomatic girl with COVID-19


title: Impact of the COVID-19 epidemic on census, organization and activity of a large urban Emergency Department

text: BACKGROUND: The spread of coronavirus disease 2019 (COVID-19) is overwhelming the response of many regional health services across Italy. This article aims to report and discuss the data of the first 8 weeks of COVID-19 epidemic in the emergency department (ED) of the University Hospital of Parma. METHODS: The ED visits were analyzed as follows: total ED visits, divided in COVID-19/ non-COVID-19 cases, and in trauma-related/non-trauma-related cases; outcome (i.e., discharged, admitted, dead in the ED) of patients, altogether or stratified according to triage class; age classes of the entire ED population. RESULTS: Total ED visits decreased starting from the first days of the outbreak, then exhibiting progressive growth afterwards. COVID suspected cases rapidly increased, whereas non-COVID suspected dropped and remained well below the standard. Trauma-related cases declined, both as ED visits and as hospital admissions. The percentage and absolute number of patients admitted to hospital wards progressively increased, rapidly overwhelming the number of cases that could be discharged. The admission rate in the lowest priority classes also displayed a marked increase. The youngest age classes dramatically declined, whilst the oldest progressively increased, remaining considerably over the standard rate of the local ED. CONCLUSIONS: The COVID-19 pandemic has obliged the health care systems to undergo a paradigm shift. Even triage criteria have partially lost their meaning, as shown by the dramatic increase of hospital admissions, even in the lowest priority classes. A deep re-organizational process of the ED was undertaken. Hospitals must be constantly resilient and prepared to these new emergencies in terms of equipment, medical and nurses staff, larger bed capacity in short time, availability of intensive and sub-intensive beds, and flexibility.


Cutaneous manifestations in the current pandemic of coronavirus infection disease (COVID 2019)


title: Domestic violence and COVID-19: Our hidden epidemic

text: In times of disaster, domestic violence rates tend to increase. This is a concern in the context of COVID-19, which is a more prolonged crisis than most of those studied.


Mobilization and Preparation of a Large Urban Academic Center During the COVID-19 Pandemic


title: Prevalence of hospital PCR-confirmed COVID-19 cases in patients with chronic inflammatory and autoimmune rheumatic diseases

text: BACKGROUND: The susceptibility of patients with rheumatic diseases and the risks or benefits of immunosuppressive therapies for COVID-19 are unknown. METHODS: We performed a retrospective study with patients under follow-up in rheumatology departments from seven hospitals in Spain. We matched updated databases of rheumatology patients with severe acute respiratory syndrome coronavirus 2-positive PCR tests performed in the hospital to the same reference populations. Rates of PCR+ confirmed COVID-19 were compared among groups. RESULTS: Patients with chronic inflammatory diseases had 1.32-fold higher prevalence of hospital PCR+ COVID-19 than the reference population (0.76% vs 0.58%). Patients with systemic autoimmune or immune-mediated disease (AI/IMID) showed a significant increase, whereas patients with inflammatory arthritis (IA) or systemic lupus erythematosus did not. COVID-19 cases in some but not all diagnostic groups had older ages than cases in the reference population. Patients with IA on targeted-synthetic or biological disease-modifying antirheumatic drugs (DMARDs), but not those on conventional-synthetic DMARDs, had a greater prevalence despite a similar age distribution. CONCLUSION: Patients with AI/IMID show a variable risk of hospital-diagnosed COVID-19. Interplay of ageing, therapies and disease-specific factors seem to contribute. These data provide a basis to improve preventive recommendations to rheumatic patients and to analyse the specific factors involved in COVID-19 susceptibility.


title: Extrapulmonary manifestations of COVID-19: Radiologic and clinical overview

text: COVID-19 is principally a respiratory illness and pulmonary manifestations constitute main presentations of the disease. According to the reported studies, SARS-CoV-2 infection is not limited to the respiratory system and other organs can be also affected. Renal dysfunction, gastrointestinal complications, liver dysfunction, cardiac manifestations, mediastinal findings, neurological abnormalities, and hematological manifestations are among the reported extrapulmonary features. Considering the broad spectrum of clinical manifestations and the increasing worldwide burden of the disease, there is an urgent need to rapidly scale up the diagnostic capacity to detect COVID-19 and its complications. This paper focuses on the most common extrapulmonary manifestations in patients with COVID-19 pneumonia. Further studies are needed to elaborate and confirm the causative relationship between SARS-CoV-2 and the reported extrapulmonary manifestations of COVID-19.


title: COVID-19 pandemic and Zagreb earthquakes as stressors in patients with temporomandibular disorders

text: OBJECTIVE: To evaluate stress effect of COVID-19 pandemic and Zagreb earthquakes on symptoms of temporomandibular disorders (TMD). MATERIALS AND METHODS: One hundred and two previously diagnosed TMD patients were contacted by email to participate in an online survey about impact of those events on current and/or new symptoms, perceived stress, anxiety and symptom intensity in time-points at the baseline, following pandemic and following earthquake. We compared data between earthquake-affected and non-affected respondents. RESULTS: Response rate was 79.4%. Effects stress had on deterioration of symptoms were significantly different between earthquake-affected and non-affected (p = .024). In earthquake-affected, numerical pain rating scale (NPRS) scores significantly increased between baseline and after COVID-19 (p > .001) and between baseline and after earthquakes (p > .05). However, scores insignificantly dropped from COVID-19 to after earthquakes time-points. In earthquake-affected, positive correlation was found between impact of COVID-19 on stress and NPRS (p < .001) and between earthquakes' impact on stress and NPRS (p < .001). Earthquake-affected respondents reported significantly more new behavioral habits when compared to non-affected (p = .048). CONCLUSIONS: A series of stressful events do not necessarily have a cumulative effect, but are likely to have a complex interaction (e.g., acute stress might trigger the protective mechanisms), which could have decreased pain scores after the earthquakes.


text: Stress refers to situations in which one feels that the demands imposed on them exceed the limitations of their ability to adapt. This causes a series of adverse consequences among which is compromised health (Lazarus and Folkman, 1984). On 11th March 2020, the World Health Organization declared the pandemic status of COVID-19 diseases, leading to the European Union states imposing the lockdown, Croatia being one among them. Infection prevention became the nation's most important goal, and people had to change their day-to-day habits.


title: Pathogenesis of SARS-CoV-2 in Transgenic Mice Expressing Human Angiotensin-Converting Enzyme 2

text: COVID-19 has spread worldwide since 2019 and is now a severe threat to public health. We previously identified the causative agent as a novel SARS-related coronavirus (SARS-CoV-2) that uses human angiotensin-converting enzyme 2 (hACE2) as the entry receptor. Here, we successfully developed a SARS-CoV-2 hACE2 transgenic mouse (HFH4-hACE2 in C3B6 mice) infection model. The infected mice generated typical interstitial pneumonia and pathology that were similar to those of COVID-19 patients. Viral quantification revealed the lungs as the major site of infection, although viral RNA could also be found in the eye, heart, and brain in some mice. Virus identical to SARS-CoV-2 in full-genome sequences was isolated from the infected lung and brain tissues. Last, we showed that pre-exposure to SARS-CoV-2 could protect mice from severe pneumonia. Our results show that the hACE2 mouse would be a valuable tool for testing potential vaccines and therapeutics.


title: Increase in COVID-19 cases and case-fatality and case-recovery rates in Europe: A cross-temporal meta-analysis

text: The new coronavirus (COVID-19) infection reported in China in December 2019 has become a pandemic in a few weeks, affecting the entire world. In this respect, it is crucial to determine the case-increase, case-fatality, and case-recovery rates to control COVID-19. In this study, the case-increase, case-fatality, and case-recovery rates of COVID-19 in 36 European countries were analyzed with the meta-analysis method using data released by the health organizations and WHO. The data were obtained from the website of health organizations of 36 European countries and the website of WHO until 11 May 2020. The analyses were carried out on 1 744 704 COVID-19-diagnosed cases in 36 European countries. The case-increase, case-fatality and case-recovery rates of COVID-19 were calculated using 95% confidence intervals (95% CI), single-arm meta-analysis, cross-temporal meta-analysis, and meta-regression random-effects model. The standardized case-increase rate of COVID-19 is 5% (95% CI [0.040, 0.063]) and the average case-increase rate in European countries has started to decline by around 3% (95% CI [0.047, 0.083]) weekly. The countries with the highest rate of case increase are Belgium, Sweden, Russia, the Netherlands and the United Kingdom. Although the case-fatality rate of COVID-19 patients was 4.5% as of May 11 (95% CI [0.037-0.055]), this rate is 6.3% (95% CI [0.047, 0.083]) in standardized time (6th week). The case-recovery rates of patients are 46% (95% CI [0.376-0.547]). This study presents important results regarding the COVID-19 pandemic in Europe. Although the rate of increase in new COVID-19 cases has dropped, there is not much decline in the case-fatality rates and no increase in case-recovery rates. The case-fatality rate of COVID-19 in Europe was estimated to be in the range of 4% to 4.5% and a minimum of 4 weeks (as of 11 May) is expected to have the figure below 1% in a country with an average case-increase rate. Monitoring case fatalities in Belgium, the Netherlands and Sweden, and treatment successes in Germany and Austria play a role of utmost importance.


title: Morphogenetic and structural characteristics of alexandergrass pastures under continuous stocking/ Características morfogênicas e estruturais de pastos de papuã manejados sob lotação contínua

text: The aim of this study was to evaluate some morphogenetic and structural characteristics to explain variations in forage accumulation of Alexandergrass (Urochloa (Syn. Brachiaria) plantaginea) under continuous stocking method. The experimental treatments consisted of four grazing heights (10, 20, 30, and 40 cm), allocated to experimental units following a randomized block design with three replicates. The following variables were analyzed: leaf appearance, elongation, and senescence rates, leaf lamina length, number of leaves per tiller, leaf area index (LAI), and forage accumulation rate. Data were submitted to analysis of variance and means were compared by Student's t-test (P≤0.05). The main results were: i) different grazing heights had different tissue flows; ii) grazing heights between 30-40 cm showed the highest LAI, and produced similar values; iii) forage accumulation rate increased according to grazing height increments, but did not change above 30 cm. In conclusion, Alexandergrass pastures under continuous stocking should not be maintained at grazing heights lower than 30 cm if the objective is to maximize forage production.(AU)


title: Se préparer pour la pandémie de COVID-19: revue des moyens déployés dans un bloc opératoire d'un grand hôpital tertiaire au Singapour./ Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore

text: The coronavirus disease 2019 (COVID-19) outbreak has been designated a public health emergency of international concern. To prepare for a pandemic, hospitals need a strategy to manage their space, staff, and supplies so that optimum care is provided to patients. In addition, infection prevention measures need to be implemented to reduce in-hospital transmission. In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here, we describe the outbreak response measures of the anesthetic department staffing the largest (1,700-bed) academic tertiary level acute care hospital in Singapore (Singapore General Hospital) and a smaller regional hospital (Sengkang General Hospital). These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow and processes, introduction of personal protective equipment for staff, and formulation of clinical guidelines for anesthetic management. Simulation was valuable in evaluating the feasibility of new operating room set-ups or workflow. We also discuss how the hierarchy of controls can be used as a framework to plan the necessary measures during each phase of a pandemic, and review the evidence for the measures taken. These containment measures are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.


title: Penicillium subrubescens adapts its enzyme production to the composition of plant biomass

text: Penicillium subrubescens is able to degrade a broad range of plant biomass and it has an expanded set of Carbohydrate Active enzyme (CAZyme)-encoding genes in comparison to other Penicillium species. Here we used exoproteome and transcriptome analysis to demonstrate the versatile plant biomass degradation mechanism by P. subrubescens during growth on wheat bran and sugar beet pulp. On wheat bran P. subrubescens degraded xylan main chain and side residues from Day 2 of cultivation, whereas it started to degrade side chains of pectin in sugar beet pulp prior to attacking the main chain on Day 3. In addition, on Day 3 the cellulolytic enzymes were highly increased. Our results confirm that P. subrubescens adapts its enzyme production to the available plant biomass and is a promising new fungal cell factory for the production of CAZymes.


title: Treatment of Proximal Femoral Fragility Fractures in Patients with COVID-19 During the SARS-CoV-2 Outbreak in Northern Italy

text: BACKGROUND: From February 20 to April 2020, the coronavirus SARS (severe acute respiratory syndrome)-CoV-2 spread in northern Italy, drastically challenging the care capacities of the national health care system. Unprepared for this emergency, hospitals have quickly reformulated paths of assistance in an effort to guarantee treatment for infected patients. Orthopaedic departments have been focused on elderly traumatology, especially the treatment of femoral neck fractures in patients with coronavirus disease-2019 (COVID-19). The purpose of the present study was to evaluate the orthopaedic management strategy for femoral fragility fractures in COVID-19-positive patients with the hypothesis that operative treatment may contribute to the overall stability of the patient. METHODS: Sixteen patients affected by proximal femoral fracture and a recent history of fever, shortness of breath, and desaturation were admitted to the emergency room. Thoracic computed tomography (CT) and oropharyngeal swabs confirmed that they were positive for COVID-19, requiring hospitalization and prophylaxis with low-molecular-weight heparin. RESULTS: Three patients died before surgery because of severe respiratory insufficiency and multiple-organ-failure syndrome. Ten patients underwent surgery on the day after admission, whereas 3 patients had suspended their use of direct thrombin inhibitors and needed surgery to be delayed until the third day after admission. In all patients except 1, we noted an improvement in terms of O2 saturation and assisted respiration. In 9 patients, hemodynamic and respiratory stability was observed at an average of 7 days postoperatively. Four patients who underwent surgical treatment died of respiratory failure on the first day after surgery (1 patient), the third day after surgery (2 patients), or the seventh day after surgery (1 patient). CONCLUSIONS: We noted a stabilization of respiratory parameters in 12 COVID-19-positive patients who underwent surgery treatment of proximal femoral fractures. We believe that in elderly patients with COVID-19 who have proximal femoral fractures, surgery may contribute to the overall stability of the patient, seated mobilization, improvement in physiological ventilation, and general patient comfort in bed. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


In Reply: Rongeurs, Neurosurgeons, and COVID-19: How Do We Protect Health Care Personnel During Neurosurgical Operations in the Midst of Aerosol-Generation From High-Speed Drills?


title: Vaccines for COVID-19: The current state of play

text: There is a strong consensus globally that a COVID-19 vaccine is likely the most effective approach to sustainably controlling the COVID-19 pandemic. An unprecedented research effort and global coordination has resulted in a rapid development of vaccine candidates and initiation of trials. Here, we review vaccine types, and progress with 10 vaccine candidates against SARS-CoV-2 - the virus that causes COVID-19 - currently undergoing early phase human trials. We also consider the many challenges of developing and deploying a new vaccine on a global scale, and recommend caution with respect to our expectations of the timeline that may be ahead.


title: SARS-CoV-2 productively infects human gut enterocytes

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause coronavirus disease 2019 (COVID-19), an influenza-like disease that is primarily thought to infect the lungs with transmission through the respiratory route. However, clinical evidence suggests that the intestine may present another viral target organ. Indeed, the SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) is highly expressed on differentiated enterocytes. In human small intestinal organoids (hSIOs), enterocytes were readily infected by SARS-CoV and SARS-CoV-2, as demonstrated by confocal and electron microscopy. Enterocytes produced infectious viral particles, whereas messenger RNA expression analysis of hSIOs revealed induction of a generic viral response program. Therefore, the intestinal epithelium supports SARS-CoV-2 replication, and hSIOs serve as an experimental model for coronavirus infection and biology.


title: Incidental COVID-19 in a Heart-Kidney Transplant Recipient with Malnutrition and Recurrent Infections: Implications for the SARS-CoV-2 Immune Response

text: The clinical course and outcomes of immunocompromised patients, such as transplant recipients, with COVID-19 remains unclear. It has been postulated that a substantial portion of the disease burden seems to be mediated by the host immune activation to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we present a simultaneous heart-kidney transplant (SHKT) recipient who was hospitalized for the management of respiratory failure from volume overload complicated by failure to thrive, multiple opportunistic infections, and open non-healing wounds in the setting of worsening renal dysfunction weeks prior to the first case of SARS-CoV-2 being detected in the state of Connecticut. After his third endotracheal intubation, routine nucleic acid testing (NAT) for SARS-CoV-2, in anticipation of a planned tracheostomy, was positive. His hemodynamics, respiratory status and ventilator requirements remained stable without any worsening for 4 weeks until he had a negative NAT test. It is possible that the immunocompromised status of our patient may have prevented significant immune activation leading up to clinically-significant cytokine storm that could have resulted in acute respiratory distress syndrome and multisystem organ failure.


title: Incidental COVID-19 in a heart-kidney transplant recipient with malnutrition and recurrent infections: Implications for the SARS-CoV-2 immune response

text: The clinical course and outcomes of immunocompromised patients, such as transplant recipients, with COVID-19 remain unclear. It has been postulated that a substantial portion of the disease burden seems to be mediated by the host immune activation to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we present a simultaneous heart-kidney transplant (SHKT) recipient who was hospitalized for the management of respiratory failure from volume overload complicated by failure to thrive, multiple opportunistic infections, and open non-healing wounds in the setting of worsening renal dysfunction weeks prior to the first case of SARS-CoV-2 being detected in the state of Connecticut. After his third endotracheal intubation, routine nucleic acid testing (NAT) for SARS-CoV-2, in anticipation of a planned tracheostomy, was positive. His hemodynamics, respiratory status, and ventilator requirements remained stable without any worsening for 4 weeks until he had a negative NAT test. It is possible that the immunocompromised status of our patient may have prevented significant immune activation leading up to clinically significant cytokine storm that could have resulted in acute respiratory distress syndrome and multisystem organ failure.


title: The comparative politics of COVID-19: The need to understand government responses

text: COVID-19 has created a ramifying public health, economic, and political crisis throughout many countries in the world. While globally the pandemic is at different stages and far from under control in some countries, now is the time for public health researchers and political scientists to start understanding how and why governments responded the way they have, explore how effective these responses appear to be, and what lessons we can draw about effective public health policymaking in preparation of the next wave of COVID-19 or the next infectious disease pandemic. We argue that there will be no way to understand the different responses to COVID-19 and their effects without understanding policy and politics. We propose four key focuses to understand the reasons for COVID-19 responses: social policies to crisis management as well as recovery, regime type (democracy or autocracy), formal political institutions (federalism, presidentialism), and state capacity (control over health care systems and public administration). A research agenda to address the COVID-19 pandemic that takes politics as a serious focus can enable the development of more realistic, sustainable interventions in policies and shape our broader understanding of the politics of public health.


title: Peer mentoring for professional and personal growth in academic medicine

text: Mentorship is a critical component of career development, particularly in academic medicine. Peer mentorship, which does not adhere to traditional hierarchies, is perhaps more accessible for underrepresented groups, including women and minorities. In this article, we review various models of peer mentorship, highlighting their respective advantages and disadvantages. Structured peer mentorship groups exist in different settings, such as those created under the auspices of formal career development programs, part of training grant programs, or through professional societies. Social media has further enabled the establishment of informal peer mentorship through participatory online groups, blogs, and forums that provide platforms for peer-to-peer advice and support. Such groups can evolve rapidly to address changing conditions, as demonstrated by physician listserv and Facebook groups related to the COVID-19 pandemic. Peer mentorship can also be found among colleagues brought together through a common location, interest, or goal, and typically these relationships are informal and fluid. Finally, we highlight here our experience with intentional formation of a small peer mentoring group that provides structure and a safe space for professional and social-emotional growth and support. In order to maximize impact and functionality, this model of peer mentorship requires commitment among peers and a more formalized process than many other peer mentoring models, accounting for group dynamics and the unique needs of members. When done successfully, the depth of these mentoring relationships can produce myriad benefits for individuals with careers in academic medicine including, but not limited to, those from underrepresented backgrounds.


title: Provision of Emergency Maxillofacial Service During the COVID-19 Pandemic : A Collaborative Five Centre UK Study

text: The global pandemic of Coronavirus disease (COVID-19) represents one of the greatest challenges to healthcare systems, and has forced medical specialties to rapidly adapt their approaches to patient care. Oral and Maxillofacial Surgery is considered particularly at risk of disease transmission due to aerosol generation during surgical interventions, patient proximity and operating environment. On day 2 (26th March, 2020) of when severe restrictions in population movement were instigated in the United Kingdom, we began a study to prospectively monitor the presentation and management of maxillofacial emergencies at five hospital trusts. Data was collected onto an online live database fed through a smartphone application. Of the total 529 patients over six weeks, 395 attended for face-to-face consultations and 134 patients received remote consultations via telephone or video link. There were 255 trauma related cases, 221 infection and 48 cases of postoperative complications. Most trauma cases were minor soft tissue injury related to slip, trip or fall at home. There were 44 cases of facial fractures with a tendency for conservative treatment. 19 cases were related to domestic violence or self-harm. Of the 216 dental related emergencies, 68% could have been managed in the primary care setting. A quarter of all emergency patients were satisfactorily managed by remote consultations. There was a significant change in the provision of emergency maxillofacial service during the pandemic lockdown. We discuss the study findings as well as the potential implications in relation to planning for possible further COVID- 19 spikes and future pandemics.


Which cancer type has the highest risk of COVID-19 infection?


title: [Mental health status and its influencing factors among college students during the epidemic of COVID-19]

text: OBJECTIVE: To investigate the mental health status of college students during the epidemic of COVID-19 and identify the factors influencing the mental health of the students. METHODS: Using a general questionnaire, a self-designed new coronavirus pneumonia knowledge and cognitive behavior questionnaire, the Generalized Anxiety Disorder 7 (GAD-7) and Patient Health Questionnaire 9 (PHQ-9), we conducted an internet-based questionnaire survey of 3881 college students in Guangdong Province. A multinomial-logistic regression model was used to analyze the collected data. RESULTS: The survey showed that 69.47% of the college students had a high level of awareness of COVID-19; the overall incidence of anxiety was 26.60%, and the incidences of mild, moderate and severe anxiety were 23.19%, 2.71%, and 0.70%, respectively. Depressive emotions were detected in 21.16% of the students, and the incidences of mild, moderate, and moderate-to-severe depression were 16.98%, 3.17%, and 1.01%, respectively. The results of multivariate analysis showed that an older age was associated with a higher level of awareness of COVID-19 and greater changes in future health behaviors were associated with less anxiety and depression among the students. The students currently in rural areas, of non-medical majors, and reporting half of their information concerning the epidemic being negative were more likely to have anxiety; female gender, residence in suburbs, a drinking history, and excessive negative information concerning the epidemic were all associated with the likeliness of depression. CONCLUSIONS: The college students have different levels of anxiety and depression during the epidemic. Depression and anxiety are closely related, but the factors contributing to different levels of such emotions can be different, and colleges and related departments are urged to provide precision mental health education for college students.


[Brug af hydroxychloroquin til COVID-19]


title: Pharmacotherapy for reducing saliva and droplet production in airborne procedures may help to decrease the COVID-19 transmission: A hypothesis

text: The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected health care service practices worldwide. Therefore, a global reaction to prepare health care systems is mandatory. Preventing the transmission of this virus during medical and dental procedures producing airborne particles and droplets, could be considered as one of the main venues in prevention of Coronavirus disease 2019 (COVID-19) transmission in health care facilities. To the best of our knowledge, no intervention has been approved for this purpose, so the major suggestion in this regard is using personal preventive equipment (PPE) and similar measures as well as other sanitizing practices. Since we do not know how long we should face this universal issue, using antecedent pharmacotherapies for reducing oral-respiratory secretions to combat this virus might play a role in this regard. Given that currently there is no definitive cure for COVID-19, so we hypothesize that, considering drug solutions to reduce saliva and droplet production may be helpful in controlling Coronavirus spread during aerosol and respiratory droplet producing procedures.


title: Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services

text: BACKGROUND: The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and effects on other services, including delivery of surgery. METHODS: This was a scoping review of all available literature pertaining to COVID-19 and surgery, using electronic databases, society websites, webinars and preprint repositories. RESULTS: Several perioperative guidelines have been issued within a short time. Many suggestions are contradictory and based on anecdotal data at best. As regions with the highest volume of operations per capita are being hit, an unprecedented number of operations are being cancelled or deferred. No major stakeholder seems to have considered how a pandemic deprives patients with a surgical condition of resources, with patients disproportionally affected owing to the nature of treatment (use of anaesthesia, operating rooms, protective equipment, physical invasion and need for perioperative care). No recommendations exist regarding how to reopen surgical delivery. The postpandemic evaluation and future planning should involve surgical services as an essential part to maintain appropriate surgical care for the population during an outbreak. Surgical delivery, owing to its cross-cutting nature and synergistic effects on health systems at large, needs to be built into the WHO agenda for national health planning. CONCLUSION: Patients are being deprived of surgical access, with uncertain loss of function and risk of adverse prognosis as a collateral effect of the pandemic. Surgical services need a contingency plan for maintaining surgical care in an ongoing or postpandemic phase.


Scrolling for data or doom during COVID-19?


title: Impact of COVID-19 pandemic restrictions on community-dwelling caregivers and persons with dementia

text: Restrictions related to the 2019 novel coronavirus (COVID-19) pose unique and significant challenges for community-dwelling caregivers and people with dementia, including disrupted routines, a lack of structure, decreased access to respite care, and new or worsening safety issues related to interpersonal violence and hygiene. In addition to identifying issues confronting caregivers, the authors also describe possible ways to address some of these pressing concerns. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Társasági hírek


title: The renin-angiotensin-aldosterone system as a link between obesity and coronavirus disease 2019 severity

text: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory distress coronavirus 2 (SARS-CoV2), is a rapidly evolving pandemic challenging the world and posing unprecedented public health issues. Current data show that COVID-19 is associated with increased disease severity in individuals with obesity. Obesity is usually associated with dysregulated renin-angiotensin-aldosterone (RAAS) axis. RAAS has also been implicated in acute lung injury as well as myocardial injury and has thus attracted interest as a potential regulator of COVID-19 severity. Whilst research all over the world is still struggling to provide a detailed characterization of the biology of SARS-CoV2 and its associated disease profile, it has become evident that SARS-CoV2 uses the membrane-bound form of angiotensin-converting enzyme 2 (ACE2) as a receptor for cell internalization. ACE2 is a protective component of the RAAS axis and is downregulated after SARS-CoV2 infection. The RAAS axis could thus be a link between obesity and COVID-19 severity; therefore, more accurate understanding of the underlying mechanisms would be needed with the hope of proposing efficient therapeutic interventions.


Re: Ming-Chun Chan, Sharon E.K. Yeo, Yew-Lam Chong, Yee-Mun Lee. Stepping Forward: Urologists' Efforts During the COVID-19 Outbreak in Singapore. Eur Urol 2020;78:e38-9


Re: Ming-Chun Chan, Sharon E.K. Yeo, Yew-Lam Chong, Yee-Mun Lee. Stepping Forward: Urologists' Efforts During the COVID-19 Outbreak in Singapore. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2020.03.004


title: RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists

text: PURPOSE: To assess the interobserver variability between chest radiologists in the interpretation of the Radiological Society of North America (RSNA) expert consensus statement reporting guidelines in patients with suspected coronavirus disease 2019 (COVID-19) pneumonia in a setting with limited reverse transcription polymerase chain reaction testing availability. METHODS: Chest computed tomography (CT) studies in 303 consecutive patients with suspected COVID-19 were reviewed by 3 fellowship-trained chest radiologists. Cases were assigned an impression of typical, indeterminate, atypical, or negative for COVID-19 pneumonia according to the RSNA expert consensus statement reporting guidelines, and interobserver analysis was performed. Objective CT features associated with COVID-19 pneumonia and distribution of findings were recorded. RESULTS: The Fleiss kappa for all observers was almost perfect for typical (0.815), atypical (0.806), and negative (0.962) COVID-19 appearances (P < .0001) and substantial (0.636) for indeterminate COVID-19 appearance (P < .0001). Using Cramer V analysis, there were very strong correlations between all radiologists' interpretations, statistically significant for all (typical, indeterminate, atypical, and negative) COVID-19 appearances (P < .001). Objective CT imaging findings were recorded in similar percentages of typical cases by all observers. CONCLUSION: The RSNA expert consensus statement on reporting chest CT findings related to COVID-19 demonstrates substantial to almost perfect interobserver agreement among chest radiologists in a relatively large cohort of patients with clinically suspected COVID-19. It therefore serves as a reliable reference framework for radiologists to accurately communicate their level of suspicion based on the presence of evidence-based objective findings.


Loneliness and Isolation in Long-term Care and the COVID-19 Pandemic


Telehealth Reimbursement Allows Access to Mental Health Care During COVID-19


title: Efficacy of chloroquine and hydroxychloroquine in the treatment of COVID-19

text: OBJECTIVE: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also called COVID-19, has caused a pandemic which has swiftly involved the entire world and raised great public health concerns. The scientific community is actively exploring treatments that would potentially be effective in combating COVID-19. Hydroxychloroquine has been demonstrated to limit the replication of SARS-CoV-2 virus in vitro. In malarial pandemic countries, chloroquine is widely used to treat malaria. In malarial non-pandemic nations, chloroquine is not widely used. Chloroquine and hydroxychloroquine share similar chemical structures and mechanisms of action. The aim of this study was to indirectly investigate the efficacy of chloroquine and hydroxychloroquine for the treatment of COVID-19 by determining the prevalence of COVID-19 in malaria pandemic and non-pandemic nations. We sought evidence to support or refute the hypothesis that these drugs could show efficacy in the treatment of COVID-19. MATERIALS AND METHODS: We reviewed in vitro studies, in vivo studies, original studies, clinical trials, and consensus reports, that were conducted to evaluate the antiviral activities of chloroquine and hydroxychloroquine. The studies on "COVID-19 and its allied treatment were found from World Health Organization (WHO), ISI-Web of Science, PubMed, EMBASE, Scopus, Google Scholar, and clinical trial registries. The search was based on keywords: antiviral drugs, chloroquine, hydroxychloroquine, COVID-19, COVID-19 treatment modalities, and coronavirus. In addition, we analyzed the prevalence of COVID-19 in malaria pandemic and non-pandemic countries. The review and analyses were performed on March 28, 2020. RESULTS: For this study, we identified a total of 09 published articles: 03 clinical trials with sample size 150; 03 in vitro studies and 03 expert consensus reports. These studies were all suggestive that chloroquine and hydroxychloroquine can successfully treat COVID-19 infections. We found that COVID-19 infections are highly pandemic in countries where malaria is least pandemic and are least pandemic in nations where malaria is highly pandemic. CONCLUSIONS: Chloroquine and hydroxychloroquine have antiviral characteristics in vitro. The findings support the hypothesis that these drugs have efficacy in the treatment of COVID-19. People are currently using these drugs for malaria. It is reasonable, given the hypothetical benefit of these two drugs, that they are now being tested in clinical trials to assess their effectiveness to combat this global health crisis.


title: Evaluation of the QIAstat-Dx Respiratory SARS-CoV-2 Panel, the first rapid multiplex PCR commercial assay for SARS-CoV-2 detection

text: In the race to contain SARS-CoV-2, efficient detection and triage of infected patients must rely on rapid and reliable testing. In this work we performed the first evaluation of the QIAstat-Dx Respiratory SARS-CoV-2 Panel (QIAstat-SARS) for SARS-CoV-2 detection. This assay is the first rapid multiplex PCR (mPCR) assay including SARS-CoV-2 detection, and is fully compatible with a non-PCR trained laboratory or point-of-care (POC) testing.This evaluation was performed using 69 primary clinical samples (66 NPS, 1 BAL and 1 tracheal aspirate and 1 bronchial aspirate) comparing the SARS-CoV-2 detection with the currently WHO recommended RT-PCR (WHO-PCR) workflow. Additionally, a comparative limit of detection (LoD) assessment was performed between QIAstat-SARS and the WHO-PCR using a quantified clinical sample. Compatibility of sample pre-treatment for viral neutralisation or viscous samples with the QIAstat-SARS system were also tested.The QIAstat-Dx Respiratory SARS-CoV-2 Panel demonstrated a comparable sensitivity to the WHO recommended assay with a limit of detection at 1000 copies/mL. The overall percent agreement between QIAstat-Dx SARS and WHO-PCR on 69 clinical samples was 97% with a sensitivity at 100% (40/40) and specificity at 93% (27/29). No cross reaction was encountered for any other respiratory viruses or bacteria included in the panel.The QIAstat-SARS rapid multiplex-PCR panel provides a highly sensitive, robust and accurate assay for rapid detection of SARS-CoV-2. This assay allows rapid decisions even in non-PCR trained laboratory or point-of-care testing, allowing innovative organisation.


title: Redox-Modulating Agents in the Treatment of Viral Infections

text: Viruses use cell machinery to replicate their genome and produce viral proteins. For this reason, several intracellular factors, including the redox state, might directly or indirectly affect the progression and outcome of viral infection. In physiological conditions, the redox balance between oxidant and antioxidant species is maintained by enzymatic and non-enzymatic systems, and it finely regulates several cell functions. Different viruses break this equilibrium and induce an oxidative stress that in turn facilitates specific steps of the virus lifecycle and activates an inflammatory response. In this context, many studies highlighted the importance of redox-sensitive pathways as novel cell-based targets for therapies aimed at blocking both viral replication and virus-induced inflammation. In the review, we discuss the most recent findings in this field. In particular, we describe the effects of natural or synthetic redox-modulating molecules in inhibiting DNA or RNA virus replication as well as inflammatory pathways. The importance of the antioxidant transcription factor Nrf2 is also discussed. Most of the data reported here are on influenza virus infection. We believe that this approach could be usefully applied to fight other acute respiratory viral infections characterized by a strong inflammatory response, like COVID-19.


title: Contributory Role of Positron Emission Tomography in a Left Ventricular Assist Device Recipient at the Time of COVID-19 Pandemic

text: In this study, We report on the use of fluorine 18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) scan examinations for detecting potential COVID-19 respiratory syndrome in asymptomatic left ventricular assist device (LVAD) recipients. Thus, extreme caution and thoughtful approaches should be taken for a timely detection in delicate LVAD populations, especially if patients are living in a high-density COVID-19-infected area, and the potential intention for LVAD treatment is bridge to transplantation.


title: Effect of shelter-in-place on emergency department radiology volumes during the COVID-19 pandemic

text: PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has led to significant disruptions in the healthcare system including surges of infected patients exceeding local capacity, closures of primary care offices, and delays of non-emergent medical care. Government-initiated measures to decrease healthcare utilization (i.e., "flattening the curve") have included shelter-in-place mandates and social distancing, which have taken effect across most of the USA. We evaluate the immediate impact of the Public Health Messaging and shelter-in-place mandates on Emergency Department (ED) demand for radiology services. METHODS: We analyzed ED radiology volumes from the five University of California health systems during a 2-week time period following the shelter-in-place mandate and compared those volumes with March 2019 and early April 2019 volumes. RESULTS: ED radiology volumes declined from the 2019 baseline by 32 to 40% (p < 0.001) across the five health systems with a total decrease in volumes across all 5 systems by 35% (p < 0.001). Stratifying by subspecialty, the smallest declines were seen in non-trauma thoracic imaging, which decreased 18% (p value < 0.001), while all other non-trauma studies decreased by 48% (p < 0.001). CONCLUSION: Total ED radiology demand may be a marker for public adherence to shelter-in-place mandates, though ED chest radiology demand may increase with an increase in COVID-19 cases.


title: Effect of Mitigation Measures on the Spreading of COVID-19 in Hard-Hit States

text: State government-mandated social distancing measures have helped to slow down the growth of the COVID-19 pandemic in the United States. Current predictive models of the development of COVID-19, especially after mitigation efforts, are largely based on extrapolating the data from other countries. Since most states enforced stay-at-home orders towards the end of March, their effect should be reflected in the death and infection counts at the end of April. Using the data available until April 25th, we investigate the change in the infection rate due to the mitigation efforts, and project death and infection counts until September, 2020, for some of the most heavily impacted states: New York, New Jersey, Michigan, Massachusetts, Illinois and Louisiana. We find that with the current mitigation efforts five of those six states reduce their reproduction number to a value less than one, stopping the exponential growth of the pandemic. We also projected different scenarios after the mitigation is relaxed. Analysis for other states can be found at https://covid19projection.org/.


title: Resumption of laser/IPL skin services post COVID-19 lockdown-British Medical Laser Association (BMLA) guidance document

text: The COVID-19 pandemic has had a significant negative impact on the global health economies. As health care resources have been prioritised to cater for patients affected by COVID-19, routine health care services have remained suspended. In an effort to slow the spread of SARS-CoV-2 virus, the UK introduced a country-wide lockdown which came into effect on the 23rd March 2020. Since then, clinics offering laser and intense pulsed light services have remained closed for business. As the rate of COVID-19 infection slows, the UK government has issued guidance for lifting of the lockdown in a cautious and phased manner. With this in view and to facilitate safe resumption of laser and intense pulsed light services, the British Medical Laser Services has issued this guidance document, based on best available and current scientific evidence.


docid: rwfdfeii

title: Performance Characteristics of Four High-Throughput Immunoassays for Detection of IgG Antibodies against SARS-CoV-2

text: The role of serologic testing for SARS-CoV-2, both in the clinical and public health settings, will continue to evolve as we gain increasing insight into our immune response to the virus. Here, we evaluated four high throughput serologic tests for detection of anti-SARS-CoV-2 IgG antibodies, including assays from Abbott Laboratories (Abbott Park, IL), Epitope Diagnostics Inc. (San Diego, CA), Euroimmun (Lubeck, Germany), and Ortho-Clinical Diagnostics (Rochester, NY), using a panel of serially collected serum samples (N=224) from 56 patients with confirmed COVID-19, healthy donor sera from 2018 and a cross-reactivity serum panel collected in early 2020. Sensitivity of the Abbott, Epitope, Euroimmun and Ortho-Clinical IgG assays in convalescent serum samples collected more than 14 days post symptom onset or initial positive RT-PCR result was 92.9% (78/84), 88.1% (74/84), 97.6% (82/84) and 98.8% (83/84), respectively. Among unique convalescent patients, sensitivity of the Abbott, Epitope, Euroimmun and Ortho-Clinical anti-SARS-CoV-2 IgG assays was 97.3% (36/37), 73% (27/37), 94.6% (35/37) and 97.3% (36/37), respectively. Overall assay specificity and positive predictive values based on a 5% prevalence rate are 99.6%/92.8%, 99.6%/90.6%, 98.0%/71.2% and 99.6%/92.5%, respectively, for the Abbott, Epitope, Euroimmun and Ortho-Clinical IgG assays. In conclusion, we show high sensitivity in convalescent sera and high specificity for the Abbott, Euroimmun and Ortho-Clinical anti-SARS-CoV-2 IgG assays. With the unprecedented influx of commercially available serologic tests for detection of antibodies against SARS-CoV-2, it remains imperative that laboratories thoroughly evaluate such assays for accuracy prior to implementation.


title: A direct construction of the Standard Brownian Motion

text: In this note, we combine the two approaches of Billingsley (1998) and Cs\H{o}rg\H{o} and R\'ev\'esz (1980), to provide a detailed sequential and descriptive for creating s standard Brownian motion, from a Brownian motion whose time space is the class of non-negative dyadic numbers. By adding the proof of Etemadi's inequality to text, it becomes self-readable and serves as an independent source for researches and professors.


title: Combating the COVID-19 Epidemic: Experiences from Vietnam

text: The COVID-19 pandemic is spreading fast globally. Vietnam's strict containment measures have significantly reduced the spread of the epidemic in the country. This was achieved through the use of emergency control measures in the epidemic areas and integration of resources from multiple sectors including health, mass media, transportation, education, public affairs, and defense. This paper reviews and shares specific measures for successful prevention and control of COVID-19 in Vietnam, which could provide useful learning for other countries.


title: Strong policies control the spread of COVID-19 in China

text: OBJECTIVE: The coronavirus disease 2019 (COVID-19) outbroke in Wuhan, Hubei Province, China, affecting more than 200 countries and regions. This study aimed to predict the development of the epidemic with specific interventional policies applied in China and evaluate their effectiveness. METHODS: COVID-19 data of Hubei Province and the next five most affected provinces were collected from daily case reports of COVID-19 on the Health Committee official website of these provinces. The number of current cases, defined as the number of confirmed cases minus the number of cured cases and those who have died, was examined in this study. A modified Susceptible-Exposed-Infectious- Removed (SEIR) model was used to assess the effects of interventional policies on the epidemic. In this study, January 28 was day zero of the model. RESULTS: The results of the modified SEIR model showed that the number of current cases in Hubei and Zhejiang provinces tended to be stabilized after 70 days and after 60 days in the four other provinces. The predicted number of current cases without policy intervention was shown to far exceed that with policy intervention. The estimated number of COVID-19 cases in Hubei Province with policy intervention was predicted to peak at 51,222, whereas that without policy intervention was predicted to reach 157,721. CONCLUSION: Based on the results of the model, strong interventional policies were found to be vital components of epidemic control. Applying such policies is likely to shorten the duration of the epidemic and reduce the number of new cases. This article is protected by copyright. All rights reserved.


title: CD-sACE2 inclusion compounds: An effective treatment for coronavirus disease 2019 (COVID-19)

text: Coronaviruses are common human viruses and include the severe acute respiratory syndrome coronavirus (SARS-CoV), the middle east respiratory syndrome coronavirus and the SARS-CoV-2. Coronaviruses mainly bind to transmembrane receptor proteins on the human cell membrane through spike proteins (S-proteins), thus releasing the RNA of the virus into the interior of the host cell to cause an infection. In this article, we discuss the mechanism and production of cyclodextrin-soluble angiotensin-converting enzyme 2 (CD-sACE2) inclusion compounds in the treatment of SARS-CoV-2 infections by blocking S-proteins. On the basis of the current research evidence, we believe that CD-sACE2 inclusion compounds have the potential to treat COVID-19. We hope that our article can provide a theoretical basis for later experiments.


title: A two-patch epidemic model with nonlinear reinfection

text: The propagation of infectious diseases and its impact on individuals play a major role in disease dynamics, and it is important to incorporate population heterogeneity into efforts to study diseases. As a simplistic but illustrative example, we examine interactions between urban and rural populations in the dynamics of disease spreading. Using a compartmental framework of susceptible--infected--susceptible ($\mathrm{SI\widetilde{S}}$) dynamics with some level of immunity, we formulate a model that allows nonlinear reinfection. We investigate the effects of population movement in the simplest scenario: a case with two patches, which allows us to model movement between urban and rural areas. To study the dynamics of the system, we compute a basic reproduction number for each population (urban and rural). We also compute steady states, determine the local stability of the disease-free steady state, and identify conditions for the existence of endemic steady states. From our analysis and computational experiments, we illustrate that population movement plays an important role in disease dynamics. In some cases, it can be rather beneficial, as it can enlarge the region of stability of a disease-free steady state.


docid: ycoeagkq

title: Unique skin manifestations of COVID-19: Is drug eruption specific to COVID-19?

text: â¢COVID-19 is associated with specific skin manifestations and drug eruption.â¢This case shows COVID-19-related drug eruption and specific clinical features.â¢Drug eruption preceding COVID-19 symptoms may facilitate early diagnosis.


docid: gtjuktjp

title: Focusing on Vulnerable Populations During COVID-19


title: Mild COVID-19 infection despite chronic B cell depletion in a patient with aquaporin-4-positive neuromyelitis optica spectrum disorder

text: Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus SARS-CoV-2, which affects the lung and other organs. After an incubation period of 3-14 days, the infection presents with symptoms of variable severity, from mild flu-like disease to severe pneumonia and cytokine storm with increased mortality. Immunosuppressed patients may have higher risk of adverse outcomes; hence, there is an urgent need to evaluate the immune response and clinical outcomes of SARS-CoV-2 infection in these patients. Here, we report a 59-year-old woman with aquaporin-4-positive (AQPR4+) neuromyelitis Optica treated with rituximab who developed mild respiratory symptoms with COVID-19, despite B cell depletion at the time of infection.


title: High-throughput interrogation of programmed ribosomal frameshifting in human cells

text: Programmed ribosomal frameshifting (PRF) is the controlled slippage of the translating ribosome to an alternative frame. This process is widely employed by human viruses such as HIV and SARS coronavirus and is critical for their replication. Here, we developed a high-throughput approach to assess the frameshifting potential of a sequence. We designed and tested >12,000 sequences based on 15 viral and human PRF events, allowing us to systematically dissect the rules governing ribosomal frameshifting and discover novel regulatory inputs based on amino acid properties and tRNA availability. We assessed the natural variation in HIV gag-pol frameshifting rates by testing >500 clinical isolates and identified subtype-specific differences and associations between viral load in patients and the optimality of PRF rates. We devised computational models that accurately predict frameshifting potential and frameshifting rates, including subtle differences between HIV isolates. This approach can contribute to the development of antiviral agents targeting PRF.


title: Adult ICU Triage During the Coronavirus Disease 2019 Pandemic: Who Will Live and Who Will Die? Recommendations to Improve Survival

text: OBJECTIVES: Coronavirus disease 2019 patients are currently overwhelming the world's healthcare systems. This article provides practical guidance to front-line physicians forced to make critical rationing decisions. DATA SOURCES: PubMed and Medline search for scientific literature, reviews, and guidance documents related to epidemic ICU triage including from professional bodies. STUDY SELECTION: Clinical studies, reviews, and guidelines were selected and reviewed by all authors and discussed by internet conference and email. DATA EXTRACTION: References and data were based on relevance and author consensus. DATA SYNTHESIS: We review key challenges of resource-driven triage and data from affected ICUs. We recommend that once available resources are maximally extended, triage is justified utilizing a strategy that provides the greatest good for the greatest number of patients. A triage algorithm based on clinical estimations of the incremental survival benefit (saving the most life-years) provided by ICU care is proposed. "First come, first served" is used to choose between individuals with equal priorities and benefits. The algorithm provides practical guidance, is easy to follow, rapidly implementable and flexible. It has four prioritization categories: performance score, ASA score, number of organ failures, and predicted survival. Individual units can readily adapt the algorithm to meet local requirements for the evolving pandemic. Although the algorithm improves consistency and provides practical and psychologic support to those performing triage, the final decision remains a clinical one. Depending on country and operational circumstances, triage decisions may be made by a triage team or individual doctors. However, an experienced critical care specialist physician should be ultimately responsible for the triage decision. Cautious discharge criteria are proposed acknowledging the difficulties to facilitate the admission of queuing patients. CONCLUSIONS: Individual institutions may use this guidance to develop prospective protocols that assist the implementation of triage decisions to ensure fairness, enhance consistency, and decrease provider moral distress.


title: The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis

text: OBJECTIVE: To determine the pooled global prevalence of olfactory and gustatory dysfunction in patients with the 2019 novel coronavirus (COVID-19). DATA SOURCES: Literature searches of PubMed, Embase, and Scopus were conducted on April 19, 2020, to include articles written in English that reported the prevalence of olfactory or gustatory dysfunction in COVID-19 patients. REVIEW METHODS: Search strategies developed for each database contained keywords such as anosmia, dysgeusia, and COVID-19. Resulting articles were imported into a systematic review software and underwent screening. Data from articles that met inclusion criteria were extracted and analyzed. Meta-analysis using pooled prevalence estimates in a random-effects model were calculated. RESULTS: Ten studies were analyzed for olfactory dysfunction (n = 1627), demonstrating 52.73% (95% CI, 29.64%-75.23%) prevalence among patients with COVID-19. Nine studies were analyzed for gustatory dysfunction (n = 1390), demonstrating 43.93% (95% CI, 20.46%-68.95%) prevalence. Subgroup analyses were conducted for studies evaluating olfactory dysfunction using nonvalidated and validated instruments and demonstrated 36.64% (95% CI, 18.31%-57.24%) and 86.60% (95% CI, 72.95%-95.95%) prevalence, respectively. CONCLUSIONS: Olfactory and gustatory dysfunction are common symptoms in patients with COVID-19 and may represent early symptoms in the clinical course of infection. Increased awareness of this fact may encourage earlier diagnosis and treatment, as well as heighten vigilance for viral transmission. To our knowledge, this is the first meta-analysis to report on the prevalence of these symptoms in COVID-19 patients.


title: Hospital care in Departments defined as COVID-free: A proposal for a safe hospitalization protecting healthcare professionals and patients not affected by COVID-19

text: The COVID-19 pandemic influenced the normal course of clinical practice leading to significant delays in the delivery of healthcare services for patients non affected by COVID-19. In the near future, it will be crucial to identify facilities capable of providing health care in compliance with the safety of healthcare professionals, administrative staff and patients. All the staff involved in the project of a Covid-free hospital should be subjected to a diagnostic swab for COVID-19 before the beginning of healthcare activity and then periodically in order to avoid the risk of contamination of patients during the process of care. The modifications of various activities involved in the process of care are described: outpatient care, reception of inpatients, inpatient ward and operating room. For outpatient care, modality of appointment procedure, characteristics of waiting room and personal protective equipment (PPE) for healthcare professionals and administrative staff are presented. Reception of inpatients shall be conditional on a negative swab for COVID-19 obtained with a drive-in procedure. The management of the operating room represents the most crucial step of the patient's care process. The surgical team should be restricted and monitored with periodic swabs; surgical procedures should be performed by experienced surgeons according to standard procedures; surgical training experimental treatments and research protocols should be suspended. Adequate personal protective equipment and measures to reduce aerosolization in the operating room (closed circuits, continuous cycle insufflators, fume extraction) should be adopted. Prevention of possible transmission of the virus during procedures in open, laparoscopic and endoscopic surgery is to use a multi-tactic approach, which includes correct filtration and ventilation of the operating room, the use of appropriate PPE (FFP3 plus surgical mask and protective visor for all the staff working in the operating room) and smoke evacuation devices with a suction and filter system. on behalf of the UrOP Executive Committee Giuseppe Ludovico, Angelo Cafarelli, Ottavio De Cobelli, Ferdinando De Marco, Giovanni Ferrari, Stefano Pecoraro, Angelo Porreca, Domenico Tuzzolo.


Microsurgical reconstruction in the time of COVID-19


Wakley Prize Essay 2020: medicine and plain truths in a pandemic year


docid: bbwkopkg

title: Nursing resilience interventions-A way forward in challenging healthcare territories