Adapting to the contemporary normal in cancer management and workflow during COVID-19 situation in the Philippines: Multi-cancer center collaborative approach


docid: kxwuxwqz

title: Health equity and distributive justice considerations in critical care resource allocation


docid: efbfqnem

title: GEOM: Energy-annotated molecular conformations for property prediction and molecular generation

text: Machine learning outperforms traditional approaches in many molecular design tasks. Although molecules are often thought of as 2D graphs, they in fact consist of an ensemble of inter-converting 3D structures called conformers. Molecular properties arise from the contribution of many conformers, and in the case of a drug binding a target, may be due mainly to a few distinct members. Molecular representations in machine learning are typically based on either one single 3D conformer or on a 2D graph that strips geometrical information. No reference datasets exist that connect these graph and point cloud ensemble representations. Here, we use first-principles simulations to annotate over 400,000 molecules with the ensemble of geometries they span. The Geometrical Embedding Of Molecules (GEOM) dataset contains over 33 million molecular conformers labeled with their relative energies and statistical probabilities at room temperature. This dataset will assist benchmarking and transfer learning in two classes of tasks: inferring 3D properties from 2D molecular graphs, and developing generative models to sample 3D conformations.


title: Inactivation of severe acute respiratory syndrome coronavirus 2 in plasma and platelet products using a riboflavin and ultraviolet light-based photochemical treatment

text: BACKGROUND AND OBJECTIVE: Severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is a member of the coronavirus family. Coronavirus infections in humans are typically associated with respiratory illnesses; however, viral RNA has been isolated in serum from infected patients. Coronaviruses have been identified as a potential low-risk threat to blood safety. The Mirasol Pathogen Reduction Technology (PRT) System utilizes riboflavin and ultraviolet (UV) light to render blood-borne pathogens noninfectious, while maintaining blood product quality. Here, we report on the efficacy of riboflavin and UV light against the pandemic virus SARS-CoV-2 when tested in both plasma and platelets units. MATERIALS AND METHODS: Stock SARS-CoV-2 was grown in Vero cells and inoculated into either plasma or platelet units. Those units were then treated with riboflavin and UV light. The infectious titres of SARS-CoV-2 were determined by plaque assay using Vero cells. A total of five (n = 5) plasma and three (n = 3) platelet products were evaluated in this study. RESULTS: In both experiments, the measured titre of SARS-CoV-2 was below the limit of detection following treatment with riboflavin and UV light. The mean log reductions in the viral titres were ≥3·40 and ≥4·53 for the plasma units and platelet units, respectively. CONCLUSION: Riboflavin and UV light effectively reduced the titre of SARS-CoV-2 in both plasma and platelet products to below the limit of detection in tissue culture. The data suggest that the process would be effective in reducing the theoretical risk of transfusion transmitted SARS-CoV-2.


title: COVID-19 the showdown for mass casualty preparedness and management: the Cassandra Syndrome

text: Since December 2019, the world is potentially facing one of the most difficult infectious situations of the last decades. COVID-19 epidemic warrants consideration as a mass casualty incident (MCI) of the highest nature. An optimal MCI/disaster management should consider all four phases of the so-called disaster cycle: mitigation, planning, response, and recovery. COVID-19 outbreak has demonstrated the worldwide unpreparedness to face a global MCI.This present paper thus represents a call for action to solicitate governments and the Global Community to actively start effective plans to promote and improve MCI management preparedness in general, and with an obvious current focus on COVID-19.


title: Harmless Effects of Sterilizing 222-nm far-UV Radiation on Mouse Skin and Eye Tissues

text: In this issue, Yamano et al. provide further evidence that germicidal 222-nm far UV light has no immediate and delayed harmful effects on the skin and ocular tissue of rats. The safety of 222-nm krypton-chlorine excimer lamps, highlighted in the commentary article, has already received relevant applications in the treatment of surgical site infections and in the control of airborne and foodborne pathogens.


Cancer and coronavirus disease 2019; how do we manage cancer optimally through a public health crisis?


title: Targeting Neprilysin (NEP) pathways: A potential new hope to defeat COVID-19 ghost

text: COVID-19 is an ongoing viral pandemic disease that is caused by SARS-CoV2, inducing severe pneumonia in humans. However, several classes of repurposed drugs have been recommended, no specific vaccines or effective therapeutic interventions for COVID-19 are developed till now. Viral dependence on ACE-2, as entry receptors, drove the researchers into RAS impact on COVID-19 pathogenesis. Several evidences have pointed at Neprilysin (NEP) as one of pulmonary RAS components. Considering the protective effect of NEP against pulmonary inflammatory reactions and fibrosis, it is suggested to direct the future efforts towards its potential role in COVID-19 pathophysiology. Thus, the review aimed to shed light on the potential beneficial effects of NEP pathways as a novel target for COVID-19 therapy by summarizing its possible molecular mechanisms. Additional experimental and clinical studies explaining more the relationships between NEP and COVID-19 will greatly benefit in designing the future treatment approaches.


New Challenges and Opportunities for Echocardiographic Education during the COVID-19 Pandemic: A Call to Focus on Competency and Pathology


Time-Out Protocol to Ensure Understanding and Implementation of the Storm of Instructions and Protocols During the COVID-19 Pandemic


title: Glutathione Modified Fluorescent CdS QDs Synthesized Using Environmentally Benign Pathway for Detection of Mercury Ions in Aqueous Phase

text: An adept, rapid and novel water-soluble glutathione functionalized CdS quantum dots (GSH@CdS QDs) were fabricated using green pathway for sensing of heavy metal contamination prevalent in industrial wastewater. GSH@CdS QDs were facilely synthesized in an aqueous phase reaction and were effectively characterized using FT-IR, XRD, FESEM, HRTEM and EDX techniques. The distinct fluorescence characteristics of GSH@CdS QDs were explored and the QDs showed selective sensitivity towards mercury ions with a low limit of detection of 0.54 nM under optimal conditions. The detailed interaction between GSH@CdS QDs and Hg2+ and the probable fluorescence quenching mechanism were established in this study. In comparison to already reported fluorescent probes, GSH@CdS QDs showed high sensitivity, biocompatibility, long fluorescence stability and convenient removal of mercury ions. Graphical Abstract Facile green route for the fabrication of glutathione capped CdS quantum dots for fluorescence-based detection of toxic Hg2+ ions.


title: Herd immunity and a vaccination game: An experimental study

text: Would the affected communities voluntarily obtain herd immunity if a cure for COVID-19 was available? This paper experimentally investigates people's vaccination choices in the context of a nonlinear public good game. A "vaccination game" is defined in which costly commitments (vaccination) are required of a fraction of the population to reach the critical level needed for herd immunity, without which defectors are punished by the natural contagion of epidemics. Our experimental implementation of a vaccination game in a controlled laboratory setting reveals that endogenous epidemic punishment is a credible threat, resulting in voluntary vaccination to obtain herd immunity, for which the orthodox principle of positive externalities fails to account. The concave nature of the infection probability plays a key role in facilitating the elimination of an epidemic.


One Health approach and Coronavirus Disease 2019


title: The impact of a nation-wide lockdown on COVID-19 transmissibility in Italy

text: On March 10, 2020, Italy imposed a national lockdown to curtail the spread of COVID-19. Here we estimate that, fourteen days after the implementation of the strategy, the net reproduction number has dropped below the epidemic threshold - estimated range 0.4-0.7. Our findings provide a timeline of the effectiveness of the implemented lockdown, which is relevant for a large number of countries that followed Italy in enforcing similar measures.


title: SARS-COV-2 children transmission: the evidence is that today we do not have enough evidence

text: I have read with interest the review by Ludvigsson on the role of children as transmitters of the new coronavirus (SARS-COV-2). An in-depth review of the current literature focused on 40 published articles and 7 non-peer reviewed papers1 . All the papers included have been done under lockdown conditions. As a consequence, we should not ignore a main bias of this review1 . The main conclusion we can draw now is that under confined conditions, children are not the main drivers of the COVID-19 pandemic. And "Confined" is not a normal situation.


SARS-CoV-2 children transmission: The evidence is that today we do not have enough evidence


title: Translating COVID-19 Pandemic Surge Theory to Practice in the Emergency Department: How to Expand Structure

text: Multiple professional societies, nongovernment and government agencies have studied the science of sudden onset disaster mass casualty incidents to create and promote surge response guidelines. The COVID-19 pandemic has presented the health-care system with challenges that have limited science to guide the staff, stuff, and structure surge response.This study reviewed the available surge science literature specifically to guide an emergency department's surge structural response using a translational science approach to answer the question: How does the concept of sudden onset mass casualty incident surge capability apply to the process to expand COVID-19 pandemic surge structure response?The available surge structural science literature was reviewed to determine the application to a pandemic response. The on-line ahead of print and print COVID-19 scientific publications, as well as gray literature were studied to learn the best available COVID-19 surge structural response science. A checklist was created to guide the emergency department team's COVID-19 surge structural response.


docid: pkwfwggs

title: Covid-19: preparedness, decentralisation, and the hunt for patient zero


Seven days in medicine: 6-12 May 2020


Co-infection of SARS-CoV-2 and HIV in a patient in Wuhan city, China


title: Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study

text: Background: Mortality of patients with coronavirus disease 2019 (COVID-19), acute respiratory distress syndrome (ARDS), and systemic inflammation is high. In areas of pandemic outbreak, the number of patients can exceed maximum capacity of intensive care units (ICUs), and, thus, these individuals often receive non-invasive ventilation outside of the ICU. Effective treatments for this population are needed urgently. Anakinra is a recombinant interleukin-1 receptor antagonist that might be beneficial in this patient population. Methods: We conducted a retrospective cohort study at the San Raffaele Hospital in Milan, Italy. We included consecutive patients (aged ≥18 years) with COVID-19, moderate-to-severe ARDS, and hyperinflammation (defined as serum C-reactive protein ≥100 mg/L, ferritin ≥900 ng/mL, or both) who were managed with non-invasive ventilation outside of the ICU and who received standard treatment of 200 mg hydroxychloroquine twice a day orally and 400 mg lopinavir with 100 mg ritonavir twice a day orally. We compared survival, mechanical ventilation-free survival, changes in C-reactive protein, respiratory function, and clinical status in a cohort of patients who received additional treatment with anakinra (either 5 mg/kg twice a day intravenously [high dose] or 100 mg twice a day subcutaneously [low dose]) with a retrospective cohort of patients who did not receive anakinra (referred to as the standard treatment group). All outcomes were assessed at 21 days. This study is part of the COVID-19 Biobank study, which is registered with ClinicalTrials.gov, NCT04318366. Findings: Between March 17 and March 27, 2020, 29 patients received high-dose intravenous anakinra, non-invasive ventilation, and standard treatment. Between March 10 and March 17, 2020, 16 patients received non-invasive ventilation and standard treatment only and comprised the comparison group for this study. A further seven patients received low-dose subcutaneous anakinra in addition to non-invasive ventilation and standard treatment; however, anakinra treatment was interrupted after 7 days because of a paucity of effects on serum C-reactive protein and clinical status. At 21 days, treatment with high-dose anakinra was associated with reductions in serum C-reactive protein and progressive improvements in respiratory function in 21 (72%) of 29 patients; five (17%) patients were on mechanical ventilation and three (10%) died. In the standard treatment group, eight (50%) of 16 patients showed respiratory improvement at 21 days; one (6%) patient was on mechanical ventilation and seven (44%) died. At 21 days, survival was 90% in the high-dose anakinra group and 56% in the standard treatment group (p=0·009). Mechanical ventilation-free survival was 72% in the anakinra group versus 50% in the standard treatment group (p=0·15). Bacteraemia occurred in four (14%) of 29 patients receiving high-dose anakinra and two (13%) of 16 patients receiving standard treatment. Discontinuation of anakinra was not followed by inflammatory relapses. Interpretation: In this retrospective cohort study of patients with COVID-19 and ARDS managed with non-invasive ventilation outside of the ICU, treatment with high-dose anakinra was safe and associated with clinical improvement in 72% of patients. Confirmation of efficacy will require controlled trials. Funding: None.


Guillain-Barré syndrome in the COVID-19 era: just an occasional cluster?


title: Power-law distribution in the number of confirmed COVID-19 cases

text: COVID-19 is an emerging respiratory infectious disease caused by the coronavirus SARS-CoV-2. It was first reported on in early December 2019 in Wuhan, China and within three month spread as a pandemic around the whole globe. Here, we study macro-epidemiological patterns along the time course of the pandemic. We compute the distribution of confirmed COVID-19 cases and deaths for countries worldwide and for counties in the US, and show that both distributions follow a truncated power-law over five orders of magnitude. We are able to explain the origin of this scaling behavior as a dual-scale process: the large-scale spread of the virus between countries and the small-scale accumulation of case numbers within each country. Assuming exponential growth on both scales, the critical exponent of the power-law is determined by the ratio of large-scale to small-scale growth rates. We confirm this theory in numerical simulations in a simple meta-population model, describing the epidemic spread in a network of interconnected countries. Our theory gives a mechanistic explanation why most COVID-19 cases occurred within a few epicenters, at least in the initial phase of the outbreak. Assessing how well a simple dual-scale model predicts the early spread of epidemics, despite the huge contrasts between countries, could help identify critical temporal and spatial scales of response in which to mitigate future epidemic threats.


Critical Review of the Literature on Chest CT and Coronavirus Disease (COVID-19): Data Adjustment


title: "This is our next problem": Cleaning up from the COVID-19 response

text: The purpose of this discussion is to highlight the essential role that solid waste management must play in a humanitarian response towards disasters, in particular the ongoing Covid-19 pandemic. We highlight a number of potential avenues for scholarly investigation into the waste impacts of our response to Covid-19, but in particular, briefly unpacks the relationship between disasters, consumption and disposability as one potential research topic. The discussion is intended to start a conversation that is, at the moment, critically relevant, and to contribute to a more inclusive, and less normatively Western waste management studies discourse.


title: Preventive strategy for the clinical treatment of hip fractures in the elderly during the COVID-19 outbreak: Wuhan's experience

text: Hip fractures in the elderly account for more than half of osteoporotic fractures and represent a substantial economic and social burden. Novel coronavirus pneumonia (COVID-19), which began to spread in December 2019, has created challenges in the management of elderly hip fracture patients, not only by influencing the choice of operation and postoperative rehabilitation methods, but also by generating new risks for the medical staff. During this period, our infection and orthopedic treatment unit in the center of the epidemic area effectively treated 82 elderly patients with hip fracture, and no cross-infection occurred. Therefore, our experience in prevention and treatment is worth recommending to frontline anti-epidemic personnel.


title: EZH2-mediated H3K27me3 inhibits ACE2 expression

text: The outbreak of corona virus disease 2019 (COVID-19) caused by SARS-CoV-2 infection is spreading globally and quickly, leading to emerging health issues. SARS-CoV-2 enters into and infects host cells through its spike glycoprotein recognizing the cell receptor Angiotensin-converting enzyme II (ACE2). Here, we noticed that ACE2 was further enhanced by SARS-CoV-2 infection. Human germ cells and early embryos express high level of ACE2. Notably, RNA-seq result showed that reduction of H3K27me3, but not H3K4/9/36me3, led to upregulation of Ace2 expression in mouse germ cell line GC-2. In agreement with this result, we found in human embryonic stem cells that ACE2 expression was significantly increased in absence of EZH2, the major enzyme catalyzing H3K27me3. ChIP-seq analysis further confirmed decrease of H3K27me3 signal and increase of H3K27ac signal at ACE2 promoter upon EZH2 knockout. Therefore, we propose that EZH2-mediated H3K27me3 at ACE2 promoter region inhibits ACE2 expression in mammalian cells. This regulatory pattern may also exist in other human cells and tissues. Our discovery provides clues for pathogenesis and targeted drug therapy towards ACE2 expression for prevention and adjuvant therapy of COVID-19.


title: Sustainable and resilient strategies for touristic cities against COVID-19: an agent-based approach

text: Touristic cities will suffer from COVID-19 emergency because of its economic impact on their communities. The first emergency phases involved a wide closure of such areas to support"social distancing"measures (i.e. travels limitation; lockdown of (over)crowd-prone activities). In the second phase, individual's risk-mitigation strategies (facial masks) could be properly linked to"social distancing"to ensure re-opening touristic cities to visitors. Simulation tools could support the effectiveness evaluation of risk-mitigation measures to look for an economic and social optimum for activities restarting. This work modifies an existing Agent-Based Model to estimate the virus spreading in touristic areas, including tourists and residents' behaviours, movement and virus effects on them according to a probabilistic approach. Consolidated proximity-based and exposure-time-based contagion spreading rules are included according to international health organizations and previous calibration through experimental data. Effects of tourists' capacity (as"social distancing"-based measure) and other strategies (i.e. facial mask implementation) are evaluated depending on virus-related conditions (i.e. initial infector percentages). An idealized scenario representing a significant case study has been analysed to demonstrate the tool capabilities and compare the effectiveness of those solutions. Results show that"social distancing"seems to be more effective at the highest infectors' rates, although represents an extreme measure with important economic effects. This measure loses its full effectiveness (on the community) as the infectors' rate decreases and individuals' protection measures become predominant (facial masks). The model could be integrated to consider other recurring issues on tourist-related fruition and schedule of urban spaces and facilities (e.g. cultural/leisure buildings).


Concomitant neurological symptoms observed in a patient diagnosed with coronavirus disease 2019


docid: yewybomh

title: Mounting a Regional Response to the COVID-19 Pandemic: Another Reason to "Keep" Your Lab

text: Context: Declining reimbursement shifts hospital laboratories from system assets to cost centers. This has resulted in increased outsourcing of laboratory services which can jeopardize a hospital systems ability to respond to a health care crisis. Objectives: To demonstrate investment in a core laboratory serving an academic medical center equipped a regional health system to respond to the pandemic. Design: COVID-19 diagnostic testing data was analyzed. Volumes were evaluated by result date (3/16/2020 - 5/6/2020) and the average of received to verified turn-around-time (TAT) was calculated and compared for in-house and send-out testing, and different in-house testing methodologies. Results: Daily viral diagnostic testing capacity increased by greater than 3000 % (from 21 tests per day to 658 tests per day). Total viral diagnostic testing resulted by the core lab increased by 128 times over 22 days of test method validation and 826 times over the analysis period while average turn-around-time per day for send-out testing increased from 3.7 days to 21 days. Decreased overall average TAT was observed at the core laboratory (0.45 days) verses send-out testing (7.63 days) (P < .001). Conclusions: Investment in a core laboratory provided the health system with the necessary expertise and resources to mount a robust response to the pandemic. Local access to testing allowed rapid triage of patients and conservation of scarce personal protective equipment. In addition, the core laboratory was able to support regional health departments and several hospitals outside of the system.


title: COVID-19: gastrointestinal symptoms and potential sources of 2019-nCoV transmission

text: A new type of coronavirus, i.e. se-vere acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly known as 2019-nCoV) appeared in December 2019 in the province of Hubei, China, and over the past four months the number of cases of infection has exceeded 240,000 worldwide, leading to a pandemia [1]. At the genetic level, 2019-nCoV is closely related to the SARS-CoV and, to a lesser extent, to MERS-CoV, which appeared as epidemiological threats in recent years in China and the Middle East, respectively. Infections with the Coronaviridae virus family in a small percentage of patients, especially in those over 60 years of age with a positive clinical history, lead to severe acute respiratory syndrome [2].


title: COVID-19: to be or not to be; that is the diagnostic question

text: Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.


title: Remote Monitoring in Clinical Trials During the COVID-19 Pandemic

text: The coronavirus disease 2019 (COVID-19) pandemic has rapidly challenged the pharmaceutical industry to implement remote clinical trials. The industry's lack of extensive experience with remote measurements initiates multiple questions about how to select candidates for remote collection, their validity, and regulatory implications of moving certain assessments to a remote mode. We propose a decision tree for migration of clinic to remote assessments and highlight activities required to ensure that these measurements are valid, safe, and usable.


title: Assessing the Impact of the COVID-19 Outbreak on the Attitudes and Practice of Italian Oncologists Toward Breast Cancer Care and Related Research Activities

text: PURPOSE: To investigate the impact of the COVID-19 outbreak on the attitudes and practice of Italian oncologists toward breast cancer care and related research activities. METHODS: A 29-question anonymous online survey was sent by e-mail to members of the Italian Association of Medical Oncology and the Italian Breast Cancer Study Group on April 3, 2020. Only medical oncologists (both those in training and specialists) were invited to complete the questionnaire. RESULTS: Out of 165 responding oncologists, 121 (73.3.%) worked in breast units. In the (neo)adjuvant setting, compared with before the emergency, fewer oncologists adopted weekly paclitaxel (68.5% v 93.9%) and a dose-dense schedule for anthracycline-based chemotherapy (43% v 58.8%) during the COVID-19 outbreak. In the metastatic setting, compared with before the emergency, fewer oncologists adopted first-line weekly paclitaxel for HER2-positive disease (41.8% v 53.9%) or CDK4/6 inhibitors for luminal tumors with less-aggressive characteristics (55.8% v 80.0%) during the COVID-19 outbreak. A significant change was also observed in delaying the timing for monitoring therapy with CDK4/6 inhibitors, assessing treatment response with imaging tests, and flushing central venous devices. Clinical research and scientific activities were reduced in 80.3% and 80.1% of respondents previously implicated in these activities, respectively. CONCLUSION: Medical oncologists face many challenges in providing cancer care during the COVID-19 outbreak. Although most of the changes in their attitudes and practice were reasonable responses to the current health care emergency without expected major negative impact on patient outcomes, some potentially alarming signals of undertreatment were observed.


title: Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a rapid review

text: BACKGROUND: Convalescent plasma and hyperimmune immunoglobulin may reduce mortality in patients with respiratory virus diseases, and are currently being investigated in trials as a potential therapy for coronavirus disease 2019 (COVID-19). A thorough understanding of the current body of evidence regarding the benefits and risks is required. OBJECTIVES: To assess whether convalescent plasma or hyperimmune immunoglobulin transfusion is effective and safe in the treatment of people with COVID-19. SEARCH METHODS: The protocol was pre-published with the Center for Open Science and can be accessed here: osf.io/dwf53 We searched the World Health Organization (WHO) COVID-19 Global Research Database, MEDLINE, Embase, Cochrane COVID-19 Study Register, Centers for Disease Control and Prevention COVID-19 Research Article Database and trials registries to identify ongoing studies and results of completed studies on 23 April 2020 for case-series, cohort, prospectively planned, and randomised controlled trials (RCTs). SELECTION CRITERIA: We followed standard Cochrane methodology and performed all steps regarding study selection in duplicate by two independent review authors (in contrast to the recommendations of the Cochrane Rapid Reviews Methods Group). We included studies evaluating convalescent plasma or hyperimmune immunoglobulin for people with COVID-19, irrespective of disease severity, age, gender or ethnicity. We excluded studies including populations with other coronavirus diseases (severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS)) and studies evaluating standard immunoglobulins. DATA COLLECTION AND ANALYSIS: We followed recommendations of the Cochrane Rapid Reviews Methods Group regarding data extraction and assessment. To assess bias in included studies, we used the assessment criteria tool for observational studies, provided by Cochrane Childhood Cancer. We rated the certainty of evidence using the GRADE approach for the following outcomes: all-cause mortality at hospital discharge, improvement of clinical symptoms (7, 15, and 30 days after transfusion), grade 3 and 4 adverse events, and serious adverse events. MAIN RESULTS: We included eight studies (seven case-series, one prospectively planned, single-arm intervention study) with 32 participants, and identified a further 48 ongoing studies evaluating convalescent plasma (47 studies) or hyperimmune immunoglobulin (one study), of which 22 are randomised. Overall risk of bias of the eight included studies was high, due to: study design; small number of participants; poor reporting within studies; and varied type of participants with different severities of disease, comorbidities, and types of previous or concurrent treatments, including antivirals, antifungals or antibiotics, corticosteroids, hydroxychloroquine and respiratory support. We rated all outcomes as very low certainty, and we were unable to summarise numerical data in any meaningful way. As we identified case-series studies only, we reported results narratively. Effectiveness of convalescent plasma for people with COVID-19 The following reported outcomes could all be related to the underlying natural history of the disease or other concomitant treatment, rather than convalescent plasma. All-cause mortality at hospital discharge All studies reported mortality. All participants were alive at the end of the reporting period, but not all participants had been discharged from hospital by the end of the study (15 participants discharged, 6 still hospitalised, 11 unclear). Follow-up ranged from 3 days to 37 days post-transfusion. We do not know whether convalescent plasma therapy affects mortality (very low-certainty evidence). Improvement of clinical symptoms (assessed by respiratory support) Six studies, including 28 participants, reported the level of respiratory support required; most participants required respiratory support at baseline. All studies reported improvement in clinical symptoms in at least some participants. We do not know whether convalescent plasma improves clinical symptoms (very low-certainty evidence). Time to discharge from hospital Six studies reported time to discharge from hospital for at least some participants, which ranged from four to 35 days after convalescent plasma therapy. Admission on the intensive care unit (ICU) Six studies included patients who were critically ill. At final follow-up the majority of these patients were no longer on the ICU or no longer required mechanical ventilation. Length of stay on the ICU Only one study (1 participant) reported length of stay on the ICU. The individual was discharged from the ICU 11 days after plasma transfusion. Safety of convalescent plasma for people with COVID-19 Grade 3 or 4 adverse events The studies did not report the grade of adverse events after convalescent plasma transfusion. Two studies reported data relating to participants who had experienced adverse events, that were presumably grade 3 or 4. One case study reported a participant who had moderate fever (38.9 °C). Another study (3 participants) reported a case of severe anaphylactic shock. Four studies reported the absence of moderate or severe adverse events (19 participants). We are very uncertain whether or not convalescent plasma therapy affects the risk of moderate to severe adverse events (very low-certainty evidence). Serious adverse events One study (3 participants) reported one serious adverse event. As described above, this individual had severe anaphylactic shock after receiving convalescent plasma. Six studies reported that no serious adverse events occurred. We are very uncertain whether or not convalescent plasma therapy affects the risk of serious adverse events (very low-certainty evidence). AUTHORS' CONCLUSIONS: We identified eight studies (seven case-series and one prospectively planned single-arm intervention study) with a total of 32 participants (range 1 to 10). Most studies assessed the risks of the intervention; reporting two adverse events (potentially grade 3 or 4), one of which was a serious adverse event. We are very uncertain whether convalescent plasma is effective for people admitted to hospital with COVID-19 as studies reported results inconsistently, making it difficult to compare results and to draw conclusions. We identified very low-certainty evidence on the effectiveness and safety of convalescent plasma therapy for people with COVID-19; all studies were at high risk of bias and reporting quality was low. No RCTs or controlled non-randomised studies evaluating benefits and harms of convalescent plasma have been completed. There are 47 ongoing studies evaluating convalescent plasma, of which 22 are RCTs, and one trial evaluating hyperimmune immunoglobulin. We will update this review as a living systematic review, based on monthly searches in the above mentioned databases and registries. These updates are likely to show different results to those reported here.


The double burden of disease of COVID-19 in cardiovascular patients: overlapping conditions could lead to overlapping treatments


2019-nCoV in context: lessons learned?


COVID-19: A Lesson in Humility and an Opportunity for Sagacity and Hope


docid: qogkoser

title: Market structure dynamics during COVID-19 outbreak

text: In this note, we discuss the impact of the COVID-19 outbreak from the perspective of the market-structure. We observe that the US market-structure has dramatically changed during the past four weeks and that the level of change has followed the number of infected cases reported in the USA. Presently, market-structure resembles most closely the structure during the middle of the 2008 crisis but there are signs that it may be starting to evolve into a new structure altogether. This is the first article of a series where we will be analyzing and discussing market-structure as it evolves to a state of further instability or, more optimistically, stabilization and recovery.


title: Current State of Research About Chinese Herbal Medicines (CHM) for the Treatment of Coronavirus Disease 2019 (COVID-19): A Scoping Review

text: Background: There is currently no effective treatment against coronavirus disease 2019 (COVID-19). The optimal selection of interventions targeting the virus is unknown. Therefore, evidence from randomized controlled trials (RCTs) to support specific treatment against COVID-19 is urgently needed. The use of Chinese herbal medicines (CHMs) might have a role in the treatment and symptomatic management of patients with COVID-19. It was aimed at providing an overview of the available evidence and ongoing trials concerning the effects of CHMs for the treatment of COVID-19. Methods: This is a narrative review of relevant studies. Searches were conducted to identify documents published till April 22, 2020. Electronic databases, evidence-based collections, websites of relevant organizations, and trial registries were consulted. Results: A total of 25 guidelines on the treatment of patients with COVID-19 were identified. Four guidelines provided recommendations on the use of CHMs; these guidelines were developed in China and South Korea and were based on the consensus of experts exclusively. The remaining 21 guidelines provided no guidance on CHMs. No finished RCTs of CHMs for the treatment of patients with COVID-19 was found. According to the evidence evaluated in this review, a Cochrane review of CHMs for severe acute respiratory syndrome and five uncontrolled observational studies of the effects of CHMs in patients with COVID-19, the effects of CHMs for COVID-19 are unknown. A total of 52 ongoing clinical trials of CHM interventions for the treatment of COVID-19 were found. These trials will be carried out mostly in China (n = 51). Forty (77%) of the ongoing trials will be randomized, whereas 12 (23%) have an unclear sequence generation procedure. Forty-seven trials (90%) will have a sample size <400 participants. Conclusions: To the authors' knowledge, only the Chinese and the South Korean guidelines recommend CHMs as a treatment option for patients with COVID-19. These guidelines base their recommendations on the consensus of experts. Clinical guidelines or health authorities from other countries do not provide advice on CHMs. Due to the absence of RCT, there is currently no reliable evidence on the effects of any specific CHM intervention for the treatment of patients with COVID-19. A high number of clinical trials of different herbal products are being currently conducted in China.


Visiting Sub-Interships in Wake of the Covid-19 Crisis: An Opportunity for Improvement


Cardiovascular Collateral Damages at the Time of COVID-19


title: Evidence-Based Guidelines for Management of Head and Neck Mucosal Malignancies during the COVID-19 Pandemic

text: OBJECTIVE: Due to the current coronavirus disease 2019 (COVID-19) pandemic, otolaryngologists face novel challenges when treating patients with head and neck cancer. The purpose of this review is to evaluate the current evidence surrounding the treatment of these patients during this pandemic and to provide evidence-based recommendations with attention to increased risk in this setting. DATA SOURCES: A review of the literature was performed with PubMed. Because recently published articles on this topic may not yet be indexed into PubMed, otolaryngology journals were hand searched for relevant articles. Guidelines from national organizations were reviewed to identify additional relevant sources of information. REVIEW METHODS: Two groups of search terms were created: one with terms related to COVID-19 and another with terms related to head and neck cancer and its management. Searches were performed of all terms in each group as well as combinations of terms between groups. Searches and subsequent exclusion of articles were performed in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Additional articles were identified after relevant journals and guidelines from national organizations were reviewed. CONCLUSIONS: Patients with head and neck mucosal malignancy require continued treatment despite the current pandemic state. Care must be taken at all stages of treatment to minimize the risk to patients and health care workers while maintaining focus on minimizing use of limited resources. IMPLICATIONS FOR PRACTICE: Patient care plans should be guided by best available evidence to optimize outcomes while maintaining a safe environment in the setting of this pandemic.


COVID-19 and hypertension


title: A tug-of-war between severe acute respiratory syndrome coronavirus 2 and host antiviral defence: lessons from other pathogenic viruses

text: World Health Organization has declared the ongoing outbreak of coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern. The virus was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses. Human infection with SARS-CoV-2 leads to a wide range of clinical manifestations ranging from asymptomatic, mild, moderate to severe. The severe cases present with pneumonia, which can progress to acute respiratory distress syndrome. The outbreak provides an opportunity for real-time tracking of an animal coronavirus that has just crossed species barrier to infect humans. The outcome of SARS-CoV-2 infection is largely determined by virus-host interaction. Here, we review the discovery, zoonotic origin, animal hosts, transmissibility and pathogenicity of SARS-CoV-2 in relation to its interplay with host antiviral defense. A comparison with SARS-CoV, Middle East respiratory syndrome coronavirus, community-acquired human coronaviruses and other pathogenic viruses including human immunodeficiency viruses is made. We summarize current understanding of the induction of a proinflammatory cytokine storm by other highly pathogenic human coronaviruses, their adaptation to humans and their usurpation of the cell death programmes. Important questions concerning the interaction between SARS-CoV-2 and host antiviral defence, including asymptomatic and presymptomatic virus shedding, are also discussed.


title: The 100 pc White Dwarf Sample in the SDSS Footprint

text: We present follow-up spectroscopy of 711 white dwarfs within 100 pc, and present a detailed model atmosphere analysis of the 100 pc white dwarf sample in the SDSS footprint. Our spectroscopic follow-up is complete for 83% of the white dwarfs hotter than 6000 K, where the atmospheric composition can be constrained reliably. We identify 1508 DA white dwarfs with pure hydrogen atmospheres. The DA mass distribution has an extremely narrow peak at $0.59~M_{\odot}$, and reveals a shoulder from relatively massive white dwarfs with $M=0.7$-$0.9~M_{\odot}$. Comparing this distribution with binary population synthesis models, we find that the contribution from single stars that form through mergers cannot explain the over-abundance of massive white dwarfs. In addition, the mass distribution of cool DAs shows a near absence of $M>1~M_{\odot}$ white dwarfs. The pile-up of 0.7-$0.9~M_{\odot}$ and the disappearance of $M>1~M_{\odot}$ white dwarfs is consistent with the effects of core crystallization. Even though the evolutionary models predict the location of the pile-up correctly, the delay from the latent heat of crystallization by itself is insufficient to create a significant pile-up, and additional cooling delays from related effects like phase separation are necessary. We also discuss the population of infrared-faint (ultracool) white dwarfs, and demonstrate for the first time the existence of a well defined sequence in color and magnitude. Curiously, this sequence is connected to a region in the color-magnitude diagrams where the number of helium-dominated atmosphere white dwarfs is low. This suggests that the infrared-faint white dwarfs likely have mixed H/He atmospheres.


The importance of detection and percutaneous closure of patent foramen ovale during the coronavirus disease 2019 pandemic


Intensive care for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a makeshift ICU in Wuhan


title: Resilience strategies to manage psychological distress amongst healthcare workers during the COVID-19 pandemic: a narrative review

text: The COVID-19 pandemic marks an extraordinary global public health crisis unseen in the last century, with its rapid spread worldwide and associated mortality burden. The longevity of the crisis, and disruption to normality is unknown. With COVID-19 set to be a chronic health crisis, clinicians will be required to maintain a state of high alert for an extended period. The support received before and during an incident is likely to influence whether clinicians experience psychological growth or injury. An abundance of information is emerging on disease epidemiology, pathogenesis and infection control prevention. However, literature on interventions for supporting the psychological wellbeing of healthcare workers during disease outbreaks is limited. This article summarises the available management strategies to increase resilience in healthcare workers during the COVID-19 pandemic and beyond. It focuses on self care and organisational justice. It highlights various individual as well as organisational strategies. With the success of slowing disease spread in many countries to date, and reduced workload due to limitations on elective surgery in many institutions, there is more time and opportunity to be proactive in implementing measures to mitigate or minimise potential adverse psychological effects and improve, restore and preserve the wellbeing of the workforce now and for years to come. The purpose of this review is to review available literature on strategies for minimising the psychological impact of the COVID-19 pandemic on clinicians and to identify proactive holistic approaches which may be beneficial for healthcare workers both for the current crisis and into the future.


docid: lfpvvtsm

title: Resilience strategies to manage psychological distress among healthcare workers during the COVID-19 pandemic: a narrative review

text: The COVID-19 pandemic marks an extraordinary global public health crisis unseen in the last century, with its rapid spread worldwide and associated mortality burden. The longevity of the crisis and disruption to normality is unknown. With COVID-19 set to be a chronic health crisis, clinicians will be required to maintain a state of high alert for an extended period. The support received before and during an incident is likely to influence whether clinicians experience psychological growth or injury. An abundance of information is emerging on disease epidemiology, pathogenesis and infection control prevention. However, literature on interventions for supporting the psychological well-being of healthcare workers during disease outbreaks is limited. This article summarises the available management strategies to increase resilience in healthcare workers during the COVID-19 pandemic and beyond. It focuses on self-care and organisational justice. It highlights various individual as well as organisational strategies. With the success of slowing disease spread in many countries to date, and reduced work-load due to limitations on elective surgery in many institutions, there is more time and opportunity to be pro-active in implementing measures to mitigate or minimise potential adverse psychological effects and improve, restore and preserve the well-being of the workforce now and for years to come. The purpose of this review is to review available literature on strategies for minimising the psychological impact of the COVID-19 pandemic on clinicians and to identify pro-active holistic approaches which may be beneficial for healthcare workers both for the current crisis and into the future.


New insights in COVID-19-associated chilblains: a comparative study with chilblain lupus erythematosus


title: Is Albumin Predictor of Mortality in COVID-19?

text: Coronavirus 2019 (COVID-19) is a pandemic associated with a high risk of mortality. Human serum albumin (HSA) is an acute phase reactant with antioxidant property; however, its behavior and impact on survival in COVID-19 patients have never been studied so far. Among 319 COVID-19 patients followed up for a median of 19 days, 64 died. Compared with survivors, nonsurvivors had more prevalence of intensive care unit (ICU) admission, chronic obstructive pulmonary disease (COPD), heart failure, elevated levels of D-dimer, high-sensitivity C reactive protein (hs-CRP) and troponins, and lower values of albumin. At the Cox regression analysis, albumin (hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.23-0.63, p < 0.001) and age (HR: 1.03, 95% CI: 1.01-1.06, p = 0.001) were independently associated with mortality, irrespective of adjustment for gender, ICU admission, heart failure, COPD, and hs-CRP levels. Our observation leads to the hypothesis that HSA analysis may be used to identify patients at higher risk of death in COVID-19 patients.


title: Telemedicine in the era of COVID-19: a neurosurgical perspective

text: Despite the substantial growth of telemedicine and the evidence of its advantages, utilization of telemedicine in neurosurgery has been limited. Barriers have included medicolegal issues surrounding provider reimbursement, interstate licensure, and malpractice liability as well as technological challenges. Recently, the COVID-19 pandemic has limited typical evaluation of patients with neurological issues and resulted in a surge in demand for virtual medical visits. Meanwhile, federal and state governments took action to facilitate the rapid implementation of telehealth programs, placing a temporary lift on medicolegal barriers that had previously limited its expansion. This created a unique opportunity for widespread telehealth use to meet the surge in demand for remote medical care. After initial hurdles and challenges, our experience with telemedicine in neurosurgery at Penn Medicine has been overall positive from both the provider and the patients' perspective. One of the unique challenges we face is guiding patients to appropriately set up devices in a way that enables an effective neuro exam. However, we argue that an accurate and comprehensive neurologic exam can be conducted through a telemedicine platform, despite minor weaknesses inherent to absence of physical presence. Additionally, certain neurosurgical visits such as post-operative checks, vascular pathology, and brain tumors inherently lend themselves to easier evaluation through telehealth visits. In the era of COVID-19 and beyond, telemedicine remains a promising and effective approach to continue neurologic patient care.


Palliative care strategies offer guidance to clinicians and comfort for COVID-19 patient and families


Lung ultrasound for pregnant women admitted to ICU for Covid-19 pneumonia


title: Understanding COVID-19 Risks and Vulnerabilities among Black Communities in America: The Lethal Force of Syndemics

text: Black communities in the United States are bearing the brunt of the COVID-19 pandemic and the underlying conditions that exacerbate its negative consequences. Syndemic theory provides a useful framework for understanding how such interacting epidemics to develop under conditions of health and social disparity. Multiple historical and present-day factors have created the syndemic conditions within which Black Americans experience the lethal force of COVID-19. These factors include racism and its manifestations (e.g., chattel slavery, mortgage redlining, political gerrymandering, lack of Medicaid expansion, employment discrimination, and healthcare provider bias). Improving racial disparities in COVID-19 will require that we implement policies that address structural racism at the root of these disparities.


title: Why is SARS-CoV-2 infection more severe in obese men? The gut lymphatics - Lung axis hypothesis

text: Consistent observations report increased severity of SARS-CoV-2 infection in overweight men with cardiovascular factors. As the visceral fat possesses an intense immune activity, is involved in metabolic syndrome and is at the crossroad between the intestines, the systemic circulation and the lung, we hypothesized that it plays a major role in severe forms of SARS-CoV-2 infection. SARS-CoV2 presents the ability to infect epithelial cells of the respiratory tract as well as the intestinal tract. Several factors may increase intestinal permeability including direct enterocyte damage by SARS-CoV2, systemic inflammatory response syndrome (SIRS) and epithelial ischemia secondary to SARS-CoV2- associated endothelial dysfunction. This increase permeability further leads to translocation of microbial components such as MAMPs (microbial-associated molecular pattern), triggering an inflammatory immune response by TLR-expressing cells of the mesentery fat (mostly macrophages and adipocytes). The pro-inflammatory cytokines produced by the mesentery fat mediates systemic inflammation and aggravate acute respiratory distress syndrome (ARDS) through the mesenteric lymph drainage.


title: Disruptions during a pandemic: Gaps identified and lessons learned

text: Global disruptions caused by coronavirus disease 2019 (COVID-19) affects all walks of life, and dentistry and dental education are no exceptions. Dental education uniquely blends didactic courses and hands-on clinical training seamlessly to prepare oral healthcare providers of the future. Apart from economical and access to care implications, closure of all the dental institutions in the United States affects their educational mission greatly, equally disturbing pre-doctoral and graduate training. Efforts are ongoing to continue the educational mission in dental institutions by delivering scheduled course content remotely using multiple online tools. In spite of those efforts, since clinical experiences cannot be completely replaced by any available alternative method of instruction that is delivered remotely, students are missing out on valuable patient-based clinical experiences. In this perspective article, we briefly discuss the several implications of COVID-19, in the context of dental education. We then highlight some of the lessons we can learn from this pandemic which we hope will have several positive implications, including curricular changes, increased public health awareness and preparedness for future public health emergencies.


Early Lessons From World War COVID Reinventing Our Stroke Systems of Care


title: [Diabetes and COVID-19 infection]

text: Based on the epidemiological data currently available, diabetes does not seem to be a risk factor for infection with SARS-CoV-2 but may be associated with a more severe course Diabetes is extremely common in older patients with co-morbidities who are at risk of unfavorable outcomes As with any other infection, poorly controlled pre-existing diabetes can promote secondary infections and lead to acute complications related to hyperglycemia, worsened itself by the infection It is important to advise patients to have enough diabetic equipment and supplies at home, to make regular blood glucose self-tests, and to contact a caregiver immediately in case of glycemic imbalance or signs of infection Antidiabetic therapy may need adjustments following usual sick day rules Insulin therapy should be considered to treat any persistent hyperglycemia in patients hospitalized for an acute infection


title: How to verify the death of a patient

text: When a patient dies, it is important that nurses understand their role in the verification of death. This article explains the steps required to verify the death of an adult patient. Verification of death is not a mechanistic task, but one that requires sensitivity and compassion. It is also crucial that nurses understand the legal implications of verifying a patient's death. With the development of the current coronavirus disease 2019 (COVID-19) pandemic, nurses must also understand any changes in their role when verifying the death of a patient. Verification or confirmation of death is the process of ascertaining whether a patient is deceased, based on a physical assessment. Nurses can only verify a death if the patient is expected to die and has a do not attempt cardiopulmonary resuscitation (DNACPR) order in place. A DNACPR order is essential because it allows the nurse to verify the death without being concerned with the need to resuscitate the patient. Nurses should ensure they act in accordance with local and national guidance regarding the verification of a patient's death. REFLECTIVE ACTIVITY: How to articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: How this article might inform your practice when verifying a patient's death. How you could use this information to educate your colleagues on the appropriate steps required when verifying a patient's death.


docid: ekuisufv

title: Why judiciously timed anti-IL 6 therapy may be of benefit in severe COVID-19 infection


title: Spatiotemporal dynamics in demography-sensitive disease transmission: COVID-19 spread in NY as a case study

text: The rapid transmission of the highly contagious novel coronavirus has been represented through several data-guided approaches across targeted geographies, in an attempt to understand when the pandemic will be under control and imposed lockdown measures can be relaxed. However, these epidemiological models predominantly based on training data employing number of cases and fatalities are limited in that they do not account for the spatiotemporal population dynamics that principally contributes to the disease spread. Here, a stochastic cellular automata enabled predictive model is presented that is able to accurate describe the effect of demography-dependent population dynamics on disease transmission. Using the spread of coronavirus in the state of New York as a case study, results from the computational framework remarkably agree with the actual count for infected cases and deaths as reported across organizations. The predictions suggest that an extended lockdown in some form, for up to 180 days, can significantly reduce the risk of a second wave of the outbreak. In addition, increased availability of medical testing is able to reduce the number of infected patients, even when less stringent social distancing guidelines and imposed. Equipping this stochastic approach with demographic factors such as age ratio, pre-existing health conditions, robustifies the model to predict the transmittivity of future outbreaks before they transform into an epidemic.


title: Implementation of Preoperative Screening Protocols in Otolaryngology During the COVID-19 Pandemic

text: OBJECTIVE: To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic. METHODS: This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a "high-risk case protocol" was utilized to maximize available resources. As information and technology evolved, a "universal point-of-care protocol" was implemented. RESULTS: Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure (P = .92). DISCUSSION: Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on "COVID-19 clinics" or other community testing facilities. IMPLICATIONS FOR PRACTICE: Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays.


Positive RT-PCR tests among discharged COVID-19 patients in Shenzhen, China


docid: gfghkxqm

title: Acute pulmonary embolism in non-hospitalized COVID-19 patients referred to CTPA by emergency department

text: OBJECTIVES: To evaluate the prevalence of acute pulmonary embolism (APE) in non-hospitalized COVID-19 patients referred to CT pulmonary angiography (CTPA) by the emergency department. METHODS: From March 14 to April 6, 2020, 72 non-hospitalized patients referred by the emergency department to CTPA for COVID-19 pneumonia were retrospectively identified. Relevant clinical and laboratory data and CT scan findings were collected for each patient. CTPA scans were reviewed by two radiologists to determinate the presence or absence of APE. Clinical classification, lung involvement of COVID-19 pneumonia, and CT total severity score were compared between APE group and non-APE group. RESULTS: APE was identified in 13 (18%) CTPA scans. The mean age and D-dimer of patients from the APE group were higher in comparison with those from the non-APE group (74.4 vs. 59.6 years, p = 0.008, and 7.29 vs. 3.29 µg/ml, p = 0.011). There was no significant difference between APE and non-APE groups concerning clinical type, COVID-19 pneumonia lung lesions (ground-glass opacity: 85% vs. 97%; consolidation: 69% vs. 68%; crazy paving: 38% vs. 37%; linear reticulation: 69% vs. 78%), CT severity score (6.3 vs. 7.1, p = 0.365), quality of CTPA (1.8 vs. 2.0, p = 0.518), and pleural effusion (38% vs. 19%, p = 0.146). CONCLUSIONS: Non-hospitalized patients with COVID-19 pneumonia referred to CT scan by the emergency departments are at risk of APE. The presence of APE was not limited to severe or critical clinical type of COVID-19 pneumonia. KEY POINTS: â¢ Acute pulmonary embolism was found in 18% of non-hospitalized COVID-19 patients referred by the emergency department to CTPA. Two (15%) patients had main, four (30%) lobar, and seven (55%) segmental acute pulmonary embolism. â¢ Five of 13 (38%) patients with acute pulmonary embolism had a moderate clinical type. â¢ Severity and radiological features of COVID-19 pneumonia showed no significant difference between patients with or without acute pulmonary embolism.


title: Coronavirus Disease 2019 Pandemic: Health System and Community Response to a Text Message (Text4Hope) Program Supporting Mental Health in Alberta

text: In an effort to support the mental health of Albertans during the coronavirus disease 2019 (COVID-19) pandemic, Alberta Health Services launched a supportive text message (Text4Mood) program on March 23, 2020. The program was simultaneously approved for funding by the 6 regional health foundations and launched within 1 week of conception. Residents of Alberta can subscribe to the program by texting "COVID19HOPE" to a sort code number. Each subscriber receives free daily supportive text messages, for 3 months, crafted by a team of clinical psychologists, psychiatrists, mental health therapist, and mental health service users. Within 1 week of the launch of Text4Hope, 32 805 subscribers had signed up to the program, and there have been expressions of interests from other jurisdictions to implement a similar program to support the mental health of those in quarantine, isolation, or lockdown.


title: Concurrent chilblains and retinal vasculitis in a child with COVID-19

text: Reports on COVID-19 in children are limited. Despite new data emerging, and understanding of the disease improves rapidly, there are as yet several features and complications related to the disease that remain unknown. Herein, we report the first case of a child with chilblains and retinal vasculitis related to COVID-19.


The American College of Obstetricians and Gynecologists in 2020: A Clear Vision for the Future


title: At a crossroads, wondering which way to go

text: Having returned from travelling and working in Australia, the Covid-19 pandemic has given Anna Leach the chance to consider where she would like to take her career next.


title: Teleneurology during the COVID-19 pandemic: A step forward in modernizing medical care

text: BACKGROUND: The COVID-19 pandemic mandated rapid transition from face-to-face encounters to teleneurology visits. While teleneurology is regularly used in acute stroke care, its application in other branches of neurology was limited. Here we review how the recent pandemic has created a paradigm shift in caring for patients with chronic neurological disorders and how academic institutions have responded to the present need. METHOD: Literature review was performed to examine the recent changes in health policies. Number of outpatient visits and televisits in the Department of Neurology was reviewed from Yale University School of Medicine and Johns Hopkins School of Medicine to examine the road to transition to televisit. RESULTS: The federal government and the insurance providers extended their supports during the COVID-19 pandemic. Several rules and regulations regarding teleneurology were revised and relaxed to address the current need. New technologies for video conferencing were incorporated. The transition to televisits went smoothly in both the institutions and number of face-to-face encounters decreased dramatically along with a rapid rise in televisits within 2 weeks of the declaration of national emergency. CONCLUSION AND RELEVANCE: The need for "social distancing" during the COVID-19 pandemic has created a major surge in the number of teleneurology visits, which will probably continue for the next few months. It may have initiated a more permanent transition to virtual technology incorporated medical care.


docid: kksrzvuk

title: Repurposing Drugs for the Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19)

text: BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), termed coronavirus disease 2019 (COVID-19) by the World Health Organization, is a newly emerging zoonotic agent that emerged in China in December 2019. No specific treatment for COVID-19 is currently available. Usual palliative treatment includes maintaining hydration and nutrition and controlling fever and cough. The clinical severity and extent of transmission need to be determined, and therapeutic options need to be developed and optimized. METHODS: The present review discusses the recent repurposing of drugs for COVID-19 treatment. RESULTS: Several compounds, including remdesivir, lopinavir, ritonavir, interferon-ß, ribavirin, chloroquine/hydroxychloroquine, azithromycin, tocilizumab, and ivermectin, have emerged as promising alternatives. They block the virus from entering host cells, prevent viral replication, and attenuate exacerbation of the host's immune response. CONCLUSION: Although some evidence indicates the positive actions of different classes of compounds for the treatment of COVID-19, few clinical assays have been established to definitively demonstrate their therapeutic value in humans. Multicenter clinical studies are urgently needed to validate and standardize therapeutic regimens that involve these agents. Although science has not yet presented us with a specific drug against COVID-19, the repurposing of drugs appears to be promising in our fight against this devastating disease.


title: Updated diagnosis, treatment and prevention of COVID-19 in children: experts' consensus statement (condensed version of the second edition)

text: In the early February, 2020, we called up an experts' committee with more than 30 Chinese experts from 11 national medical academic organizations to formulate the first edition of consensus statement on diagnosis, treatment and prevention of coronavirus disease 2019 (COVID-19) in children, which has been published in this journal. With accumulated experiences in the diagnosis and treatment of COVID-19 in children, we have updated the consensus statement and released the second edition recently. The current version in English is a condensed version of the second edition of consensus statement on diagnosis, treatment and prevention of COVID-19 in children. In the current version, diagnosis and treatement criteria have been optimized, and early identification of severe and critical cases is highlighted. The early warning indicators for severe pediatric cases have been summarized which is utmost important for clinical practice. This version of experts consensus will be valuable for better prevention, diagnosis and treatment of COVID-19 in children worldwide.


title: [Clinical experience of high-flow nasal cannula oxygen therapy in severe corona virus disease 2019 (COVID-19) patients]

text: Acute respiratory failure due to acute hypoxemia is the major manifestation in severe coronavirus disease 2019 (COVID-19) induced by severe acute respiratory syndrome coronavirus 2 infection. Rational and effective respiratory support is crucial in the management of COVID-19 patients. High-flow nasal cannula (HFNC) has been utilized widely due to its superiority over other non-invasive respiratory support techniques. To avoid HFNC failure and intubation delay, the key issues are proper patients, timely application and improving compliance. It should be noted that elder patients are vulnerable for failed HFNC. We applied HFNC for oxygen therapy in severe and critical COVID-19 patients and summarized the following experiences. Firstly, to select the proper size of nasal catheter, to locate it at suitable place, and to confirm the nose and the upper respiratory airway unobstructed. Secondly, an initial flow of 60 L/min and 37â should be given immediately for patients with obvious respiratory distress or weak cough ability; otherwise, low-level support should be given first and the level gradually increased. Thirdly, to avoid hypoxia or hypoxemia, the treatment goal of HFNC should be maintained the oxygen saturation (SpO2) above 95% for patients without chronic pulmonary disease. Finally, patients should wear a surgical mask during HFNC treatment to reduce the risk of virus transmission through droplets or aerosols.


Re: Testing recommendation for COVID-19 and planned surgery


Nasal Gene Expression of Angiotensin-Converting Enzyme 2 in Children and Adults


Response to: 'Experience of telemedicine use in a big cohort of patients with rheumatoid arthritis during COVID-19 pandemic' by Santos-Moreno et al


Did the General Population in Germany Drink More Alcohol during the COVID-19 Pandemic Lockdown?


title: The Impact of COVID-19 on Plastic Surgery Residency Training

text: Nowadays didactic and surgical activities for residents in the surgery field are less and less due to an increasing burden of documentation and "non-educational work." Considering the current lockdown due to the COVID-19 pandemic, it has never been so important to find different ways to allow residents to improve their knowledge. We asked all plastic and esthetic surgery residents in our country to fill out a questionnaire to investigate changes in their didactical activity and analyze problems about their professional growth in the last few months. From the results of such questionnaires, we found that most of the residents feel the decrease in surgical activities during this time is a detrimental factor for their training and that even if all the schools have changed their didactical activities no school has introduced the use of virtual simulators to compensate for the decrease in surgical practice. Actually, the majority of residents use webinars to keep updated, stating that such technologies are useful but not sufficient to analyze plastic surgery topics in depth during COVID-19 lockdown. Virtual interactive tools are well known in different clinical and surgical specialties, and they are considered as a valid support, but it seems that in plastic surgery they are not so used. According to the most recent studies about residents' didactical program, we have investigated the potential of Anatomage Table in combination with Touch Surgery application as physical and mental aids to bypass the decreased number and kind of surgical interventions performed in this particular time. Anatomage is an academic user-friendly touch screen table; it is used by both medical students and residents to learn human anatomy and to master surgical anatomy. Touch Surgery is an application available on smartphones and tablets that gives the possibility to watch real and virtually designed surgical videos, accompanied by explanatory comments on the surgical phases; they are interactive and give the possibility to check what you have learned through tests administered after virtual classes. In our opinion, these tools represent reliable solutions to improve plastic residents' training, mostly during the COVID-19 pandemic. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.


title: COVID19-Tracker: una aplicación Shiny para analizar datos de la epidemia de SARS-CoV-2 en España./ [COVID19-Tracker: a shiny app to analise data on SARS-CoV-2 epidemic in Spain]

text: Data visualization is an important tool for exploring and communicating findings in medical research, and specially in epidemiological surveillance. The COVID19-Tracker web application systematically produces daily updated data visualization and analysis of SARS-CoV-2 epidemic in Spain. It collects automatically daily data on COVID-19 diagnosed cases and mortality, from February 24th, 2020 onwards. Three applications have already been developed: 1) to analyze data trends and estimating short-term projections; 2) to estimate the case fatality rate; and 3) to assess the effect of the lockdowns on the data trends. The application may help for a better understanding of the SARS-CoV-2 epidemic data in Spain.


title: Quality Improvement Tool to Rapidly Identify Risk Factors for SARS-CoV-2 Infection among Healthcare Workers

text: The rapid growth of the coronavirus disease 2019 (COVID-19) pandemic, limited availability of personal protective equipment, and uncertainties regarding transmission modes of the novel severe acute respiratory syndrome coronavirus - 2 (SARS-CoV-2) have heightened concerns for safety of healthcare workers (HCWs). Systematic studies of occupational risks for COVID-19 in the context of community risks are difficult and are only recently starting to be reported. Ongoing quality improvement studies in various locales and within many affected healthcare institutions are needed. We propose a template design for small-scale quality improvement surveys. Such surveys have the potential for rapid implementation and completion, are cost-effective, impose little administrative or workforce burden, can reveal occupational risks while taking into account community risks, and can be easily repeated with short intervals of time between repetitions. We describe a template design and propose a survey instrument that is easily modifiable to fit the particular needs of various healthcare institutions in the hope of beginning a collaborative effort to refine the design and instrument. These methods, along with data management and analytic techniques, can be widely useful and shared globally. Our goal is to facilitate quality improvement surveys aimed at reducing the risk of occupational infection of healthcare workers during the COVID-19 pandemic.


title: COVID-19: Understanding and mitigating trauma in ICU survivors

text: The spread of coronavirus disease 2019 (COVID-19) has placed many individuals in need of critical care, with a high proportion of hospitalized patients being admitted to intensive care units (ICU) to treat acute outcomes of COVID-19 (e.g., respiratory failure via mechanical ventilation). The ICU is known to be a setting where individuals are at a high risk of experiencing significant psychological difficulties, and patients with COVID-19 are particularly susceptible to such experiences, which can impact their recovery process (e.g., postintensive care syndrome). This article seeks to highlight the intersection between critical care related to trauma and COVID-19 and point providers toward opportunities for anticipating and managing secondary effects in effort to promote psychological adaptation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Pre- and Posttreatment Chest CT Findings: 2019 Novel Coronavirus (2019-nCoV) Pneumonia


Baricitinib for COVID-19: a suitable treatment?


title: Epidemiologic and clinical characteristics of 91 hospitalized patients with COVID-19 in Zhejiang, China: a retrospective, multi-centre case series

text: BACKGROUND: Recent studies have focused on initial clinical and epidemiological characteristics of the coronavirus disease 2019 (COVID-19), which is the mainly revealing situation in Wuhan, Hubei. AIM: This study aims to reveal more data on the epidemiological and clinical characteristics of COVID-19 patients outside of Wuhan, Zhejiang, China. DESIGN: This study was a retrospective case series. METHODS: Eighty-eight cases of laboratory-confirmed and three cases of clinically confirmed COVID-19 were admitted to five hospitals in Zhejiang province, China. Data were collected from 20 January 2020 to 11 February 2020. RESULTS AND DISCUSSION: Of all 91 patients, 88 (96.70%) were laboratory-confirmed COVID-19 with throat swab samples that tested positive for SARS-Cov-2, three (3.30%) cases were clinically diagnosed. The median age of the patients was 50 (36.5-57) years, and female accounted for 59.34%. In this sample, 40 (43.96%) patients had contracted the disease from local cases, 31 (34.07%) patients had been to Wuhan/Hubei, eight (8.79%) patients had contacted with people from Wuhan, and 11 (12.09%) patients were diagnosed after having flown together in the same flight with no passenger that could later be identified as the source of infection. In particular within the city of Ningbo, 60.52% cases can be traced back to an event held in a temple. The most common symptoms were fever (71.43%), cough (60.44%) and fatigue (43.96%). The median of incubation period was 6 (interquartile range 3-8) days and the median time from the first visit to a doctor to the confirmed diagnosis was 1 (1-2) days. According to the chest computed tomography scans, 67.03% cases had bilateral pneumonia. CONCLUSIONS: Social activity cluster, family cluster and flying alongside with persons already infected with COVID-19 were how people got infected with COVID-19 in Zhejiang.


The coronavirus outbreak: the central role of primary care in emergency preparedness and response


title: Novel multiple swab method enables high efficiency in SARS-CoV-2 screenings without loss of sensitivity for screening of a complete population

text: BACKGROUND: In the pandemic, testing for SARS-CoV-2 by RT-PCR is one of the pillars on which countermeasures are based. Factors limiting the output of laboratories interfere with the effectiveness of public health measures. Conserving reagents by pooling samples in low-probability settings is proposed, but may cause dilution and loss of sensitivity. Blood transfusion services had experience in performance of high throughput NAT analysis and can support the national health system by screening of the inhabitants for SARS-COV-2. METHODS: We evaluated a new approach of a multiple swab method by simultaneously incubating multiple respiratory swabs in a single tube. Analytical sensitivity was constant up to a total number of 50 swabs. It was consequently applied in the testing of 50 symptomatic patients (five-sample pools) as well as 100 asymptomatic residents of a nursing home (ten-sample pools). RESULTS: The novel method did not cause false negative results with non-significantly differing Ct values between single swab and multiple swab NAT. In two routine applications, all mini pools containing positive patient samples were correctly identified. CONCLUSIONS: The new method enables countries to increase the total number of testing significantly. The multiple swab method is able to screen system relevant groups of employees frequently. Secondly the example in Germany shows that blood transfusion services can support general health systems with their experience in NAT and their high throughput instruments. Screening of a huge number of inhabitants is currently the only option to prevent a second infection wave and enable exit strategies in many countries. This article is protected by copyright. All rights reserved.


Coronavirus Epidemic and Extracorporeal Therapies in Intensive Care: si vis pacem para bellum


Benefit v. risk when using chloroquine in patients with severe COVID-19 disease


title: Correction to: COVID-19 pandemic: the 3R's (reduce, refine, and replace) of personal protective equipment (PPE) sustainability

text: This article was updated to fix a typo in the title introduced during the production process.


COVID-19 pandemic: the 3R's (reduce, refine, and replace) of personal protective equipment (PPE) sustainability


Lung Ultrasound During the COVID-19 Pandemic: Building a Mobile Lung Ultrasound Unit


Proposed Changes to the Inpatient Services for the Disabled in the United States Post-COVID-19


title: Virtual Dysphagia Evaluation: Practical Guidelines for Dysphagia Management in the Context of the COVID-19 Pandemic

text: With encouraging signs of pandemic containment nationwide, the promise of return to a full range of clinical practice is on the horizon. Clinicians are starting to prepare for a transition from limited evaluation of emergent and urgent complaints to resumption of elective surgical procedures and routine office visits within the next few weeks to months. Otolaryngology as a specialty faces unique challenges when it comes to the COVID-19 pandemic due to the fact that a comprehensive head and neck examination requires aerosol-generating endoscopic procedures. Since the COVID-19 pandemic is far from being over and the future may hold other highly communicable infectious threats that may require similar precautions, standard approaches to the clinical evaluation of common otolaryngology complaints will have to be modified. In this communication, we present practical recommendations for dysphagia evaluation with modifications to allow a safe and comprehensive assessment.


Current Knowledge and Research Priorities in the Digestive Manifestations of COVID-19


title: Bem-estar em equinos do Jockey Club do Paraná: indicadores clínicos, etológicos e ritmo circadiano do cortisol/ Welfare in horses of the Jockey Club Paraná: clinic ethologic indicators and circadian rhythm of cortisol

text: Com o objetivo de estudar parâmetros indicativos de bem-estar, 30 equinos de corrida foram avaliados quanto ao temperamento, comportamento, parâmetros clínicos (condição geral, escoriações, escore corporal, cólicas no último ano, frequências cardíaca e respiratória) e níveis de cortisol plasmático (matutino, vespertino e ritmo circadiano). Todos os animais apresentaram boas condições físicas gerais, parâmetros clínicos normais para a espécie e não tiveram cólica no ano anterior ao estudo, demonstrando a preocupação dos tratadores com a saúde física dos animais. Contudo, 36,7% dos animais estudados apresentavam estereotipias. Apesar da alta incidência de indivíduos com ritmo circadiano do cortisol (RCC) alterado dentro do grupo de animais com comportamentos anormais (63,64%), não foi encontrada diferença estatística (P>0,05) quando comparado com a incidência do grupo de animais sem estereotipia (31,58%). Quatro animais com estereotipia portavam dispositivos para restringir a expressão de anomalias. Desses, todos apresentaram RCC alterado, permitindo demonstrar que equinos restringidos fisicamente de realizar sua estereotipia apresentam 18 vezes mais chances de ter alteração no RCC do que um animal de comportamento normal. Conclui-se que os equinos do Jockey Club do Paraná, apesar de apresentarem condições físicas satisfatórias comparados a estudos nacionais anteriores, possuíam alterações comportamentais e de função adrenocortical compatíveis com estresse crônico. Os achados também corroboram noções prévias de que a estereotipia é uma forma de tentar aliviar o estresse crônico em equinos, e que o uso de meios físicos para restringir sua manifestação aumenta a chance de distúrbios no metabolismo do cortisol.(AU)


Infection control strategies of patient diversion in response to COVID-19


title: Assessing Disease Exposure Risk with Location Data: A Proposal for Cryptographic Preservation of Privacy

text: Governments and researchers around the world are implementing digital contact tracing solutions to stem the spread of infectious disease, namely COVID-19. Many of these solutions threaten individual rights and privacy. Our goal is to break past the false dichotomy of effective versus privacy-preserving contact tracing. We offer an alternative approach to assess and communicate users' risk of exposure to an infectious disease while preserving individual privacy. Our proposal uses recent GPS location histories, which are transformed and encrypted, and a private set intersection protocol to interface with a semi-trusted authority. There have been other recent proposals for privacy-preserving contact tracing, based on Bluetooth and decentralization, that could further eliminate the need for trust in authority. However, solutions with Bluetooth are currently limited to certain devices and contexts while decentralization adds complexity. The goal of this work is two-fold: we aim to propose a location-based system that is more privacy-preserving than what is currently being adopted by governments around the world, and that is also practical to implement with the immediacy needed to stem a viral outbreak.


Research during SARS-CoV-2 pandemic: To "Preprint" or not to "Preprint", that is the question


title: Tracing New Clinical Manifestations in Patients with COVID-19 in Chile and Its Potential Relationship with the SARS-CoV-2 Divergence

text: Purpose of Review: In this review, we discuss the current implications of the changing genomic epidemiology of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), etiological agent of the Coronavirus Disease 2019 (COVID-19) and its potential relationship with the change of clinical manifestations in patients with confirmed infection. Recent Findings: Over the course of the current pandemic, the virus has been found more diverse in new countries. Simultaneously, also new clinical manifestations are observed, particularly more prominent gastrointestinal and neurological findings. Summary: SARS-CoV-2/COVID-19 is changing not only its epidemiology, but also its genomic diversity and clinical manifestations, both aspects coupled, needs to be considered in the study of this ongoing pandemic.


title: Rapid Validation of Telepathology by an Academic Neuropathology Practice During the COVID-19 Pandemic

text: CONTEXT: The coronavirus disease 19 (COVID-19) pandemic is placing unparalleled burdens on regional and institutional resources in medical facilities across the globe. This disruption is causing unprecedented downstream effects to traditionally established channels of patient care delivery, including those of essential anatomic pathology services. With Washington state being the initial North American COVID-19 epicenter, the University of Washington in Seattle has been at the forefront of conceptualizing and implementing innovative solutions in order to provide uninterrupted quality patient care amidst this growing crisis. OBJECTIVE: To conduct a rapid validation study assessing our ability to reliably provide diagnostic Neuropathology services via a whole slide imaging (WSI) platform as part of our departmental COVID-19 planning response. DESIGN: This retrospective study assessed diagnostic concordance of neuropathological diagnoses rendered via WSI as compared to those originally established via traditional histopathology in a cohort of 30 cases encompassing a broad range of neurosurgical and neuromuscular entities. This study included the digitalization of 93 slide preparations, which were independently examined by groups of board-certified neuropathologists and neuropathology fellows. RESULTS: There were no major or minor diagnostic discrepancies identified in either the attending neuropathologist or neuropathology trainee groups for either the neurosurgical or neuromuscular case cohorts. CONCLUSIONS: Our study demonstrates that accuracy of neuropathological diagnoses and interpretation of ancillary preparations via WSI are not inferior to those generated via traditional microscopy. This study provides a framework for rapid subspecialty validation and deployment of WSI for diagnostic purposes during a pandemic event.


Nyfødte bør være hos mor, også hvis mor har covid-19


Coronavirus fears cancel world's biggest physics meeting


title: Severe immune thrombocytopenic purpura in critical COVID-19

text: COVID-19 is a new disease with many undescribed clinical manifestations. We report herein a case of severe immune thrombocytopenic purpura (ITP) in a critical COVID-19 patient. A patient presented a severe episode of immune thrombocytopenia (< 10 × 109/L) 20 days after admission for a critical COVID-19. This thrombocytopenia was associated with a life-threatening bleeding. Response to first-line therapies was delayed as it took up to 13 days after initiation of intravenous immunoglobulin and high-dose dexamethasone to observe an increase in platelet count. COVID-19 may be associated with late presenting severe ITP. Such ITP may also be relatively resistant to first-line agents. Hematological manifestations of COVID-19, such as the ones associated with life-threatening bleeding, must be recognized.


title: SARS-CoV-2 infection in two patients following recent lung transplantation

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes Coronavirus disease 2019 (COVID-19) has become a world spreading health problem with pandemic character. Lung transplant recipients may be particularly at risk due to the high degree of immunosupression and the lung being the organ primarily affected by COVID-19. We describe a 16-year old male and a 64-year old female recently lung transplanted patients with COVID-19 during inpatient rehabilitation. Both patients were on triple immunosuppressive therapy and had no signs of allograft dysfunction. Both patients had close contact to a person who developed COVID-19 and were tested positive for SARS-CoV-2. Subsequently, both patients underwent systematic screening and SARS-CoV-2 was detected ultimately. While the 16-year old boy was completely asymptomatic, the 64-year old woman developed only mild COVID-19. Immunosuppressive therapy was unchanged and no experimental treatment was initiated. No signs of graft involvement or dysfunction were noticed. In conclusion, our report of patients with asymptomatic SARS-CoV-2 infection and mild COVID-19 respectively, may indicate that lung transplant recipients are not per se at risk for severe COVID-19. Further observations and controlled trials are urgently needed to study SARS-CoV-2 infection in lung transplant recipients.


title: Impact of COVID-19 on Forecasting Stock Prices: An Integration of Stationary Wavelet Transform and Bidirectional Long Short-Term Memory

text: COVID-19 is an infectious disease that mostly affects the respiratory system. At the time of this research being performed, there were more than 1.4 million cases of COVID-19, and one of the biggest anxieties is not just our health, but our livelihoods, too. In this research, authors investigate the impact of COVID-19 on the global economy, more specifically, the impact of COVID-19 on financial movement of Crude Oil price and three U.S. stock indexes: DJI, S&P 500 and NASDAQ Composite. The proposed system for predicting commodity and stock prices integrates the Stationary Wavelet Transform (SWT) and Bidirectional Long Short-Term Memory (BDLSTM) networks. Firstly, SWT is used to decompose the data into approximation and detail coefficients. After decomposition, data of Crude Oil price and stock market indexes along with COVID-19 confirmed cases were used as input variables for future price movement forecasting. As a result, the proposed system BDLSTM+WT-ADA achieved satisfactory results in terms of five-day Crude Oil price forecast.


docid: mqduxqdl

title: Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding

text: BACKGROUND: In late December, 2019, patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). As of Jan 26, 2020, more than 2000 cases of 2019-nCoV infection have been confirmed, most of which involved people living in or visiting Wuhan, and human-to-human transmission has been confirmed. METHODS: We did next-generation sequencing of samples from bronchoalveolar lavage fluid and cultured isolates from nine inpatients, eight of whom had visited the Huanan seafood market in Wuhan. Complete and partial 2019-nCoV genome sequences were obtained from these individuals. Viral contigs were connected using Sanger sequencing to obtain the full-length genomes, with the terminal regions determined by rapid amplification of cDNA ends. Phylogenetic analysis of these 2019-nCoV genomes and those of other coronaviruses was used to determine the evolutionary history of the virus and help infer its likely origin. Homology modelling was done to explore the likely receptor-binding properties of the virus. FINDINGS: The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic analysis revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homology modelling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues. INTERPRETATION: 2019-nCoV is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. Although our phylogenetic analysis suggests that bats might be the original host of this virus, an animal sold at the seafood market in Wuhan might represent an intermediate host facilitating the emergence of the virus in humans. Importantly, structural analysis suggests that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans. The future evolution, adaptation, and spread of this virus warrant urgent investigation. FUNDING: National Key Research and Development Program of China, National Major Project for Control and Prevention of Infectious Disease in China, Chinese Academy of Sciences, Shandong First Medical University.


In the frame, road map for Australian sport on an uncertain journey through COVID-19


A Radiation Mitigator as a Potential Treatment for COVID-19


At the Heart of the Matter: Unmasking and Addressing COVID-19's Toll on Diverse Populations


Assessing the fear of COVID-19 among different populations: A response to Ransing et al. (2020)


title: Malignant melanotic Xp11 neoplasms exhibit a clinicopathological spectrum and gene expression profiling akin to alveolar soft part sarcoma: a proposal for reclassification

text: The classification of the distinct group of mesenchymal neoplasms, first described as 'Xp11 translocation perivascular epithelioid cell tumor (PEComa)' and for which recently the term 'melanotic Xp11 neoplasm' or 'Xp11 neoplasm with melanocytic differentiation' has been proposed, remains challenging and controversial. We collected 27 melanotic Xp11 neoplasms, the largest series to date, for a comprehensive evaluation. Fourteen of the cases, along with 8 alveolar soft part sarcomas (ASPS), 9 conventional PEComas, and a control group of 7 normal tissues were submitted to RNA sequencing. Follow-up available in 22 patients showed 5-year overall survival (OS) and 5-year disease-free survival (DFS) of 47.6 and 35.7% respectively, which were similar to ASPS and significantly worse than conventional PEComa. Univariate analysis of location (occurring in the kidney versus not kidney), infiltrative growth pattern, nuclear pleomorphism, mitotic activity ≥2/50 HPF, necrosis, and lymphovascular invasion were found to be associated with OS and/or DFS. Multivariate analysis identified that location was the only factor found to independently correlate with DFS. More importantly, RNA sequencing-based clustering analysis segregated melanotic Xp11 neoplasm and ASPS, clearly from other tumors including conventional PEComa and Xp11 translocation renal cell carcinoma (RCC) and formed a compact cluster representative of the largely similar expression signature. In this study, we first clearly define the true biologic nature that melanotic Xp11 neoplasms are distinctive malignant mesenchymal tumors, rather than simply PEComa variants with occasionally unpredictable behavior. Meanwhile, melanotic Xp11 neoplasm and ASPS more likely represent phenotypic variants of the same entity, which is distinct from conventional PEComa and Xp11 translocation RCC. Based on these important findings, melanotic Xp11 neoplasm might be reclassified into a distinctive entity together with ASPS, independent from PEComa, in the future revisions of the current World Health Organization categories of tumors of soft tissue and bone for the improved reclassification. This article is protected by copyright. All rights reserved.