title: Piecewise quadratic growth during the 2019 novel coronavirus epidemic

text: The temporal growth in the number of deaths in the COVID-19 epidemic is subexponential. Here we show that a piecewise quadratic law provides an excellent fit during the thirty days after the first three fatalities on January 20 and later since the end of March 2020. There is also a brief intermediate period of exponential growth. During the second quadratic growth phase, the characteristic time of the growth is about eight times shorter than in the beginning, which can be understood as the occurrence of separate hotspots. Quadratic behavior can be motivated by peripheral growth when further spreading occurs only on the outskirts of an infected region. We also study numerical solutions of a simple epidemic model, where the spatial extend of the system is taken into account. To model the delayed onset outside China together with the early one in China within a single model with minimal assumptions, we adopt an initial condition of several hotspots, of which one reaches saturation much earlier than the others. At each site, quadratic growth commences when the local number of infections has reached a certain saturation level. The total number of deaths does then indeed follow a piecewise quadratic behavior.


COVID-19: organoids go viral


title: The protective rather than prothrombotic fibrinogen in COVID-19 and other inflammatory states

text: Hypercoagulability has been recognized as a common complication of COVID-19. Exact mechanisms for this extreme coagulation activation have not yet been elucidated. However, one of the consistent laboratory finding is the increase in fibrinogen, in some cases, marked elevation. High circulating levels of fibrinogen have been linked to thrombosis for years and for this reason, hyperfibrinogenemia is considered one of the mechanisms for COVID-19 coagulopathy. In this forum article, instead of the prothrombotic role, a protective function for fibrinogen is discussed. Fibrinogen, like the other well-known acute phase reactants, is increased in COVID-19 possibly to protect the host.


title: A geroscience perspective on COVID-19 mortality

text: A novel coronavirus, SARS-CoV-2, emerged in December 2019, leading within a few months to a global pandemic. COVID-19, the disease caused by this highly contagious virus, can have serious health consequences, though risks of complications are highly age-dependent. Rates of hospitalization and death are less than 0.1% in children, but increase to 10% or more in older people. Moreover, at all ages, men are more likely than women to suffer serious consequences from COVID-19. These patterns are familiar to the geroscience community. The effects of age and sex on mortality rates from COVID-19 mirror the effects of aging on almost all major causes of mortality. These similarities are explored here, and underscore the need to consider the role of basic biological mechanisms of aging on potential treatment and outcomes of COVID-19.


COVID-19: protecting the medically vulnerable


title: Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies

text: The coronavirus disease 2019 (COVID-19) virus is spreading rapidly, and scientists are endeavoring to discover drugs for its efficacious treatment in China. Chloroquine phosphate, an old drug for treatment of malaria, is shown to have apparent efficacy and acceptable safety against COVID-19 associated pneumonia in multicenter clinical trials conducted in China. The drug is recommended to be included in the next version of the Guidelines for the Prevention, Diagnosis, and Treatment of Pneumonia Caused by COVID-19 issued by the National Health Commission of the People's Republic of China for treatment of COVID-19 infection in larger populations in the future.


title: [Study on treatment of "cytokine storm" by anti-2019-nCoV prescriptions based on arachidonic acid metabolic pathway]

text: Since the outbreak of 2019-nCoV, the epidemic has developed rapidly and the situation is grim. LANCET figured out that the 2019-nCoV is closely related to "cytokine storm". "Cytokine storm" is an excessive immune response of the body to external stimuli such as viruses and bacteria. As the virus attacking the body, it stimulates the secretion of a large number of inflammatory factors: interleukin(IL), interferon(IFN), C-X-C motif chemokine(CXCL) and so on, which lead to cytokine cascade reaction. With the exudation of inflammatory factors, cytokines increase abnormally in tissues and organs, interfering with the immune system, causing excessive immune response of the body, resulting in diffuse damage of lung cells, pulmonary fibrosis, and multiple organ damage, even death. Arachidonic acid(AA) metabolic pathway is principally used to synthesize inflammatory cytokines, such as monocyte chemotactic protein 1(MCP-1), tumor necrosis factor(TNF), IL, IFN, etc., which is closely related to the occurrence, development and regression of inflammation. Therefore, the inhibition of AA metabolism pathway is benefit for inhibiting the release of inflammatory factors in the body and alleviating the "cytokine storm". Based on the pharmacophore models of the targets on AA metabolic pathway, the traditional Chinese medicine database 2009(TCMD 2009) was screened. The potential herbs were ranked by the number of hit molecules, which were scored by pharmacophore fit value. In the end, we obtained the potential active prescriptions on "cytokine storm" according to the potential herbs in the "National novel coronavirus pneumonia diagnosis and treatment plan(trial version sixth)". The results showed that the hit components with the inhibitory effect on AA were magnolignan â , lonicerin and physcion-8-O-ß-D-glucopy-ranoside, which mostly extracted from Magnoliae Officinalis Cortex, Zingiberis Rhizoma Recens, Lonicerae Japonicae Flos, Rhei Radix et Rhizoma, Salviae Miltiorrhizae Radix et Rhizoma, Scutellariae Radix, Gardeniae Fructus, Ginseng Radix et Rhizoma, Arctii Fructus, Dryopteridis Crassirhizomatis Rhizoma, Paeoniaeradix Rubra, Dioscoreae Rhizoma. Finally the anti-2019-nCoV prescriptions were analyzed to obtain the potential active prescriptions on AA metabolic pathway, Huoxiang Zhengqi Capsules, Jinhua Qinggan Granules, Lianhua Qingwen Capsules, Qingfei Paidu Decoction, Xuebijing Injection, Reduning Injection and Tanreqing Injection were found that may prevent 2019-nCoV via regulate cytokines. This study intends to provide reference for clinical use of traditional Chinese medicine to resist new coronavirus.


Covid-19 and child disabilities: whom to protect and how


Potential underlying mechanisms of cerebral venous thrombosis associated with COVID-19


title: Is BMI higher in younger patients with COVID-19? Association between BMI and COVID-19 hospitalization by age

text: OBJECTIVE: Obesity has been found to be a risk factor for hospitalization with COVID-19. We were interested in understanding whether patients hospitalized with COVID-19 differed in BMI at older versus younger ages, and if trends were independent of diabetes and hypertension. METHODS: We performed a cross-sectional analysis of patients hospitalized with moderate to severe COVID-19 at Northwestern Memorial Hospital from March 19th , 2020 until April 4th , 2020. We compared patients hospitalized with COVID-19 above and below the age of 50, and to those hospitalized without COVID-19. RESULTS: We found patients younger than 50 years of age hospitalized with COVID-19 without diabetes or hypertension had mean BMI greater than those older than 50 years of age, with BMI 43.1 (95%CI 34.5 - 51.7) kg/m2 vs 30.1 (95%CI 27.7 - 32.5) kg/m2 (p=0.02). Furthermore, BMI appears to inversely correlate with increasing age amongst patients hospitalized with COVID-19. We did not detect the same difference or trend for patients hospitalized without COVID-19. CONCLUSION: We found younger patients (age <50 years) with COVID-19 had higher mean BMI than older patients with COVID-19, with and without diabetes and hypertension. This trend did not exist in patients without COVID-19 hospitalized during the same time-period.


Coronavirus Disease 2019 (COVID-19) Infection and Renin Angiotensin System Blockers


Management of upper GI bleeding in patients with COVID-19 pneumonia


Navigating shifting waters: rapid response to change in the era of COVID-19


title: Research progress on repositioning drugs and specific therapeutic drugs for SARS-CoV-2

text: SARS-CoV-2 has been widely spread around the world and COVID-19 was declared a global pandemic by the World Health Organization. Limited clinically effective antiviral drugs are available now. The development of anti-SARS-CoV-2 drugs has become an urgent work worldwide. At present, potential therapeutic targets and drugs for SARS-CoV-2 are continuously reported, and many repositioning drugs are undergoing extensive clinical research, including remdesivir and chloroquine. On the other hand, structures of many important viral target proteins and host target proteins, including that of RdRp and Mpro were constantly reported, which greatly promoted structure-based drug design. This paper summarizes the current research progress and challenges in the development of anti-SARS-CoV-2 drugs, and proposes novel short-term and long-term drug research strategies.


title: Use of Rapid Online Surveys to Assess People's Perceptions During Infectious Disease Outbreaks: A Cross-sectional Survey on COVID-19

text: BACKGROUND: Given the extensive time needed to conduct a nationally representative household survey and the commonly low response rate of phone surveys, rapid online surveys may be a promising method to assess and track knowledge and perceptions among the general public during fast-moving infectious disease outbreaks. OBJECTIVE: This study aimed to apply rapid online surveying to determine knowledge and perceptions of coronavirus disease 2019 (COVID-19) among the general public in the United States and the United Kingdom. METHODS: An online questionnaire was administered to 3000 adults residing in the United States and 3000 adults residing in the United Kingdom who had registered with Prolific Academic to participate in online research. Prolific Academic established strata by age (18-27, 28-37, 38-47, 48-57, or ≥58 years), sex (male or female), and ethnicity (white, black or African American, Asian or Asian Indian, mixed, or "other"), as well as all permutations of these strata. The number of participants who could enroll in each of these strata was calculated to reflect the distribution in the US and UK general population. Enrollment into the survey within each stratum was on a first-come, first-served basis. Participants completed the questionnaire between February 23 and March 2, 2020. RESULTS: A total of 2986 and 2988 adults residing in the United States and the United Kingdom, respectively, completed the questionnaire. Of those, 64.4% (1924/2986) of US participants and 51.5% (1540/2988) of UK participants had a tertiary education degree, 67.5% (2015/2986) of US participants had a total household income between US $20,000 and US $99,999, and 74.4% (2223/2988) of UK participants had a total household income between £15,000 and £74,999. US and UK participants' median estimate for the probability of a fatal disease course among those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 5.0% (IQR 2.0%-15.0%) and 3.0% (IQR 2.0%-10.0%), respectively. Participants generally had good knowledge of the main mode of disease transmission and common symptoms of COVID-19. However, a substantial proportion of participants had misconceptions about how to prevent an infection and the recommended care-seeking behavior. For instance, 37.8% (95% CI 36.1%-39.6%) of US participants and 29.7% (95% CI 28.1%-31.4%) of UK participants thought that wearing a common surgical mask was "highly effective" in protecting them from acquiring COVID-19, and 25.6% (95% CI 24.1%-27.2%) of US participants and 29.6% (95% CI 28.0%-31.3%) of UK participants thought it was prudent to refrain from eating at Chinese restaurants. Around half (53.8%, 95% CI 52.1%-55.6%) of US participants and 39.1% (95% CI 37.4%-40.9%) of UK participants thought that children were at an especially high risk of death when infected with SARS-CoV-2. CONCLUSIONS: The distribution of participants by total household income and education followed approximately that of the US and UK general population. The findings from this online survey could guide information campaigns by public health authorities, clinicians, and the media. More broadly, rapid online surveys could be an important tool in tracking the public's knowledge and misperceptions during rapidly moving infectious disease outbreaks.


title: Can video consultations replace face-to-face interviews? Palliative medicine and the Covid-19 pandemic: rapid review

text: During the Covid-19 pandemic, a strategy to minimise face-to-face (FtF) visits and limit viral spread is essential. Video consultations offer clinical assessment despite restricted movement of people.We undertook a rapid literature review to identify the highest currently available level of evidence to inform this major change in clinical practice. We present a narrative synthesis of the one international and one national guideline and two systematic reviews-all published within the last 18 months.The global evidence appears to support video consultations as an effective, accessible, acceptable and cost-effective method of service delivery. Organisations must ensure software is simple, effective, reliable and safe, with the highest level of security for confidentiality.Although video consultations cannot fully replace FtF, they can radically reduce the need for FtF and the risk of Covid-19 spread in our communities while maintaining high standards of care. For patient safety, it will be critical to follow the WHO guidance regarding: a standard operating procedure; clinical protocols for when video consultations can (and cannot) be used; policies to ensure equity of access in disadvantaged populations; adequate staff training; and administrative support to coordinate appointments.


title: SAveRUNNER: a network-based algorithm for drug repurposing and its application to COVID-19

text: The novelty of new human coronavirus COVID-19/SARS-CoV-2 and the lack of effective drugs and vaccines gave rise to a wide variety of strategies employed to fight this worldwide pandemic. Many of these strategies rely on the repositioning of existing drugs that could shorten the time and reduce the cost compared to de novo drug discovery. In this study, we presented a new network-based algorithm for drug repositioning, called SAveRUNNER (Searching off-lAbel dRUg aNd NEtwoRk), which predicts drug-disease associations by quantifying the interplay between the drug targets and the disease-specific proteins in the human interactome via a novel network-based similarity measure that prioritizes associations between drugs and diseases locating in the same network neighborhoods. Specifically, we applied SAveRUNNER on a panel of 14 selected diseases with a consolidated knowledge about their disease-causing genes and that have been found to be related to COVID-19 for genetic similarity, comorbidity, or for their association to drugs tentatively repurposed to treat COVID-19. Focusing specifically on SARS subnetwork, we identified 282 repurposable drugs, including some the most rumored off-label drugs for COVID-19 treatments, as well as a new combination therapy of 5 drugs, actually used in clinical practice. Furthermore, to maximize the efficiency of putative downstream validation experiments, we prioritized 24 potential anti-SARS-CoV repurposable drugs based on their network-based similarity values. These top-ranked drugs include ACE-inhibitors, monoclonal antibodies, and thrombin inhibitors. Finally, our findings were in-silico validated by performing a gene set enrichment analysis, which confirmed that most of the network-predicted repurposable drugs may have a potential treatment effect against human coronavirus infections.


docid: qgvqerek

title: The Zoltar forecast archive: a tool to facilitate standardization and storage of interdisciplinary prediction research

text: Forecasting has emerged as an important component of informed, data-driven decision-making in a wide array of fields. We introduce a new data model for probabilistic predictions that encompasses a wide range of forecasting settings. This framework clearly defines the constituent parts of a probabilistic forecast and proposes one approach for representing these data elements. The data model is implemented in Zoltar, a new software application that stores forecasts using the data model and provides standardized API access to the data. In one real-time case study, an instance of the Zoltar web application was used to store, provide access to, and evaluate real-time forecast data on the order of 10$^7$ rows, provided by over 20 international research teams from academia and industry making forecasts of the COVID-19 outbreak in the US. Tools and data infrastructure for probabilistic forecasts, such as those introduced here, will play an increasingly important role in ensuring that future forecasting research adheres to a strict set of rigorous and reproducible standards.


title: $\mathcal{R}_{0}$ fails to predict the outbreak potential in the presence of natural-boosting immunity

text: Time varying susceptibility of host at individual level due to waning and boosting immunity is known to induce rich long-term behavior of disease transmission dynamics. Meanwhile, the impact of the time varying heterogeneity of host susceptibility on the shot-term behavior of epidemics is not well-studied, even though the large amount of the available epidemiological data are the short-term epidemics. Here we constructed a parsimonious mathematical model describing the short-term transmission dynamics taking into account natural-boosting immunity by reinfection, and obtained the explicit solution for our model. We found that our system show"the delayed epidemic", the epidemic takes off after negative slope of the epidemic curve at the initial phase of epidemic, in addition to the common classification in the standard SIR model, i.e.,"no epidemic"as $\mathcal{R}_{0}\leq1$ or normal epidemic as $\mathcal{R}_{0}>1$. Employing the explicit solution we derived the condition for each classification.


title: Analysis of Risk Perceptions and Related Factors Concerning COVID-19 Epidemic in Chongqing, China

text: OBJECTIVE: To assess perceptions of risk and related factors concerning COVID-19 epidemic among residents in Chongqing city, China. METHODS: With convenience sampling, a web questionnaire survey was conducted among 476 residents living in Chongqing on February 13rd to 14th in 2020, when citizens just started to get back to work. RESULTS: Residents' estimated perceived risks were (4.63 ± 0.57), (4.19 ± 0.76), (3.23 ± 0.91) and (2.29 ± 0.96) for the infectivity, pathogenicity, lethality and self-rated infection possibility of COVID-19, respectively. Females (OR = 4.234), people with income ≥ 2000 yuan (2000-4999 yuan: OR = 5.052, 5000-9999 yuan: OR = 4.301, ≥ 10,000 yuan: OR = 23.459), the married status (OR = 1.811), the divorced status, widows or widowers (OR = 3.038), people living with families including children (OR = 5.085) or chronic patients (OR = 2.423) had a higher perceived risk level, as well as people who used free media websites (OR = 1.756), community workers (OR = 4.064) or community information platforms (OR = 2.235) as main media information sources. The perceived risk increased by 4.9% for every one-year increase of age. People who used WeChat contacts (OR = 0.196) as the main media information source, reported a lower perceived risk. CONCLUSION: Residents reported a high level of risk perception towards COVID-19 in Chongqing and it was impacted by the population demographic characteristics. Media information sources, including community information platforms and community workers may cause the increase of public risk perceptions.


title: [Exploration and practice of online teaching system of medical immunology based on small private online course (SPOC) model during coronavirus disease 2019 (COVID-19) pandemic]

text: During the pandemic of coronavirus disease 2019 (COVID-19), the Chinese Ministry of Education put forward the requirement of turning offline education into online teaching to universities. Our department positively responded and rapidly mobilized to establish an online teaching system of medical immunology based on the small private online course (SPOC) model, which has a main body of the SPOC model with "video course as the main part, supplemented by online Q&A". The system also has feedback improvement sections of online discussion and chapter tests and evaluates the quality and effect of teaching with students' group display, course examination, and questionnaires. At the same time, the COVID-19 hotspot is also organically combined with immunological knowledge throughout the online teaching. In this process, our department continuously summarizes experiences and discovers problems. Herein, we generalize and sort out the exploration and practice of constructing the online teaching system, to carry out offline teaching after the pandemic and to continue this teaching model in the future, for reference and guidance.


title: Spatial analysis and prediction of COVID-19 spread in South Africa after lockdown

text: What is the impact of COVID-19 on South Africa? This paper envisages assisting researchers and decision-makers in battling the COVID-19 pandemic focusing on South Africa. This paper focuses on the spread of the disease by applying heatmap retrieval of hotspot areas and spatial analysis is carried out using the Moran index. For capturing spatial autocorrelation between the provinces of South Africa, the adjacent, as well as the geographical distance measures, are used as a weight matrix for both absolute and relative counts. Furthermore, generalized logistic growth curve modeling is used for the prediction of the COVID-19 spread. We expect this data-driven modeling to provide some insights into hotspot identification and timeous action controlling the spread of the virus.


title: A Veterinary Vaccine Development Process Map to assist in the development of new vaccines

text: The UK Government recognised the importance of vaccines in the control of new emerging disease threats and in 2015 established the UK Vaccine Network to focus on specific areas of need. One of these was the understanding of what is involved in the development of a new vaccine and what are the potential bottlenecks to a rapid response in the face of an epidemic such as Ebola, MERS and more recently COVID-19. A Working Group was established to initially produce a Vaccine Development Process Map for a Human Vaccine. However, in view of the importance of animal wellbeing and the significant impact of diseases with Zoonotic potential, a similar Map has been created outlining the Veterinary Vaccine Development Process. This paper describes the production of that Map and covers the process from the generation of a Target Product Profile (TPP) through Discovery and Feasibility, and on to Product Development and Registration.


Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis


title: Pharmacy Emergency Preparedness and Response (PEPR): a proposed framework for expanding pharmacy professionals' roles and contributions to emergency preparedness and response during the COVID-19 pandemic and beyond

text: BACKGROUND: Pharmacists have long been involved in public health and emergency preparedness and response (EP&R), including through preventive measures such as screening, vaccinations, testing, medical and pharmaceutical countermeasures, as well as ensuring medication safety and access during natural disasters and pandemics. Pharmacy professionals are considered essential partners in response to the ongoing COVID-19 pandemic. Community and hospital pharmacies are expanding services and hours to provide essential services, putting pharmacists and their co-workers at the frontlines for patient care and safety to improve public health. In addition, pharmacy professionals are increasingly integrating into global, national, state and local EP&R efforts, including into interprofessional teams, such as Medical Reserve Corps (MRCs). However, lacunae exist for further integration of pharmacists into public health and safety initiatives. There are increasing opportunities and recommendations that should be expanded upon to provide improved patient care and population health interventions, and to ensure healthcare worker and public health safety. OBJECTIVE: Develop a Pharmacy Emergency Preparedness and Response (PEPR) Framework and recommendations for pharmacy professional pathways towards full integration within public health EP&R efforts (such as the COVID-19 pandemic), and enhanced recognition of pharmacists' skills, roles and contributions as integral members of the interprofessional healthcare team. METHODS: This paper draws on the American Society of Health-System Pharmacists (ASHP) 2003 Statement on the Role of Health-System Pharmacists in Emergency Preparedness and lessons learned from previous and current public health emergencies, such as the 2009 H1N1 pandemic and the current COVID-19 pandemic, to provide expanded guidance for pharmacists and pharmacy professionals across all practice settings in EP&R. The proposed PEPR framework also incorporates information and recommendations from The Pharmacy Organizations' Joint Policy Recommendations to Combat the COVID-19 Pandemic (March 2020), CDC-NIOSH, International Pharmaceutical Federation (FIP) Guidance, health departments and emergency preparedness guidance and resources, Boards of Pharmacy, and other pharmacy professional organizations and educational institutions. RESULTS: Based on methods and resources utilized in developing this proposed PEPR Framework, five key focus areas were identified, as follows: CONCLUSION: Pharmacists and pharmacy professionals have been at the frontlines in responding to the COVID-19 pandemic. Yet, challenges remain, such as limited availability of personal protection equipment, high risk of infectious exposures inherent in healthcare professions, and legislative hurdles resulting in lack of provider status and related reimbursements. Recommendations to enhance pharmacy's scope as public health professionals involved in EP&R include targeted training and education on key framework areas and policymaking. Pharmacy professionals should further integrate with interdisciplinary public health teams. Additional research and dissemination on impacts and outcomes of EP&R can enhance recognition of pharmacy professionals' contribution and value during public health emergencies. The proposed PEPR Framework can be utilized to develop, implement, evaluate, and disseminate results in order to strengthen existing efforts and to establish new initiatives in EP&R.


Eritema multiforme inducido por hidroxicloroquina en paciente con COVID-19./ Eritema multiforme inducido por hidroxicloroquina en paciente con COVID-19./ Hydroxychloroquine-induced erythema multiforme in a patient with COVID-19


The START (Surgical Triage And Resource Allocation Tool) of Surgical Prioritization During the COVID-19 Pandemic


Diffuse cutaneous manifestation in a new mother with COVID-19 (SARS-Cov-2)


COVID-19 consequences on medical students interested in neurosurgery: an Italian perspective


title: Using statistics and mathematical modelling to understand infectious disease outbreaks: COVID-19 as an example

text: During an infectious disease outbreak, biases in the data and complexities of the underlying dynamics pose significant challenges in mathematically modelling the outbreak and designing policy. Motivated by the ongoing response to COVID-19, we provide a toolkit of statistical and mathematical models beyond the simple SIR-type differential equation models for analysing the early stages of an outbreak and assessing interventions. In particular, we focus on parameter estimation in the presence of known biases in the data, and the effect of non-pharmaceutical interventions in enclosed subpopulations, such as households and care homes. We illustrate these methods by applying them to the COVID-19 pandemic.


title: Successful Treatment of Preterm Labor in Association with Acute COVID-19 Infection

text: Novel coronavirus disease 2019 (COVID-19) infection occurring during pregnancy is associated with an increased risk of preterm delivery. This case report describes successful treatment of preterm labor during acute COVID-19 infection. Standard treatment for preterm labor may allow patients with acute COVID-19 infection to recover without the need for preterm delivery. KEY POINTS: · Acute COVID-19 infection is associated with a high rate of preterm delivery.. · Standard treatment for preterm labor such as intravenous magnesium sulfate, antepartum steroid therapy and antibiotic prophylaxis for group B streptococcus infection were effective in this patient.. · In the absence of maternal or fetal compromise, acute COVID-19 infection is not an indication for early elective delivery..


title: How should front-line general practitioners use personal protective equipment (PPE)?

text: The COVID-19 outbreak continues to evolve with the number of cases increasing in Malaysia, placing a significant burden on general practitioners (GPs) to assess and manage suspected cases GPs must be well equipped with knowledge to set up their clinics, use Personal Protective Equipment (PPE) appropriately, adopt standard protocols on triaging and referrals, as well as educate patients about PPE The correct use of PPE will help GPs balance between personal safety and appropriate levels of public concern


title: A Novel Indicator Predicts 2019 Novel Coronavirus Infection in Subjects with Diabetes

text: AIMS: Diabetes mellitus (DM) is associated with significant morbidity and mortality. The disease severity in 2019 novel coronavirus (Covid 19) infection has varied from mild self-limiting flu-like illness to fulminant pneumonia, respiratory failure and death. Since DM and Covid 19 infection are closely associated with inflammatory status, mean platelet volume (MPV) was suggested to be useful in predicting Covid infection onset. This study aimed to evaluate the diagnostic role of MPV in Covid patients with diabetes. METHODS: A total of 640 subjects (160 Covid patients with type 2 diabetes, 160 healthy controls, 160 patients with non-spesific infections and 160 Covid patients without type 2 diabetes) enrolled in the study. RESULTS: MPV was significantly higher (11.21 ± 0.61 fL) as compared to the results from the last routine visits of the the same individuals with diabetes (10.59 ± 0.96 fL) (p = 0.000). CONCLUSIONS: MPV could be used as a simple and cost-effective tool to predict the Covid infection in subjects with diabetes in primary care.


title: Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction

text: AIMS: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly evolved into a sweeping pandemic. Its major manifestation is in the respiratory tract, and the general extent of organ involvement and the microscopic changes in the lungs remain insufficiently characterised. Autopsies are essential to elucidate COVID-19-associated organ alterations. METHODS AND RESULTS: This article reports the autopsy findings of 21 COVID-19 patients hospitalised at the University Hospital Basel and at the Cantonal Hospital Baselland, Switzerland. An in-corpore technique was performed to ensure optimal staff safety. The primary cause of death was respiratory failure with exudative diffuse alveolar damage and massive capillary congestion, often accompanied by microthrombi despite anticoagulation. Ten cases showed superimposed bronchopneumonia. Further findings included pulmonary embolism (n = 4), alveolar haemorrhage (n = 3), and vasculitis (n = 1). Pathologies in other organ systems were predominantly attributable to shock; three patients showed signs of generalised and five of pulmonary thrombotic microangiopathy. Six patients were diagnosed with senile cardiac amyloidosis upon autopsy. Most patients suffered from one or more comorbidities (hypertension, obesity, cardiovascular diseases, and diabetes mellitus). Additionally, there was an overall predominance of males and individuals with blood group A (81% and 65%, respectively). All relevant histological slides are linked as open-source scans in supplementary files. CONCLUSIONS: This study provides an overview of postmortem findings in COVID-19 cases, implying that hypertensive, elderly, obese, male individuals with severe cardiovascular comorbidities as well as those with blood group A may have a lower threshold of tolerance for COVID-19. This provides a pathophysiological explanation for higher mortality rates among these patients.


title: The capacity of goat epidermal adult stem cells to reconstruct the damaged ocular surface of total LSCD and activate corneal genetic programs

text: Epidermal adult stem cells (EpiASCs) have the potential for unlimited proliferation and differentiation, however, the ability of these stem cells to activate corneal genetic programs in response to corneal stroma stimulation needs to be further validated. Herein, a feasible strategy was developed to reconstruct the damaged corneal surface in a goat model with total limbal stem cell deficiency (LSCD) by transplanting EpiASCs, which had been explanted and cultured from the skin of an adult ram goat and were then purified by selecting single cell-derived clones and cultivating them on a denuded human amniotic membrane (HAM). These artificial tissues were then successfully transplanted into ewe goats with total LSCD. Binding of EpiASCs to the base membrane of an EpiASCs-HAM-Sheet (EHS) indicated their proliferating status. After transplantation, the EpiASCs could survive in the host tissue and they reconstructed the damaged ocular surface of total LSCD. The crystal reconstructed corneal epithelium expressed CK3 and Pax-6 similar to normal corneal epithelium and expressed the Sry gene after transplantation. These results demonstrated that EpiASCs could be induced to differentiate into corneal epithelial cell types in a corneal microenvironment and had the ability to activate corneal genetic programs. This work offer a foundation for promoting tissue-engineered cornea into clinical application.


title: 2019 novel coronavirus (COVID-19) pneumonia complications: the importance of lung ultrasound

text: In December 2019, a novel coronavirus (SARS-Cov-2) was first reported in Wuhan, China, and rapidly spread around the world, leading to an international emerging public health emergency. As reported from Chinese experiences, approximately 20% of patients had a severe course, requiring intensive care, with an overall case fatality rate of 2.3%. In diagnosis, chest computed tomography most commonly showed ground-glass opacity with or without consolidative patterns.Herein, we report a case of a patient affected by COVID-19 pneumonia referred in the emergency department of our institution on April 4, 2020, with peculiar lung ultrasound findings.


title: Favipiravir, an anti-influenza drug against life-threatening RNA virus infections

text: Favipiravir has been developed as an anti-influenza drug and licensed as an anti-influenza drug in Japan. Additionally, favipiravir is being stockpiled for 2 million people as a countermeasure for novel influenza strains. This drug functions as a chain terminator at the site of incorporation of the viral RNA and reduces the viral load. Favipiravir cures all mice in a lethal influenza infection model, while oseltamivir fails to cure the animals. Thus, favipiravir contributes to curing animals with lethal infection. In addition to influenza, favipiravir has a broad spectrum of anti-RNA virus activities in vitro and efficacies in animal models with lethal RNA viruses and has been used for treatment of human infection with life-threatening Ebola virus, Lassa virus, rabies, and severe fever with thrombocytopenia syndrome. The best feature of favipiravir as an antiviral agent is the apparent lack of generation of favipiravir-resistant viruses. Favipiravir alone maintains its therapeutic efficacy from the first to the last patient in an influenza pandemic or an epidemic lethal RNA virus infection. Favipiravir is expected to be an important therapeutic agent for severe influenza, the next pandemic influenza strain, and other severe RNA virus infections for which standard treatments are not available.


Risk of COVID-19 for patients with cancer


COVID-19 recovery can benefit biodiversity


COVID-19 Infection: Perioperative Implications: Comment


title: A precision medicine approach to managing 2019 novel coronavirus pneumonia

text: In December 2019, several patients with pneumonia of an unknown cause were detected in Wuhan, China. On 7 January 2020, the causal organism was identified as a new coronavirus, later named as the 2019 novel coronavirus (2019-nCoV). Genome sequencing found the genetic sequence of 2019-nCoV homologous to that of severe acute respiratory syndrome-associated coronavirus. As of 29 January 2020, the virus had been diagnosed in more than 7000 patients in China and 77 patients in other countries. It is reported that both symptomatic and asymptomatic patients with 2019-nCoV can play a role in disease transmission via airborne and contact. This finding has caused a great concern about the prevention of illness spread. The clinical features of the infection are not specific and are often indistinguishable from those of other respiratory infections, making it difficult to diagnose. Given that the virus has a strong ability to spread between individuals, it is of top priority to identify potential or suspected patients as soon as possible-or the virus may cause a serious pandemic. Therefore, a precision medicine approach to managing this disease is urgently needed for detecting and controlling the spread of the virus. In this article, we present such an approach to managing 2019-nCoV-related pneumonia based on the unique traits of the virus recently revealed and on our experience with coronaviruses at West China Hospital in Chengdu, China.


Coronavirus and Exceptional Health Situations: The First Disaster With Benefits on Air Pollution


title: Investigation of effective climatology parameters on COVID-19 outbreak in Iran

text: SARS CoV-2 (COVID-19) Coronavirus cases are confirmed throughout the world and millions of people are being put into quarantine. A better understanding of the effective parameters in infection spreading can bring about a logical measurement toward COVID-19. The effect of climatic factors on spreading of COVID-19 can play an important role in the new Coronavirus outbreak. In this study, the main parameters, including the number of infected people with COVID-19, population density, intra-provincial movement, and infection days to end of the study period, average temperature, average precipitation, humidity, wind speed, and average solar radiation investigated to understand how can these parameters effects on COVID-19 spreading in Iran? The Partial correlation coefficient (PCC) and Sobol'-Jansen methods are used for analyzing the effect and correlation of variables with the COVID-19 spreading rate. The result of sensitivity analysis shows that the population density, intra-provincial movement have a direct relationship with the infection outbreak. Conversely, areas with low values of wind speed, humidity, and solar radiation exposure to a high rate of infection that support the virus's survival. The provinces such as Tehran, Mazandaran, Alborz, Gilan, and Qom are more susceptible to infection because of high population density, intra-provincial movements and high humidity rate in comparison with Southern provinces.


Broad Issues Facing Older Women: Utilization of health prevention services, fragility, longevity, and meaningful relationships


Authors' response: Plenty of coronaviruses but no SARS-CoV-2


Correction: Rapid Reporting and Dissemination of Results and Its Consequences Regarding the Use of Hydroxychloroquine for COVID-19


From Hematologist's desk: The effect of COVID-19 on the blood system


title: Variation of biogeochemical cycle of riverine dissolved inorganic carbon and silicon with the cascade damming

text: To investigate the variation of the biogeochemical cycle of riverine dissolved inorganic carbon (DIC) and silicon (DSi) with the cascade damming, the bicarbonate ([Formula: see text]), dissolved silicon (DSi), and other environmental factors within the cascade reservoirs of the lower reaches of Yalongjiang River, passing through the southeastern Qinghai-Tibet Plateau, were systematically analyzed by collecting water samples during the wet season and dry season from 2018 to 2019, respectively. The results showed that the lower ratio of DSi to[Formula: see text] (0.044 ± 0.001) was mainly controlled by the domination of carbonate mineral in the sedimentary rock of the Yalongjiang River drainage basin. The DSi:[Formula: see text] ratio was positively correlated with discharge (P < 0.05), and negatively correlated with the water retention time (P < 0.01) and chlorophyll a, implying that the variations of DSi:[Formula: see text] ratio were mainly determined by the rock chemical weathering processes and the hydrologic process outside the reservoirs and the biological processes within the cascade reservoirs. The phytoplankton photosynthetic process stoichiometrically assimilated DSi and [Formula: see text], resulted in 3.46 × 104 t·Si a-1 and 1.89 × 104 t·C a-1 sequestering in the cascade reservoirs, respectively. Compared with the situation of dam-free in the lower reaches of Yalongjiang River, the export flux of [Formula: see text] and DSi at the mouth of Yalongjiang River was reduced by 11.87% and 62.50%, respectively; the ratio of DSi:[Formula: see text] decreased by 36.01% for only building the Ertan dam and 53.15% for the cascade damming, respectively. The water renewal time prolonged from 45 to 126.6 days due to the regulation of the cascade reservoirs in the mainstream. Ultimately, a conceptual model on migration-transformation of DIC and DSi within the cascade reservoirs in the lower reaches of Yalongjiang River was established. These findings demonstrated that riverine cascade damming could extend the biogeochemical coupling cycle of DIC and DSi within the inland aquatic ecosystems and ensure the ecological environment security in the hot-dry valley.


A Challenging Colectomy for Acute Severe Ulcerative Colitis Complicated by COVID-19


title: Coronaviruses and people with intellectual disability: an exploratory data analysis

text: BACKGROUND: Corona virus disease 2019 (COVID-19) has been announced as a new coronavirus disease by the World Health Organization. At the time of writing this article (April 2020), the world is drastically influenced by the COVID-19. Recently, the COVID-19 Open Research Dataset (CORD-19) was published. For researchers on ID such as ourselves, it is of key interest to learn whether this open research dataset may be used to investigate the virus and its consequences for people with an ID. METHODS: From CORD-19, we identified full-text articles containing terms related to the ID care and applied a text mining technique, specifically the term frequency-inverse document frequency analysis in combination with K-means clustering. RESULTS: Two hundred fifty-nine articles contained one or more of our specified terms related to ID. We were able to cluster these articles related to ID into five clusters on different topics, namely: mental health, viral diseases, diagnoses and treatments, maternal care and paediatrics, and genetics. CONCLUSION: The CORD-19 open research dataset consists of valuable information about not only COVID-19 disease but also ID and the relationship between them. We suggest researchers investigate literature-based discovery approaches on the CORD-19 and develop a new dataset that addresses the intersection of these two fields for further research.


title: 2019-novel Coronavirus severe adult respiratory distress syndrome in two cases in Italy: An uncommon radiological presentation

text: INTRODUCTION: Several recent case reports have described common early chest imaging findings of lung pathology caused by 2019 novel Coronavirus (SARS-COV2) which appear to be similar to those seen previously in SARS-CoV and MERS-CoV infected patients. OBJECTIVE: We present some remarkable imaging findings of the first two patients identified in Italy with COVID-19 infection travelling from Wuhan, China. The follow-up with chest X-Rays and CT scans was also included, showing a progressive adult respiratory distress syndrome (ARDS). RESULTS: Moderate to severe progression of the lung infiltrates, with increasing percentage of high-density infiltrates sustained by a bilateral and multi-segmental extension of lung opacities, were seen. During the follow-up, apart from pleural effusions, a tubular and enlarged appearance of pulmonary vessels with a sudden caliber reduction was seen, mainly found in the dichotomic tracts, where the center of a new insurgent pulmonary lesion was seen. It could be an early alert radiological sign to predict initial lung deterioration. Another uncommon element was the presence of mediastinal lymphadenopathy with short-axis oval nodes. CONCLUSIONS: Although only two patients have been studied, these findings are consistent with the radiological pattern described in literature. Finally, the pulmonary vessels enlargement in areas where new lung infiltrates develop in the follow-up CT scan, could describe an early predictor radiological sign of lung impairment.


title: Down Syndrome and COVID-19: A Perfect Storm?

text: People with Down syndrome show signs of chronic immune dysregulation, including a higher prevalence of autoimmune disorders, increased rates of hospitalization during respiratory viral infections, and higher mortality rates from pneumonia and sepsis. At the molecular and cellular levels, they show markers of chronic autoinflammation, including interferon hyperactivity, elevated levels of many inflammatory cytokines and chemokines, and changes in diverse immune cell types reminiscent of inflammatory conditions observed in the general population. However, the impact of this immune dysregulation in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and CoV disease of 2019 (COVID-19) remains unknown. This Perspective outlines why individuals with Down syndrome should be considered an at-risk population for severe COVID-19. Specifically, the immune dysregulation caused by trisomy 21 may result in an exacerbated cytokine release syndrome relative to that observed in the euploid population, thus justifying additional monitoring and specialized care for this vulnerable population.


title: Improving on legacy conferences by moving online

text: Scientific conferences and meetings have an important role in research, but they also suffer from a number of disadvantages: in particular, they can have a massive carbon footprint, they are time-consuming, and the high costs involved in attending can exclude many potential participants. The COVID-19 pandemic has led to the cancellation of many conferences, forcing the scientific community to explore online alternatives. Here, we report on our experiences of organizing an online neuroscience conference, neuromatch, that attracted some 3000 participants and featured two days of talks, debates, panel discussions, and one-on-one meetings facilitated by a matching algorithm. By offering most of the benefits of traditional conferences, several clear advantages, and with fewer of the downsides, we feel that online conferences have the potential to replace many legacy conferences.


title: Baricitinib, a drug with potential effect to prevent SARS-COV-2 from entering target cells and control cytokine storm induced by COVID-19

text: In December 2019, a novel coronavirus pneumonia (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suddenly broke out in China and rapidly spread all over the world. Recently, a cell surface protein, known as angiotensin-converting enzyme II (ACE2), has been identified to be involved in receptor-mediated endocytosis for SARS-CoV-2 entry to the cells. Many studies have reported the clinical characteristics of COVID-19: sudden deterioration of disease around 1-2 weeks after onset; much lower level of lymphocytes, especially natural killer (NK) cells in peripheral blood; extremely high pro-inflammatory cytokines and C reactive protein (CRP). About 15.7% of patients develop severe pneumonia, and cytokine storm is an important factor leading to rapid disease progression. Currently, there are no specific drugs for COVID-19 and the cytokine storm it causes. Baricitinib intracellularly inhibits the proinflammatory signal of several cytokines by suppressing Janus kinase (JAK) JAK1/JAK2. It has been demonstrated clinical benefits for the patients with rheumatoid arthritis (RA), active systemic lupus erythematosus and atopic dermatitis with good efficacy and safety records. Baricitinib is expected to interrupt the passage and intracellular assembly of SARS-CoV-2 into the target cells mediated by ACE2 receptor, and treat cytokine storm caused by COVID-19. Several clinical trials are currently investigating the drug, and one of which has been completed with encouraging results. In this paper, we will elaborate the role of cytokine storm mediated by JAK-STAT pathway in severe COVID-19, the possible mechanisms of baricitinib on reducing the viral entry into the target cells and cytokine storm, the key points of pharmaceutical care based on the latest research reports, clinical trials progress and drug instruction from the US FDA, so as to provide reference for the treatment of severe COVID-19.


docid: mcvthwcf

title: Collapsing glomerulopathy in a COVID-19 patient


title: Cytokine Release Syndrome (CRS) and Nicotine in COVID-19 Patients: Trying to Calm the Storm

text: SARS-CoV-2 is a new coronavirus that has caused a worldwide pandemic. It causes severe acute respiratory syndrome (COVID-19), which is fatal in many cases, and is characterized by a cytokine release syndrome (CRS). Great efforts are currently being made to block the signal transduction pathway of pro-inflammatory cytokines in order to control this "cytokine storm" and rescue severely affected patients. Consequently, possible treatments for cytokine-mediated hyperinflammation, preferably within approved safe therapies, are urgently being researched to reduce rising mortality. One approach to inhibit proinflammatory cytokine release is to activate the cholinergic anti-inflammatory pathway through nicotinic acetylcholine receptors (α7nAchR). Nicotine, an exogenous α7nAchR agonist, is clinically used in ulcerative colitis to counteract inflammation. We have found epidemiological evidence, based on recent clinical SARS-CoV-2 studies in China, that suggest that smokers are statistically less likely to be hospitalized. In conclusion, our hypothesis proposes that nicotine could constitute a novel potential CRS therapy in severe SARS-CoV-2 patients.


Retrospective search of SARS-CoV-2 in respiratory samples in Vallès Occidental (Barcelona, Spain) before the first case was reported


title: How to Fight an Infodemic: The Four Pillars of Infodemic Management

text: In this issue of the Journal of Medical Internet Research, the World Health Organization (WHO) is presenting a framework for managing the coronavirus disease (COVID-19) infodemic. Infodemiology is now acknowledged by public health organizations and the WHO as an important emerging scientific field and critical area of practice during a pandemic. From the perspective of being the first "infodemiologist" who originally coined the term almost two decades ago, I am positing four pillars of infodemic management: (1) information monitoring (infoveillance); (2) building eHealth Literacy and science literacy capacity; (3) encouraging knowledge refinement and quality improvement processes such as fact checking and peer-review; and (4) accurate and timely knowledge translation, minimizing distorting factors such as political or commercial influences. In the current COVID-19 pandemic, the United Nations has advocated that facts and science should be promoted and that these constitute the antidote to the current infodemic. This is in stark contrast to the realities of infodemic mismanagement and misguided upstream filtering, where social media platforms such as Twitter have advertising policies that sideline science organizations and science publishers, treating peer-reviewed science as "inappropriate content."


text: In this issue of the Journal of Medical Internet Research, the World Health Organization (WHO) is presenting a framework for managing the coronavirus disease (COVID-19) infodemic. Infodemiology is now acknowledged by public health organizations and the WHO as an important emerging scientific field and critical area of practice during a pandemic. From the perspective of being the first "infodemiolgist" who originally coined the term almost two decades ago, I am positing four pillars of infodemic management: (1) information monitoring (infoveillance); (2) building eHealth Literacy and science literacy capacity; (3) encouraging knowledge refinement and quality improvement processes such as fact checking and peer-review; and (4) accurate and timely knowledge translation, minimizing distorting factors such as political or commercial influences. In the current COVID-19 pandemic, the United Nations has advocated that facts and science should be promoted and that these constitute the antidote to the current infodemic. This is in stark contrast to the realities of infodemic mismanagement and misguided upstream filtering, where social media platforms such as Twitter have advertising policies that sideline science organizations and science publishers, treating peer-reviewed science as "inappropriate content."


title: Urology practice during the COVID-19 pandemic

text: The severe acute respiratory syndrome coronavirus 2 and the disease it causes, coronavirus disease 2019 (COVID-19) is generating a rapid and tragic health emergency in Italy due to the need to provide assistance to an overwhelming number of infected patients and, at the same time, treat all the non-deferrable oncological and benign conditions. A panel of Italian urologists has agreed on possible strategies for the reorganization of urological routine practice and on a set of recommendations that should facilitate the process of rescheduling both surgical and outpatient activities during the COVID-19 pandemic and in the subsequent phases. This document could be a valid tool to be used in routine clinical practice and, possibly, a cornerstone for further discussion on the topic also considering the further evolution of the COVID-19 pandemic. It also may provide useful recommendations for national and international urological societies in a condition of emergency.


Time to pause, to think, and to recalibrate after COVID-19


docid: gzrhnwoe

title: Should we use angiotensin II infusion in COVID-19-associated vasoplegic shock?


title: Persistent detection of SARS-CoV-2 RNA in patients and healthcare workers with COVID-19

text: BACKGROUND: Current guidelines for returning health care workers (HCW) to service after a positive SARS-CoV-2 RT-PCR test and ceasing of transmission precautions for patients is based on two general strategies. A test-based strategy that requires negative respiratory RT-PCR tests obtained after the resolution of symptoms. Alternatively, due to the limited availability of testing, many sites employ a symptom-based strategy that recommends excluding HCW from the workforce and keeping patients on contact precautions until a fixed period of time has elapsed from symptom recovery. The underlying assumption of the symptom-based strategy is that waiting for a fixed period of time is a surrogate for negative RT-PCR testing, which itself is a surrogate for the absence of shedding infectious virus. OBJECTIVES: To better understand the appropriate length of symptom based return to work and contact precaution strategies. STUDY DESIGN: We performed an observational analysis of 150 patients and HCW that transitioned from RT-PCR SARS-CoV-2 positive to negative over the course of 2 months at a US academic medical center. RESULTS: We found that the average time to transition from RT-PCR positive to negative was 24 days after symptom onset and 10 % remained positive even 33 days after symptom onset. No difference was seen in HCW and patients. CONCLUSIONS: These findings suggest until definitive evidence of the length of infective viral shedding is obtained that the fixed length of time before returning to work or ceasing contract precautions be revised to over one-month.


title: Hybrid Deep Learning for Detecting Lung Diseases from X-ray Images

text: Lung disease is common throughout the world. These include chronic obstructive pulmonary disease, pneumonia, asthma, tuberculosis, fibrosis, etc. Timely diagnosis of lung disease is essential. Many image processing and machine learning models have been developed for this purpose. Different forms of existing deep learning techniques including convolutional neural network (CNN), vanilla neural network, visual geometry group based neural network (VGG), and capsule network are applied for lung disease prediction.The basic CNN has poor performance for rotated, tilted, or other abnormal image orientation. Therefore, we propose a new hybrid deep learning framework by combining VGG, data augmentation and spatial transformer network (STN) with CNN. This new hybrid method is termed here as VGG Data STN with CNN (VDSNet). As implementation tools, Jupyter Notebook, Tensorflow, and Keras are used. The new model is applied to NIH chest X-ray image dataset collected from Kaggle repository. Full and sample versions of the dataset are considered. For both full and sample datasets, VDSNet outperforms existing methods in terms of a number of metrics including precision, recall, F0.5 score and validation accuracy. For the case of full dataset, VDSNet exhibits a validation accuracy of 73%, while vanilla gray, vanilla RGB, hybrid CNN and VGG, and modified capsule network have accuracy values of 67.8%, 69%, 69.5%, 60.5% and 63.8%, respectively. When sample dataset rather than full dataset is used, VDSNet requires much lower training time at the expense of a slightly lower validation accuracy. Hence, the proposed VDSNet framework will simplify the detection of lung disease for experts as well as for doctors.


title: Critical Care Surge Capacity to Respond to the COVID-19 Pandemic in Italy: A Rapid and Affordable Solution in the Novara Hospital

text: The rapid insurgence and spread of coronavirus disease 2019 (COVID-19) exceeded the limit of the intensive care unit (ICU) contingency plan of the Maggiore della Carità University Hospital (Novara, Italy) generating a crisis management condition. This brief report describes how a prompt response to the sudden request of invasive mechanical ventilation (IMV) was provided by addressing the key elements of health care system surge capacity from contingency to crisis. In a short time and at a relatively low cost, a structural modification of a hospital aisle allowed to convert the general ICU into a COVID-19 unit, increasing the number of COVID-19 critical care beds by 107%.


title: Use of RAAS inhibitors and risk of clinical deterioration in COVID-19: results from an Italian cohort of 133 hypertensives

text: BACKGROUND: The effect of chronic use of renin-angiotensin-aldosterone system (RAAS) inhibitors on the severity of COVID-19 infection is still unclear in patients with hypertension. We aimed to investigate the association between chronic use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and COVID-19 related outcomes in hypertensive patients. METHODS: A single center study was conducted on 133 consecutive hypertensive subjects presenting to the Emergency Department with acute respiratory symptoms and/or fever who were diagnosed with COVID-19 infection between 9th and 31st March 2020. RESULTS: All patients were grouped according to their chronic antihypertensive medications (ACEIs, N=40; ARBs, N=42; not on RAAS inhibitors, N=51). There was no statistical difference between ACEIs and ARBs groups in terms of hospital admission rate, oxygen therapy and need for non-invasive ventilation. Patients chronically treated with RAAS inhibitors showed a significantly lower rate of admission to semi-intensive/intensive care units, when compared to the non-RAAS population (odds ratio [OR] 0.25, CI95% 0.09-0.66 p=0.006). Similarly, the risk of mortality was lower in the former group, although not reaching statistical significance (OR 0.56, CI95% 0.17-1.83, p=0.341). CONCLUSIONS: Our data suggest that chronic use of RAAS inhibitors does not negatively affect clinical course of COVID-19 in hypertensive patients. Further studies are needed to confirm this finding and determine whether RAAS inhibitors may have a protective effect on COVID 19-related morbidity and mortality.


title: Letalidad del COVID-19: ausencia de patrón epidemiológico./ [Case fatality rate of COVID-19: absence of epidemiological pattern]

text: OBJECTIVE: Analyze a set of indicators to understand the variability of the evolution and impact of the COVID-19 epidemic in a set of selected countries. METHOD: Ecological study of a group of countries with more than 200 reported cases. Demographic variables, health expenditure variables, and variables about characteristics of health services were included as explanatory variables. and incidence, mortality and fatality rates have been analyzed as response variables. In addition, a relative fatality index has been created. Data are from international organizations. Spearman's correlation coefficient was used to estimate the magnitude of the associations. RESULTS: Number of tests and of medical professionals are associated with a higher incidence rate. Mortality and case fatality rate are not associated with demographic, health expenditure, or health services variables. CONCLUSION: Differences suggest a general underestimation of the magnitude of the epidemic. Improvement of case identification and effectiveness of epidemiological surveillance systems is necessary.


Psychosocial needs and responses for breast cancer patients during Covid-19 pandemic in a hospital of southern europe


Neutralizing antibody response in mild COVID-19


Virtual special issue - Using touchscreen tablets for virtual connection


title: The statistical physics of discovering exogenous and endogenous factors in a chain of events

text: Event occurrence is not only subject to the environmental changes, but is also facilitated by the events that have occurred in a system. Here, we develop a method for estimating such extrinsic and intrinsic factors from a single series of event-occurrence times. The analysis is performed using a model that combines the inhomogeneous Poisson process and the Hawkes process, which represent exogenous fluctuations and endogenous chain-reaction mechanisms, respectively. The model is fit to a given dataset by minimizing the free energy, for which statistical physics and a path-integral method are utilized. Because the process of event occurrence is stochastic, parameter estimation is inevitably accompanied by errors, and it can ultimately occur that exogenous and endogenous factors cannot be captured even with the best estimator. We obtained four regimes categorized according to whether respective factors are detected. By applying the analytical method to real time series of debate in a social-networking service, we have observed that the estimated exogenous and endogenous factors are close to the first comments and the follow-up comments, respectively. This method is general and applicable to a variety of data, and we have provided an application program, by which anyone can analyze any series of event times.


title: The incidence of the novel coronavirus SARS-CoV-2 among asymptomatic patients: a systematic review

text: BACKGROUND: the recent outbreak of the coronavirus disease 2019 (COVID-19) has quickly spread globally since its discovery in Wuhan, China, in December 2019. A comprehensive strategy, including surveillance, diagnostics, research, and clinical treatment is urgently needed to win the battle against COVID-19. Recently, numerous studies reported the incidence of SARS-CoV-2 in asymptomatic patients. Yet, the incidence and viral transmission from the asymptomatic cases are not apparent yet. AIM: this study aims to systematically review the published literature on SARS-CoV-2 in the asymptomatic patients to estimate the incidence of COVID-19 among asymptomatic cases, as well as describe its epidemiological and clinical significance. METHOD: the literature was searched through four scientific databases: PubMed, Web of Science, Scopus, and Science Direct. RESULTS: a total of 63 studies satisfied the inclusion criteria where the majority of the reported studies were from China. However, there was a lack of SARS-CoV-2 epidemiological studies from several countries worldwide, tracing the actual incidence of COVID-19, especially in asymptomatic patients. Studies with a large sample size (n>1000) estimated that percentage of people contracting SARS-CoV-2 and are likely to be asymptomatic ranges from 1.2-12.9%. However, the other studies with a smaller sample size reported a much higher incidence and indicated that up to 87.9% of COVID-19 infected individuals could be asymptomatic. Most of these studies indicated that asymptopatics are a potential source of infection to the community. CONCLUSION: this review highlighted the need for more robust and well-designed studies to better estimate COVID-19 incidence among asymptomatic patients worldwide. The early identification of the asymptomatic cases, as well as monitoring and tracing close contact, could help in mitigating the spread of COVID-19.


title: Crackovid: Optimizing Group Testing

text: We study the problem usually referred to as group testing in the context of COVID-19. Given $n$ samples taken from patients, how should we select mixtures of samples to be tested, so as to maximize information and minimize the number of tests? We consider both adaptive and non-adaptive strategies, and take a Bayesian approach with a prior both for infection of patients and test errors. We start by proposing a mathematically principled objective, grounded in information theory. We then optimize non-adaptive optimization strategies using genetic algorithms, and leverage the mathematical framework of adaptive sub-modularity to obtain theoretical guarantees for the greedy-adaptive method.


title: Traditional Chinese Medicine: an effective treatment for 2019 novel coronavirus pneumonia (NCP)

text: The novel coronavirus pneumonia broke out in 2019 and spread rapidly. In 30 different countries, there are over seventy thousand patients have been diagnosed in total. Therefore, it is urgent to develop the effective program to prevent and treat for the novel coronavirus pneumonia. In view of Traditional Chinese Medicine has accumulated a solid theoretical foundation of plague in ancient and recent decades. Meanwhile, Traditional Chinese Medicine can provide the more effective and personalized treatment via adjusting the specific medicine for each patient based on the different syndromes. In addition, TCM often has different effect on the distinct stages of diseases, contributing to the prevention, treatment and rehabilitation. Nowadays, TCM has exhibited decent effect in the in the fight against NCP. Therefore, it is convinced that Traditional Chinese Medicine is an effective treatment for 2019 novel coronavirus pneumonia.


Children's emergency presentations during the COVID-19 pandemic


title: Excess Mortality Estimation During the COVID-19 Pandemic: Preliminary Data from Portugal

text: INTRODUCTION: Portugal is experiencing the effects of the COVID-19 pandemic since March 2020. All-causes mortality in Portugal increased during March and April 2020 compared to previous years, but this increase is not explained by COVID-19 reported deaths. The aim of this study was to analyze and consider other criteria for estimating excessive all-cause mortality during the early COVID-19 pandemic period. MATERIAL AND METHODS: Public data was used to estimate excess mortality by age and region between March 1 and April 22, proposing baselines adjusted for the lockdown period. RESULTS: An excess mortality of 2400 to 4000 deaths was observed. Excess mortality was associated with older age groups (over age 65) [corrected]. DISCUSSION: The data suggests a ternary explanation for early excess mortality: COVID-19, non-identified COVID-19 and decrease in access to healthcare. The estimates have implications in terms of communication of non-pharmaceutical actions, for research, and to healthcare professionals. CONCLUSION: Despite the inherent uncertainty, the excess mortality occurred between March 1 and April 22 could be 3.5- to 5-fold higher than what can be explained by the official COVID-19 deaths [corrected].


Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19


title: Decontamination of surgical face masks and N95 respirators by dry heat pasteurization for one hour at 70°C

text: BACKGROUND: The need for protective masks greatly exceeds their global supply during the current COVID-19 pandemic. METHODS: We optimized the temperature used in the dry heat pasteurization method to destroy pathogens and decontaminate masks while retaining their filtering capacity. RESULTS: The current study showed that dry heat at both 60°C and 70°C for 1 hour could successfully kill 6 species of respiratory bacteria and one fungi species, and inactivate the H1N1 indicator virus. After being heated at 70°C for 1, 2, and 3 hours, the N95 respirators and surgical face masks showed no changes in their shape and components. The filtering efficiency of bacterial aerosol for N95 respirators were 98%, 98%, and 97% after being heated for 1, 2, and 3 hour, respectively, all of which were over the 95% efficiency required and similar to the value before being heated (99%). The filtering efficiency for surgical face masks was 97%, 97%, and 96% for 1, 2, and 3 hours of heating, respectively, all of which were also similar to the value before being heated (97%). CONCLUSIONS: This method can be used at home and can significantly resolve the current shortage of masks.


title: Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019

text: AIMS: To investigate the characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019 (COVID-19). METHODS AND RESULTS: We enrolled 671 eligible hospitalized patients with severe COVID-19 from 1 January to 23 February 2020, with a median age of 63 years. Clinical, laboratory, and treatment data were collected and compared between patients who died and survivors. Risk factors of death and myocardial injury were analysed using multivariable regression models. A total of 62 patients (9.2%) died, who more often had myocardial injury (75.8% vs. 9.7%; P < 0.001) than survivors. The area under the receiver operating characteristic curve of initial cardiac troponin I (cTnI) for predicting in-hospital mortality was 0.92 [95% confidence interval (CI), 0.87-0.96; sensitivity, 0.86; specificity, 0.86; P < 0.001]. The single cut-off point and high level of cTnI predicted risk of in-hospital death, hazard ratio (HR) was 4.56 (95% CI, 1.28-16.28; P = 0.019) and 1.25 (95% CI, 1.07-1.46; P = 0.004), respectively. In multivariable logistic regression, senior age, comorbidities (e.g. hypertension, coronary heart disease, chronic renal failure, and chronic obstructive pulmonary disease), and high level of C-reactive protein were predictors of myocardial injury. CONCLUSION: The risk of in-hospital death among patients with severe COVID-19 can be predicted by markers of myocardial injury, and was significantly associated with senior age, inflammatory response, and cardiovascular comorbidities.


title: Fabrication of All-Cellulose Nanocomposites from Corn Stalk

text: BACKGROUND: In order to help farmers and industries develop value-added composite and nano materials from agricultural residuals. Cellulose nanofibers (CNFs) were made by using a TEMPO oxidation method and celluloses were prepared by acid-base method and extracting method, which were all from corn stalk, an agricultural residual. The prepared celluloses were dissolved separately in DMAc/LiCl solvent and added CNFs of 0.0, 0.5, 1.5 and 3.0% to form all-cellulose nanocomposite, and then casted into films. Morphology, structure and properties of the nanocomposite films were characterized by atomic force microscopy (AFM), field emission scanning electron microscope (FE-SEM), thermogravimetry analysis (TGA), X-ray diffraction (XRD), and mechanical testing. RESULTS: The all-cellulose nanocomposite films with different cellulose cellulose matrix exhibited a good optical transparency and layer structure. The all-cellulose nanocomposites films with the cellulose prepared by the extracting method (Composite E) exhibited a higher crystallinity, better thermal stability and higher mechanical strength than those of the all-cellulose nanocomposites films with the cellulose prepared by the acid-base method (Composite A). CONCLUSION: Crystal structure of the all-cellulose nanocomposite films all presented a co-existence of Cellulose I and Cellulose II. However, on the contrary to Composite A, the diffraction intensity of Cellulose I in Composite E was higher than that of Cellulose II. This was another reason that the mechanical properties of Composite E were superior to Composite A. In addition, the mechanical properties of the all-cellulose nanocomposites films were significantly different when the addition of CNF reached 3.0% in weight, as indicated by a multiple-range comparison. This article is protected by copyright. All rights reserved.


title: Procalcitonin levels in COVID-19 patients

text: Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared a pandemic. This study analysed 95 SARS-CoV-2-infected patients, including 62 moderate COVID-19 patients, 21 severe COVID-19 patients and 12 critical COVID-19 patients (6 patients died, all critical). The results showed that the mean serum procalcitonin (PCT) levels were over four times higher in severe patients than in moderate patients and were over eight times higher in critical patients than in moderate patients. For discharged patients, both high-normal PCT levels and abnormal PCT levels decreased during recovery. However, in death cases, serum levels of PCT increased as the disease worsened. We demonstrate that PCT may be an indicator of disease severity in COVID-19 and may contribute to determining the severity of patients infected with SARS-CoV-2. Moreover, serial PCT measurements may be useful in predicting the prognosis.


Lung tissue distribution of drugs as a key factor for COVID-19 treatment


title: Takotsubo Syndrome in the Setting of COVID-19 Infection

text: A 58 year old woman was admitted with symptoms of COVID-19. She subsequently developed mixed shock and echocardiogram showed mid-distal left ventricular hypokinesis and apical ballooning, findings typical for stress, or Takotsubo, cardiomyopathy. Over the next few days her left ventricular function improved, further supporting reversibility of acute stress cardiomyopathy.


Acute normovolemic hemodilution for major cancer surgeries during the COVID-19 pandemic: A beacon of hope


title: COVID-19 and ethnicity: A novel pathophysiological role for inflammation

text: INTRODUCTION: There have been recent mounting concerns regarding multiple reports stating a significantly elevated relative-risk of COVID-19 mortality amongst the Black and Minority Ethnic (BAME) population. An urgent national enquiry investigating the possible reasons for this phenomenon has been issued in the UK. Inflammation is at the forefront of COVID-19 research as disease severity appears to correlate with pro-inflammatory cytokine dysregulation. This narrative review aims to shed light on the novel, pathophysiological role of inflammation in contributing towards the increased COVID-19 mortality risk amongst the BAME population. METHODS: Searches in PubMed, Medline, Scopus, medRxiv and Google Scholar were performed to identify articles published in English from inception to 18th June 2020. These databases were searched using keywords including: 'COVID-19' or 'Black and Minority Ethnic' or 'Inflammation'. A narrative review was synthesized using these included articles. RESULTS: We suggest a novel pathophysiological mechanism by which acute inflammation from COVID-19 may augment existing chronic inflammation, in order to potentiate a 'cytokine storm' and thus the more severe disease phenotype observed in the BAME population. Obesity, insulin resistance, cardiovascular disease, psychological stress, chronic infections and genetic predispositions are all relevant factors which may be contributing to elevated chronic systemic inflammation amongst the BAME population. CONCLUSION: Overall, this review provides early insights and directions for ongoing research regarding the pathophysiological mechanisms that may explain the severe COVID-19 disease phenotype observed amongst the BAME population. We suggest 'personalization' of chronic disease management, which can be used with other interventions, in order to tackle this.


docid: jdizyzbl

title: Visual explanation of country specific differences in Covid-19 dynamics

text: This report provides a visual examination of Covid-19 case and death data. In particular, it shows that country specific differences can too a large extend be explained by two easily interpreted parameters. Namely, the delay between reported cases and deaths and the fraction of cases observed. Furthermore, this allows to lower bound the actual total number of people already infected.


docid: aeufkvxw

title: Incomplete Kawasaki Disease in a Child with Covid-19


Covid-19 et quelques problématiques éthiques en France./ [Covid-19 and some ethical issues in France]


title: N95 Reprocessing by Low Temperature Sterilization with 59% Vaporized Hydrogen Peroxide during the 2020 COVID-19 Pandemic

text: BACKGROUND: Response to the COVID-19 pandemic by hospital systems has been strained by severe shortages in personal protective equipment (PPE), particularly N95 respirators. Recently, the Centers for Disease Control and Prevention endorsed decontamination strategies to prolong the lifespan of single use respirators. Battelle and Duke University have validated hospital protocols to decontaminate respirators using vaporized hydrogen peroxide (VHP) at 30%-35% concentrations. To prolong our supply of respirators, we evaluated and implemented VHP decontamination at 59% hydrogen peroxide concentration while detailing the effects of this process on the filtration efficiency and quantitative fit of single-use respirators. This study may help other health systems develop local solutions to their N95 mask shortage during this COVID-19 pandemic. METHODS: N95 respirators (3M 8211 FF and 9210 FF) that were treated with 5 and 10 cycles of VHP by the V-PRO® maX Low Temperature Sterilization System were evaluated quantitatively for filtration efficiency as well as with quantitative fit testing per Occupational Safety and Health Administration standards. A decontamination protocol was concurrently implemented at our institution. This process involved depositing used masks, reprocessing, and re-distributing treated masks efficiently back to frontline providers. Furthermore, we implemented patient safety officers (PSO) on COVID-19/person under investigation (PUI) units to ensure optimized donning/doffing of respirators through frontline provider education. RESULTS: There were no statistically significant changes in mean filtration efficiency between the control and VHP-treated respirators. Furthermore, both treated and untreated respirators demonstrated fit factors above the minimum pass requirement. CONCLUSION: We have successfully demonstrated that N95 respirator decontamination with VHP at 59% hydrogen peroxide can be safely utilized to decontaminate single-use N95 respirators without significant effects on filtration efficiency or quantitative fit testing. With the COVID-19 pandemic and N95 respirator shortage, health systems without access to commercial decontamination processes should investigate the viability of such a process in their facilities.


Guidelines for control and prevention of COVID-19 in surgical and anesthetic settings


Cardiovascular disease, heart failure and COVID-19


title: Dental Public Health Landscape: Challenges, Technological Innovation and Opportunities in the 21st Century and COVID-19 Pandemic

text: In response to the 2008 economic and financial crisis and to its effects on healthcare systems, dental care has become unaffordable for many people, and a huge number of patients worldwide are avoiding or skipping necessary dental treatments [...].


COVID-19 Associated Pediatric Multi-System Inflammatory Syndrome


title: Health systems preparedness during COVID-19 pandemic: China and India

text: This commentary reviews the health systems preparedness during the COVID-19 epidemic in China and India. It provides insight into how nonmedical measures were employed to contain and control the epidemic in Wuhan which was the epicenter. The methods employed by the Chinese provided the roadmap for the countries as the epidemic became pandemic. It provides contrasts in health system preparedness between China and India.


Potential repurposing of Favipiravir in COVID-19 outbreak based on current evidence


title: Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019-a multi-centre observational study

text: OBJECTIVES: Since December 2019, the novel coronavirus disease 2019 (COVID-19) that emerged in Wuhan city has spread rapidly around the world. The risk for poor outcome dramatically increases once a patient progresses to the severe or critical stage. The present study aims to investigate the risk factors for disease progression in individuals with mild to moderate COVID-19. METHODS: We conducted a cohort study that included 1007 individuals with mild to moderate COVID-19 from three hospitals in Wuhan. Clinical characteristics and baseline laboratory findings were collected. Patients were followed up for 28 days for observation of disease progression. The end point was the progression to a more severe disease stage. RESULTS: During a follow up of 28 days, 720 patients (71.50%) had recovered or were symptomatically stable, 222 patients (22.05%) had progressed to severe disease, 22 patients (2.18%) had progressed to the critically ill stage and 43 patients (4.27%) had died. Multivariate Cox proportional hazards models identified that increased age (hazard ratio (HR) 2.56, 95% CI 1.97-3.33), male sex (HR 1.79, 95% CI 1.41-2.28), presence of hypertension (HR 1.44, 95% CI 1.11-1.88), diabetes (HR 1.82, 95% CI 1.35-2.44), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.38-2.93) and coronary artery disease (HR 1.83, 95% CI 1.26-2.66) were risk factors for disease progression. History of smoking was protective against disease progression (HR 0.56, 95% CI 0.34-0.91). Elevated procalcitonin (HR 1.72, 95% CI 1.02-2.90), urea nitrogen (HR 1.72, 95% CI 1.21-2.43), α-hydroxybutyrate dehydrogenase (HR 3.02, 95% CI 1.26-7.21) and D-dimer (HR 2.01, 95% CI 1.12-3.58) at baseline were also associated with risk for disease progression. CONCLUSIONS: This study identified a panel of risk factors for disease progression in individuals with mild to moderate COVID-19.


Care of haematology patients in a COVID-19 epidemic


docid: mppivvio

title: 18F-FDG PET/CT in Hodgkin Lymphoma With Unsuspected COVID-19

text: We present an asymptomatic 70-year-old man referred for an F-FDG PET/CT for initial staging of a Hodgkin lymphoma. F-FDG PET/CT showed bilateral cervical lymphadenopathy (stage II). Incidentally, the CT demonstrated bilateral ground-glass opacities with low-grade F-FDG activity. CT findings were suspicious for COVID-19 pneumonitis. The COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) examination result was negative. Given the high clinical suspicion for COVID-19, the patient was isolated and repeat RT-PCR was positive at 72 hours. RT-PCR may be falsely negative in early COVID-19 disease, even with positive CT findings.


Annals Graphic Medicine - COVID Blues


title: Predictors for imaging progression on chest CT from coronavirus disease 2019 (COVID-19) patients

text: OBJECTIVE: This study aimed to investigate the potential parameters associated with imaging progression on chest CT from coronavirus disease 19 (COVID-19) patients. RESULTS: The average age of 273 COVID-19 patients enrolled with imaging progression were older than those without imaging progression (p = 0.006). The white blood cells, platelets, neutrophils and acid glycoprotein were all decreased in imaging progression patients (all p < 0.05), and monocytes were increased (p = 0.025). The parameters including homocysteine, urea, creatinine and serum cystatin C were significantly higher in imaging progression patients (all p < 0.05), while eGFR decreased (p < 0.001). Monocyte-lymphocyte ratio (MLR) was significantly higher in imaging progression patients compared to that in imaging progression-free ones (p < 0.001). Logistic models revealed that age, MLR, homocysteine and period from onset to admission were factors for predicting imaging progression on chest CT at first week from COVID-19 patients (all p < 0.05). CONCLUSION: Age, MLR, homocysteine and period from onset to admission could predict imaging progression on chest CT from COVID-19 patients. METHODS: The primary outcome was imaging progression on chest CT. Baseline parameters were collected at the first day of admission. Imaging manifestations on chest CT were followed-up at (6±1) days.


title: Supporting Infant Emotion Regulation Through Attachment-Based Intervention: a Randomized Controlled Trial

text: Infant emotion regulation has long-term implications for human development, highlighting the need for preventive interventions that support emotion regulation early in life. Such interventions may be especially important for infants higher in emotional reactivity who need to regulate their emotions more frequently and intensely than infants lower in emotional reactivity. The current randomized trial examined main and moderated effects of an attachment-based intervention on (a) infants' use of mother-oriented and self-soothing emotion regulation strategies and (b) infant emotion dysregulation in 186 low-income, predominantly Latino infants. We tested the brief (10-session) Attachment and Biobehavioral Catch-up (ABC) intervention in the context of home-based federal Early Head Start (EHS) services. Control participants received home-based EHS plus 10 weekly books. Intent-to-treat analyses with covariates revealed main effects of the intervention on infants' use of mother-oriented emotion regulation strategies during a brief (40-s) novel and potentially fear-inducing procedure (d = 0.31). Infant emotional reactivity moderated intervention impacts on mother-oriented emotion regulation strategies and on infant emotion dysregulation: We found stronger effects of the intervention for infants relatively higher in emotional reactivity. Findings are discussed in terms of the preventive value of attachment-based interventions for supporting early emotion regulation.


title: Managing Crowded Museums: Visitors Flow Measurement, Analysis, Modeling, and Optimization

text: We present an all-around study of the visitors flow in crowded museums: a combination of Lagrangian field measurements and statistical analyses enable us to create stochastic digital-twins of the guests dynamics, unlocking comfort- and safety-driven optimizations. Our case study is the Galleria Borghese museum in Rome (Italy), in which we performed a real-life data acquisition campaign. We specifically employ a Lagrangian IoT-based visitor tracking system based on Raspberry Pi receivers, displaced in fixed positions throughout the museum rooms, and on portable Bluetooth Low Energy beacons handed over to the visitors. Thanks to two algorithms: a sliding window-based statistical analysis and an MLP neural network, we filter the beacons RSSI and accurately reconstruct visitor trajectories at room-scale. Via a clustering analysis, hinged on an original Wasserstein-like trajectory-space metric, we analyze the visitor paths to get behavioral insights, including the most common flow patterns. On these bases, we build the transition matrix describing, in probability, the room-scale visitor flows. Such a matrix is the cornerstone of a stochastic model capable of generating visitor trajectories in silico. We conclude by employing the simulator to increase the number of daily visitors while respecting numerous logistic and safety constraints. This is possible thanks to optimized ticketing and new entrance/exit management.


title: Considering how biological sex impacts immune responses and COVID-19 outcomes

text: A male bias in mortality has emerged in the COVID-19 pandemic, which is consistent with the pathogenesis of other viral infections. Biological sex differences may manifest themselves in susceptibility to infection, early pathogenesis, innate viral control, adaptive immune responses or the balance of inflammation and tissue repair in the resolution of infection. We discuss available sex-disaggregated epidemiological data from the COVID-19 pandemic, introduce sex-differential features of immunity and highlight potential sex differences underlying COVID-19 severity. We propose that sex differences in immunopathogenesis will inform mechanisms of COVID-19, identify points for therapeutic intervention and improve vaccine design and increase vaccine efficacy.


title: COVID-19, Australia: Epidemiology Report 18 (Fortnightly reporting period ending 7 June 2020)

text: Notified cases of COVID-19 and associated deaths reported to the National Notifiable Diseases Surveillance System (NNDSS) to 7 June 2020. Confirmed cases in Australia notified up to 7 June 2020: notifications = 7,277; deaths = 102. Over the past fortnightly reporting period, the number of new cases in all jurisdictions continues to decline, or remain very low, and testing rates continue to be high across all jurisdictions, with the positivity rate remaining very low at less than 0.1%. The incidence of COVID-19 has markedly reduced since a peak in mid-March. A combination of early case identification, physical distancing, public health measures and a reduction in international travel have been effective in slowing the spread of disease in Australia. Of the 147 cases notified between 25 May and 7 June, 63% acquired their infection overseas. The proportion of cases locally acquired has dropped substantially to 28% of new cases this period compared with 50% and greater observed since 30 March 2020. Of the cases considered to be locally-acquired over this period, most were associated with contacts of confirmed cases or were associated with known outbreaks. A small proportion of overall cases have experienced severe disease, requiring hospitalisation or intensive care with some fatalities. The crude case fatality rate amongst Australian cases is 1.4%. People who are older and have one or more comorbidities are more likely to experience severe disease. The highest rate of COVID-19 continues to be among people aged 65-79 years. Three-quarters of all cases in this age group have been associated with overseas travel, including several outbreaks linked to cruise ships. The lowest rate of disease is in children under 18, a pattern reflected in international reports. Internationally, as of 7 June 2020, the largest numbers of both cases and deaths have been reported in the United States. Of the confirmed cases reported globally, the case fatality rate is approximately 5.8%. Countries in South America are seeing rapid growth in case numbers, while the United States is seeing a steady decline in its daily new case numbers. Case numbers in Europe remain relatively steady, with several countries in Eastern Europe experiencing rapid growth. In the South East Asia region, India and Bangladesh are seeing accelerating epidemics, compounded by the recovery from Cyclone Amphan. Reported cases are increasing in Africa, although the numbers are much smaller. In the Pacific there are few new cases reported daily.


Exit strategy to control covid-19 and relaunch the economy


Prevention of thrombosis in pregnant women with suspected SARS-CoV-2 infection: clinical management algorithm


Suggestions to Prepare for the Second Epidemic of COVID-19 in Korea


title: Técnica quirúrgica de la traqueostomía percutánea en el paciente con COVID-19

text: Generalidades Desde diciembre de 2019 se detectó una nueva infección respiratoria, causada por el virus denominado SARS-CoV-2, decretada posteriormente como pandemia, lo cual ha exigido al personal de salud replantear la forma de prestar sus servicios en salud y garantizar la auto-protección con recursos que han sido insuficientes incluso en los países más desarrollados Dado que la transmisión del SARS-CoV-2 ocurre a través de aerosoles expulsados de la vía aérea, que pueden ser inhalados o llevados a las mucosas por contacto con las manos contaminadas, se requiere minimizar la posibilidad de contagio para los equipos de atención en salud Objetivos Brindar herramientas a los cirujanos que les permitan elegir la técnica con menor probabilidad de exposición a aerosoles Describir el paso a paso de la técnica quirúrgica de la traqueostomía percutánea, enfati-zando en el control sobre la generación de aerosoles en pasos críticos Aspectos técnicos La técnica completamente percutánea con kit de traqueostomía permite un mejor sello entre tejidos y dispositivos Los escenarios más frecuentes para realizar una traqueostomía son: el paciente intubado con ventilación mecánica y el paciente con falla en la intubación que requiere una intervención de emergencia Conclusión El alto contagio del COVID-19 al practicar intervenciones en la vía aérea nos obliga a hacer énfasis en las estrategias que reduzcan la formación de aerosoles y permitan la contención de los mismos durante la realización de traqueostomíasBackground: Since December 2019, a new respiratory infection was detected, caused by the virus called SARS-CoV-2, later decreed as a pandemic, which has required health personnel to rethink the way of providing their health services and guarantee the self-protection with resources that have been insufficient even in the most developed countries As the transmission of SARS-CoV-2 occurs through aerosols expelled from the airway, which can be inhaled or brought to the mucosa by contact with contaminated hands, it is necessary to minimize the possibility of contagion for the health care teams Objectives: Provide tools to surgeons that allow them to choose the technique with the least probability of exposure to aerosols Describe the step-by-step of the percutaneous tracheostomy technique, emphasizing control about the generation of aerosols in critical steps Technical aspects: The fully percutaneous technique with a tracheostomy kit allows a better seal between tissues and devices The most frequent scenarios for performing a tracheostomy are an intubated patient with mechanical ventilation and a patient with failure of intubation that requires emergency intervention Conclusion: The high contagion of COVID-19 when practicing airway interventions forces us to emphasize strategies that reduce the formation of aerosols and allow them to be contained during tracheostomies


title: Impact of COVID-19 pandemic on mental health of young people and adults: a systematic review protocol of observational studies

text: INTRODUCTION: Since the WHO declared COVID-19 as a pandemic, the spread of the new coronavirus has been the focus of attention of scientists, governments and populations. One of the main concerns is the impact of this pandemic on health outcomes, mainly on mental health. Even though there are a few empirical studies on COVID-19 and mental health, so far, there is no systematic review about the impact of COVID-19 on mental health of young people and adults yet. We aim to critically synthesise the scientific evidence about the impact of the COVID-19 pandemic on the mental health of young people and adults. METHODS AND ANALYSIS: A systematic review will be performed through eight databases: MEDLINE (Medical Literature Analysis and Retrieval System Online), ISI-of-Knowledge, CENTRAL (Cochrane Central Register of Controlled Trials), EMBASE (Excerpta Medica Database), SCOPUS, LILACS (Latin American and Caribbean Health Sciences Literature), PsycINFO (Psychology Information) and CNKI (Chinese National Knowledge Infrastructure), from inception until 30 June 2020. No restriction regarding the publication date, setting or languages will be considered. Preliminary search strategies were carried out on 29 March 2020 and will be updated in June 2020. The primary outcomes will be the prevalence and the severity of psychological symptoms in young people and adults (>18 years old) resulting from the impact of COVID-19 pandemic. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Pooled standardised mean differences and 95% CIs will be calculated. The risk of bias of the observational studies will be assessed through the Methodological Index for Non-Randomised Studies (MINORS). Additionally, if sufficient data are available, a meta-analysis will be conducted. Heterogeneity between the studies will be determined by the I2 statistics. Subgroup analyses will also be performed. Publication bias will be checked with funnel plots and Egger's test. Heterogeneity will be explored by random-effects analysis. ETHICS AND DISSEMINATION: Ethical assessment was not required. Findings will be disseminated through peer-reviewed publication and will be presented at conferences related to this field. PROSPERO REGISTRATION NUMBER: CRD42020177366.