title: Coronavirus in water environments: Occurrence, persistence and concentration methods - A scoping review

text: Coronaviruses (CoV) are a large family of viruses causing a spectrum of disease ranging from the common cold to more severe diseases as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). The recent outbreak of coronavirus disease 2019 (COVID-19) has become a public health emergency worldwide. SARS-CoV-2, the virus responsible for COVID-19, is spread by human-to-human transmission via droplets or direct contact. However, since SARS-CoV-2 (as well as other coronaviruses) has been found in the fecal samples and anal swabs of some patients, the possibility of fecal-oral (including waterborne) transmission need to be investigated and clarified. This scoping review was conducted to summarize research data on CoV in water environments. A literature survey was conducted using the electronic databases PubMed, EMBASE, and Web Science Core Collection. This comprehensive research yielded more than 3000 records, but only 12 met the criteria and were included and discussed in this review. In detail, the review captured relevant studies investigating three main areas: 1) CoV persistence/survival in waters; 2) CoV occurrence in water environments; 3) methods for recovery of CoV from waters. The data available suggest that: i) CoV seems to have a low stability in the environment and is very sensitive to oxidants, like chlorine; ii) CoV appears to be inactivated significantly faster in water than non-enveloped human enteric viruses with known waterborne transmission; iii) temperature is an important factor influencing viral survival (the titer of infectious virus declines more rapidly at 23°C-25 °C than at 4 °C); iv) there is no current evidence that human coronaviruses are present in surface or ground waters or are transmitted through contaminated drinking-water; v) further research is needed to adapt to enveloped viruses the methods commonly used for sampling and concentration of enteric, non enveloped viruses from water environments. The evidence-based knowledge reported in this paper is useful to support risk analysis processes within the drinking and wastewater chain (i.e., water and sanitation safety planning) to protect human health from exposure to coronavirus through water.


Key elements of preparedness for pandemic coronavirus disease 2019 (COVID-19) in nuclear medicine units


title: Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review

text: At the end of 2019 a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing severe acute respiratory syndrome expanded globally from Wuhan, China. In March 2020 the World Health Organization declared the SARS-Cov-2 virus a global pandemic. We performed a narrative review to describe existing literature with regard to Corona Virus Disease 2019 (COVID-19) epidemiology, pathophysiology, diagnosis, management and future perspective. MEDLINE, EMBASE and Scopus databases were searched for relevant articles. Although only when the pandemic ends it will be possible to assess the full health, social and economic impact of this global disaster, this review represents a picture of the current state of the art. In particular, we focus on public health impact, pathophysiology and clinical manifestations, diagnosis, case management, emergency response and preparedness.


title: Is COVID-19 associated thrombosis caused by overactivation of the complement cascade? A literature review

text: Severe acute respiratory syndrome coronavirus 2 is responsible for the current COVID-19 pandemic resulting in an escalating number of cases and fatalities worldwide. Preliminary evidence from these patients, as well as past coronavirus epidemics, indicates that those infected suffer from disproportionate complement activation as well as excessive coagulation, leading to thrombotic complications and poor outcome. In non-coronavirus cohorts, evidence has accumulated of an interaction between the complement and coagulation systems, with one amplifying activation of the other. A pressing question is therefore if COVID-19 associated thrombosis could be caused by overactivation of the complement cascade? In this review, we summarize the literature on thrombotic complications in COVID-19, complement activation in coronavirus infections, and the crosstalk between the complement and coagulation systems. We demonstrate how the complement system is able to activate the coagulation cascade and platelets, inhibit fibrinolysis and stimulate endothelial cells. We also describe how these interactions see clinical relevance in several disorders where overactive complement results in a prothrombotic clinical presentation, and how it could be clinically relevant in COVID-19.


title: Systematic review of international guidelines for tracheostomy in COVID-19 patients

text: At this moment, the world lives under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that carry a particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures in demand at this moment is tracheostomy due the increasing ICU admissions. This review of international guidelines for tracheostomy in COVID-19 infected patients, aims to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy, from all over the world.


Herpes zoster in COVID-19-positive patients


Management of CLL patients early in the COVID-19 pandemic: An international survey of CLL experts


title: Two-layer Thermally Driven Turbulence: Mechanisms for Interface Breakup

text: It is commonly accepted that the breakup criteria of drops or bubbles in turbulence is governed by surface tension and inertia. However, also {\it{buoyancy}} can play an important role at breakup. In order to better understand this role, here we numerically study Rayleigh-B\'enard convection for two immiscible fluid layers, in order to identify the effects of buoyancy on interface breakup. We explore the parameter space spanned by the Weber number $5\leq We \leq 5000$ (the ratio of inertia to surface tension) and the density ratio between the two fluids $0.001 \leq \Lambda \leq 1$, at fixed Rayleigh number $Ra=10^8$ and Prandtl number $Pr=1$. At low $We$, the interface undulates due to plumes. When $We$ is larger than a critical value, the interface eventually breaks up. Depending on $\Lambda$, two breakup types are observed: The first type occurs at small $\Lambda \ll 1$ (e.g. air-water systems) when local filament thicknesses exceed the Hinze length scale. The second, strikingly different, type occurs at large $\Lambda$ with roughly $0.5<\Lambda \le 1$ (e.g. oil-water systems): The layers undergo a periodic overturning caused by buoyancy overwhelming surface tension. For both types the breakup criteria can be derived from force balance arguments and show good agreement with the numerical results.


title: Impact of Covid-19 lockdown on characteristics of autopsy cases in Greece. Comparison between 2019 and 2020

text: In order to reduce transmission of COVID-19, social distancing measures were proposed, including spatial distancing (2m distance), or even generalized lockdown. Main concern was to prevent overwhelming of the healthcare systems, mainly of the intensive care units (ICUs) by decreasing the spreading of the disease. In Greece, the Government, after consulting with experts in the fields of infectious disease and epidemiology, implemented a rather aggressive stance with an early lockdown. Aim of our study, is to identify and compare the characteristics of cases referred for autopsy during the first month of the lockdown period for the COVID-19 outbreak, versus the cases referred during the same period in 2019. 231 autopsy cases were included in our study, 125 in 2019 and 106 in 2020. Regarding gender, age and nationality, no significant differences were detected between the two time periods. Age subgroup analysis demonstrated increased number of cases within the age group 70-79 years, in 2020. As to the place of death, the increase in the percentage of out-of-hospital deaths was not confirmed as statistically significant. Regarding type of death (violent, sudden/unexpected), the drop of violent deaths in the 2020 examined period, was not confirmed as statistically significant; however, further subgroup analysis showed a significant drop of fatal injuries resulting from road traffic accidents in the 2020 period. The slight increase of sudden/unexpected deaths, especially myocardial infarction cases, did not reach statistical significance. One month after lockdown, we cannot detect significant differences in the two time periods examined. Further study should be conducted soon when more data will become available. Frequency of fatal myocardial infarction seems to remain unaffected by the COVID-19 pandemic while deaths resulting from road traffic accidents exhibit a significant decrease. Homicides and suicides remain at low levels, in our jurisdiction area, seemingly unaffected by the COVID-19 outbreak and the subsequent lockdown. It appears that since sudden/unexpected deaths, statistically remain unaffected, the preventive measures taken by the Greek authorities prevented overwhelming of the healthcare system, which could function properly.


title: Improving Detection and Response to Respiratory Events - Kenya, April 2016-April 2020

text: Respiratory pathogens, such as novel influenza A viruses, Middle East respiratory syndrome coronavirus (MERS-CoV), and now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are of particular concern because of their high transmissibility and history of global spread (1). Clusters of severe respiratory disease are challenging to investigate, especially in resource-limited settings, and disease etiology often is not well understood. In 2014, endorsed by the Group of Seven (G7),* the Global Health Security Agenda (GHSA) was established to help build country capacity to prevent, detect, and respond to infectious disease threats. GHSA is a multinational, multisectoral collaboration to support countries towards full implementation of the World Health Organization's International Health Regulations (IHR).§ Initially, 11 technical areas for collaborator participation were identified to meet GHSA goals. CDC developed the Detection and Response to Respiratory Events (DaRRE) strategy in 2014 to enhance country capacity to identify and control respiratory disease outbreaks. DaRRE initiatives support the four of 11 GHSA technical areas that CDC focuses on: surveillance, laboratory capacity, emergency operations, and workforce development.¶ In 2016, Kenya was selected to pilot DaRRE because of its existing respiratory disease surveillance and laboratory platforms and well-developed Field Epidemiology and Laboratory Training Program (FELTP) (2). During 2016-2020, Kenya's DaRRE partners (CDC, the Kenya Ministry of Health [MoH], and Kenya's county public health officials) conceptualized, planned, and implemented key components of DaRRE. Activities were selected based on existing capacity and determined by the Kenya MoH and included 1) expansion of severe acute respiratory illness (SARI) surveillance sites; 2) piloting of community event-based surveillance; 3) expansion of laboratory diagnostic capacity; 4) training of public health practitioners in detection, investigation, and response to respiratory threats; and 5) improvement of response capacity by the national emergency operations center (EOC). Progress on DaRRE activity implementation was assessed throughout the process. This pilot in Kenya demonstrated that DaRRE can support IHR requirements and can capitalize on a country's existing resources by tailoring tools to improve public health preparedness based on countries' needs.


title: Adaptation of Russian population to SARS-CoV-2: Asymptomatic course, comorbidities, mortality, and other respiratory viruses - A reply to Fear versus Data: Short Communication to International Journal of Antimicrobial Agents

text: In the current research, we report results of our studying SARS-CoV-2 spread in Russia and adaptation of Russian population to it in March-June 2020. Two groups of people have been investigated: 1) 12,082 persons already proven positive for SARS-CoV-2 (clinical information is studied); 2) 7,864+4,458 persons with respiratory suspicions (PCR tests and clinical information). In the latter, SARS-CoV-2 positive persons comprised 5.37% in March and 11.42% in June 2020. A number of viral co-infections was observed for SARS-CoV-2. Rhinoviruses accounted for the largest co-infection part (7.91% of samples tested positive for SARS-CoV-2); respiratory syncytial virus 7.03%; adenoviruses 4.84%; metapneumoviruses 3.29%; parainfluenza viruses 2.42%; enterovirus D68 1.10% and some other viruses (entero-, echo-, parecho-) less than 1%. In the group of 12,537 humans, SARS-CoV-2 case fatality rate was determined to be 0.6% on average (in contrast with official Russian governmental statistics that reports 1.5% mortality). It is within range of mortality caused by other common seasonal respiratory viruses (0.01-2.21% in Russia in 2012-2020 range). Most of deaths were of people with other comorbidities, also similar with different respiratory viruses. Proportion of SARS-CoV-2 asymptomatic carriers was 56.68% in March and 70.67% in June 2020. Obviously, this new pathogen presents a substantial risk to human population, as it was not contained at the very beginning of its outbreak in Wuhan and spread to the whole world. However, measures of its surveillance, prevention and treatment must be strictly evidence-based and not dictated by fear.


Psychosocial Impact of COVID-19 on Older Adults: A Cultural Geriatric Mental Health-Care Perspectived


Farm resilience in the face of the unexpected: lessons from the COVID-19 pandemic


Deep brain stimulation telemedicine for psychiatric patients during the COVID-19 pandemic


title: A simple iterative map forecast of the COVID-19 pandemic

text: We develop a simple 3-dimensional iterative map model to forecast the global spread of the coronavirus disease. Our model contains at most two fitting parameters, which we determine from the data supplied by the world health organisation for the total number of cases and new cases each day. We find that our model provides a surprisingly good fit to the currently-available data, which exhibits a cross-over from exponential to power-law growth, as lock-down measures begin to take effect. Before these measures, our model predicts exponential growth from day 30 to 69, starting from the date on which the world health organisation provided the first `Situation report' (21 January 2020 $-$ day 1). Based on this initial data the disease may be expected to infect approximately 23% of the global population, i.e. about 1.76 billion people, taking approximately 83 million lives. Under this scenario, the global number of new cases is predicted to peak on day 133 (about the middle of May 2020), with an estimated 60 million new cases per day. If current lock-down measures can be maintained, our model predicts power law growth from day 69 onward. Such growth is comparatively slow and would have to continue for several decades before a sufficient number of people (at least 23% of the global population) have developed immunity to the disease through being infected. Lock-down measures appear to be very effective in postponing the unimaginably large peak in the daily number of new cases that would occur in the absence of any interventions. However, should these measure be relaxed, the spread of the disease will most likely revert back to its original exponential growth pattern. As such, the duration and severity of the lock-down measures should be carefully timed against their potentially devastating impact on the world economy.


Self-reported olfactory loss in COVID-19: is it really a favorable prognostic factor?


COVID-19 immunity passports and vaccination certificates: scientific, equitable, and legal challenges


Covid-19 med akutte magesmerter som debutsymptom./ Covid-19 med akutte magesmerter som debutsymptom./ Acute abdomen as an early symptom of COVID-19


WITHDRAWN: Community pharmacists: On the frontline of health service against COVID-19 in LMICs


docid: amdtrasf

title: Seattle's covid-19 lessons are yielding hope


Corona-Krise und die politischen Maßnahmen: Gedanken von BVDD und DDG


title: Insights from early mathematical models of 2019-nCoV acute respiratory disease (COVID-19) dynamics

text: In December 2019, a novel coronavirus (SARS-CoV-2) has been identified to cause acute respiratory disease in humans. An outbreak of this disease has been reported in mainland China with the city of Wuhan as the recognized epicenter. The disease has also been exported to other countries, including the Philippines, but the level of spread is still under control (as of 08 February 2020). To describe and predict the dynamics of the disease, several preliminary mathematical models are formulated by various international study groups. Here, the insights that can be drawn from these models are discussed, especially as inputs for designing strategies to control the epidemics. Proposed model-based strategies on how to prevent the spread of the disease in local setting, such as during large social gatherings, are also presented. The model shows that the exposure time is a significant factor in spreading the disease. With a basic reproduction number equal to 2, and 14-day infectious period, an infected person staying more than 9 hours in the event could infect other people. Assuming the exposure time is 18 hours, the model recommends that attendees of the social gathering should have a protection with more than 70 percent effectiveness.


Oral manifestations in COVID-19 patients


Renin-Angiotensin-Aldosterone Inhibitors and Susceptibility to and Severity of COVID-19


Failure of free flaps in head and neck oncology surgery in COVID-19 patients


Challenges in the Production of Convalescent Hyperimmune Plasma in the Age of COVID-19


Lesiones cutáneas acro-isquémicas durante la epidemia COVID-19./ [Acro-ischemic skin lesions during COVID-19 epidemic]


Pautas éticas para la asignación de recursos sanitarios escasos en el marco de la pandemia por COVID-19 en Colombia


Incidencia de COVID-19 entre los profesionales de oftalmología./ Incidencia de COVID-19 entre los profesionales de oftalmología./ Incidence of COVID-19 among ophthalmology professionals


Free 24-hour specialist support during Covid-19


Brachytherapy during the COVID-19- Lessons from Iran


Leveraging e-learning for medical education in low- and middle-income countries


title: Being a dentist in the pandemic

text: Data sources The authors provide no detail as to how the review was undertaken. Therefore the paper does not provide any methodological processes for data extraction. The paper describes the assimilation of available information regarding 2019-nCoV at the time of writing. The authors provide information on the COVID-19 pandemic in order to inform front-line dentists.The paper is as essay on the available information relating to:Background to the pandemicâ¢ Coronaviruses in generalâ¢ Pathogenesisâ¢ COVID-19â¢ Clinical manifestationsâ¢ Patient characteristicsâ¢ Diagnosisâ¢ Protocol for managing the disease in the clinical settingâ¢ Transmission dynamicsâ¢ Transmission dynamics in dentistry practiceâ¢ Infection controlâ¢ Mouth rinsesâ¢ Rubber dam isolationâ¢ Anti-retraction handpieceâ¢ Appropriate disinfectantsâ¢ Management of medical waste.Conclusions Face-to-face communication and consistent exposure to body fluids such as blood and saliva predispose dental care workers to risk of infection and there is high risk of cross-infection. The authors apply available international guidelines to provide a protocol for managing possible exposure to patients or those suspected of having a 2019-nCoV infection. Dentists play a significant role in disrupting the transmission trail of the virus by simply postponing non-emergency care for all patients.


Adoption of telerehabilitation in a developing country before and during the COVID-19 pandemic


Le nouveau Coronavirus Covid-19 : quels risques ophtalmiques ?/ [The novel coronavirus Covid-19: What are the ophthalmic risks?]


The Landscape of Prescription Drug Shortages During the COVID-19 Pandemic


docid: pcrqdroq

title: A Hybrid Natural Language Generation System Integrating Rules and Deep Learning Algorithms

text: This paper proposes an enhanced natural language generation system combining the merits of both rule-based approaches and modern deep learning algorithms, boosting its performance to the extent where the generated textual content is capable of exhibiting agile human-writing styles and the content logic of which is highly controllable. We also come up with a novel approach called HMCU to measure the performance of the natural language processing comprehensively and precisely.


title: Variable computed tomography appearances of COVID-19

text: The coronavirus disease 2019 (COVID-19) is typically diagnosed by specific assays that detect viral nucleic acid from the upper respiratory tract; however, this may miss infections involving only the lower airways. Computed tomography (CT) has been described as a diagnostic modality in the COVID-19 diagnosis and treatment plan. We present a case series with virologically confirmed COVID-19 pneumonia. Variable CT features were observed: consolidation with ground-glass opacities, ground-glass opacities with subpleural reticular bands, and an anterior-posterior gradient of lung abnormalities resembling that of acute respiratory distress syndrome. In one patient, we noted evolution of CT findings, where there was interval resolution of bilateral lung consolidation with development of bronchiolectasis and subpleural fibrotic bands. While sensitive for detecting lung parenchymal abnormalities in COVID-19 pneumonia, CT for initial diagnosis is discouraged and should be reserved for specific clinical indications. Interpretation of chest CT findings should be correlated with duration of symptoms to better determine the disease stage and aid in patient management.


docid: ixxejiqu

title: COVID-19 and pulmonary embolism: an unwanted alliance


Philadelphia-positive acute lymphoblastic leukaemia (ALL) in Italy during the COVID-19 pandemic: a Campus ALL study


docid: jaofxzap

title: Current methods for development of rapid reviews about diagnostic tests: an international survey

text: BACKGROUND: Rapid reviews (RRs) have emerged as an efficient alternative to time-consuming systematic reviews-they can help meet the demand for accelerated evidence synthesis to inform decision-making in healthcare. The synthesis of diagnostic evidence has important methodological challenges. Here, we performed an international survey to identify the current practice of producing RRs for diagnostic tests. METHODS: We developed and administered an online survey inviting institutions that perform RRs of diagnostic tests from all over the world. RESULTS: All participants (N = 25) reported the implementation of one or more methods to define the scope of the RR; however, only one strategy (defining a structured question) was used by ≥90% of participants. All participants used at least one methodological shortcut including the use of a previous review as a starting point (92%) and the use of limits on the search (96%). Parallelization and automation of review tasks were not extensively used (48 and 20%, respectively). CONCLUSION: Our survey indicates a greater use of shortcuts and limits for conducting diagnostic test RRs versus the results of a recent scoping review analyzing published RRs. Several shortcuts are used without knowing how their implementation affects the results of the evidence synthesis in the setting of diagnostic test reviews. Thus, a structured evaluation of the challenges and implications of the adoption of these RR methods is warranted.


Potentially irreversible olfactory and gustatory impairments in COVID-19: Indolent vs. fulminant SARS-CoV-2 neuroinfection


COVID-19 crisis: an extraordinary time for collaboration and science-a call for leadership, now and beyond


Impact of the COVID-19 pandemic on ongoing cardiovascular research projects: considerations and adaptations


title: A Comprehensive Analysis of Clinical Trials in the COVID-19 Pandemic Era

text: Background and objective: Despite medical advances, we are facing the unprecedented disaster of the coronavirus disease 2019 (COVID-19) pandemic without available treatments and effective vaccines. As the COVID-19 pandemic has approached its culmination, desperate efforts have been made to seek proper treatments and response strategies, and the number of clinical trials has been rapidly increasing. In this time of the pandemic, it is believed that learning lessons from it would be meaningful in preparing for future pandemics. Thus, this study aims at providing a comprehensive landscape of COVID-19 related clinical trials based on the ClinicalTrials.gov database. Materials and methods: Up to 30 March 2020, we identified a total of 147 eligible clinical trials and reviewed the overview of the studies. Results: Until then, the most clinical trials were set up in China. Treatment approaches are the most frequent purpose of the registered studies. Chloroquine, interferon, and antiviral agents such as remdesivir, lopinavir, and ritonavir are agents under investigation in these trials. Conclusions: In this study, we introduced the promising therapeutic options that many researchers and clinicians are interested in, and to address the hidden issues behind clinical trials in this COVID-19 pandemic.


Facial Abrikosoff tumour: The role of the dermatologist during COVID-19 pandemic


title: Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial

text: BACKGROUND: A vaccine to protect against COVID-19 is urgently needed. We aimed to assess the safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 (Ad5) vectored COVID-19 vaccine expressing the spike glycoprotein of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain. METHODS: We did a dose-escalation, single-centre, open-label, non-randomised, phase 1 trial of an Ad5 vectored COVID-19 vaccine in Wuhan, China. Healthy adults aged between 18 and 60 years were sequentially enrolled and allocated to one of three dose groups (5â×â1010, 1â×â1011, and 1·5â×â1011 viral particles) to receive an intramuscular injection of vaccine. The primary outcome was adverse events in the 7 days post-vaccination. Safety was assessed over 28 days post-vaccination. Specific antibodies were measured with ELISA, and the neutralising antibody responses induced by vaccination were detected with SARS-CoV-2 virus neutralisation and pseudovirus neutralisation tests. T-cell responses were assessed by enzyme-linked immunospot and flow-cytometry assays. This study is registered with ClinicalTrials.gov, NCT04313127. FINDINGS: Between March 16 and March 27, 2020, we screened 195 individuals for eligibility. Of them, 108 participants (51% male, 49% female; mean age 36·3 years) were recruited and received the low dose (n=36), middle dose (n=36), or high dose (n=36) of the vaccine. All enrolled participants were included in the analysis. At least one adverse reaction within the first 7 days after the vaccination was reported in 30 (83%) participants in the low dose group, 30 (83%) participants in the middle dose group, and 27 (75%) participants in the high dose group. The most common injection site adverse reaction was pain, which was reported in 58 (54%) vaccine recipients, and the most commonly reported systematic adverse reactions were fever (50 [46%]), fatigue (47 [44%]), headache (42 [39%]), and muscle pain (18 [17%]. Most adverse reactions that were reported in all dose groups were mild or moderate in severity. No serious adverse event was noted within 28 days post-vaccination. ELISA antibodies and neutralising antibodies increased significantly at day 14, and peaked 28 days post-vaccination. Specific T-cell response peaked at day 14 post-vaccination. INTERPRETATION: The Ad5 vectored COVID-19 vaccine is tolerable and immunogenic at 28 days post-vaccination. Humoral responses against SARS-CoV-2 peaked at day 28 post-vaccination in healthy adults, and rapid specific T-cell responses were noted from day 14 post-vaccination. Our findings suggest that the Ad5 vectored COVID-19 vaccine warrants further investigation. FUNDING: National Key R&D Program of China, National Science and Technology Major Project, and CanSino Biologics.


title: Policies and practices of SHEA Research Network hospitals during the COVID-19 pandemic

text: To understand hospital policies and practices as the COVID-19 pandemic accelerated, the Society for Healthcare Epidemiology of America (SHEA) conducted a survey through the SHEA Research Network (SRN). The survey assessed policies and practices around the optimization of personal protection equipment (PPE), testing, healthcare personnel policies, visitors of COVID-19 patients in relation to procedures, and types of patients. Overall, 69 individual healthcare facilities responded in the United States and internationally, for a 73% response rate.


title: [Healing the schism between public health and medicine, promoting the integration of prevention and treatment]

text: It has been nearly 30 years since the publication of "Healing the Schism: Epidemiology, Medicine, and the Public's Health" by Professor Kerr L. White. Although scholars have been calling for strengthening the integration of public health and clinical medicine in Chinese medical education and eliminating barriers between public health professionals and clinicians, these effects are not obvious. The epidemic situation of COVID-19 has become an open course for Chinese citizens on the treatment, prevention and control of infectious diseases. Consequently, the public has higher expectations on the modernization of public health governance, and the social atmosphere of bridging the gap between public health and clinical medical education has been establishing. In the future, when combating with novel infectious diseases and public health emergencies, the response capacity of public health system and treatment capacity of clinical system in China will be significantly improved, and the situation of insufficient integration of medical treatment and prevention is bound to be reversed.


Covid-19: Women's health campaigners sue FDA over access to medical abortion pills


Festina lente: hydroxychloroquine, COVID-19 and the role of the rheumatologist


title: Well-controlled vs poorly-controlled diabetes in patients with COVID-19: Are there any differences in outcomes and imaging findings?

text: AIMS: We aimed to compare the clinical outcomes and imaging findings between COVID-19 patients with well-controlled diabetes and those with poorly-controlled diabetes. METHODS: In this retrospective single-center study, 117 patients with coexistent COVID-19 and type 2 diabetes mellitus were included. Patients were divided into two groups based on HbA1c values. Clinical data and laboratory parameters were collected from patients' medical records. Also, the chest computed tomography (CT) score was defined by the summation of individual scores from 5 lung lobes: scores of 0, 1, 2, 3, 4 and 5 were respectively assigned for each lobe if pulmonary involvement was 0%, less than 5%, 5%-25%, 26%-49%, 50%-75%, or more than 75% of each region. RESULTS: Among all patients with diabetes, 93 (79.5%) patients had poorly-controlled diabetes and 24 (20.5%) had well-controlled diabetes; 66 (56.4%) patients were male and the median age was 66 years (IQR, 55-75 years). The chest CT severity scores were not significantly different between patients with well-controlled diabetes and those with poorly-controlled diabetes (p = 0.33). Also, the mortality and recovery rates were similar between the two groups (p = 0.54 and p = 0.85, respectively). CONCLUSION: Based on the results, clinical outcomes and chest CT severity scores are similar between patients with well-controlled and poorly-controlled diabetes among the Iranian population with COVID-19.


title: Venous Thromboembolism Complicated with COVID-19: What Do We Know So Far?

text: Coronavirus disease (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is responsible for the ongoing 2019-2020 pandemic. Venous thromboembolism (VTE), a frequent cardiovascular and/or respiratory complication among hospitalized patients, is one of the known sequelae of the illness. Hospitalized COVID-19 patients are often elderly, immobile, and show signs of coagulopathy. Therefore, it is reasonable to assume a high incidence of VTE among these patients. Presently, the incidence of VTE is estimated at around 25% of patients hospitalized in the intensive care unit for COVID-19 even under anticoagulant treatment at prophylactic doses. In this review, we discuss present knowledge of the topic, the unique challenges of diagnosis and treatment of VTE, as well as some of the potential mechanisms of increased risk for VTE during the illness. Understanding the true impact of VTE on patients with COVID-19 will potentially improve our ability to reach a timely diagnosis and initiate proper treatment, mitigating the risk for this susceptible population during a complicated disease.


title: Only strict quarantine measures can curb the coronavirus disease (COVID-19) outbreak in Italy, 2020

text: Several Italian towns are under lockdown to contain the COVID-19 outbreak. The level of transmission reduction required for physical distancing interventions to mitigate the epidemic is a crucial question. We show that very high adherence to community quarantine (total stay-home policy) and a small household size is necessary for curbing the outbreak in a locked-down town. The larger the household size and amount of time in the public, the longer the lockdown period needed.


Similarities between COVID-19 and anti-MDA5 syndrome: what can we learn for better care?


title: The chronicle of COVID-19: possible strategies to curb the pandemic

text: COVID-19, an epidemic that emerged in Wuhan, has become a pandemic affecting worldwide and is in a rapidly evolving condition. Day by day, the confirmed cases and deaths are increasing many folds. SARS-CoV-2 is a novel virus; therefore, limited data are available to curb the disease. Epidemiological approaches, isolation, quarantine, social distancing, lockdown, and curfew are being employed to halt the spread of the disease. Individual and joint efforts all over the world are producing a wealth of data and information which are expected to produce therapeutic strategies against COVID-19. Current research focuses on the utilization of antiviral drugs, repurposing strategies, vaccine development as well as basic to advanced research about the organism and the infection. The review focuses on the life cycle, targets, and possible therapeutic strategies, which can lead to further research and development of COVID-19 therapy.


title: Photobiomodulation: Shining Light on COVID-19

text: Objective: To evaluate the hypothesis that light could reduce the lethality of COVID-19. Methods: Most models for projections of the spread and lethality of COVID-19 take into account the ambient temperature, neglecting light. Recent advances in understanding the mechanism of action of COVID-19 have shown that it causes a systemic infection that significantly affects the hematopoietic system and hemostasis, factors extremely dependent of light, mainly in the region of visible and infrared radiation. Results: In the COVID-19 patients hemoglobin is decreasing and protoporphyrin is increasing, generating an extremely harmful accumulation of iron ions in the bloodstream, which are able to induce an intense inflammatory process in the body with a consequent increase in C-reactive protein and albumin. Observing the unsaturation characteristics of the cyclic porphyrin ring allows it to absorb and emit radiation mainly in the visible region. This characteristic can represent an important differential to change this process in the event of an imbalance in this system, through the photobiomodulation to increase the production of adenosine triphosphate (ATP) using red and near-infrared radiation (R-NIR) and vitamin D using ultraviolet B (UVB) radiation. These two compounds have the primary role of activating the defense mechanisms of the immune system, enabling greater resistance of the individual against the attack by the virus. According to the theory of electron excitation in photosensitive molecules, similar to hemoglobin heme, after the photon absorption there would be an increase in the stability of the iron ion bond with the center of the pyrrole ring, preventing the losses of heme function oxygen transport (HbO2). The light is also absorbed by cytochrome c oxidase in the R-NIR region, with a consequent increase in electron transport, regulating enzyme activity and resulting in a significant increase of oxygen rate consumption by mitochondria, increasing ATP production. Conclusions: The most favorable range of optical radiation to operate in this system is between R-NIR region, in which cytochrome c oxidase and porphyrin present absorption peaks centered at 640 nm and HbO2 with absorption peak centered at 900 nm. Based on the mechanisms described earlier, our hypothesis is that light could reduce the lethality of COVID-19.


title: Stimulator of IFN genes mediates neuroinflammatory injury by suppressing AMPK signal in experimental subarachnoid hemorrhage

text: BACKGROUND: Neuroinflammation is closely associated with the poor prognosis in subarachnoid hemorrhage (SAH) patients. This study was aimed to determine the role of stimulator of IFN genes (STING), an essential regulator to innate immunity, in the context of SAH. METHODS: A total of 344 male C57BL/6 J mice were subjected to endovascular perforation to develop a model of SAH. Selective STING antagonist C-176 and STING agonist CMA were administered at 30 min or 1 h post-modeling separately. To investigate the underlying mechanism, the AMPK inhibitor compound C was administered intracerebroventricularly at 30 min before surgery. Post-SAH assessments included SAH grade, neurological test, brain water content, western blotting, RT-PCR, and immunofluorescence. Oxygenated hemoglobin was introduced into BV2 cells to establish a SAH model in vitro. RESULTS: STING was mainly distributed in microglia, and microglial STING expression was significantly increased after SAH. Administration of C-176 substantially attenuated SAH-induced brain edema and neuronal injury. More importantly, C-176 significantly alleviated both short-term and persistent neurological dysfunction after SAH. Meanwhile, STING agonist CMA remarkably exacerbated neuronal injury and deteriorated neurological impairments. Mechanically, STING activation aggravated neuroinflammation via promoting microglial activation and polarizing into M1 phenotype, evidenced by microglial morphological changes, as well as the increased level of microglial M1 markers including IL-1ß, iNOS, IL-6, TNF-α, MCP-1, and NLRP3 inflammasome, while C-176 conferred a robust anti-inflammatory effect. However, all the mentioned beneficial effects of C-176 including alleviated neuroinflammation, attenuated neuronal injury and the improved neurological function were reversed by AMPK inhibitor compound C. Meanwhile, the critical role of AMPK signal in C-176 mediated anti-inflammatory effect was also confirmed in vitro. CONCLUSION: Microglial STING yielded neuroinflammation after SAH, while pharmacologic inhibition of STING could attenuate SAH-induced inflammatory injury at least partly by activating AMPK signal. These data supported the notion that STING might be a potential therapeutic target for SAH.


SARS-CoV-2: too infectious to handle?


title: Extending rituximab dosing intervals in patients with MS during the COVID-19 pandemic and beyond?

text: OBJECTIVE: To evaluate disease activity in patients with relapsing-remitting MS (RRMS) receiving rituximab with an extended dosing interval. METHODS: In the context of COVID-19 pandemic, this was an interim analysis of an ongoing prospective observational study of patients who were stable on rituximab for at least 6 months and who had a planned extended dosing interval of 24 months. Only data for patients with active RRMS before rituximab were analyzed. RESULTS: Among 177 patients receiving rituximab, 33 had RRMS and MRI activity before rituximab and at least 8 months of follow-up after the last infusion. The mean (SD) age was 40 (14) years, 25 were females, the mean disease duration was 10 (6.8) years, the mean annual relapse rate (ARR) before rituximab was 1.7 (1.3), and the median Expanded Disability Status Scale (EDSS) score before rituximab was 4.5 (1-7). Before extended dosing, when rituximab was infused every 6 months, the mean (SD) ARR decreased to 0.04 (0.1) (p < 0.0001) and the EDSS score to 4 (0-7) (p = 0.04). At the time of this analysis, the median follow-up since the last infusion was 11 (8-31) months. No patient showed relapse or disability progression. In total, 30 patients had at least 1 MRI performed since the last infusion (median time between the last MRI and the last infusion 10 [8-31] months). No MRI showed activity. The CD19+ cell proportion was >1% for 10 of 25 patients at the last count (median time 8 [6-25] months). CONCLUSIONS: An extended dosing interval for rituximab for patients with stable MS during the COVID-19 pandemic may be associated with a low risk of disease activity.


Coronavirus disease 2019 (COVID-19) outbreak in Iran: Actions and problems


title: Identification of compound causing yellow bone discoloration following alpha-glycosyl isoquercitrin exposure in Sprague-Dawley rats

text: Previous rat toxicity studies of alpha-glycosyl isoquercitrin (AGIQ), a water-soluble flavonol glycoside derived from rutin, revealed systemic yellow bone discoloration. This investigative study was conducted to determine the AGIQ metabolite(s) responsible for the discoloration. Female Sprague-Dawley rats were administered dietary AGIQ at doses of 0%, 1.5%, 3.0%, or 5.0% (0, 1735.0, 3480.8, and 5873.7 mg/kg/day, respectively) for 14 days, followed by a 14- or 28-day recovery period. Measurements of quercetin in urine and quercetin, quercetin 3-O-glucuronide, kaempferol, and 3-o-methylquercetin metabolites of AGIQ in bone (femur), white and brown fat, and cerebrum samples were conducted following the exposure period and each recovery period. Gross examination of the femur revealed yellow discoloration that increased in intensity with dose and was still present in a dose-related manner following both recovery periods. Quercetin, at levels correlating with AGIQ dose, was measured in the urine following the 14-day exposure period and, at lower concentrations, 14 or 28 days following cessation of AGIQ exposure. All four metabolites were present in a dose-dependent manner in the femur following 14 days of dietary exposure; only quercetin, quercetin 3-O-glucuronide, and 3-o-methylquercetin were present during the recovery periods. Quercetin, quercetin 3-O-glucuronide, and 3-o-methylquercetin were detected in white fat (along with kaempferol), brown fat (excluding quercetin due to analytical interference), and cerebrum samples, indicating systemic availability of the metabolites. Collectively, these data implicate quercetin, quercetin 3-O-glucuronide, or 3-o-methylquercetin (or a combination thereof) as the most likely metabolite of AGIQ causing the yellow discoloration of bone in rats administered dietary AGIQ.


title: Current Status of COVID-19 Therapies and Drug Repositioning Applications

text: The rapid and global spread of a new human coronavirus (SARS-CoV-2) has produced an immediate urgency to discover promising targets for the treatment of COVID-19. Drug repositioning is an attractive approach that can facilitate the drug discovery process by repurposing existing pharmaceuticals to treat illnesses other than their primary indications. Here, we review current information concerning the global health issue of COVID-19 including promising approved drugs and ongoing clinical trials for prospective treatment options. In addition, we describe computational approaches to be used in drug repurposing and highlight examples of in silico studies of drug development efforts against SARS-CoV-2.


HBO2 for COVID-19: Clinical trials at clinicaltrials.gov


Do chronic respiratory diseases or their treatment affect the risk of SARS-CoV-2 infection?


title: Association of hypertension with the severity and fatality of SARS-CoV-2 infection: A meta-analysis

text: Hypertension is a common comorbidity in COVID-19 patients. However, the association of hypertension with the severity and fatality of COVID-19 remain unclear. In the present meta-analysis, relevant studies reported the impacts of hypertension on SARS-CoV-2 infection were identified by searching PubMed, Elsevier Science Direct, Web of Science, Wiley Online Library, Embase and CNKI up to 20 March 2020. As the results shown, 12 publications with 2389 COVID-19 patients (674 severe cases) were included for the analysis of disease severity. The severity rate of COVID-19 in hypertensive patients was much higher than in non-hypertensive cases (37.58% vs 19.73%, pooled OR: 2.27, 95% CI: 1.80-2.86). Moreover, the pooled ORs of COVID-19 severity for hypertension vs. non-hypertension was 2.21 (95% CI: 1.58-3.10) and 2.32 (95% CI: 1.70-3.17) in age <50 years and â©¾50 years patients, respectively. Additionally, six studies with 151 deaths of 2116 COVID-19 cases were included for the analysis of disease fatality. The results showed that hypertensive patients carried a nearly 3.48-fold higher risk of dying from COVID-19 (95% CI: 1.72-7.08). Meanwhile, the pooled ORs of COVID-19 fatality for hypertension vs. non-hypertension was 6.43 (95% CI: 3.40-12.17) and 2.66 (95% CI: 1.27-5.57) in age <50 years and â©¾50 years patients, respectively. Neither considerable heterogeneity nor publication bias was observed in the present analysis. Therefore, our present results provided further evidence that hypertension could significantly increase the risks of severity and fatality of SARS-CoV-2 infection.


title: Laboratory characteristics of pregnant compared to non-pregnant women infected with SARS-CoV-2

text: KEY MESSAGE: Laboratory characteristics of SARS-CoV-2 infection did not differ between pregnant and non-pregnant women. A trend of lower lymphocyte count was observed in the pregnant women group PURPOSE: Laboratory abnormalities, which characterize SARS-CoV-2 infection have been identified, nevertheless, data concerning laboratory characteristics of pregnant women with SARS-CoV-2 are limited. The aim of this study is to evaluate the laboratory characteristics of pregnant compared to non-pregnant women with SARS-CoV-2 infection. METHODS: A retrospective cohort study of all pregnant women with SARS-CoV-2 who were examined at the obstetric emergency room in a tertiary medical center between March and April 2020. Patients were compared with non-pregnant women with SARS-CoV-2 matched by age, who were examined at the general emergency room during the study period. All patients were confirmed for SARS-CoV-2 on admission. Clinical characteristics and laboratory results were compared between the groups. RESULTS: Study group included 11 pregnant women with SARS-CoV-2, who were compared to 25 non-pregnant controls. Respiratory complaints were the most frequent reason for emergency room visit, and were reported in 54.5% and 80.0% of the pregnant and control groups, respectively (p = 0.12). White blood cells, hemoglobin, platelets, and liver enzymes counts were within the normal range in both groups. Lyphocytopenia was observed in 45.5% and 32% of the pregnant and control groups, respectively (p = 0.44). The relative lymphocyte count to WBC was significantly reduced in the pregnant group compared to the controls [13.6% (4.5-19.3) vs. 26.5% (15.7-29.9); p = 0.003]. C-reactive protein [20(5-41) vs. 14 (2-52) mg/dL; p = 0.81] levels were elevated in both groups but without significant difference between them. CONCLUSION: Laboratory characteristics of SARS-CoV-2 infection did not differ between pregnant and non-pregnant women, although a trend of lower lymphocyte count was observed in the pregnant women group.


title: Withanone and caffeic acid phenethyl ester are predicted to interact with main protease (Mpro) of SARS-CoV-2 and inhibit its activity

text: The recent novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2/2019-nCoV) has caused a large number of deaths around the globe. There is an urgent need to understand this new virus and develop prophylactic and therapeutic drugs. Since drug development is an expensive, intense and time-consuming path, timely repurposing of the existing drugs is often explored wherein the research avenues including genomics, bioinformatics, molecular modeling approaches offer valuable strengths. Here, we have examined the binding potential of Withaferin-A (Wi-A), Withanone (Wi-N) (active withanolides of Ashwagandha) and Caffeic Acid Phenethyl Ester (CAPE, bioactive ingredient of propolis) to a highly conserved protein, Mpro of SARS-CoV-2. We found that Wi-N and CAPE, but not Wi-A, bind to the substrate-binding pocket of SARS-CoV-2 Mpro with efficacy and binding energies equivalent to an already claimed N3 protease inhibitor. Similar to N3 inhibitor, Wi-N and CAPE were interacting with the highly conserved residues of the proteases of coronaviruses. The binding stability of these molecules was further analyzed using molecular dynamics simulations. The binding free energies calculated using MM/GBSA for N3 inhibitor, CAPE and Wi-N were also comparable. Data presented here predicted that these natural compounds may possess the potential to inhibit the functional activity of SARS-CoV-2 protease (an essential protein for virus survival), and hence (i) may connect to save time and cost required for designing/development, and initial screening for anti-COVID drugs, (ii) may offer some therapeutic value for the management of novel fatal coronavirus disease, (iii) warrants prioritized further validation in the laboratory and clinical tests.Communicated by Ramaswamy H. Sarma.


title: At the epicenter of the American Coronavirus outbreak - New York inner city hospital COVID-19 experience and current data: a retrospective analysis

text: BACKGROUND: In the midst of COVID-19 pandemic, emerging clinical data across the globe has equipped front line health care workers, policy makers and researchers to better understand and combat the illness more prepared. OBJECTIVE: Correlation of clinical and laboratory parameters with patients requiring mechanical ventilation and mortality in patients infected with SARS-CoV-2. METHODS: Review of patients with SARS-CoV-2 confirmed infection admitted and managed by our institution during the last month. Patients were grouped into intubated and non-intubated and sub grouped to alive and deceased. Comprehensive analysis using the following parameters were performed, Age, Sex, Ethnicity, Body Mass Index (BMI), Comorbidities, Inflammatory markers, Laboratory values, cardiac and renal function, electrocardiogram (EKG), Chest x ray findings, temperature, treatment groups, hospital acquired SARS-CoV-2 patients. RESULTS: A total of 184 patients were included in our study with age ranging from 28-97 years, mean of 64.72, 73 females (39.67%), 111 males (60.33%), with a mean BMI of 29.10. We had 114 African Americans (61.96%), 58 Hispanics (31.52%), 11 Asians (5.98%), 1 Caucasian (0.54%), with mean number of comorbidities of 1.70. Overall mortality rate was 17.39%, 16.30% of our patients required mechanical ventilation and 11.41% had hospital acquired SARS-CoV-2 infection. Pertinent and statistically significant results in the Intubated (I-T) versus Non Intubated (NI-T) SARS-CoV-2 confirmed patients for the following parameters with P values were: Age P=.01, BMI P= .07, African American Ethnicity P< .001, Hispanic Ethnicity P=.02, DM P=.001, Cr P=0.29, BUN P=.001, Procalcitonin P=.03, CRP P=.007, LDH P= .001, Glucose P=.01, Temperature P=.004, bilateral (B/L) pulmonary infiltrates in CXR P<.001, B/L patchy opacity P=.02. In the living and deceased subgroups of SARS-CoV-2 confirmed patients (linking to or against mortality) were BMI P=.04, LOS P<.001, HTN P=.02, Multiple comorbidity P=.045, BUN P=.04, EKG findings with arrhythmias/block P= .02. CONCLUSIONS: We arrived at the following conclusions based on a comprehensive review of our study group, data collection and statistical analysis. Parameters that were strongly correlated with the need for mechanical ventilation were younger age group, overweight, Hispanic ethnicity, higher core body temperature , EKG findings with sinus tachycardia and bilateral diffuse pulmonary infiltrates on the CXR. Those intubated exhibited increased disease severity with significantly elevated levels of serum Procalcitonin, C reactive protein (CRP), Lactate Dehydrogenase (LDH), Mean glucose, Creatinine, Blood urea nitrogen (BUN). Mortality was strongly correlated with BMI, African American ethnicity, Hypertension, presence of multiple comorbidities with a mean of 2.32, worsening renal function with acute kidney injury or acute on chronic kidney injury and EKG findings of arrhythmias and heart blocks.


title: Diabetes Epidemiology in the COVID-19 Pandemic

text: Diabetes has been identified as an important risk factor for mortality and rates of progression to acute respiratory distress syndrome (ARDS) in hospitalized patients with coronavirus disease 2019 (COVID-19). However, many recent reports on this topic reflect hurried approaches and have lacked careful epidemiologic design, conduct, and analysis. Features of prior studies have posed problems for our understanding of the true contribution of diabetes and other underlying comorbidities to prognosis in COVID-19. In this Perspective, we discuss some of the challenges of interpreting the current literature on diabetes and COVID-19 and discuss opportunities for future epidemiologic studies. We contend that the COVID-19 pandemic is a defining moment for the field of epidemiology and that diabetes epidemiology should play a significant role.


Effect of the COVID-19 Pandemic on Outcomes for Patients Admitted with Gastrointestinal Bleeding in New York City


title: Experience summary of a COVID-19 designated community hospital and its operation model

text: OBJECT: To summarize the administration model of a COVID-19 designated hospital transformed from a community hospital to improve the emergency capacity of community hospitals and the efficiency of diagnosis and treatment of medical staff in the COVID-19 pandemic. METHODS: Analyze the surrounding environment, ward layout, area management, treatment process, medical staff and patient management of the designated community hospital. RESULTS: From February 5, 2020, to February 18, 2020, the designated community hospital has received 198 COVID-19 mild and general patients (including 41 in the hospital at the beginning of the period). Among them, 39 were transferred to module hospitals, 131 were discharged, and 28 were in the hospital at the end of the period, and none of them became severe. There were 41 medical staff, and none of them had COVID-19 infection. CONCLUSIONS: We have achieved excellent results in the prevention and control stratagems implemented in this new community-designated hospital that specializes in treating patients with COVID-19. Its diagnosis and treatment model has completed the treatment of COVID- 19 patients successfully. After adjustment, this community hospital can shoulder the critical task of being a designated hospital for COVID-19, which includes admission, isolation, and therapy of suspected and mild COVID-19 patients, reducing the medical burden of superior hospitals. Furthermore, our experience provides concepts for community hospitals to temporarily undertake medical responsibilities to reduce the spread of COVID-19 during the pandemic.


title: Crystal structure of Nsp15 endoribonuclease NendoU from SARS-CoV-2

text: Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) is rapidly spreading around the world. There is no existing vaccine or proven drug to prevent infections and stop virus proliferation. Although this virus is similar to human and animal SARS-CoVs and Middle East Respiratory Syndrome coronavirus (MERS-CoVs), the detailed information about SARS-CoV-2 proteins structures and functions is urgently needed to rapidly develop effective vaccines, antibodies, and antivirals. We applied high-throughput protein production and structure determination pipeline at the Center for Structural Genomics of Infectious Diseases to produce SARS-CoV-2 proteins and structures. Here we report two high-resolution crystal structures of endoribonuclease Nsp15/NendoU. We compare these structures with previously reported homologs from SARS and MERS coronaviruses.


title: In Silico Screening of Some Naturally Occurring Bioactive Compounds Predicts Potential Inhibitors against SARS-COV-2 (COVID-19) Protease

text: SARS-COV-2 identified as COVID-19 in Wuhan city of China in the month of December, 2019 has now been declared as pandemic by World Health Organization whose transmission chain and cure both have emerged as a tough problem for the medical fraternity. The reports pertaining to the treatment of this pandemic are still lacking. We firmly believe that Nature itself provides a simple solution for any complicated problem created in it which motivated us to carry out In Silico investigations on some bioactive natural compounds reportedly found in the fruits and leaves of Anthocephalus Cadamba which is a miraculous plant found on the earth aiming to predict the potential inhibitors against aforesaid virus. Having modeled the ground state ligand structure of the such nine natural compounds applying density functional theory at B3LYP/631+G (d, p) level we have performed their molecular docking with SARS-COV-2 protease to calculate the binding affinity as well as to screen the binding at S-protein site during ligand-protein interactions. Out of these nine studied naturally occurring compounds; Oleanic Acid has been appeared to be potential inhibitor for COVID-19 followed by Ursolic Acid, IsoVallesiachotamine,Vallesiachotamine,Cadambine,Vincosamide-N-Oxide, Isodihydroamino-cadambine, Pentyle Ester of Chlorogenic Acid and D-Myo-Inositol. Hence these bioactive natural compounds or their structural analogs may be explored as anti-COVID19 drug agent which will be possessing the peculiar feature of cost-less synthesis and less or no side effect due to their natural occurrence. The solubility and solvent-effect related to the phytochemicals may be the point of concern. The In-vivo investigations on these proposed natural compounds or on their structural analogs are invited for designing and developing the potential medicine/vaccine for the treatment of COVID-19 pandemic.


Rigor before speculation in COVID-19 therapy


COVID-19: Rätsel um den Verlauf bei Kindern : Coronavirus-Pandemie


title: [Roles of multidisciplinary team (MDT) in diagnosis and treatment of suspected cases of corona virus disease 2019 (COVID-19)]

text: OBJECTIVE: To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of corona virus disease 2019 (COVID-19). METHODS: The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. RESULTS: Of the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times per case. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged; there was no cross-infection occurred in suspected patients during the hospitalization; there were no deaths and no medical staff infections. CONCLUSIONS: The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved under MDT mode, particularly for complicated and refractory cases.


title: [Research progress of intervention of Chinese herbal medicine and its active components on human coronavirus]

text: The outbreak caused by 2019 novel coronavirus(2019-nCoV) is still spreading, posing a great threat to the safety and health of general population. However, there have not been any effective drugs for treatment, with symptomatic treatment and prevention prevailing. The treatment plans of severe acute respiratory syndrome(SARS) and Middle East respiratory syndrome(MERS) are often used for reference in clinic. The advantages of traditional Chinese medicine(TCM) in treating SARS and MERS are that it can intervene and block the progression of disease in early stage, significantly reduce symptoms, shorten the treatment duration of patients, reduce complications and side effects caused by hormone therapy. The coronavirus disease 2019(COVID-19) belongs to the category of TCM epidemic diseases. Chinese patent medicines and prescriptions in medical observation and clinical treatment were recommended in the "pneumonia diagnosis and treatment plan for new coronavirus infection"(trial version fifth) of the National Health Commission of the People's Republic of China. Qingfei Paidu Decotion was recommended for the treatment of COVID-19 by the National Health Commission of the People's Republic of China and National Administration of Traditional Chinese Medicine. TCM shows good clinical efficacy and great potential in the treatment of COVID-19. Previous studies of TCM have shown broad-spectrum antiviral activity, providing a variety of sources for the discovery of new antiviral drugs. In this paper, we reviewed traditional Chinese medicines and its active ingredients in the hope of bringing novel inspirations to the drug screening and clinical treatment for COVID-19.


title: Modelling the spread of COVID-19 with new fractal-fractional operators: Can the lockdown save mankind before vaccination?

text: Countries around the world are implementing lock-down measures in a bid to flatten the curve of the new deadly COVID-19 disease. Our paper does not claim to have found the cure for COVID-19, neither does it claim that the suggested model have taken into account all the complexities around the spread of the disease. Nonetheless, the fundamental question asked in this paper is to know if within the conditions taken into account in this suggested model, the integral lock-down is effective in saving human lives. To answer this question, a mathematical model was suggested taking into account the possibility of transmission of COVID-19 from dead bodies to humans and the effect of lock-down. Three cases were considered. The first case suggested that there is transmission from dead to the living (medical staffs as they perform postmortem procedures on corpses, and direct contacts with during burial ceremonies). This case has no equilibrium points except for disease free equilibrium, a clear indication that care must be taken when dealing with corpses due to corona-19. In the second case we removed the transmission rate from dead bodies. This case showed an equilibrium point, although the number of deaths, carriers and infected grew exponentially up to a certain stability level. In the last case, we incorporated a lock-down and social distancing effect, using the next generation matrix. We could achieve a zero reproduction number, with number of deaths, infected and carriers decaying very rapidly. This is a clear indication that if lock-down recommendations are observed the threat of COVID-19 can be reduced to zero in few months.While our mathematical model agrees with the effectiveness of the lock-down, it is important to mention damaging effects of inadequate testing. The long waiting period of few days before confirmation of status, can only lead to more infections. The asymptomatic tested person could be positive and spread the infection, or could contact the virus in days after testing and will spread the disease further, after being given a false result. Testing kit that with immediate results are needed for more efficient measures. We used Italy's Data to guide the construction of the mathematical model. To include non-locality into mathematical formulas, differential and integral operators were suggested. Properties and numerical approximations were presented in details. Finally, the suggested differential and integral operators were applied to the model.


docid: gpxjsnel

title: COVID-19 in Prisons and Jails in the United States


COVID-19 and ACEI/ARB: NOT ASSOCIATED?


title: The Gugging Swallowing Screen in dysphagia screening for patients with stroke: A systematic review

text: BACKGROUND: Dysphagia in patients with stroke can cause serious complications, such as aspiration and pneumonia, that often lead to increase in mortality and length of hospitalization. Several screening tests for dysphagia have been developed and are used in clinical practice to prevent dysphagia complications. The Gugging Swallowing Screen is 1 such screening test. It is suggested for use in the assessment of the ability of patients to swallow fluid and non-fluid foods separately. It also promotes effective communication between healthcare providers. OBJECTIVES: We aimed to investigate the validity and benefit of the Gugging Swallowing Screen. DESIGN: This was a systematic review. DATA SOURCE: We sourced data from electronic databases including Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, KoreaMed, Research Information Sharing Service, and Korean studies Information Service System. REVIEW METHODS: We conducted a systematic review of electronic databases. We included studies published in English and Korean up to November 2018 that pertained to the Gugging Swallowing Screen. We designed strategies that included Medical Subject Headings and keywords, such as "dysphagia," "swallowing," "assessment," "screening," and "GUSS," used alone or in combination. RESULTS: Of the 297 studies that appeared in the search result, 219 articles were reviewed by 2 independent reviewers after duplicate studies were eliminated. Finally, 8 articles were included in this study. With regard to validity, the Gugging Swallowing Screen had a pooled sensitivity of 0.97 (95% confidence interval: 0.93-0.99), a pooled specificity of 0.67 (95% confidence interval: 0.59-0.74), and an area under the receiver operating characteristic curve of 0.9381. With regard to benefit, early systematic dysphagia screening using Gugging Swallowing Screen performed by nurses reduced both screening time and pneumonia rate compared to the control group (p = 0.004). The incidence of X-ray-verified pneumonia was significantly lower in the Gugging Swallowing Screen group than in the clinical screening group (p Ë 0.01), but no significant difference was observed in the incidence of pneumonia compared to the value predicted using the 10 mL water swallowing test. CONCLUSIONS: The Gugging Swallowing Screen is a reliable and sensitive tool for screening dysphagia. Early and systematic assessment can prevent aspiration and pneumonia. However, further studies are needed to confirm the effectiveness of this tool.


title: The Faith Community and the SARS-CoV-2 Outbreak: Part of the Problem or Part of the Solution?

text: The current outbreak of the SARS-CoV-2 virus is a critical moment in time for institutional religion in the USA and throughout the world. Individual clergy and congregations, across faith traditions, have been sources of misinformation and disinformation, promoting messages and actions that engender fear, animosity toward others, and unnecessary risk-taking. But there is a positive role for religion and faith-based institutions here, and many examples of leaders and organizations stepping up to contribute to the collective recovery. Personal faith and spirituality may be a source of host resistance and resilience. Religiously sponsored medical care institutions are vital to health care response efforts. Ministries and faith-based organizations are source of religious health assets that can help to meet community-wide needs. There is a pastoral role for clergy and laypeople who are instrumental in providing comfort and strength to the suffering and fearful in our midst. The outbreak presents an ethical challenge to all of us to step outside of our own preoccupations and to be present and of service for others. This includes having the courage to represent the highest values of our faith in speaking out against religiously motivated foolishness and hatred and in calling for political and public health leaders to be truthful and transparent in their messages to us.


title: Surveillance of the first cases of COVID-19 in Sergipe using a prospective spatiotemporal analysis: the spatial dispersion and its public health implications

text: INTRODUCTION: Coronavirus disease 2019 (COVID-19) has become a global public health emergency with lethality ranging from 1% to 5%. This study aimed to identify active high-risk transmission clusters of COVID-19 in Sergipe. METHODS: We performed a prospective space-time analysis using confirmed cases of COVID-19 during the first 7 weeks of the outbreak in Sergipe. RESULTS: The prospective space-time statistic detected "active" and emerging spatio-temporal clusters comprising six municipalities in the south-central region of the state. CONCLUSIONS: The Geographic Information System (GIS) associated with spatio-temporal scan statistics can provide timely support for surveillance and assist in decision-making.


title: Mobilizing Primary Health Care:Cuba's Powerful Weapon against COVID-19

text: A strong foundation of primary care is critical to the health system and is particularly important during pandemics like COVID-19. Primary care practices should be a natural fi t for triaging, testing, treating, and educating patients.-Corinne Lewis, Shanoor Seervai, Tanya Shah, Melinda K. Abrams, and Laurie Zephyrin MD The Commonwealth Fund, April 22, 2020[1.


Is SARS-CoV-2 transfusion transmitted?


title: Measuring Emotions in the COVID-19 Real World Worry Dataset

text: The COVID-19 pandemic is having a dramatic impact on societies and economies around the world. With various measures of lockdowns and social distancing in place, it becomes important to understand emotional responses on a large scale. In this paper, we present the first ground truth dataset of emotional responses to COVID-19. We asked participants to indicate their emotions and express these in text. This resulted in the Real World Worry Dataset of 5,000 texts (2,500 short + 2,500 long texts). Our analyses suggest that emotional responses correlated with linguistic measures. Topic modeling further revealed that people in the UK worry about their family and the economic situation. Tweet-sized texts functioned as a call for solidarity, while longer texts shed light on worries and concerns. Using predictive modeling approaches, we were able to approximate the emotional responses of participants from text within 14% of their actual value. We encourage others to use the dataset and improve how we can use automated methods to learn about emotional responses and worries about an urgent problem.


High mortality rates for SARS-CoV-2 infection in patients with pre-existing chronic liver disease and cirrhosis: Preliminary results from an international registry


Electrocardiographic/QT interval monitoring with a portable device in hospitalized patients with COVID-19: a protocol proposal


title: Emerging infectious diseases and outbreaks: implications for women's reproductive health and rights in resource-poor settings

text: This century is witnessing dramatic changes in the health needs of the world's populations. The double burden of infectious and chronic diseases constitutes major causes of morbidity and mortality. Over the last two decades, there has been a rise in infectious diseases, including the severe acute respiratory syndrome virus (SARS), the H1N1 pandemic influenza, the Ebolavirus and the Covid-19 virus. These diseases have rapidly spread across the world and have reminded us of the unprecedented connectivity that defines our modern civilization. Though some countries have made substantial progress toward improving global surveillance for emerging infectious diseases (EIDs), the vast majority of Low-and Middle-income Countries (LMICs) with fragile health systems and various system-related bottlenecks remain vulnerable to outbreaks and, as such, experience dramatic social and economic consequences when they are reported. Lessons learned from past outbreaks suggest that gender inequalities are common across a range of health issues relating to Sexual and Reproductive Health and Rights (SRHR), with women being particularly disadvantaged, partially due to the burden placed on them. Though these countries are striving to improve their health systems and be more inclusive to this vulnerable group, the national/ global outbreaks have burdened the overall system and thus paralyzed normal services dedicated to the delivery of Sexual and Reproductive Health (SRH) services. In this paper, we discuss the global commitments to SRH, the impact of the EIDs on the LMICs, the failure in the delivery of SRH services, and the strategies for successful implementation of recovery plans that must address the specific and differentiated needs of women and girls in resource-poor settings.


docid: bbfupijl

title: CoVID-19 vs. epilepsy: It is time to move, act, and encourage physical exercise


One Aspect of Coronavirus disease (COVID-19) Outbreak in Iran: High Anxiety among MS Patients


title: COVID-19 Orthopaedic Safe Care Toolset: Guidelines for the Diagnosis and Management of Patients with Fracture and COVID-19

text: The SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) was reported in Wuhan, Hubei Province, People's Republic of China, and, subsequently, in other provinces and regions across the People's Republic of China and >212 countries. COVID-19, the disease caused by this coronavirus, was declared a worldwide pandemic by the World Health Organization (WHO). The incidence of patients with fracture who are also positive for COVID-19 is on the rise. The diagnosis and management of such patients can be complicated as their clinical characteristics are heterogeneous. Furthermore, a surgical procedure can be particularly challenging given that the use of high-speed devices results in aerosol generation. In this study, we develop and propose globally applicable guidelines to fill this knowledge gap and we identify and propose the necessary protective strategies for medical personnel in an orthopaedic emergency department and in the inpatient wards. We also introduce diagnostic criteria, surgical complication management, and follow-up strategies for infected patients. These guidelines may be helpful to decrease the infection rate of orthopaedic trauma personnel and to provide diagnosis and treatment therapy for patients with fracture and COVID-19.


Transient cortical blindness in COVID-19 pneumonia; a PRES-like syndrome: Case report


title: Social Distancing 2.0 with Privacy-Preserving Contact Tracing to Avoid a Second Wave of COVID-19

text: How to avoid a second wave of COVID-19 after reopening the economy is a pressing question. The extremely high basic reproductive number $R_0$ (5.7 to 6.4, shown in new studies) of SARS-CoV-2 further complicates the challenge. Here we assess effects of Social distancing 2.0, i.e. proximity alert (to maintain inter-personal distance) plus privacy-preserving contact tracing. To solve the dual task, we develop an open source mobile app. The app uses a Bluetooth-based, decentralized contact tracing platform over which the anonymous user ID cannot be linked by the government or a third party. Modeling results show that a 50\% adoption rate of Social distancing 2.0, with privacy-preserving contact tracing, would suffice to decrease the $R_0$ to less than 1 and prevent the resurgence of COVID-19 epidemic.


Covid-19: public health expertise is being sidelined


COVID-19 in a patient with severe chronic rhinosinusitis with nasal polyps during therapy with dupilumab


Prehabilitation could save lives in a pandemic


title: The role of extracellular vesicles in COVID-19 virus infection

text: Extracellular vesicles releasing from various types of cells contribute to intercellular communication via delivering bio-molecules like nucleic acids, proteins, and lipids to recipient cells. Exosomes are 30-120 nm extracellular vesicles that participate in several pathological conditions. Virus-infected cells release exosomes that are implicated in infection through transferring viral components such as viral-derived miRNAs and proteins. As well, exosomes contain receptors for viruses that make recipient cells susceptible to virus entry. Since December 2019, SARS-CoV-2 (COVID-19) infection has become a worldwide urgent public health concern. There is currently no vaccine or specific antiviral treatment existing for COVID-19 virus infection. Hence, it is critical to find a safe and effective therapeutic tool to patients with severe COVID-19 virus infection. Extracellular vesicles may contribute to spread this virus as they transfer such receptors as CD9 and ACE2, which make recipient cells susceptible to virus docking. Upon entry, COVID-19 virus may be directed into the exosomal pathway, and its component is packaged into exosomes for secretion. Exosome-based strategies for the treatment of COVID-19 virus infection may include following items: inhibition of exosome biogenesis and uptake, exosome-therapy, exosome-based drug delivery system, and exosome-based vaccine. Mesenchymal stem cells can suppress nonproductive inflammation and improve/repair lung cells including endothelial and alveolar cells, which damaged by COVID-19 virus infection. Understanding molecular mechanisms behind extracellular vesicles related COVID-19 virus infection may provide us with an avenue to identify its entry, replication, spreading, and infection to overcome its adverse effects.


Personal Experiences With Coronavirus Disease 2019 and Diabetes: The Time for Telemedicine is Now


title: Coping with hypoxemia: Could erythropoietin (EPO) be an adjuvant treatment of COVID-19?

text: A very recent epidemiological study provides preliminary evidence that living in habitats located at 2500â¯m above sea level (masl) might protect from the development of severe respiratory symptoms following infection with the novel SARS-CoV-2 virus. This epidemiological finding raises the question of whether physiological mechanisms underlying the acclimatization to high altitude identifies therapeutic targets for the effective treatment of severe acute respiratory syndrome pivotal to the reduction of global mortality during the COVID-19 pandemic. This article compares the symptoms of acute mountain sickness (AMS) with those of SARS-CoV-2 infection and explores overlapping patho-physiological mechanisms of the respiratory system including impaired oxygen transport, pulmonary gas exchange and brainstem circuits controlling respiration. In this context, we also discuss the potential impact of SARS-CoV-2 infection on oxygen sensing in the carotid body. Finally, since erythropoietin (EPO) is an effective prophylactic treatment for AMS, this article reviews the potential benefits of implementing FDA-approved erythropoietin-based (EPO) drug therapies to counteract a variety of acute respiratory and non-respiratory (e.g. excessive inflammation of vascular beds) symptoms of SARS-CoV-2 infection.


Postmortem Examination of Patients With COVID-19


docid: yvbdeudz

title: Coronavirus surveillance of wildlife in the Lao People's Democratic Republic detects viral RNA in rodents

text: Coronaviruses can become zoonotic, as in the case of COVID-19, and hunting, sale, and consumption of wild animals in Southeast Asia increases the risk for such incidents. We sampled and tested rodents (851) and other mammals and found betacoronavirus RNA in 12 rodents. The sequences belong to two separate genetic clusters and are closely related to those of known rodent coronaviruses detected in the region and distantly related to those of human coronaviruses OC43 and HKU1. Considering the close human-wildlife contact with many species in and beyond the region, a better understanding of virus diversity is urgently needed for the mitigation of future risks.


Caring for Critically Ill Adults in PICUs Is Not "Child's Play"


title: Stocks Vote with Their Feet: Can a Piece of Paper Document Fights the COVID-19 Pandemic?

text: Assessing the trend of the COVID-19 pandemic and policy effectiveness is essential for both policymakers and stock investors, but challenging because the crisis has unfolded with extreme speed and the previous index was not suitable for measuring policy effectiveness for COVID-19. This paper builds an index of policy effectiveness on fighting COVID-19 pandemic, whose building method is similar to the index of Policy Uncertainty, based on province-level paper documents released in China from Jan.1st to Apr.16th of 2020. This paper also studies the relationships among COVID-19 daily confirmed cases, stock market volatility, and document-based policy effectiveness in China. This paper uses the DCC-GARCH model to fit conditional covariance's change rule of multi-series. This paper finally tests four hypotheses, about the time-space difference of policy effectiveness and its overflow effect both on the COVID-19 pandemic and stock market. Through the inner interaction of this triad structure, we can bring forward more specific and scientific suggestions to maintain stability in the stock market at such exceptional times.


Tortoises, hares, and vaccines: A cautionary note for SARS-CoV-2 vaccine development


title: Iron: Innocent bystander or vicious culprit in COVID-19 pathogenesis?

text: The coronavirus 2 (SARS-CoV-2) pandemic is viciously spreading through the continents with rapidly increasing mortality rates. Current management of COVID-19 is based on the premise that respiratory failure is the leading cause of mortality. However, mounting evidence links accelerated pathogenesis in gravely ill COVID-19 patients to a hyper-inflammatory state involving a cytokine storm. Several components of the heightened inflammatory state were addressed as therapeutic targets. Another key component of the heightened inflammatory state is hyper-ferritinemia which reportedly identifies patients with increased mortality risk. In spite of its strong association with mortality, it is not yet clear if hyper-ferritinemia in COVID-19 patients is merely a systemic marker of disease progression, or a key modulator in disease pathogenesis. Here we address implications of a possible role for hyper-ferritinemia, and altered iron homeostasis in COVID-19 pathogenesis, and potential therapeutic targets in this regard.


title: Hydroxychloroquine in Patients with Rheumatic Disease Complicated by COVID-19: Clarifying Target Exposures and the Need for Clinical Trials

text: OBJECTIVE: To characterize hydroxychloroquine (HCQ) exposure in patients with rheumatic disease receiving longterm HCQ compared to target concentrations with reported antiviral activity against the coronavirus disease 2019 caused by SARS-CoV-2 (COVID-19). METHODS: We evaluated total HCQ concentrations in serum and plasma from published literature values, frozen serum samples from a pediatric systemic lupus erythematosus trial, and simulated concentrations using a published pharmacokinetic model during pregnancy. For each source, we compared observed or predicted HCQ concentrations to target concentrations with reported antiviral activity against SARS-CoV-2. RESULTS: The average total serum/plasma HCQ concentrations were below the lowest SARS-CoV-2 target of 0.48 mg/l in all studies. Assuming the highest antiviral target exposure (total plasma concentration of 4.1 mg/l), all studies had about one-tenth the necessary concentration for in vitro viral inhibition. Pharmacokinetic model simulations confirmed that pregnant adults receiving common dosing for rheumatic diseases did not achieve target exposures; however, the models predict that a dosage of 600 mg once a day during pregnancy would obtain the lowest median target exposure for most patients after the first dose. CONCLUSION: We found that the average patient receiving treatment with HCQ for rheumatic diseases, including children and non-pregnant/pregnant adults, are unlikely to achieve total serum or plasma concentrations shown to inhibit SARS-CoV-2 in vitro. Nevertheless, patients receiving HCQ long term may have tissue concentrations far exceeding that of serum/plasma. Because the therapeutic window for HCQ in the setting of SARS-CoV-2 is unknown, well-designed clinical trials that include patients with rheumatic disease are urgently needed to characterize the efficacy, safety, and target exposures for HCQ.


The challenge of ventilator-associated pneumonia diagnosis in COVID-19 patients


Two cases of COVID-19 presenting with a clinical picture resembling chilblains: first report from the Middle East


title: Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency

text: OBJECTIVE: Pressure ulcers (PUs) involve the destruction of skin and underlying tissue due to prolonged pressure and shear forces. These ulcers are painful and significantly reduce a person's quality of life. PUs are also expensive to manage and impact negatively on the achievement of cost-effective, efficient care delivery. METHOD: Prone positioning is a postural therapy that aims to enhance respiratory function through increasing oxygenation levels. In contemporary clinical practice, ventilation in the prone position is indicated for patients with severe acute respiratory distress syndrome. However, despite its advantages in terms of respiratory function, several studies have examined complications of prone position ventilation and have identified PUs (facial PUs as well as PUs on other weight-bearing areas of the body) as a frequent complication in patients who are already in a precarious medical situation. International data suggest that up to 57% of patients nursed in the prone position develop a PU. The aim of this clinical review is to identify and review evidence-based recommendations developed to facilitate the selection and application of preventive interventions aimed at reducing PU development in patients ventilated in the prone position. Given the current COVID-19 crisis, this review is timely as intensive care unit (ICU) patients with COVID-19 require ventilation in the prone position at a level that is disproportionate to the general intensive care population. Up to 28% of patients admitted to the ICU with confirmed infection due to severe COVID-19 are cared for in the prone position. The scope of this review is limited to adult individuals only. RESULTS: The skin assessment should be undertaken before proning and following positioning the patient back into the supine position. Although it is essential to keep the skin clean and moisturised, using pH-balanced cleansers, there is inconsistency in terms of the evidence to support the type of moisturiser. Use of positioning devices in addition to repositioning is recommended to offload pressure points on the face and body. Further, using dressings such as hydrocolloids, transparent film and silicone may be of benefit in decreasing facial skin breakdown. CONCLUSION: Given the importance of PU prevention in this cohort of patients, adopting a focused prevention strategy, including skin assessment and care, offloading and pressure redistribution, and dressings for prevention may contribute to a reduction in the incidence and prevalence of these largely preventable wounds.


title: Combating Disinformation in a Social Media Age

text: The creation, dissemination, and consumption of disinformation and fabricated content on social media is a growing concern, especially with the ease of access to such sources, and the lack of awareness of the existence of such false information. In this paper, we present an overview of the techniques explored to date for the combating of disinformation with various forms. We introduce different forms of disinformation, discuss factors related to the spread of disinformation, elaborate on the inherent challenges in detecting disinformation, and show some approaches to mitigating disinformation via education, research, and collaboration. Looking ahead, we present some promising future research directions on disinformation.


title: Does lopinavir measure up in the treatment of COVID-19?

text: INTRODUCTION: Lopinavir in combination with ritonavir is approved for the treatment of HIV and has recently been subject to a clinical trial in severe COVID-19. AREAS COVERED: This evaluation is of LOTUS China (the Lopinavir Trial for Suppression of SARS-Cov-2 in China), which was a randomized trial in hospitalized subjects with COVID-9 in a respiratory sample and pneumonia. As, in severe COVID-19, lopinavir/ritonavir had no beneficial effects but increased gastrointestinal adverse effects, this combination should not be used at this stage of COVID-19. EXPERT OPINION: In my opinion, the rationale for undertaking a trial of lopinavir/ritonavir in COVID-19 was poor. The analysis of a modified intention to treat group analysis in LOTUS China may have introduced bias. After LOTUS China, there is probably no future for lopinavir in the treatment of severe COVID-19, but some clinical trials for prevention or in various stages of COVID-19 have recently started or are ongoing. The major limitation of these trials is that as lopinavir does not inhibit COVID-19, it is unlikely to prevent infection, reduce viral load, or reduce the severity. However, these trials may be worthwhile in finally determining whether lopinavir has any role in preventing or treating COVID-19.


title: Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China

text: As of 29 February 2020 there were 79,394 confirmed cases and 2,838 deaths from COVID-19 in mainland China. Of these, 48,557 cases and 2,169 deaths occurred in the epicenter, Wuhan. A key public health priority during the emergence of a novel pathogen is estimating clinical severity, which requires properly adjusting for the case ascertainment rate and the delay between symptoms onset and death. Using public and published information, we estimate that the overall symptomatic case fatality risk (the probability of dying after developing symptoms) of COVID-19 in Wuhan was 1.4% (0.9-2.1%), which is substantially lower than both the corresponding crude or naïve confirmed case fatality risk (2,169/48,557 = 4.5%) and the approximator1 of deaths/deaths + recoveries (2,169/2,169 + 17,572 = 11%) as of 29 February 2020. Compared to those aged 30-59 years, those aged below 30 and above 59 years were 0.6 (0.3-1.1) and 5.1 (4.2-6.1) times more likely to die after developing symptoms. The risk of symptomatic infection increased with age (for example, at ~4% per year among adults aged 30-60 years).


title: Dynamics and predisposition of respiratory viral co-infections in children and adults

text: OBJECTIVES: The epidemiology of respiratory co-infection pairings is poorly understood. Here we assess the dynamics of respiratory viral co-infections in children and adults and determine predisposition for or against specific viral pairings. METHODS: Over 5 respiratory seasons from November 30, 2013 through June 6, 2018, mono- and co-infection prevalence of 13 viral pathogens were tabulated at The Cleveland Clinic. Employing a model to proportionally distribute viral pairs utilizing individual virus' co-infection rate with prevalence patterns of concurrent co-circulating viruses, we compared predicted-to-observed occurrences of 132 viral pairing permutations using binomial analysis. RESULTS: Of 30,535 respiratory samples, 9,843 (32.2%) were positive for ≥1 virus of which 1,018 (10.8%) were co-infected. Co-infected samples predominantly originated from children. Co-infection rate in pediatric population was 35.0% (2068/5906), compared to only 5.8% (270/4591) in adults. Adenovirus C (ADVC) had the highest co-infection rate (426/623, 68.3%) while influenza B had the lowest (55/546, 10.0%). ADVC-rhinovirus (HRV), RSVA-HRV, and RSVB-HRV pairings occurred at significantly higher frequencies than predicted by the proportional distribution model (p<0.05). Additionally, several viral pairings had fewer co-infections than predicted by our model: notably metapneumovirus (hMPV)-PIV3, hMPV-RSVA, and RSVA-RSVB. CONCLUSIONS: This is one of the largest studies on respiratory viral co-infections in children and adults. Co-infections are substantially more common in children, especially under 5 years of age and the most frequent pairings occurred at a higher frequency than would be expected by random. Specific pairings occur at altered rates than those predicted by proportional distribution suggesting either direct or indirect interactions result between specific viral pathogens.


De huisartsenpraktijk en COVID-19


title: Scientific research progress of COVID-19/SARS-CoV-2 in the first five months

text: A cluster of pneumonia (COVID-19) cases have been found in Wuhan China in late December, 2019, and subsequently, a novel coronavirus with a positive stranded RNA was identified to be the aetiological virus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), which has a phylogenetic similarity to severe acute respiratory syndrome coronavirus (SARS-CoV). SARS-CoV-2 transmits mainly through droplets and close contact and the elder or people with chronic diseases are high-risk population. People affected by SARS-CoV-2 can be asymptomatic, which brings about more difficulties to control the transmission. COVID-19 has become pandemic rapidly after onset, and so far the infected people have been above 2 000 000 and more than 130 000 died worldwide according to COVID-19 situation dashboard of World Health Organization (https://covid19.who.int). Here, we summarized the current known knowledge regarding epidemiological, pathogenesis, pathology, clinical features, comorbidities and treatment of COVID-19/ SARS-CoV-2 as reference for the prevention and control COVID-19.


title: CT features of SARS-CoV-2 pneumonia according to clinical presentation: a retrospective analysis of 120 consecutive patients from Wuhan city

text: OBJECTIVES: To characterize the chest computed tomography (CT) findings of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) according to clinical severity. We compared the CT features of common cases and severe cases, symptomatic patients and asymptomatic patients, and febrile and afebrile patients. METHODS: This was a retrospective analysis of the clinical and thoracic CT features of 120 consecutive patients with confirmed SARS-CoV-2 pneumonia admitted to a tertiary university hospital between January 10 and February 10, 2020, in Wuhan city, China. RESULTS: On admission, the patients generally complained of fever, cough, shortness of breath, and myalgia or fatigue, with diarrhea often present in severe cases. Severe patients were 20 years older on average and had comorbidities and an elevated lactate dehydrogenase (LDH) level. There were no differences in the CT findings between asymptomatic and symptomatic common type patients or between afebrile and febrile patients, defined according to Chinese National Health Commission guidelines. CONCLUSIONS: The clinical and CT features at admission may enable clinicians to promptly evaluate the prognosis of patients with SARS-CoV-2 pneumonia. Clinicians should be aware that clinically silent cases may present with CT features similar to those of symptomatic common patients. KEY POINTS: â¢ The clinical features and predominant patterns of abnormalities on CT for asymptomatic, typic common, and severe cases were summarized. These findings may help clinicians to identify severe patients quickly at admission. â¢ Clinicians should be cautious that CT findings of afebrile/asymptomatic patients are not better than the findings of other types of patients. These patients should also be quarantined. â¢ The use of chest CT as the main screening method in epidemic areas is recommended.


title: Mental Health Services in Lombardy during COVID-19 outbreak

text: Lombardy is the Region in Italy the most heavily affected by coronavirus disease (COVID-19) contagion. The Regional Health Authority mandates that mental health services should be guaranteed, identifying mental health as a priority for their citizens. Recommendations for occupational and health safety have been provided to patients and hospital staff, including support for telemedicine activities and remote psychosocial interventions. Services of the Mental Health Departments of Milano "Niguarda" and Brescia "Spedali Civili" Hospitals are providing continued care at a community, residential and hospital level, and to positive COVID-19 psychiatric patients in need of hospitalization.


Scientists fear coronavirus spread in countries least able to contain it


COVID-19: Some clinical questions after the first 4 months


title: COVID-19: some clinical questions after the first four months

text: Coronavirus disease 2019 (COVID-19) is a multiorgan disease with multiple faces and clinical features. Most patients present with none or only mild symptoms, but severe presentations with need for mechanical ventilation and high case fatality may be observed.


Rescheduling of clinical activities and teleconsulting for public dermatology. Two prompt answers to COVID-19 emergency


title: 'On a ledge with no safety net'

text: There is still time to protect the world's most fragile countries, David Miliband, the head of the International Rescue Committee, tells Adam Vaughan.


Echocardiographic Findings in Patients with COVID-19 with Significant Myocardial Injury


Serological Assays for SARS-CoV-2 Infectious Disease: Benefits, Limitations and Perspectives