title: Search efficiency of fractional Brownian motion in a random distribution of targets

text: Efficiency of search for randomly distributed targets is a prominent problem in many branches of the sciences. For the stochastic process of L\'evy walks, a specific range of optimal efficiencies was suggested under variation of search intrinsic and extrinsic environmental parameters. In this article, we study fractional Brownian motion as a search process, which under parameter variation generates all three basic types of diffusion, from sub- to normal to superdiffusion. In contrast to L\'evy walks, fractional Brownian motion defines a Gaussian stochastic process with power law memory yielding anti-persistent, respectively persistent motion. Computer simulations of this search process in a uniformly random distribution of targets show that maximising search efficiencies sensitively depends on the definition of efficiency, the variation of both intrinsic and extrinsic parameters, the perception of targets, the type of targets, whether to detect only one or many of them, and the choice of boundary conditions. We find that different search scenarios favour different modes of motion for optimising search success, defying a universality across all search situations. Some of our results are explained by a simple analytical model. Having demonstrated that search by fractional Brownian motion is a truly complex process, we propose an over-arching conceptual framework based on classifying different search scenarios. This approach incorporates search optimisation by L\'evy walks as a special case.


title: Sex-related impairment and patient needs/benefits in anogenital psoriasis: Difficult-to-communicate topics and their impact on patient-centred care

text: Genital psoriasis affects 2-5% of psoriasis patients; generalised plaque or intertriginous psoriasis also affects the genital area in 29-40% of cases. Anogenital psoriasis has been associated with significant quality of life impairments, but little is known about specific patient needs/treatment goals. This study aimed to examine the overall and sex-related disease burden, patient needs and treatment benefits in patients with anogenital psoriasis, compared to patients with psoriasis not affecting the anal/genital areas. Within the cross-sectional nationwide survey, 2,009 participants were consecutively recruited in 157 randomly assigned German dermatology practices and clinics, according to the following inclusion criteria aged 18 years or over; diagnosis of psoriasis vulgaris; ability to answer the questionnaires; and written informed consent. Based on a high-resolution grid on the topical distribution of psoriasis, two groups were formed: anogenital psoriasis (n = 622) and comparison group (n = 1,303). Clinical severity was assessed by the Psoriasis Area and Severity Index (PASI). Patients completed the EuroQoL visual analogue scale (EQ VAS), the Dermatology Life Quality Index (DLQI), and the Patient Benefit Index (PBI). Patients with anogenital psoriasis had higher PASI (13.0±10.6 vs. 8.9±7.6, P < 0.001) and more DLQI impairments (8.9±6.9 vs. 7.0±6.2, P = 0.002) than controls. At the item-level, they also reported more sex-related DLQI impairments (DLQI-i9: 0.5±0.8 vs. 0.3±0.7, P < 0.001) and treatment needs (PBI-i17: 2.2±1.8 vs. 1.9±1.8, P = 0.001). A great percentage of missing/not-relevant responses was found for sex-related items (23.3-41.9%). These results suggest that the assessment of sex-related impairments and treatment needs should be prioritised in patients with anogenital psoriasis. Questionnaires may be used as a less uncomfortable way for patients to discuss their genital lesions and sexual function during healthcare visits. However, the great percentage of missing/not-relevant responses to sex-related items calls for in-depth assessments and effective patient-physician communication regarding these sensitive topics.


title: Effective Reproductive Number estimation for initial stage of COVID-19 pandemic in Latin American Countries

text: OBJECTIVES: The coronavirus disease 2019 (COVID-19) has become pandemic and turn in a challenge for Latin America. Understanding the dynamics of the epidemic is essential for decision making, and to reduce the health, economic, and social impacts of the pandemic. The present study aimed to estimate the effective reproductive number (Rt) of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-Cov2) infection during the first 10 days of the outbreak in seven Latin American countries with the highest incidence of cases as of March 23, 2020. Furthermore, we chose to compare the seven countries with Spain and Italy given their history with the virus. METHODS: Incidence data retrieved from the COVID-19 data repository by Johns Hopkins University were analyzed. The Rt was calculated for the first 10 days of the epidemic in Brazil, Ecuador, Chile, Colombia, Panama, Mexico, and Peru. Rt estimations were compared with Spain and Italy values for the same interval. RESULTS: The median Rt for the first 10 days of the COVID-19 epidemic were 2.90 (2.67-3.14) for Spain and 2.83 (2.7-2.96) for Italy. Latin American Rt estimations were higher in Ecuador (3.95(3.7-4.21)), Panama (3.95(3.7-4.21)), and Brazil (3.95(3.7-4.21)). The smallest one was observed in Peru (2.36(2.11-2.63)). All Latin American countries had Rt greater than 2. CONCLUSIONS: The initial stages of the COVID-19 epidemic in Latin America suggested a high Rt. Interventions such as domestic and international travel restrictions, educational institutions closure, social distancing, and intensified case surveillance should be adopted to prevent the collapse of the health systems.


docid: ucyusfig

title: Physical health risks during simulation-based COVID-19 pandemic readiness training


Covid-19: Continued outbreaks in care homes risk extending pandemic, say experts


Effective health communication - a key factor in fighting the COVID-19 pandemic


Use of Face Masks in COVID-19


title: Clinical features and outcomes of HIV patients with coronavirus disease 2019

text: Little is known about the clinical outcomes of HIV patients infected with SARS-CoV-2. We describe 47 patients referred to our hospital between 21 February and 16 April 2020 with proven/probable COVID-19, 45 (96%) of whom fully recovered and two died.


Thoracic Surgery for Malignancy and Emergency Irrespective of Covid-19


title: COVID-19 for the Cardiologist: A Current Review of the Virology, Clinical Epidemiology, Cardiac and Other Clinical Manifestations and Potential Therapeutic Strategies

text: The coronavirus disease-2019 (COVID-19), a contagious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), has reached pandemic status. As it spreads across the world, it has overwhelmed healthcare systems, strangled the global economy and led to a devastating loss of life. Widespread efforts from regulators, clinicians and scientists are driving a rapid expansion of knowledge of the SARS-CoV2 virus and the COVID-19 disease. We review the most current data with a focus on our basic understanding of the mechanism(s) of disease and translation to the clinical syndrome and potential therapeutics. We discuss the basic virology, epidemiology, clinical manifestation, multi-organ consequences, and outcomes. With a focus on cardiovascular complications, we propose several mechanisms of injury. The virology and potential mechanism of injury form the basis for a discussion of potential disease-modifying therapies.


The Coronavirus Disease 2019 (COVID-19) Outbreak and Mental Health: Current Risks and Recommended Actions


title: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers

text: BACKGROUND: Health care workers (HCWs) are at risk for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. PURPOSE: To examine the burden of SARS-CoV-2, SARS-CoV-1, and Middle Eastern respiratory syndrome (MERS)-CoV on HCWs and risk factors for infection, using rapid and living review methods. DATA SOURCES: Multiple electronic databases including the WHO Database of Publications on Coronavirus Disease and medRxiv preprint server (2003 through 27 March 2020, with ongoing surveillance through 24 April 2020), and reference lists. STUDY SELECTION: Studies published in any language reporting incidence of or outcomes associated with coronavirus infections in HCWs and studies on the association between risk factors (demographic characteristics, role, exposures, environmental and administrative factors, and personal protective equipment [PPE] use) and HCW infections. New evidence will be incorporated on an ongoing basis by using living review methods. DATA EXTRACTION: One reviewer abstracted data and assessed methodological limitations; verification was done by a second reviewer. DATA SYNTHESIS: 64 studies met inclusion criteria; 43 studies addressed burden of HCW infections (15 on SARS-CoV-2), and 34 studies addressed risk factors (3 on SARS-CoV-2). Health care workers accounted for a significant proportion of coronavirus infections and may experience particularly high infection incidence after unprotected exposures. Illness severity was lower than in non-HCWs. Depression, anxiety, and psychological distress were common in HCWs during the coronavirus disease 2019 outbreak. The strongest evidence on risk factors was on PPE use and decreased infection risk. The association was most consistent for masks but was also observed for gloves, gowns, eye protection, and handwashing; evidence suggested a dose-response relationship. No study evaluated PPE reuse. Certain exposures (such as involvement in intubations, direct patient contact, or contact with bodily secretions) were associated with increased infection risk. Infection control training was associated with decreased risk. LIMITATION: There were few studies on risk factors for SARS-CoV-2, the studies had methodological limitations, and streamlined rapid review methods were used. CONCLUSION: Health care workers experience significant burdens from coronavirus infections, including SARS-CoV-2. Use of PPE and infection control training are associated with decreased infection risk, and certain exposures are associated with increased risk. PRIMARY FUNDING SOURCE: World Health Organization.


A familial cluster of severe coronavirus disease 2019 that required intubation of all family members


title: Nuclear medicine in responding to global pandemic COVID-19-American College of Nuclear Medicine member experience

text: In the global pandemic COVID-19, it is important for everyone including nuclear medicine personnel to know how to stop transmission and contain and prevent the spread of COVID-19. Here, we summarize our American College of Nuclear Medicine members' experiences from Wuhan, China; Singapore; and the USA, so to provide advice to the nuclear medicine personnel for their clinical practice and management strategies in responding to COVID-19.


title: Management von Patienten mit Tracheostoma während der COVID-19-Pandemie: Literaturüberblick und Demonstration./ [Management of tracheostomy patients during the COVID-19 pandemic: review of the literature and demonstration]

text: BACKGROUND: Since emergence of the new coronavirus in China in December 2019, many countries have been struggling to control skyrocketing numbers of infections, including among healthcare personnel. It has now been clearly demonstrated that SARS-CoV2 resides in the upper airways and transmits easily via aerosols and droplets, which significantly increases the risk of infection when performing upper airway procedures. Ventilated COVID-19 patients in a critical condition in the intensive care unit may require tracheotomy for long-term ventilation and to improve weaning. However, the risk of secondary infection of medical personnel performing subsequent tracheostomy care remains unclear. OBJECTIVE: This study aimed to evaluate the risk of droplet dispersion during tracheostomy tube change and overview tracheostomy tube change in COVID-19 patients. MATERIALS AND METHODS: The current literature was reviewed, quantitative and qualitative analyses of droplet formation during tracheostomy tube change in nâ¯= 8 patients were performed, and an overview of and checklist for tracheostomy tube change were compiled. RESULTS: This study demonstrates that tracheostomy tube change, in particular insertion of the new tube, may cause significant droplet formation. The aerosolization of particles smaller than 5â¯µm was not analyzed. CONCLUSION: Our data, together with the current literature, clearly emphasize that tracheostomy care is associated with a high infection risk and should only be performed by a small group of well-trained, maximally protected healthcare personnel.


title: COVID-19 in Newborns and Infants-Low Risk of Severe Disease: Silver Lining or Dark Cloud?

text: One hundred years after the 1918 influenza pandemic, we now face another pandemic with the severe acute respiratory syndrome-novel coronavirus-2 (SARS-CoV-2). There is considerable variability in the incidence of infection and severe disease following exposure to SARS-CoV-2. Data from China and the United States suggest a low prevalence of neonates, infants, and children, with those affected not suffering from severe disease. In this article, we speculate different theories why this novel agent is sparing neonates, infants, and young children. The low severity of SARS-CoV-2 infection in this population is associated with a high incidence of asymptomatic or mildly symptomatic infection making them efficient carriers. KEY POINTS: · There is a low prevalence of novel coronavirus disease in neonates, infants, and children.. · The fetal hemoglobin may play a protective role against coronavirus in neonates.. · Immature angiotensin converting enzyme (ACE2) interferes with coronavirus entry into the cells..


title: Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

text: Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20-24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.


docid: sgrdyzaz

title: Augmenting the Disaster Healthcare Workforce

text: In disasters such as the COVID-19 pandemic, we need to use all available resources to bolster our healthcare workforce. Many factors go into this process, including selecting the groups of professionals we will need, streamlining their licensing and credentialing processes, identifying appropriate roles for them, and supporting their health and well-being. The questions we must answer are these: How many staff will we need? How do we provide them with emergency licenses and credentials to practice? What interstate licensing compacts and registration systems exist to facilitate the process? What caveats are there to using retired healthcare professionals and healthcare students? How can we best avoid attrition among and increase the numbers of international medical graduates? Which non-clinical volunteers can we use and in what capacities? The answers to these questions will change as the crisis develops, although the earlier we address them, the smoother will be the process of using augmentees for the healthcare system.


'Closing borders is ridiculous': the epidemiologist behind Sweden's controversial coronavirus strategy


title: Outcome of COVID-19 in liver transplant recipients: A preliminary report from Northwestern Italy

text: Covid-19 pandemic is deeply affecting transplant activity worldwide. It is unclear whether solid organ transplant recipients are at increased risk of developing severe complications and how they should be managed, also concerning immunosuppression. This is a report about the course and management of SARS-CoV-2 infection in liver transplant recipients from a single center in Northwestern Italy in the period March-April 2020. Three patients who were treated at our institution are reported in detail, whereas summary data are provided for those managed at peripheral Hospitals. Presentation varied from asymptomatic to rapidly progressive respiratory failure due to bilateral interstitial pneumonia. Accordingly, treatment and changes to immunosuppression were adapted to the severity of the disease. Overall mortality was 20%, whereas Covid-related mortality was 10%. Two cases of prolonged (>2 months) viral carriage were observed in two asymptomatic patients who contracted the infection in the early course after transplant. Besides depicting Covid-19 course and possible treatment scenarios in liver transplant patients, these cases are discussed in relation to the changes in our practice prompted by Covid-19 epidemic, with potential implications for other transplant programs.


Clinical Care, Research, and Telehealth Services in the Era of Social Distancing to Mitigate COVID-19


title: Clinical characteristics and outcomes of patients with severe covid-19 with diabetes

text: OBJECTIVE: This study explores the clinical characteristics of patients with diabetes with severe covid-19, and the association of diabetes with survival duration in patients with severe covid-19. RESEARCH DESIGN AND METHODS: In this single-center, retrospective, observational study, the clinical and laboratory characteristics of 193 patients with severe covid-19 were collected. 48 patients with severe covid-19 had diabetes, and 145 patients (ie, the controls) did not have diabetes. A severe case was defined as including at least one of the following criteria: (1) Respiratory rate >30/min. (2) Oxygen saturation ≤93%. (3) PaO2/FiO2≤300 mm Hg. (4) Patients, either with shock or respiratory failure, requiring mechanical ventilation, or combined with other organ failure, requiring admission to intensive care unit (ICU). RESULTS: Of 193 patients with severe covid-19, 48 (24.9%) had diabetes. Compared with patients with severe covid-19 without diabetes, patients with diabetes were older, susceptible to receiving mechanical ventilation and admission to ICU, and had higher mortality. In addition, patients with severe covid-19 with diabetes had higher levels of leukocyte count, neutrophil count, high-sensitivity C reaction protein, procalcitonin, ferritin, interleukin (IL) 2 receptor, IL-6, IL-8, tumor necrosis factor α, D-dimer, fibrinogen, lactic dehydrogenase and N-terminal pro-brain natriuretic peptide. Among patients with severe covid-19 with diabetes, more non-survivors were men (30 (76.9%) vs 9 (23.1%)). Non-survivors had severe inflammatory response, and cardiac, hepatic, renal and coagulation impairment. Finally, the Kaplan-Meier survival curve showed a trend towards poorer survival in patients with severe covid-19 with diabetes than patients without diabetes. The HR was 1.53 (95% CI 1.02 to 2.30; p=0.041) after adjustment for age, sex, hypertension, cardiovascular disease and cerebrovascular disease by Cox regression. The median survival durations from hospital admission in patients with severe covid-19 with and without diabetes were 10 days and 18 days, respectively. CONCLUSION: The mortality rate in patients with severe covid-19 with diabetes is considerable. Diabetes may lead to an increase in the risk of death.


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


title: Automated diagnosis of COVID-19 with limited posteroanterior chest X-ray images using fine-tuned deep neural networks

text: The novel coronavirus 2019 (COVID-19) is a respiratory syndrome that resembles pneumonia. The current diagnostic procedure of COVID-19 follows reverse-transcriptase polymerase chain reaction (RT-PCR) based approach which however is less sensitive to identify the virus at the initial stage. Hence, a more robust and alternate diagnosis technique is desirable. Recently, with the release of publicly available datasets of corona positive patients comprising of computed tomography (CT) and chest X-ray (CXR) imaging; scientists, researchers and healthcare experts are contributing for faster and automated diagnosis of COVID-19 by identifying pulmonary infections using deep learning approaches to achieve better cure and treatment. These datasets have limited samples concerned with the positive COVID-19 cases, which raise the challenge for unbiased learning. Following from this context, this article presents the random oversampling and weighted class loss function approach for unbiased fine-tuned learning (transfer learning) in various state-of-the-art deep learning approaches such as baseline ResNet, Inception-v3, Inception ResNet-v2, DenseNet169, and NASNetLarge to perform binary classification (as normal and COVID-19 cases) and also multi-class classification (as COVID-19, pneumonia, and normal case) of posteroanterior CXR images. Accuracy, precision, recall, loss, and area under the curve (AUC) are utilized to evaluate the performance of the models. Considering the experimental results, the performance of each model is scenario dependent; however, NASNetLarge displayed better scores in contrast to other architectures, which is further compared with other recently proposed approaches. This article also added the visual explanation to illustrate the basis of model classification and perception of COVID-19 in CXR images.


title: Mortality of people with intellectual disabilities during the 2017/2018 influenza epidemic in the Netherlands: potential implications for the COVID-19 pandemic

text: BACKGROUND: Data on the development of Covid-19 among people with intellectual disabilities (IDs) are scarce and it is uncertain to what extent general population data applies to people with ID. To give an indication of possible implications, this study investigated excess mortality patterns during a previous influenza epidemic. METHODS: Using Dutch population and mortality registers, a historical cohort study was designed to compare mortality during the 2017-2018 influenza epidemic with mortality in the same period in the three previous years. People with ID were identified by entitlements to residential ID-care services as retrieved from a national database. RESULTS: Data covered the entire adult Dutch population (12.6 million; GenPop), of which 91 064 individuals were identified with an ID. During the influenza epidemic, mortality among people with ID increased almost three times as much than in the GenPop (15.2% vs. 5.4%), and more among male individuals with ID (+19.5%) than among female individuals with ID (+10.6%), as compared with baseline. In both cohorts, comparable increases in mortality within older age groups and due to respiratory causes were seen. Particularly in the ID-cohort, excess deaths also occurred in younger age groups, due to endocrine diseases and ID-specific causes. CONCLUSIONS: During the 2017-2018 influenza epidemic, excess mortality among people with ID was three times higher than in the general Dutch population, appeared more often at young age and with a broader range of underlying causes. These findings suggest that a pandemic may disproportionally affect people with ID while population data may not immediately raise warnings. Early detection of diverging patterns and faster implementation of tailored strategies therefore require collection of good quality data.


docid: hfubakzo

title: The renin-angiotensin system: An integrated view of lung disease and coagulopathy in COVID-19 and therapeutic implications

text: The renin-angiotensin system (RAS) has long been appreciated as a major regulator of blood pressure, but has more recently been recognized as a mechanism for modulating inflammation as well. While there has been concern in COVID-19 patients over the use of drugs that target this system, the RAS has not been explored fully as a druggable target. The abbreviated description of the RAS suggests that its dysregulation may be at the center of COVID-19.


title: The mutual effects of COVID-19 and obesity

text: â¢The rate of obesity was increased during this era of the COVID-19 epidemic.â¢Obesity is dangerous in COVID-19 patients.


title: The trinity of COVID-19: immunity, inflammation and intervention

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Alongside investigations into the virology of SARS-CoV-2, understanding the fundamental physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies. Here, we provide an overview of the pathophysiology of SARS-CoV-2 infection. We describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of dysfunctional immune responses to disease progression. From nascent reports describing SARS-CoV-2, we make inferences on the basis of the parallel pathophysiological and immunological features of the other human coronaviruses targeting the lower respiratory tract - severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Finally, we highlight the implications of these approaches for potential therapeutic interventions that target viral infection and/or immunoregulation.


title: Multiplex detection and dynamics of IgG antibodies to SARS-CoV2 and the highly pathogenic human coronaviruses SARS-CoV and MERS-CoV

text: BACKGROUND: Knowledge of the COVID-19 epidemic extent and the level of herd immunity is urgently needed to help manage this pandemic. METHODS: We used a panel of 167 samples (77 pre-epidemic and 90 COVID-19 seroconverters) and SARS-CoV1, SARS-CoV2 and MERS-CoV Spike and/or Nucleopcapsid (NC) proteins to develop a high throughput multiplex screening assay to detect IgG antibodies in human plasma. Assay performances were determined by ROC curves analysis. A subset of the COVID-19+ samples (n = 36) were also tested by a commercial NC-based ELISA test and the results compared with those of the novel assay. RESULTS: On samples collected ≥14 days after symptoms onset, the accuracy of the assay is 100 % (95 % CI: 100-100) for the Spike antigen and 99.9 % (95 % CI:99.7-100) for NC. By logistic regression, we estimated that 50 % of the patients have seroconverted at 5.7 ± 1.6; 5.7 ± 1.8 and 7.9 ± 1.0 days after symptoms onset against Spike, NC or both antigens, respectively and all have seroconverted two weeks after symptoms onset. IgG titration in a subset of samples showed that early phase samples present lower IgG titers than those from later phase. IgG to SARS-CoV2 NC cross-reacted at 100 % with SARS-CoV1 NC. Twenty-nine of the 36 (80.5 %) samples tested were positive by the commercial ELISA while 31/36 (86.1 %) were positive by the novel assay. CONCLUSIONS: Our assay is highly sensitive and specific for the detection of IgG antibodies to SARS-CoV2 proteins, suitable for high throughput epidemiological surveys. The novel assay is more sensitive than a commercial ELISA.


Dexamethasone in the management of covid -19


Subversion of host stress granules by coronaviruses: Potential roles of π-rich disordered domains of viral nucleocapsids


text: Coronavirus nucleocapsids (CoV N's) play both structural and non-structural roles in viral life-cycle. Here, we propose a mechanism for host stress granule (SG) subversion by CoV N proteins. We posit that disordered domains of CoV N's can engage in π-π intermolecular fuzzy interactions with host SG proteins and are crucial to the viral hijacking of host machineries. This article is protected by copyright. All rights reserved.


docid: woinmedd

title: Cardiovascular Manifestation and Treatment in COVID-19

text: The novel coronavirus disease 2019 (COVID-19), with first presentation of atypical pneumonia, has spread rapidly from Wuhan, China on December 12, 2019 to over 200 countries, caused 2310572 infected individuals and 158691 mortalities, updated on 2020/4/19. Many studies have published timely to help global health-care workers to understand and control the disease. Vulnerable patients with risk factors such as elderly, cardiovascular diseases (e.g. hypertension, coronary disease, or cardiomyopathy), diabetes, chronic kidney disease etc., have worse outcomes after covid-19 infection. COVID-19 could directly cause cardiovascular injuries such as pericarditis, myocarditis, myocardial infarction, heart failure, arrhythmias or thromboembolic events, which urge cardiologists to be involved in the frontline to practice. Here we provide a review of COVID-19 on cardiovascular system to assist clinical cardiologists to better understand the disease and being capable of providing comprehensive medical support.


Lung-protective mechanical ventilation in patients with covid-19


An unexpected and suspended time


title: Missed or delayed diagnosis of ARDS: a common and serious problem

text: Clinical recognition of acute respiratory distress syndrome (ARDS) is delayed or missed entirely in a substantial proportion of patients. In the LUNG SAFE study, the largest international cohort of patients with ARDS, investigators were able to determine if ARDS was present, and at what stage the clinician made the diagnosis of ARDS. The diagnosis of ARDS was delayed or missed in two-thirds of patients, with the diagnosis missed entirely in 40% of patients, while ARDS recognition ranged from 51% in mild ARDS to 79% in severe cases. Failure to recognize ARDS in a timely fashion leads to failure to use strategies that improve survival in ARDS. Early diagnosis of ARDS may facilitate measures to abrogate progression of the lung injury, including protective mechanical ventilation, fluid restriction, and adjunctive measures proven to improve survival such as prone positioning. Information overload and a complex 'syndrome' diagnosis likely play key roles in ARDS under-recognition. Clinical under-recognition has important consequences particularly in terms of therapeutic options not considered. The development of approaches to enable more timely recognition has the potential to save lives.


title: Age-structured impact of social distancing on the COVID-19 epidemic in India

text: The outbreak of the novel coronavirus, COVID-19, has been declared a pandemic by the WHO. The structures of social contact critically determine the spread of the infection and, in the absence of vaccines, the control of these structures through large-scale social distancing measures appears to be the most effective means of mitigation. Here we use an age-structured SIR model with social contact matrices obtained from surveys and Bayesian imputation to study the progress of the COVID-19 epidemic in India. The basic reproductive ratio R0 and its time-dependent generalization are computed based on case data, age distribution and social contact structure. The impact of social distancing measures - workplace non-attendance, school closure, lockdown - and their efficacy with durations are then investigated. A three-week lockdown is found insufficient to prevent a resurgence and, instead, protocols of sustained lockdown with periodic relaxation are suggested. Forecasts are provided for the reduction in age-structured morbidity and mortality as a result of these measures. Our study underlines the importance of age and social contact structures in assessing the country-specific impact of mitigatory social distancing.


"Is It Safe for Me to Go to Work?" Risk Stratification for Workers during the Covid-19 Pandemic


title: All Hands on Deck: A Synchronized Whole-of-World Approach for COVID-19 Mitigation

text: The COVID-19 pandemic can no longer be mitigated by nationwide approach of individual nations alone. Given its scale and accelerating expansion COVID-19 behooves a coordinated and simultaneous Whole- of-World approach that galvanizes clear global leadership and solidarity from all governments of the world. Considering an 'all hands-on deck' concept, we present a comprehensive list of tools and entities responsible for and enabling them, as well a conceptual framework to achieve the maximum impact. The list is drawn from pandemic mitigation tools developed in response to past outbreaks including influenza, coronaviruses, and Ebola and includes tools to minimize transmission in various settings including person-to-person, crowd, funerals, travel, workplace, and events and gatherings including business, social and religious venues. Included are the roles of individuals, communities, government and other sectors such as school system, health, institutions, and business. While individuals and communities have significant responsibilities to prevent person-to-person transmission, other entities can play a significant role to enable individuals and communities to make use of the tools. Historic and current data indicate the role of political will, whole-of-government approach, and the role of early introduction of mitigation measures. There is also an urgent need to further elucidate the immunologic mechanisms underlying the epidemiological characteristics such as the low disease burden among women, and role of COVID-19 in inducing Kawasaki like syndromes in children. Understanding the role of and development of anti-inflammatory strategies based on our understanding pro-inflammatory cytokines (IL1, IL-6) is also critical. Similarly, the role of oxygen therapy as an anti-inflammatory strategy is evident and access to oxygen therapy should be prioritized to avoid the aggravation of COVID-19 infection. We highlight the need for global solidarity to share both mitigation commodities and infrastructure between countries. Given the global reach ofCOVID-19 and potential for repeat waves of outbreaks, we call on all countries and communities to act synergistically and emphasize the need for synchronized pan-global mitigation efforts to minimize everyone's risk, maximize collaboration and to commit to shared progress.


title: CO-Search: COVID-19 Information Retrieval with Semantic Search, Question Answering, and Abstractive Summarization

text: The COVID-19 global pandemic has resulted in international efforts to understand, track, and mitigate the disease, yielding a significant corpus of COVID-19 and SARS-CoV-2-related publications across scientific disciplines. As of May 2020, 128,000 coronavirus-related publications have been collected through the COVID-19 Open Research Dataset Challenge. Here we present CO-Search, a retriever-ranker semantic search engine designed to handle complex queries over the COVID-19 literature, potentially aiding overburdened health workers in finding scientific answers during a time of crisis. The retriever is built from a Siamese-BERT encoder that is linearly composed with a TF-IDF vectorizer, and reciprocal-rank fused with a BM25 vectorizer. The ranker is composed of a multi-hop question-answering module, that together with a multi-paragraph abstractive summarizer adjust retriever scores. To account for the domain-specific and relatively limited dataset, we generate a bipartite graph of document paragraphs and citations, creating 1.3 million (citation title, paragraph) tuples for training the encoder. We evaluate our system on the data of the TREC-COVID information retrieval challenge. CO-Search obtains top performance on the datasets of the first and second rounds, across several key metrics: normalized discounted cumulative gain, precision, mean average precision, and binary preference.


New Decade's Urgent Health Care Challenges Spotlight Increasing Role of Professional Case Managers


Re: The MRI in Active Surveillance "MRIAS" Trial: Use of Baseline mpMRI and Saturation Biopsy to Reduce the Frequency of Surveillance Prostate Biopsies


title: Mesenchymal Stem Cells -Bridge Catalyst Between Innte And Adaptive Immunity In Covid 19

text: Majority of patients infected with the COVID 19 virus display a mild to moderate course of disease and spontaneously recover at 14 - 20 days,. However, about 15 % of patients progress to severe stages and 2.5% of these patients succumb to this illness. Most patients with severe disease belong to the elderly age group (< 65 years of age) and have multiple associated co-morbidities. The immune responses induced by the COVID 19 virus, during the incubation and non-severe stages, requires the early initiation of a specific adaptive immune response to eliminate the virus and prevent the progress to severe stages. In patients with a dysfunctional bridge adaptive immunity, the innate immune response becomes exaggerated due to the lack of feedback from the adaptive immune cells. The resultant cytokine storm is responsible for the severe lung injury leading to acute respiratory distress syndrome seen in COVID 19 patients. Mesenchymal stem cells are known to suppress overactive immune responses as well as bring about tissue regeneration and repair. This immuno-modulatory effect of MSCs could hold potential to manage a patient with severe symptoms of COVID 19 infection due to a dysfunctional adaptive immune system.


Mental Health and Psychosocial Aspects of Coronavirus Outbreak in Pakistan: Psychological Intervention for Public Mental Health Crisis


title: Cuidar Al Que Cuida: El Impacto Emocional De La Epidemia De Coronavirus En Las Enfermeras Y Otros Profesionales De La Salud./ [Caring For The Caregiver: The Emotional Impact Of The Coronavirus Epidemic On Nurses And Other Health Professionals]

text: The health crisis caused by the Covid-19 virus pandemic has once again highlighted the role of health professionals as a key element for their containment, who suffer from high tension marked by healthcare pressure and the lack of means of protection. Given this tension, it is relevant to analyze the emotional impact on health professionals of the coronavirus pandemic and the coping resources to reduce or mitigate this impact. Stress, sleep disorders and depressive symptoms stand out. Some strategies are recommended that have been used by professionals who have previously been under pressure from COVID-19 and have been helpful to them. Finally, some recommendations whose efficacy is known for managing emotional impact are pointed out.


title: New coronavirus pneumonia and outbreak epidemic virus and eye disease/ 中华实验眼科杂志

text: Since the outbreak of the new coronavirus pneumonia (NCP) in Wuhan City, China, the main transmission mode as well as the diagnosis and treatment of NCP have become a focus of research in China and World Health Organization.Understanding the mode of infection, transmission and biological behavior of the novel coronavirus (2019-nCoV) is undoubtedly a key of cutting off the spread and prevention of the disease which doctors are fearing to be a worldwide epidemic.In February 2020, Lancet published a correspondence paper, which reviewed a case of NCP patient who first started with conjunctivitis, and raised the issue that the transmission of 2019-nCoV through the ocular surface must not be ignored, causing widespread concern.However, due to a lack of clinical observation data and laboratory research at present, the relationship between NCP pathogen infection and ocular surface infection is not completely clear.So far, there have been many studies and reports on the observation of large-scale epidemic virus infections and eye diseases.This article reviews the eye performance of various types of epidemic virus infections and provides a reference for NCP prevention and control.


title: Advanced head and neck surgery training during the COVID-19 pandemic

text: BACKGROUND: The COVID-19 pandemic has significantly impacted medical training. Here we assess its effect on head and neck surgical education. METHODS: Surveys were sent to current accredited program directors and trainees to assess the impact of COVID-19 on the fellow's experience and employment search. Current fellows' operative logs were compared with those of the 2018 to 2019 graduates. RESULTS: Despite reduction in operative volume, 82% of current American Head and Neck Society fellows have reached the number of major surgical operations to support certification. When surveyed, 86% of program directors deemed their fellow ready to enter practice. The majority of fellows felt prepared to practice ablative (96%), and microvascular surgery (73%), and 57% have secured employment to follow graduation. Five (10%) had a pending job position put on hold due to the pandemic. CONCLUSIONS: Despite the impact of the COVID-19 pandemic, current accredited trainees remain well-positioned to obtain proficiency and enter the work-force.


In reply


title: Local Government Efforts to Mitigate the Novel Coronavirus Pandemic among Older Adults

text: As the coronavirus crisis spreads swiftly through the population, it takes a particularly heavy toll on minority individuals and older adults, with older minority adults at especially high risk. Given the shockingly high rates of infections and deaths in nursing homes, staying in the community appears to be a good option for older adults in this crisis, but in order for some older adults to do so much assistance is required. This situation draws attention to the need for benevolent intervention on the part of the state should older adults become ill or lose their sources of income and support during the crisis. This essay provides a brief overview of public support and the financial and health benefits for older individuals who remain in the community during the pandemic. It reports the case example of Austin, Texas, a city with a rapidly aging and diverse population of almost a million residents, to ask how we can assess the success of municipalities in responding to the changing needs of older adults in the community due to COVID-19. It concludes with a discussion of what governmental and non-governmental leadership can accomplish in situations such as that brought about by the current crisis.


title: Selection and Use of Respiratory Protection by Healthcare Workers to Protect from Infectious Diseases in Hospital Settings

text: OBJECTIVES: Infection control policies and guidelines recommend using facemasks and respirators to protect healthcare workers (HCWs) from respiratory infections. Common types of respirators used in healthcare settings are filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). Aims of this study were to examine the current attitudes and practices of HCWs regarding the selection and use of respiratory protection and determine the acceptability of a novel PAPR. METHODS: In-depth interviews were undertaken with 20 HCWs from a large tertiary hospital in Sydney, Australia. Participants were fit tested with a lightweight tight-fitting half-facepiece PAPR (CleanSpace2™ Power Unit, PAF-0034, by CleanSpace Technology®) using the TSI™ Portacount quantitative fit test method. RESULTS: Interview results showed that HCWs had a limited role in the selection and use of facemasks and respirators and had been using the devices provided by the hospital. The majority of subjects had no knowledge of hospital policy for the use of facemasks and respirators, had not been trained on the use of respirators, and had not been fit tested previously. Compliance with the use of facemasks and respirators was perceived as being low and facemasks and respirators were typically used only for short periods of time.All 20 participants were successfully fit tested to the CleanSpace2™ PAPR (overall geometric mean fit factor-6768). According to the exit surveys, CleanSpace2™ PAPRs were easy to don (14/20) and doff (15/20) and comfortable to wear (14/20). Most participants believed that PAPRs provide higher protection, comfort and reusability over N95 FFR and can be used during pandemics and other high-risk situations. CONCLUSIONS: HCWs should be aware of infection control policies and training should be provided on the correct use of respiratory protective devices. PAPRs can be used in hospital settings to protect HCWs from certain highly infectious and emerging pathogens, however, HCWs require adequate training on storage, use, and cleaning of PAPRs.


title: Factors affecting the adoption of telemedicine during COVID-19

text: Novel coronavirus disease (COVID-19) has put restriction of travel, and social distancing has become a new normal. This outbreak of the pandemic has made telemedicine more relevant than ever. The objective of this study is to identify the factors affecting the rate of adoption of telemedicine and effect of the COVID-19 on these factors. The research develops five hypotheses to test the influence of a disease outbreak on the rate of telemedicine adoption. The method used for the study is the Wilcoxon signed-rank test, and the sampling method used for the study is purposive sampling. The respondents were taken from a multispecialty clinic in North India and the sample size for the study is 43. The study concludes that patients are seeing more value in the use of telemedicine during COVID-19. They are more willing to experiment with telemedicine and are not intimidated by the technology related to telemedicine.


Effectiveness of Surgical and Cotton Masks in Blocking SARS-CoV-2: A Controlled Comparison in 4 Patients


docid: lclpuqvw

title: COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice

text: The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities. There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists. Health workers represent between 3.8% and 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter). All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55 to 65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases, and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Health care facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for patients with cancer. For those who are working with COVID-19 infected patients' isolation is compulsory in the following settings: (a) unprotected close contact with COVID-19 pneumonia patients; (b) onset of fever, cough, shortness of breath, and other symptoms (gastrointestinal complaints, anosmia, and dysgeusia have been reported in a minority of cases). For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves. The procedures described are essential in trying to maintain safety of health care workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.


title: [Investigation of a cluster epidemic of COVID-19 in Ningbo]

text: Objective: To investigate a cluster epidemic of COVID-19 after a mass gathering activity in Ningbo of Zhejiang province and analyze the transmission chain and status of infection cases of different generations. Methods: The tracking of all the close contacts of the first COVID-19 case and epidemiological investigation were conducted on January 29, 2020 after a cluster epidemic of COVID-19 related with a Buddhism rally on January 19 (the 1.19 rally) in Ningbo occurred. The swabs of nose/throat of the cases and close contacts were collected and tested for nucleic acids by real-time fluorescence quantitative RT-PCR. Results: From January 26 to February 20, 2020, a total of 67 COVID-19 cases and 15 asymptomatic infection cases related with the 1.19 rally were reported in Ningbo. The initial case was the infection source who infected 29 second generation cases and 4 asymptomatic infection cases, in whom 23 second generation cases and 3 asymptomatic infection cases once took bus with the initial case, the attack rate was 33.82% (23/68) and the infection rate was 38.24% (26/68). The risks of suffering from COVID-19 and being infected were 28.91 times and 26.01 times higher in rally participants taking bus with initial case compared with those taking no bus with initial case. In this epidemic, 37 third+ generation cases and 11 related asymptomatic infection cases occurred, the attack rate was 2.88% (37/1 283) and the infection rate was 4.76% (48/1 008). The main transmission routes included vehicle sharing and family transmission. Conclusion: It was a cluster epidemic of COVID-19 caused by a super spreader in a massive rally. The epidemic has been under effective control.


title: Controlling the Hidden Growth of COVID-19

text: The COVID-19 pandemic has plagued the world for months. The U.S. has taken measures to counter it. On a daily basis, newly confirmed cases have been reported. In the early days, these numbers showed an increasing trend. Recently, the numbers have been generally flattened out. This report tries to estimate the hidden number of currently alive infections in the population by using the confirmed cases. A major result indicates an existing infections estimate at about 10-50 times the daily confirmed new cases, with the stringent social distancing policy tipping to the upper end of this range. It clarifies the relationship between the infection rate and the test rate to put the epidemic under control, which says that the test rate shall keep up at the same pace as infection rate to prevent an outbreak. This relationship is meaningful in the wake of business re-opening in the U.S. and the world. The report also reveals the connections of all the measures taken to the epidemic spread. A stratified sampling method is proposed to add to the current tool kits of epidemic control. Again, this report is a summary of some straight observations and thoughts, not through a thorough study backed with field data. The results appear obvious and suitable for general education to interested policymakers and the public.


Urgent call for greater multilateralism and coordination of covid-19 trials


title: Humanism in the Age of COVID-19: Renewing Focus on Communication and Compassion

text: The global COVID-19 pandemic has become one of the largest clinical and operational challenges faced by emergency medicine, and our EDs continue to see increased volumes of infected patients, many of whom are not only ill, but acutely aware and fearful of their circumstances and potential mortality. Given this, there may be no more important time to focus on staff-patient communication and expression of compassion. However, many of the techniques usually employed by emergency clinicians to provide comfort to patients and their families are made more challenging or impossible by the current circumstances. Geriatric ED patients, who are at increased risk of severe disease, are particularly vulnerable to the effects of isolation. Despite many challenges, emergency clinicians have at their disposal a myriad of tools that can still be used to express compassion and empathy to their patients. Placing emphasis on using these techniques to maximize humanism in the care of COVID-19 patients during this crisis has the potential to bring improvements to ED patient care well after this pandemic has passed.


POCUS in COVID-19: pearls and pitfalls


title: The Cholera Epidemics in Hamburg and What to Learn for COVID-19 (SARS-CoV-2)

text: © 2020 International Society for Advancement of Cytometry.


title: A bioinspired mucoadhesive restores lubrication of degraded cartilage through reestablishment of lamina splendens

text: Adsorbed lubricious films composed of biomacromolecules are natively present at all articulating interfaces in the human body where they provide ultralow friction and maintain normal physiological function. Biolubrication gets impaired due to diseases such as osteoarthritis, in which cartilage damage results from alterations in synovial fluid and lamina splendens composition. Osteoarthritis is treated with hyaluronic acid (HA) orally or via intra-articular injection, but due to the poor adsorption of HA on the cartilage surface in the absence of adhesive molecules, pain relief is temporary. Here, we describe how natural lubrication on degraded cartilage surface can be restored with the help of a bioinspired mucoadhesive biopolymer chitosan catechol (Chi-C). Quartz crystal microbalance was used to mimic the formation of lamina splendens in vitro, known as synovial fluid conditioning films (SyCF), and colloidal probe atomic force microscopy was used to measure their nanoscale frictional properties. Clear evidence of glycoprotein (PRG4) recruitment by Chi-C increased the softness of SyCF, which also improved nanoscale lubrication in vitro, decreasing the friction coefficient from 0.06 to 0.03. At the macroscale, cartilage damage induced by Chondroitinase ABC increased the coefficient of friction (COF) from 0.07â¯±â¯0.04 (healthy tissue) to 0.15â¯±â¯0.03 (after tissue damage) in the presence of synovial fluid after sliding for 50â¯min. After Chi-C treatment of damaged cartilage, the COF fell to 0.06â¯±â¯0.03, which is comparable to healthy cartilage. Chi-C did not adversely affect the metabolic activity of human chondrocytes. This study provides new key insight into the potential for restoring biolubrication through the use of muco-adhesive molecules.


Reply to "Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients": To consider varicella-like exanthem associated with COVID-19, virus varicella zoster and virus herpes simplex must be ruled out


title: Evaluation of the suitability of 19 pharmacogenomics biomarkers for individualized metformin therapy for type 2 diabetes patients

text: Objectives Type 2 Diabetes mellitus is a progressive metabolic disease characterized by relative insulin insufficiency and insulin resistance resulting in hyperglycemia. Despite the widespread use of metformin, there is considerable variation in treatment response; with approximately one-third of patients failing to achieve adequate glycemic control. Studies have reported the involvement of single nucleotide polymorphisms and their interactions in genetic pathways i.e., pharmacodynamics and pharmacokinetics. This study aims to investigate the association between 19 pharmacogenetics biomarkers and response to metformin treatment. Methods MassARRAY panels were designed and optimized by Inqaba Biotechnical Industries, to genotype 19 biomarkers for 140 type 2 diabetic outpatients. Results The CT genotype of the rs12752688 polymorphism was significantly associated with increased response to metformin therapy after correction (OR=0.33, 95% CI [0.16-0.68], p-value=0.006). An association was also found between the GA genotype of SLC47A2 rs12943590 and a decreased response to metformin therapy after correction (OR=2.29, 95% CI [1.01-5.21], p-value=0.01). Conclusions This is the first study investigating the association between genetic variants and responsiveness to medication for diabetic patients from the indigenous Nguni population in South Africa. It is suggested that rs12752688 and rs12943590 be included in pharmacogenomics profiling systems to individualize metformin therapy for diabetic patients from African populations.


Esophageal oncologic surgery in SARS-CoV-2 (COVID-19) emergency


title: Urological implications of SARS CoV-19

text: INTRODUCTION: The novel coronavirus disease 2019 (COVID-19), pandemic has afflicted > 3 3 million people around the world since December 2019 Though, more than 1000 publications have appeared in scientific journals addressing a plethora of questions, there is a considerable hiatus in understanding of the behavior and natural history of the virus and its impact on urology Also, a modified approach is the need of hour in taking care of patients as urologists should safeguard their teams, families, and patients MATERIAL AND METHODS: The authors have used guidelines from USA, Canada, UK, Europe and India for making recommendations to help urologist define their own policies that may have to be fine-tuned on the basis of continued and evolving challenges they would encounter and the local resources at their disposal RESULTS: COVID-19 do effect genitourinary system from kidney to testis The authors provide scientific basis to urologists to help identify patients by remote consultation who are likely to be harmed by coming to the hospital, and not to miss those who need hospitalization for diagnostic or therapeutic interventions There is uncompromised need of specific precautions during surgery to safe guard the surgeon and his team along with the patient CONCLUSIONS: Urological operations during COVID-19 pandemic should be limited to emergency cases during the acute phase with an exit strategy planned in a staggered manner, based on the scientific risk stratification Telemedicine (e-clinics or virtual clinics) would help achieve the goal of risk stratification


"One more time": why replicating some syntheses of evidence relevant to COVID-19 makes sense


Issues to be considered when planning sero-epidemiological studies in regions with a low incidence of SARS-CoV-2


docid: tmkjkytb

title: [Pathological changes of fatal coronavirus disease 2019 (COVID-19) in the lungs: report of 10 cases by postmortem needle autopsy]

text: Objectives: To observe the pulmonary changes with coronavirus disease 2019 (COVID-19) in postmortem needle specimens, to detect the presence of 2019 novel coronavirus(2019-nCoV) in the lung tissues, and to analyze the clinicopathological characteristics. Methods: For 10 decedents with 2019-nCoV infection in Wuhan, bilateral lungs underwent ultrasound-guided percutaneous multi-point puncture autopsy, and pulmonary pathological changes were described in routine hematoxylin-eosin staining (HE) slides. Electron microscopy was also performed. The reverse transcription polymerase chain reaction (RT-PCR) was employed to detect 2019-nCoV nucleic acid in lung tissue, and the pathological characteristics were demonstrated in combination with clinical data analysis. Results: Of the 10 deaths associated with COVID-19, 7 were male and 3 were female. The average age was 70 (39-87) years. Medical record showed that 7 patients had underlying diseases. The average course of disease was 30 (16-36) days. Nine cases showed fibrinous and suppurative exudation in the alveolar cavity accompanied by the formation of hyaline membrane, and fibroblastic proliferation of alveolar septum. Type â ¡ alveolar epithelial cells showed reactive hyperplasia and desquamation. Many macrophages accumulated in the alveolar cavity. Capillary hyaline thrombus and intravascular mixed thrombus were noted. In some cases, acute bronchiolitis with mucous membrane exfoliation, accumulation of bronchiolar secretions, and bronchiolar epithelial metaplasia occurred. In the cohort, a large number of bacteria (cocci) were detected in 1 case and a large number of fungi (yeast type) were detected in 1 case. Nine cases were positive for the nucleic acids of 2019-nCoV while one case remained negative by RT-PCR. Coronavirus particles were detected in the cytoplasm of type â ¡ alveolar epithelium. Conclusions: The pulmonary pathological changes of fatal COVID-19 are diffuse alveolar damage (DAD), mainly in the acute exudative stage and the organic proliferative stage. There are fibrinous exudate aggregation in alveolar cavity with hyaline membrane formation, fibroblastic proliferation in alveolar septum, and alveolar epithelial cell injuries with reactive hyperplasia and desquamation of type â ¡ alveolar epithelial cells. A large amount of neutrophils and monocytes infiltration is present in most cases and bacteria and fungi are detected in some cases, suggesting a serious bacterial or fungal infection secondary to the DAD.


COVID-19: Leaving lockdown-Of Schrodinger, cats, testing and masks


title: Electrostatic Charged Nanofiber Filter for Filtering Airborne Novel Coronavirus (COVID-19) and Nano-aerosols

text: The World Health Organization declared the novel coronavirus (COVID-19) outbreak as a pandemic on March 12, 2020. Within 3-1/2 months since outbreak in December 2019, over 1.3 million people have been infected across 206 countries with over 70,000 deaths. COVID-19 has a size of 60-140nm with mean size of the nano-aerosols, 100nm. The virus can be airborne by attaching to human secretion (fine particles, nasal/saliva droplets) of infected person or suspended fine particulates in air. While NIOSH has standardized N95 and N98 at 300nm, to-date there is no filter standards, nor special filter technologies, tailored for capturing airborne viruses and 100nm nano-aerosols. The latter also are present in high number concentration in atmospheric pollutants. This study addresses developing novel charged PVDF nanofiber filter technology to effectively capture the deadly airborne coronavirus with our target set at 100nm (nano-aerosol), and not 300nm. The virus and its attached particle were simulated by sodium chloride aerosols, 50-500nm, generated from sub-micron aerosol generator. PVDF nanofibers were produced with fiber diameters 84, 191, 349 and 525nm with excellent morphology. The fibers were subsequently charged by corona discharge. The amounts of charged fibers in a filter were increased to achieve high efficiency of 90% for the virus filter but the electrical interference between neighbouring fibers resulted in progressively marginal increase in efficiency and concurrently much higher pressure drop across the filter. The quality factor which measured the efficiency-to-pressure-drop kept decreasing. By redistributing the fibers in the filter into several modules, each separated by a permeable scrim material, the electrical interference was reduced, if not fully mitigated. Also, the additional scrim materials introduced macropores into the filter that further reduced the airflow resistance. With this approach, the quality factor can maintain relatively constant with increasing fiber amounts to achieve high filter efficiency. The optimal amounts of fiber in each module depended on the diameter of fibers in the module. Small fiber diameter that has already high performance required small amount of fibers per module. In contrast, large diameter fiber required more amounts of fiber per module to compensate for the poorer performance without incurring higher pressure drop. This approach was applied to develop four new nanofiber filters tailored for capturing 100nm airborne COVID-19 to achieve over 90% efficiency with pressure drop below 30Pa (3.1mm water). One filter developed meeting the 90% efficiency has ultralow pressure drop of only 18Pa (1.9mm water) while another filter meeting the 30Pa limit has high efficiency reaching 94%. These optimized filters based on rigorous engineering approach provide the badly needed technology for protecting the general public from the deadly airborne COVID-19 and other viruses, and nano-aerosols from air pollution which lead to chronic diseases.


Family Member Visits to Critically Ill Patients During COVID-19: A New Pathway (Re: Telemed J E Health 2020. [Epub ahead of print]; DOI: 10.1089/tmj.2020.29040.rb)


Letter to the Editor: Family Member Visits to Critically Ill Patients During COVID-19: A New Pathway


title: Early Experience With COVID-19 and Solid Organ Transplantation at a US High-volume Transplant Center

text: BACKGROUND: The novel coronavirus SARS-CoV-2 (COVID-19) poses unique challenges for immunosuppressed patients. Solid organ transplant recipients (SOT) comprise a large proportion of this group, yet there is limited knowledge about the presentation, clinical course and immunosuppression management of this novel infection among heart, lung, liver, pancreas and kidney transplant recipients. METHODS: We present 21 SOT diagnosed with COVID-19 between January 1, 2020 - April 22, 2020 at a US high-volume transplant center. Diagnostic workup, clinical course, immunosuppression/antiviral management and immediate outcomes are described. RESULTS: Twenty-one (15.9%) of 132 symptomatic patients tested were positive. Mean age at diagnosis was 54.8 ± 10.9 years. Median time from transplant was 5.58 years (IQR 2.25, 7.33). Median follow-up was 18 days (IQR 13, 30). Fourteen patients required inpatient management, with 7 (50%) placed in the intensive care unit (ICU). All transplant types were represented. Nearly 43% exhibited GI symptoms. Over half (56.2%) presented with elevated serum creatinine suggestive of acute kidney injury. The majority of patients (5/7) with concomitant infections at baseline required the ICU. Eighty-percent received hydroxychloroquine ± azithromycin. Ten received toclizumab and/or ribavirin; 1 received remdesivir. Antimetabolites ± calcineurin inhibitors were held or reduced. Over half of hospitalized patients (8/14) were discharged home. Only 1 mortality (4.8%) to date, in a critically-ill heart/kidney patient who had been in the ICU prior to diagnosis. CONCLUSION: COVID-19 positive SOT at our institution had favorable short-term outcomes. Those with concomitant infections had more severe illness. More data will be available to evaluate long-term outcomes and disease impact on graft function.


title: COVID-19 in older adults

text: The advent of the SARS-CoV-2 and COVID-19 pandemic has generated a lot of publications at a rapid pace. We know that older adults disproportionately suffer the most severe of COVID outcomes. Here we attempt to coalesce the key knowledge of SARS-CoV-2 biology to the disease and clinical care concepts in the context of older adults.


title: Estrogen regulates the expression of SARS-CoV-2 receptor ACE2 in differentiated airway epithelial cells

text: There is marked sexual dimorphism in the current coronavirus disease 2019 (COVID-19) pandemic. Here we report that estrogen can regulate the expression of angiotensin-converting enzyme 2 (ACE2), a key component for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cell entry, in differentiated airway epithelial cells. Further studies are required to elucidate the mechanisms by which sex steroids regulate SARS-CoV-2 infectivity.


title: Frequency of Abnormalities Detected by Point-of-Care Lung Ultrasound in Symptomatic COVID-19 Patients: Systematic Review and Meta-Analysis

text: The COVID-19 pandemic has resulted in significant morbidity, mortality, and strained healthcare systems worldwide. Thus, a search for modalities that can expedite and improve the diagnosis and management of this entity is underway. Recent data suggested the utility of lung ultrasound (LUS) in the diagnosis of COVID-19 by detecting an interstitial pattern (B-pattern). Hence, we aimed to pool the proportion of various reported lung abnormalities detected by LUS in symptomatic COVID-19 patients. We conducted a systematic review (PubMed, MEDLINE, and EMBASE until April 25, 2020) and a proportion meta-analysis. We included seven studies examining the role of LUS in 122 COVID-19 patients. The pooled proportion (PP) of B-pattern detected by lung ultrasound (US) was 0.97 (95% CI: 0.94-1.00 I 2 0%, Q 4.6). The PP of finding pleural line abnormalities was 0.70 (95% CI: 0.13-1.00 I 2 96%, Q 103.9), of pleural thickening was 0.54 (95% 0.11-0.95 I 2 93%, Q 61.1), of subpleural or pulmonary consolidation was 0.39 (95% CI: 0.21-0.58 I 2 72%, Q 17.8), and of pleural effusion was 0.14 (95% CI: 0.00-0.37 I 2 93%, Q 27.3). Our meta-analysis revealed that almost all SARS-CoV-2-infected patients have abnormal lung US. The most common abnormality is interstitial involvement depicted as B-pattern. The finding from our review highlights the potential role of this modality in the triage, diagnosis, and follow-up of COVID-19 patients. A sizable diagnostic accuracy study comparing LUS, computed tomography scan, and COVID-19-specific tests is warranted to further test this finding and to delineate the diagnostic and prognostic yield of each of these modalities.


title: Microglia influence host defense, disease, and repair following murine coronavirus infection of the central nervous system

text: The present study examines functional contributions of microglia in host defense, demyelination, and remyelination following infection of susceptible mice with a neurotropic coronavirus. Treatment with PLX5622, an inhibitor of colony stimulating factor 1 receptor (CSF1R) that efficiently depletes microglia, prior to infection of the central nervous system (CNS) with the neurotropic JHM strain of mouse hepatitis virus (JHMV) resulted in increased mortality compared with control mice that correlated with impaired control of viral replication. Single cell RNA sequencing (scRNASeq) of CD45+ cells isolated from the CNS revealed that PLX5622 treatment resulted in muted CD4+ T cell activation profile that was associated with decreased expression of transcripts encoding MHC class II and CD86 in macrophages but not dendritic cells. Evaluation of spinal cord demyelination revealed a marked increase in white matter damage in PLX5622-treated mice that corresponded with elevated expression of transcripts encoding disease-associated proteins Osteopontin (Spp1), Apolipoprotein E (Apoe), and Triggering receptor expressed on myeloid cells 2 (Trem2) that were enriched within macrophages. In addition, PLX5622 treatment dampened expression of Cystatin F (Cst7), Insulin growth factor 1 (Igf1), and lipoprotein lipase (Lpl) within macrophage populations which have been implicated in promoting repair of damaged nerve tissue and this was associated with impaired remyelination. Collectively, these findings argue that microglia tailor the CNS microenvironment to enhance control of coronavirus replication as well as dampen the severity of demyelination and influence repair.


Initial rapid and proactive response for the COVID-19 outbreak - Taiwan's experience


title: Initiation Factor 3 is Dispensable For Mitochondrial Translation in Cultured Human Cells

text: The initiation of protein synthesis in bacteria is ruled by three canonical factors: IF1, IF2, and IF3. This system persists in human mitochondria; however, it functions in a rather different way due to specialization and adaptation to the organellar micro-environment. We focused on human mitochondrial IF3, which was earlier studied in vitro, but no knock-out cellular models have been published up to date. In this work, we generated human HeLa cell lines deficient in the MTIF3 gene and analyzed their mitochondrial function. Despite the lack of IF3mt in these cells, they preserved functional mitochondria capable of oxygen consumption and protein synthesis; however, the translation of ATP6 mRNA was selectively decreased which compromised the assembly of ATP synthase. Together with the analogous results obtained earlier for baker's yeast mitochondrial IF3, our findings point to a functional divergence of mitochondrial initiation factors from their bacterial ancestors.


COVID-19: The daunting experience of healthcare workers in Sardinia, Italy


Ethical dilemmas faced by health care workers during COVID-19 pandemic: Issues, implications and suggestions


title: How the asymptomatic population is influencing the COVID-19 outbreak in India?

text: According to the current perception, symptomatic, presymptomatic, and asymptomatic infectious persons can infect the healthy population susceptible to the SARS-Cov-2. More importantly, various reports indicate that the number of asymptomatic cases can be several-fold higher than the reported symptomatic cases. In this article, we take the reported cases in India and various states within the country as the specimen to understand the progression of the COVID-19. Employing a modified SEIRD model, we predict the spread of COVID-19 by the symptomatic as well as asymptomatic infectious population. Considering reported infection primarily due to symptomatic we compare the model predicted results with the available data to estimate the dynamics of the asymptomatically infected population. Our data indicate that in the absence of the asymptomatic infectious population, the number of symptomatic cases would have been much less. Therefore, the current progress of the symptomatic infection can be reduced by quarantining the asymptomatically infectious population via extensive or random testing. This study is motivated strictly towards academic pursuit; this theoretical investigation is not meant for influencing policy decisions or public health practices.


title: Splitting one ventilator for multiple patients -- a technical assessment

text: Due to the recent coronavirus outbreak, many efforts and innovative solutions have surfaced to deal with the possible shortage of ventilators upon catastrophic surges of patients. One solution involves splitting one ventilator to treat multiple patients and is in principle easy to implement, but there are obvious risks, and little is known on how the technique would work on patients with ARDS from Covid-19. Previous studies have shown that multiple test lungs of equal characteristics can be successfully ventilated from one machine, but that large variations in tidal volume delivery occurs when lungs with different compliance are connected. In contribution to the discussion of the feasibility of the technique, a technical assessment was done including experiments expanding on the previous studies using two types of test lungs, different ventilator settings and test lung characteristics. Using two test lungs connected to a ventilator, the tidal volumes and pressures into both lungs were measured for different combinations of lung compliance, airway resistances, modes of ventilation, inspiratory and end-expiratory pressure levels. We found discrepancies in delivered tidal volumes for paired test lungs proportional with compliance differences, little influence from differences in airway resistances, and that changes in compliance of only one test lung would also change the tidal volume delivered to the other test lung when in volume controlled mode. For one of the test lung types, we also found that higher PEEP settings could strongly influence the tidal volume balance between the test lungs. From this study and from a technical point of view, we were not able to identify reliable settings, adjustments or any simple measures to overcome the hazards of this simple technique, and a more advanced solution is indicated for mitigating risks.


title: Responsible Return to Essential and Non-Essential Surgery During the COVID-19 Pandemic

text: Non-essential surgery had largely been suspended during the COVID-19 Pandemic. Enormous amounts of resources were utilized to shift surgical practices to a "disaster footing" with most elective surgeons assuming new roles to offset the anticipated burden from surgical and medical personnel delivering acute care. As the number of COVID-19-infected patients began to plateau in the state of Ohio, a four-phase "Responsible Return to Surgery" approach was adopted in concert with the Ohio Department of Health and the Ohio Hospital Association. This approach was adopted understanding that a simple return to the status quo prior to the COVID-19 pandemic might be harmful to patients, providers, and staff. The discrete phases undertaken at our quaternary care institution for a responsible return to non-essential surgery are outlined with the goal of ensuring timely care, minimizing community transmission, and preserving personal protective equipment. Operationalizing these phases relied upon the widespread use of telehealth, systematic COVID-19 testing, and real-time monitoring of hospital and personal protective equipment resources.


title: Differential occupational risk for COVID-19 and other infection exposure according to race and ethnicity

text: BACKGROUND: There are racial and ethnic disparities in the risk of contracting COVID-19. This study sought to assess how occupational segregation according to race and ethnicity may contribute to the risk of COVID-19. METHODS: Data about employment in 2019 by industry and occupation and race and ethnicity were obtained from the Bureau of Labor Statistics Current Population Survey. This data was combined with information about industries according to whether they were likely or possibly essential during the COVID-19 pandemic and the frequency of exposure to infections and close proximity to others by occupation. The percentage of workers employed in essential industries and occupations with a high risk of infection and close proximity to others by race and ethnicity was calculated. RESULTS: People of color were more likely to be employed in essential industries and in occupations with more exposure to infections and close proximity to others. Black workers in particular faced an elevated risk for all of these factors. CONCLUSION: Occupational segregation into high-risk industries and occupations likely contributes to differential risk with respect to COVID-19. Providing adequate projection to workers may help to reduce these disparities.


title: COVID-19, superinfections and antimicrobial development: What can we expect?

text: Coronavirus disease 2019 (COVID-19) arose at a time of great concern about antimicrobial resistance (AMR). No studies have specifically assessed COVID-19-associated superinfections or AMR. Based on limited data from case series, it is reasonable to anticipate that an appreciable minority of patients with severe COVID-19 will develop superinfections, most commonly pneumonia due to nosocomial bacteria and Aspergillus. Microbiology and AMR patterns are likely to reflect institutional ecology. Broad-spectrum antimicrobial use is likely to be widespread among hospitalized patients, both as directed and empiric therapy. Stewardship will have a crucial role in limiting unnecessary antimicrobial use and AMR. Congressional COVID-19 relief bills are considering antimicrobial reimbursement reforms and antimicrobial subscription models, but it is unclear if these will be included in final legislation. Prospective studies on COVID-19 superinfections are needed, data from which can inform rational antimicrobial treatment and stewardship strategies, and models for market reform and sustainable drug development.


title: SARS-CoV-2 detection by direct rRT-PCR without RNA extraction

text: Rapid and reliable screening of SARS-CoV-2 is fundamental to assess viral spread and limit the pandemic we are facing. In this study, we compared direct rRT-PCR method (without RNA extraction) using SeeGene AllplexTM 2019-nCoV rRT-PCR with the RealStar® SARS-CoV-2 rRT-PCR kit (Altona Diagnostics). Furthermore, we assessed the impact of swab storage media composition on PCR efficiency. We show that SeeGene and Altona's assays provide similar efficiency. Importantly, we provide evidence that RNA extraction can be successfully bypassed when samples are stored in UTM medium or in molecular water but not when samples are stored in saline solution and in Hanks medium.


docid: nsdsgcmf

title: Excavating SARS-coronavirus 2 genome for epitope-based subunit vaccine synthesis using immunoinformatics approach

text: Since the outbreak of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) in December 2019 in China, there has been an upsurge in the number of deaths and infected individuals throughout the world, thereby leading to the World Health Organization declaration of a pandemic. Since no specific therapy is currently available for the same, the present study was aimed to explore the SARS-CoV-2 genome for the identification of immunogenic regions using immunoinformatics approach. A series of computational tools were applied in a systematic way to identify the epitopes that could be utilized in vaccine development. The screened-out epitopes were passed through several immune filters, such as promiscuousity, conservancy, antigenicity, nonallergenicity, population coverage, nonhomologous to human proteins, and affinity with human leukocyte antigen alleles, to screen out the best possible ones. Further, a construct comprising 11 CD4, 12 CD8, 3 B cell, and 3 interferon-Î³ epitopes, along with an adjuvant ß-defensin, was designed in silico, resulting in the formation of a multiepitope vaccine. The in silico immune simulation and population coverage analysis of the vaccine sequence showed its capacity to elicit cellular, humoral, and innate immune cells and to cover up a worldwide population of more than 97%. Further, the interaction analysis of the vaccine construct with Toll-like receptor 3 (immune receptor) was carried out by docking and dynamics simulations, revealing high affinity, constancy, and pliability between the two. The overall findings suggest that the vaccine may be highly effective, and is therefore required to be tested in the lab settings to evaluate its efficacy.


title: Sniffing out the evidence; It's now time for public health bodies recognize the link between COVID-19 and smell and taste disturbance

text: Since the outbreak of the pandemic, anecdotal observations have been accumulating rapidly that sudden anosmia and dysgeusia are peculiar symptoms associated with the COVID-19 infection. Prof C. Hopkins, as President of British Rhinological Society, published a letter describing "the loss of sense of smell as a marker of COVID-19 infection" and proposed that adults presenting with anosmia but no other symptoms should self-isolate for seven days. The Hopkins team published the first case report and case series as well as other evidence that isolated sudden onset anosmia (ISOA), should be considered highly suspicious for SARS-CoV-2(1). Subsequently, a larger series of 2428 patients presenting with new onset anosmia during the COVID-19 pandemic has been reported, of whom 16% report loss of sense of smell as an isolated symptom. Only 51% reported the recognized symptoms of cough or fever. A major limitation of this series however, was a lack of access to testing to confirm the COVID-19 status of the patients(2); in the 80 who had been tested 74% were positive. In the same way, the American Academy of Otolaryngology-head and neck surgery (AA0-HNS) proposed "that anosmia could be added to the list of screening tools for possible COVID-19 infection. More, they warrant serious consideration for self-isolation and testing those patients".


title: Visualization of Diseases at Risk in the COVID-19 Literature

text: This paper presents a project, named VIDAR-19, able to extract automatically diseases from the CORD-19 dataset, and also diseases which might be considered as risk factors. The project relies on the ICD-11 classification of diseases maintained by the WHO. This nomenclature is used as a data source of the extraction mechanism, and also as the repository for the results. Developed for the COVID-19, the project has the ability to extract diseases at risk and to calculate relevant indicators. The outcome of the project is presented in a dashboard which enables the user to explore graphically diseases at risk which are put back in the classification hierarchy. Beyond the COVID-19, VIDAR has much broader applications and might be directly used for any corpus dealing with other pathologies.


[covid-19 - 2019]


title: The antiviral compound remdesivir potently inhibits RNA-dependent RNA polymerase from Middle East respiratory syndrome coronavirus

text: Antiviral drugs for managing infections with human coronaviruses are not yet approved, posing a serious challenge to current global efforts aimed at containing the outbreak of severe acute respiratory syndrome-coronavirus 2 (CoV-2). Remdesivir (RDV) is an investigational compound with a broad spectrum of antiviral activities against RNA viruses, including severe acute respiratory syndrome-CoV and Middle East respiratory syndrome (MERS-CoV). RDV is a nucleotide analog inhibitor of RNA-dependent RNA polymerases (RdRps). Here, we co-expressed the MERS-CoV nonstructural proteins nsp5, nsp7, nsp8, and nsp12 (RdRp) in insect cells as a part a polyprotein to study the mechanism of inhibition of MERS-CoV RdRp by RDV. We initially demonstrated that nsp8 and nsp12 form an active complex. The triphosphate form of the inhibitor (RDV-TP) competes with its natural counterpart ATP. Of note, the selectivity value for RDV-TP obtained here with a steady-state approach suggests that it is more efficiently incorporated than ATP and two other nucleotide analogs. Once incorporated at position i, the inhibitor caused RNA synthesis arrest at position i + 3. Hence, the likely mechanism of action is delayed RNA chain termination. The additional three nucleotides may protect the inhibitor from excision by the viral 3'-5' exonuclease activity. Together, these results help to explain the high potency of RDV against RNA viruses in cell-based assays.


Response to the letter, "The cardiovascular burden of congenital heart disease - not only in times of COVID-19"


Selenium supplementation can relieve the clinical complications of COVID-19 and other similar viral infections


title: Influence of Storage Conditions on SARS-CoV-2 Nucleic Acid Detection in Throat Swabs

text: The detection of SARS-CoV-2 infection is the premise of quarantine. In many countries or areas, samples need to be shipped or inactivated before SARS-CoV-2 testing. In this study, we checked the influence of sample storage conditions on SARS-CoV-2 nucleic acid testing results, including sample inactivation time, storage temperature, and storage time. All of these conditions caused an increase in the cycle threshold values of the nucleic acid tests and led to the misclassification of at least 10.2% of positive cases as negative or suspected. The results highlight the importance of immediate testing of samples for SARS-CoV-2 nucleic acid detection.


The prevalence of ophthalmic manifestations in COVID-19 and the diagnostic value of ocular tissue/fluid


title: The Tajima heterochronous n-coalescent: inference from heterochronously sampled molecular data

text: The observed sequence variation at a locus informs about the evolutionary history of the sample and past population size dynamics. The standard Kingman coalescent model on genealogies - timed trees that represent the ancestry of the sample - is used in a generative model of molecular sequence variation to infer evolutionary parameters. However, the state space of Kingman's genealogies grows superexponentially with sample size n, making inference computationally unfeasible already for small n. We introduce a new coalescent model called Tajima heterochronous n-coalescent with a substantially smaller cardinality of the genealogical space. This process allows to analyze samples collected at different times, a situation that in applications is both met (e.g. ancient DNA and RNA from rapidly evolving pathogens like viruses) and statistically desirable (variance reduction and parameter identifiability). We propose an algorithm to calculate the likelihood efficiently and present a Bayesian nonparametric procedure to infer the population size trajectory. We provide a new MCMC sampler to explore the space of Tajima's genealogies and model parameters. We compare our procedure with state-of-the-art methodologies in simulations and applications. We use our method to re-examine the scientific question of how Beringian bison went extinct analyzing modern and ancient molecular sequences of bison in North America, and to reconstruct population size trajectory of SARS-CoV-2 from viral sequences collected in France and Germany.


title: Raccomandazioni di etica clinica per l'ammissione a trattamenti intensivi e per la loro sospensione, in condizioni eccezionali di squilibrio tra necessità e risorse disponibili./ [Clinical ethics recommendations for the allocation of intensive care treatments, in exceptional, resource-limited circumstances.]

text: On February 21st, 2020 the first case of severe acute respiratory syndrome due to the coronavirus 2 (SARS-CoV-2) causing the CoViD-19 disease, was identified in Italy. In the following days, despite the restrictive public health measures aimed to avoid the infection's spread, the number of cases increased. As of March 8th, 2020, Italy is the 2nd most affected country in the world. As of March 6th, 2020, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) published operational recommendations and ethical considerations to support the clinicians involved in the care of critically-ill CoViD-19 patients, in regard a probable scenario where an imbalance between supply and demand of ICU beds, is put in place by a steadily rising number of these patients.


Correction to Lancet Glob Health 2020; published online Feb 28. https://doi.org/10.1016/S2214-109X(20)30074-7


title: Causal Inference on Networks under Continuous Treatment Interference

text: This paper presents a methodology to draw causal inference in a non-experimental setting subject to network interference. Specifically, we develop a generalized propensity score-based estimator that allows us to estimate both direct and spillover effects of a continuous treatment, which spreads through weighted and directed edges of a network. To showcase this methodology, we investigate whether and how spillover effects shape the optimal level of policy interventions in agricultural markets. Our results show that, in this context, neglecting interference may lead to a downward bias when assessing policy effectiveness.


title: Coronavirus, Ageism, and Twitter: An Evaluation of Tweets about Older Adults and COVID-19

text: OBJECTIVES: In March 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic. High morbidity and mortality rates of COVID-19 have been observed among older adults and widely reported in both mainstream and social media. The objective of this study was to analyze tweets related to COVID-19 and older adults, and to identify ageist content. DESIGN: We obtained a representative sample of original tweets containing the keywords "elderly," "older," and/or "boomer" plus the hashtags "#COVID19" and/or "#coronavirus." SETTING: Tweets posted between March 12 and March 21, 2020. MEASUREMENTS: We identified the type of user and number of followers for each account. Tweets were classified by three raters as (1) informative, (2) personal accounts, (3) personal opinions, (4) advice seeking, (5) jokes, and (6) miscellaneous. Potentially offensive content, as well as that downplaying the severity of COVID-19 because it mostly affects older adults, was identified. RESULTS: A total of 18,128 tweets were obtained, of which a random sample of 351 was analyzed. Most accounts (91.7%) belonged to individuals. The most common types of tweets were personal opinions (31.9%), followed by informative tweets (29.6%), jokes/ridicule (14.3%), and personal accounts (13.4%). Overall, 72 tweets (21.9%) likely intended to ridicule or offend someone and 21.1% had content implying that the life of older adults was less valuable or downplayed the relevance of COVID-19. CONCLUSION: Most tweets related to COVID-19 and older adults contained personal opinions, personal accounts, and jokes. Almost one-quarter of analyzed tweets had ageist or potentially offensive content toward older adults.


Managing bioanalytical studies during the COVID-19 pandemic: an overview


title: Secondary Transmission of Coronavirus Disease from Presymptomatic Persons, China

text: We explored the secondary attack rate in different types of contact with persons presymptomatic for coronavirus disease (COVID-19). Close contacts who lived with or had frequent contact with an index case-patient had a higher risk for COVID-19. Our findings provide population-based evidence for transmission from persons with presymptomatic COVID-19 infections.


docid: lhwkthzx

title: Evidence for Use or Disuse of Renin-Angiotensin System Modulators in Patients Having COVID-19 With an Underlying Cardiorenal Disorder

text: Coronavirus disease 19 (COVID-19) originated in Wuhan, China, in December 2019 has been declared pandemic by World Health Organization due to an exponential rise in the number of infected and deceased persons across the globe. Emerging reports suggest that susceptibility and mortality rates are higher in patients with certain comorbidities when compared to the average population. Cardiovascular diseases and diabetes are important risk factors for a lethal outcome of COVID-19. Extensive research ensuing the outbreak of coronavirus-related severe acute respiratory syndrome in the year 2003, and COVID-19 recently revealed a role of renin-angiotensin system (RAS) components in the entry of coronavirus wherein angiotensin-converting enzyme 2 (ACE2) had garnered the significant attention. This raises the question whether the use of RAS inhibitors, the backbone of treatment of cardiovascular, neurovascular, and kidney diseases could increase the susceptibility for coronavirus infection or unfortunate outcomes of COVID-19. Thus, currently, there is a lack of consensus regarding the effects of RAS inhibitors in such patients. Moreover, expert bodies like American Heart Association, American College of Cardiology, and so on have now released official statements that RAS inhibitors must be continued, unless suggested otherwise by a physician. In this brief review, we will elaborate on the role of RAS and ACE2 in pathogenesis of COVID-19. Moreover, we will discuss the potential effect of the use and disuse of RAS inhibitors in patients having COVID-19 with cardiometabolic comorbidities.


title: The role of biomarkers in diagnosis of COVID-19 - A systematic review

text: AIMS: As of the 28th April 2020, the COVID-19 pandemic has infiltrated over 200 countries and affected over three million confirmed people. We review different biomarkers to evaluate if they are able to predict clinical outcomes and correlate with the severity of COVID-19 disease. METHODS: A systematic review of the literature was carried out to identify relevant articles using six different databases. Keywords to refine the search included 'COVID-19', 'SARS-CoV2', 'Biomarkers', among others. Only studies which reported data on pre-defined outcomes were included. KEY FINDINGS: Thirty-four relevant articles were identified which reviewed the following biomarkers: C-reactive protein, serum amyloid A, interleukin-6, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, D-dimer, cardiac troponin, renal biomarkers, lymphocytes and platelet count. Of these, all but two, showed significantly higher levels in patients with severe complications of COVID-19 infection compared to their non-severe counterparts. Lymphocytes and platelet count showed significantly lower levels in severe patients compared to non-severe patients. SIGNIFICANCE: Although research is still in its early stages, the discovery of how different biomarkers behave during the course of the disease could help clinicians in identifying severe disease earlier and subsequently improve prognosis. Nevertheless, we urge for more research across the globe to corroborate these findings.