docid: oifagatl

title: Tagging enhances histochemical and biochemical detection of Ran Binding Protein 9 in vivo and reveals its interaction with Nucleolin

text: The lack of tools to reliably detect RanBP9 in vivo has significantly hampered progress in understanding the biological functions of this scaffold protein. We report here the generation of a novel mouse strain, RanBP9-TT, in which the endogenous protein is fused with a double (V5-HA) epitope tag at the C-terminus. We show that the double tag does not interfere with the essential functions of RanBP9. In contrast to RanBP9 constitutive knock-out animals, RanBP9-TT mice are viable, fertile and do not show any obvious phenotype. The V5-HA tag allows unequivocal detection of RanBP9 both by IHC and WB. Importantly, immunoprecipitation and mass spectrometry analyses reveal that the tagged protein pulls down known interactors of wild type RanBP9. Thanks to the increased detection power, we are also unveiling a previously unknown interaction with Nucleolin, a protein proposed as an ideal target for cancer treatment. In summary, we report the generation of a new mouse line in which RanBP9 expression and interactions can be reliably studied by the use of commercially available αtag antibodies. The use of this line will help to overcome some of the existing limitations in the study of RanBP9 and potentially unveil unknown functions of this protein in vivo such as those linked to Nucleolin.


title: Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review

text: Coronavirus disease 2019 (COVID-19) outbreak, first reported in Wuhan, China, has rapidly swept around the world just within a month, causing global public health emergency. In diagnosis, chest computed tomography (CT) manifestations can supplement parts of limitations of real-time reverse transcription polymerase chain reaction (RT-PCR) assay. Based on a comprehensive literature review and the experience in the frontline, we aim to review the typical and relatively atypical CT manifestations with representative COVID-19 cases at our hospital, and hope to strengthen the recognition of these features with radiologists and help them make a quick and accurate diagnosis.Key Pointsâ¢ Ground glass opacities, consolidation, reticular pattern, and crazy paving pattern are typical CT manifestations of COVID-19.â¢ Emerging atypical CT manifestations, including airway changes, pleural changes, fibrosis, nodules, etc., were demonstrated in COVID-19 patients.â¢ CT manifestations may associate with the progression and prognosis of COVID-19.


Expression of Concern: Mehra MR et al. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med. DOI: 10.1056/NEJMoa2007621


title: A systematic review of the prophylactic role of chloroquine and hydroxychloroquine in coronavirus disease-19 (COVID-19)

text: OBJECTIVE: The pandemic coronavirus disease-19 (COVID-19) has pushed the global healthcare system to a crisis and amounted to a huge economic burden. Different drugs for prophylaxis against COVID-19 including chloroquine (CQ) or hydroxychloroquine (HCQ) have been tried. This study was performed to systematically review the role of CQ and HCQ in preventing the spread of COVID-19. METHODS: PubMed, EMBASE, ClinicalTrials.gov, International Clinical Trials Registry Platform and Cochrane Library databases were searched for studies that evaluated the prophylactic role of CQ or HCQ on SARS-CoV-2 (pre-clinical studies) or COVID-19 (clinical studies) until 30 March 2020. The available literature was critically appraised. RESULTS: A total of 45 articles were screened and 5 (3 in vitro pre-clinical studies and 2 clinical opinions) were included. The pre-clinical studies showed the prophylactic effects of CQ and HCQ against SARS-CoV-2. On the other hand, the clinical opinions advocated the prophylactic use of CQ and HCQ against COVID-19. However, no original clinical studies on the prophylactic role of CQ or HCQ on COVID-19 were available. CONCLUSION: Although pre-clinical results are promising, to date there is a dearth of evidence to support the efficacy of CQ or HCQ in preventing COVID-19. Considering potential safety issues and the likelihood of imparting a false sense of security, prophylaxis with CQ or HCQ against COVID-19 needs to be thoroughly evaluated in observational studies or high-quality randomized controlled studies.


docid: tlfmkrbi

title: Covid-19: Millions of women and children at risk as visits to essential services plummet


Neurologic Features in Severe SARS-CoV-2 Infection


title: The Greek Response to COVID-19: A True Success Story from an IBD Perspective

text: BACKGROUND: After the first case of infection with the novel coronavirus, SARS-CoV-2, in China, an outbreak rapidly spread, finally evolving into a global pandemic. The new disease was named coronavirus disease 2019 (COVID-19) and by May 10, 2020, it has affected more than 4 million people worldwide and caused more than 270,000 deaths. METHODS: We describe the Greek experience regarding the response to COVID-19, with particular focus on 2 COVID-19 reference hospitals in the metropolitan area of Athens, the capital of Greece. RESULTS: The first case of SARS-CoV-2 infection in Greece was reported on February 26, 2020, and prompted a decisive response from the Greek government. The primary focus was containment of virus spread, considering shortage of ICU beds. A general lockdown was implemented early on, and the national Health Care System underwent massive re-structuring. Our 2 gastrointestinal (GI) centers, which provide care for more than 1500 inflammatory bowel disease (IBD) patients, are located in hospitals that were transformed to COVID-19 reference centers. To maintain sufficient care for our patients, while also contributing to the fight against COVID-19, we undertook specific measures. These included provision of telemedicine services, electronic prescriptions and home delivery of medications, isolation of infusion units and IBD clinics in COVID-free zones of the hospitals, in addition to limiting endoscopies to emergencies only. Such practices allowed us to avoid interruption of appropriate therapies for IBD patients. In fact, within the SECURE-IBD database, there have been only 4 Greek IBD patients, to date, who have been reported as positive for SARS-CoV-2. CONCLUSION: Timely application of preventive measures and strict compliance to guidelines limited the spread of COVID-19 in Greece and minimally impacted our IBD community, without interfering with therapeutic management.


title: Features of Mild-to-Moderate COVID-19 Patients With Dysphonia

text: INTRODUCTION: To explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients. METHODS: The clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general, and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and nondysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis. RESULTS: A total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (P = 0.022). The proportion of smokers was significantly higher in the dysphonic group (P = 0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with nondysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea, and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain, and nasal obstruction was higher in dysphonic group compared with nondysphonic group. There were significant associations between the severity of dysphonia, dysphagia, and cough. CONCLUSION: Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than nondysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation.


title: An Evaluation of Neurosurgical Resident Education and Sentiment During the Coronavirus Disease 2019 Pandemic: A North American Survey

text: BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a tremendous impact on the healthcare system. Owing to restrictions in elective surgery and social distancing guidelines, the training curriculum for neurosurgical trainees has been rapidly evolving. This evolution could have significant long-term effects on the training of neurosurgery residents. The objective of the present study was to assess the effects of COVID-19 on neurosurgical training programs and residents. METHODS: A survey consisting of 31 questions assessing changes to resident clinical and educational workload and their sentiment regarding how these changes might affect their careers was distributed electronically to neurosurgery residents in the United States and Canada. RESULTS: The survey respondents were from 29 states and Canada and were relatively evenly spread across all levels of residency. Nearly 82% reported that the inpatient and outpatient volumes had been either greatly (44.0%) or moderately (37.8%) reduced. Greater than 91% reported that their work responsibilities or access to the hospital had been reduced, with a significant reduction in work hours and a significant increase in resident didactics (P < 0.001). Senior residents expressed concern about their educational experience and their future career prospects as a result of the pandemic. CONCLUSION: Universally, residents have experienced reduced work hours and a reduction in their operative case volumes. Programs have adapted by increasing didactic time and using electronic platforms. It is quite possible that this remarkable period will prompt a critical reappraisal of the pre-COVID-19 adequacy of educational content in our training programs and that the enhanced educational efforts driven by this pandemic could be lasting.


title: Veno-venous Extracorporeal Membrane Oxygenation Support in COVID-19 Respiratory Distress Syndrome: Initial Experience

text: SARS-CoV-2 may cause severe respiratory failure due to massive alveolar damage. Currently, no adequate curative therapy for Coronavirus Disease 2019 (COVID-19) disease exists. By considering overall impact of COVID-19 pandemic outbreak, an increased need of extracorporeal membrane oxygenation (ECMO) support becomes evident. We report on our preliminary institutional experience with COVID-19 patients receiving venovenous ECMO support.


title: Characteristics of in peripheral blood of 70 hospitalized patients and 8 diarrhea patients with COVID-19

text: Objective: To analyze the blood test indicators of patients after infection of COVID-19 in Chongqing and analyze the clinical indicators of 8 patients with diarrhea. Materials and Methods: From January 26, 2019 to February 13, 2020, 70 patients diagnosed with 2019-nCoV according to the World Health Organization interim guidance for NCP and divided into diarrhea and non-diarrhea groups. The laboratory tests liver and kidney function, blood routine, coagulation function, and immune status. Results: The study population included 70 hospitalized patients with confirmed CONV-2019. NCP patients (43males and 27 females) with a mean age of 48.57±17.80 (9~82) years and only 4.3% of patients have lung-related diseases. The positive rate of ESR, CRP, PT, IL6, lymphocyte count, GGT, Prealbumin and CD4 was more than 50%. We further analyzed the differences between 8 diarrhea patients and 62 non-diarrhea patients. Among these indicators, only Lymphocyte, CRP, Prealbumin and Cystatin C positive rate is more than 50%. Although there is no statistical difference in GGT, 100% of the 7 patients tested decreased. Conclusion: Our data recommended that the ESR, CRP, PT, IL6, lymphocyte count, GGT, prealbumin and CD4 have important value in the diagnosis of COVID-19, and the decrease of GGT may be an important indicator for judging the intestinal dysfunction of patients.


It is time for computable evidence synthesis: The COVID-19 Knowledge Accelerator Initiative


title: Angiotensin-converting enzyme 2: The old door for new severe acute respiratory syndrome coronavirus 2 infection

text: Coronavirus (CoV) disease 2019 (COVID-19) is an ongoing pandemic caused by severe acute respiratory syndrome CoV 2 (SARS-CoV-2). The highly contagious SARS-CoV-2 belongs to the genus Betacoronavirus, and it is phylogenetically closely related to SARS-CoV, a human CoV that caused an outbreak back in 2002 to 2003. Both SARS-CoV-2 and SARS-CoV enter human cells via the interactions between viral crown-like spike protein and human angiotensin-converting enzyme 2 (ACE2) receptor. Here, we aim to review the involvement of ACE2 in human CoV infections by discussing the roles of ACE2 in CoV evolution, cross-species transmissibility, and COVID-19 susceptibility. We also provide our perspectives on COVID-19 treatment and prevention.


Synergistic effect of vitamin D and remdesivir can fight COVID-19


An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries


title: COVID-19 epidemic in Brazil: Where are we at?

text: OBJETIVE: To analyze the trends of COVID-19 in Brazil in 2020 by Federal Units (FU). METHOD: Ecological time-series based on cumulative confirmed cases of COVID-19 from March 11 to May 12. Joinpoint regression models were applied to identify points of inflection in COVID-19 trends, considering the days since the 50th confirmed case as time unit. RESULTS: Brazil reached its 50th confirmed case of COVID-19 in 11 March 2020 and, 63 days after that, on May 12, 177,589 cases had been confirmed. The trends for all regions and FU are upward. In the last segment, from the 31st to the 63rd day, Brazil presented a daily percentage change (DPC) of 7.3% (95%CI= 7.2;7.5). For the country the average daily percentage change (ADPC) was 14.2% (95%CI: 13.8;14.5). The highest ADPC values were found in the North, Northeast and Southeast regions. CONCLUSIONS: In summary, our results show that all FUs in Brazil present upward trends of COVID-19. In some FUs, the slowdown in DPC in the last segment must be considered with caution. Each FU is at a different stage of the pandemic and, therefore, non-pharmacological measures should be adopted accordingly.


title: Anosmia in COVID-19: Mechanisms and Significance

text: The global pandemic of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 remains a challenge for prevention due to asymptomatic or paucisymptomatic patients. Anecdotal and preliminary evidence from multiple institutions shows that these patients present with a sudden onset of anosmia without rhinitis. We aim to review the pathophysiology of anosmia related to viral upper respiratory infections and the prognostic implications. Current evidence suggests that SARS-CoV-2-related anosmia may be a new viral syndrome specific to COVID-19 and can be mediated by intranasal inoculation of SARS-CoV-2 into the olfactory neural circuitry. The clinical course of neuroinvasion of SARS-CoV-2 is yet unclear, however an extended follow up of these patients to assess for neurological sequelae including encephalitis, cerebrovascular accidents and long-term neurodegenerative risk may be indicated.


Tocilizumab administration in a refractory case of COVID-19


COVID-19 in Pediatrics: A Laboratory Perspective


title: Analysis of adjunctive serological detection to nucleic acid test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis

text: BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused coronavirus disease 2019 (COVID-19) epidemic in China, December 2019. The clinical features and treatment of COVID-19 patients remain largely elusive. However, accurate detection is required for SARS-CoV-2 infection diagnosis. We aimed to evaluate the antibodies-based test and nucleic acid-based test for SARS-CoV-2-infected patients. METHODS: We retrospectively studied 133 patients diagnosed with SARS-CoV-2 and admitted to Renmin Hospital of Wuhan University, China, from January 23 to March 1, 2020. Demographic data, clinical records, laboratory tests, and outcomes were collected. Data were accessed by SARS-CoV-2 IgM-IgG antibody test and real-time reverse transcriptase PCR (RT-PCR) detection for SARS-CoV-2 nucleic acid in COVID-19 patients. RESULTS: Of 133 COVID-19 patients, there were 44 moderate cases, 52 severe cases, and 37 critical cases with no differences in gender and age among three subgroups. In RT-PCR detection, the positive rate was 65.9%, 71.2%, and 67.6% in moderate, severe, and critical cases, respectively. Whereas the positive rate of IgM/IgG antibody detection in patients was 79.5%/93.2%, 82.7%/100%, and 73.0%/97.3% in moderate, severe, and critical cases, respectively. Moreover, the IgM and IgG antibodies concentrations were also examined with no differences among three subgroups. CONCLUSION: The IgM-IgG antibody test exhibited a useful adjunct to RT-PCR detection, and improved the accuracy in COVID-19 diagnosis regardless of the severity of illness, which provides an effective complement to the false-negative results from a nucleic acid test for SARS-CoV-2 infection diagnosis after onsets.


Coronavirus disease (COVID-19) - impact on vaccine preventable diseases


Management strategies for the colonoscopic surveillance of people with Lynch syndrome during the COVID-19 pandemic


title: Development and Validation of a Nomogram for Assessing Survival in Patients with COVID-19 Pneumonia

text: BACKGROUND: The outbreak of coronavirus disease (COVID-19) in 2019 has spread worldwide and continues to cause great threat to peoples' health as well as put pressure on the accessibility of medical systems. Early prediction of survival of hospitalized patients will help the clinical management of COVID-19, but such a prediction model which is reliable and valid is still lacking. METHODS: We retrospectively enrolled 628 confirmed cases of COVID-19 using positive RT-PCR tests for SARS-CoV-2 in Tongji Hospital in Wuhan, China. These patients were randomly grouped into a training cohort (60%) and a validation cohort (40%). In the training cohort, least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate Cox regression analysis were utilized to identify prognostic factors for in-hospital survival of patients with COVID-19. A nomogram based on the three variables was built for clinical use. Areas under the ROC curves (AUC), concordance index (C-index) and calibration curve were used to evaluate the efficiency of the nomogram in both the training and validation cohorts. RESULTS: Hypertension, higher neutrophil-to-lymphocyte ratio and increased NT-proBNP value were found to be significantly associated with poorer prognosis in hospitalized patients with COVID-19. The three predictors were further used to build a prediction nomogram. The C-index of the nomogram in the training and validation cohorts was 0.901 and 0.892, respectively. The AUC in the training cohort was 0.922 for 14- day and 0.919 for 21-day probability of in-hospital survival, while in the validation cohort was 0.922 and 0.881, respectively. Moreover, the calibration curve for 14- day and 21-day survival also showed high coherence between the predicted and actual probability of survival. CONCLUSION: We managed to build a predictive model and constructed a nomogram for predicting in-hospital survival of patients with COVID-19. This model represents good performance and might be utilized clinically in the management of COVID-19.


title: Therapeutic ISCOMATRIX™ adjuvant vaccine elicits effective anti-tumor immunity in the TRAMP-C1 mouse model of prostate cancer

text: Cancer vaccine development has proven challenging with the exception of some virally induced cancers for which prophylactic vaccines exist. Currently, there is only one FDA approved vaccine for the treatment of prostate cancer and as such prostate cancer continues to present a significant unmet medical need. In this study, we examine the effectiveness of a therapeutic cancer vaccine that combines the ISCOMATRIX™ adjuvant (ISCOMATRIX) with the Toll-like receptor 3 agonist, polyinosinic-polycytidylic acid (Poly I:C), and Flt3L, FMS-like tyrosine kinase 3 ligand. We employed the TRAMP-C1 (transgenic adenocarcinoma of the mouse prostate) model of prostate cancer and the self-protein mPAP (prostatic acid phosphatase) as the tumor antigen. ISCOMATRIX™-mPAP-Poly I:C-Flt3L was delivered in a therapeutic prime-boost regime that was consistently able to achieve complete tumor regression in 60% of animals treated and these tumor-free animals were protected upon rechallenge. Investigations into the underlying immunological mechanisms contributing to the effectiveness of this vaccine identified that both innate and adaptive responses are elicited and required. NK cells, CD4+ T cells and interferon-Î³ were all found to be critical for tumor control while tumor infiltrating CD8+ T cells became disabled by an immunosuppressive microenvironment. There is potential for broader application of this cancer vaccine, as we have been able to demonstrate effectiveness in two additional cancer models; melanoma (B16-OVA) and a model of B cell lymphoma (Eµ-myc-GFP-OVA).


Incidental COVID-19 on PET/CT imaging


Study Explores Psychological Harm to Health Workers During Outbreaks


Gastrointestinal endoscopy during the COVID-19 pandemic: an updated review of guidelines and statements from international and national societies


title: Comparative analysis of SARS-CoV-2 receptor ACE2 expression in multiple solid tumors and matched non-diseased tissues

text: The emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a global public health emergency. SARS-CoV-2 employs the host cell receptor ACE2 for cellular entry. Nonetheless, the differences in ACE2 expression pattern in lung versus other normal and solid tumor tissues remain incompletely characterized. Here, we analyze a large data set comprising ACE2 mRNA expression for 7592 tissue samples across 22 types of primary solid tumor and 4461 samples across matched 18 non-diseased tissues. Our results unravel eight normal tissues and 10 primary solid tumors, which might be at high risk of SARS-CoV-2 infection. These findings may provide additional insight into the prevention and treatment of SARS-CoV-2 infection, in particular for patients with these 10 vulnerable cancer types.


title: Modeling the transmission of new coronavirus in S\~ao Paulo State, Brazil -- Assessing epidemiological impacts of isolating young and elder persons

text: We developed a mathematical model to describe the transmission of new coronavirus in the S\~ao Paulo State, Brazil. The model divided a community in subpopulations comprised by young and elder persons, in order to take into account higher risk of fatality among elder persons with severe CoViD-19. From data collected in the S\~ao Paulo State, we estimated the transmission and additional mortality rates, from which we calculated the basic reproduction number R0. From estimated parameters, estimation of the deaths due to CoViD-19 was three times lower than those found in literature. Considering isolation as a control mechanism, we varied isolation rates of young and elder persons in order to assess their epidemiological impacts. The epidemiological scenarios focused mainly on evaluating the number of severe CoViD-19 cases and deaths due to this disease when isolation is introduced in a population.


title: A quick evaluation method of nosocomial infection risk for cancer hospitals during the COVID-19 pandemic

text: Nosocomial infections caused by COVID-19 will result in the immediate closure of the infected medical facility due to the highly contagious nature of COVID-19, further worsening medical shortages. We performed a Delphi consulting study to develop a risk model based on the experience of recently resumed activities in many cancer hospitals in China. Similar method had been used in a Chinese cancer hospital and effectively reduced the nosocomial Infection. We believe that the model can quickly identify COVID-19 cluster risks for medical facilities. The evaluation model could also be integrated into the hospital's emergency response system in a timely manner.


title: Remdesivir during induction chemotherapy for newly diagnosed paediatric acute lymphoblastic leukaemia with concomitant SARS-CoV-2 infection

text: The COVID-19 pandemic potentially makes treatment of acute leukaemia more difficult. Most induction chemotherapy regimens for acute leukaemia lead to extended periods of cytopaenia and immunosuppression rendering patients vulnerable to opportunistic infections. As with many aspects of SARS-CoV-2, there is no universally accepted way of treating patients who present with acute leukaemia and associated infection.


title: Self-collection: An appropriate alternative during the SARS-CoV-2 pandemic

text: OBJECTIVES: To evaluate the reliability of self-collection for SARS-CoV-2 and other respiratory viruses because swab collections for SARS-CoV-2 put health workers at risk of infection and require use of personal protective equipment (PPE). METHODS: In a prospective study, patients from two states in Australia attending dedicated COVID-19 collection clinics were offered the option to first self-collect (SC) nasal and throat swabs (SCNT) prior to health worker collect (HC) using throat and nasal swabs (Site 1) or throat and nasopharyngeal swabs (Site 2). Samples were analysed for SARS-CoV-2 as well as common respiratory viruses. Concordance of results between methods was assessed using Cohen's kappa (κ) and Cycle threshold (Ct) values were recorded for all positive results as a surrogate measure for viral load. RESULTS: Of 236 patients sampled by HC and SC, 25 had SARS-CoV-2 (24 by HC and 25 by SC) and 63 had other respiratory viruses (56 by HC and 58 by SC). SC was highly concordant with HC (κâ¯=â¯0.890) for all viruses including SARS-CoV-2 and more concordant than HC to positive results by any method (κâ¯=â¯0.959 vs 0.933). Mean SARS-CoV-2 E-gene and N-gene, rhinovirus and parainfluenza Ct values did not differ between HC and SCNT. CONCLUSIONS: Self-collection of nasal and throat swabs offers a reliable alternative to health worker collection for the diagnosis of SARS-CoV-2 and other respiratory viruses and provides patients with easier access to testing, reduces exposure of the community and health workers to those being tested and reduces requirement for PPE.


title: Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series

text: A prothrombotic coagulopathy is commonly found in critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS). A unique feature of COVID-19 respiratory failure is a relatively preserved lung compliance and high Alveolar-arterial oxygen gradient, with pathology reports consistently demonstrating diffuse pulmonary microthrombi on autopsy, all consistent with a vascular occlusive etiology of respiratory failure rather than the more classic findings of low-compliance in ARDS. The COVID-19 pandemic is overwhelming the world's medical care capacity with unprecedented needs for mechanical ventilators and high rates of mortality once patients progress to needing mechanical ventilation, and in many environments including in parts of the United States the medical capacity is being exhausted. Fibrinolytic therapy has previously been used in a Phase 1 clinical trial that led to reduced mortality and marked improvements in oxygenation. Here we report a series of three patients with severe COVID-19 respiratory failure who were treated with tissue plasminogen activator. All three patients had a temporally related improvement in their respiratory status, with one of them being a durable response.


Pneumocystis Jirovecii Pneumonia and SARS-CoV-2 Co-Infection in newly diagnosed HIV-1 infection


Should Clinicians Use Chloroquine or Hydroxychloroquine Alone or in Combination With Azithromycin for the Prophylaxis or Treatment of COVID-19?


An Uncomplicated Delivery in a Patient with Covid-19 in the United States


title: Systematic review with meta-analysis: liver manifestations and outcomes in COVID-19

text: BACKGROUND: The incidence of elevated liver chemistries and the presence of the pre-existing chronic liver disease (CLD) have been variably reported in COVID-19. AIMS: To assess the prevalence of CLD, the incidence of elevated liver chemistries and the outcomes of patients with and without underlying CLD/elevated liver chemistries in COVID-19. METHODS: A comprehensive search of electronic databases from 1 December 2019 to 24 April 2020 was done. We included studies reporting underlying CLD or elevated liver chemistries and patient outcomes in COVID-19. RESULTS: 107 articles (n = 20 874 patients) were included for the systematic review. The pooled prevalence of underlying CLD was 3.6% (95% CI, 2.5-5.1) among the 15 407 COVID-19 patients. The pooled incidence of elevated liver chemistries in COVID-19 was 23.1% (19.3-27.3) at initial presentation. Additionally, 24.4% (13.5-40) developed elevated liver chemistries during the illness. The pooled incidence of drug-induced liver injury was 25.4% (14.2-41.4). The pooled prevalence of CLD among 1587 severely infected patients was 3.9% (3%-5.2%). The odds of developing severe COVID-19 in CLD patients was 0.81 (0.31-2.09; P = 0.67) compared to non-CLD patients. COVID-19 patients with elevated liver chemistries had increased risk of mortality (OR-3.46 [2.42-4.95, P < 0.001]) and severe disease (OR-2.87 [95% CI, 2.29-3.6, P < 0.001]) compared to patients without elevated liver chemistries. CONCLUSIONS: Elevated liver chemistries are common at presentation and during COVID-19. The severity of elevated liver chemistries determines the outcome of COVID-19. The presence of CLD does not alter the outcome of COVID-19. Further studies are needed to analyse the outcomes of compensated and decompensated liver disease.


title: Structural and biological survey of 7-chloro-4-(piperazin-1-yl)quinoline and its derivatives

text: The 7-chloro-4-(piperazin-1-yl)quinoline structure is an important scaffold in medicinal chemistry. It exhibited either alone or as hybrid with other active pharmacophores diverse pharmacological profiles such as: antimalarial, antiparasitic, anti-HIV, antidiabetic, anticancer, sirtuin Inhibitors, dopamine-3 ligands, acetylcholinesterase inhibitors, and serotonin antagonists. In the presented review, a comprehensive discussion of compounds having this structural core is surveyed and illustrated.


title: The issue of recurrently positive patients who recovered from COVID-19 according to the current discharge criteria: investigation of patients from multiple medical institutions in Wuhan, China

text: The current discharge criteria for COVID-19 require that patients have two consecutive negative results for RT-PCR detection. Here, we observed that recurrently positive RT-PCR test results in patients with three consecutive negative results (3xNegRPos, 5.4%) were significantly decreased compared with those in patients with two consecutive negative results (2xNegRPos, 20.6%); such patients reported positive RT-PCR test results within 1 to 12 days after meeting the discharge criteria. These results confirmed that many recovered patients could show a positive RT-PCR test result, and most of these patients could be identified by an additional RT-PCR test prior to discharge.


COVID-19 experience in Bergamo, Italy


title: Pivoting to teleconsultation for paediatric ophthalmology and strabismus: Our experience during COVID-19 times

text: Purpose: The objective is to analyse and report the data of teleconsultations provided to paediatric ophthalmology and strabismus patients during COVID-19 times and to elaborate our experience for guiding future teleconsultation practices to General, paediatric Ophthalmologists and Strabismologists. Methods: Retrospective analysis of electronic medical record data of teleconsultations provided in the department of Strabismus, Paediatric and Neuro-ophthalmology was done. Patients with optic nerve related disorders were excluded. Study period was one month. Statistical analysis of collected data was done using Microsoft excel. Results: A total of 198 patients were provided teleconsultations (an average of seven teleconsultations/day). The final analysis included 161 patients after excluding optic nerve related disorders. The median age was seven years. We had a near equal gender distribution (53% males and 47% females) of whom a third were new cases. Video calling was used in 14%, review of clinical photos shared was used in 53%. Rest of the 33% were given telephonic advice. Allergic conjunctivitis (14%), pseudophakia (9%), strabismus (12%), status post strabismus surgery (8%), cranial nerve palsies (11%) were common diagnoses. 19% (n = 30) were advised/needed visit in emergency services on same or next day. Conclusion: Our experience of teleconsultation during COVID-19 times for paediatric ophthalmology and strabismus patients was very encouraging. Pivoting teleconsultation platform can provide primary eye care to most of the patients and work as essential forward triage for rest. As we continue to further explore the currently available avenues in multimedia such as video conferencing and web/mobile based applications, we believe that tele-ophthalmology platform can provide a reliable service in patient care.


Circadian rhythm sleep-wake disorders and the COVID-19 pandemic


Vietnam's response to COVID-19: prompt and proactive actions


Omalizumab and COVID-19 treatment: Could it help?


title: Evidenced-based best practice advice for patients treated with systemic immunosuppressants in relation to COVID-19

text: The emergence of the COVID-19 pandemic led to significant uncertainty among physicians and patients about the safety of immunosuppressive medications used for the management of dermatologic conditions. We review available data on commonly used immunosuppressants and their effect on viral infections beyond COVID-19. Notably, the effect of some immunosuppressants on viruses related to SARS-CoV2, including SARS and MERS, has been previously investigated. In the absence of data on the effect of immunosuppressants on COVID-19, these data could be used to make clinical decisions on initiation and continuation of immunosuppressive medications during this pandemic. In summary, we recommend considering the discontinuation of oral JAK inhibitors and prednisone, considering the delay of rituximab infusion, and the careful continuation of cyclosporine, mycophenolate, azathioprine, methotrexate, and biologics in patients currently benefitting from such treatments.


title: Caution regarding potential changes in AVR practices during the COVID-19 pandemic

text: To improve resource allocation in face of the COVID-19 pandemic, hospitals around the country are restricting the performance of elective surgery to preserve ventilators, operating rooms, ICU beds and protect anesthesiologists. For patients with severe aortic stenosis, efforts to bring treatment to symptomatic patients amid this pandemic might lead to favored use of catheter based management using minimalist techniques that do not require these elements. In this context, some patients with well tested surgical indications for valve replacement may be treated by catheter-based methods. It is important that outcomes for these cases are followed closely both at respective sites and in national registries. As we recover from this pandemic, surgical cases should once again be driven by multi-disciplinary discussion and clinical trial data, and not a mentality of crisis management.


docid: sufpwhij

title: Procedimientos endoscópicos y pandemia COVID-19: consideraciones básicas

text: El SARS-Cov-2 es un coronavirus productor de la enfermedad COVID-19 Esta inició en Wuhan, capital de la provincia Hubei, China En menos de cuatro meses la enfermedad se dispersó por el mundo, lo que dio origen a miles de muertes La Organización Mundial de la Salud (OMS) la ha declarado pandemia La humanidad está consternada, múltiples gobiernos han obligado al aislamiento total, con éxito variable debido a la negligencia de parte de la comunidad En muchas ciudades las instituciones y el personal sanitario no son suficientes para atender la catástrofe El aislamiento es la única estrategia eficaz para detener el crecimiento logarítmico de COVID-19 El motivo científico del aislamiento es que más del 60 % de los contagios surgen de personas asintomáticas La enfermedad no solo produce síntomas respiratorios El SARS-Cov-2, además, puede producir náuseas, dolor abdominal, vómito, diarrea, anosmia y ageusia El 50% de los infectados pueden tener síntomas digestivos, que incluso preceden a los respiratorios La ruta fecal-oral trasmite el virus, aún sin diarrea En las unidades de endoscopia están todas las formas de contagio: aerosoles (vómitos, arcadas, eructos, flatos), materia fecal, contacto estrecho, contaminación del ambiente Se deben suspender todas las endoscopias programadas para diagnóstico Solo deben realizarse las urgentes y terapéuticas Todo el personal de endoscopia debe tener medidas de protección estrictas El paciente debe saber que en la sala de endoscopia puede contagiarse, con constancia en el consentimiento informado Debe contactarse al paciente posendoscopia vía telefónica a los días 7 y 14 para indagar sobre todos los síntomas mencionados (AU) SARS-CoV-2 is the coronavirus which produces the dreaded COVID-19 Starting in Wuhan, the capital of China's Hubei province, it has spread it spread throughout the world in less than four months and has caused thousands of deaths The WHO has declared it to be a pandemic Humanity is shocked, and many governments have imposed total isolation It has had varying success due to community negligence In many cities, institutions and health personnel have not successfully managed this catastrophe Isolation is the only effective strategy to stop the logarithmic growth of COVID 19 The scientific reason for isolation is that more than 60 % of infections arise from asymptomatic people SARS-CoV-2 not only produces respiratory symptoms but can also cause nausea, abdominal pain, vomiting, diarrhea, anosmia and ageusia Fifty percent of those infected may have digestive symptoms which may even precede respiratory symptoms The fecal-oral route can transmit the virus even when there is no diarrhea All forms of contagion are found in endoscopy units: aerosols from vomiting, retching, bel-ching, and flatus;fecal matter, close contact, and contamination of the environment All diagnostic endoscopies should be discontinued Only urgent and therapeutic endoscopy should be performed All endoscopy personnel must have strict protection measures Each patient should be informed, and sign an informed consent form, that the virus can be spread within the endoscopy room After performance of endoscopy, the patient should be contacted by phone on days 7 and 14 to inquire about all symptoms mentioned (AU)


title: Covid-19 Pandemic: What Changes for Dentists and Oral Medicine Experts? A Narrative Review and Novel Approaches to Infection Containment

text: The authors performed a narrative review on Severe Acute Respiratory Syndrome- CoronaVirus-2 ( SARS-CoV-2) and all infectious agents with the primary endpoints to illustrate the most accepted models of safety protocols in dentistry and oral medicine, and to propose an easy view of the problem and a comparison (pre- vs post-COVID19) for the most common dental procedures. The outcome is forecast to help dentists to individuate for a given procedure the differences in terms of safety protocols to avoid infectious contagion (by SARS-CoV-2 and others dangerous agents). An investigation was performed on the online databases Pubmed and Scopus using a combination of free words and Medical Subject Headings (MESH) terms: "dentist" OR "oral health" AND "COVID-19" OR "SARS-CoV-2" OR "coronavirus-19". After a brief excursus on all infectious agents transmittable at the dental chair, the authors described all the personal protective equipment (PPE) actually on the market and their indications, and on the basis of the literature, they compared (before and after COVID-19 onset) the correct safety procedures for each dental practice studied, underlining the danger of underestimating, in general, dental cross-infections. The authors have highlighted the importance of knowing exactly the risk of infections in the dental practice, and to modulate correctly the use of PPE, in order to invest adequate financial resources and to avoid exposing both the dental team and patients to preventable risks.


title: Metatranscriptomic Characterization of COVID-19 Identified A Host Transcriptional Classifier Associated With Immune Signaling

text: BACKGROUND: The recent identification of a novel coronavirus, also known as SARS-CoV-2, has caused a global outbreak of respiratory illnesses. The rapidly developing pandemic has posed great challenges to diagnosis of this novel infection. However, little is known about the metatranscriptomic characteristics of patients with Coronavirus Disease 2019 (COVID-19). METHODS: We analyzed metatranscriptomics in 187 patients (62 cases with COVID-19 and 125 with non-COVID-19 pneumonia). Transcriptional aspects of three core elements - pathogens, the microbiome, and host responses - were interrogated. Based on the host transcriptional signature, we built a host gene classifier and examined its potential for diagnosing COVID-19 and indicating disease severity. RESULTS: The airway microbiome in COVID-19 patients had reduced alpha diversity, with 18 taxa of differential abundance. Potentially pathogenic microbes were also detected in 47% of the COVID-19 cases, 58% of which were respiratory viruses. Host gene analysis revealed a transcriptional signature of 36 differentially expressed genes significantly associated with immune pathways such as cytokine signaling. The host gene classifier built on such a signature exhibited potential for diagnosing COVID-19 (AUC of 0.75-0.89) and indicating disease severity. CONCLUSIONS: Compared to those with non-COVID-19 pneumonias, COVID-19 patients appeared to have a more disrupted airway microbiome with frequent potential concurrent infections, and a special trigger host immune response in certain pathways such as interferon gamma signaling. The immune-associated host transcriptional signatures of COVID-19 hold promise as a tool for improving COVID-19 diagnosis and indicating disease severity.


title: Metatranscriptomic Characterization of COVID-19 Identified A Host Transcriptional Classifier Associated With Immune Signaling ;Clinical Infectious Diseases ;Oxford Academic

text: BACKGROUND The recent identification of a novel coronavirus, also known as SARS-CoV-2, has caused a global outbreak of respiratory illnesses The rapidly developing pandemic has posed great challenges to diagnosis of this novel infection However, little is known about the metatranscriptomic characteristics of patients with Coronavirus Disease 2019 (COVID-19) METHODS We analyzed metatranscriptomics in 187 patients (62 cases with COVID-19 and 125 with non-COVID-19 pneumonia) Transcriptional aspects of three core elements – pathogens, the microbiome, and host responses – were interrogated Based on the host transcriptional signature, we built a host gene classifier and examined its potential for diagnosing COVID-19 and indicating disease severity RESULTS The airway microbiome in COVID-19 patients had reduced alpha diversity, with 18 taxa of differential abundance Potentially pathogenic microbes were also detected in 47% of the COVID-19 cases, 58% of which were respiratory viruses Host gene analysis revealed a transcriptional signature of 36 differentially expressed genes significantly associated with immune pathways such as cytokine signaling The host gene classifier built on such a signature exhibited potential for diagnosing COVID-19 (AUC of 0 75-0 89) and indicating disease severity CONCLUSIONS Compared to those with non-COVID-19 pneumonias, COVID-19 patients appeared to have a more disrupted airway microbiome with frequent potential concurrent infections, and a special trigger host immune response in certain pathways such as interferon gamma signaling The immune-associated host transcriptional signatures of COVID-19 hold promise as a tool for improving COVID-19 diagnosis and indicating disease severity


title: Fighting COVID-19

text: The current COVID-19 pandemic caused by the novel coronavirus (SARS-CoV2) poses a threat to global health owing to its high rate of spread and severe forms of respiratory infection. The lack of vaccines and antivirals prevents clinical strategies against the disease, creating an emerging need for the development of safe and effective treatments. Strategies for vaccine development include complete vaccines against viruses, subunits, and nucleic acids, but are still in their early stages. Studies carried out to date on possible SARS-CoV2 drug targets highlight glycoprotein S, Mpro (main protease or protease type 3C), and a member of the transmembrane serine protease II families (TMPRSS2). However, due to the pandemic state, priority is given to marketed drugs. These include chloroquine (CQ), hydroxychloroquine (HCQ), nitazoxanide, remdesivir, Lopinavir/ritonavir (LPV / r), in addition to treatment with convalescent plasma. But, therapeutic specific effects against SARS-CoV2 have not yet been verified. Most of the information obtained about treatment is based on preliminary and limited studies. We conclude that, at this time of emergency, the search for new therapies is more urgent due to the need to save lives. Thus, we point out as interesting targets for future more specific research: glycoprotein S, Mpro, and TMPRSS2.


docid: ayccccvg

title: A phased approach to unlocking during the COVID-19 pandemic-Lessons from trend analysis

text: BACKGROUND: The COVID-19 pandemic has led to radical political control of social behaviour. The purpose of this paper is to explore data trends from the pandemic regarding infection rates/policy impact and draw learning points for informing the unlocking process. METHODS: The daily published cases in England in each of 149 Upper Tier Local Authority (UTLA) areas were converted to Average Daily Infection Rate (ADIR), an R value-the number of further people infected by one infected person during their infectious phase with Rate of Change of Infection Rate (RCIR) also calculated. Stepwise regression was carried out to see what local factors could be linked to differences in local infection rates. FINDINGS: By the 19th April 2020 the infection R has fallen from 2.8 on 23rd March before the lockdown and has stabilised at about 0.8 sufficient for suppression. However, there remain significant variations between England regions. Regression analysis across UTLAs found that the only factor relating to reduction in ADIR was the historic number of confirmed number infection/000 population, There is, however, wide variation between Upper Tier Local Authorities (UTLA) areas. Extrapolation of these results showed that unreported community infection may be 150 times higher than reported cases, providing evidence that by the end of the 2nd week in April, 26.8% of the population may already have had the disease and so have increased immunity. INTERPRETATION: Analysis of current case data using infectious ratio has provided novel insight into the current national state and can be used to make better-informed decisions about future management of restricted social behaviour and movement.


title: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic

text: The novel coronavirus disease 2019 (COVID-19) outbreak once again demonstrated the importance of the renin-angiotensin system (RAS) in patients with diabetes. Activation of the RAS increases in patients with diabetes. The virus attaches to the ACE2 enzyme at low cytosolic pH values and enters into the cell and causes infection. Especially in the presence of diabetes mellitus and accompanying comorbid conditions such as hypertension, obesity, old age, and smoking, cytosolic pH is low, thus the virus easily may enter the cell by attaching to ACE2. ACEIs and ARBs lead to a reduction in angiotensin II level by increasing the ACE2 level, thus they cause a low cytosolic pH. Increased cardiac ACE2 levels due to ACEIs and ARBs can trigger cardiac arrhythmias and myocarditis by causing the virus to easily enter the heart tissue. There is ACE2 activity in the rostral ventrolateral medulla in the brain stem. The release of angiotensin 1-7 in the brain stem leads to the activation of the sympathetic nervous system. This activation causes systemic vasoconstriction and the patient's blood pressure increases. The most important event is the increased sympathetic activity via the central stimulation, this activity increases pulmonary capillary leaking, causing the ARDS. As the cytosolic pH, which is already low in patients with diabetes will decrease further with the mechanisms mentioned above, the viral load will increase and the infection will be exacerbated. As a result, the use of ACEIs and ARBs in patients with diabetes can lead to increased morbidity and mortality of COVID-19.


The COVID-19 pandemic in the USA: what might we expect?


The relevance of water and wastewater research


title: Digital Media's Role in COVID-19 Pandemic

text: UNSTRUCTURED: The SARS-CoV-2 outbreak has a tremendous impact on global health, the economy, and the whole society. Various measures are being taken to respond to the pandemic, while digital media playing a pivotal role, especially in the use of visual data to disseminate information, mobile health to coordinate medical resources, social media to promote public health campaigns, and digital tools to assist population management and disease tracing. However, digital media also faces some challenges like misinformation, lack of guidance, and information leakage. We encourage the increased use of digital media with the focus on improving trust, building social solidarity, reducing chaos, educating the public for prevention measures, and reducing the medical burden in facility-based sites.


title: Another invisible enemy indoors: COVID-19, human health, the home, and United States indoor air policy

text: After the emergence of the respiratory virus SARS-CoV-2 (COVID-19), many exposure and environmental health scientists promptly recognized the potentially catastrophic public health ramifications of concurrent infectious and air pollution-mediated disease. Nevertheless, much of this attention has been focused on outdoor interactions. Each year, 3.8 million people worldwide prematurely die from illnesses attributable to indoor air. Hence, poor household indoor air quality is a long-standing public health issue with even greater relevance now that many individuals are spending more time at home. At present, the Environmental Protection Agency does not regulate indoor air, and state-level legislation has resulted in a patchwork of national coverage. Here, we describe common sources of indoor air pollution, the health impacts of indoor pollutants, and populations disparately impacted by COVID-19 and poor indoor air quality. Furthermore, we detail the need for better legislation that promotes the integrity of the indoor air environment, and what individuals can do to personally protect themselves as we await more comprehensive indoor air legislation.


title: Thromboembolic risks in patients with COVID-19: major concern to consider in our management

text: COVID-19 pandemic is an emergent cardiovascular risk factor and a major cause of mortality worldwide. Thromboembolism is highly suspected as a leading cause of death in these patients through vascular inflammation caused by SARS COV2. Until now there is no real treatment of COVID-19 and many proposed drugs are under clinical trials. Considering the high incidence of thromboembolic events in critically ill patients with COVID-19, prevention of this disorder should be essential in order to reduce mortality in these patients.


title: COVID-19 and the eye: how much do we really know? A best evidence review

text: To identify and classify available information regarding COVID-19 and eye care according to the level of evidence, within four main topics of interest: evidence of the virus in tears and the ocular surface, infection via the conjunctival route, ocular manifestations, and best practice recommendations. A structured review was conducted in PubMed, ScienceDirect, LILACS, SciELO, the Cochrane Library and Google Scholar on COVID-19 and ophthalmology. The Oxford Centre for Evidence Based Medicine 2011 Levels of Evidence worksheet was used for quality assessments. 1018 items were identified in the search; 26 records were included in the qualitative synthesis, which encompassed 6 literature reviews, 10 case series or cross-sectional studies, 4 case reports, and 6 intervention descriptions. Seventeen out of 26 records (65%) were categorized as level 5 within the Oxford CBME methodology grading system, the rest were level 4. The evidence generated on COVID-19 and ophthalmology to date is limited, although this is understandable given the circumstances. Both the possible presence of viral particles in tears and conjunctiva, and the potential for conjunctival transmission remain controversial. Ocular manifestations are not frequent and could resemble viral infection of the ocular surface. Most recommendations are based on the strategies implemented by Asian countries during previous coronavirus outbreaks. There is a need for substantive studies evaluating these strategies in the setting of SARS-CoV-2. In the meantime, plans for applying these measures must be implemented with caution, taking into account the context of each individual country, and undergo regular evaluation.


Management and outcomes of post-acute COVID-19 patients in Northern Italy


COVID-19, quarantine, and atopic dermatitis


'Led by the science', evidence gaps, and the risks of aerosol transmission of SARS-COV-2


title: Brief recommendations on the management of adult patients with familial hypercholesterolemia during the COVID-19 pandemic

text: Individuals with Familial Hypercholesterolaemia (FH) are at very high risk of cardiovascular disease, which is associated with poor outcomes from coronavirus infections. COVID-19 puts strain on healthcare systems and may impair access to routine FH services. On behalf of the International Lipid Expert Panel (ILEP) and the European FH Patient Network (FH Europe), we present brief recommendations on the management of adult patients with FH during the COVID-19 pandemic. We discuss the implications of COVID-19 infections for FH patients, the importance of continuing lipid-lowering therapy where possible, issues relating to safety monitoring and service delivery. We summarise the evidence for additional benefits of statins and other lipid-lowering drugs during viral infections. The recommendations do not override in any way the individual responsibility of physicians to make appropriate and accurate decisions taking into account the condition of a given patient and the doses, rules, and regulations applicable to drugs and devices at the time of their prescription/use.


title: The Role of Genetic Sex and Mitochondria in Response to COVID-19 Infection

text: The difference between the female and male immune response to COVID-19 infection, and infections in general, is multifactorial. The well-known determiners of the immune response, such as X and Y chromosomes, sex hormones, and microbiota, are functionally interconnected and influence each other in shaping the organism's immunity. We focus our commentary on the interplay between the genetic sex and mitochondria and how this may affect a sex-dependent immune response in COVID-19 infection. Realizing the existence of these interactions may help in designing novel methods or fine-tuning the existing and routine therapies to fight COVID-19 and other infections.


title: Diet Supplementation, Probiotics, and Nutraceuticals in SARS-CoV-2 Infection: A Scoping Review

text: The severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) global pandemic is a devastating event that is causing thousands of victims every day around the world. One of the main reasons of the great impact of coronavirus disease 2019 (COVID-19) on society is its unexpected spread, which has not allowed an adequate preparation. The scientific community is fighting against time for the production of a vaccine, but it is difficult to place a safe and effective product on the market as fast as the virus is spreading. Similarly, for drugs that can directly interfere with viral pathways, their production times are long, despite the great efforts made. For these reasons, we analyzed the possible role of non-pharmacological substances such as supplements, probiotics, and nutraceuticals in reducing the risk of Sars-CoV-2 infection or mitigating the symptoms of COVID-19. These substances could have numerous advantages in the current circumstances, are generally easily available, and have negligible side effects if administered at the already used and tested dosages. Large scientific evidence supports the benefits that some bacterial and molecular products may exert on the immune response to respiratory viruses. These could also have a regulatory role in systemic inflammation or endothelial damage, which are two crucial aspects of COVID-19. However, there are no specific data available, and rigorous clinical trials should be conducted to confirm the putative benefits of diet supplementation, probiotics, and nutraceuticals in the current pandemic.


docid: elwdwpsm

title: Maternal choline and respiratory coronavirus effects on fetal brain development

text: Prenatal COVID-19 infection is anticipated by the U.S. Centers for Disease Control to affect fetal development similarly to other common respiratory coronaviruses through effects of the maternal inflammatory response on the fetus and placenta. Plasma choline levels were measured at 16 weeks gestation in 43 mothers who had contracted common respiratory viruses during the first 6-16 weeks of pregnancy and 53 mothers who had not. When their infants reached 3 months of age, mothers completed the Infant Behavior Questionnaire-Revised (IBQ-R), which assesses their infants' level of activity (Surgency), their fearfulness and sadness (Negativity), and their ability to maintain attention and bond to their parents and caretakers (Regulation). Infants of mothers who had contracted a moderately severe respiratory virus infection and had higher gestational choline serum levels (≥7.5 mM consistent with U.S. Food and Drug Administration dietary recommendations) had significantly increased development of their ability to maintain attention and to bond with their parents (Regulation), compared to infants whose mothers had contracted an infection but had lower choline levels (<7.5 mM). For infants of mothers with choline levels ≥7.5 µM, there was no effect of viral infection on infant IBQ-R Regulation, compared to infants of mothers who were not infected. Higher choline levels obtained through diet or supplements may protect fetal development and support infant early behavioral development even if the mother contracts a viral infection in early gestation when the brain is first being formed.


On the Role of Chest Radiography and CT in the Coronavirus Disease (COVID-19) Pandemic


Critical care response to a hospital outbreak of the 2019-nCoV infection in Shenzhen, China


Sharing Health Data and Biospecimens with Industry - A Principle-Driven, Practical Approach


World Affairs : CORONAVIRUS 個人主義がウイルスをまき散らす : イタリア


Een groene herstart van patiënt aardbol?


Droplets and Aerosols in the Transmission of SARS-CoV-2


COVID-19: implications for immunosuppression in kidney disease and transplantation


title: The World of Clinical Trial Development Post COVID-19: Lessons Learned from a Global Pandemic

text: The novel coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a global health threat (1). Patients with cancer are one of the most vulnerable populations. During this pandemic, clinical trial accrual to NCI studies has fallen dramatically. Investigators quickly turned to regulatory bodies to simplify treatment schedules, facilitate telemedicine, and decrease required data collection. Going forward, the oncology research community must use the lessons learned to focus on redesigning studies to ensure that critical scientific questions are answered safely while expanding access and increasing partnerships with community physicians. These changes will accelerate clinical progress while protecting our patients.


title: The World of Clinical Trial Development Post-Covid-19: Lessons Learned from a Global Pandemic

text: The novel coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a global health threat.1 Cancer patients are one of the most vulnerable populations. During this pandemic clinical trial accrual to NCI studies has fallen dramatically. Investigators quickly turned to regulatory bodies to simplify treatment schedules, facilitate telemedicine and to decrease required data collection Going forward the oncology research community must use the lessons learned to focus on redesigning studies to ensure that the critical scientific questions are answered safely while expanding access and increasing partnerships with community physicians. These changes will accelerate clinical progress while protecting our patients.


Timely Lessons from a Pandemic on the Benefits of Person Centric Care in Long Term Care Facilities


docid: nfjkcmxu

title: Covid-19 and cardiovascular risk: Susceptibility to infection to SARS-CoV-2, severity and prognosis of Covid-19 and blockade of the renin-angiotensin-aldosterone system. An evidence-based viewpoint

text: The presence of cardiovascular co-morbidities and the known effects of coronaviruses on the cardiovascular system have called attention to the potential implications for patients with cardiovascular risk factors. This evidence-based viewpoint will address two questions: (a) are individuals with underlying cardiovascular risk factors (e.g. high blood pressure or diabetes) or overt disease (e.g. coronary heart disease, heart failure, kidney disease) more likely to develop severe Covid-19 and to die than those without underlying conditions? (b) does the regular use of angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin-receptor blockers (ARB) make patients more likely to get infected and to die of Covid-19? With a necessary cautionary note that the evidence around the links between Covid-19 and cardiovascular disease is accruing at a fast pace, to date we can conclude that: (a) the greater susceptibility of individuals with underlying cardiovascular conditions to develop more severe Covid-19 with higher mortality rate is likely to be confounded, in part, by age and the type of co-morbidities. Patients with heart failure or chronic kidney disease might show an excess risk; (b) neither ACE-i nor ARB are associated with greater risk of SARS-Cov2 infection, or severity or risk of death in patients with Covid-19. Patients on these drugs should not stop them, unless under strict medical supervision and with the addition of a suitable replacement medicine.


Colchicine may not be effective in COVID-19 infection; it may even be harmful?


Addressing the COVID-19 Pandemic in Populations With Serious Mental Illness


"Thinking outside the box in COVID-19 era"-Application of Modified Aerosol Box in Dermatology


Thinking outside the box in COVID-19 era-Application of modified aerosol box in dermatology


Rural areas at risk during COVID-19 pandemic


title: Comparison and Application of Different Immunoassay Methods for the Detection of SARS-CoV-2

text: The detection data of IgM and IgG antibodies in 169 patients with coronavirus disease (COVID-19) were analyzed to evaluate differences in clinical performance between the colloidal gold method and chemiluminescence method. In this study, chemiluminescence detection of IgM antibody showed a positive conversion earlier (about 1~2 days earlier), positive conversion rates higher in different stages of disease, and a trend of declining positive rate later than colloidal gold method. For IgG antibody, the chemiluminescence method showed a positive conversion earlier and the positive rate climbing more quickly than the colloidal gold method. No obvious negative-converting tendency of IgG detection was observed within 35 days after the onset of disease. Although colloidal gold method is generally less sensitive than chemiluminescence method, it shows advantages of shorter turn-around time, more simple procedure and no special equipment required. The two methodologies can be chosen according to different laboratory conditions. A reasonable understanding of the performance of reagents with different methodologies can help in clinical disease diagnosis effectively and assist in the diagnosis of the progression of COVID-19, for which the dynamic changes of antibody will provide reliable evidence. This article is protected by copyright. All rights reserved.


Telemental Health in the Context of a Pandemic: the COVID-19 Experience


New evidence of SARS-CoV-2 transmission through the ocular surface


Dr. Hong Yu leads a team battling against the COVID-19 outbreak in Wuhan


title: A unifying structural and functional model of the coronavirus replication organelle: Tracking down RNA synthesis

text: Zoonotic coronavirus (CoV) infections, such as those responsible for the current severe acute respiratory syndrome-CoV 2 (SARS-CoV-2) pandemic, cause grave international public health concern. In infected cells, the CoV RNA-synthesizing machinery associates with modified endoplasmic reticulum membranes that are transformed into the viral replication organelle (RO). Although double-membrane vesicles (DMVs) appear to be a pan-CoV RO element, studies to date describe an assortment of additional CoV-induced membrane structures. Despite much speculation, it remains unclear which RO element(s) accommodate viral RNA synthesis. Here we provide detailed 2D and 3D analyses of CoV ROs and show that diverse CoVs essentially induce the same membrane modifications, including the small open double-membrane spherules (DMSs) previously thought to be restricted to gamma- and delta-CoV infections and proposed as sites of replication. Metabolic labeling of newly synthesized viral RNA followed by quantitative electron microscopy (EM) autoradiography revealed abundant viral RNA synthesis associated with DMVs in cells infected with the beta-CoVs Middle East respiratory syndrome-CoV (MERS-CoV) and SARS-CoV and the gamma-CoV infectious bronchitis virus. RNA synthesis could not be linked to DMSs or any other cellular or virus-induced structure. Our results provide a unifying model of the CoV RO and clearly establish DMVs as the central hub for viral RNA synthesis and a potential drug target in CoV infection.


Asthma and COVID: What Are the Important Questions?


title: The Economic Implications of COVID-19 in the United States

text: The novel coronavirus disease 2019 (COVID-19) first reported in Wuhan, China, in 2019 has evolved into a pandemic and public health emergency, leading to extensive fatalities and halting global economies Older adults have emerged as a critically vulnerable population as earlier data suggests a disproportionately increased incidence of COVID-19 in this population, as well as worse health outcomes Disease attenuating behaviors such as social distancing has been encouraged and mandated across different countries leading to downstream economic ramifications This paper seeks to outline the economic implications of COVID-19 in the U S (particularly in terms of vocational, retail, and service industries), highlighting the role of nursing homes in disease dissemination We also discuss potential costs associated with COVID-19 management focusing on the senior population who rely on Medicare benefits for health insurance


A carton-made protective shield for suspicious/confirmed COVID-19 intubation and extubation during surgery


Letter to editor regarding Ogen Y 2020 paper: "Assessing nitrogen dioxide (NO2) levels as a contributing factor to coronavirus (COVID-19) fatality"


Statewide Stay-at-Home Directives on the Spread of COVID-19 in Metropolitan and Nonmetropolitan Counties in the United States


title: COVID-19: decision making and palliative care

text: Due to the current development around the COVID-19 pandemic, palliative ch has created a Task Force to provide recommendations for health professionals on the treatment of palliative care patients in the various settings â inpatient and outpatient.


title: The Relationship between Status at Presentation and Outcomes among Pregnant Women with COVID-19

text: OBJECTIVE: This study was aimed to compare maternal and pregnancy outcomes of symptomatic and asymptomatic pregnant women with novel coronavirus disease 2019 (COVID-19). STUDY DESIGN: This is a retrospective cohort study of pregnant women with COVID-19. Pregnant women were divided into two groups based on status at admission, symptomatic or asymptomatic. All testing was done by nasopharyngeal swab using polymerase chain reaction (PCR) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Initially, nasopharyngeal testing was performed only on women with a positive screen (symptoms or exposure) but subsequently, testing was universally performed on all women admitted to labor and delivery. Chi-square and Wilcoxon's rank-sum tests were used to compare outcomes between groups. RESULTS: Eighty-one patients were tested because of a positive screen (symptoms [n = 60] or exposure only [n = 21]) and 75 patients were universally tested (all asymptomatic). In total, there were 46 symptomatic women and 22 asymptomatic women (tested based on exposure only [n = 12] or as part of universal screening [n = 10]) with confirmed COVID-19. Of symptomatic women (n = 46), 27.3% had preterm delivery and 26.1% needed respiratory support while none of the asymptomatic women (n = 22) had preterm delivery or need of respiratory support (p = 0.007 and 0.01, respectively). CONCLUSION: Pregnant women who presented with COVID19-related symptoms and subsequently tested positive for COVID-19 have a higher rate of preterm delivery and need for respiratory support than asymptomatic pregnant women. It is important to be particularly rigorous in caring for COVID-19 infected pregnant women who present with symptoms. KEY POINTS: · Respiratory support is often needed for women who present with symptoms.. · Low rate of severe disease in women who present without symptoms.. · There were no neonatal infections on day 0 of life..


title: Health and Economic Outcomes of Home Maintenance Allergen Immunotherapy in Select Patients with High Health Literacy during the COVID-19 Pandemic: A Cost-Effectiveness Analysis During Exceptional Times

text: BACKGROUND: Allergen immunotherapy (AIT) is safe and effective but is typically administered under strict clinic observation to mitigate the risk of a systemic reaction to immunotherapy (SRIT). However, in the setting of the global coronavirus disease 2019 pandemic, alternative care models should be explored. OBJECTIVE: To evaluate the cost-effectiveness of home immunotherapy self-administration (HITSA) in a highly idealized circumstance for provision of maintenance AIT in a shelter-in-place or other scenarios of unforeseen reduction in nonessential medical services. METHODS: Markov modeling was used to compare in-office clinic AIT in selected patients using cohort analysis and microsimulation from the societal and health care perspectives. RESULTS: Assuming similar SRIT rates, HITSA was found to be a cost-effective option with an incremental cost-effectiveness ratio of $44,554/quality-adjusted life-year when considering both incremental epinephrine autoinjector costs and coronavirus disease 2019 risks. Excluding epinephrine autoinjector costs, HISTA dominated other options. However, outside of pandemic considerations, HITSA was not cost-effective (incremental cost-effectiveness ratio, $198,877,286) at annual epinephrine autoinjector costs above $287. As the incremental HITSA SRIT rate increased above 15%, clinic AIT was the most cost-effective strategy. Excluding both pandemic risks and risk of motor vehicle accident fatality from round-trip clinic transit, clinic AIT dominated other strategies. Clinic AIT was the more cost-effective option at very high fatality relative risk for HITSA or at very low annual risk of contracting coronavirus disease 2019. CONCLUSIONS: Under idealized assumptions HITSA can be a safe and cost-effective option during a global pandemic in appropriately selected patients provided home rates of SRIT remain stable.


title: ACDC-Tracing: Towards Anonymous Citizen-Driven Contact Tracing

text: As we enter the control phase of the COVID-19 pandemic, many efforts have been dedicated to developing smartphone-based contact tracing apps in order to automatically identify people that a person with COVID-19 might have infected. These applications while potentially useful, present significant adoption, societal, technical and privacy challenges. We propose ACDC-Tracing, a simpler, anonymous, voucher-based contact tracing solution that relies on peoples' knowledge of their own close contacts. People who test positive are given an anonymous voucher which they can share with a limited number of people whom they think they might be infected. The recipients can use this voucher to book a COVID-19 test and can receive their test results without ever revealing their identity. People receiving positive result are given vouchers to further backtrack the path of infection. This is a fully anonymous solution which does not require any sharing of location data, Bluetooth, or having an app installed on people's mobile device. Moreover, ACDC-Tracing can be tested for effectiveness at a small scale without requiring adoption by the entire population, which would enable acquiring fast evidence about its efficacy and scalability. Finally, it is compatible with and complementary to alternative approaches to contact tracing.


Quality improvement in the time of coronavirus disease 2019 - A change strategy well suited to pandemic response


title: Echocardiographic parameters and vertebral heart size (VHS) in lambs during the neonatal period/ Parâmetros ecocardiográficos e tamanho cardíaco vertebral (VHS) em cordeiros durante o período neonatal

text: Due to cardiac immaturity, newborns have a different morphology and cardiac output when compared with adults. The purpose of this study was to describe the cardiac changes in echocardiographic characteristics and vertebral heart size (VHS) in newborn lambs during the neonatal period. Twenty-eight healthy Ile de France lambs were evaluated from birth to 35 days old. With the assistance of echocardiography, this study evaluated, both in systole and diastole, indexes related to the right and left ventricles, the aorta (Ao), the left atrium (LA), the E point to septal separation (EPSS) and the thickness of the interventricular septum (VSd, VSs). The left atrium-to-aorta ratio (LA:Ao) was analyzed and both the shortening (SF%) and ejection fractions were calculated (EF%). The VHS was obtained by measuring the heart's long and short axes and comparing it to the thoracic vertebrae. Throughout the first 35 days, the results obtained demonstrated an increased LV:RV ratio when compared to adult lambs. The calculated indexes and the LA:Ao ratio did not present statistically significant differences. The VHS values were normally distributed, presenting a mean of 9.67 vertebrae (v) during the entire period. Both radiographic and echocardiographic parameters showed significant differences between the analyzed moments. The VHS values ranged from 8.4v at the minimum end to 11.2v at the maximum. In order to prevent these changes from being misdiagnosed as heart diseases, this study contributed to take note of neonatal physiological anatomy peculiarities and in addition, it describes the parameters for this age in Ilê de France lambs.(AU)


title: Recovery of Elective Facial Plastic Surgery in the Post-Coronavirus Disease 2019 Era: Recommendations from the European Academy of Facial Plastic Surgery Task Force

text: The impact of the COVID-19 pandemic has resulted in widespread disruption to routine surgical services across the globe. As the peak of the initial pandemic passes, surgeons will increasingly resume elective work to address the backlog. Whilst urgent cases such as cancer work will be prioritized, the safe resumption of facial plastic surgery will remain an ongoing challenge; particularly if there are secondary waves of infection. Rhinoplasty and nasal reconstructive surgery in particular poses a unique challenge to address due to the due to the potential for aerosolizing the virus. A task force of facial plastic surgeons from the European Academy of Facial Plastic Surgery has collaborated to create this document detailing recommendations for resuming a safe facial plastic surgery practice. These include the need to embrace telemedicine, advice on surgical prioritization, planning of clinical area flow plans, advice on pre-/peri- and postoperative care as well as recommendations on training for residents and well-being for surgeons. The recommendations have been made in line with the best available evidence in the literature and are applicable to facial plastic surgery colleagues from around the world in order to resume a safe practice.


title: Insights on Otolaryngology Residency Training during the COVID-19 Pandemic

text: Otolaryngology residency training programs are facing a novel challenge due to severe acute respiratory syndrome coronavirus 2. The widespread impact and chronicity of this pandemic makes it unique from any crisis faced by our training programs to date. This international medical crisis has the potential to significantly alter the course of training for our current resident cohort. The decrease in clinical opportunities due to the limitations on elective surgical cases and office visits as well as potential resident redeployment could lead to a decline in overall experience as well as key indicator cases. It is important that we closely monitor the impact of this pandemic on resident education and ensure the implementation of alternative learning strategies while maintaining an emphasis on safety and well-being.


Invisible spread of SARS-CoV-2


The Twitter pandemic: The critical role of Twitter in the dissemination of medical information and misinformation during the COVID-19 pandemic


title: Autophagy as an emerging target for COVID-19: lessons from an old friend, chloroquine

text: During the last week of December 2019, Wuhan (China) was confronted with the first case of respiratory tract disease 2019 (coronavirus disease 2019, COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the rapid outbreak of the transmission (~3.64 million positive cases and high mortality as of 5 May 2020), the world is looking for immediate and better therapeutic options. Still, much information is not known, including origin of the disease, complete genomic characterization, mechanism of transmission dynamics, extent of spread, possible genetic predisposition, clinical and biological diagnosis, complete details of disease-induced pathogenicity, and possible therapeutic options. Although several known drugs are already under clinical evaluation with many in repositioning strategies, much attention has been paid to the aminoquinoline derivates, chloroquine (CQ) and hydroxychloroquine (HCQ). These molecules are known regulators of endosomes/lysosomes, which are subcellular organelles central to autophagy processes. By elevating the pH of acidic endosomes/lysosomes, CQ/HCQ inhibit the autophagic process. In this short perspective, we discuss the roles of CQ/HCQ in the treatment of COVID-19 patients and propose new ways of possible treatment for SARS-CoV-2 infection based on the molecules that selectivity target autophagy.Abbreviation: ACE2: angiotensin I converting enzyme 2; CoV: coronavirus; CQ: chloroquine; ER: endoplasmic reticulum; HCQ: hydroxychloroquine; MERS-CoV: Middle East respiratory syndrome coronavirus; SARS-CoV: severe acute respiratory syndrome coronavirus; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.


Coronavirus - preventing an occupational hazard among doctors


COVID-19: Impact on Perianesthesia Nursing Areas


title: Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies

text: Purpose: Coronavirus disease 2019 (COVID-19) is an emerging disease that was first reported in Wuhan city, the capital of Hubei province in China, and has subsequently spread worldwide. Risk factors for mortality have not been well summarized. Current meta-analysis of retrospective cohort studies was done to summarize available findings on the association between age, gender, comorbidities and risk of death from COVID-19 infection.Methods: Online databases including Web of Science, PubMed, Scopus, Cochrane Library and Google scholar were searched to detect relevant publications up to 1 May 2020, using relevant keywords. To pool data, random-effects model was used. Furthermore, sensitivity analysis and publication bias test were also done.Results: In total, 14 studies with 29,909 COVID-19 infected patients and 1445 cases of death were included in the current meta-analysis. Significant associations were found between older age (≥65 vs <65 years old) (pooled ORs = 4.59, 95%CIs = 2.61-8.04, p < .001), gender (male vs female) (pooled ORs = 1.50, 95%CIs = 1.06-2.12, p = .021) and risk of death from COVID-19 infection. In addition, hypertension (pooled ORs = 2.70, 95%CIs = 1.40-5.24, p = .003), cardiovascular diseases (CVDs) (pooled ORs = 3.72, 95%CIs = 1.77-7.83, p = .001), diabetes (pooled ORs = 2.41, 95%CIs = 1.05-5.51, p = .037), chronic obstructive pulmonary disease (COPD) (pooled ORs = 3.53, 95%CIs = 1.79-6.96, p < .001) and cancer (pooled ORs = 3.04, 95%CIs = 1.80-5.14, p < .001), were associated with higher risk of mortality.Conclusions: Older age (≥65 years old), male gender, hypertension, CVDs, diabetes, COPD and malignancies were associated with greater risk of death from COVID-19 infection. These findings could help clinicians to identify patients with poor prognosis at an early stage.


title: Laboratory considerations amidst the coronavirus disease 2019 outbreak: the Spedali Civili in Brescia experience

text: Coronavirus disease 2019 emergency has created an enormous stress on providers that have been transformed into coronavirus disease hospitals. This article presents the experience of the clinical laboratory of Spedali Civili in Brescia (a teaching hospital in Lombardy with over 1500 beds) in managing the crisis, and to offer practical considerations for laboratory testing for this cohort of patients. Our contribution is threefold: by comparing the demand for tests in two representative period before and within the crisis, we show the change in compositions of the analytes that other labs may expect; we present the new panels of tests that hospital staff can order with different advantage for wards and laboratory; and we show how to reorganize staff on the basis of changes mentioned above.


title: Amyotrophic lateral sclerosis care and research in the United States during the COVID-19 pandemic: Challenges and opportunities

text: Coronavirus disease 2019 has created unprecedented challenges for amyotrophic lateral sclerosis (ALS) clinical care and research in the United States. Traditional evaluations for making an ALS diagnosis, measuring progression, and planning interventions rely on in-person visits that may now be unsafe or impossible. Evidence- and experience-based treatment options, such as multidisciplinary team care, feeding tubes, wheelchairs, home health, and hospice, have become more difficult to obtain and in some places are unavailable. In addition, the pandemic has impacted ALS clinical trials by impairing the ability to obtain measurements for trial eligibility, to monitor safety and efficacy outcomes, and to dispense study drug, as these also often rely on in-person visits. We review opportunities for overcoming some of these challenges through telemedicine and novel measurements. These can reoptimize ALS care and research in the current setting and during future events that may limit travel and face-to-face interactions.


title: Bariatric Surgical Practice During the Initial Phase of COVID-19 Outbreak

text: There is no data on patients with severe obesity who developed coronavirus disease 2019 (COVID-19) after bariatric surgery. Four gastric bypass operations, performed in a 2-week period between Feb 24 and March 4, 2020, in Tehran, Iran, were complicated with COVID-19. The mean age and body mass index were 46 ± 12 years and 49 ± 3 kg/m2. Patients developed their symptoms (fever, cough, dyspnea, and fatigue) 1, 2, 4, and 14 days after surgery. One patient had unnoticed anosmia 2 days before surgery. Three patients were readmitted in hospital. All 4 patients were treated with hydroxychloroquine. In two patients who required admission in intensive care unit, other off-label therapies including antiretroviral and immunosuppressive agents were also administered. All patients survived. In conclusion, COVID-19 can complicate the postoperative course of patients after bariatric surgery. Correct diagnosis and management in the postoperative setting would be challenging. Timing of infection after surgery in our series would raise the possibility of hospital transmission of COVID-19: from asymptomatic patients at the time of bariatric surgery to the healthcare workers versus acquiring the COVID-19 infection by non-infected patients in the perioperative period.


Coronavirus disease 2019 and the cardiovascular system: Impacts and implications


The management of orthopedics and traumatology patients during SARS-CoV-2 pandemic


Still much to learn about the diagnostic role of SARS-CoV-2 antibody detection


Intersecting U.S. Epidemics: COVID-19 and Lack of Health Insurance


title: Acute respiratory distress syndrome due to SARS-CoV-2 and Influenza A co-infection in an Italian patient: Mini-review of the literature

text: A case of acute respiratory distress syndrome due to SARS-CoV-2 and Influenza A co-infection and a mini-review of the literature is reported. Even in COVID-19 epidemics, the early identification of concurrent respiratory pathogens is important to improve etiological diagnosis, preventive measures and patients' clinical management and outcome.


COVID-19: Initial experience of hand surgeons in Northern Italy


title: Design of Potent Membrane Fusion Inhibitors against SARS-CoV-2, an Emerging Coronavirus with High Fusogenic Activity

text: The 2019 coronavirus disease (COVID-19), caused by the emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed serious threats to global public health and economic and social stabilities, calling for the prompt development of therapeutics and prophylactics. In this study, we first verified that SARS-CoV-2 uses human angiotensin-converting enzyme 2 (ACE2) as a cell receptor and that its spike (S) protein mediates high membrane fusion activity. The heptad repeat 1 (HR1) sequence in the S2 fusion protein of SARS-CoV-2 possesses markedly increased α-helicity and thermostability, as well as a higher binding affinity with its corresponding heptad repeat 2 (HR2) site, than the HR1 sequence in S2 of severe acute respiratory syndrome coronavirus (SARS-CoV). Then, we designed an HR2 sequence-based lipopeptide fusion inhibitor, termed IPB02, which showed highly potent activities in inhibiting SARS-CoV-2 S protein-mediated cell-cell fusion and pseudovirus transduction. IPB02 also inhibited the SARS-CoV pseudovirus efficiently. Moreover, the structure-activity relationship (SAR) of IPB02 was characterized with a panel of truncated lipopeptides, revealing the amino acid motifs critical for its binding and antiviral capacities. Therefore, the results presented here provide important information for understanding the entry pathway of SARS-CoV-2 and the design of antivirals that target the membrane fusion step.IMPORTANCE The COVID-19 pandemic, caused by SARS-CoV-2, presents a serious global public health emergency in urgent need of prophylactic and therapeutic interventions. The S protein of coronaviruses mediates viral receptor binding and membrane fusion, thus being considered a critical target for antivirals. Herein, we report that the SARS-CoV-2 S protein has evolved a high level of activity to mediate cell-cell fusion, significantly differing from the S protein of SARS-CoV that emerged previously. The HR1 sequence in the fusion protein of SARS-CoV-2 adopts a much higher helical stability than the HR1 sequence in the fusion protein of SARS-CoV and can interact with the HR2 site to form a six-helical bundle structure more efficiently, underlying the mechanism of the enhanced fusion capacity. Also, importantly, the design of membrane fusion inhibitors with high potencies against both SARS-CoV-2 and SARS-CoV has provided potential arsenals to combat the pandemic and tools to exploit the fusion mechanism.


title: COVID-19 and U.S.-based refugee populations: Commentary

text: The arrival of the pandemic known as COVID-19 has resulted in an emergency appraisal of the way mental health services are delivered to refugee and asylum-seeker populations at the Boston Medical Center in Massachusetts. The following commentary summarizes some of the main approaches used to address the unique needs of this vulnerable population under lockdown. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Cutaneous autoimmune diseases during COVID-19 pandemic


COVID-19: Wait for a novel drug or act with the age old drug - Do we have a choice?


title: Emergency Flexibility for States to Increase and Maintain Medicaid Eligibility for LTSS under COVID-19

text: Medicaid provides essential coverage for health care and long-term services and supports (LTSS) to low-income older adults and disabled individuals but eligibility is complicated and restrictive. In light of the current public health emergency, states have been given new authority to streamline and increase the flexibility of Medicaid LTSS eligibility, helping them enroll eligible individuals and ensure that current beneficiaries are not inadvertently disenrolled. Though state budgets are under increased pressure during the economic crisis created by the coronavirus, we caution states against cutting Medicaid LTSS eligibility or services to balance their budgets. These services are critical to an especially vulnerable population during a global pandemic.


docid: upfehzcw

title: Early institutional head and neck oncologic and microvascular surgery practice patterns across the United States during the SARS-CoV-2 (COVID19) pandemic

text: BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic has caused rapid changes in head and neck cancer (HNC) care. "Real-time" methods to monitor practice patterns can optimize provider safety and patient care. METHODS: Head and neck surgeons from 14 institutions in the United States regularly contributed their practice patterns to a shared spreadsheet. Data from 27 March 2020 to 5 April 2020 was analyzed. RESULTS: All institutions had significantly restricted HNC clinic evaluations. Two institutions stopped free-flap surgery with the remaining scheduling surgery by committee review. Factors contributing to reduced clinical volume included lack of personal protective equipment (PPE) (35%) and lack of rapid COVID-19 testing (86%). CONCLUSIONS: The COVID-19 pandemic has caused a reduction in HNC care. Rapid COVID-19 testing and correlation with infectious potential remain paramount to resuming the care of patients with head and neck cancer. Cloud-based platforms to share practice patterns will be essential as the pandemic evolves.


Editöre Mektup - Ruh Sagligi ve Covid-19 Pandemisi: Dikkate Alinmasi Gereken Bir Konu; Uyum Bozuklugu ve Psikososyal Müdahaleler./ Editöre Mektup - Ruh Sagligi ve Covid-19 Pandemisi: Dikkate Alinmasi Gereken Bir Konu; Uyum Bozuklugu ve Psikososyal Müdahaleler./ Letter To The Editor - The Covid-19 Pandemic And Mental Health As Issues Considered Within The Context Of Adjustment Disorder And Psychosocial Interventions


Massive Hemothorax Due to Intrathoracic Herniation of the Gastric Remnant After Roux-en-Y Gastric Bypass with Concurrent Hiatal Hernia Repair


title: Dynamic changes of D-dimer and neutrophil-lymphocyte count ratio as prognostic biomarkers in COVID-19

text: BACKGROUND: Since December 2019, the outbreak of COVID-19 caused a large number of hospital admissions in China. Many patients with COVID-19 have symptoms of acute respiratory distress syndrome, even are in danger of death. This is the first study to evaluate dynamic changes of D-Dimer and Neutrophil-Lymphocyte Count Ratio (NLR) as a prognostic utility in patients with COVID-19 for clinical use. METHODS: In a retrospective study, we collected data from 349 hospitalized patients who diagnosed as the infection of the COVID-19 in Wuhan Pulmonary Hospital. We used ROC curves and Cox regression analysis to explore critical value (optimal cut-off point associated with Youden index) and prognostic role of dynamic changes of D-Dimer and NLR. RESULTS: Three hundred forty-nine participants were enrolled in this study and the mortality rate of the patients with laboratory diagnosed COVID-19 was 14.9%. The initial and peak value of D-Dimer and NLR in deceased patients were higher statistically compared with survivors (P < 0.001). There was a more significant upward trend of D-Dimer and NLR during hospitalization in the deceased patients, initial D-Dimer and NLR were lower than the peak tests (MD) -25.23, 95% CI: - 31.81- -18.64, P < 0.001; (MD) -43.73, 95% CI:-59.28- -31.17, P < 0.001. The test showed a stronger correlation between hospitalization days, PCT and peak D-Dimer than initial D-Dimer. The areas under the ROC curves of peak D-Dimer and peak NLR tests were higher than the initial tests (0.94(95%CI: 0.90-0.98) vs. 0.80 (95% CI: 0.73-0.87); 0.93 (95%CI:0.90-0.96) vs. 0.86 (95%CI:0.82-0.91). The critical value of initial D-Dimer, peak D-Dimer, initial NLR and peak NLR was 0.73 mg/L, 3.78 mg/L,7.13 and 14.31 respectively. 35 (10.03%) patients were intubated. In the intubated patients, initial and peak D-Dimer and NLR were much higher than non-intubated patients (P < 0.001). The critical value of initial D-Dimer, peak D-Dimer, initial NLR and peak NLR in prognosticate of intubation was 0.73 mg/L, 12.75 mg/L,7.28 and 27.55. The multivariable Cox regression analysis showed that age (HR 1.04, 95% CI 1.00-1.07, P = 0.01), the peak D-Dimer (HR 1.03, 95% CI 1.01-1.04, P < 0.001) were prognostic factors for COVID-19 patients' death. CONCLUSIONS: To dynamically observe the ratio of D-Dimer and NLR was more valuable during the prognosis of COVID-19. The rising trend in D-Dimer and NLR, or the test results higher than the critical values may indicate a risk of death for participants with COVID-19.


title: The COVID-19 pandemic: A rapid global response for children with cancer from SIOP, COG, SIOP-E, SIOP-PODC, IPSO, PROS, CCI, and St Jude Global

text: The COVID-19 pandemic is one of the most serious global challenges to delivering affordable and equitable treatment to children with cancer we have witnessed in the last few decades. This Special Report aims to summarize general principles for continuing multidisciplinary care during the SARS-CoV-2 (COVID-19) pandemic. With contributions from the leadership of the International Society for Pediatric Oncology (SIOP), Children's Oncology Group (COG), St Jude Global program, and Childhood Cancer International, we have sought to provide a framework for healthcare teams caring for children with cancer during the pandemic. We anticipate the burden will fall particularly heavily on children, their families, and cancer services in low- and middle-income countries. Therefore, we have brought together the relevant clinical leads from SIOP Europe, COG, and SIOP-PODC (Pediatric Oncology in Developing Countries) to focus on the six most curable cancers that are part of the WHO Global Initiative in Childhood Cancer. We provide some practical advice for adapting diagnostic and treatment protocols for children with cancer during the pandemic, the measures taken to contain it (e.g., extreme social distancing), and how to prepare for the anticipated recovery period.


COVID 19 uncertainty


title: Estimates of the proportion of SARS-CoV-2 infected individuals in Sweden

text: In this paper a Bayesian SEIR model is studied to estimate the proportion of the population infected with SARS-CoV-2, the virus responsible for COVID-19. To capture heterogeneity in the population and the effect of interventions to reduce the rate of epidemic spread, the model uses a time-varying contact rate, whose logarithm has a Gaussian process prior. A Poisson point process is used to model the occurrence of deaths due to COVID-19 and the model is calibrated using data of daily death counts in combination with a snapshot of the the proportion of individuals with an active infection, performed in Stockholm in late March. The methodology is applied to regions in Sweden. The results show that the estimated proportion of the population who has been infected is around 13.5% in Stockholm, by 2020-05-15, and ranges between 2.5% - 15.6% in the other investigated regions. In Stockholm where the peak of daily death counts is likely behind us, parameter uncertainty does not heavily influence the expected daily number of deaths, nor the expected cumulative number of deaths. It does, however, impact the estimated cumulative number of infected individuals. In the other regions, where random sampling of the number of active infections is not available, parameter sharing is used to improve estimates, but the parameter uncertainty remains substantial.