The impact of the SARS-CoV-2 outbreak on the safety and availability of blood transfusions in Italy


docid: bkujpxyn

title: Covid-19: la troublante decouverte des possibles vertus de la nicotine


COVID-19 vaccines start moving into advanced trials


title: Support Estimation with Sampling Artifacts and Errors

text: The problem of estimating the support of a distribution is of great importance in many areas of machine learning, computer science, physics and biology. Most of the existing work in this domain has focused on settings that assume perfectly accurate sampling approaches, which is seldom true in practical data science. Here we introduce the first known approach to support estimation in the presence of sampling artifacts and errors where each sample is assumed to arise from a Poisson repeat channel which simultaneously captures repetitions and deletions of samples. The proposed estimator is based on regularized weighted Chebyshev approximations, with weights governed by evaluations of so-called Touchard (Bell) polynomials. The supports in the presence of sampling artifacts are calculated using discretized semi-infite programming methods. The estimation approach is tested on synthetic and textual data, as well as on GISAID data collected to address a new problem in computational biology: mutational support estimation in genes of the SARS-Cov-2 virus. In the later setting, the Poisson channel captures the fact that many individuals are tested multiple times for the presence of viral RNA, thereby leading to repeated samples, while other individual's results are not recorded due to test errors. For all experiments performed, we observed significant improvements of our integrated methods compared to those obtained through adequate modifications of state-of-the-art noiseless support estimation methods.


title: COVID-19 response needs to broaden financial inclusion to curb the rise in poverty

text: The ongoing COVID-19 pandemic risks wiping out years of progress made in reducing global poverty. In this paper, we explore to what extent financial inclusion could help mitigate the increase in poverty using cross-country data across 78 low- and lower-middle-income countries. Unlike other recent cross-country studies, we show that financial inclusion is a key driver of poverty reduction in these countries. This effect is not direct, but indirect, by mitigating the detrimental effect that inequality has on poverty. Our findings are consistent across all the different measures of poverty used. Our forecasts suggest that the world's population living on less than $1.90 per day could increase from 8% to 14% by 2021, pushing nearly 400 million people into poverty. However, urgent improvements in financial inclusion could substantially reduce the impact on poverty.


title: Laser Spectroscopic Technique for Direct Identification of a Single Virus I: FASTER CARS

text: From the famous 1918 H1N1 influenza to the present COVID-19 pandemic, the need for improved virial detection techniques is all too apparent. The aim of the present paper is to show that identification of individual virus particles in clinical sample materials quickly and reliably is near at hand. First of all, our team has developed techniques for identification of virions based on a modular atomic force microscopy (AFM). Furthermore, Femtosecond Adaptive Spectroscopic Techniques with Enhanced Resolution via Coherent Anti-Stokes Raman Scattering (FASTER CARS) [1] using tip-enhanced techniques markedly improves the sensitivity.


[COVID-19 and the Invisible Damage]


docid: fdfearkn

title: Testing for Novel Coronavirus Antibodies: A Necessary Adjunct


E-learning during Covid-19


title: Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian Society of Nephrology

text: BACKGROUND: Between February and April 2020, Italy experienced an overwhelming growth of the COVID-19 pandemic. Little is known, at the country level, where and how patients on renal replacement therapy (RRT) have been mostly affected. METHODS: Survey of the network of Nephrology centers using a simplified 17 items electronic questionnaire designed by Italian Society of Nephrology COVID-19 Research Group. We used spatial epidemiology and geographical information systems to map SARS-CoV-2 spread among RRT patients in Italy. RESULTS: On April 9th 2020, all nephrology centers (n = 454) listed in the DialMap database were invited to complete the electronic questionnaire. Within 11 days on average, 365 centers responded (80.4% response rate; 2.3% margin of error) totaling 60,441 RRT patients. The surveyed RRT population included 30,821 hemodialysis (HD), 4139 peritoneal dialysis (PD), and 25,481 transplanted (Tx) patients respectively. The proportion of SARS-CoV-2 positive RRT patients in Italy was 2.26% (95% CI 2.14-2.39) with significant differences according to treatment modality (p < 0.001). The proportion of patients positive for SARS-CoV-2 was significantly higher in HD (3.55% [95% CI 3.34-3.76]) than PD (1.38% [95% CI 1.04-1.78] and Tx (0.86% [95% CI 0.75-0.98]) (p < 0.001), with substantial heterogeneity across regions and along the latitude gradient (p < 0.001). In RRT patients the highest rate was in the north-west (4.39% [95% CI 4.11-4.68], followed by the north-east (IR 2.06% [1.79-2.36]), the center (0.91% [0.75-1.09]), the main islands (0.67% [0.47-0.93]), and the south (0.59% [0.45-0.75]. During the COVID-19 pandemic, among SARS-Cov-2 positive RRT patients the fatality rate was 32.8%, as compared to 13.3% observed in the Italian population as of April 23rd. CONCLUSIONS: A substantial proportion of the 60,441 surveyed RRT patients in Italy were SARS-Cov-2 positive and subsequently died during the exponential phase of COVID-19 pandemic. Infection risk and rates seems to differ substantially across regions, along geographical latitude, and by treatment modality.


title: Modifications of emergency dental clinic protocols to combat COVID-19 transmission

text: During the COVID-19 pandemic, incidence rates for dental diseases will continue unabated. However, the intent to prevent the spread of this lethal respiratory disease will likely lead to reduced treatment access due to restrictions on population movements. These changes have the potential to increase dental-related emergency department visits and subsequently contribute to greater viral transmission. Moreover, dentists experience unique challenges with preventing transmission due to frequent aerosol-producing procedures. This paper presents reviews and protocols implemented by directors and residents at the Dental College of Georgia to manage a dental emergency clinic during the COVID-19 pandemic. The methods presented include committee-based prioritization of dental patients, a multilayered screening process, team rotations with social and temporal spacing, and modified treatment room protocols. These efforts aid in the reduction of viral transmission, conservation of personal protective equipment, and expand provider availability. These protocols transcend a university and hospital-based models and are applicable to private and corporate models.


docid: yuvmtesy

title: Niveles de estrés, ansiedad y depresión en la primera fase del brote del COVID-19 en una muestra recogida en el norte de España./ Niveles de estrés, ansiedad y depresión en la primera fase del brote del COVID-19 en una muestra recogida en el norte de España./ Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain

text: The SARS-CoV-2 virus reached Spain in March 2020, and a nationwide state of alert was declared on March 14th, leading to the confinement of the entire population. The current study was conducted in the Basque Autonomous Community in northern Spain. The authors analyzed stress, anxiety, and depression with the arrival of the virus and the levels of symptoms according to age, comorbidity, and confinement. Levels of anxiety, stress, and depression were measured in a sample of 976 adults, using the DASS scale (Depression Anxiety, and Stress Scale). Although levels of symptoms were generally low at the start of the alert, younger individuals with chronic diseases reported more symptoms than the rest of the population. The study also detected higher levels of symptoms after the stay-at-home order was issued. Such symptoms are predicted to increase as the confinement continues. The authors propose psychological interventions for prevention and treatment in order to mitigate the pandemic's psychological impacts.


title: Uncovering socioeconomic gaps in mobility reduction during the COVID-19 pandemic using location data

text: Using smartphone location data from Colombia, Mexico, and Indonesia, we investigate how non-pharmaceutical policy interventions intended to mitigate the spread of the COVID-19 pandemic impact human mobility. In all three countries, we find that following the implementation of mobility restriction measures, human movement decreased substantially. Importantly, we also uncover large and persistent differences in mobility reduction between wealth groups: on average, users in the top decile of wealth reduced their mobility up to twice as much as users in the bottom decile. For decision-makers seeking to efficiently allocate resources to response efforts, these findings highlight that smartphone location data can be leveraged to tailor policies to the needs of specific socioeconomic groups, especially the most vulnerable.


title: The History of Investigation and Modern Classification of Coronaviruses (nidovirales: Coronaviridae) ;история Изучения И Современная Классификация Коронавирусов (nidovirales: Coronaviridae)

text: An epidemic of COVID-19 (Coronavirus disease 2019) etiologically associated with the SARS-CoV-2 (Severe acute respiratory syndrome-related coronavirus 2) that occurred at the turn of 2019-2020 firstly in Wuhan (Hubei province of China) and then spread to many countries around the world has generated a new wave of interest in coronaviruses The first coronaviruses â€“ representatives of the family Coronaviridae from the order Nidovirales â€“ were discovered in the first half of the last century The first human coronavirus, HCoV-B814, was isolated in 1965 and to date it has not been preserved in virological collections Over the past time, there has been a repeated layering of obsolete names By the beginning of the XXI century coronaviruses were a serious veterinary problem but it was believed that epidemic coronaviruses were not especially dangerous The scientific community had to revise these views for the very first time in 2002, when SARS-CoV (Severe acute respiratory syndrome-related coronavirus) virus entered the human population from the bats in Southeast Asia, and then in 2012 â€“ when natural foci of the MERS-CoV (Middle East respiratory syndrome-related coronavirus) were discovered on the territory of the Arabian Peninsula As a result of increased interest in coronaviruses a large number of new members of the Coronaviridae were discovered in the first two decades of the XXI century, which required several revisions of the taxonomic structure of this family This review is devoted to the history of studying coronaviruses and the system of their modern classification, which has developed at the beginning of 2020 in accordance with the latest recommendations of the International Committee on Taxonomy of Viruses ;Ð’Ð¾Ð·Ð½Ð¸ÐºÑˆÐ°Ñ Ð½Ð° Ñ€ÑƒÐ±ÐµÐ¶Ðµ 2019-2020 Ð³Ð³ ÑÐ½Ð°Ñ‡Ð°Ð»Ð° Ð² Ð³ Ð£Ñ…Ð°Ð½ÑŒ (ÐºÐ¸Ñ‚Ð°Ð¹ÑÐºÐ¾Ð¹ Ð¿Ñ€Ð¾Ð²Ð¸Ð½Ñ†Ð¸Ð¸ Ð¥ÑƒÐ±ÑÐ¹) Ð¸ Ñ€Ð°ÑÐ¿Ñ€Ð¾ÑÑ‚Ñ€Ð°Ð½Ð¸Ð²ÑˆÐ°ÑÑÑ Ð·Ð°Ñ‚ÐµÐ¼ Ð²Ð¾ Ð¼Ð½Ð¾Ð³Ð¸Ðµ ÑÑ‚Ñ€Ð°Ð½Ñ‹ Ð¼Ð¸Ñ€Ð° ÑÐ¿Ð¸Ð´ÐµÐ¼Ð¸Ñ COVID-19 (Coronavirus disease 2019), ÑÑ‚Ð¸Ð¾Ð»Ð¾Ð³Ð¸Ñ‡ÐµÑÐºÐ¸ ÑÐ²ÑÐ·Ð°Ð½Ð½Ð°Ñ Ñ Ð²Ð¸Ñ€ÑƒÑÐ¾Ð¼ Ñ‚ÑÐ¶Ñ‘Ð»Ð¾Ð³Ð¾ Ð¾ÑÑ‚Ñ€Ð¾Ð³Ð¾ Ñ€ÐµÑÐ¿Ð¸Ñ€Ð°Ñ‚Ð¾Ñ€Ð½Ð¾Ð³Ð¾ ÑÐ¸Ð½Ð´Ñ€Ð¾Ð¼Ð° 2â€‘Ð³Ð¾ Ñ‚Ð¸Ð¿Ð° (SARS-CoV-2 â€“ Severe acute respiratory syndrome 2), Ð¿Ð¾Ñ€Ð¾Ð´Ð¸Ð»Ð° Ð½Ð¾Ð²ÑƒÑŽ Ð²Ð¾Ð»Ð½Ñƒ Ð¸Ð½Ñ‚ÐµÑ€ÐµÑÐ° Ðº ÐºÐ¾Ñ€Ð¾Ð½Ð°Ð²Ð¸Ñ€ÑƒÑÐ°Ð¼ ÐŸÐµÑ€Ð²Ñ‹Ðµ ÐºÐ¾Ñ€Ð¾Ð½Ð°Ð²Ð¸Ñ€ÑƒÑÑ‹ â€“ Ð¿Ñ€ÐµÐ´ÑÑ‚Ð°Ð²Ð¸Ñ‚ÐµÐ»Ð¸ ÑÐµÐ¼ÐµÐ¹ÑÑ‚Ð²Ð° Coronaviridae Ð¸Ð· Ð¾Ñ‚Ñ€ÑÐ´Ð° Nidovirales â€“ Ð±Ñ‹Ð»Ð¸ Ð¾Ñ‚ÐºÑ€Ñ‹Ñ‚Ñ‹ ÐµÑ‰Ñ‘ Ð² Ð¿ÐµÑ€Ð²Ð¾Ð¹ Ð¿Ð¾Ð»Ð¾Ð²Ð¸Ð½Ðµ Ð¿Ñ€Ð¾ÑˆÐ»Ð¾Ð³Ð¾ Ð²ÐµÐºÐ° ÐŸÐµÑ€Ð²Ñ‹Ð¹ ÐºÐ¾Ñ€Ð¾Ð½Ð°Ð²Ð¸Ñ€ÑƒÑ Ñ‡ÐµÐ»Ð¾Ð²ÐµÐºÐ°, HCoV-B814, Ð±Ñ‹Ð» Ð¸Ð·Ð¾Ð»Ð¸Ñ€Ð¾Ð²Ð°Ð½ Ð² 1965 Ð³ Ð¸ Ðº Ð½Ð°ÑÑ‚Ð¾ÑÑ‰ÐµÐ¼Ñƒ Ð²Ñ€ÐµÐ¼ÐµÐ½ Ð½Ðµ ÑÐ¾Ñ…Ñ€Ð°Ð½Ð¸Ð»ÑÑ Ð² Ð²Ð¸Ñ€ÑƒÑÐ¾Ð»Ð¾Ð³Ð¸Ñ‡ÐµÑÐºÐ¸Ñ… ÐºÐ¾Ð»Ð»ÐµÐºÑ†Ð¸ÑÑ… Ð—Ð° Ð¿Ñ€Ð¾ÑˆÐµÐ´ÑˆÐµÐµ Ð²Ñ€ÐµÐ¼Ñ Ð¿Ñ€Ð¾Ð¸Ð·Ð¾ÑˆÐ»Ð¾ Ð¼Ð½Ð¾Ð³Ð¾ÐºÑ€Ð°Ñ‚Ð½Ð¾Ðµ Ð½Ð°ÑÐ»Ð¾ÐµÐ½Ð¸Ðµ ÑƒÑÑ‚Ð°Ñ€ÐµÐ²ÑˆÐ¸Ñ… Ð½Ð°Ð·Ð²Ð°Ð½Ð¸Ð¹ Ðš Ð½Ð°Ñ‡Ð°Ð»Ñƒ XXI Ð²ÐµÐºÐ° ÐºÐ¾Ñ€Ð¾Ð½Ð°Ð²Ð¸Ñ€ÑƒÑÑ‹ Ð¿Ñ€ÐµÐ´ÑÑ‚Ð°Ð²Ð»ÑÐ»Ð¸ ÑÐµÑ€ÑŒÑ‘Ð·Ð½ÑƒÑŽ Ð²ÐµÑ‚ÐµÑ€Ð¸Ð½Ð°Ñ€Ð½ÑƒÑŽ Ð¿Ñ€Ð¾Ð±Ð»ÐµÐ¼Ñƒ, Ð¾Ð´Ð½Ð°ÐºÐ¾ ÑÑ‡Ð¸Ñ‚Ð°Ð»Ð¾ÑÑŒ, Ñ‡Ñ‚Ð¾ ÑÐ¿Ð¸Ð´ÐµÐ¼Ð¸Ñ‡ÐµÑÐºÐ¸Ðµ ÐºÐ¾Ñ€Ð¾Ð½Ð°Ð²Ð¸Ñ€ÑƒÑÑ‹ Ð½Ðµ Ð¾Ñ‚Ð½Ð¾ÑÑÑ‚ÑÑ Ðº Ñ‡Ð¸ÑÐ»Ñƒ Ð¾ÑÐ¾Ð±Ð¾ Ð¾Ð¿Ð°ÑÐ½Ñ‹Ñ… ÐÐ°ÑƒÑ‡Ð½Ð¾Ð¼Ñƒ ÑÐ¾Ð¾Ð±Ñ‰ÐµÑÑ‚Ð²Ñƒ Ð¿Ñ€Ð¸ÑˆÐ»Ð¾ÑÑŒ Ð¿ÐµÑ€ÐµÑÐ¼Ð°Ñ‚Ñ€Ð¸Ð²Ð°Ñ‚ÑŒ ÑÑ‚Ð¸ Ð¿Ñ€ÐµÐ´ÑÑ‚Ð°Ð²Ð»ÐµÐ½Ð¸Ñ ÑÐ½Ð°Ñ‡Ð°Ð»Ð° Ð² 2002 Ð³ , ÐºÐ¾Ð³Ð´Ð° Ð²Ð¸Ñ€ÑƒÑ Ñ‚ÑÐ¶Ñ‘Ð»Ð¾Ð³Ð¾ Ð¾ÑÑ‚Ñ€Ð¾Ð³Ð¾ Ñ€ÐµÑÐ¿Ð¸Ñ€Ð°Ñ‚Ð¾Ñ€Ð½Ð¾Ð³Ð¾ ÑÐ¸Ð½Ð´Ñ€Ð¾Ð¼Ð° (SARS-CoV â€“ Severe acute respiratory syndrome-related coronavirus) Ð¿Ñ€Ð¾Ð½Ð¸Ðº Ð² Ð¿Ð¾Ð¿ÑƒÐ»ÑÑ†Ð¸ÑŽ Ð»ÑŽÐ´ÐµÐ¹ Ð¸Ð· Ð¿Ð¾Ð¿ÑƒÐ»ÑÑ†Ð¸Ð¸ Ð»ÐµÑ‚ÑƒÑ‡Ð¸Ñ… Ð¼Ñ‹ÑˆÐµÐ¹ Ð² Ð®Ð³Ð¾-Ð’Ð¾ÑÑ‚Ð¾Ñ‡Ð½Ð¾Ð¹ ÐÐ·Ð¸Ð¸, Ð° Ð¿Ð¾Ñ‚Ð¾Ð¼ Ð² 2012 Ð³ â€“ ÐºÐ¾Ð³Ð´Ð° Ð±Ñ‹Ð»Ð¸ Ð¾Ñ‚ÐºÑ€Ñ‹Ñ‚Ñ‹ Ð¿Ñ€Ð¸Ñ€Ð¾Ð´Ð½Ñ‹Ðµ Ð¾Ñ‡Ð°Ð³Ð¸ Ð²Ð¸Ñ€ÑƒÑÐ° Ð‘Ð»Ð¸Ð¶Ð½ÐµÐ²Ð¾ÑÑ‚Ð¾Ñ‡Ð½Ð¾Ð³Ð¾ Ñ€ÐµÑÐ¿Ð¸Ñ€Ð°Ñ‚Ð¾Ñ€Ð½Ð¾Ð³Ð¾ ÑÐ¸Ð½Ð´Ñ€Ð¾Ð¼Ð° (MERS-CoV â€“ Middle East respiratory syndrome-related coronavirus) Ð½Ð° Ñ‚ÐµÑ€Ñ€Ð¸Ñ‚Ð¾Ñ€Ð¸Ð¸ ÐÑ€Ð°Ð²Ð¸Ð¹ÑÐºÐ¾Ð³Ð¾ Ð¿Ð¾Ð»ÑƒÐ¾ÑÑ‚Ñ€Ð¾Ð²Ð° Ð’ Ñ€ÐµÐ·ÑƒÐ»ÑŒÑ‚Ð°Ñ‚Ðµ Ð°ÐºÑ‚Ð¸Ð²Ð¸Ð·Ð°Ñ†Ð¸Ð¸ Ð¸Ð½Ñ‚ÐµÑ€ÐµÑÐ° Ðº ÐºÐ¾Ñ€Ð¾Ð½Ð°Ð²Ð¸Ñ€ÑƒÑ Ð°Ð¼, Ð² Ð¿ÐµÑ€Ð²Ñ‹Ðµ Ð´Ð²Ð° Ð´ÐµÑÑÑ‚Ð¸Ð»ÐµÑ‚Ð¸Ñ XXI Ð²ÐµÐºÐ° Ð±Ñ‹Ð»Ð¾ Ð¾Ñ‚ÐºÑ€Ñ‹Ñ‚Ð¾ Ð±Ð¾Ð»ÑŒÑˆÐ¾Ðµ ÐºÐ¾Ð»Ð¸Ñ‡ÐµÑÑ‚Ð²Ð¾ Ð½Ð¾Ð²Ñ‹Ñ… Ð¿Ñ€ÐµÐ´ÑÑ‚Ð°Ð²Ð¸Ñ‚ÐµÐ»ÐµÐ¹ Coronaviridae, Ñ‡Ñ‚Ð¾ Ð¿Ð¾Ñ‚Ñ€ÐµÐ±Ð¾Ð²Ð°Ð»Ð¾ Ð½ÐµÑÐºÐ¾Ð»ÑŒÐºÐ¸Ñ… Ñ€ÐµÐ²Ð¸Ð·Ð¸Ð¹ Ñ‚Ð°ÐºÑÐ¾Ð½Ð¾Ð¼Ð¸Ñ‡ÐµÑÐºÐ¾Ð¹ ÑÑ‚Ñ€ÑƒÐºÑ‚ÑƒÑ€Ñ‹ ÑÑ‚Ð¾Ð³Ð¾ ÑÐµÐ¼ÐµÐ¹ÑÑ‚Ð²Ð° ÐÐ°ÑÑ‚Ð¾ÑÑ‰Ð¸Ð¹ Ð¾Ð±Ð·Ð¾Ñ€ Ð¿Ð¾ÑÐ²ÑÑ‰Ñ‘Ð½ Ð¸ÑÑ‚Ð¾Ñ€Ð¸Ð¸ Ð¸Ð·ÑƒÑ‡ÐµÐ½Ð¸Ñ ÐºÐ¾Ñ€Ð¾Ð½Ð°Ð²Ð¸Ñ€ÑƒÑÐ¾Ð² Ð¸ ÑÐ¸ÑÑ‚ÐµÐ¼Ðµ Ð¸Ñ… ÑÐ¾Ð²Ñ€ÐµÐ¼ÐµÐ½Ð½Ð¾Ð¹ ÐºÐ»Ð°ÑÑÐ¸Ñ„Ð¸ÐºÐ°Ñ†Ð¸Ð¸, ÐºÐ¾Ñ‚Ð¾Ñ€Ð°Ñ ÑÐ»Ð¾Ð¶Ð¸Ð»Ð°ÑÑŒ Ð½Ð° Ð½Ð°Ñ‡Ð°Ð»Ð¾ 2020 Ð³ Ð² ÑÐ¾Ð¾Ñ‚Ð²ÐµÑ‚ÑÑ‚Ð²Ð¸Ðµ Ñ Ð¿Ð¾ÑÐ»ÐµÐ´Ð½Ð¸Ð¼Ð¸ Ñ€ÐµÐºÐ¾Ð¼ÐµÐ½Ð´Ð°Ñ†Ð¸ÑÐ¼Ð¸ ÐœÐµÐ¶Ð´ÑƒÐ½Ð°Ñ€Ð¾Ð´Ð½Ð¾Ð³Ð¾ ÐšÐ¾Ð¼Ð¸Ñ‚ÐµÑ‚Ð° Ð¿Ð¾ Ñ‚Ð°ÐºÑÐ¾Ð½Ð¾Ð¼Ð¸Ð¸ Ð²Ð¸Ñ€ÑƒÑÐ¾Ð²


Enhanced Recovery After Cesarean (ERAC) - beyond the pain scores


title: Necessity of ventilation for mitigating virus transmission quantified simply

text: To mitigate the SARS-CoV-2 pandemic, officials have employed social distancing and stay-at-home measures. Less attention has focused on ventilation. Effective distancing practices for open spaces may be ineffective for poorly ventilated spaces, both of which are commonly filled with turbulent air. While turbulence initially reduces the risk of infection near a virion-source, it eventually increases the exposure risk for all occupants in a space without ventilation. Here we estimate the time-scale for virions injected into a room of turbulent air to infect an occupant, distinguishing cases of low vs. high initial virion mass loads and virion-destroying vs. virion-reflecting walls. An open window typifies ventilation and we show that its minimum area needed to ensure safety depends only on the ratio of total viral load to threshold load for infection. Our minimalist estimates complement more detailed approaches and present opportunities for generalization.


title: SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020

text: End of April 2020, French clinicians observed an increase in cases presenting with paediatric inflammatory multisystem syndrome (PIMS). Nationwide surveillance was set up and demonstrated temporospatial association with the coronavirus disease (COVID-19) epidemic for 156 reported cases as at 17 May: 108 were classified as confirmed (nâ¯=â¯79), probable (nâ¯=â¯16) or possible (nâ¯=â¯13) post-COVID-19 PIMS cases. A continuum of clinical features from Kawasaki-like disease to myocarditis was observed, requiring intensive care in 67% of cases.


The liaison between respiratory failure and high blood pressure: evidence from COVID-19 patients


Society for Vascular Medicine (SVM) Leaders Respond to the COVID-19 Crisis


title: Elevated interleukin-6 is associated with severity of COVID-19: a meta-analysis

text: Coronavirus disease 2019 (COVID-19) has spread rapidly around the world since its emergence in humans last December. Previous studies suggested that numerous markers of inflammation were elevated in patients in with severe disease relative to patients with milder conditions, and an elevated level of interleukin-6 (IL-6) was associated with a high case fatality of COVID-19 infection. This article is protected by copyright. All rights reserved.


Familial cluster of SARS-CoV-2 infection associated with a railway journey


Molecular mimicry between SARS-CoV-2 and respiratory pacemaker neurons


title: Évolution de l'activité d'électro-convulsivo-thérapie en France depuis le début de la pandémie COVID-19./ [Evolution of electro-convulsive therapy activity in France since the beginning of the COVID-19 pandemic]

text: The recent COVID-19 pandemic has led to major organisational changes in health care settings, especially in psychiatric hospitals. We conducted a national online survey to assess the evolution of electroconvulsive therapy (ECT) in the different centres practicing this treatment. 65 responses from all over France were analysed. More than 90 % of the centres practising ECT experienced a decrease in their activity. Half of the centres experienced a total cessation of activity and 25 % of the centres experienced a decrease of more than half of their usual activity. Post-pandemic COVID-19 psychiatric care is expected to be difficult. It is essential not to add to this difficulty the complications, often serious, that will be associated with delaying or stopping the practice of ECT. It will also be necessary to remain vigilant with regard to the specific neuropsychiatric consequences that will follow the pandemic.


Medical education during pandemics: a UK perspective


Letter to the Editor: Case of the Index Patient Who Caused Tertiary Transmission of Coronavirus Disease 2019 in Korea: the Application of Lopinavir/Ritonavir for the Treatment of COVID-19 Pneumonia Monitored by Quantitative RT-PCR


Symptomatic Infants have Higher Nasopharyngeal SARS-CoV-2 Viral Loads but Less Severe Disease than Older Children


title: Neutrophil extracellular traps in COVID-19

text: In severe cases of coronavirus disease 2019 (COVID-19), viral pneumonia progresses to respiratory failure. Neutrophil extracellular traps (NETs) are extracellular webs of chromatin, microbicidal proteins, and oxidant enzymes that are released by neutrophils to contain infections. However, when not properly regulated, NETs have the potential to propagate inflammation and microvascular thrombosis - including in the lungs of patients with acute respiratory distress syndrome. We now report that sera from patients with COVID-19 have elevated levels of cell-free DNA, myeloperoxidase-DNA (MPO-DNA), and citrullinated histone H3 (Cit-H3); the latter 2 are specific markers of NETs. Highlighting the potential clinical relevance of these findings, cell-free DNA strongly correlated with acute-phase reactants, including C-reactive protein, D-dimer, and lactate dehydrogenase, as well as absolute neutrophil count. MPO-DNA associated with both cell-free DNA and absolute neutrophil count, while Cit-H3 correlated with platelet levels. Importantly, both cell-free DNA and MPO-DNA were higher in hospitalized patients receiving mechanical ventilation as compared with hospitalized patients breathing room air. Finally, sera from individuals with COVID-19 triggered NET release from control neutrophils in vitro. Future studies should investigate the predictive power of circulating NETs in longitudinal cohorts and determine the extent to which NETs may be novel therapeutic targets in severe COVID-19.


ACMQ Student, Resident, and Fellow Section (SRF) COVID-19 Resident and Fellow Survey


title: Corona Virus International Public Health Emergencies: Implications for Radiology Management

text: The outbreak of 2019 novel coronavirus (2019-nCoV) pneumonia was reported in Wuhan, Hubei Province, China in December 2019 and has spread internationally. This article discusses how radiology departments can most effectively respond to this public health emergency.


docid: bzenjntv

title: COVID-19 Pandemic Spurs Policy Changes Benefiting Older Adults

text: This article reviews recent federal and state policy changes in response to the COVID-19 pandemic that affect health care and quality of life for older adults. Specific regulations and guidelines issued at the state and federal level have increased access and provided additional funding for essential services and supports. Many of these changes are temporary and have the potential to improve care beyond the immediate crisis. This period of greater flexibility offers the opportunity to accrue evidence on quality and access to influence sustained change. [Journal of Gerontological Nursing, 46(6), 19-23.].


ASPHER statement on the novel coronavirus disease (COVID-19) outbreak emergency


Annals On Call - Clinical Reasoning and COVID-19 Part 2


COVID-19 online surveys need to follow standards and guidelines: Comment on "Does COVID-19 pandemic affect sexual behaviour? A cross-sectional, cross-national online survey" and "Binge watching behavior during COVID 19 pandemic: A cross-sectional, cross-national online survey"


Covid-19: Doctors feel shut out of plans for dealing with backlog of missed care


Covid-19: healthcare and politics are inexorably intertwined


Reply: Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID-19) Pandemic: An ACC/SCAI Consensus Statement


title: Digitalization of COVID-19 pandemic management and cyber risk from connected systems

text: What makes cyber risks arising from connected systems challenging during the management of a pandemic? Assuming that a variety of cyber-physical systems are already operational-collecting, analyzing, and acting on data autonomously-what risks might arise in their application to pandemic management? We already have these systems operational, collecting, and analyzing data autonomously, so how would a pandemic monitoring app be different or riskier? In this review article, we discuss the digitalization of COVID-19 pandemic management and cyber risk from connected systems.


docid: qhhssnqk

title: Mathematical model of infection kinetics and its analysis for COVID-19, SARS and MERS

text: The purpose of this paper is to reveal the spread rules of the three pneumonia: COVID-19, SARS and MERS. We compare the new spread characteristics of COVID-19 with those of SARS and MERS. By considering the growth rate and inhibition constant of infectious diseases, their propagation growth model is established. The parameters of the three coronavirus transmission growth models are obtained by nonlinear fitting. Parametric analysis shows that the growth rate of COVID-19 is about twice that of the SARS and MERS, and the COVID-19 doubling cycle is two to three days, suggesting that the number of COVID-19 patients would double in two to three days without human intervention. The infection inhibition constant in Hubei is two orders of magnitude lower than in other regions, which reasonably explains the situation of the COVID-19 outbreak in Hubei.


title: Assessing the Burden of Nondeferrable Major Uro-oncologic Surgery to Guide Prioritisation Strategies During the COVID-19 Pandemic: Insights from Three Italian High-volume Referral Centres

text: The coronavirus 2019 (COVID-19) pandemic has led to an unprecedented emergency scenario for all aspects of health care, including urology. At the time of writing, Italy was the country with the highest rates of both infection and mortality. A panel of experts recently released recommendations for prioritising urologic surgeries in a low-resource setting. Of note, major cancer surgery represents a compelling challenge. However, the burden of these procedures and the impact of such recommendations on urologic practice are currently unknown. To fill this gap, we assessed the yearly proportion of high-priority major uro-oncologic surgeries at three Italian high-volume academic centres. Of 2387 major cancer surgeries, 32.3% were classified as high priority (12.6% of radical nephroureterectomy, 17.3% of nephrectomy, 33.9% of radical prostatectomy, and 36.2% of radical cystectomy cases). Moreover, 26.4% of high-priority major cancer surgeries were performed in patients at higher perioperative risk (American Society of Anesthesiologists score ≥3), with radical cystectomy contributing the most to this cohort (50%). Our real-life data contextualise ongoing recommendations on prioritisation strategies during the current COVID-19 pandemic, highlighting the need for better patient selection for surgery. We found that approximately two-thirds of elective major uro-oncologic surgeries can be safely postponed or changed to another treatment modality when the availability of health care resources is reduced. PATIENT SUMMARY: We used data from three high-volume Italian academic urology centres to evaluate how many surgeries performed for prostate, bladder, kidney, and upper tract urothelial cancer can be postponed in times of emergency. We found that approximately two-thirds of patients with these cancers do not require high-priority surgery. Conversely, of patients requiring high-priority surgery, approximately one in four is considered at high perioperative risk. These patients may pose challenges in allocation of resources in critical scenarios such as the current COVID-19 pandemic.


Coronavirus disease-2019: An update on third coronavirus outbreak of 21st century


title: Severe refractory thrombocytopenia in a woman positive for coronavirus disease 2019 with lupus and antiphospholipid syndrome

text: The coronavirus disease 2019 (COVID-19) pandemic has created new challenges that necessitate prompt responses in unexpected clinical situations. Multiple extrapulmonary manifestations and complications of COVID-19 have already been described, but only scattered data are present on immunologic manifestations. We present a case of severe refractory thrombocytopenia in a 51-year-old woman with a history of long-standing systemic lupus erythematosus and antiphospholipid syndrome who presented with hemoptysis in the setting of COVID-19 infection. The patient failed to respond to initial treatment with intravenous immunoglobulin, high-dose steroids, and platelet transfusion, but responded to eltrombopag, with prompt improvement of a platelet count. The current case report provides clinical data of relevance to the largely unexplored question of the immunologic complications of COVID-19 in patients with a pre-existing inflammatory state.


docid: nxctkbqe

title: T-Cell Subset Counts in Peripheral Blood Can Be Used as Discriminatory Biomarkers for Diagnosis and Severity Prediction of Coronavirus Disease 2019

text: This study evaluated the significance of lymphocyte subset detection in peripheral blood in the diagnosis and prognosis of coronavirus disease 2019 (COVID-19). Our results revealed that CD3+ T cells, CD4+ T cells, CD8+ T cells, and natural killer cells were significantly decreased in patients with COVID-19. These patients had a relatively slight decrease in CD4+ T cells but a severe decrease in CD8+ T cells. The significantly elevated CD4/CD8 ratio was observed in COVID-19 patients. T-cell subset counts were related to the severity and prognosis of COVID-19, suggesting that the counts of CD8+ T and CD4+ T cells can be used as diagnostic markers of COVID-19 and predictors of disease severity.


Cardiopulmonary Resuscitation in the prone position: a good option for patients with COVID-19


How the coronavirus pandemic slashed carbon emissions - in five graphs


docid: gefhmzng

title: Possible method for the production of a Covid-19 vaccine


Outbreak of chilblain-like acral lesions in children in the metropolitan area of Milan, Italy, during the COVID-19 pandemic


title: Colon capsule endoscopy: an innovative method for detecting colorectal pathology during the COVID-19 pandemic?

text: AIM: The coronavirus pandemic has led to significant challenges for healthcare delivery across the globe. Non-emergency endoscopic activity in the UK has been postponed, raising concerns of increased delays in the diagnosis of colorectal cancer and a surge in demand once services resume. Measures to mitigate this risk must be considered. METHOD: This paper reviews various investigative modalities for colorectal disease which could be deployed during cessation of colonoscopy services. We focus on colon capsule endoscopy (CCE) due to its relevance during the COVID-19 pandemic and its ability to triage patients effectively to further endoscopic investigations. RESULTS: CT of the abdomen and pelvis has been suggested as a triage tool while access to colonoscopy is limited. However, CT may lead to the spread of COVID-19 as patients attend the hospital, and it exposes them to the risks of radiation. Faecal immunochemistry tests have been demonstrated as a good predictor of colonic pathology and could be safely used to risk stratify patients when prioritizing colonoscopy. CCE is a safe and innovative technology for investigating the colon. Procedures can be carried out in the community and can be conducted safely during the coronavirus pandemic. It has been shown to be an accurate detector of colonic neoplasia and can reduce demand for colonoscopy. CONCLUSION: As colonoscopy services resume, they will probably experience high demand leading to further delays for patients. CCE could be used to reduce the number of patients requiring colonoscopy and triage those requiring further endoscopic investigations appropriately.


Funders Support Mental Health Care: COVID-19 And Before


Adaptation to the Plastic Barrier Sheet to Facilitate Intubation during the COVID-19 Pandemic


title: Characteristics and Outcomes of Recipients of Heart Transplant With Coronavirus Disease 2019

text: Importance: Recipients of heart transplant (HT) may be at increased risk of adverse outcomes attributable to infection with coronavirus disease 2019 (COVID-19) because of multiple comorbidities and clinically significant immunosuppression. Objective: To describe the characteristics, treatment, and outcomes of recipients of HT with COVID-19. Design, Setting, and Participants: This case series from a single large academic heart transplant program in New York, New York, incorporates data from between March 1, 2020, and April 24, 2020. All recipients of HT followed up by this center who were infected with COVID-19 were included. Interventions: Heart transplant and a confirmed diagnosis of COVID-19. Main Outcomes and Measures: The primary measure was vital status at end of study follow-up. Secondary measures included patient characteristics, laboratory analyses, changes to immunosuppression, and treatment administered for COVID-19. Results: Twenty-eight patients with HT received a confirmed diagnosis of COVID-19. The median age was 64.0 (interquartile range [IQR], 53.5-70.5) years, 22 (79%) were men, and the median time from HT was 8.6 (IQR, 4.2-14.5) years. Comorbid conditions included hypertension in 20 patients (71%), diabetes in 17 patients (61%), and cardiac allograft vasculopathy in 16 patients (57%). Twenty-two participants (79%) were admitted for treatment, and 7 (25%) required mechanical ventilation. Most (13 of 17 [76%]) had evidence of myocardial injury (median high-sensitivity troponin T, 0.055 [IQR, 0.0205-0.1345] ng/mL) and elevated inflammatory biomarkers (median peak high-sensitivity C-reactive protein, 11.83 [IQR, 7.44-19.26] mg/dL; median peak interleukin 6, 105 [IQR, 38-296] pg/mL). Among patients managed at the study institution, mycophenolate mofetil was discontinued in 16 patients (70%), and 6 (26%) had a reduction in the dose of their calcineurin inhibitor. Treatment of COVID-19 included hydroxychloroquine (18 patients [78%]), high-dose corticosteroids (8 patients [47%]), and interleukin 6 receptor antagonists (6 patients [26%]). Overall, 7 patients (25%) died. Among 22 patients (79%) who were admitted, 11 (50%) were discharged home, 4 (18%) remain hospitalized at the end of the study, and 7 (32%) died during hospitalization. Conclusions and Relevance: In this single-center case series, COVID-19 infection was associated with a case fatality rate of 25% in recipients of HT. Immunosuppression was reduced in most of this group of patients. Further study is required to evaluate the optimal approach to management of COVID-19 infection in the HT population.


Mental wellness system for COVID-19


title: Coronavirus disease-2019 epidemic response in Uganda: The need to strengthen and engage primary healthcare

text: In Uganda, the numbers of new coronavirus disease cases have continued to increase slowly since the first case was confirmed. Given that the disease is likely to be holoendemic, the role of primary care (PC) with its features of comprehensiveness, accessibility, coordination and continuity, functioning at the heart of a primary healthcare (PHC) approach, will be important. The elements of PC are applicable in the epidemic preparation, case finding and management, follow-up and post-epidemic phases of responding to this pandemic. This also presents opportunities and lessons for strengthening PHC as well as for reflections on missed opportunities. The effective use of available resources in response to the epidemic should mainly focus on community mobilisation and PHC teams for the prevention, screening, testing and treatment of mild and moderate cases.


docid: gbdxdzba

title: COVID-19 and maternal and child food and nutrition insecurity: a complex syndemic

text: Globally, the COVID-19 pandemic has already led to major increases in unemployment and is expected to lead to unprecedented increases in poverty and food and nutrition insecurity, as well as poor health outcomes. Families where young children, youth, pregnant and lactating women live need to be protected against the ongoing protracted pandemic and the aftershocks that are very likely to follow for years to come. The future wellbeing of the vast majority of the world now depends on reconfiguring the current ineffective food, nutrition, health, and social protection systems to ensure food and nutrition security for all. Because food, nutrition, health, and socio-economic outcomes are intimately inter-linked, it is essential that we find out how to effectively address the need to reconfigure and to provide better intersecoral coordination among global and local food, health care, and social protection systems taking equity and sutainability principles into account. Implementation science research informed by complex adaptive sytems frameworks will be needed to fill in the major knowledge gaps. Not doing so will not only put the development of individuals at further risk, but also negatively impact on the development potential of entire nations and ultimately our planet.


docid: ttwhmtre

title: A mathematical model for the coronavirus COVID-19 outbreak

text: A mathematical model is proposed for quantitative description of the outbreak of novel coronavirus COVID-19 in China. Although the model is relatively simple, the comparison with the public data shows that an exact solution solution of the model (with the correctly-specified parameters) leads to the results, which are in good agreement with the measured data. Prediction of the total number of the COVID-19 cases is discussed and an example is presented using the measured data in Austria.


title: How to Build the Plane While Flying: VTE/PE Thromboprophylaxis Clinical Guidelines for COVID-19 Patients

text: Over the years, the practice of medicine has evolved from authority-based to experience-based to evidence-based with the introduction of the scientific process, clinical trials, and outcomes-based data analysis (Tebala GD. Int J Med Sci. 2018;15(12):1397-1405). The time required to perform the necessary randomized controlled trials, a systematic literature review, and meta-analysis of these trials to then create, accept, promulgate, and educate the practicing clinicians to use the evidence-based clinical guidelines is typically measured in years. When the severe acute respiratory syndrome novel coronavirus-2 (SARS-nCoV-2) pandemic commenced in Wuhan, China at the end of 2019, there were few available clinical guidelines to deploy, let alone adapt and adopt to treat the surge of coronavirus disease 2019 (COVID-19) patients. The aim of this study is to first explain how clinical guidelines, on which bedside clinicians have grown accustomed, can be created in the midst of a pandemic, with an evolving scientific understanding of the pathophysiology of the hypercoagulable state. The second is to adapt and adopt current venous thromboembolism diagnostic and treatment guidelines, while relying on the limited available observational reporting of COVID-19 patients to create a comprehensive clinical guideline to treat COVID-19 patients.


title: Conservative two-stage group testing

text: Inspired by applications in testing for COVID-19, we consider a variant of two-stage group testing we call"conservative"two-stage testing, where every item declared to be defective must be definitively confirmed by being tested by itself in the second stage. We study this in the linear regime where the prevalence is fixed while the number of items is large. We study various nonadaptive test designs for the first stage, and derive a new lower bound for the total number of tests required. We find that a first-stage design with constant tests per item and constant items per test due to Broder and Kumar (arXiv:2004.01684) is extremely close to optimal. Simulations back up the theoretical results.


title: Laboratory diagnostics within a modular hospital at the time of Coronavirus disease 2019 (COVID-19) in Wuhan

text: An outbreak of the so-called Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), has been spreading rapidly nationwide in China since December 2019. Wuhan, Hubei Province, is the hardest-hit region, with a rise in confirmed cases and its hospitals overwhelmed. On 2nd February, 2020, Wuhan began to build a modular hospital to treat patients caught with mild illness. The mobile modular hospital is mainly composed of medical modules, technical support modules, ward units, living support units and transportation capacity under field conditions, and there are complete equipment and specialized personnel to treat patients. Due to the severity and particularity of SARS-CoV-2, taking granted from lessons learnt from mobile modular hospitals, we use the existing large venues to construct a new fixed modular hospital. As patients need to be treated and tested, it is important to develop a clinical laboratory in the modular hospital and ensure biosafety. The construction of a clinical laboratory in the modular hospital is faced with problems such as time pressure, limited site selection, high level of biosafety, lack of experience and so forth. This paper mainly discusses how to construct the clinical laboratory in the modular hospital quickly and safely and put it into use to provide testing service for patients under various limited conditions.


title: Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase

text: OBJECTIVE: This study investigated the influence of Coronavirus Disease 2019 (COVID-19) on lung function in early convalescence phase. METHODS: A retrospective study of COVID-19 patients at the Fifth Affiliated Hospital of Sun Yat-sen University were conducted, with serial assessments including lung volumes (TLC), spirometry (FVC, FEV1), lung diffusing capacity for carbon monoxide (DLCO),respiratory muscle strength, 6-min walking distance (6MWD) and high resolution CT being collected at 30 days after discharged. RESULTS: Fifty-seven patients completed the serial assessments. There were 40 non-severe cases and 17 severe cases. Thirty-one patients (54.3%) had abnormal CT findings. Abnormalities were detected in the pulmonary function tests in 43 (75.4%) of the patients. Six (10.5%), 5(8.7%), 25(43.8%) 7(12.3%), and 30 (52.6%) patients had FVC, FEV1, FEV1/FVC ratio, TLC, and DLCO values less than 80% of predicted values, respectively. 28 (49.1%) and 13 (22.8%) patients had PImax and PEmax values less than 80% of the corresponding predicted values. Compared with non-severe cases, severe patients showed higher incidence of DLCO impairment (75.6%vs42.5%, p = 0.019), higher lung total severity score (TSS) and R20, and significantly lower percentage of predicted TLC and 6MWD. No significant correlation between TSS and pulmonary function parameters was found during follow-up visit. CONCLUSION: Impaired diffusing-capacity, lower respiratory muscle strength, and lung imaging abnormalities were detected in more than half of the COVID-19 patients in early convalescence phase. Compared with non-severe cases, severe patients had a higher incidence of DLCO impairment and encountered more TLC decrease and 6MWD decline.


title: Ventilators, Guidelines, Judgment, and Trust

text: Covid-19 confronts us with tragic choices, in which every option is unacceptable. On the New York State Task Force on Life and the Law, I worked on guidelines for such situations. We did not envision the scale or character of Covid-19. To minimize fear that the decisions made in these situations might be unfair, we all must know what guidelines or mandates inform them. Only with transparency about how decisions will be made, by whom, and according to what requirements can we have confidence that fairness prevails. We now face many related questions about process, goals, leadership, and trust. For example, how might ethical guidelines evolve as scientific understanding advances? Should guidelines vary with different venues? And if, as I have argued, judgment is necessary even with the best of guidelines, how can we prepare clinicians to make good judgments? Are there implications for better training of personnel in nonemergency times for what they might face in the worst of times?


Perforated Marginal Ulcer in a COVID-19 Patient. Laparoscopy in these Trying Times?


title: Nutritional composition of pre-dried silage of different winter cereals/ Composição nutricional da silagem pré-secada de diferentes cereais de inverno

text: This study aimed to assess the chemical composition of the forage and pre-dried silage from twelve winter cereals harvested at pre-flowering. We used black oat (Avena strigosa) cv. EMB 139 and cv. IAPAR 61; white oat (Avena sativa) cv. IPR and 126 hp. URS Taura; barley (Hordeum vulgare) cv. BRS Brau and cv. BRS Cauê; wheat (Triticum aestivum) cv. BRS Umbu and cv. BRS Tarumã; rye (Secale cereale) cv. Temprano and cv. BRS Serrano; and triticale (X. Triticosecale) cv. IPR and 111 hp. BRS Saturno. Plants were harvested at pre-flowering, when they were pre-dried and ensiled. The analysis of variance evidenced nutritional differences between species and cultivars. Triticale cv. IPR 111 showed notorious chemical characteristics in relation to the other treatments, highest protein content (113.7 g kg-1) and lower content of NDF and ADF (657.9 and 380.9 g kg-1, respectively). Among the pre-dried silages, barley cv. BRS Cauê had the highest level of NDT (614.7 g kg-1). Triticale cv. IPR 111 was shown as a high-quality nutritional food as forage and kept these characteristics after conservation. On the other hand, the pre-dried silage of barley cv. BRS Cauê showed the highest potential for nutrient degradability.(AU)


COVID-19 Update


docid: cyjfljoa

title: COVID-19 and the difficulty of inferring epidemiological parameters from clinical data

text: Knowing the infection fatality ratio (IFR) is of crucial importance for evidence-based epidemic management: for immediate planning; for balancing the life years saved against the life years lost due to the consequences of management; and for evaluating the ethical issues associated with the tacit willingness to pay substantially more for life years lost to the epidemic, than for those to other diseases. Against this background Verity et al. (2020, Lancet Infections Diseases) have rapidly assembled case data and used statistical modelling to infer the IFR for COVID-19. We have attempted an in-depth statistical review of their approach, to identify to what extent the data are sufficiently informative about the IFR to play a greater role than the modelling assumptions, and have tried to identify those assumptions that appear to play a key role. Given the difficulties with other data sources, we provide a crude alternative analysis based on the Diamond Princess Cruise ship data and case data from China, and argue that, given the data problems, modelling of clinical data to obtain the IFR can only be a stop-gap measure. What is needed is near direct measurement of epidemic size by PCR and/or antibody testing of random samples of the at risk population.


Commentary: What is the relationship between Covid-19 and cardiovascular disease?


Using Controlled Trials to Resolve Key Unknowns About Policy During the COVID-19 Pandemic


Managing COVID-19 in Low- and Middle-Income Countries


title: Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

text: Importance: The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described typical clinical manifestations including fever, cough, diarrhea, and fatigue. However, to our knowledge, it has not been reported that patients with COVID-19 had any neurologic manifestations. Objective: To study the neurologic manifestations of patients with COVID-19. Design, Setting, and Participants: This is a retrospective, observational case series. Data were collected from January 16, 2020, to February 19, 2020, at 3 designated special care centers for COVID-19 (Main District, West Branch, and Tumor Center) of the Union Hospital of Huazhong University of Science and Technology in Wuhan, China. The study included 214 consecutive hospitalized patients with laboratory-confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 infection. Main Outcomes and Measures: Clinical data were extracted from electronic medical records, and data of all neurologic symptoms were checked by 2 trained neurologists. Neurologic manifestations fell into 3 categories: central nervous system manifestations (dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizure), peripheral nervous system manifestations (taste impairment, smell impairment, vision impairment, and nerve pain), and skeletal muscular injury manifestations. Results: Of 214 patients (mean [SD] age, 52.7 [15.5] years; 87 men [40.7%]) with COVID-19, 126 patients (58.9%) had nonsevere infection and 88 patients (41.1%) had severe infection according to their respiratory status. Overall, 78 patients (36.4%) had neurologic manifestations. Compared with patients with nonsevere infection, patients with severe infection were older, had more underlying disorders, especially hypertension, and showed fewer typical symptoms of COVID-19, such as fever and cough. Patients with more severe infection had neurologic manifestations, such as acute cerebrovascular diseases (5 [5.7%] vs 1 [0.8%]), impaired consciousness (13 [14.8%] vs 3 [2.4%]), and skeletal muscle injury (17 [19.3%] vs 6 [4.8%]). Conclusions and Relevance: Patients with COVID-19 commonly have neurologic manifestations. During the epidemic period of COVID-19, when seeing patients with neurologic manifestations, clinicians should suspect severe acute respiratory syndrome coronavirus 2 infection as a differential diagnosis to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.


docid: ekglbwrl

title: Catastrophic failure of outbreak containment: Limited testing causes discontinuity in epidemic transition

text: Standard measures such as quarantining suspects and contact tracing could not contain the ongoing COVID-19 pandemic. Unlike for other recent epidemics where such instruments were successful, in the present case a large fraction of the infected have only mild unspecific symptoms. By employing network models we here show that even for near perfect contact tracing and unlimited suspect testing, containment starts to fail when more than approximately half of the carriers fall into the weak-symptom category. The situation becomes considerably more severe if the number of daily available tests is limited. In this case the epidemic transition becomes discontinuous and a much larger percentage of the population becomes infected. While moderate levels of social distancing can bring the situation back under control, the limited number of daily tests introduces a finite time horizon: If social distancing is implemented after the cut off date, containment catastrophically breaks down resulting in an exponential disease spread.


title: Survey of COVID-19 Disease Among Orthopaedic Surgeons in Wuhan, People's Republic of China

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) broke out in Wuhan, the People's Republic of China, in December 2019 and now is a pandemic all around the world. Some orthopaedic surgeons in Wuhan were infected with COVID-19. METHODS: We conducted a survey to identify the orthopaedic surgeons who were infected with COVID-19 in Wuhan. A self-administered questionnaire was distributed to collect information such as social demographic variables, clinical manifestations, exposure history, awareness of the outbreak, infection control training provided by hospitals, and individual protection practices. To further explore the possible risk factors at the individual level, a 1:2 matched case-control study was conducted. RESULTS: A total of 26 orthopaedic surgeons from 8 hospitals in Wuhan were identified as having COVID-19. The incidence in each hospital varied from 1.5% to 20.7%. The onset of symptoms was from January 13 to February 5, 2020, and peaked on January 23, 8 days prior to the peak of the public epidemic. The suspected sites of exposure were general wards (79.2%), public places at the hospital (20.8%), operating rooms (12.5%), the intensive care unit (4.2%), and the outpatient clinic (4.2%). There was transmission from these doctors to others in 25% of cases, including to family members (20.8%), to colleagues (4.2%), to patients (4.2%), and to friends (4.2%). Participation in real-time training on prevention measures was found to have a protective effect against COVID-19 (odds ratio [OR], 0.12). Not wearing an N95 respirator was found to be a risk factor (OR, 5.20 [95% confidence interval (CI), 1.09 to 25.00]). Wearing respirators or masks all of the time was found to be protective (OR, 0.15). Severe fatigue was found to be a risk factor (OR, 4 [95% CI, 1 to 16]) for infection with COVID-19. CONCLUSIONS: Orthopaedic surgeons are at risk during the COVID-19 pandemic. Common places of work could be contaminated. Orthopaedic surgeons have to be more vigilant and take more precautions to avoid infection with COVID-19. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


COVID-19: desperate times call for desperate measures


Dialysis in Northern India during COVD-19 pandemic: trying to maintain a balance


title: Estimated Use of Intensive Care Beds Due to COVID-19 in Germany Over Time

text: BACKGROUND: There is concern in Germany that the capacity of intensive care unit (ICU) beds may not be sufficient for the COVID-19 pandemic. The aim was to determine the maximum daily number of COVID-19 cases requiring intensive care from 11 April through 30 June 2020. METHODS: We assumed three non-exponential scenarios for the development of the cumulative case numbers up to 30 June 2020 (linear, slow quadratic, and fast quadratic). We assumed that 3-10% of of patients would require intensive care, that 8 days would elapse from a positive test to the need for intensive care, and that intensive care would be necessary for 14 or 20 days. RESULTS: Extrapolation of the maximum registered daily COVID-19 cases reveals a range of 4133 to 12 233 cases. Assuming that 3-10% of newly detected COVID-19 cases become intensive care patients and the average length of ICU stay is between 14 and 20 days, we arrive at a maximum daily number of ICU cases between 1989 (linear extrapolation, 3% ICU, 14 days in ICU) and 20 966 (fast quadratic extrapolation, 10% ICU, 20 days in ICU). CONCLUSION: Our results give no rise for concern that triage of COVID-19 patients may become necessary in Germany. However, the occupancy of ICU beds should be managed centrally to ensure optimal use of bed capacity. If, contrary to expectations, an exponential increase in case numbers should occur after all, our results will become invalid.


Mental health impact of COVID-19 pandemic on Spanish healthcare workers


docid: xflrqdzy

title: Safety Considerations for Neuraxial Anaesthesia in Parturients with COVID-19


title: COVID-19 and comorbidities: A systematic review and meta-analysis

text: 1.0 Abstract SARS-CoV-2 has caused a worldwide pandemic that began with an outbreak of pneumonia cases in the Hubei province of China. Knowledge of those most at risk is integral for treatment, guideline implementation and resource allocation. We conducted a systematic review and meta-analysis to evaluate comorbidities associated with severe and fatal cases of COVID-19. A search was conducted on PubMed and EmBase on April 20, 2020. Pooled estimates were collected using a random effects model. Thirty three studies were included in the systematic review and twenty two in the meta-analysis. Of the total cases 40.80% (95%CI: 35.49%, 46.11%) had comorbidities, while fatal cases had 74.37% (95%CI: 55.78%, 86.97%). Hypertension was more prevalent in severe [47.65% (95%CI: 35.04%, 60.26%)] and fatal [47.90% (95%CI: 40.33%, 55.48%)] cases compared to total cases [14.34% (95%CI: 6.60%, 28.42%)]. Diabetes was more prevalent among fatal cases [24.89% (95%CI: 18.80%, 32.16%)] compared to total cases [9.65% (95%CI: 6.83%, 13.48%)]. Respiratory diseases had a higher prevalence in fatal cases [10.89% (95%CI: 7.57%, 15.43%)] in comparison to total cases [3.65% (95%CI: 2.16%, 6.1%)]. Studies assessing the mechanisms accounting for the associations between severe cases and hypertension, diabetes and respiratory diseases are crucial in understanding this new disease, managing patients at risk and developing policies and guidelines that will reduce future risk of severe COVID-19 disease.


title: Clinical characteristics of acute respiratory syndrome with SARS-CoV-2 infection in children in South China

text: BACKGROUND: A retrospective study was conducted to summarize the clinical information of childhood infections during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic. METHODS: Children with SARS-CoV-2 infection in 11 hospitals from three provinces of South China were included in the study. Clinical information was collected and compared with children and adults infected by SARS-CoV-2 in Wuhan. RESULTS: In total, 52 children were enrolled, including 28 boys. The median age was 9 years (interquartile range [IQR], 4-12); 44.2% cases were of clustered occurrences, 40.4% patients had fever, 48.1% had cough, and 46.2% had a high lymphocyte count. No abnormalities were found in the liver and kidney function. Also, 82.7% of patients received antiviral therapy, but such therapy did not shorten the time to virus negativity or hospital stay (P = .082). The time to virus negativity was 12.0 days (IQR, 8.0-16.8) and hospital stay was 14.5 days (IQR, 10.3-17.9). Compared with reports in Wuhan, there were more acute upper respiratory tract infection (AURTI) and fewer pneumonia cases (P = .000). Compared with the non-ICU adult COVID-19 in Wuhan, these children's diseases were relatively mild, with fewer complications. CONCLUSIONS: Children with SARS-CoV-2 infection had a mild fever, lymphocyte elevation was more common than reduction, and antiviral treatment had no obvious effect. The overall clinical manifestations were mild, and the prognosis was good.


title: Virtual Visits in Ophthalmology: Timely Advice for Implementation During the COVID-19 Public Health Crisis

text: Virtual visits (VVs) are necessitated due to the public health crisis and social distancing mandates due to COVID-19. However, these have been rare in ophthalmology. Over 3.5 years of conducting >350 ophthalmological VVs, our group has gained numerous insights into best practices. This communication shares these experiences with the medical community to support patient care during this difficult time and beyond. We highlight that mastering the technological platform of choice, optimizing lighting, camera positioning, and "eye contact," being thoughtful and creative with the virtual eye examination, and ensuring good documenting and billing will make a successful and efficient VV. Moreover, we think these ideas will stimulate further VV creativity and expertise to be developed in ophthalmology and across medicine. This approach, holds promise for increasing its adoption after the crisis has passed.


Letter to the Editor: Fasting plasma glucose associated with mortality rate in T2DM patients with COVID-19 infection


Epidemiological characteristics and spatial-temporal analysis of COVID-19 in Shandong Province, China


title: Controlling a Networked SIS Model via a Single Input over Undirected Graphs

text: This paper formulates and studies the problem of controlling a networked SIS model using a single input in which the network structure is described by a connected undirected graph. A necessary and sufficient condition on the values of curing and infection rates for the healthy state to be exponentially stable is obtained via the analysis of signed Laplacians when the control input is the curing budget of a single agent. In the case when the healthy state is stabilizable, an explicit expression for the minimum curing budget is provided. The utility of the algorithm is demonstrated using a simulation over a network of cities in the northeastern United States.


Acute At Home Management of Anaphylaxis During the Covid-19 Pandemic


title: Inhibition of Bruton tyrosine kinase in patients with severe COVID-19

text: Patients with severe COVID-19 have a hyperinflammatory immune response suggestive of macrophage activation. Bruton tyrosine kinase (BTK) regulates macrophage signaling and activation. Acalabrutinib, a selective BTK inhibitor, was administered off-label to 19 patients hospitalized with severe COVID-19 (11 on supplemental oxygen; 8 on mechanical ventilation), 18 of whom had increasing oxygen requirements at baseline. Over a 10-14 day treatment course, acalabrutinib improved oxygenation in a majority of patients, often within 1-3 days, and had no discernable toxicity. Measures of inflammation - C-reactive protein and IL-6 - normalized quickly in most patients, as did lymphopenia, in correlation with improved oxygenation. At the end of acalabrutinib treatment, 8/11 (72.7%) patients in the supplemental oxygen cohort had been discharged on room air, and 4/8 (50%) patients in the mechanical ventilation cohort had been successfully extubated, with 2/8 (25%) discharged on room air. Ex vivo analysis revealed significantly elevated BTK activity, as evidenced by autophosphorylation, and increased IL-6 production in blood monocytes from patients with severe COVID-19 compared with blood monocytes from healthy volunteers. These results suggest that targeting excessive host inflammation with a BTK inhibitor is a therapeutic strategy in severe COVID-19 and has led to a confirmatory international prospective randomized controlled clinical trial.


The challenge of emergency medicine facing the COVID-19 outbreak


title: Perspectives of tele-orthodontics in the COVID-19 emergency and as a future tool in daily practice

text: AIM: The aim of our study was to explain how tele-orthodontics represents the only way to perform orthodontics during a period of restriction as the one subsequent to COVID-19 emergencies: To do this, we report a case study and explore the proposal of a model of tele-orthodontics, considering the advantages of this modality in the immediate post-emergency phase and in the future daily practice. MATERIALS AND METHODS: Study design: Our study involves 30 patients, who had undergone different orthodontic therapies in a traditional way, and that the clinician continued to follow by means of tele-orthodontics. Given the obvious limitations of tele-practice, a comparison with patients who did not undergo any follow-up or underwent only in-office follow-ups could not be possible. The communication tools used in our study and proposed in our model of tele-orthodontics are videocalls, dedicated applications, intraoral and extraoral photos taken by the patients and instant messaging. RESULTS: Tele-orthodontics allowed to perform some orthodontic follow-ups with less chairside time, reduced time spent by the patients in the dental office from up to 45 min, less risk of infection, fewer to no missed appointments, specific troubleshooting solutions, and more follow-ups with odontophobic patients. Overall, tele-orthodontics balanced the disadvantages of less personal contacts and in-office visits. CONCLUSIONS: The need to respect safety distance and the fears patients have about the risk of infection make tele-orthodontics a fundamental tool during a pandemic lockdown and in its immediate post-emergency phase. Tele-orthodontics demonstrated to be a viable tool to continue at least some orthodontic care in times of emergency, but it may be considered an appropriate solution and addition even in normal times to ease therapy demands for both the orthodontist and the patient, while reducing time and money spent, without an excessive decrease in orthodontic quality.


title: Potential Cytoprotective Activity of Ozone Therapy in SARS-CoV-2/COVID-19

text: (1) Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) in China at the end of 2019 has caused a large global outbreak. Systemic ozone therapy (OT) could be potentially useful in the clinical management of several complications secondary to SARS-CoV-2. The rationale and mechanism of action has already been proven clinically in other viral infections and has been shown in research studies to be highly effective at decreasing organ damage mediated by inflammation and oxidative stress. This review summarizes the OT studies that illustrate the possible cytoprotective mechanism of action of ozone and its physiological by-products in target organs affected by SARS-CoV-2. (2) Methods: This review encompasses a total of 74 peer-reviewed original articles. It is mainly focused on ozone as a modulator of the NF-κ B/Nrf2 pathways and IL-6/IL-1ß expression. (3) Results: In experimental models and the few existent clinical studies, homeostasis of the free radical and antioxidant balance by OT was associated with a modulation of NF-κ B/Nrf2 balance and IL-6 and IL-1ß expression. These molecular mechanisms support the cytoprotective effects of OT against tissue damage present in many inflammatory diseases, including viral infections. (4) Conclusions: The potential cytoprotective role of OT in the management of organ damage induced by COVID-19 merits further research. Controlled clinical trials are needed.


High frequency of antiphospholipid antibodies in critically ill COVID-19 patients: a link with hypercoagulability?


title: High Frequency of Antiphospholipid Antibodies in Critically-ill COVID-19 Patients: a Link with Hypercoagulability?

text: Coronavirus disease 2019 (COVID-19) is associated with both severe systemic inflammation and a prothrombotic state, as reflected by significant increases in fibrinogen and D-dimers levels that have been associated with poor prognosis and high rates of severe pulmonary embolism. A recent report suggested a role for antiphospholipid antibodies (aPLA) in the thrombotic manifestations associated with severe COVID-19. As we also recently noticed unexplained lengthening of activated partial thromboplastin time (aPTT) in some critically ill COVID-19 patients, we explored our patients for aPLA positivity.


title: A Lens on the Post-COVID-19 "New Normal" for Imaging Departments

text: The COVID-19 pandemic has redefined the diagnostic imaging that is being practiced. It is important to consider how COVID-19 will reshape the practice in the post-COVID era. The "new normal" should reflect what has been learned from COVID-19 and preparedness for the future.


title: LaCulturaNonSiFerma -- Report su uso e la diffusione degli hashtag delle istituzioni culturali italiane durante il periodo di lockdown

text: This report presents an analysis of #hashtags used by Italian Cultural Heritage institutions to promote and communicate cultural content during the COVID-19 lock-down period in Italy. Several activities to support and engage users' have been proposed using social media. Most of these activities present one or more #hashtags which help to aggregate content and create a community on specific topics. Results show that on one side Italian institutions have been very proactive in adapting to the pandemic scenario and on the other side users' reacted very positively increasing their participation in the proposed activities.


title: Clinical phenotypes of SARS-CoV-2: implications for clinicians and researchers

text: Patients with COVID-19 present a broad spectrum of clinical presentation. Whereas hypoxaemia is the marker of severity, different strategies of management should be customised to five specific individual phenotypes. Many intubated patients present with phenotype 4, characterised by pulmonary hypoxic vasoconstriction, being associated with severe hypoxaemia with "normal" (>40â mL·cmH2O-1) lung compliance and likely representing pulmonary microvascular thrombosis. Phenotype 5 is often associated with high plasma procalcitonin and has low pulmonary compliance, Which is a result of co-infection or acute lung injury after noninvasive ventilation. Identifying these clinical phenotypes and applying a personalised approach would benefit the optimisation of therapies and improve outcomes.


Consultation-Liaison Psychiatry in the Age of COVID-19: Reaffirming Ourselves and Our Worth


COVID-19 and a Potential Rise in Bullying Behaviors


COVID-19 randomised trial protocols: rapid publication without barriers


title: Clinical performance of different SARS-CoV-2 IgG antibody tests

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays are urgently needed for rapid diagnosis, contact tracing, and for epidemiological studies. So far, there is limited data on how commercially available tests perform with real patient samples, and if positive tested samples show neutralizing abilities. Focusing on IgG antibodies, we demonstrate the performance of two enzyme-linked immunosorbent assay (ELISA) assays (Euroimmun SARS-CoV-2 IgG and Vircell COVID-19 ELISA IgG) in comparison to one lateral flow assay (FaStep COVID-19 IgG/IgM Rapid Test Device) and two in-house developed assays (immunofluorescence assay [IFA] and plaque reduction neutralization test [PRNT]). We tested follow up serum/plasma samples of individuals polymerase chain reaction-diagnosed with COVID-19. Most of the SARS-CoV-2 samples were from individuals with moderate to the severe clinical course, who required an in-patient hospital stay. For all examined assays, the sensitivity ranged from 58.8 to 76.5% for the early phase of infection (days 5-9) and from 93.8% to 100% for the later period (days 10-18).


Tracheal introducers and airway trauma COVID-19. [Br J Anaesth] (2020) [Epub ahead of print]


Targeting the immunology of coronavirus disease-19: synchronization creates symphony


Acute myopathic quadriplegia in COVID-19 patients in the intensive care unit


COVID-19: Main therapeutic options


title: Transport and deposition of dilute microparticles in turbulent thermal convection

text: We analyze the transport and deposition behavior of dilute microparticles in turbulent Rayleigh-B\'enard convection. Two-dimensional direct numerical simulations were carried out for the Rayleigh number ($Ra$) of $10^{8}$ and the Prandtl number ($Pr$) of 0.71 (corresponding to the working fluids of air). The Lagrangian point particle model was used to describe the motion of microparticles in the turbulence. Our results show that the suspended particles are homogeneously distributed in the turbulence for Stokes number ($St$) less than $10^{-3}$, and they tend to cluster into bands for $10^{-3} \lesssim St \lesssim 10^{-2}$. At even larger $St$, the microparticles will quickly sediment in the convection. We also calculate the mean-square displacement (MSD) of the particle's trajectories. At short time intervals, the MSD exhibits a ballistic regime, and it is isotropic in vertical and lateral directions; at longer time intervals, the MSD reflects a confined motion for the particles, and it is anisotropic in different directions. We further obtained a phase diagram of the particle deposition positions on the wall, and three deposition states depending on the particle's density and diameter were identified. An interesting finding is that the dispersed particles preferred to deposit on the vertical wall where the hot plumes arise, which is verified by tilting the cell and altering the rotation direction of the large-scale circulation.


Incidence of pulmonary embolism in patients with COVID-19


Preventing a covid-19 pandemic


Since the coronavirus disease 2019 (COVID-19) outbreak was declared a pandemic on 11 March 2020. Several dental care facilities in affected countries have been completely closed or have been only providing minimal treatment for emergency cases. However, several facilities in some affected countries are still providing regular dental treatment. This can in part be a result of the lack of universal protocol or guidelines regulating the dental care provision during such a pandemic. This lack of guidelines can on one hand increase the nosocomial COVID-19 spread through dental health care facilities, and on the other hand deprive patients' in need of the required urgent dental care. Moreover, ceasing dental care provision during such a period will incense the burden on hospitals emergency departments already struggle with the pandemic. This work aimed to develop guidelines for dental patients' management during and after the COVID-19 pandemic. Guidelines for dental care provision during the COVID-19 pandemic were developed after considering the nature of COVID-19 pandemic, and were based on grouping the patients according to condition and need, and considering the procedures according to risk and benefit. It is hoped that the guidelines proposed in this work will help in the management of dental care around the world during and after this COVID-19 pandemic.


docid: icdbxtvf

title: Managing COVID-19 in the oncology clinic and avoiding the distraction effect


The expert COVID-19 team for older persons of the Quebec Health and Social Services Ministry


Assessment of SARS-CoV-2 Transmission Among Attendees of Live Concert Events in Japan Using Contact Tracing Data


title: A new pharmacological approach based on remdesivir aerosolized administration on SARS-CoV-2 pulmonary inflammation: A possible and rational therapeutic application

text: The new zoonotic coronavirus (SARS-CoV-2) responsible for coronavirus disease (COVID-19) is a new strain of coronavirus not previously seen in humans and which appears to come from bat species. It originated in Wuhan, Hubei Province, China, and spread rapidly throughout the world, causing over 5,569,679 global cases and 351,866 deaths in almost every country in the world, including Europe, particularly Italy. In general, based on existing data published to date, 80.9% of patients infected with the virus develop mild infection; 13.8% severe pneumonia; 4.7% respiratory failure, septic shock or multi-organ failure; 3% of these cases are fatal. Critical patients have been shown to develop acute respiratory distress syndrome (ARDS) and hospitalization in intensive care units. The average age of patients admitted to hospital is 57-79 years, with one third half with an underlying disease. Asymptomatic infections have also been described, but their frequency is not known. SARS-CoV-2 transmission is mainly airborne from one person to another via droplets. The data available so far seem to indicate that SARS-CoV-2 is capable of producing an excessive immune reaction in the host. The virus attacks type II pneumocytes in the lower bronchi through the binding of the Spike protein (S protein) to viral receptors, of which the angiotensin 2 conversion enzyme (ACE2) receptor is the most important. ACE2 receptor is widely expressed in numerous tissues, including the oropharynx and conjunctiva, but mostly distributed in ciliated bronchial epithelial cells and type II pneumocytes in the lower bronchi. The arrival of SARS-CoV-2 in the lungs causes severe primary interstitial viral pneumonia that can lead to the "cytokine storm syndrome", a deadly uncontrolled systemic inflammatory response triggered by the activation of interleukin 6 (IL-6), whose effect is extensive lung tissue damage and disseminated intravascular coagulation (DIC), that are life-threatening for patients with COVID-19. In the absence of a therapy of proven efficacy, current management consists of off-label or compassionate use therapies based on antivirals, antiparasitic agents in both oral and parenteral formulation, anti-inflammatory drugs, oxygen therapy and heparin support and convalescent plasma. Like most respiratory viruses can function and replicate at low temperatures (i.e. 34-35 °C) and assuming viral thermolability of SARS-CoV-2, local instillation or aerosol of antiviral (i.e. remdesivir) in humid heat vaporization (40°-41 °C) in the first phase of infection (phenotype I, before admission), both in asymptomatic but nasopharyngeal swab positive patients, together with antiseptic-antiviral oral gargles and povidone-iodine eye drops for conjunctiva (0,8-5% conjunctival congestion), would attack the virus directly through the receptors to which it binds, significantly decreasing viral replication, risk of evolution to phenotypes IV and V, reducing hospitalization and therefore death.


Novel coronavirus infection during the 2019-2020 epidemic: preparing intensive care units-the experience in Sichuan Province, China


Recomendaciones generales para los Servicios de Cirugía en Colombia durante la pandemia COVID-19 (SARS-CoV-2)


title: How and why use the EasyBreath® Decathlon surface snorkeling mask as a personal protective equipment during the COVID-19 pandemic?

text: During the COVID-19 outbreak, personal protective equipment is widely used to limit infection of caregivers. Innovative solutions have been described to overcome supply shortage. The adaptation of the EasyBreath® surface snorkeling mask by the Prakash team has benefited from outstanding media coverage. We present four 3D-printed devices that we have modified from the initial innovative design in order to adapt to local constraints. We tested the mask during surgery. The modifications that we made provide better ergonomics, visibility and communication capacities, but that have no official approval for use and can therefore only be recommended in the absence of a validated alternative solution. 3D printing is a tool of prime importance in the production of devices for medical use in health crisis situations.


Delivery method choice for COVID-19 pregnant women: stick to obstetric indications and avert anorectum contamination


title: A proposed mechanism for the possible therapeutic potential of Metformin in COVID-19

text: The whole world is facing a tough time these days struggling against the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). There is not any specific effective drug for this viral infection. Thus, we are trying to treat patients with non-specific drug cocktails. Metformin, as a strong base, a potential regulator of Vacuolar ATPase (V-ATPase) and endosomal Na+/H+ exchangers (eNHEs), additionally a regenerative agent for lung fibrosis, seems to be beneficial for patients in acute, chronic and recovery phases of COVID-19.


title: Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics

text: AIM: To investigate anxiety, stress, and depression levels of physicians during the Covid-19 outbreak and explored associated factors in both clinical and general site. METHODS: An online survey is conducted to asses psychological responses of healthcare workers and related factors during Covid-19 outbreak. It is consisted of three subsections covering the following areas: 1) sociodemographic data 2) information on individuals` working condition 3) Depression Anxiety and Stress Scale-21 (DAS-21). RESULTS: Of all 442 participants, 286 (64.7%) had symptoms of depression, 224 (51.6%) anxiety, and 182 (41.2%) stress. Being female, young, and single, having less work experience, working in frontline were associated with higher scores, whereas having a child was associated with lower scores in each subscale. Factors found to be associated with higher DAS-21 total scores in frontline workers were as follows: increased weekly working hours, increased number of Covid-19 patients cared for, lower level of support from peers and supervisors, lower logistic support, and lower feelings of competence during Covid-19 related tasks. CONCLUSIONS: Our findings highlight the factors which need to be taken into consideration to protect the mental wellbeing of doctors while fighting with a disaster that has major impacts on society worldwide.


title: COVID-19: A Global Threat to the Nervous System

text: In less than 6 months, the severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2) has spread worldwide infecting nearly 6 million people and killing over 350,000. Initially thought to be restricted to the respiratory system, we now understand that coronavirus disease 2019 (COVID-19) also involves multiple other organs, including the central and peripheral nervous system. The number of recognized neurologic manifestations of SARS-CoV-2 infection is rapidly accumulating. These may result from a variety of mechanisms, including virus-induced hyperinflammatory and hypercoagulable states, direct virus infection of the central nervous system (CNS), and postinfectious immune mediated processes. Example of COVID-19 CNS disease include encephalopathy, encephalitis, acute disseminated encephalomyelitis, meningitis, ischemic and hemorrhagic stroke, venous sinus thrombosis, and endothelialitis. In the peripheral nervous system, COVID-19 is associated with dysfunction of smell and taste, muscle injury, the Guillain-Barre syndrome, and its variants. Due to its worldwide distribution and multifactorial pathogenic mechanisms, COVID-19 poses a global threat to the entire nervous system. Although our understanding of SARS-CoV-2 neuropathogenesis is still incomplete and our knowledge is evolving rapidly, we hope that this review will provide a useful framework and help neurologists in understanding the many neurologic facets of COVID-19. ANN NEUROL 2020;88:1-11 ANN NEUROL 2020;88:1-11.


Covid-19 and decarceration


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


docid: qrmuvbaw

title: Bovine coronavirus in neonatal calf diarrhoea in Iran

text: Partial gene sequencing for the bovine coronavirus at the World Genebank is available for many countries, which are distributed unevenly in five continents, but so far, no sequencing of strains has been recorded in Iran. One hundred ninety-four stool samples from calves with diarrhoea less than one-month old were collected from five different geographical regions of country in order to detect coronavirus and characterize it if coronavirus was found. Samples were screened for the presence of BCoV by using a commercially available ELISA kit. Furthermore, RT-PCR was carried out on positive samples for confirmation of the presence of N and S specific genes. Sequencing and phylogenetic analysis was carried out following RT-PCR tests. 7.2% of samples, were positive for BCoV and all stool samples from the South-West, Northeast and West regions of Iran were negative. The results showed that all the strains of coronavirus identified in Iran were completely in independent clusters and that they did not stand in the same cluster as any of the strains identified in other parts of the world. The strains from Iran were quite different from strains in other parts of the world but from the point of similarity these viruses showed some similarities to the European strains, such as those found in France, Croatia, Denmark and Sweden.


Just when I thought I was out, they pull me back in: the older physician in the COVID-19 pandemic


Keeping trainees safe in a pandemic: the evolving role of medical simulation training


Science superpowers after COVID-19 lockdowns lift: a letter of hope from China to the United States


title: Hospitalization and Mortality among Black Patients and White Patients with Covid-19

text: BACKGROUND: Many reports on coronavirus disease 2019 (Covid-19) have highlighted age- and sex-related differences in health outcomes. More information is needed about racial and ethnic differences in outcomes from Covid-19. METHODS: In this retrospective cohort study, we analyzed data from patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) on qualitative polymerase-chain-reaction assay. The Ochsner Health population is 31% black non-Hispanic and 65% white non-Hispanic. The primary outcomes were hospitalization and in-hospital death. RESULTS: A total of 3626 patients tested positive, of whom 145 were excluded (84 had missing data on race or ethnic group, 9 were Hispanic, and 52 were Asian or of another race or ethnic group). Of the 3481 Covid-19-positive patients included in our analyses, 60.0% were female, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. A total of 39.7% of Covid-19-positive patients (1382 patients) were hospitalized, 76.9% of whom were black. In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black. In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17). CONCLUSIONS: In a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission.


docid: kdudslre

title: Hypothesis for the management and treatment of the COVID-19-induced acute respiratory distress syndrome and lung injury using mesenchymal stem cell-derived exosomes

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a member of the coronaviridae that causes respiratory disorders. After infection, large amounts of inflammatory cytokines are secreted, known as the cytokine storm. These cytokines can cause pulmonary damage induced by inflammation resulting in acute respiratory distress syndrome (ARDS), and even death. One of the therapeutic approaches for treatment of ARDS is a mesenchymal stem cell (MSC). MSCs suppress inflammation and reduce lung injury through their immunomodulatory properties. MSCs also have the potential to prevent apoptosis of the lung cells and regenerate them. But our suggestion is using MSCs-derived exosomes. Because these exosomes apply the same immunomodulatory and tissue repair effects of MSCs and they don't have problems associated to cell maintenance and injections. For investigation the hypothesis, MSCs should be isolated from tissues and characterized. Then, the exosomes should be isolated from the supernatants and characterized. These exosomes should be injected into a transgenic animal for COVID-19. In the final section, lung function assessment, histological examination, micro-CT, differential leukocyte, viral load analysis, cytokine assay, and CRP level analysis can be investigated. COVID-19 treatment is currently focused on supportive therapies and no vaccine has been developed for it. So, numerous researches are needed to find potential therapies. Since the pathogenesis of this disease was identified in previous studies and can cause lung injury with ARDS, investigation of the therapeutic approaches that can suppress inflammation, cytokine storm and ARDS can be helpful in finding a novel therapeutic approach for this disease.


title: A tale of two countries. How decentralised organisation and long-term investment build resilient healthcare systems

text: Healthcare systems are faced with unique challenges during the ongoing Covid-19 pandemic. This viewpoint compares the response to the Covid-19 pandemic in the UK and in Germany. Despite being two large European countries of comparable size with good healthcare systems and similar patterns of exposure to Covid-19, Covid-19 related deaths in the UK currently far outnumber those in Germany. This has several reasons, but two explanations stick out: 1. lower long-term investment into healthcare in the UK rendered the NHS more vulnerable to Covid-19; 2. the existence of a well-governed decentralised and partially redundant organisation of healthcare increased resilience in Germany' s healthcare systems, enhancing the ability to adapt in response to unexpected challenges to healthcare. The response to the current pandemic also illustrates the power and the necessity to learn from each other through transparent communication of successes and mistakes.


title: 2019 Novel coronavirus disease (COVID-19) in hemodialysis patients: A report of two cases

text: OBJECTIVE: To analyze the diagnosis and treatment of patients with chronic renal failure complicated with novel coronavirus pneumonia, and to evaluate the effect of blood purification technology on the treatment and prognosis of such patients. METHODS: Two COVID-19 cases undergoing hemodialysis with chronic renal failure were retrospectively analysed in our hospital. RESULTS: Two COVID-19 patients were admitted to hospital due to cough, with or without fever. Laboratory tests showed decreased lymphocyte count, elevated PCT, IL-10, IL-6, TNF-α, IL-2R, high-sensitivity cardiac troponin I, NT-proBNP, creatinine, and urea nitrogen. Chest CT scan showed multiple blurred plaques and patchy shadows in both patients. Two patients received continuous venovenous hemodiafiltration (CVVHDF) every other day for 4-6 h everytime, in addition to the standard treatment. After CVVHDF, not only cytokines were reduced, but also liver function and cardiac function significantly improved. Both patients did not develop severe pneumonia. They were discharged on March 1, 2020 when meeting the discharge criteria. CONCLUSION: Two COVID-19 patients on maintenance hemodialysis discharged after a month of hospitalization. The removal of cytokines through blood purification technology may be beneficial for the recovery of COVID-19 patients.


Management for patients with pediatric surgical disease during the COVID-19 epidemic


title: Weakly Supervised Deep Learning for COVID-19 Infection Detection and Classification from CT Images

text: An outbreak of a novel coronavirus disease (i.e., COVID-19) has been recorded in Wuhan, China since late December 2019, which subsequently became pandemic around the world. Although COVID-19 is an acutely treated disease, it can also be fatal with a risk of fatality of 4.03% in China and the highest of 13.04% in Algeria and 12.67% Italy (as of 8th April 2020). The onset of serious illness may result in death as a consequence of substantial alveolar damage and progressive respiratory failure. Although laboratory testing, e.g., using reverse transcription polymerase chain reaction (RT-PCR), is the golden standard for clinical diagnosis, the tests may produce false negatives. Moreover, under the pandemic situation, shortage of RT-PCR testing resources may also delay the following clinical decision and treatment. Under such circumstances, chest CT imaging has become a valuable tool for both diagnosis and prognosis of COVID-19 patients. In this study, we propose a weakly supervised deep learning strategy for detecting and classifying COVID-19 infection from CT images. The proposed method can minimise the requirements of manual labelling of CT images but still be able to obtain accurate infection detection and distinguish COVID-19 from non-COVID-19 cases. Based on the promising results obtained qualitatively and quantitatively, we can envisage a wide deployment of our developed technique in large-scale clinical studies.


title: Coronavirus 101

text: COVID-2019 emerged from China in late December. It follows two other coronavirus outbreaks, the SARS-CoV and the MERS-CoV. Coronaviruses usually circulate among animals but sometimes can jump to humans. These three strains have caused severe disease in humans and global transmission concerns. Symptoms of COVID-2019 include cough, fever, and shortness of breath. Related illnesses can range from mild to severe to fatal. Primary care providers must be alert to respiratory symptoms they encounter that are associated with pertinent travel history, be prepared to safely screen, examine and possibly test and/or report suspicions to the health department for further evaluation.


title: Prevalence of acute liver injury and hypertransaminemia in patients with COVID-19: a protocol for a systematic review

text: INTRODUCTION: COVID-19 has spread rapidly in China and around the world. Published studies have revealed that some patients with COVID-19 had abnormal liver function in laboratory tests. However, the results were inconsistent and the analysis of epidemiological data stratified by the severity of COVID-19 was not available in previous meta-analyses. Furthermore, these meta-analyses were suspected of overestimating the incidence of liver injury in patients with COVID-19 because some studies considered transaminase elevation as liver injury, which might partially result from cardiac and muscle injury. This systematic review aims to enrol published literatures related to COVID-19 without language restriction, analyse the data based on the severity of the COVID-19 and explore the impact of varied definitions of liver injury on the incidence of liver injury. METHODS AND ANALYSIS: We have conducted a preliminary search on PubMed and Excerpta Medica Database on 13 April 2020, for the studies published after December 2019 on the prevalence of acute liver injury and hypertransaminemia in patients with COVID-19. Two reviewers will independently screen studies, extract data and assess the risk of bias. We will estimate the pooled incidence of hypertransaminemia and acute liver injury in patients with COVID-19 by using the random-effects model. The I² test will be used to identify the extent of heterogeneity. Publication bias will be assessed by funnel plot and performing the Begg's and Egger's test if adequate studies are available. We will perform a risk of bias assessment using the Joanna Briggs Institute's critical appraisal checklist. ETHICS AND DISSEMINATION: Since this study will be based on the published data, it does not require ethical approval. The final results of this study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020179462.


Patients with arterial hypertension and COVID-19 are at higher risk of ICU admission


docid: ustcepbv

title: A Rush to Judgment? Rapid Reporting and Dissemination of Results and Its Consequences Regarding the Use of Hydroxychloroquine for COVID-19


Transient complete heart block in a patient with critical COVID-19


title: Knowledge, attitude, practice and perceived barriers among healthcare professionals regarding COVID-19: A Cross-sectional survey from Pakistan

text: A self-administered validated (Cronbach alpha= 0.077) questionnaire was used to assess knowledge, attitude and practice among HCPs in Pakistan regarding COVID-19. Findings showed HCPs had good knowledge (93.2%, n=386), positive attitude (8.43±1.78) and good practice (88.7%, n=367) regarding COVID-19. HCPs perceived that limited infection control material (50.7%, n=210) and poor knowledge regarding transmission (40.6%, n=168) are the major barriers in infection control practice. Regression analysis indicated pharmacist role (OR: 2.247, 95% CI: 1.11-4.55, P=0.025) was the substantial determinant of good practice. HCPs in Pakistan have good knowledge, yet, there were areas where gaps in knowledge and practice were observed.


Keeping the Fire House Running: A Proposed Approach to Mitigate Spread of COVID-19 Among Public Safety Personnel


O papel da atenção primária na rede de atenção à saúde no Brasil: limites e possibilidades no enfrentamento da COVID-19./ O papel da atenção primária na rede de atenção à saúde no Brasil: limites e possibilidades no enfrentamento da COVID-19./ The role of primary care in the Brazilian healthcare system: limits and possibilities for fighting COVID-19


title: Information Extraction from a Strategic Sender: The Zero Error Case

text: We introduce a setting where a receiver aims to perfectly recover a source known privately to a \textit{strategic} sender over a possibly noisy channel. The sender is endowed with a utility function and sends signals to the receiver with the aim of maximizing this utility. Due to the strategic nature of the sender not all the transmitted information is truthful, which leads to question: how much true information can be recovered by the receiver from such a sender? We study this question in this paper. We pose the problem as a game between the sender and receiver, where the receiver tries to maximize the number of sequences that can be recovered perfectly and the sender maximizes its utility. We show that, in spite of the sender being strategic and the presence of noise in the channel, there is a strategy for the receiver by which it can perfectly recover an \textit{exponentially} large number of sequences. Our analysis leads to the notion of the \textit{information extraction capacity} of the sender which quantifies the growth rate of the number of recovered sequences with blocklength, in the presence of a noiseless channel. We identify cases where this capacity is equal to its theoretical maximum, and also when it is strictly less than maximum. In the latter case, we show that the capacity is sandwiched between the independence number and the Shannon capacity of a suitably defined graph. These results lead to an exact characterization of the information extraction capacity in large number of cases. We show that in the presence of a noisy channel, the rate of information extraction achieved by the receiver is the minimum of the zero-error capacity of the channel and the information extraction capacity of the sender. Our analysis leads to insights into a novel regime of communication involving strategic agents.


Peritoneal Dialysis in the time of COVID-19


title: Outbreak of cutaneous form of avian poxvirus disease in previously pox-vaccinated commercial turkeys/ Surto de bouba aviária na forma cutânea em perus comerciais previamente vacinados

text: This study describes an outbreak of avian poxvirus disease in previously pox-vaccinated turkeys in Brazil. The turkeys had suggestive gross lesions of cutaneous avian poxvirus in the skin of the head and cervical area without changes in the flock mortality rates. In the slaughterhouse, 30 carcasses were removed from the slaughter line to collect tissue from cutaneous lesions for histological analyses and characterization of the virus. The virus was identified by conventional polymerase chain reaction (PCR) and subsequent gene sequencing. Acanthosis, hyperkeratosis, and hydropic degeneration were seen on skin histopathology. Eosinophilic intracytoplasmic inclusion bodies (Bollinger) on keratinocytes were observed in 46.6% of the samples. Avian poxvirus DNA was detected on PCR in 83.3% of the total samples. PCR associated with histopathology had 93.3% of positivity for avian poxvirus. In the phylogenetic study, samples show 100% matching suggesting that the outbreak occurred by a single viral strain and was different from those strains affecting other wild birds such as canaries and sparrows. A single mutation (Adenine for Guanine) was detected in our study's strain and in the strains of turkey, chickens, and vaccine strains published in GenBank. Also, when the sequence strain of the present study and sequences from GenBank of canarypox and sparrowpox strains were aligned, a Thymine was found replacing the Adenine or Guanine. The in ovo vaccination method as single-use in turkeys of this study apparently did not provide adequate protection against avianpox disease, but additional vaccination administered by wing-web when turkeys were 45-60 days old in the new flocks controlled the disease. In the subsequent year, new cases of this disease were not found. It was not possible to confirm the source of the virus strain, but infection with a field strain derived from chickens is one possibility...(AU)