title: Contamination of Fishery Products with Mercury, Cadmium, and Lead in Tunisia: Level's Estimation and Human Health Risk Assessment

text: The levels of metallic trace elements were determined in fishery products sampled from Tunisian fishing ports. Mean concentrations were 0.20 ± 0.01, 0.05 ± 0.01, and 0.10 ± 0.01 mg/kg in fish flesh for Hg, Cd, and Pb, respectively. The mean concentrations of these elements were below regulatory thresholds; however, we also detected some specimens with higher levels. The mercury level showed a significant difference between fish categories, region, and year of sampling (p < 0.05). Samples from the center sites had the highest levels of Pb (0.17 ± 0.03 mg/kg; range 0.10; 0.22 mg/kg). Temporal analysis of Pb showed a significant difference between sampling year (p < 0.05). In addition, distribution among fish categories was statistically significant (p = 0.046). The rates of samples exceeding limits of Hg, Cd, and Pb were 5.3, 2.6, and 0.4%, respectively. Through the above results, the maximum weekly and monthly intakes for fish flesh consumption could not exceed the set limits. These data were important to inform consumers about fish content and the risk generated by some of these species.


Different manifestations of COVID-19 pneumonia in a child: focal crazy paving sign on chest and three-dimensional computed tomography


title: Clinical pathways for urology patients during the COVID-19 pandemic

text: The public health emergency caused by the Coronavirus Disease 2019 (COVID-19) pandemic has resulted in a significant reallocation of health resources with a consequent reorganization of the clinical activities also in several urological centers. A panel of Italian urologists has agreed on a set of recommendations on pathways of pre-, intra- and post-operative care for urological patients undergoing urgent procedures or non-deferrable oncological interventions during the COVID-19 pandemic. Simplification of the diagnostic and staging pathway has to be prioritized in order to reduce hospital visits and consequently the risk of contagion. In absence of strict uniform regulations that impose the implementation of nasopharyngeal swabs, we recommend that an accurate triage for COVID-19 symptoms be performed both by telephone at home before hospitalization and at the time of hospitalization. We recommend that during hospital stay patients should be provided with as many instructions as possible to facilitate their return to, and stay at, home. Patients should be discharged under stable good conditions in order to minimize the risk of readmission. It is advisable to reduce or reschedule post-discharge controls and implement an adequate system of communication for telemonitoring discharged patients.


Re: Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic


Multiomics Evaluation of Gastrointestinal and Other Clinical Characteristics of COVID-19


title: Projected increases in suicide in Canada as a consequence of COVID-19

text: Macroeconomic indicators, notably unemployment, are significant moderators of suicide. We projected the number of excess suicides in Canada as a consequence of the impact of COVID-19 on unemployment. Annual suicide mortality (2000-2018) and unemployment (2000-2019) data were derived from Statistics Canada. Time-trend regression models were used to evaluate and predict the number of excess suicides in 2020 and 2021 for two possible projection scenarios following the COVID-19 pandemic: 1) an increase in unemployment of 1.6% in 2020, 1.2% in 2021, or 2) an increase in unemployment of 10.7% in 2020, 8.9% in 2021. A percentage point increase in unemployment was associated with a 1.0% increase in suicide between 2000 and 2018. In the first scenario, the rise in unemployment rates resulted in a projected total of 418 excess suicides in 2020-2021 (suicide rate per 100,000: 11.6 in 2020). In the second scenario, the projected suicide rates per 100,000 increased to 14.0 in 2020 and 13.6 in 2021, resulting in 2114 excess suicides in 2020-2021. These results indicate that suicide prevention in the context of COVID-19-related unemployment is a critical priority. Furthermore, timely access to mental healthcare, financial provisions and social/labour support programs, as well as optimal treatment for mental disorders is urgently needed.


COVID-19 and hypercoagulability in the outpatient setting


title: The pandemic of viruses with a long incubation phase in the small world

text: A model of the spread of viruses in selected city and in a network of cities is considered, taking into account the delay caused by the long incubation period of the virus. The effect of delay effects is shown in comparison with pandemics without such delay. A temporary asymmetry of the spread of infection has been identified, which means that the time for a pandemic to develop significantly exceeds the time for its completion. Model calculations of the spread of viruses in a network of interconnected large and small cities were carried out, and dynamics features were revealed in comparison with the spread of viruses in a single city, including the possibility of reinfection of megalopolis.


title: The impact of biosensing in a pandemic outbreak: COVID-19

text: COVID-19 pandemic outbreak is the most astounding scene ever experienced in the XXI century. In this opinionated review, we underscore the crucial role of biosensing to handle with such situations. As a matter of fact, testing accelerates life-saving decisions on treatment and isolation of COVID-19 patients in an early stage, and thereby, decelerating or even preventing the spread of such emerging infectious diseases. Meanwhile, it is also proven that a timely and broad application of testing leads to lower mortality rates in countries like Germany or South Korea. Besides, biosensors are also powerful tools for effective assessment of clinical progress and to provide alertness on severity or critical trends of infection. In view hereof, we critically discuss the state-of-the-art biosensing devices for COVID-19 testing. We spot the urgent needs and highlight innovative diagnostic approaches for targeting various COVID-19 related biomarkers. Finally, we outline our recommendations on biosensors and biosensing-related issues towards pandemic outbreaks.


title: End-tidal-to-arterial Pco2 Ratio as Signifier for Physiologic Dead-space Ratio and Oxygenation Dysfunction in Acute Respiratory Distress Syndrome

text: BACKGROUND: The ratio of end-tidal-to-arterial carbon dioxide tension (PETCO2/PaCO2) was recently suggested for monitoring pulmonary gas exchange in subjects with COVID-19 associated ARDS. Yet, no evidence was offered supporting that claim. Therefore, we evaluated whether PETCO2/PaCO2 might be relevant in assessing ARDS not associated with COVID-19. METHODS: We evaluated the correspondence between PETCO2/PaCO2 and VD/VT measured in 561 subjects with ARDS from a previous study in whom PETCO2 data were also available. Subjects also were analyzed according to four categories representing increasing severity of PETCO2/PaCO2 (≥0.80, 0.61 to 0.79, 0.50-0.59 and < 0.50). Correlation was assessed by either Pearson Spearman tests, group comparisons were assessed using either ANOVA or Kruskal-Wallis tests, and dichotomous variables assessed by Fisher Exact test. Overall mortality risk was assessed by multivariate logistic regression. Alpha was set at 0.05. RESULTS: PETCO2/PaCO2 correlated strongly with VD/VT (R = -0.87 [-0.89, -0.85] P < 0.001). Decreasing PETCO2/PaCO2 was associated with increased VD/VT and hospital mortality between all groups. In the univariate analysis for every 0.01 decrease in PETCO2/PaCO2 mortality risk increased by â¼1% (OR: 0.009 [0.003-0.029] P < 0.001), and maintained a strong independent association with mortality risk when adjusted for other variables: 0.19 (0.04-0.91) P = 0.039. PETCO2/PaCO2 < 0.50 was characterized both by very high VD/VT (0.82 ± 0.05, P < 0.001) and hospital mortality (70%). CONCLUSION: PETCO2/PaCO2 as a surrogate for VD/VT may be a useful and practical measurement for both management and ongoing research into the nature of ARDS.


title: Coronavirus Infections and Type 2 Diabetes-Shared Pathways with Therapeutic Implications

text: Individuals with diabetes are at increased risk for bacterial, mycotic, parasitic, and viral infections. The severe acute respiratory syndrome (SARS)-CoV-2 (also referred to as COVID-19) coronavirus pandemic highlights the importance of understanding shared disease pathophysiology potentially informing therapeutic choices in individuals with type 2 diabetes (T2D). Two coronavirus receptor proteins, angiotensin-converting enzyme 2 (ACE2) and dipeptidyl peptidase-4 (DPP4) are also established transducers of metabolic signals and pathways regulating inflammation, renal and cardiovascular physiology, and glucose homeostasis. Moreover, glucose-lowering agents such as the DPP4 inhibitors, widely used in subjects with T2D, are known to modify the biological activities of multiple immunomodulatory substrates. Here, we review the basic and clinical science spanning the intersections of diabetes, coronavirus infections, ACE2, and DPP4 biology, highlighting clinical relevance and evolving areas of uncertainty underlying the pathophysiology and treatment of T2D in the context of coronavirus infection.


title: From "Infodemics" to Health Promotion: A Novel Framework for the Role of Social Media in Public Health

text: Despite the ubiquity of health-related communications via social media, no consensus has emerged on whether this medium, on balance, jeopardizes or promotes public health. During the COVID-19 pandemic, social media has been described as the source of a toxic "infodemic" or a valuable tool for public health. No conceptual model exists for examining the roles that social media can play with respect to population health.We present a novel framework to guide the investigation and assessment of the effects of social media on public health: the SPHERE (Social media and Public Health Epidemic and REsponse) continuum. This model illustrates the functions of social media across the epidemic-response continuum, ranging across contagion, vector, surveillance, inoculant, disease control, and treatment.We also describe attributes of the communications, diseases and pathogens, and hosts that influence whether certain functions dominate over others. Finally, we describe a comprehensive set of outcomes relevant to the evaluation of the effects of social media on the public's health. (Am J Public Health. Published online ahead of print June 18, 2020: e1-e4. doi:10.2105/AJPH.2020.305746).


title: Coupled population balance and large eddy simulation model for polydisperse droplet evolution in a turbulent round jet

text: A population balance model coupled with large eddy simulations (LES) is adapted and applied to study the evolution of oil droplets in a turbulent jet including the effects of droplet breakup. A key unknown in simulating secondary breakup in turbulent multiphase jets is the inflow size distribution generated within the primary breakup zone near the nozzle exit. A mono-disperse injection inflow condition is commonly used for simplicity, but this choice is often unrealistic. In order to provide more realistic inlet conditions for LES, we develop a one dimensional (1D) parcel model to predict the evolution of the dispersed phase along the jet centerline due to the combined effects of advection, radial turbulent transport and droplet breakup due to turbulence in the regions closer to the jet nozzle that cannot be resolved using coarse LES. The model is validated with experimental data measured far from the nozzle. The 1D model is also used to generate an initial size distribution for use in a coarse-resolution LES of a turbulent jet. Number density fields for each bin of the discretized droplet size distribution are modeled using an Eulerian LES approach and scalar transport equations are solved for each bin. LES results are compared to published experimental data, with good agreement and we examine the statistics of the velocity field and the concentration of the polydisperse oil droplet plumes for two droplet Weber numbers. We find that the centerline decay rate of the concentration for different droplet sizes is modified in the breakup dominated zone. Unlike Reynolds averaged approaches, LES also allows us to quantify size distribution variability due to turbulence. We quantify the radial and axial distributions and the variability of key quantities such as the Sauter mean diameter, total surface area and droplet breakup time-scale and explore their sensitivity to the Weber number.


title: 2019-novel coronavirus survey: knowledge and attitudes of hospital staff of a large Italian teaching hospital

text: One week after the World Health Organization (WHO) declared the 2019 novel coronavirus (2019-nCoV) outbreak a global health emergency we conducted a survey to explore knowledge and attitudes on 2019-nCoV, recently renamed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in a large cohort of hospital staff. A representative sample of 2,046 hospital staff of a large university hospital in northern Italy (54% healthcare workers and 46% administrative staff, overall response rate: 25%) was administered an online questionnaire: overall there is good knowledge on 2019-nCoV control measures. The mean of correct answers for questions on general aspects of 2019-nCoV epidemic was 71.6% for HCWs and 61.2% for non-HCWs. The mean of correct answers for questions on 2019-nCoV patient management was 57.8% among HCWs. Nevertheless, on recommended precautions, also among healthcare workers there is still much to do in order to promote effective control measures and correct preventive behaviours at the individual level.


Tale of three seeding patterns of SARS-CoV-2 in Saudi Arabia


Pain Medicine Goes Digital: A Lamentation on COVID-19, the Printing Press, and the 21st Century


Off-label use of tocilizumab in patients with SARS-CoV-2 infection


title: Tele-consultations in the wake of COVID-19 - Suggested guidelines for clinical ophthalmology

text: While telemedicine has been around for a few decades, it has taken great importance and prominence in recent times. With the fear of the virus being transmitted, patients and physicians across specialties are using consultation via a telephone call or video from the safety of their homes. Though tele-ophthalmology has been popular for screening, there are no clear guidelines on how to comprehensively manage patients seeking advice and treatment for a particular eye condition. Some major barriers to diagnosis and management are compromised detailed examination, no measurement of the visual acuity or intraocular pressure and a retinal evaluation not being feasible. Despite these limitations, we do need to help those patients who need immediate care or attention. Hence, this article has put together some guidelines to follow during such consultations. They are important and timely due to the medicolegal and financial implications.


Vitamin-D and COVID-19: do deficient risk a poorer outcome?


Efforts to Reduce the Impacts of COVID-19 Outbreak on Radiation Oncology in Taiwan


title: Clinical trials in the time of a pandemic

text: The first rumblings about a new coronavirus spreading in China were heard in January 2020. By the end of that month, the World Health Organization, recognizing the severity of the disease and the potential for global spread, had declared a public health emergency. By February 2020, cases had been identified in multiple countries, clinical trials of treatments with some biological plausibility had begun in China, and the initial steps of vaccine development were underway. In mid-March, by which time countries around the world were experiencing rapidly increasing numbers of cases and deaths, the World Health Organization categorized the outbreak as a pandemic. This new coronavirus was designated SARS-COV-2 in recognition of its similarity to the coronavirus responsible for the severe acute respiratory syndrome outbreak in 2002-2003. The race is on to develop treatments that can mitigate the severe consequences of infection and vaccines that can prevent infection and/or diminish the severity of disease in those who do get infected. Many challenges face these development efforts. Some are similar to those faced in the past; others are new. The urgency of finding ways to treat, and ultimately prevent, the consequences of this new and potentially deadly infection has led to unprecedented focus on clinical trials.


title: Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study

text: BACKGROUND: We need an effective treatment to cure COVID-19 patients and to decrease virus carriage duration. METHODS: We conducted an uncontrolled, non-comparative, observational study in a cohort of 80 relatively mildly infected inpatients treated with a combination of hydroxychloroquine and azithromycin over a period of at least three days, with three main measurements: clinical outcome, contagiousness as assessed by PCR and culture, and length of stay in infectious disease unit (IDU). RESULTS: All patients improved clinically except one 86 year-old patient who died, and one 74 year-old patient still in intensive care. A rapid fall of nasopharyngeal viral load was noted, with 83% negative at Day7, and 93% at Day8. Virus cultures from patient respiratory samples were negative in 97.5% of patients at Day5. Consequently patients were able to be rapidly discharged from IDU with a mean length of stay of five days. CONCLUSION: We believe there is urgency to evaluate the effectiveness of this potentially-life saving therapeutic strategy at a larger scale, both to treat and cure patients at an early stage before irreversible severe respiratory complications take hold and to decrease duration of carriage and avoid the spread of the disease. Furthermore, the cost of treatment is negligible.


Cardiac considerations in patients with COVID-19


docid: slmfgeiz

title: The Detrimental Impact of the COVID-19 Crisis on Health Equity and Social Determinants of Health


The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19)


title: Meeting Laboratory Course Learning Goals Remotely via Custom Home Experiment Kits

text: In this paper, the use of cost-effective, custom home experiment kits for remote teaching of first-semester introductory physics labs is described. The kit experiments were designed to match the existing onsite lab experiment learning goals and the general laboratory course learning goals in remote teaching. Additionally, a revised group project approach optimized for remote use and that leverages the kits was developed and employed. Student survey results at the end of the Summer 2020 semester indicate that the critical learning goals were met, student satisfaction with the remote lab was maintained, and successful collaboration via video-conferencing breakout rooms was achieved.


title: Nanomechanical sonification of the 2019-nCoV coronavirus spike protein through a materiomusical approach

text: Proteins are key building blocks of virtually all life, providing the material foundation of spider silk, cells, and hair, but also offering other functions from enzymes to drugs, and pathogens like viruses. Based on a nanomechanical analysis of the structure and motions of atoms and molecules at multiple scales, we report sonified versions of the coronavirus spike protein of the pathogen of COVID-19, 2019-nCoV. The audio signal, created using a novel nanomechanical sonification method, features an overlay of the vibrational signatures of the protein's primary, secondary and higher-order structures. Presenting musical encoding in two versions - one in the amino-acid scale and one based on equal temperament tuning - the method allows for expressing protein structures in audible space, offering novel avenues to represent, analyze and design architectural features across length- and time-scales. We further report a hierarchical frequency spectrum analysis of five distinct protein structures, which offer insights into how genetic mutations, and the binding of the virus spike protein to the human ACE2 cell receptor directly influence the audio. Applications of the approach may include the development of de novo antibodies by designing protein sequences that match, through melodic counterpoints, the binding sites in the spike protein. Other applications of audible coding of matter include material design by manipulating sound, detecting mutations, and offering a way to reach out to broader communities to explain the physics of proteins. It also forms a physics-based compositional technique to create new art, referred to as materiomusic, which is akin to finding a new palette of colors for a painter. Here, the nanomechanical structure of matter, reflected in an oscillatory framework, presents a new palette for sound generation, and can complement or support human creativity.


Clinical Features and Chest CT Manifestations of Coronavirus Disease (COVID-19)


Prevention of COVID-19 in Older Adults: A Brief Guidance from the International Association for Gerontology and Geriatrics (IAGG) Asia/Oceania region


title: Virtual screening-driven drug discovery of SARS-CoV2 enzyme inhibitors targeting viral attachment, replication, post-translational modification and host immunity evasion infection mechanisms

text: The novel coronavirus SARS-CoV2, the causative agent of the pandemic disease COVID-19, emerged in December 2019 forcing lockdown of communities in many countries. The absence of specific drugs and vaccines, the rapid transmission of the virus, and the increasing number of deaths worldwide necessitated the discovery of new substances for anti-COVID-19 drug development. With the aid of bioinformatics and computational modelling, ninety seven antiviral secondary metabolites from fungi were docked onto five SARS-CoV2 enzymes involved in viral attachment, replication, post-translational modification, and host immunity evasion infection mechanisms followed by molecular dynamics simulation and in silico ADMET prediction (absorption, distribution, metabolism, excretion and toxicity) of the hit compounds. Thus, three fumiquinazoline alkaloids scedapin C (15), quinadoline B (19) and norquinadoline A (20), the polyketide isochaetochromin D1 (8), and the terpenoid 11a-dehydroxyisoterreulactone A (11) exhibited high binding affinities on the target proteins, papain-like protease (PLpro), chymotrypsin-like protease (3CLpro), RNA-directed RNA polymerase (RdRp), non-structural protein 15 (nsp15), and the spike binding domain to GRP78. Molecular dynamics simulation was performed to optimize the interaction and investigate the stability of the top-scoring ligands in complex with the five target proteins. All tested complexes were found to have dynamic stability. Of the five top-scoring metabolites, quinadoline B (19) was predicted to confer favorable ADMET values, high gastrointestinal absorptive probability and poor blood-brain barrier crossing capacities.Communicated by Ramaswamy H. Sarma.


A family cluster of SARS-CoV-2 infection involving 11 patients in Nanjing, China


Mobilizing animal models against a pandemic


Prolonged virus shedding even after seroconversion in a patient with COVID-19


title: Covid-19 and lung cancer: A greater fatality rate?

text: BACKGROUND: Currently there are no reported series determining the Covid-19 infected lung cancer patient´s characteristics and outcome that allow us to clarify strategies to protect our patients. In our study we determine whether exists differences in cumulative incidence and severity of Covid-19 infection between lung cancer patients visiting our Medical Oncology department and the reference population of our center (320,000 people), in the current epicenter of the pandemic in Europe (Madrid, Spain). We also describe clinical and demographic factors associated with poor prognosis and Covid-19 treatment outcomes. PATIENTS AND METHODS: We retrospectively reviewed 1878 medical records of all Covid-19 patients who were admitted at Hospital Universitario Infanta Leonor of Madrid between March 5, 2020 and April 7, 2020, in order to detect cumulative incidence of Covid-19 in lung cancer patients. We also described Covid-19 treatment outcome, mortality and associated risk factors using univariate and multivariate logistic regression analysis. RESULTS: 17/1878 total diagnosis in our center had lung cancer (0.9 %) versus 1878/320,000 of the total reference population (p = 0.09). 9/17 lung cancer patients with Covid-19 diagnosis died (52.3 %) versus 192/1878 Covid-19 patients in our center (p < 0.0001). Dead lung cancer patients were elderly compared to survivors: 72 versus 64.5 years old (p = 0.12). Combined treatment with hydroxychloroquine and azithromycin improves the outcome of Covid-19 in lung cancer patients, detecting only 1/6 deaths between patients under this treatment versus others treatment, with statistical significance in the univariate and multivariate logistic regression (OR 0.04, p = 0.018). CONCLUSIONS: Lung cancer patients have a higher mortality rate than general population. Combined hydroxychloroquine and azithromycin treatment seems like a good treatment option. It is important to try to minimize visits to hospitals (without removing their active treatments) in order to decrease nosocomial transmission.


title: Convalescent plasma: A possible treatment protocol for COVID- 19 patients suffering from diabetes or underlying liver diseases

text: BACKGROUND & AIM: As on date, no specific treatment is available for devastating COVID-19 (SARS-CoV-2) infection. This pandemic viral infection has affected over 200 countries within a very short time and created a calamitous situation across the globe. As per WHO guidelines, the treatment is mainly symptomatic and supportive. This clinical protocol has not proven sufficient to save the lives of COVID-19 patients suffering from diabetes or having underlying liver diseases; hence there is utmost need to tackle this situation by other means such as Convalescent Plasma (CP) therapy. METHODS: A comprehensive literature survey was carriedout using Elsevier, PubMed, Taylor & Francis, Springer, Nature and Google search engines. RESULTS: The patients suffering from diabetes or liver dysfunction or any other underlying diseases are at greatest risk of SARS-CoV-2 infection. From the study, it is proved that plasma collected from the recovered patients of viral infection has considerable potential to treat the viral disease without the occurrence of adverse effects. CONCLUSION: The CP therapy can be a possible life saving alternative to treat critical COVID-19 patients having diabetes or underlying liver dysfunction. Hence, randomised clinical trials are recommended at the earliest to save the lives of infected individuals of COVID-19.


docid: seluzzxc

title: Effect of dietary energy and weaning weight on nitrogen balance and energy metabolizability of piglets/ Efeito da energia da dieta e do peso ao desmame sobre o balanço de nitrogênio e metabolizabilidade da energia de leitões

text: This study aimed to evaluate the effects of dietary metabolizable energy (ME; 3.40, 3.60, or 3.80 Mcal/kg) and weaning weight (WW; 4.5 ± 0.4 and 6.7 ± 0.5 kg) on nitrogen balance (NB) and gross energy metabolizability in weanling piglets. In total, 32 barrow piglets were individually housed in metabolic cages for 28 d in a 2x3 factorial arrangement with five barrows per treatment. Only light and 3.80 ME and heavy and 3.40 ME/kg treatments had six barrows per treatment each. The diets were formulated to maintain a constant nutrient to ME ratio. Nitrogen balance was evaluated in three periods through total collection of feces and urine. Heavy piglets had 14% greater N intake, absorption, and retention in starter and total periods (P<0.05). The increasing in the levels of dietary ME linearly augmented N intake, absorption, and retention during starter and total periods (P<0.05). The dietary ME levels linearly increased energy metabolizability in all periods (P<0.05). In conclusion, heavy weaned piglets had better efficiency in nitrogen retention. Besides, increasing dietary ME levels can improve the N retention and the metabolizability of dietary energy.(AU)


Women and children first: the need for ringfencing during the COVID-19 pandemic


title: The impact of COVID-19 pandemic on urological emergencies: a single-center experience

text: PURPOSE: COVID-19 pandemic represents a novel challenge for healthcare systems, and it affects even the daily urological practice. Italy was the first country after China to experience a lock-down period. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological emergencies. METHODS: we retrospectively reviewed urgent urological consultations requested by the Emergency Department (ED) of Padua University Hospital in the 36-day period between February 22nd and March 30th, 2020 and compared them to the prior year cases within a similar time frame (February 24th to March 31st, 2019). Pediatric population (age < 15 years); surgical complications and traumas were excluded to avoid confounding from the reduction of activities during the lockdown. The number of daily consultations, the number of invasive procedures performed and admissions were evaluated, together with the predictors of admission were identified through multivariate logistic regression models. RESULTS: The final sample resulted in 107 consultations performed in 2020 and 266 in 2019. A higher number of daily consultations was performed during 2019 (7.33 vs 2.97, p < 0.001). Similarly, the number of daily-invasive procedures was higher in 2019 (p = 0.006), while there was no difference in the number of daily admissions (15 vs 12, p = 0.80). On multivariate analysis, the year (2020 vs 2019, OR 2.714, 95% CI 1.096-6.757, p = 0.0297) was a significant predictor of admission. CONCLUSIONS: Urgent urology practice was affected during COVID-19 pandemic with a remarkable reduction in urgent urological consultations; furthermore, a higher risk of admissions was observed in 2020. The consequences of a potentially delayed diagnosis remain to be determined.


Cochrane Corner: Coronavirus (COVID-19): remote care through telehealth


Severe acute respiratory syndrome coronavirus 2 in pregnancy: symptomatic pregnant women are only the tip of the iceberg


title: Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019

text: OBJECTIVES: The aim of this study was to determine the frequency of venous thromboembolism in critically ill coronavirus disease 2019 patients and associate a degree of inflammatory marker elevation to venous thromboembolism development. DESIGN: An observational study that identified patients with severe coronavirus disease 2019 between March 12, 2020, and March 31, 2020. Data reported are those available through May 6, 2020. SETTING: A multicenter study including three Indianapolis area academic hospitals. PATIENTS: Two-hundred forty consecutive patients with confirmed severe acute respiratory syndrome coronavirus 2 infection were admitted to one of three hospitals. One-hundred nine critically ill coronavirus disease 2019 patients admitted to the ICU were included in the analysis. INTERVENTIONS: All patients received routine subcutaneous chemical venous thromboembolism prophylaxis. MEASUREMENTS AND MAIN RESULTS: The primary outcome of this study was to determine the frequency of venous thromboembolism and the degree of inflammatory and coagulation marker elevation associated with venous thromboembolism development. Descriptive statistics outlined the frequency of venous thromboembolism at any time during severe coronavirus disease 2019. Clinical course and laboratory metrics were compared between patients that developed venous thromboembolism and patients that did not develop venous thromboembolism. Hypercoagulable thromboelastography was defined as two or more hypercoagulable parameters. MAIN RESULTS: One-hundred nine patients developed severe coronavirus disease 2019 requiring ICU care. The mean (± SD) age was 61 ± 16 years and 57% were male. Seventy-five patients (69%) were discharged home, 7 patients (6%) remain in the hospital, and 27 patients (25%) died. Venous thromboembolism was diagnosed in 31 patients (28%) 8 ± 7 days after hospital admission, including two patients diagnosed with venous thromboembolism at presentation to the hospital. Elevated admission D-dimer and peak D-dimer were associated with venous thromboembolism development (p < 0.05). D-dimer greater than 2,600 ng/mL predicted venous thromboembolism with an area under the receiver operating characteristic curve of 0.760 (95% CI, 0.661-0.858; p < 0.0001), sensitivity of 89.7%, and specificity of 59.5%. Twelve patients (11%) had thromboelastography performed and 58% of these patients had a hypercoagulable study. The calculated coagulation index was hypercoagulable in 50% of patients with thromboelastography. CONCLUSIONS: These data show that coronavirus disease 2019 results in a hypercoagulable state. Routine chemical venous thromboembolism prophylaxis may be inadequate in preventing venous thromboembolism in severe coronavirus disease 2019.


title: Riechstörungen bei COVID-19  aktueller Wissensstand./ [Smell disorders at COVID-19 - the current level of knowledge]

text: Early reports of SARS-CoV-2 infections only rarely mentioned smell and taste disorders. Several studies, particularly from Europe and the USA, have now confirmed these symptoms as an early key feature of COVID-19. About 70â% of patients seem to experience a reduction of smell and taste in the course of the disease, with most of the studies published to date based on questionnaires and anamnestic data. Validated smell tests have so far only been used in a few studies. A distinction between taste and taste disorders, i.âe. a distinction between retronasal aroma taste and the olfactory system from the dysfunction of taste capsules and the further cranial nerves, was mostly not made in the studies available to date. Some reports associate olfactory disorders with a milder clinical course. At the same time, the olfactory system via the olfactory bulb represents an entry point into the central nervous system, and an olfactory disorder could be a predisposing factor for central neurological symptoms. The clinical significance of smell and taste disorders in COVID-19 patients is currently still unclear. Further open questions concern the exact prevalence and the prognosis, so that overall higher quality studies with validated smell tests and larger numbers of patients are required.


title: COVID-19 Prevention and Control Public Health Strategies in Shanghai, China

text: CONTEXT: COVID-19 was characterized as a pandemic by the World Health Organization on March 11, 2020. This research aims to analyze the public health strategies to prevent and control COVID-19 in Shanghai, China, and provide recommendations for public health policy and interventions in the United States. PROGRAM: Based on the Social-Ecological Model, this research collected information for public health strategies from the Shanghai Municipal Health Commission and various Chinese websites. EVALUATION: The daily confirmed new cases of COVID-19 decreased from 27 to 0 in 53 days since the first case of COVID-19 was confirmed in Shanghai on January 20, 2020. DISCUSSION: The pattern of daily confirmed new cases suggests the effectiveness of public health strategies. This research also provides recommendations on the development and improvements of public health strategies in the U.S. by acknowledging the differences in political and social systems between the two countries.


docid: swlfywgx

title: Digit analysis for Covid-19 reported data

text: The coronavirus which appeared in December 2019 in Wuhan has spread out worldwide and caused the death of more than 280,000 people (as of May, 11 2020). Since February 2020, doubts were raised about the numbers of confirmed cases and deaths reported by the Chinese government. In this paper, we examine data available from China at the city and provincial levels and we compare them with Canadian provincial data, US state data and French regional data. We consider cumulative and daily numbers of confirmed cases and deaths and examine these numbers through the lens of their first two digits and in particular we measure departures of these first two digits to the Newcomb-Benford distribution, often used to detect frauds. Our finding is that there is no evidence that cumulative and daily numbers of confirmed cases and deaths for all these countries have different first or second digit distributions. We also show that the Newcomb-Benford distribution cannot be rejected for these data.


title: Proteolytic Cleavage of the SARS-CoV-2 Spike Protein and the Role of the Novel S1/S2 Site

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 19 (COVID-19) has rapidly spread to the entire world within a few months. The origin of SARS-CoV-2 has been related to the lineage B Betacoronavirus SARS-CoV and SARS-related coronaviruses found in bats. Early characterizations of the SARS-CoV-2 genome revealed the existence of a distinct four amino acid insert within the spike (S) protein (underlined, SPRRAR↓S), at the S1/S2 site located at the interface between the S1 receptor binding subunit and the S2 fusion subunit. Notably, this insert appears to be a distinguishing feature among SARS-related sequences and introduces a potential cleavage site for the protease furin. Here, we investigate the potential role of this novel S1/S2 cleavage site and present direct biochemical evidence for proteolytic processing by a variety of proteases. We discuss these findings in the context of the origin of SARS-CoV-2, viral stability, and transmission.


docid: bpvvptea

title: Wastewater-Based Epidemiology: Global Collaborative to Maximize Contributions in the Fight Against COVID-19


title: Effective treatment of severe COVID-19 patients with tocilizumab

text: After analyzing the immune characteristics of patients with severe coronavirus disease 2019 (COVID-19), we have identified that pathogenic T cells and inflammatory monocytes with large amount of interleukin 6 secreting may incite the inflammatory storm, which may potentially be curbed through monoclonal antibody that targets the IL-6 pathways. Here, we aimed to assess the efficacy of tocilizumab in severe patients with COVID-19 and seek a therapeutic strategy. The patients diagnosed as severe or critical COVID-19 in The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) and Anhui Fuyang Second People's Hospital were given tocilizumab in addition to routine therapy between 5 and 14 February 2020. The changes of clinical manifestations, computerized tomography (CT) scan image, and laboratory examinations were retrospectively analyzed. Fever returned to normal on the first day, and other symptoms improved remarkably within a few days. Within 5 d after tocilizumab, 15 of the 20 patients (75.0%) had lowered their oxygen intake, and 1 patient needed no oxygen therapy. CT scans manifested that the lung lesion opacity absorbed in 19 patients (90.5%). The percentage of lymphocytes in peripheral blood, which decreased in 85.0% of patients (17/20) before treatment (mean, 15.52 ± 8.89%), returned to normal in 52.6% of patients (10/19) on the fifth day after treatment. Abnormally elevated C-reactive protein decreased significantly in 84.2% of patients (16/19). No obvious adverse reactions were observed. All patients have been discharged on average 15.1 d after giving tocilizumab. Preliminary data show that tocilizumab, which improved the clinical outcome immediately in severe and critical COVID-19 patients, is an effective treatment to reduce mortality.


title: Cure domiciliari oncologiche nel corso dell'epidemia da CoViD-19./ [The CoViD-19 epidemic is posing entirely new problems for home cancer care services.]

text: We report on the protocol adopted by the Oncological Home Care Service of the Tuscany Cancer Association during the CoViD-19 pandemic. Based on the experience in home cancer care gained during the 2009 earthquake, we have developed strategies to ensure continuity of care, non-abandonment and protection of operators. In this context, the double triage protocol plays a central role, aimed at identifying patients at risk for CoViD-19 infection and rationalizing home access. we describe the protocol and present the preliminary data.


COVID-19 in the maritime setting: the challenges, regulations and the international response


Consensus Guidelines for the Management of Melanoma during the COVID-19 Pandemic: Surgery, Systemic Anti-cancer Therapy, Radiotherapy and Follow-up


RECOVERY trial: the UK covid-19 study resetting expectations for clinical trials


Reimagining healthcare after covid-19: a new normal for medicine


Fallacies and Facts Around COVID-19: The Multifaceted Infection


title: Predictors of fatality including radiographic findings in adults with COVID-19

text: BACKGROUND: Older age and elevated d-dimer are reported risk factors for coronavirus disease 2019 (COVID-19). However, whether early radiographic change is a predictor of fatality remains unknown. METHODS: We retrospectively reviewed records of all laboratory-confirmed patients admitted to a quarantine unit at Tongji Hospital, a large regional hospital in Wuhan, China, between January 31 and March 5, 2020. Confirmed cases were defined by positive RT-PCR detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in throat-swab specimens. Chest CT images were reviewed independently by two radiologists. The Tongji Hospital ethics committee approved this study. RESULTS: A total of 102 patients were confirmed to have SARS-CoV-2 infection. As of March 25, 85 confirmed patients were discharged, 15 died, and 2 remained hospitalized. When compared with survivors, non-survivors were older (median age, 69 [interquartile range, 58-77] vs. 55 [44-66], p = 0.003), and more likely to have decreased lymphocyte count (0.5 vs. 0.9 × 109/L, p = 0.006), elevated lactate dehydrogenase (LDH) (569.0 vs. 272.0 U/L, p < 0.001), elevated d-dimer (> 1 µg/mL, 86% vs. 37%, p = 0.002) on admission. Older age and elevated LDH were independent risk factors for fatality in a multivariate regression model included the above variables. In a subset of patients with CT images within the first week, higher total severity score, and more involved lung lobes (5 involved lobes) in CT images within the first week were significantly associated with fatality. Moreover, in this subset of patients, higher total severity score was the only independent risk factor in a multivariate analysis incorporating the above mentioned variables. CONCLUSIONS: Older age, elevated LDH on admission, and higher severity score of CT images within the first week are potential predictors of fatality in adults with COVID-19. These predictors may help clinicians identify patients with a poor prognosis at an early stage.


title: Coronavirus : cerveau prédictif et gestion de la terreur./ [Coronavirus: Predictive brain and terror management]

text: Emerging infectious diseases like Covid-19 cause a major threat to global health. When confronted with new pathogens, individuals generate several beliefs about the epidemic phenomenon. Many studies have shown that individual protective behaviors largely depend on these beliefs. Due to the absence of treatment and vaccine against these emerging pathogens, the relation between these beliefs and these behaviors represents a crucial issue for public health policies. In the premises of the Covid-19 pandemic, several preliminary studies have highlighted a delay in the perception of risk by individuals, which potentially holds back the implementing of the necessary precautionary measures: people underestimated the risks associated with the virus, and therefore also the importance of complying with sanitary guidelines. During the peak of the pandemic, the salience of the threat and of the risk of mortality could then have transformed the way people generate their beliefs. This potentially leads to upheavals in the way they understand the world. Here, we propose to explore the evolution of beliefs and behaviors during the Covid-19 crisis, using the theory of predictive coding and the theory of terror management, two influential frameworks in cognitive science and in social psychology.


Cancer at the time of the COVID-19 hurricane


Overcoming COVID-19: Addressing the perception of risk and transitioning protective behaviors to habits


Recommendations from national regulatory agencies for ongoing cancer trials during the COVID-19 pandemic


The role of enzymatic debridement in burn care in the COVID-19 pandemic. Commentary by the Italian Society of Burn Surgery (SIUST)


title: ESMO management and treatment adapted recommendations in the COVID-19 era: colorectal cancer

text: COVID-19 pandemic challenges health system capacities in many countries. National healthcare services have to manage unexpected shortage of healthcare resources that have to be reallocated according to the principles of fair and ethical prioritisation, in order to maintain the highest levels of care to all patients, ensure the safety of patients and healthcare workers and save as many lives as possible. Beyond that, cancer care services have to pursue restructuring, following the same evidence-based dispositions. In this article, we propose guidance to the management of colorectal cancer during the pandemic, prioritised according to a three-tiered framework, based on expert clinical judgement and magnitude of benefit expected from specific interventions. Since the availability of resources for diagnostic procedures, surgery and postoperative care, systemic therapy and radiotherapy may differ, authors did separate prioritisation analyses. The impact of postponing or abrogating cancer interventions on outcomes according to a high, medium or low priority scale, is outlined and discussed. The implementation of healthcare services using telemedicine is explored: it reveals itself as functional and effective for limiting patients' need to travel to centres and thereby has the potential to reduce diffusion of severe acute respiratory syndrome coronavirus 2. Colorectal cancer demands a considerable amount of medical resources. Therefore, the redefinition of its diagnostic and therapeutic algorithms with a rigorous method is crucial in order to ensure the highest quality of continuum of care in the broader context of the pandemic and the challenged healthcare systems.


title: Comparison of the Accula SARS-CoV-2 Test with a Laboratory-Developed Assay for Detection of SARS-CoV-2 RNA in Clinical Nasopharyngeal Specimens

text: Background: Several point-of-care (POC) molecular tests have received emergency use authorization (EUA) from the Food and Drug Administration (FDA) for diagnosis of SARS-CoV-2. The test performance characteristics of the Accula (Mesa Biotech) SARS-CoV-2 POC test need to be evaluated to inform its optimal use.Objectives: The aim of this study was to assess test performance of the Accula SARS-CoV-2 test.Study design: The performance of the Accula test was assessed by comparing results of 100 nasopharyngeal swab samples previously characterized by the Stanford Health Care EUA laboratory-developed test (SHC-LDT) targeting the envelope (E) gene. Assay concordance was assessed by overall percent agreement, positive percent agreement (PPA), negative percent agreement (NPA), and Cohen's kappa coefficient.Results: Overall percent agreement between the assays was 84.0% (95% confidence interval [CI] 75.3 to 90.6%), PPA was 68.0% (95% CI 53.3 to 80.5%) and the kappa coefficient was 0.68 (95% CI 0.54 to 0.82). Sixteen specimens detected by the SHC-LDT were not detected by the Accula test, and showed low viral load burden with a median cycle threshold value of 37.7. NPA was 100% (95% CI 94.2 to 100%).Conclusion: Compared to the SHC-LDT, the Accula SARS-CoV-2 test showed excellent negative agreement. However, positive agreement was low for samples with low viral load. The false negative rate of the Accula POC test calls for a more thorough evaluation of POC test performance characteristics in clinical settings, and for confirmatory testing in individuals with moderate to high pre-test probability of SARS-CoV-2 who test negative on Accula.


title: Confidence sets for dynamic poverty indexes

text: In this study, we extend the research on the dynamic poverty indexes, namely the dynamic Headcount ratio, the dynamic income-gap ratio, the dynamic Gini and the dynamic Sen, proposed in D'Amico and Regnault (2018). The contribution is twofold. First, we extend the computation of the dynamic Gini index, thus the Sen index accordingly, with the inclusion of the inequality within each class of poverty where people are classified according to their income. Second, for each poverty index, we establish a central limit theorem that gives us the possibility to determine the confidence sets. An application to the Italian income data from 1998 to 2012 confirms the effectiveness of the considered approach and the possibility to determine the evolution of poverty and inequality in real economies.


title: The Nrf2 Activator (DMF) and Covid-19: Is there a Possible Role?

text: Introduction: COVID-19 is a new viral illness that can affect the lungs and airways with lethal consequences leading to the death of the patients. The ACE2 receptors were widely disturbed among body tissues such as lung, kidney, small intestine, heart, and others in different percent and considered a target for the nCOVID-19 virus. S-protein of the virus was binding to ACE2 receptors caused downregulation of endogenous anti-viral mediators, upregulation of NF-κB pathway, ROS and pro-apoptotic protein. Nrf2 was a transcription factor that's play a role in generation of anti-oxidant enzymes. Aim: To describe and establish role of Nrf2 activators for treatment COVID-19 positive patients. Methods: We used method of analysis of the published papers with described studies about COVID-19 connected with pharmacological issues and aspects which are included in global fighting against COVID-19 infection, and how using DMF (Nrf2 activator) in clinical trial for nCOVID-19 produce positive effects in patients for reduce lung alveolar cells damage. Results: we are found that Nrf2 activators an important medication that's have a role in reduce viral pathogenesis via inhibit virus entry through induce SPLI gene expression as well as inhibit TRMPSS2, upregulation of ACE2 that's make a competition with the virus on binding site, induce gene expression of anti-viral mediators such as RIG-1 and INFs, induce anti-oxidant enzymes, also they have a role in inhibit NF-κB pathway, inhibit both apoptosis proteins and gene expression of TLRs. Conclusion: We are concluded that use DMF (Nrf2 activator) in clinical trial for nCOVID-19 positive patients to reduce lung alveolar cells damage.


Single-Use Plastics and COVID-19: Scientific Evidence and Environmental Regulations


docid: jkoegawm

title: An apparatus for nondestructive and rapid comparison of mask approaches in defense against infected respiratory aerosols

text: At the front lines of the world's response to the COVID-19 pandemic are hero-clinicians facing a lack of critical supplies including protective medical grade breathing masks and filtering materials. At the same time, the general public is now being advised to wear masks to help stop the spread. As a result, in the absence of centrally coordinated production and distribution efforts, supply chains for masks, respirators, and materials for advanced filtration technology are immensely burdened. Here we describe experimental efforts to nondestructively quantify three vital characteristics of mask approaches: breathability, material filtration effectiveness, and sensitivity to fit. We focus on protection against water aerosols $>$0.3$\mu$m using off-the-shelf particulate, flow, and pressure sensors, permitting rapid comparative evaluation of these three properties. We present and discuss both the pressure drop and the particle transmission as a function of flow to permit comparison of relative protection for a set of proposed filter and mask designs. The design considerations of the testing apparatus can be reproduced by university laboratories and medical facilities and used for rapid local quality control of respirator masks which are of uncertified origin, monitoring the long-term effects of various disinfection schemes, and evaluating improvised products not designed or marketed for filtration.


title: Prevalence of serum IgG antibodies against SARS-CoV-2 among clinic staff

text: The SARS-CoV-2 pandemic threatens health care providers and society. For planning of treatment capacities, it is of major importance to obtain reliable information on infection and fatality rates of the novel coronavirus. A German community study, the so-called Heinsberg study, found a 5-fold higher infection rate (and thus a remarkably lower fatality rate) than the officially reported cases suggest. We were interested to examine the SARS-CoV-2-IgG antibody status among clinic staff of a large neurological center in Northern Germany. Blood samples and questionnaires (demographic data, medical history) were collected pseudonymously. In total, 406 out of 525 (77.3%) of our employees participated in the study. The infection rate among the staff was as high as 2.7%. Including drop-outs (missing questionnaire but test result available), the infection rate was even higher (2.9%). Only 36% of the positively tested employees did suffer from flu-like symptoms in 2020. None of the nurses-having closest and longest contact to patients-were found to be positive. Despite the fact that the infection rate among clinic staff may not be directly compared to the situation in the surrounding county (due to different testing procedures), one might hypothesize that the infection rate could be more than 30-fold higher than the number of officially reported cases for the county of Hameln-Pyrmont. The high rate of IgG-positive, asymptomatic healthcare workers might help to overcome fears in daily work.


title: Artificial intelligence vs COVID-19: limitations, constraints and pitfalls

text: This paper provides an early evaluation of Artificial Intelligence (AI) against COVID-19. The main areas where AI can contribute to the fight against COVID-19 are discussed. It is concluded that AI has not yet been impactful against COVID-19. Its use is hampered by a lack of data, and by too much data. Overcoming these constraints will require a careful balance between data privacy and public health, and rigorous human-AI interaction. It is unlikely that these will be addressed in time to be of much help during the present pandemic. In the meantime, extensive gathering of diagnostic data on who is infectious will be essential to save lives, train AI, and limit economic damages.


title: Enhancing Covid-19 Decision-Making by Creating an Assurance Case for Simulation Models

text: Simulation models have been informing the COVID-19 policy-making process. These models, therefore, have significant influence on risk of societal harms. But how clearly are the underlying modelling assumptions and limitations communicated so that decision-makers can readily understand them? When making claims about risk in safety-critical systems, it is common practice to produce an assurance case, which is a structured argument supported by evidence with the aim to assess how confident we should be in our risk-based decisions. We argue that any COVID-19 simulation model that is used to guide critical policy decisions would benefit from being supported with such a case to explain how, and to what extent, the evidence from the simulation can be relied on to substantiate policy conclusions. This would enable a critical review of the implicit assumptions and inherent uncertainty in modelling, and would give the overall decision-making process greater transparency and accountability.


title: Histiocytic hyperplasia with hemophagocytosis and acute alveolar damage in COVID-19 infection

text: The spectrum of COVID-19 infection includes acute respiratory distress syndrome (ARDS) and macrophage activation syndrome (MAS), although the histological basis for these disorders has not been thoroughly explored. Post-mortem pulmonary and bone marrow biopsies were performed in 33 patients. Samples were studied with a combination of morphological and immunohistochemical techniques. Bone marrow studies were also performed in three living patients. Bone marrow post-mortem studies showed striking lesions of histiocytic hyperplasia with hemophagocytosis (HHH) in most (16/17) cases. This was also observed in three alive patients, where it mimicked the changes observed in hemophagocytic histiocytosis. Pulmonary changes included a combination of diffuse alveolar damage with fibrinous microthrombi predominantly involving small vessels, in particular the alveolar capillary. These findings were associated with the analytical and clinical symptoms, which helps us understand the respiratory insufficiency and reveal the histological substrate for the macrophage activation syndrome-like exhibited by these patients. Our results confirm that COVID-19 infection triggers a systemic immune-inflammatory disease and allow specific therapies to be proposed.


Dermatology and specialty rotations: COVID-19 may reemphasize the importance of internal medicine


Response to: 'Case series of acute arthritis in COVID-19 admission' by López-González et al


title: Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg

text: Objective: The outbreak of COVID-19 was declared a pandemic by the WHO in March 2020. Studies from China, where the virus first spread, have reported increased psychological strain in healthcare professionals. The aim of this study was to investigate the psychosocial burden of physicians and nurses depending on their degree of contact with COVID-19 patients. In addition, we explored which supportive resources they used and which supportive needs they experienced during the crisis. Methods: Data were collected between March and April 2020 at the University Hospital Augsburg. A total of 75 nurses and 35 physicians, working either in a special COVID-19 ward or in a regular ward, took part in the survey. The participants filled in two standardized questionnaires (the Patient Health Questionnaire, PHQ; and the Maslach Burnout Inventory, MBI), and reported their fear of a COVID-19 infection and stress at work on a 10-point Likert scale. Finally, they answered three open-ended questions about causes of burden, supportive resources and needs during the crisis. Results: Nurses working in the COVID-19 wards reported higher levels of stress, exhaustion, and depressive mood, as well as lower levels of work-related fulfilment compared to their colleagues in the regular wards. Physicians reported similar scores independent of their contact with COVID-19 patients. The most common causes for burden were job strain and uncertainty about the future. Psychosocial support as well as leisure time were listed as important resources, and a better infrastructure adjustment to COVID-19 at the hospital (e.g. sufficient staff, keeping teams and working schedules stable) as suggestion for improvement. Conclusions: Our findings indicate that especially nurses working in COVID-19 wards are affected psychologically by the consequences of the pandemic. This might be due to a higher workload and longer time in direct contact with COVID-19 patients, compared to physicians.


title: Sleep disturbances among medical workers during the outbreak of COVID-2019

text: BACKGROUND: The outbreak of Corona Virus Disease-2019 (COVID-19) has posed unprecedented pressure and threats to healthcare workers in Wuhan and the entire country. AIMS: To assess the effect of the COVID-19 outbreak on the sleep quality of healthcare workers in a children's healthcare centre in Wuhan. METHODS: A cross-sectional, anonymized, self-reported questionnaire survey was conducted at the Children's Healthcare Centre of Renmin Hospital, Wuhan University, Wuhan, China. The questionnaire consisted of three parts, including socio-demographic characteristics and COVID-19 epidemic-related factors, the Pittsburgh sleep quality index (PSQI), and Zung's self-rating anxiety scale (SAS) and self-rating depression scale (SDS). RESULTS: In total, 47 out of 123 (38%) participants with PSQI scores > 7 were identified as having sleep disturbance. A logistic regression analysis showed that sleep disturbance was independently associated with being an only child (adjusted odds ratio (OR) and 95% confidence interval (CI) 3.40 (1.21-9.57), P < 0.05), exposure to COVID-19 patients (adjusted OR and 95% CI 2.97 (1.08-8.18), P < 0.05) and depression (adjusted OR and 95% CI 2.83 (1.10-7.27), P < 0.05). CONCLUSIONS: We observed that, during the outbreak of COVID-19, sleep disturbance was highly prevalent among paediatric healthcare workers, and sleep disturbance was independently associated with being an only child, exposure to COVID-19 patients and depression. Therefore, more mental health services are required for front-line paediatric healthcare workers in Wuhan.


Disease Control, Civil Liberties, and Mass Testing - Calibrating Restrictions during the Covid-19 Pandemic


title: [Thoughts and suggestions on modern construction of disease prevention and control system]

text: The critical period for the prevention and control of COVID-19 in China, in response to requirements for accelerating the modernization of the disease prevention and control system, we analyzed and summarized the current situation, existing problems, and deficiencies in China's modernization of disease prevention and control system. In addition, we put forward the contents and countermeasures for the modernization of the disease prevention and control system. The modernization of the disease prevention and control system should be built around governance modernization, talent modernization, equipment modernization, scientific research modernization, and modernization of the regulatory system. The countermeasures and suggestions need to reposition the disease prevention and control system, rationalize the management system and operating mechanism, strengthen the modernization of talents and equipment, strengthen scientific research on disease prevention and control, and further improve the disease prevention and control legal system.


title: Thoughts and suggestions on modern construction of disease prevention and control system/ 中华预防医学杂志

text: The critical period for the prevention and control of novel coronavirus pneumonia (NCP) in China, in response to requirements for accelerating the modernization of the disease prevention and control system, we analyzed and summarized the current situation, existing problems, and deficiencies in China′s modernization of disease prevention and control system. In addition, we put forward the contents and countermeasures for the modernization of the disease prevention and control system. The modernization of the disease prevention and control system should be built around governance modernization, talent modernization, equipment modernization, scientific research modernization, and modernization of the regulatory system. The countermeasures and suggestions need to reposition the disease prevention and control system, rationalize the management system and operating mechanism, strengthen the modernization of talents and equipment, strengthen scientific research on disease prevention and control, and further improve the disease prevention and control legal system.


title: Prominent changes in blood coagulation of patients with SARS-CoV-2 infection

text: Background As the number of patients increases, there is a growing understanding of the form of pneumonia sustained by the 2019 novel coronavirus (SARS-CoV-2), which has caused an outbreak in China. Up to now, clinical features and treatment of patients infected with SARS-CoV-2 have been reported in detail. However, the relationship between SARS-CoV-2 and coagulation has been scarcely addressed. Our aim is to investigate the blood coagulation function of patients with SARS-CoV-2 infection. Methods In our study, 94 patients with confirmed SARS-CoV-2 infection were admitted in Renmin Hospital of Wuhan University. We prospectively collect blood coagulation data in these patients and in 40 healthy controls during the same period. Results Antithrombin values in patients were lower than that in the control group (p < 0.001). The values of D-dimer, fibrin/fibrinogen degradation products (FDP), and fibrinogen (FIB) in all SARS-CoV-2 cases were substantially higher than those in healthy controls. Moreover, D-dimer and FDP values in patients with severe SARS-CoV-2 infection were higher than those in patients with milder forms. Compared with healthy controls, prothrombin time activity (PT-act) was lower in SARS-CoV-2 patients. Thrombin time in critical SARS-CoV-2 patients was also shorter than that in controls. Conclusions The coagulation function in patients with SARS-CoV-2 is significantly deranged compared with healthy people, but monitoring D-dimer and FDP values may be helpful for the early identification of severe cases.


Time to Revisit Uneven Policy in the United States for Medication for Opioid Use Disorder during Covid-19


docid: xwburzfu

title: Non-invasive ventilation in the treatment of early hypoxemic respiratory failure caused by COVID-19: considering nasal CPAP as the first choice


Recognizing and Mitigating the Threat Posed by COVID-19 to Otolaryngologists: A UK Perspective


Sixty seconds on . . . nightingales


title: Exploratory Analysis of COVID-19 Related Tweets in North America to Inform Public Health Institutes

text: Social media is a rich source where we can learn about people's reactions to social issues. As COVID-19 has significantly impacted on people's lives, it is essential to capture how people react to public health interventions and understand their concerns. In this paper, we aim to investigate people's reactions and concerns about COVID-19 in North America, especially focusing on Canada. We analyze COVID-19 related tweets using topic modeling and aspect-based sentiment analysis, and interpret the results with public health experts. We compare timeline of topics discussed with timing of implementation of public health interventions for COVID-19. We also examine people's sentiment about COVID-19 related issues. We discuss how the results can be helpful for public health agencies when designing a policy for new interventions. Our work shows how Natural Language Processing (NLP) techniques could be applied to public health questions with domain expert involvement.


docid: zvseglza

title: Artesunate interacts with the vitamin D receptor to reverse sepsis-induced immunosuppression in a mouse model via enhancing autophagy

text: BACKGROUND AND PURPOSE: Immunosuppression is the predominant cause of mortality for sepsis because of failure to eradicate pathogens. No effective and specific drugs capable of reversing immunosuppression are clinically available. Evidences implicate the involvement of the vitamin D receptor (NR1I1) in sepsis-induced immunosuppression. The anti-malarial artesunate was investigated to determine action on sepsis-induced immunosuppression. EXPERIMENTAL APPROACH: The effect of artesunate on sepsis-induced immunosuppression was investigated in mice and human and mice cell lines. Bioinformatics predicted vitamin D receptor as a candidate target for artesunate, which was then identified using PCR and immunoblotting. Vdr, Atg16l1 and NF-κB p65 were modified to investigate artesunate 's effect on pro-inflammatory cytokines release, bacterial clearance and autophagy activities in sepsis-induced immunosuppression. KEY RESULTS: Artesunate significantly reduced the mortality of caecal ligation and puncture (CLP)-induced sepsis immunosuppression mice challenged with Pseudomonas aeruginosa and enhanced pro-inflammatory cytokine release and bacterial clearance to reverse sepsis-induced immunosuppression in vivo and in vitro. Mechanistically, artesunate interacted with vitamin D receptor, inhibiting its nuclear translocation, which influenced ATG16L1 transcription and subsequent autophagy activity. Artesunate inhibited the physical interaction between vitamin D receptor and NF-κB p65 in LPS-tolerant macrophages and then promoted the nuclear translocation of NF-κB p65, which activated the transcription of NF-κB p65 target genes such as pro-inflammatory cytokines. CONCLUSION AND IMPLICATIONS: Our findings provide evidence that artesunate interacted with vitamin D receptor to reverse sepsis-induced immunosuppression in an autophagy and NF-κB-dependent manner, highlighting a novel approach for sepsis treatment and drug repurposing of artesunate has a bidirectional immunomodulator.


Exercise Caution When Sharing Medical Advice About Coronavirus on Social Media


title: Pediatric, Family-Centered, "At-Home" Otologic Physical Examination in the COVID-19 Era

text: SARS-CoV-2, the novel coronavirus resulting in the present COVID-19 pandemic, has increased the otolaryngologist's reliance on telemedicine to manage outpatient pathology. The nature of telemedicine, however, limits a provider's ability to obtain a comprehensive physical examination, specifically of the tympanic membrane. Various smartphone-based otoscopic attachments are now available that facilitate patient-obtained otoscopic image capture of the tympanic membrane. Here, we present 3 cases in which a patient-purchased, over-the-counter otoscope was utilized to alter otologic management during the time of social distancing. Further research is necessary to improve our understanding the safety and efficacy of patient-based "at-home" otoscopic examination and to optimize the use of these devices.


Détection pré et postopératoire de l'infection virale en cas de chirurgie carcinologique ne pouvant être retardée, pendant la pandémie de COVID-19./ [Pre-e post-operative screening in limited-term elective oncological surgery patients during the COVID-19 pandemic period.]


Impact of COVID-19 on tuberculosis services in India


A Novel Coronavirus (COVID-19) Outbreak: A Call for Action


docid: lqdgvsaq

title: Focus on Receptors for Coronaviruses with Special Reference to Angiotensin-converting Enzyme 2 as a Potential Drug Target - A Perspective

text: Coronaviruses (CoVs) possess an enveloped, single, positive-stranded RNA genome which encodes for four membrane proteins, namely spike (S), envelope (E), membrane (M) and nucleocapsid (N) proteins 3-5 [1]. With regard to pathogenicity, S proteins are essential for viral entry into host cells [2, 3]. SARS-CoV binds to the angiotensin-converting enzyme (ACE)2 which is present on nonimmune cells, such as respiratory and intestinal epithelial cells, endothelial cells, kidney cells (renal tubules) and cerebral neurons and immune cells, such as alveolar monocytes/macrophages [4-6]. Of note, CD209L or liver/lymph node special intercellular adhesion molecule-3-grabbing non-integrin (SIGN) and dendritic cell (DC)-SIGN are alternative receptors for SARS-CoV but with lower affinity [7]. In the case of MERS-CoV, S proteins bind to the host cell receptor dipeptidyl peptidase 4 (DPP4 or CD26) which is broadly expressed on intestinal, alveolar, renal, hepatic and prostate cells as well as on activated leukocytes [8]. Then, viruses replicate in target cells with release of mature virions, which, in turn, invade new target cells [9]. Evidence has been provided that SARSCoV proteins are cleaved into two subunits, S1 and S2, respectively, and the amino acids 318-510 of the S1 represent the receptor-binding domain (RBD) which binds to ACE2 [10, 11]. Quite importantly, in the context of RBD there is the receptor-binding motif (RBM) (amino acids 424- 494), which accounts for complete binding to ACE2 [11]. Moreover, by means of two residues at positions 479 and 487 RBD allows virus progression and tropism [10, 11]. In the case of MERSCoV, its RBM binds to DPP4 with residues 484-567, thus, suggesting that its RBD differs from that of SARS-CoV [12, 13]. In a very recent paper, Wan and associates [14] have investigated the receptor recognition by COVID-19 (a new term to indicate the 2019-nCoV in Wuhan) on the bases of structural studies. In this respect, the sequence of COVID-19 RBM is similar to that of SARSCoV, thus, implicating that ACE2 may represent the binding receptors for COVID-19. Furthermore, gln493 residue of COVID-19 RBM seems to allow interaction with human ACE2, thus, suggesting the ability of this virus to infect human cells. According, to Wan and associates structural analysis [14], COVID-19 binds to human ACE2 with a lesser efficiency than human SARS-CoV (2002) but with higher affinity than human SARS-CoV (2003). Furthermore, same authors predicted that a single mutation at the 501 position may enhance the COVID-19 RBD binding capacity to human ACE2 and this evolution should be monitored in infected patients [14]. These predictive findings by Wan and associates [14] are confirmed by two contemporary studies by Letko and Muster [15] and Peng and associates [16]. In particular, the report by Peng and associates [16], points out the possible origin of COVID-19 from bats [16]. From a pathogenic point of view, evidence has been provided that binding of S2 to ACE2 receptor leads to its down-regulation with subsequent lung damage in the course of SARS-CoV infection [17]. Down-regulation of ACE2 causes excessive production of angiotensin (ANG) II by the related enzyme ACE with stimulation of ANG type 1a receptor (AT1R) and enhanced lung vascular permeability [18]. In particular, same authors have reported that recombinant ACE2 could attenuate severe acute lung injury in mice [18]. Moreover, Battle and associates [19] also proposed to use already available recombinant ACE2 for intercepting COVID-19 and attenuating infection. In the previous paragraphs, the presence of ACE2 on immune cells has been pointed out and, by analogy to epithelial cells, this receptor may also be down-regulated following viral entry. Therefore, in CoV-infected animal models and in infected humans further investigations are required to clarify a possible reduced expression of ACE2 on immune cells. In fact, in the course of SARS-CoV infection, a number of immune disorders have been detected. Three reports have demonstrated the ability of CoV to inhibit interferon (IFN)-ï¢ production in the course of SARS acting as IFN antagonist [20-22]. In senescent Balb/c mice, depletion of T lymphocytes is associated to more severe interstitial pneumonitis and delayed clearance of SARS-CoV, thus, suggesting a protective role played by these cells [23]. In this connection, both SARS-CoV and MERS-CoV have been shown to induce T cell apoptosis, thus, aggravating the clinical course of disease [24, 25]. Quite interestingly, memory CD8+ T cells specific for SARS-CoV M and N proteins have been detected up to 11 years post-infection [26]. As far as humoral immune responsiveness is concerned, evidence has been provided that S1 subunit from MERS-CoV is highly immunogenic in mice [27]. Moreover, monoclonal antibodies have been shown to be highly neutralizing against MERS-CoV replication and endowed with post exposure effectiveness in susceptible mice [28, 29]. Human neutralizing antibodies have also been isolated from a recovered patient, thus, suggesting the role of humoral immunity in the control of the persistence of CoV in the host [30]. In particular, IgG response occurs early in infection and its prolonged production may serve for virus clearance during recovery also in view of the absence of viremia in convalescent sera from SARS patients [31]. According to current literature, severity of COVID-19 infection correlates with lymphopenia and patients who died from COVID-19 had lower lymphocyte counts when compared to survivors [32, 33]. These data suggest that lymphocyte-mediated anti-viral activity is poorly effective against COVID-19. Despite lymphopenia, evidence for an exaggerate release of proinflammatory cytokines [interleukin (IL)-1 and IL-6] has been reported in the course acute respiratory syndrome in COVID19 infected patients, thus, aggravating the clinical course of disease [34]. As recently reported, during COVID-19 pandemic in both Italy and China higher frequency of fatalities have been observed in the frail elderly population with previous comorbidities [35]. It is well known that decline of immunity occurs in ageing and, therefore, COVID-19 may gain easier access to the respiratory tract in frail elderly patients [36]. There is evidence that ACE2 protects from severe acute lung failure and operates as a negative regulator of the renin-angiotensin system (RAS) [18, 37]. It is well known that ANG II via activation of the AT1R promotes detrimental effects on the host, such as, vasoconstriction, reactive oxygen species generation, inflammation and matrix remodelling [38]. ACE2 counterbalances the noxious effects exhibited by ANG II and AT1R via activation of AT2R which arrests cell growth, inflammation and fibrosis [39]. In this framework, Gurwitz [40] proposed to use AT1R blockers, such as losartan, as a potential treatment of COVID-19 infection. In fact, losartan as well as olmesartan, used for treating hypertension in patients, were able to increase ACE2 expression after 28 days treatment of rats with myocardial infarction [41]. Then, Gurwitz suggests to evaluate severity of symptoms in COVID-19 infected patients under previous chronic treatment with AT1R blockers in comparison to COVID-19 infected patients who did not take AT1R blockers [40]. Quite interestingly, 75% of aged COVID-19 infected patients admitted to Italian hospitals had hypertension [unpublished data]. However, the putative effects of ACE-2 down-regulation on the cardiovascular system in the course of COVID-19 pandemic need more intensive studies. Taken together, these evidences suggest that CoV-induced down-regulation of ACE2 activates RAS with collateral damage to organs, such as lungs, in the course of SARS-related pneumonia. Then, putative therapeutic measures aimed at increasing ACE2 levels on respiratory epithelial cells should be taken into serious consideration. Quite interestingly, over the past few years, three key papers have demonstrated the ability of a polyphenol, resveratrol (RES), to experimentally deactivate the RAS system in maternal and post-weaning high fat diet, arterial ageing and high fat diet, respectively [42-44]. In all these experimental models, RES led to an increase of ACE2 with reduction of organ damage, such as liver steatosis and aorta media thickness and decrease of adipose tissue mass, respectively. As far as the mechanism of action of RES is concerned, this polyphenol is able to activate sirtuin (Sirt)1 [45-47]. In turn, Sirt1 down-regulates AT1R expression via ACE2 up-regulation [43, 48]. Of importance, Lin and associates [48] have demonstrated the ability of RES to in vitro inhibit MERS-CoV infection of Vero E6 cells, thus, prolonging cell survival in virtue of an anti-apoptotic mechanism. These findings suggest a direct antiviral effect exerted by RES. It would be very interestingly to evaluate the direct effects of RES on COVID-19, in vitro. The data above discussed strongly suggest, that RES, as an activators of ACE2, should be investigated in animal models of CoV-induced severe pneumonia, also taking into account the antioxidant, anti-inflammatory and immunomodulating effects exerted by polyphenols [49]. Then, successful animal studies may pave the way for RES-based human trials in COVID-infected patients. Note added in proof During the reviewing process of this perspective other related papers have been published. Hanff and associates [50] have discussed the possible association between COVID-19-associated cardiovascular mortality and dysregulation of the Renin Angiotensin System (RAS). From a pharmacologic point of view, RAS inhibition leads to upregulation of ACE2, thus, attenuating acute respiratory syndrome and myocarditis in COVID-19-infected patients. Conversely, increase in ACE2 expression may facilitate the access into the host of COVID-19, thus, aggravating the clinical picture. Such a dilemma would be solved byclinical trials based on RAS blockade or initiation and monitoring related effects. Contemporarily, Danser and associates [51] claim that there is no evidence to stop RAS blockers in the course of COVID-19 infection. In fact, there are no available data which support that ACE inhibitors or ANG II type I receptor blockers increase COVID-19 infection via its binding to ACE2. Finally, Kuster and associates [52] write that there are no data on the strict relationship between ACE2 activity and SARS-CoV2 mortality. Moreover, in the SARSCoV2, cells expressing ACE2 were not attacked by the virus, while cells lacking ACE2 were bound by the SARS-CoV2 virus [53]. These findings suggest that also in the case of RES effects on COVID-19 infection, the dual role of ACE2 should be taken into serious consideration.


A fatal case of COVID-19 infection presenting with an erythema multiforme-like eruption and fever


title: The immediate impact of the 2019 novel coronavirus (COVID-19) outbreak on subjective sleep status

text: BACKGROUND: An outbreak of the 2019 novel coronavirus (COVID-19) has been ongoing in China since January 2020. The threat of infection affects the work and life of most of the population and may also damage sleep. This study aims to examine the subjective sleep status and mental health of the population during the peak of the COVID-19 epidemic. METHOD: The data were collected through an online questionnaire with a sample of 5461 individuals in China from February 5, 2020, to February 23, 2020. Participants were divided into four groups based on their degree of threat from COVID-19: Group 1 was most closely associated with COVID-19, including inpatients diagnosed with COVID-19, first-line hospital workers and first-line management staff; Group 2 included outpatients diagnosed with COVID-19 and patients who developed a fever and visited the hospital; Group 3 included people related to Group 1 or 2, such as their colleagues, relatives, friends and rescuers; and Group 4 was the farthest removed from contact with COVID-19, covering the general public affected by COVID-19 prevention strategies. The Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Acute Stress Disorder Scale (ASDS) were used. RESULTS: Threat degree of COVID-19 (groups) had significant correlations with insomnia, depression, anxiety, and stress (p < 0.05, p < 0.01). Age, gender, and area (Hubei province or other provinces) had significant correlations with insomnia (p < 0.01). A total of 1380 (24.46%) participants were suspected of having major depression based on the PHQ-9. Additionally, 1042 (18.47%) participants were suspected of having generalized anxiety disorder based on the GAD-7. A total of 892 (15.8%) of the participants had Acute Stress Disorder (ASD) according to the ASDS. The prevalence of clinical insomnia during the outbreak was 20.05% (1131) according to the ISI. The factors of satisfaction with the current sleep pattern and how perceptible the symptoms of the current sleep pattern are to other people (p < 0.05) and the middle (difficulty staying asleep) and terminal (waking up too early) (p < 0.01) factors of the ISI were significantly different across groups. A total of 1129 (20.01%) participants spent more than one hour awake in bed. CONCLUSION: The results indicated that insomnia is more severe in people who are female, young, living in the epicenter and experiencing a high degree of threat from COVID-19. As prevention and treatment efforts continue with regard to COVID-19, the general public has developed poor sleep hygiene habits, which deserve attention.


docid: wbccvqwf

title: Coronavirus infectious waste management


title: Decontamination of face masks with steam for mask reuse in fighting the pandemic COVID-19: Experimental supports

text: The coronavirus disease 2019 pandemic caused by the novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has claimed many lives worldwide. Wearing medical masks (MMs) or N95 masks ([N95Ms] namely N95 respirators) can slow the virus spread and reduce the infection risk. Reuse of these masks can minimize waste, protect the environment, and help solve the current imminent shortage of masks. Disinfection of used masks is needed for their reuse with safety, but improper decontamination can damage the blocking structure of masks. In this study, we demonstrated using the avian coronavirus of infectious bronchitis virus to mimic SARS-CoV-2 that MMs and N95Ms retained their blocking efficacy even after being steamed on boiling water for 2 hours. We also demonstrated that three brands of MMs blocked over 99% viruses in aerosols. The avian coronavirus was completely inactivated after being steamed for 5 minutes. Altogether, this study suggested that MMs are adequate for use on most social occasions and both MMs and N95Ms can be reused for a few days with steam decontamination between use.


Hospital-at-Home as an Alternative to Release the Overload of Healthcare Systems During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic


Implications of Infection Prevention and Control Measures From a Patient With Atypical 2019 Novel Coronavirus Pneumonia


title: A phenomenological approach to COVID-19 spread in a population

text: A phenomenological model to describe the Corona Virus(covid-19) Pandemic spread in a given population is developed. It enables the identification of the key quantities required to form adequate policies for control and mitigation in terms of observable parameters using the Landau-Stuart equation. It is intended to be complementary to detailed simulations and methods published recently by Ferguson and collaborators, March 16, (2020). The results suggest that the initial growth/spreading rate gamma-c of the disease, and the fraction of infected persons in the population p-i can be used to define a `retardation/inhibition coefficient' k-star , which is a measure of the effectiveness of the control policies adopted. The results are obtained analytically and numerically using a simple Python code. The solutions provide both qualitative and quantitative information. They substantiate and justify two basic control policies enunciated by WHO and adopted in many countries: a) Systematic and early intensive testing individuals for covid-19 and b) Sequestration policies such as `social/physical distancing' and population density reduction by strict quarantining are essential for making k-star greater than 1, necessary for suppressing the pandemic. The model indicates that relaxing such measures when the infection rate starts to decrease as a result of earlier policies could simply restart the infection rate in the non-infected population. Presently available available statistical data in WHO and other reports can be readily used to determine the the key parameters of the model. Possible extensions to the basic model to make it more realistic are indicated.


title: Interventions for treatment of COVID-19: a protocol for a living systematic review with network meta-analysis including individual patient data (The LIVING Project)

text: BACKGROUND: COVID-19 is a rapidly spreading virus infection that has quickly caused extensive burden to individual, families, countries, and the globe. No intervention has yet been proven effective for the treatment of COVID-19. Some randomized clinical trials assessing the effects of different drugs have been published, and more are currently underway. There is an urgent need for a living, dynamic systematic review that continuously evaluates the beneficial and harmful effects of all available interventions for COVID-19. METHODS/DESIGN: We will conduct a living systematic review based on searches of major medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries from their inception onwards to identify relevant randomized clinical trials. We will update the literature search once a week to continuously assess if new evidence is available. Two review authors will independently extract data and perform risk of bias assessment. We will include randomized clinical trials comparing any intervention for the treatment of COVID-19 (e.g., pharmacological interventions, fluid therapy, invasive or noninvasive ventilation, or similar interventions) with any comparator (e.g., an "active" comparator, standard care, placebo, no intervention, or "active placebo") for participants in all age groups with a diagnosis of COVID-19. Primary outcomes will be all-cause mortality and serious adverse events. Secondary outcomes will be admission to intensive care, mechanical ventilation, renal replacement therapy, quality of life, and non-serious adverse events. The living systematic review will include aggregate data meta-analyses, Trial Sequential Analyses, network meta-analysis, and individual patient data meta-analyses. Risk of bias will be assessed with domains, an eight-step procedure will be used to assess if the thresholds for clinical significance are crossed, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations (GRADE). DISCUSSION: COVID-19 has become a pandemic with substantial mortality. A living systematic review evaluating the beneficial and harmful effects of pharmacological and other interventions is urgently needed. This review will continuously inform best practice in treatment and clinical research of this highly prevalent disease. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020178787.


Re: Covid-19 and ortho and trauma surgery: The Italian experience


Ultrasonography and SARS-CoV 2 infection: a review of what we know and do not yet know


title: The COVID-19 Pandemic: A Month of Bioethics in Finland

text: Finland's first COVID-19 infection was recorded in late January 2020. The person infected was a tourist from China in Lapland. Authorities recommended regular handwashing, coughing in one's sleeve, not touching your face, physical distancing, and home lockdown for those at risk. The pandemic spread at different paces in different regions, and the first Finnish fatality was recorded on March 20 in Uusimaa province, where the number of documented infections was considerably higher than elsewhere. In late March, the parliament granted the government emergency powers for swift regulations and restrictions. Uusimaa province was isolated from the rest of the country for a fortnight, restaurants were closed, meetings of more than 10 people were forbidden, and schools and universities assumed distant-working modes, as did businesses and civil services where this was feasible.


title: The Effect of Shelter-in-Place Orders and the COVID-19 Pandemic on Orthopaedic Trauma at a Community Level II Trauma Center

text: OBJECTIVES: Evaluate the effect of the COVID-19 pandemic and the "shelter-in-place" order on orthopaedic trauma presenting to a community level II trauma center. It is hypothesized the overall number of orthopaedic trauma encounters (OTE), the number of OTEs related to both high and low severity injuries, as well as the proportion of OTEs related to high severity versus low severity injuries decreased compared to previous years. METHODS: A retrospective analysis was conducted of OTEs between 2016-2020. High and low severity OTEs were classified according to an algorithm created by the researchers. Data were statistically analyzed and compared to external data for traffic counts, motor vehicle accidents, and TSA checkpoints. RESULTS: A 45.1% decrease (p=.0005) was seen in OTEs from March and April 2016-2019 compared to 2020. The decrease began approximately 12 days prior to the shelter-in-place order. There was a 58.8% decrease in high severity injuries with a fracture (p=.013) and a 42.9% decrease in low severities injuries (p=.0003). Proportion of high to low severity OTEs was unchanged. CONCLUSIONS: The quantity of OTEs was significantly affected by the COVID-19 pandemic and Michigan shelter-in-place order. A decrease in both high and low severity OTEs was found, however there was no statistically significant change in the ratio of high to low severity OTEs compared to previous years. While it is difficult to determine what portion of the decrease in OTE is attributable to the shelter-in-place order verses the COVID-19 pandemic in general, data suggest both play a role. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of Levels of Evidence.


title: Do's-and-don'ts bij COVID-19-coagulopathie./ [Dealing with COVID-19-associated coagulopathy]

text: COVID-19 is associated with a high prevalence of activation of the coagulation cascade. It has been suggested that this so-called COVID-19-associated coagulopathy is predictive of a poor outcome and of mortality. Consensus documents on how to manage patients with COVID-19-associated coagulopathy are based on the limited number of mainly retrospective studies that is currently available, and for this reason the recommendations are not always consistent with one another. In this article, we review the first studies into COVID-19-associated coagulopathy and give the most important do's and don'ts for diagnostics and the daily management of coagulopathy and the prevention of complications in patients with, or with strongly-suspected, COVID-19 in Dutch clinical practice.


title: Airborne pathogen projection during ophthalmic examination

text: PURPOSE: Microscale droplets act as coronaviruses (CoV) carriers in the air when released from an infected person and may infect others during close contact such as ophthalmic examination. The main objective of the present work is to demonstrate how CoV deposited droplets are projected during biomicroscopy and to discuss what kind of precautions should be taken in ophthalmic practice. METHODS: A coupled fluid-structure system comprising smoothed particle hydrodynamics and the finite element method has been built to assess the projection of droplets spreading from an infected person. Different conditions based on the maximum exit flow velocity from the infector's mouth during the ophthalmic examination were modeled. RESULTS: During exhalation, for which the exit flow is ~ 1000 mm/s, the average horizontal distance of the flow front was ~ 200 mm while individual particles can reach up to ~ 500 mm. In case of coughing or sneezing (corresponding to an exit flow of ~ 12,000 mm/s), the average horizontal distance of the flow front was ~ 1300 mm. CONCLUSION: During the ophthalmic examination, the proximity to the patient's nose and mouth was observed to be less than the horizontal distance of flow front particles. Even though mounted breath shields are used, particles flew beyond the shield and contaminate the ophthalmologist. Compared with the current protective breath shields, the use of a larger shield with a minimum radius of 18 cm is needed to decrease viral transmission.


title: [Fatal outcome of coronavirus disease 2019 in a previously healthy 50-year-old man]

text: In this case report, a 50-year-old man who had no medical history, presented with multiple cardiac arrests following a week with progressing symptoms of pneumonia After achieving return of spontaneous circulation he presented with respiratory failure with severe hypoxia, septic shock, and multiple organ failure A chest X-ray showed signs of acute respiratory distress syndrome Despite aggressive intensive care management, the patient died 7 5 hours after admission Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was later confirmed, and the presumed cause of death was SARS-CoV-2 pneumonia In conclusion: coronavirus disease 2019 (COVID-19) can lead to a fatal outcome in younger healthy residents, who are not treated timely in case of severe symptoms like dyspnoea


Geriatric patient-centered care during the COVID-19: Provision of interactions vs. the imposition of isolation


title: Air contamination with SARS-CoV-2 in the operating room

text: Angiotensin converting enzyme 2 (ACE2) is a target cell receptor for internalization and proliferation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). When ACE2-highly expressed tissues are manipulated, SARS-CoV-2 containing aerosols may be generated. Normal breathing and speaking are capable of producing aerosols so mask ventilation, suction of airway tract and bucking during tracheal intubation and extubation are clinical procedures capable of significant aerosol production. Whilst no data have been reported on the distribution of SARS-CoV-2 in the operating room (OR), contamination in the OR can be estimated from the intensive care unit (ICU) data. ICU data showed that SARS-CoV-2 was detected on all types of surface and in air within about 4 m from coronavirus disease 2019 (COVID-19) patients. High concentrations of SARS-CoV-2 was detected in the personal protective equipment (PPE) removal room and medical staff office. Submicron virus-laden aerosols could result from resuspension of particles containing SARS-CoV-2 sticking the PPE surface; removal could produce the initial velocity. Supermicron virus-laden aerosol could come from floor deposited SARS-CoV-2, which were carried across different areas by medical staff (e.g., shoe). Knowledge of aerosol generation and distribution in the OR will aid the design of strategies to reduce transmission risk.