Influence of the life style parameters including dietary habit, chronic stress and environmental factors and jobs on the human health in relation to COVID-19 pandemic


title: Information Mining for COVID-19 Research From a Large Volume of Scientific Literature

text: The year 2020 has seen an unprecedented COVID-19 pandemic due to the outbreak of a novel strain of coronavirus in 180 countries. In a desperate effort to discover new drugs and vaccines for COVID-19, many scientists are working around the clock. Their valuable time and effort may benefit from computer-based mining of a large volume of health science literature that is a treasure trove of information. In this paper, we have developed a graph-based model using abstracts of 10,683 scientific articles to find key information on three topics: transmission, drug types, and genome research related to coronavirus. A subgraph is built for each of the three topics to extract more topic-focused information. Within each subgraph, we use a betweenness centrality measurement to rank order the importance of keywords related to drugs, diseases, pathogens, hosts of pathogens, and biomolecules. The results reveal intriguing information about antiviral drugs (Chloroquine, Amantadine, Dexamethasone), pathogen-hosts (pigs, bats, macaque, cynomolgus), viral pathogens (zika, dengue, malaria, and several viruses in the coronaviridae virus family), and proteins and therapeutic mechanisms (oligonucleotide, interferon, glycoprotein) in connection with the core topic of coronavirus. The categorical summary of these keywords and topics may be a useful reference to expedite and recommend new and alternative directions for COVID-19 research.


title: COVID-19 patients with hypertension have more severe disease: a multicenter retrospective observational study

text: This study aims to explore the effect of hypertension on disease progression and prognosis in patients with coronavirus disease 2019 (COVID-19). A total of 310 patients diagnosed with COVID-19 were studied. A comparison was made between two groups of patients, those with hypertension and those without hypertension. Their demographic data, clinical manifestations, laboratory indicators, and treatment methods were collected and analyzed. A total of 310 patients, including 113 patients with hypertension and 197 patients without hypertension, were included in the analysis. Compared with patients without hypertension, patients with hypertension were older, were more likely to have diabetes and cerebrovascular disease, and were more likely to be transferred to the intensive care unit. The neutrophil count and lactate dehydrogenase, fibrinogen, and D-dimer levels in hypertensive patients were significantly higher than those in nonhypertensive patients (P < 0.05). However, multivariate analysis (adjusted for age and sex) failed to show that hypertension was an independent risk factor for COVID-19 mortality or severity. COVID-19 patients with hypertension were more likely than patients without hypertension to have severe pneumonia, excessive inflammatory reactions, organ and tissue damage, and deterioration of the disease. Patients with hypertension should be given additional attention to prevent worsening of their condition.


SARS-CoV-2 in wastewater: potential health risk, but also data source


Syndromic panels or the panels' syndrome? A perspective through the lens of respiratory tract infections: author's response


title: Prognostic Factors for Adverse Outcomes in COVID-19 Infection

text: Whilst COVID-19 infection generally run a mild course in up to 80% of those affected, a number of pre-existing co-morbidities determine the severity of infection and the outcome in an individual patient. The most important of these co-morbidities that have consistently emerged in studies from across the globe, are the patients age and sex. Other important co-morbidities that adversely affect outcomes include pre-existing diabetes, obesity, hypertension, chronic lung disease and malignancy. This comprehensive review discusses the impact of these co-morbidities and the role of laboratory predictors of poor patient outcomes.


Affective psychosis after COVID-19 infection in a previously healthy patient: a case report


title: COVID-19 Epidemic Peer Support and Crisis Intervention Via Social Media

text: This article describes a peer support project developed and carried out by a group of experienced mental health professionals, organized to offer peer psychological support from overseas to healthcare professionals on the frontline of the COVID-19 outbreak in Wuhan, China. This pandemic extremely challenged the existing health care systems and caused severe mental distress to frontline healthcare workers. The authors describe the infrastructure of the team and a novel model of peer support and crisis intervention that utilized a popular social media application on smartphone. Such a model for intervention that can be used elsewhere in the face of current global pandemic, or future disaster response.


title: Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents

text: BACKGROUND: The aim was to assess the impact of COVID-19 self-isolation/social distancing on mental health, and potential correlates, among a sample of the UK population. METHODS: A cross-sectional study. Mental health was measured using the Beck Anxiety and Depression Inventory. Mental wellbeing was measured using The Short Warwick-Edinburgh Mental Well-being Scale. Data collected on predictors included sex, age, marital status, employment, annual income, region, current smoking, current alcohol consumption, physical multimorbidity, any physical symptoms experienced during self-isolation/social distancing, and the number of days of self-isolation/social distancing. The association between potential predictors and poor mental health was studied using a multivariable logistic regression. RESULTS: 932 participants were included. Factors associated with poor mental health were sex (reference: male; female: OR=1.89, 95%CI=1.34-2.68), age (18-24 years: reference;45-54 years: OR=0.27, 95%CI=0.14-0.53; 55-64 years: OR=0.24, 95%CI=0.12-0.47; 65-74years: OR=0.10, 95% CI=0.05-0.22; and ≥75years: OR=0.08,95% CI=0.03-0.24),annual income (<£15,000: reference; £25,000-<£40,000: OR=0.54, 95% CI=0.31-0.93; £40,000-<£60,000: OR=0.39, 95% CI=0.22-0.69; and ≥£60,000: OR=0.38, 95% CI=0.21-0.67), current smoking (yes: OR=2.59, 95%CI=1.62-4.20), and physical multimorbidity (OR=2.35, 95%CI=1.61-3.46). CONCLUSIONS: In this sample of UK adults self-isolating/social distancing females, younger age groups, those with a lower annual income, current smokers and those with physical multimorbidity were associated with higher levels of poor mental health.


title: Inhibition of SARS-CoV-2 by type I and type III interferons

text: The recently emerged severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative agent of the devastating COVID-19 lung disease pandemic. Here, we tested the inhibitory activities of the antiviral interferons of type I (IFN-alpha) and type III (IFN-lambda) against SARS-CoV-2 and compared them with those against SARS-CoV-1, which emerged in 2003. Using two mammalian epithelial cell lines (human Calu-3 and simian Vero E6), we found that both IFNs dose-dependently inhibit SARS-CoV-2. In contrast, SARS-CoV-1 was restricted only by IFN-alpha in these cell lines. SARS-CoV-2 generally exhibited a broader IFN sensitivity than SARS-CoV-1. Moreover, ruxolitinib, an inhibitor of IFN-triggered Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signaling, boosted SARS-CoV-2 replication in the IFN-competent Calu-3 cells. We conclude that SARS-CoV-2 is sensitive to exogenously added IFNs. This finding suggests that type I and especially the less adverse effect-prone type III IFN are good candidates for the management of COVID-19.


title: BRCA testing in a genomic diagnostics referral center during the COVID-19 pandemic

text: The first person-to-person transmission of the 2019-novel coronavirus in Italy on 21 February 2020 led to an infection chain that represents one of the largest known COVID-19 outbreaks outside Asia. Hospitals have been forced to reorganized their units in response to prepare for an unforeseen healthcare emergency. In this context, our laboratory (Molecular and Genomic Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS) re-modulated its priorities by temporarily interrupting most of the molecular tests guaranteeing only those considered "urgent" and not postponable. In particular, this paper details changes regarding the execution of germline BRCA (gBRCA) testing in our laboratory. A substantial reduction in gBRCA testing (about 60%) compared to the first 2 months of the current year was registered, but the requests have not been reset. The requesting physicians were mainly gynaecologists and oncologists. These evidences further emphasize the new era of gBRCA testing in the management of cancer patients and confirms definitively the integration of gBRCA testing/Next Generation Sequencing (NGS) into clinical oncology. Finally, a re-organization of gBRCA testing in our Unit, mainly related to delayed and reduced arrival of tests was necessary, ensuring, however, a high-quality standard and reliability, mandatory for gBRCA testing in a clinical setting.


title: In vitro synergistic effect of retapamulin with erythromycin and quinupristin against Enterococcus faecalis

text: To find a therapeutic alternative for the treatment of skin and soft tissue infections, we evaluated the effects of combinations of retapamulin with macrolide, lincosamide, and streptogramin (MLS) antibiotics against Staphylococcus aureus, Streptococcus pyogenes, Enterococcus faecium, and Enterococcus faecalis. Using both the disk diffusion test and checkerboard assay, we initially examined the effects of combinations of retapamulin with MLS antibiotics against standard strains of these species. Combinations of retapamulin with erythromycin, quinupristin/dalfopristin and quinupristin showed synergistic activity against E. faecalis only. Synergy of retapamulin with clindamycin and dalfopristin was not observed. Then, a checkerboard assay was performed to evaluate the effects of the combinations against 15 clinical strains of E. faecalis. Retapamulin and quinupristin, the most synergistic combination, showed activity against all erythromycin-susceptible, -intermediate, and -resistant strains tested. Among the eight strains with high-level erythromycin resistance, five strains were synergistically inhibited in the presence of only 1 µg of retapamulin per ml. Time-kill assay revealed that combinations of retapamulin with erythromycin and quinupristin were bacteriostatic. These results suggest that combinations of retapamulin with erythromycin and quinupristin have in vitro synergistic activity against E. faecalis, including strains with high-level erythromycin resistance.


title: Clinical and radiological changes of hospitalised patients with COVID-19 pneumonia from disease onset to acute exacerbation: a multicentre paired cohort study

text: OBJECTIVES: To analyse clinical and radiological changes from disease onset to exacerbation in coronavirus infectious disease-19 (COVID-19) patients. METHODS: We reviewed clinical histories of 276 patients with confirmed COVID-19 pneumonia and extracted data on patients who met the diagnostic criteria for COVID-19 severe/fatal pneumonia and had an acute exacerbation starting with mild or common pneumonia. RESULTS: Twenty-four patients were included. Of these, 8% were smokers, 54% had been to Wuhan, and 46% had comorbidities. Before acute exacerbation, elevated lactate dehydrogenase (232.9 ± 88.7) was present, and chest CT scans showed the number of involved lobes was 4 (2-5) and total CT score was 6 (2-8). Following acute exacerbation, patients were likely to have more clinical symptoms (p < 0.01) and abnormal laboratory changes (p < 0.01). The number of involved lobes and CT score after an exacerbation significantly increased to 5 (5-5) and 12 (9-14), respectively. Receiver operating characteristic (ROC) curve showed that, when the cutoff value of CT score was 5, the sensitivity and specificity for severe pneumonia were 90% and 70%, respectively. CT findings of ground glass opacity with consolidations (91.7%), bilateral distribution (100.0%), and multifocal lesion (100.0%) were features in found in patients after exacerbation. CONCLUSIONS: There are significant changes in clinical, laboratory, and CT findings in patients from disease onset to exacerbation. An increase in the number of involved lobes or an increased CT score from the baseline may predict poor clinical outcomes. Combining an assessment of CT changes with clinical and laboratory changes could help clinical teams evaluate the prognosis. KEY POINTS: â¢ The common chest CT signs of COVID-19 pneumonia after exacerbation were ground glass opacity (GGO) with consolidation, bilateral distribution, and multifocal lesions. â¢ An increase in number of involved lobes or an increased CT score from the baseline may predict a poor clinical outcome. â¢ Worsened symptoms and abnormal laboratory results are also associated with poor prognosis.


title: Prevention and control strategies in the diagnosis and treatment of solid tumors in children during the COVID-19 pandemic

text: Since the emergence of patients with COVID-19 in December 2019, the virus has rapidly spread worldwide. Children with malignant tumors are more prone to be infected and develop severe infections. Prevention and control of the pandemic and ensuring the progress of the cancer diagnosis and treatment is a significant problem in the current scenario. This article proposes a scientific management system for patients with solid tumors to guarantee emergency surgery, rationally arrange limited-term surgery, appropriately defer elective surgery, and guarantee regular chemotherapy, while protecting children from SARS-CoV-2 infection and ensuring the continuity of comprehensive diagnosis and treatment.


Impact of COVID-19 on medical education and resident burnout in a postgraduate programme


No credible evidence supporting claims of the laboratory engineering of SARS-CoV-2


title: CovidSens: A Vision on Reliable Social Sensing for COVID-19

text: With the spiraling pandemic of the Coronavirus Disease 2019 (COVID-19), it has becoming inherently important to disseminate accurate and timely information about the disease. Due to the ubiquity of Internet connectivity and smart devices, social sensing is emerging as a dynamic AI-driven sensing paradigm to extract real-time observations from online users. In this paper, we propose CovidSens, a vision of social sensing based risk alert systems to spontaneously obtain and analyze social data to infer COVID-19 propagation. CovidSens can actively help to keep the general public informed about the COVID-19 spread and identify risk-prone areas. The CovidSens concept is motivated by three observations: 1) people actively share their experience of COVID-19 via online social media, 2) official warning channels and news agencies are relatively slower than people reporting on social media, and 3) online users are frequently equipped with powerful mobile devices that can perform data processing and analytics. We envision unprecedented opportunities to leverage posts generated by ordinary people to build real-time sensing and analytic system for gathering and circulating COVID-19 propagation data. Specifically, the vision of CovidSens attempts to answer the questions: How to distill reliable information on COVID-19 with prevailing rumors and misinformation? How to inform the general public about the state of the spread timely and effectively? How to leverage the computational power on edge devices to construct fully integrated edge-based social sensing platforms? In this vision paper, we discuss the roles of CovidSens and identify potential challenges in developing reliable social sensing based risk alert systems. We envision that approaches originating from multiple disciplines can be effective in addressing the challenges. Finally, we outline a few research directions for future work in CovidSens.


Characteristics and clinical outcomes of COVID-19 in Hispanic/Latino patients in a community setting: A retrospective cohort study


title: Characteristics and Clinical Course and Outcome of COVID-19 in Hispanic/Latino Patients in a Community Setting: A Retrospective Cohort Study

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus which causes coronavirus disease 2019 (COVID-19), has caused significant morbidity and mortality worldwide. The Centers for Disease Control and Prevention (CDC) suggest several possible symptoms associated with coronavirus disease 2019 (COVID-19), including cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, sore throat, new loss of taste or smell, and less commonly nausea/vomiting/diarrhea.1 This article is protected by copyright. All rights reserved.


title: Medikamentoznoe lechenie koronavirusnoi bolezni COVID-19: sushchestvuet li dokazatel'naya baza?/ [Drug treatment of coronavirus disease COVID-19: evidence exists?]

text: The article provides a review of foreign literature for 2020 on existing methods of drug treatment of coronavirus disease COVID-19. To date, in the treatment of COVID-19 in different countries, a little more than 10 drugs are used. The largest number of studies on the testing of these drugs is carried out by scientists from China, the USA, and European countries. It should be noted that among these drugs there is not a single new drug developed specifically for the treatment of COVID-19, the recommended and used drugs have previously been used to treat, as a rule, diseases of the viral etiology, less often another pathology. These suggestions are often based on analogy, the hypothesis of their supposed effectiveness for COVID-19. It can be assumed that a brake on the development of a drug specific for coronavirus disease is a poor knowledge of the pathogenesis of virus invasion in the body's adhesives and the development of complications. The review provides detailed literature data on drugs such as hydroxychloroquine / chloroquine, lopinavir/natinavir, remdesivir, ACE inhibitors and angiotensin converting enzyme receptor blockers, tissue plasminogen activator, as well as plasma transfusion transfusions.


title: Community pharmacists' exposure to COVID-19

text: INTRODUCTION: Since the beginning of the 2020 Sars-CoV-2 Italian outbreak, healthcare workers have been among the most exposed categories. There is little information about community pharmacists' on occupational exposure, symptoms development, and testing practices in the community pharmacist cohort. METHODS: Between April 30th and May 10th, a questionnaire was administered through social media to Italian community pharmacists. From 67000 pharmacists currently working in community pharmacies, 1632 answered the survey. RESULTS: The survey population reflected the general Italian community pharmacists population in terms of age, gender, and number of co-workers. Protective measures were adopted in up to 99.9% of pharmacies. 624 pharmacists (38.2%) developed at least one COVID-19 related symptom in the period between February 28th and May 10th. Also, 102 pharmacists (6.2%) were tested for COVID-19 and 15, the 15% of the tested population and 0.92% of the whole survey population, resulted positive on nasopharyngeal swab. However, while the number of symptomatic pharmacists decreased, a higher number of tests were performed, thus COVID-19 prevalence among community pharmacists could have been underestimated and is probably intermediate between other healthcare workers and the general population (0.31%). CONCLUSION: Community pharmacists have probably been one of the first categories to experience increased contact risk to SARS-CoV-2. COVID-19 prevalence among pharmacists could have been underestimated. In addition, the rates of protection measures adoption might have helped to reduce the spread of COVID-19 among co-workers and the community.


title: Private Sources of Mobility Data Under COVID-19

text: The COVID-19 pandemic is changing the world in unprecedented and unpredictable ways. Human mobility is at the epicenter of that change, as the greatest facilitator for the spread of the virus. To study the change in mobility, to evaluate the efficiency of mobility restriction policies, and to facilitate a better response to possible future crisis, we need to properly understand all mobility data sources at our disposal. Our work is dedicated to the study of private mobility sources, gathered and released by large technological companies. This data is of special interest because, unlike most public sources, it is focused on people, not transportation means. i.e., its unit of measurement is the closest thing to a person in a western society: a phone. Furthermore, the sample of society they cover is large and representative. On the other hand, this sort of data is not directly accessible for anonymity reasons. Thus, properly interpreting its patterns demands caution. Aware of that, we set forth to explore the behavior and inter-relations of private sources of mobility data in the context of Spain. This country represents a good experimental setting because of its large and fast pandemic peak, and for its implementation of a sustained, generalized lockdown. We find private mobility sources to be both correlated and complementary. Using them, we evaluate the efficiency of implemented policies, and provide a insights into what new normal means in Spain.


Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan


COVID-19 in dimethyl fumarate-treated patients with multiple sclerosis


Dépistage préopératoire du SARS-CoV-2 : est-il véritablement possible d'exclure la présence de COVID-19?/ Preoperative SARS-CoV-2 screening: Can it really rule out COVID-19?


title: Clinical characteristics of older patients infected with COVID-19: A descriptive study

text: OBJECTIVES: Since the outbreak of 2019 novel coronavirus (COVID-19), which has spread in the world rapidly. Population have a susceptibility to COVID-19, older people were more susceptible to have a variety diseases than younger, including COVID-19 infection with no doubt. This study focused on older patients with COVID-19 infection and analyzed the epidemiological and clinical characteristics of them. METHODS: We collected information on confirmed older patient transferred by Beijing Emergency Medical Service (EMS) to the designated hospitals from Jan 20 to Feb 29, 2020. The information including demographic, epidemiological, clinical, classification of severity and outcomes. All cases were categorized into three groups and compared the difference between aged 50-64 years, 65-79 years and older than 80 years. RESULTS: 56.7 % of elderly confirmed patients were male, fever (78.3 %), cough (56.7 %), dyspnea (30.0 %), and fatigue (23.3 %) were common symptoms of COVID-19 infection. Classification of severity has statistically significant differences between the three groups, compared with middle-aged patients and aged 65-79 years group, older than 80 years group had significant statistical differences in contacted to symptomatic case in 14 days. As of Feb 29, 38.3 % patients had discharged and 53.3 % patients remained in hospital in our study, the fatality of COVID-19 infection in elderly was 8.3 %. CONCLUSIONS: The COVID-19 infection is generally susceptible with a relatively high fatality rate in older patients, we should pay more attention to the elderly patients with COVID-19 infection.


docid: htwkiubq

title: COVID-19-related acute necrotizing encephalopathy with brain stem involvement in a patient with aplastic anemia

text: OBJECTIVE: To describe a novel case of coronavirus disease 2019 (COVID-19)-associated acute necrotizing encephalopathy (ANE) in a patient with aplastic anemia where there was early brain stem-predominant involvement. METHODS: Evaluation of cause, clinical symptoms, and treatment response. RESULTS: A 59-year-old woman with a background of transfusion-dependent aplastic anemia presented with seizures and reduced level of consciousness 10 days after the onset of subjective fever, cough, and headache. Nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus (SARS-CoV-2) was positive, and CT during admission demonstrated diffuse swelling of the brain stem. She required intubation and mechanical ventilation for airway protection, given her reduced level of consciousness. The patient's condition deteriorated, and MRI on day 6 demonstrated worsening brain stem swelling with symmetrical hemorrhagic lesions in the brain stem, amygdalae, putamina, and thalamic nuclei. Appearances were consistent with hemorrhagic ANE with early brain stem involvement. The patient showed no response to steroid therapy and died on the eighth day of admission. CONCLUSIONS: COVID-19 may be associated with an acute severe encephalopathy and, in this case, was considered most likely to represent an immune-mediated phenomenon. As the pandemic continues, we anticipate that the spectrum of neurologic presentation will broaden. It will be important to delineate the full clinical range of emergent COVID-19-related neurologic disease.


title: High COVID-19 Attack Rate Among Attendees at Events at a Church - Arkansas, March 2020

text: On March 16, 2020, the day that national social distancing guidelines were released (1), the Arkansas Department of Health (ADH) was notified of two cases of coronavirus disease 2019 (COVID-19) from a rural county of approximately 25,000 persons; these cases were the first identified in this county. The two cases occurred in a husband and wife; the husband is the pastor at a local church (church A). The couple (the index cases) attended church-related events during March 6-8, and developed nonspecific respiratory symptoms and fever on March 10 (wife) and 11 (husband). Before his symptoms had developed, the husband attended a Bible study group on March 11. Including the index cases, 35 confirmed COVID-19 cases occurred among 92 (38%) persons who attended events held at church A during March 6-11; three patients died. The age-specific attack rates among persons aged ≤18 years, 19-64 years, and ≥65 years were 6.3%, 59.4%, and 50.0%, respectively. During contact tracing, at least 26 additional persons with confirmed COVID-19 cases were identified among community members who reported contact with church A attendees and likely were infected by them; one of the additional persons was hospitalized and subsequently died. This outbreak highlights the potential for widespread transmission of SARS-CoV-2, the virus that causes COVID-19, both at group gatherings during church events and within the broader community. These findings underscore the opportunity for faith-based organizations to prevent COVID-19 by following local authorities' guidance and the U.S. Government's Guidelines: Opening Up America Again (2) regarding modification of activities to prevent virus transmission during the COVID-19 pandemic.


Pandemia de Covid-19 y transformación digital en Cuidados Intensivos./ Pandemia de Covid-19 y transformación digital en Cuidados Intensivos./ Covid-19 pandemic and digital transformation in critical care units


docid: fllyyuer

title: Pathogenic Priming Likely Contributes to Serious and Critical Illness and Mortality in COVID-19 via Autoimmunity

text: Homology between human and viral proteins is an established factor in viral- or vaccine-induced autoimmunity. Failure of SARS and MERS vaccines in animal trials involved pathogenesis consistent with an immunological priming that could involve autoimmunity in lung tissues due to previous exposure to the SARS and MERS spike protein. Exposure pathogenesis to SARS-CoV-2 in COVID-19 likely will lead to similar outcomes. Immunogenic peptides in viruses or bacteria that match human proteins are good candidates for pathogenic priming peptides (similar to the more diffuse idea of "immune enhancement"). Here I provide an assessment of potential for human pathogenesis via autoimmunity via exposure, via infection or injection. SAR-CoV-2 spike proteins, and all other SARS-CoV-2 proteins, immunogenic epitopes in each SARS-CoV-2 protein were compared to human proteins in search of high local homologous matching. Only one immunogenic epitope in a SARS-CoV-2 had no homology to human proteins. If all of the parts of the epitopes that are homologous to human proteins are excluded from consideration due to risk of pathogenic priming, the remaining immunogenic parts of the epitopes may be still immunogenic and remain as potentially viable candidates for vaccine development. Mapping of the genes encoding human protein matches to pathways point to targets that could explain the observed presentation of symptoms in COVID-19 disease. It also strongly points to a large number of opportunities for expected disturbances in the immune system itself, targeting elements of MCH Class I and Class II antigen presentation, PD-1 signaling, cross-presentation of soluble exogenous antigens and the ER-Phagosome pathway. Translational consequences of these findings are explored.


title: [Clinical Characteristics and Coping Strategies of Neoplasms with 2019 Novel Coronavirus Infection]

text: Since mid-December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has outbroken in Wuhan, Hubei Province, China, and spread rapidly to other provinces in China and dozens of countries and regions around the world, becoming the Public Health Emergency of International Concern (Public Health Emergency of International Concern). SARS-CoV-2 can mainly transmit by droplets or close contact, and is generally susceptible in the crowd. Tumor patients are at high risk of this pathogen because of their impaired immune function. Identifying tumor patients with 2019 novel coronavirus disease (COVID-19) early, and understanding its distribution characteristics can help to improve the cure rate of patients, and better control the epidemic and development of SARS-CoV-2 much better. With comprehensive analysis of relevant literature, this paper reviews the clinical characteristics of neoplastic patients with COVID-19, and puts forward some suggestions on how to deal with this epidemic.


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

text: The role of bioethicists amidst crises like the COVID-19 pandemic is not well defined. As professionals in the field, they should respond, but how? The observation of the early days of pandemic confinement in Finland showed that moral philosophers with limited experience in bioethics tended to apply their favorite theories to public decisions with varying results. Medical ethicists were more likely to lend support to the public authorities by soothing or descriptive accounts of the solutions assumed. These are approaches that Tuija Takala has called the firefighting and window dressing models of bioethics. Human rights lawyers drew attention to the flaws of the government's regulative thinking. Critical bioethicists offered analyses of the arguments presented and the moral and political theories that could be used as the basis of good and acceptable decisions.


Letter to the editor: Wide indication for SARS-CoV-2-testing allowed identification of international risk areas during the early phase of the COVID-19 pandemic in Germany


Passive immunotherapy with convalescent plasma against COVID-19? What about the evidence base and clinical trials?


docid: xpvloqad

title: Immunomodulation in COVID-19


Characteristics of a family cluster of Severe Acute Respiratory Syndrome Coronavirus 2 in Henan, China


title: Global Data Science Project for COVID-19 Summary Report

text: This paper aims at providing the summary of the Global Data Science Project (GDSC) for COVID-19. as on May 31 2020. COVID-19 has largely impacted on our societies through both direct and indirect effects transmitted by the policy measures to counter the spread of viruses. We quantitatively analysed the multifaceted impacts of the COVID-19 pandemic on our societies including people's mobility, health, and social behaviour changes. People's mobility has changed significantly due to the implementation of travel restriction and quarantine measurements. Indeed, the physical distance has widened at international (cross-border), national and regional level. At international level, due to the travel restrictions, the number of international flights has plunged overall at around 88 percent during March. In particular, the number of flights connecting Europe dropped drastically in mid of March after the United States announced travel restrictions to Europe and the EU and participating countries agreed to close borders, at 84 percent decline compared to March 10th. Similarly, we examined the impacts of quarantine measures in the major city: Tokyo (Japan), New York City (the United States), and Barcelona (Spain). Within all three cities, we found the significant decline in traffic volume. We also identified the increased concern for mental health through the analysis of posts on social networking services such as Twitter and Instagram. Notably, in the beginning of April 2020, the number of post with #depression on Instagram doubled, which might reflect the rise in mental health awareness among Instagram users. Besides, we identified the changes in a wide range of people's social behaviors, as well as economic impacts through the analysis of Instagram data and primary survey data.


Response to 'Reply to Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy'


title: Two simple comments regarding coronavirus

text: Two thought provoking comments related to understanding the problems with the coronavirus are presented.


title: Propensity and quantification of aerosol and droplet creation during phacoemulsification with high-speed shadowgraphy amidst COVID-19 pandemic

text: PURPOSE: To study propensity of aerosol and droplet generation during phacoemulsification using high-speed shadowgraphy and quantify its spread amidst COVID-19 pandemic. SETTING: Aerosol and droplet quantification laboratory DESIGN:: Laboratory study. METHODS: In an experimental set up, phacoemulsification was performed on enucleated goat eyes and cadaveric human corneo-scleral rims mounted on an artificial anterior chamber. Standard settings for sculpt and quadrant removal mode were used on Visalis 100 (Carl Zeiss Meditec, Germany). Microincision and standard phacoemulsification were done using titanium straight tips (2.2 and 2.8 mm in diameter). The main wound incisions were titrated equal to and larger than the sleeve size. High speed shadowgraphy technique was used to detect the possible generation of any droplets and aerosols. The visualization and quantification of size of the aerosols and droplets along with calculation of their spread were the main outcome measures. RESULTS: In longitudinal phacoemulsification using a peristaltic pump device with a straight tip, no aerosol generation was seen in a closed chamber. In larger wounds, there was a slow leak at the main wound. The atomization of balanced salt solution was observed only when the phaco tip was completely exposed next to the ocular surface. Under this condition, the nominal size of the droplet was â¼ 50 µm and the maximum calculated spread was 1.3 meters. CONCLUSIONS: There was no visible aerosol generation during microincision or standard phacoemulsification. Phacoemulsification is safe to perform in the COVID-19 era by taking adequate precautions against other modes of transmission.


Management of breast cancer during COVID-19 pandemic in Morocco


Minor aphthae associated with SARS-CoV-2 infection


Facing the SARS-CoV-2 (COVID-19) outbreak with IL-6R antagonists


title: Covid-19 transmission, outcome and associated risk factors in cancer patients at the first month of the pandemic in a Spanish hospital in Madrid

text: BACKGROUND: There are no large reported series determining the Covid-19 cancer patient's characteristics. We determine whether differences exist in cumulative incidence and mortality of Covid-19 infection between cancer patients and general population in Madrid. MATERIAL AND METHODS: We reviewed 1069 medical records of all cancer patients admitted at Oncology department between Feb 1 and April 7, 2020. We described Covid-19 cumulative incidence, treatment outcome, mortality, and associated risk factors. RESULTS: We detected 45/1069 Covid-19 diagnoses in cancer patients vs 42,450/6,662,000 in total population (p < 0.00001). Mortality rate: 19/45 cancer patients vs 5586/42,450 (p = 0.0001). Mortality was associated with older median age, adjusted by staging and histology (74 vs 63.5 years old, OR 1.06, p = 0.03). Patients who combined hydroxychloroquine and azithromycin presented 3/18 deaths, regardless of age, staging, histology, cancer treatment and comorbidities (OR 0.02, p = 0.03). CONCLUSION: Cancer patients are vulnerable to Covid-19 with an increase in complications. Combined hydroxychloroquine and azithromycin is presented as a good treatment option.


Utilization of COVID-19 testing for opportunistic screening of oral cancer


title: A Quantitative Framework for Modeling COVID-19 Risk During Adjuvant Therapy Using Published Randomized Trials of Glioblastoma in the Elderly

text: BACKGROUND: During the ongoing COVID-19 pandemic, contact with the healthcare system for cancer treatment can increase risk of infection and associated mortality. Treatment recommendations must consider this risk for elderly and vulnerable cancer patients. We re-analyzed trials in elderly glioblastoma (GBM) patients, incorporating COVID-19 risk, in order to provide a quantitative framework for comparing different radiation (RT) fractionation schedules on patient outcomes. METHODS: We extracted individual patient-level data (IPLD) for 1,321 patients from Kaplan-Meier curves from five randomized trials on treatment of elderly GBM patients including available subanalyses based on MGMT methylation status. We simulated trial data with incorporation of COVID-19 associated mortality risk in several scenarios (low, medium, and high infection and mortality risks). Median overall survival and hazard ratios were calculated for each simulation replicate. RESULTS: Our simulations reveal how COVID-19-associated risks affect survival under different treatment regimens. Hypofractionated RT with concurrent and adjuvant temozolomide (TMZ) demonstrated the best outcomes in low and medium risk scenarios. In frail elderly patients, shorter courses of RT are preferable. In patients with methylated MGMT receiving single modality treatment, TMZ-alone treatment approaches may be an option in settings with high COVID-19-associated risk. CONCLUSIONS: Incorporation of COVID-19-associated risk models into analysis of randomized trials can help guide clinical decisions during this pandemic. In elderly GBM patients, our results support prioritization of hypofractionated RT and highlight the utility of MGMT methylation status in decision-making in pandemic scenarios. Our quantitative framework can serve as a model for assessing COVID-19 risk associated with treatment across neuro-oncology.


Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis


SARS-CoV-2 related liver impairment - perception may not be the reality


title: Utility and risk of dermatologic medications during the COVID-19 pandemic

text: In the era of staggering speed in development of the novel coronavirus (CoV) pandemic (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2), we have reviewed the dermatologists' tools at hand for their utility (and potential risks) in patients affected by COVID-19. This review aims to shed light on the anti-viral and pro-viral potential of drugs routinely used in dermatology to modulate COVID-19. The literature search included peer-reviewed articles published in English language (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) from January 1990 to March 2020 and by reference lists of respective articles. Somewhat to our surprise, we have found that several of our drugs widely used in dermatology have antiviral potential. On the other hand, we also frequently use immunosuppressive drugs in our dermatologic patients that potentially pose them at increased risk for COVID-19. This article is protected by copyright. All rights reserved.


title: A fine balance: Immunosuppression and immunotherapy in a patient with multiple sclerosis and COVID-19

text: BACKGROUND: Treatment decisions in patients with multiple sclerosis (MS) during the coronavirus disease 2019 (COVID-19) pandemic are challenging. It is not known whether and how various disease modifying therapies, especially immunosuppressive drugs, affect COVID-19 risk and disease course. METHODS: Case report RESULTS: We report a fingolimod-treated MS patient who developed severe COVID-19 but recovered after treatment with tocilizumab. CONCLUSION: This report suggests that a brief course of tocilizumab for the treatment of severe COVID-19 may be effective while not aggravating pre-existing MS.


title: Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children

text: Importance: Neurological manifestations have been reported in adults with coronavirus disease 2019 (COVID-19), which is caused by the highly pathogenic virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: To report the neurological manifestations of children with COVID-19. Design, Setting, and Participants: In this case-series study, patients younger than 18 years who presented with SARS-CoV-2 infection and neurological symptoms to Great Ormond Street Hospital for Children (London, UK) between March 1, 2020, and May 8, 2020, were included after infection was confirmed by either a quantitative reverse transcription-polymerase chain reaction assay by nasopharyngeal swab or a positive test result for IgG antibodies against SARS-CoV-2 in serum. Main Outcomes and Measures: Clinical and paraclinical features were retrieved from electronic patient records. Results: Of the 27 children with COVID-19 pediatric multisystem inflammatory syndrome, 4 patients (14.8%) who were previously healthy had new-onset neurological symptoms. Symptoms included encephalopathy, headaches, brainstem and cerebellar signs, muscle weakness, and reduced reflexes. All 4 patients required intensive care unit admission for the treatment of COVID-19 pediatric multisystem inflammatory syndrome. Splenium signal changes were seen in all 4 patients on magnetic resonance imaging of the brain. In the 2 patients whose cerebrospinal fluid was tested, samples were acellular, with no evidence of infection on polymerase chain reaction or culture (including negative SARS-CoV-2 polymerase chain reaction results) and negative oligoclonal band test results. In all 3 patients who underwent electroencephalography, a mild excess of slow activity was found. Tests for N-methyl-d-aspartate receptor, myelin oligodendrocyte glycoprotein, and aquaporin-4 autoantibodies had negative results in all patients. In all 3 patients who underwent nerve conduction studies and electromyography, mild myopathic and neuropathic changes were seen. Neurological improvement was seen in all patients, with 2 making a complete recovery by the end of the study. Conclusions and Relevance: In this case-series study, children with COVID-19 presented with new neurological symptoms involving both the central and peripheral nervous systems and splenial changes on imaging, in the absence of respiratory symptoms. Additional research is needed to assess the association of neurological symptoms with immune-mediated changes among children with COVID-19.


title: Unclaimed Defined Benefit Pensions Can Help COVID-19 Economic Recovery

text: The COVID-19 economic crisis makes it vitally important that workers who earned defined benefit pensions receive them at retirement. Unfortunately, billions of dollars that could help cushion the financial shock are sitting unclaimed, because the people who they belong to cannot locate the company responsible for paying them. As defined benefit pension plans have been terminated, merged and moved over the years, large numbers of deferred vested participants have not been notified about their benefits. The widespread and growing practice of insurance company pension buy-outs can be especially problematic for participants without notice. Broader use of electronic disclosures for pensions also threatens to make the situation worse. In the wake of COVID-19, policy makers should take steps to ensure that pension benefits are part of the economic recovery.


Impact on rehabilitation programs during Covid-19 containment for children with pediatric and perinatal stroke


COVID-19: Protecting our ENT Workforce


title: Genetic sequence changes related to the attenuation of avian infectious bronchitis virus strain TW2575/98

text: The attenuated avian infectious bronchitis virus (IBV), derived from a wild strain (TW2575/98w) in chicken embryos after 75 passages, is designed as a commercial vaccine strain (TW2575/98vac) to control the disease in Taiwan. The differences in viral infectivity, replication efficiency, and genome sequences between TW2575/98w and TW2575/98vac were determined and compared. TW2575/98vac caused earlier death of chicken embryos and had higher viral replication efficiency. Thirty amino acid substitutions resulting from 44 mutated nucleotides in the viral genome were found in TW2575/98vac. All of the molecular variations lead to attenuation, found in TW2575/98, were not observed consistently in the other IBVs (TW2296/95, Ark/Ark-DPI/81, the Massachusetts strain, GA98/CWL0470/98, and CK/CH/LDL/97I) and vice versa. After further comparisons and evaluations from three aspects: (1) longitudinal analysis on the timing of variations appeared in specific homologous strain passages, (2) horizontal evaluations with the amino acid changes between wild and vaccine strains among the other 5 IBVs, and (3) inspection on alterations in the chemical characteristics of substituted amino acid residues in viral proteins, four amino acid substitutions [V342D in p87, S1493P and P2025S in HD1, as well as F2308Y in HD1(P41)] were selected as highly possible candidates for successful TW2575/98w attenuation. Our findings imply that molecular variations, which contribute to the successful attenuation of different IBVs, are diverse and not restricted to a fixed pattern or specific amino acid substitutions in viral proteins. In addition, four amino acid changes within the replicase gene-encoded proteins might be associated with TW2575/98 virus virulence.


title: Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage

text: BACKGROUND: Patients with critical illness due to infection with the 2019 coronavirus disease (COVID-19) show rapid disease progression to acute respiratory failure. The study aimed to screen the most useful predictive factor for critical illness caused by COVID-19. METHODS: The study prospectively involved 61 patients with COVID-19 infection as a derivation cohort, and 54 patients as a validation cohort. The predictive factor for critical illness was selected using LASSO regression analysis. A nomogram based on non-specific laboratory indicators was built to predict the probability of critical illness. RESULTS: The neutrophil-to-lymphocyte ratio (NLR) was identified as an independent risk factor for critical illness in patients with COVID-19 infection. The NLR had an area under receiver operating characteristic of 0.849 (95% confidence interval [CI], 0.707 to 0.991) in the derivation cohort and 0.867 (95% CI 0.747 to 0.944) in the validation cohort, the calibration curves fitted well, and the decision and clinical impact curves showed that the NLR had high standardized net benefit. In addition, the incidence of critical illness was 9.1% (1/11) for patients aged ≥ 50 and having an NLR < 3.13, and 50% (7/14) patients with age ≥ 50 and NLR ≥ 3.13 were predicted to develop critical illness. Based on the risk stratification of NLR according to age, this study has developed a COVID-19 pneumonia management process. CONCLUSIONS: We found that NLR is a predictive factor for early-stage prediction of patients infected with COVID-19 who are likely to develop critical illness. Patients aged ≥ 50 and having an NLR ≥ 3.13 are predicted to develop critical illness, and they should thus have rapid access to an intensive care unit if necessary.


title: Technical and Interpretive Pitfalls in Adrenal Imaging

text: The adrenal gland may exhibit a wide variety of pathologic conditions. A number of imaging techniques can be used to characterize these, although it is not always possible to attain a definitive diagnosis radiologically. Incorrect diagnoses may be made if radiologists are not attentive to technical parameters and interpretive factors associated with adrenal gland imaging. Hence, an appreciation of the intricacies of adrenal imaging strategies and characterization is required; this can be aided by understanding the pitfalls of adrenal imaging. Technical pitfalls at CT may relate to the imaging parameters, including region of interest characteristics, tube voltage selection, and the timing of contrast material-enhanced imaging. With MRI, imaging acquisition technique and evaluation of the reference tissues used in chemical shift MRI are important considerations that can directly influence image interpretation. Interpretive errors may occur when evaluating adrenal washout at CT without considering other radiologic features, including the size of adrenal nodules, the presence of fat or calcification, the attenuation of nodules, and atypical imaging features. The characterization of an incidental adrenal lesion as benign or malignant does not end the role of the radiologist; consideration as to whether an adrenal lesion is associated with endocrine dysfunction is required. While imaging may not be optimal for establishing endocrine activity, there are imaging features from which radiologists may infer function. In cases of known endocrine activity, imaging can guide clinical management, including further investigations such as venous sampling. ©RSNA, 2020.


title: [Diagnosis and treatment recommendation for pediatric COVID-19 (the second edition)]

text: The coronavirus disease 2019 (COVID-19) has caused a global pandemic. All people including children are generally susceptible to COVID-19, but the condition is relatively mild for children. The diagnosis of COVID-19 is largely based on the epidemiological evidence and clinical manifestations, and confirmed by positive detection of virus nucleic acid in respiratory samples. The main symptoms of COVID-19 in children are fever and cough; the total number of white blood cell count is usually normal or decreased; the chest imaging is characterized by interstitial pneumonia, which is similar to other respiratory virus infections and Mycoplasma pneumoniae infections. Early identification, early isolation, early diagnosis and early treatment are important for clinical management. The treatment of mild or moderate type of child COVID-19 is mainly symptomatic. For severe and critical ill cases, the oxygen therapy, antiviral drugs, antibacterial drugs, glucocorticoids, mechanical ventilation or even extracorporeal membrane oxygenation (ECMO) may be adopted, and the treatment plan should be adjusted timely through multi-disciplinary cooperation.


Illegal Online Sexual Behavior During the COVID-19 Pandemic: A Call for Action Based on Experiences From the Ongoing Prevent It Research Study


Lung Transplantation for Elderly Patients With End-Stage COVID-19 Pneumonia


Temporal changes in immune blood cell parameters in COVID-19 infection and recovery from severe infection


Letter to the Editor "Service and Training During the COVID-19 Pandemic: Perspectives from a Neurosurgical Center in the Philippines"


Covid-19 is shattering US cancer care


title: COVID-19: Moving beyond the pandemic

text: Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is the cause of COVID-19. As of April 11th, 2020, there were almost 2 million cases of COVID-19 internationally and over 100,000 deaths (John Hopkins University, 2020). There has been significant effort to increase hospital and healthcare capacity to reduce the number of fatalities associated with this global pandemic (Choi & Logsdon 2020).


title: Puff trains in speaking produce long-range turbulent jet-like transport potentially relevant to asymptomatic spreading of viruses

text: Droplet generation and transport during coughing and sneezing has been studied for decades to characterize disease transmission by symptomatic individuals. Nevertheless, many reports document that asymptomatic and presymptomatic individuals contribute to the spread of COVID-19, probably during conversations in social interactions. Researchers have shown that droplet emission occurs during speech, yet there are few quantitative studies of the flows that provide the transport mechanism; the relevant fluid dynamics is largely unstudied. This lack of quantitative characterization means that when virus is present there is little public health guidance for understanding risk and mitigation strategies, e.g. the"six-foot rule". Here we analyze flows during breathing and speaking, including linguistic features, using order-of-magnitudes estimates, numerical simulations, and laboratory experiments. We show how plosive sounds like `P' are associated with vortical structures, leading to rapid transport over half a meter in a split second. When produced individually, puffs decay over a meter, with the distance traveled in time $t$ scaling as $L\sim t^{1/4}$, and mix with the slower environmental circulation. In contrast, the transport of exhaled material over time scales longer than a few seconds, characteristic of speech, which is effectively a train of puffs, is a conical turbulent jet with a scaling law $L\sim t^{1/2}$. Typically, the exhaled air in front of a speaker extends 2 m after 30 seconds of normal speech. We believe this work will inform thinking about aerosol transport in disease transmission for humans and other animals, and yield a better understanding of linguistic aerodynamics, i.e., aerolinguistics.


The largest epicenter of the coronavirus outbreak in Vietnam


title: Ruptured Popliteal Artery Aneurysm Complicated with Acute Respiratory Distress Syndrome Secondary to SARS-CoV-2 Infection

text: We herein report a rare case of the ruptured popliteal artery aneurysm in an 89-year-old man, whose recovery after surgical treatment was complicated with acute respiratory distress syndrome secondary to confirmed infection with SARS-CoV-2. Presenting symptoms, patient's comorbidities, and postoperative course complicated with cardiac and respiratory failure leading to adverse outcome are discussed in this case report.


title: Roadblocks to Infection Prevention Efforts in Healthcare SARS-CoV-2/COVID-19 Response

text: The outbreak of a novel coronavirus, COVID-19, is challenging international public health and healthcare efforts. As hospitals work to acquire enough personal protective equipment and brace for potential cases, the role of infection prevention efforts and programs has become increasingly important. Lessons from the 2003 SARS-CoV outbreak in Toronto and 2015 MERS-CoV outbreak in South Korea have unveiled the critical role that hospitals play in outbreaks, especially of novel coronaviruses. Their ability to amplify the spread of disease can rapidly fuel transmission of the disease and often those failures in infection prevention and general hospital practices contribute to such events. While efforts to enhance infection prevention measures and hospital readiness are underway in the United States, it is important to understand why these programs were not able to maintain continued, sustainable levels of readiness. History has shown that infection prevention programs are primarily responsible for preparing hospitals and responding to biological events but face under-staffing and focused efforts defined by administrators. The current U.S. healthcare system though, is built upon a series of priorities that often view biopreparedness as a costly endeavor. Awareness of these competing priorities and the challenges infection prevention programs face when working to maintain biopreparedness is critical in adequately addressing this critical infrastructure in the face of an international outbreak.


Medicine: before COVID-19, and after


docid: zblusivi

title: Management of the Clinical and Academic Mission in an Urban Otolaryngology Department During the COVID-19 Global Crisis

text: OBJECTIVE: The objective of this study was to assess the strategic changes implemented in the departmental mission to continue safe delivery of otolaryngology care and to support the broader institutional mission during the COVID-19 pandemic response. STUDY DESIGN: Retrospective assessment was performed to the response and management strategy developed to transform the clinical and academic enterprise. SETTING: Large urban tertiary care referral center. RESULTS: The departmental structure was reorganized along new clinical teams to effectively meet the system directives for provision of otolaryngology care and support for inpatient cases of COVID-19. A surge deployment schedule was developed to assist frontline colleagues with clinical support as needed. Outpatient otolaryngology was consolidated across the system with conversion of the majority of visits to telehealth. Operative procedures were prioritized to ensure throughput for emergent and time-critical urgent procedures. A tracheostomy protocol was developed to guide management of emergent and elective airways. Educational and research efforts were redirected to focus on otolaryngology care in the clinical context of the COVID-19 crisis. CONCLUSION: Emergence of the COVID-19 global health crisis has challenged delivery of otolaryngology care in an unparalleled manner. The concerns for preserving health of the workforce while ethically addressing patient career needs in a timely manner has created significant dilemmas. A proactive, thoughtful approach that reorganizes the overall departmental effort through provider and staff engagement can facilitate the ability to meet the needs of otolaryngology patients and to support the greater institutional mission to combat the pandemic.


docid: qjghnfqj

title: Influence of delayed separation of plasma from whole blood and centrifugation protocol on Zn plasma concentration


Practical Implications of Novel Coronavirus COVID-19 on Hospital Operations, Board Certification, and Medical Education in Surgery in the USA


title: Exercising in Times of Lockdown: An Analysis of the Impact of COVID-19 on Levels and Patterns of Exercise among Adults in Belgium

text: Countries all over the world implemented lockdowns to counteract COVID-19. These lockdowns heavily limited people's exercise possibilities. At the same time, experts advocated to remain physically active to prevent future health problems. Based on an online survey, this study examines adults' exercise levels and patterns during the COVID-19 lockdown in Belgium. Ordinal logistic regression analyses of 13,515 valid and population-weighted responses indicate a general increase in exercise frequencies, as well as in sedentary behavior. Except for people aged 55+, previously low active adults self-reported to exercise more during the lockdown. Among the people who were already high active before COVID-19, those above 55 years old, those with low education, those used to exercise with friends or in a sport club, and those who were not using online tools to exercise, self-reported to exercise less during the lockdown. Having less time, sitting more, and missing the familiar way and competitive element of exercising were the main reasons for a self-reported exercise reduction. Given the health risks associated with physical inactivity, results imply that governments should consider how those who were not reached can be encouraged to exercise during a lockdown. After all, additional COVID-19 lockdowns might be implemented in the future.


title: How to Surge to Face the SARS-CoV-2 Outbreak: Lessons Learned From Lombardy, Italy

text: Italy is fighting against one of the worst medical emergency since the 1918 Spanish Flu. Pressure on the hospitals is tremendous. As for official data on March 14th: 8372 admitted in hospitals, 1518 in intensive care units, 1441 deaths (175 more than the day before). Unfortunately, hospitals are not prepared: even where a plan for massive influx of patients is present, it usually focuses on sudden onset disaster trauma victims (the most probable case scenario), and it has not been tested, validated, or propagated to the staff. Despite this, the All Hazards Approach for management of major incidents and disasters is still valid and the "4S" theory (staff, stuff, structure, systems) for surge capacity can be guidance to respond to this disaster.


title: A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic

text: The pandemic of COVID-19 has presented new challenges to hospital personnel providing care for infected patients with diabetes who represent more than 20% of critically ill patients in intensive care units. Appropriate glycemic management contributes to a reduction in adverse clinical outcomes in acute illness but also requires intensive patient interactions for bedside glucose monitoring, intravenous and subcutaneous insulin administration, as well as rapid intervention for hypoglycemia events. These tasks are required at a time when minimizing patient interactions is recommended as a way of avoiding prolonged exposure to COVID-19 by health care personnel who often practice in settings with limited supplies of personal protective equipment. The purpose of this manuscript is to provide guidance for clinicians for reconciling recommended standards of care for infected hospitalized patients with diabetes while also addressing the daily realities of an overwhelmed health care system in many areas of the country. The use of modified protocols for insulin administration, bedside glucose monitoring, and medications such as glucocorticoids and hydroxychloroquine that may affect glycemic control are discussed. Continuous glucose monitoring systems have been proposed as an option for reducing time spent with patients, but there are important issues that need to be addressed if these are used in hospitalized patients. On site and remote glucose management teams have potential to provide guidance in areas where there are shortages of personnel who have expertise in inpatient glycemic management.


SARS-CoV, MERS-CoV and now the 2019-novel CoV: Have we investigated enough about coronaviruses? - A bibliometric analysis


Species distribution models are inappropriate for COVID-19


title: Facing a disruptive threat: how can a nuclear medicine service be prepared for the coronavirus outbreak 2020?

text: PURPOSE: The aim of this short communication is to outline our experience in policies and processes of a nuclear medicine service during the COVID-19 outbreak in Singapore. METHODS: We describe the key considerations of policies and processes that have been implemented in our nuclear medicine service since the first case of COVID-19 was confirmed in Singapore General Hospital on 23 January 2020, up to the present time. RESULTS: Infection control, screening of patients and visitors, segregation of risk groups, segregation of staff and service continuity plans, communication and staff welfare, using electronic platforms for multi-disciplinary meetings and tele-reporting are discussed. CONCLUSION: Since our hospital received the first patient with COVID-19 in Singapore, our centre has managed 16 COVID-19 cases to date. There has not been any healthcare worker in our institution who has contracted COVID-19 through patient contact. We have highlighted for discussion some of the policies and processes to prepare a nuclear medicine service for the COVID-19 threat.


title: Pharmacological agents under investigation in the treatment of coronavirus disease 2019 and the importance of melatonin

text: Coronavirus disease 2019 (COVID-19) is a life-threatening infectious respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 pandemic causing morbidities and even deaths worldwide revealed that there is urgent need to find pharmacological agents or vaccines. Although there are a lot of agents under investigation, there is no approved agent for the prevention or treatment of the COVID-19 yet. Treatment of patients remains mainly supportive as well as compassionate use of the agents under investigation. It is well established that excessive inflammatory and immune response as well as oxidative injury play a critical role in the pathogenesis of COVID-19. In this review, we aimed to update knowledge about pathogenesis, clinical features and pharmacological treatment of COVID-19 and review the potential beneficial effects of ancient antioxidant, anti-inflammatory and immunomodulatory molecule melatonin for prevention and treatment of COVID-19.


title: Competing during a pandemic? Retailers' ups and downs during the COVID-19 outbreak

text: The COVID-19 pandemic (that started in early 2020) is causing several disruptions in the short- and mid-term, to which businesses have to adapt. Some retailers have reacted to the emergency immediately, displaying a plethora of different intervention types. The authors aim to synthesize the challenges that retailers are facing during the COVID-19 emergency. We do this from the perspective of both consumers and managers, with the goal of providing guidelines on and examples of how retailers can handle this unprecedented situation.


title: Nitazoxanide/azithromycin combination for COVID-19: A suggested new protocol for early management

text: Azithromycin has been shown to have a clinical efficacy against severe acute respiratory syndrome coronavirus 2; ivermectin has also demonstrated a remarkable experimental efficacy with a potential to be used for Coronavirus disease 2019. Further, BCG vaccination is being considered for clinical trials aiming to test its potential for lowering COVID-19 morbidity and mortality. This article illustrates some structural and functional relationships that may gather these drugs and the author, basing on a combined pathophysiological and pharmacological approach, recommends the FDA-approved antidiarrhea drug; nitazoxanide, which has been previously suggested but unfortunately widely ignored, to be tested in combination with azithromycin for their potential activity against SARS CoV-2, soonest. The author also recommends testing their combined administration as early during the clinical course of COVID-19 as possible. Further, basing on the same represented concept, the author suggests more trials for interferons to be tested against SARS CoV-2, especially in severe and critical COVID-19 cases.


title: Kaplan-Meier type survival curves for COVID-19: a health data based decision-making tool

text: Countries are recording health information on the global spread of COVID-19 using different methods, sometimes changing the rules after a few days. They are all publishing the number of new individuals infected, cured and dead, along with some supplementary data. These figures are often recorded in a non-uniform manner and do not match the standard definitions of these variables. However, in this paper we show that the Kaplan-Meier curves calculated with them could provide useful information about the dynamics of the disease in different countries. Our aim is to present a robust and simple model to show certain characteristics of the evolution of the dynamic process, showing that the differences of evolution among the countries is reflected in the corresponding Kaplan-Meier-type curves. We compare the curves obtained for the most affected countries so far, proposing possible interpretations of the properties that distinguish them.


title: A simple computational approach to the Susceptible-Infected-Recovered (SIR) epidemic model via the Laplace-Adomian Decomposition Method

text: The Susceptible-Infected-Recovered (SIR) epidemic model is extensively used for the study of the spread of infectious diseases. Even that the exact solution of the model can be obtained in an exact parametric form, in order to perform the comparison with the epidemiological data a simple but highly accurate representation of the time evolution of the SIR compartments would be very useful. In the present paper we obtain a series representation of the solution of the SIR model by using the Laplace-Adomian Decomposition Method to solve the basic evolution equation of the model. The solutions are expressed in the form of infinite series. The series representations of the time evolution of the SIR compartments are compared with the exact numerical solutions of the model. We find that there is a good agreement between the Laplace-Adomian semianalytical solutions containing only three terms, and the numerical results.


title: Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)

text: Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.


The impact of social distancing on pediatric neurosurgical emergency referrals during the COVID-19 pandemic: a prospective observational cohort study


title: Binding site analysis of potential protease inhibitors of COVID-19 using AutoDock

text: Recent outbreak of COVID-19 caused by SARS-CoV-2 in December 2019 raised global health concerns. Re-purposing the available protease inhibitor drugs for immediate use in treatment in SARS-CoV-2 infections could improve the currently available clinical management. The current study, aims to predict theoretical structure for protease of COVID-19 and to explore further whether this protein can serve as a target for protease inhibitor drugs such as remdesivir, nelfinavir, lopinavir, ritonavir and α-ketoamide. While the 3D structure of protease was predicted using SWISS MODEL server, molecular interaction studies between protein and ligands were performed using AutoDock software. The predicted protease model was reasonably good based on reports generated by different validation servers. The study further revealed that all the protease inhibitor drugs got docked with negative dock energy onto the target protein. Molecular interaction studies showed that protease structure had multiple active site residues for remdesivir, while for remaining ligands the structure had only one active site residue each. From the output of multiple sequence alignment, it is evident that ligand binding sites were conserved. The current in silico study thus, provides structural insights about the protease of COVID-19 and also its molecular interactions with some of the known protease inhibitors.


title: Battling COVID-19: critical care and peri-operative healthcare resource management strategies in a tertiary academic medical centre in Singapore

text: In December 2019, a cluster of atypical pneumonia cases were reported in Wuhan, China, and a novel coronavirus elucidated as the aetiologic agent. Although most initial cases occurred in China, the disease, termed coronavirus disease 2019, has become a pandemic and continues to spread rapidly with human-to-human transmission in many countries. This is the third novel coronavirus outbreak in the last two decades and presents an ensuing healthcare resource burden that threatens to overwhelm available healthcare resources. A study of the initial Chinese response has shown that there is a significant positive association between coronavirus disease 2019 mortality and healthcare resource burden. Based on the Chinese experience, some 19% of coronavirus disease 2019 cases develop severe or critical disease. This results in a need for adequate preparation and mobilisation of critical care resources to anticipate and adapt to a surge in coronavirus disease 2019 case-load in order to mitigate morbidity and mortality. In this article, we discuss some of the peri-operative and critical care resource planning considerations and management strategies employed in a tertiary academic medical centre in Singapore in response to the coronavirus disease 2019 outbreak.


title: School and pre-school children with type 1 diabetes during covid-19 quarantine: the synergic effect of parental care and technology

text: INTRODUCTION: Management of Type 1 Diabetes (T1D) poses numerous challenges, especially for young children and their families. Parental care positively influencesthe outcomesofchildren with T1D, while there are often criticisms in school environment. The COVID-19 pandemic has forced children and parents to spend many hours at home and diabetes care has returned mainly in the hands of parents. AIM OF THE STUDY: To evaluate the effectiveness of exclusive return to parental care in pre-school and school children with T1D treated with Tandem Basal IQ system during the COVID-19 pandemic. PATIENTS AND METHODS: 22 children (M:F = 14:8) with T1D have been evaluated. We compared insulin and CGM data (TIR, TBR and TAR) of two periods: PRE-COV and IN-COV, in which children have transitioned from normal school attendance to the exclusive care of their parents. RESULTS: During the IN-COV period a significantly (p < 0.001) higher median value of TIR (66,41%) was observed as compared to PRE-COV period (61,45%). Patients also showed a statistically significant difference (p < 0.002) between the IN-COV period and the PRE-COV period as concerning the TAR metric: respectively 29,86 ± 10,6 % vs 34,73 ± 12,8 %. The difference between the bolus insulin doses was statistically significant (PRE-COV 5,3 IU/day, IN-COV 7,9 IU/day - p<0.05). CONCLUSION: Our observational real-life study confirms the positive effect of parental care in T1D very young children and demonstrates that during the COVID-19 pandemic it was possible to obtain a good glycometabolic compensation despite the significant change in lifestyle.


title: The mechanism and treatment of gastrointestinal symptoms in patients with COVID-19

text: In addition to the typical respiratory response, new coronavirus pneumonia (COVID-19) is also associated with very common gastrointestinal symptoms. Cases with gastrointestinal symptoms are more likely to be complicated by liver injury and acute respiratory distress syndrome (ARDS), and diarrhea can also lead to electrolyte disturbances, causing nausea and vomiting, headache, fatigue, etc. If not treated in time, coma and circulatory failure may ensue. As SARS-CoV-2 infects the human body through the combination of ACE2 in the gastrointestinal tract, the mechanism underlying the gastrointestinal symptoms may involve damage to the intestinal mucosal barrier and promotion of the production of inflammatory factors, causing cytokine storms. Indeed, after cells in the lungs become infected by SARS-CoV-2, effector CD4+ T cells reach the small intestine through the gut-lung axis, causing intestinal immune damage and diarrhea; early extensive use of antibacterial and antiviral drugs can also lead to diarrhea in patients. Thus, treatment options for COVID-19 patients should be promptly adjusted when they have gastrointestinal symptoms. Additionally, when drug-induced diarrhea occurs, drugs should be withdrawn or reduced, and microecological regulators should be applied to maintain the intestinal microecological balance and prevent secondary bacterial infections. To guarantee effective treatment, attention should be paid to the patient's enteral nutrition and digestive tract function. As SARS-CoV-2 has been detected in the feces of COVID-19 patients, future prevention and control efforts must consider the possibility of fecal-oral transmission of the virus.


docid: xwagkmrc

title: COVID-19 and liver disease


How to safeguard children's mental health during emergencies


title: Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series

text: OBJECTIVE: To study the clinical characteristics of patients in Zhejiang province, China, infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) responsible for coronavirus disease 2019 (covid-2019) , DESIGN: Retrospective case series , SETTING: Seven hospitals in Zhejiang province, China , PARTICIPANTS: 62 patients admitted to hospital with laboratory confirmed SARS-Cov-2 infection Data were collected from 10 January 2020 to 26 January 2020 , MAIN OUTCOME MEASURES: Clinical data, collected using a standardised case report form, such as temperature, history of exposure, incubation period If information was not clear, the working group in Hangzhou contacted the doctor responsible for treating the patient for clarification , RESULTS: Of the 62 patients studied (median age 41 years), only one was admitted to an intensive care unit, and no patients died during the study According to research, none of the infected patients in Zhejiang province were ever exposed to the Huanan seafood market, the original source of the virus;all studied cases were infected by human to human transmission The most common symptoms at onset of illness were fever in 48 (77%) patients, cough in 50 (81%), expectoration in 35 (56%), headache in 21 (34%), myalgia or fatigue in 32 (52%), diarrhoea in 3 (8%), and haemoptysis in 2 (3%) Only two patients (3%) developed shortness of breath on admission The median time from exposure to onset of illness was 4 days (interquartile range 3-5 days), and from onset of symptoms to first hospital admission was 2 (1-4) days , CONCLUSION: As of early February 2020, compared with patients initially infected with SARS-Cov-2 in Wuhan, the symptoms of patients in Zhejiang province are relatively mild , (C) 2020 BMJ Publishing Group Ltd


text: OBJECTIVE: To study the clinical characteristics of patients in Zhejiang province, China, infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) responsible for coronavirus disease 2019 (covid-2019). DESIGN: Retrospective case series. SETTING: Seven hospitals in Zhejiang province, China. PARTICIPANTS: 62 patients admitted to hospital with laboratory confirmed SARS-Cov-2 infection. Data were collected from 10 January 2020 to 26 January 2020. MAIN OUTCOME MEASURES: Clinical data, collected using a standardised case report form, such as temperature, history of exposure, incubation period. If information was not clear, the working group in Hangzhou contacted the doctor responsible for treating the patient for clarification. RESULTS: Of the 62 patients studied (median age 41 years), only one was admitted to an intensive care unit, and no patients died during the study. According to research, none of the infected patients in Zhejiang province were ever exposed to the Huanan seafood market, the original source of the virus; all studied cases were infected by human to human transmission. The most common symptoms at onset of illness were fever in 48 (77%) patients, cough in 50 (81%), expectoration in 35 (56%), headache in 21 (34%), myalgia or fatigue in 32 (52%), diarrhoea in 3 (8%), and haemoptysis in 2 (3%). Only two patients (3%) developed shortness of breath on admission. The median time from exposure to onset of illness was 4 days (interquartile range 3-5 days), and from onset of symptoms to first hospital admission was 2 (1-4) days. CONCLUSION: As of early February 2020, compared with patients initially infected with SARS-Cov-2 in Wuhan, the symptoms of patients in Zhejiang province are relatively mild.


title: The SARS-CoV-2 Coronavirus and the COVID-19 Outbreak

text: The SARS-CoV-2, a newly identified ß-coronavirus, is the causative agent of the third large-scale pandemic from the last two decades. The outbreak started in December 2019 in Wuhan City, Hubei province in China. The patients presented clinical symptoms of dry cough, fever, dyspnea, and bilateral lung infiltrates on imaging. By February 2020, The World Health Organization (WHO) named the disease as Coronavirus Disease 2019 (COVID-19). The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses (ICTV) recognized and designated this virus as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 uses the same host receptor, angiotensin-converting enzyme 2 (ACE2), used by SARS-CoV to infect humans. One hypothesis of SARSCoV-2 origin indicates that it is likely that bats serve as reservoir hosts for SARSCoV-2, being the intermediate host not yet determined. The predominant route of transmission of SARS-CoV-2 is from human to human. As of May 10th 2020, the number of worldwide confirmed COVID-19 cases is over 4 million, while the number of global deaths is around 279.000 people. The United States of America (USA) has the highest number of COVID-19 cases with over 1.3 million cases followed by Spain, Italy, United Kingdom, Russia, France and Germany with over 223.000, 218.000, 215.000, 209.000, 176.000, and 171.000 cases, respectively.


Epidemiology of Covid-19


title: How relevant is the decision of containment measures against COVID-19 applied ahead of time?

text: The cumulative number of confirmed infected individuals by the new coronavirus outbreak until April 30th, 2020, is presented for the countries: Belgium, Brazil, United Kingdom (UK), and United States of America (USA). After an initial period with a low incidence of newly infected people, a power-law growth of the number of confirmed cases is observed. For each country, a distinct growth exponent is obtained. For Belgium, UK, and USA, countries with a large number of infected people, after the power-law growth a distinct behavior is obtained when approaching saturation. Brazil is still in the power-law regime. Such updates of the data and projections corroborate recent results regarding the power-law growth of the virus and their strong Distance Correlation between some countries around the world. Furthermore, we show that act in time is one of the most relevant non-pharmacological weapons that the health organizations have in the battle against the COVID-19, infectious disease caused by the most recently discovered coronavirus. We study how changing the social distance and the number of daily tests to identify infected asymptomatic individuals can interfere in the number of confirmed cases of COVID-19 when applied in three distinct days, namely April 16th (early), April 30th (current), and May 14th (late). Results show that containment actions are necessary to flatten the curves and should be applied as soon as possible.


docid: spyoxbki

title: The COVID-19 pandemic: major risks to healthcare and other workers on the front line


title: [Intervention mechanism of Qingwen Baidu Yin on cytokine storm based on network pharmacology]

text: The aim of this paper was to explore the intervention mechanism of Qingwen Baidu Yin in cytokine storm based on network pharmacology. TCMSP and TCMIP V2.0 server were used to predict all chemical components and action targets of Qingwen Baidu Yin. Diseases that could be treated by Qingwen Baidu Yin were predicted through Enrichr database. A compound target interaction(PPI) network diagram was constructed using STRING 11.0. OmicShare was used to analyzed the gene ontology(GO) enrichment and enrichment of the Kyoto encyclopedia of genes and genomes(KEGG) pathway of core targets. Component-target-path network diagram was constructed with Cytoscape 3.6.0 software. After analysis of the database, 267 compounds were screened for Qingwen Baidu Yin, involving 1 450 targets, and a protein interaction network was constructed. Total 219 core target proteins were predicted, such as NFKB1, STAT1, RAF1, IL2, JAK1, IL6, TNF, BCL2 and other important targets, and 221 core target pathways were enriched, including cancer pathway, Kaposi's sarcoma-associated herpes virus infection, chemokine signal pathway, PI3 K-AKT signal pathway, EB virus infection, virus carcinogenesis and T cell receptor signaling pathways, a collection of which were highly related to cytokine storms. GO annotation analysis suggested that Qingwen Baidu Yin Decoction may exert therapeutic effects by regulating protein phosphorylation, cell response to cytokine stimulation, cell proliferation, inflammatory response, transmembrane receptor protein tyrosine kinase signaling pathway, and cytokine-mediated signaling pathways. This study revealed potential active components of Qingwen Baidu Yin in defending against cytokine storm and its possible mechanism of action, and provided theoretical basis and technical support for further clinical application of this prescription.


title: Clinical and Immune Features of Hospitalized Pediatric Patients With Coronavirus Disease 2019 (COVID-19) in Wuhan, China

text: Importance: The epidemiologic and clinical characteristics of pediatric patients with coronavirus disease 2019 (COVID-19) have been reported, but information on immune features associated with disease severity is scarce. Objective: To delineate and compare the immunologic features of mild and moderate COVID-19 in pediatric patients. Design, Setting, and Participants: This single-center case series included 157 pediatric patients admitted to Wuhan Children's Hospital with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data were collected from January 25 to April 18, 2020. Exposures: Documented SARS-CoV-2 infection. Main Outcomes and Measures: Clinical and immunologic characteristics were collected and analyzed. Outcomes were observed until April 18, 2020. Results: Of the 157 pediatric patients with COVID-19, 60 (38.2%) had mild clinical type with pneumonia, 88 (56.1%) had moderate cases, 6 (3.8%) had severe cases, and 3 (1.9%) were critically ill. The 148 children with mild or moderate disease had a median (interquartile range [IQR]) age of 84 (18-123) months, and 88 (59.5%) were girls. The most common laboratory abnormalities were increased levels of alanine aminotransferase (ALT) (median [IQR], 16.0 [12.0-26.0] U/L), aspartate aminotransferase (AST) (median [IQR], 30.0 [23.0-41.8] U/L), creatine kinase MB (CK-MB) activity (median [IQR], 24.0 [18.0-34.0] U/L), and lactate dehydrogenase (LDH) (median [IQR], 243.0 [203.0-297.0] U/L), which are associated with liver and myocardial injury. Compared with mild cases, levels of inflammatory cytokines including interleukin 6, tumor necrosis factor α, and interferon Î³ were unchanged, whereas the level of immune suppressive interleukin 10 was markedly increased in moderate cases compared with mild cases (median [IQR], 3.96 [3.34-5.29] pg/mL vs 3.58 [3.10-4.36] pg/mL; P = .048). There was no statistically significant difference in absolute number of lymphocytes (including T cells and B cells) between mild and moderate cases, but moderate cases were associated with a decrease in neutrophil levels compared with mild cases (median [IQR], 2310/µL [1680/µL-3510/µL] vs 3120/µL [2040/µL-4170/µL]; P = .01). Immunoglobin G and the neutrophil to lymphocyte ratio were negatively associated with biochemical indices related to liver and myocardial injury (immunoglobulin G, ALT: r, -0.3579; AST: r, -0.5280; CK-MB activity: r, -0.4786; LDH: r, -0.4984; and neutrophil to lymphocyte ratio, ALT: r, -0.1893; AST: r, -0.3912; CK-MB activity: r, -0.3428; LDH: r, -0.3234), while counts of lymphocytes, CD4+ T cells, and interleukin 10 showed positive associations (lymphocytes, ALT: r, 0.2055; AST: r, 0.3615; CK-MB activity: r, 0.338; LDH: r, 0.3309; CD4+ T cells, AST: r, 0.4701; CK-MB activity: r, 0.4151; LDH: r, 0.4418; interleukin 10, ALT: r, 0.2595; AST: r, 0.3386; CK-MB activity: r, 0.3948; LDH: r, 0.3794). Conclusions and Relevance: In this case series, systemic inflammation rarely occurred in pediatric patients with COVID-19, in contrast with the lymphopenia and aggravated inflammatory responses frequently observed in adults with COVID-19. Gaining a deeper understanding of the role of neutrophils, CD4+ T cells, and B cells in the pathogenesis of SARS-CoV-2 infection could be important for the clinical management of COVID-19.


title: Waiting for COVID-19

text: I wrote this as a narrative piece for school, but it is a very honest description of how I'm feeling at this time. I just wanted to reassure people that I am ok. For anyone else who is feeling the same as I am, it's ok. I think it is good for us to be honest about how we are feeling, and it is perfectly reasonable for us to feel confusion during this time. I also think it is good for us to not let any anxiety overwhelm us. So let it out. Talk to someone. Write it down. And breathe. For me, watching the sunrise this morning was a good way to focus on something other than the chaos, other than my feelings.


docid: xpizewde

title: Boosting test-efficiency by pooled testing strategies for SARS-CoV-2

text: In the current COVID19 crisis many national healthcare systems are confronted with an acute shortage of tests for confirming SARS-CoV-2 infections. For low overall infection levels in the population, pooling of samples can drastically amplify the testing efficiency. Here we present a formula to estimate the optimal pooling size, the efficiency gain (tested persons per test), and the expected upper bound of missed infections in the pooled testing, all as a function of the populationwide infection levels and the false negative/positive rates of the currently used PCR tests. Assuming an infection level of 0.1 % and a false negative rate of 2 %, the optimal pool size is about 32, the efficiency gain is about 15 tested persons per test. For an infection level of 1 % the optimal pool size is 11, the efficiency gain is 5.1 tested persons per test. For an infection level of 10 % the optimal pool size reduces to about 4, the efficiency gain is about 1.7 tested persons per test. For infection levels of 30 % and higher there is no more benefit from pooling. To see to what extent replicates of the pooled tests improve the estimate of the maximal number of missed infections, we present all results for 1, 3, and 5 replicates.


title: Emerging manufacturers engagements in the COVID -19 vaccine research, development and supply

text: The World Health Organization declared the COVID-19 disease as a pandemic requiring a rapid response. Through online search, direct communication with network members and an internal survey, engagements of developing countries' vaccine manufacturers' network members in the research and development of COVID-19 vaccines and their capacities in the manufacturing, fill-finish and distribution of vaccines were assessed. Currently, 19 network members engaged in research and development of COVID-19 vaccines, using six principal technology platforms. In addition, an internal survey showed that the number of vaccines supplied collectively by 37 members, in 2018-19, was about 3.5 billion doses annually. Almost a third of network members having vaccines prequalified by the World Health Organization comply with international regulations and mechanisms to distribute vaccines across borders. The use of existing manufacturing, fill-finish and distribution capabilities can support an efficient roll-out of vaccines against COVID-19, while maintaining supply security of existing vaccines for on-going immunization programmes.


docid: xxndrzlo

title: COVID-19 Epidemic and Enhancing China's National Biosecurity System


title: Ketogenic diet therapy provision in the COVID-19 pandemic: Dual-center experience and recommendations

text: The current coronavirus-19 pandemic has changed dramatically how neurologists care for children and adults with epilepsy. Stay-at-home orders and resistance to hospitalizations by patients have led epileptologists to engage in telemedicine and reevaluate how to provide elective services. Ketogenic diet therapy is often started in the hospital, with families educated in hospital-based classes, but this is difficult to do in this current pandemic. At our two academic centers, both our pediatric and adult epilepsy diet centers have had to quickly consider alternative methods to both start and maintain ketogenic diet therapy. This paper provides several examples of how ketogenic diet therapy can be provided to patients in unique ways, along with recommendations from other experts and patients, learned over the past few months.


title: An AI approach to COVID-19 infection risk assessment in virtual visits: a case report

text: OBJECTIVE: In an effort to improve the efficiency of computer algorithms applied to screening for COVID-19 testing, we used natural language processing (NLP) and artificial intelligence (AI)-based methods with unstructured patient data collected through telehealth visits. METHODS: After segmenting and parsing documents, we conducted analysis of overrepresented words in patient symptoms. We then developed a word embedding-based convolutional neural network for predicting COVID-19 test results based on patients' self-reported symptoms. RESULTS: Text analytics revealed that concepts such as "smell" and "taste" were more prevalent than expected in patients testing positive. As a result, screening algorithms were adapted to include these symptoms. The deep learning model yielded an AUC of 0.729 for predicting positive results and was subsequently applied to prioritize testing appointment scheduling. DISCUSSION: Informatics tools such as NLP and AI methods can have significant clinical impacts when applied to data streams early in the development of clinical systems for outbreak response.


title: COVID-19 et maladies cardiovasculaires./ [COVID-19 andcardiovascular diseases]

text: COVID-2019 disease mainly affects the respiratory tract and can progress in severe cases to pneumonia, acute respiratory distress syndrome and multi-organ failure. Patients with prior cardiovascular disease are at higher risk of developing an infection and progressing to a severe form of the disease. Also, due to the growing number of infected cases, it is clear that, in addition to the typical respiratory symptoms caused by the infection, some patients suffer from cardiovascular damage. This condition can, in fact, cause significant myocardial damage, which worsens the disease and affects the prognosis. Based on the results of currently published research, it seems important to discuss the manifestations and characteristics of myocardial damage induced by COVID-19 and its impact on patient prognosis.


docid: mibxnyxl

title: Biological sex impacts COVID-19 outcomes

text: The current novel coronavirus disease 2019 (COVID-19) pandemic is revealing profound differences between men and women in disease outcomes worldwide. In the United States, there has been inconsistent reporting and analyses of male-female differences in COVID-19 cases, hospitalizations, and deaths. We seek to raise awareness about the male-biased severe outcomes from COVID-19, highlighting the mechanistic differences including in the expression and activity of angiotensin-converting enzyme 2 (ACE2) as well as in antiviral immunity. We also highlight how sex differences in comorbidities, which can be associated with both age and race, impact male-biased outcomes from COVID-19.


title: Lessons Learned from COVID-19 Pandemic in Italy

text: Since the COVID-19 outbreak, Italy has been one of the most affected countries in Europe and the second for number of deaths. In this commentary, we discuss some lessons that we learned as healthcare providers working in a large public hospital during the pandemic, with a special focus on the importance of infection containment and early diagnosis, the role of swab, serological tests, home isolation and individual protection devices, and the available therapies and management indications to better face a possible new outbreak in the near future. These comments should stimulate a more diffused, efficient and efficacious management of COVID-19 patients, also reducing the number of accesses to hospital emergency departments and the related spread of the infection.


docid: bzjzzela

title: Mitigating Risk of COVID-19 in Dialysis Facilities