bluuebunny/crossref_metadata_2025 huggingface dataset:
History of Peripheral Nerve Stimulation—Update for the 21st Century
Authors: Ottestad Einar , Orlovich Daniel S
Published: May 2020

Objective

To present a history of the development of peripheral nerve stimulation.

Methods

Narrative literature review.

Results

Peripheral nerve stimulation has a history stretching from Scribonius Largus and eels in Mesopotamia to Michael Farady’s discovery in London, the German-English physician Julius Althaus’s application of electricity to a peripheral nerve, the sensational “Electreat” in the United States, to the application by Wall and Sweet of the gate theory proposed by Melzack and Wall to specialized neurosurgeons.

Conclusions

This is now a modern field in clinical neuroscience and medicine with improved technology, renewed interest by a diverse range of specialties, and accessibility with ultrasound.
Analysis for Lorentzian conformal field theories through sine-square deformation
Authors: Liu Xun , Tada Tsukasa
Published: May 2020

We reexamine two-dimensional Lorentzian conformal field theory using the formalism previously developed in a study of sine-square deformation of Euclidean conformal field theory. We construct three types of Virasoro algebra. One of them reproduces the result by Lüscher and Mack, while another type exhibits divergence in the central charge term. The third leads to a continuous spectrum and contains no closed time-like curve in the system.
Chronic pain and depressive symptoms are related to food insecurity among urban food bank users
Authors: Bigand Teresa L , Dietz Jeremy , Gubitz Hannah N , Wilson Marian
Published: May 2020

Background

Food bank users suffer high food insecurity. Food insecurity increases risk for chronic health conditions. However, chronic pain and its relation to food insecurity among food bank users is unknown. Knowledge about populations with chronic pain is important to direct appropriate public health nutritional strategies.

Methods

Participants completed a survey including sleep, pain, depressive symptoms and food insecurity measures. Descriptive statistics characterized the burden of chronic pain among the sample, and a series of chi-square and t-tests assessed for demographic differences between food bank users who reported pain compared to those who did not. Logistic regression tested for variables predicting food insecurity.

Results

Within the sample (N = 207), 53% reported a chronic pain diagnosis. Adults with pain were more likely to receive food stamps and to have a mental health condition than those without pain. Regression analyses revealed that depressive symptoms and chronic pain significantly predicted food insecurity when controlling for age and gender.

Conclusions

Exploring the link between depression, pain and nutritional resources may enhance understanding of causal relationships driving food insecurity. Public health officials should address nutritional needs of adults including those with chronic pain who use food bank services.
Investigating materials and orientation parameters for the creation of a 3D musculoskeletal interface co-culture model
Authors: Alsaykhan Hamad , Paxton Jennifer Z
Published: May 2020

Musculoskeletal tissue interfaces are a common site of injury in the young, active populations. In particular, the interface between the musculoskeletal tissues of tendon and bone is often injured and to date, no single treatment has been able to restore the form and function of damaged tissue at the bone–tendon interface. Tissue engineering and regeneration hold great promise for the manufacture of bespoke in vitro models or implants to be used to advance repair and so this study investigated the material, orientation and culture choices for manufacturing a reproducible 3D model of a musculoskeletal interface between tendon and bone cell populations. Such models are essential for future studies focussing on the regeneration of musculoskeletal interfaces in vitro. Cell-encapsulated fibrin hydrogels, arranged in a horizontal orientation though a simple moulding procedure, were shown to best support cellular growth and migration of cells to form an in vitro tendon–bone interface. This study highlights the importance of acknowledging the material and technical challenges in establishing co-cultures and suggests a reproducible methodology to form 3D co-cultures between tendon and bone, or other musculoskeletal cell types, in vitro.
Are current guidelines overcautious regarding refeeding of patients with severe anorexia nervosa: a retrospective cohort study
Authors: Ciobanasu Oana , Seth Bhavisha , Terekh Iryna , Bruno Alessandro , Ayton Agnes
Published: May 2020

Objective

Weight restoration is an integral part of managing anorexia nervosa patients and has been found to be associated with electrolyte and fluid abnormalities gathered under the umbrella term refeeding syndrome, which has led to cautious initiation of caloric regimes. This study looks at how a sample of severe anorexia nervosa patients were managed using higher rates of refeeding than the ones currently recommended.

Design

retrospective cohort study of consecutive patients with severe eating disorders admitted to an UK specialist tertiary centre. The treatment programme uses a weight restoration regime starting at 1000 kcal/day, increased to 1500 kcal/day after two days and to 2000 kcal/day after seven days. The main outcome was the rate of hypophosphatemia, hypokalemia and hypomagnesemia within the first two weeks of weight restoration. The secondary outcomes included rate of weight gain and tendency of electrolyte shift.

Results

83% of the patient sample were categorised as extreme anorexia nervosa (BMI <15). 11.3% of patients developed hypophosphatemia, 11.3% had hypomagnesemia, 42% had hypokalaemia. The lowest levels were found between the 5-6 days after starting refeeding. The vast majority of electrolyte abnormalities fell into the mild category. Electrolyte abnormalities were easily corrected by oral supplementation, and only 5% required iv replacement. The only significant predictor for hypophosphatemia was a BMI below 13.

Conclusions

The majority of extremely ill patients with anorexia nervosa tolerate refeeding starting at 25-30kcal/kg. Oral supplementation is effective, so overcautious refeeding is unnecessary, provided that the patient is carefully monitored.
A statistical forecast of LOW mortality (< 400,000 deaths) due to COVID-19, for the whole WORLD
Authors: Barbero Cesar A.
Published: May 2020

OBJECTIVE

To forecast the death toll of COVID-19 in the whole world by fitting the time series of reported deaths with a parametric equation (integrated Gaussian equation) related to Farr’s law.

DATA

The time series of cumulative deaths due to COVID-19 produced by John Hopkins University and stored in a github repository.

RESULTS

The projected total death toll will be 261680 (392520 – 183176) which represents the 0.003 % of world population. This number amounts to 0.054 deaths per 1000, while the mean in the world (all causes) is 7.7. The daily peak of deaths (7270 (+/-500)) happened the 15 (+/- 3) of April, meaning that we are in descending curve of the pandemic. The outbreak will end completely the 23th (+/-3) of June. However, already on 9th (+/- 3) of May, 2 σ (95.45%) of the deaths will have be occured. The projected death toll is much lower (5-10 times) than those forecasted by the Imperial College Group (ICG) even considering the best scenario of total suppression of virus transmission. Using actual mortality rates it is possible to back calculate which number of infected individuals would produce such mortality. The death toll arises from a number of infected individuals between 53 (worst case) and 3.3 million. The calculated number of infected individuals is significantly lower than that calculated by ICG (227.5 millions) with suppression.
A clinical trial to study changes in neural activity and motor recovery following brain-machine interface enabled robot-assisted stroke rehabilitation
Authors: Bhagat Nikunj , Yozbatiran Nuray , Sullivan Jennifer L. , Paranjape Ruta , Losey Colin , Hernandez Zachary , Keser Zafer , Grossman Robert , Francisco Gerard , O’Malley Marcia K. , Contreras-Vidal Jose
Published: May 2020

Background

Brain-machine interfaces (BMI) based on scalp electroencephalography (EEG) have the potential to promote cortical plasticity following stroke, which has been shown to improve motor recovery outcomes. However, clinical efficacy of BMI-enabled robotic rehabilitation in chronic stroke population is confounded by the spectrum of motor impairments caused by stroke.

Objective

To evaluate the efficacy of neurorehabilitation therapy on upper-limb motor recovery, by quantifying changes in clinical, BMI-based, and kinematics-based metrics. Further, to identify neural correlates or biomarkers that can predict the extent of motor recovery.

Methods

Chronic stroke survivors (n = 10, age 55 ± 9.2y, chronicity 3.1 ± 2.8y) were recruited to participate in a 4-6 weeks long clinical study. Participants completed 12 therapy sessions that involved a BMI enabled powered exoskeleton (MAHI Exo-II) for training, which targeted elbow flexion and extension. Clinical assessments including Fugl-Meyer Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) were measured up to 2-months after therapy. BMI performance, kinematic performance, and change in movement related cortical potentials (MRCP) were also determined.

Results

On average, 132 ± 22 repetitions were performed per participant, per session. BMI accuracy across all sessions and subjects was 79 ± 18%, with a small number of false positives (23 ± 20%). FMA-UE and ARAT scores improved significantly over baseline after therapy and were retained at follow-ups (ΔFMA-UE = 3.92 ± 3.73 and ΔARAT = 5.35 ± 4.62, p < 0.05). 80% participants (7 with moderate-mild impairment and 1 with severe-moderate impairment) reached minimal clinically important difference (MCID: FMA-UE > 5.2 or ARAT > 5.7) during the course of the study. Kinematic measures indicate that, on average, participants’ movements became faster and smoother. Quantification of changes in MRCP amplitude showed significant correlation with ARAT scores (ρ = 0.72, p < 0.05) and marginally significant correlation with FMA-UE (ρ = 0.63, p = 0.051), suggesting higher activation of ipsi-lesional hemisphere post-intervention. The study did not have any adverse events.

Conclusion

This study presents evidence that BMI enabled robotic rehabilitation can promote motor recovery in individuals with chronic stroke, several years after injury and irrespective of their impairment level, or location of the lesion (cortical/subcortical) at baseline. Further, the extent of motor recovery was correlated with changes in movement related potentials, occurring contralateral to the impaired arm.

Support

NIH National Robotics Initiative Grant R01NS081854 and a grant from Mission Connect, a project of TIRR Foundation.
Nonpharmaceutical interventions for pandemic COVID-19: A cross-sectional investigation of US general public beliefs, attitudes, and actions
Authors: Kantor Bella Nichole , Kantor Jonathan
Published: May 2020

Nonpharmaceutical interventions (NPIs) represent the primary mitigation strategy for pandemic COVID-19. Despite this, many government agencies and members of the general public may be resistant to NPI adoption. We sought to understand public attitudes and beliefs regarding various NPIs and self-reported adoption of NPIs, and explore associations between NPI performance and the baseline characteristics of respondents. We performed a cross-sectional age-, sex-, and race- stratified survey of the general US population. Of the 1,005 respondents, 37% (95% CI 34.0, 39.9) felt that NPIs were inconvenient, while only 0.9% (95% CI 0.3, 1.5) of respondents believed that NPIs would not reduce their personal risk of illness. Respondents were most uncertain regarding the efficacy of mask and eye protection use, with 30.6% and 22.1%, respectively, unsure whether their use would slow disease spread. On univariate logistic regression analyses, NPI adherence was associated with a belief that NPIs would reduce personal risk of developing COVID-19 (OR 3.06, 95% CI [1.25, 7.48], p=0.014) and with a belief that the NPIs were not difficult to perform (OR 1.79, 95% CI [1.38, 2.31], p<0.0001). Respondents were compliant with straightforward, familiar, and heavily-encouraged NPI recommendations such as hand-washing; more onerous approaches, such as avoiding face touching, disinfecting surfaces, and wearing masks or goggles, were performed less frequently. NPI non-adherence is associated with both outcome expectations (belief that NPIs are effective) and process expectations (belief that NPIs are not overly inconvenient); these findings have important implications for designing public health outreach efforts, where the feasibility, as well as the effectiveness, of NPIs should be stressed.
Racial, Economic and Health Inequality and COVID-19 Infection in the United States
Authors: Abedi Vida , Olulana Oluwaseyi , Avula Venkatesh , Chaudhary Durgesh , Khan Ayesha , Shahjouei Shima , Li Jiang , Zand Ramin
Published: May 2020

Background

There is preliminary evidence of racial and social-economic disparities in the population infected by and dying from COVID-19. The goal of this study is to report the associations of COVID-19 with respect to race, health and economic inequality in the United States.

Methods

We performed a cross-sectional study of the associations between infection and mortality rate of COVID-19 and demographic, socioeconomic and mobility variables from 369 counties (total population: 102,178,117 [median: 73,447, IQR: 30,761-256,098]) from the seven most affected states (Michigan, New York, New Jersey, Pennsylvania, California, Louisiana, Massachusetts).

Findings

The risk factors for infection and mortality are different. Our analysis shows that counties with more diverse demographics, higher population, education, income levels, and lower disability rates were at a higher risk of COVID-19 infection. However, counties with higher disability and poverty rates had a higher death rate. African Americans were more vulnerable to COVID-19 than other ethnic groups (1,981 African American infected cases versus 658 Whites per million). Data on mobility changes corroborate the impact of social distancing.

Interpretation

The observed inequality might be due to the workforce of essential services, poverty, and access to care. Counties in more urban areas are probably better equipped at providing care. The lower rate of infection, but a higher death rate in counties with higher poverty and disability could be due to lower levels of mobility, but a higher rate of comorbidities and health care access.
Methods of An Open-Label Proof-Of-Concept Trial of Intravenous Valproic Acid for Severe COVID-19
Authors: Chiquete Erwin , Toapanta-Yanchapaxi Liz , Cantú-Brito Carlos
Published: May 2020

Introduction

Coronavirus disease 2019 (COVID-19) is the systemic entity caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that may cause death through severe atypical pneumonia and acute lung injury. Valproic acid (VPA) has shown anti-inflammatory activity and mild intrinsic antiviral effect. These properties warrant the study of VPA as a possible active treatment in persons with severe COVID-19.

Methods

Consecutive adult patients needing invasive mechanical ventilation (IMV) will be given intravenous (i.v.) VPA at a starting dose of 20 mg/kg/day and up to 60/kg/day (in 60 min i.v. infusions in 250 mL normal saline) as needed to reach plasma VPA concentrations of 50–100 μg/mL (measured every 72 h). These patients will be followed-up for 10 days for the primary outcome and for a further period of 30 days after treatment completion for the secondary outcome of recurrence. The primary study outcome is the reduction in the case fatality rate of at least 50% after 10 days of treatment (as compared with natural history). Secondary outcomes are the reduction of length of stay (LOS) of at least 50%, as well as COVID-19 recurrence at 30-day follow-up. The most important safety outcomes are acute liver failure, acute pancreatitis, and thrombocytopenia.

Conclusion

Although long-term adverse effects and even pro-inflammatory consequences have been reported with the chronic use of VPA, given the urgent need for a drug against COVID-19 to shorten the high mortality and LOS, the study of VPA is justified from a scientific standpoint.
Fast and easy disinfection of coronavirus-contaminated face masks using ozone gas produced by a dielectric barrier discharge plasma generator
Authors: Lee Jinyeop , Bong Cheolwoo , Bae Pan K. , Abafogi Abdurhaman T. , Baek Seung H. , Shin Yong-Beom , Bak Moon S. , Park Sungsu
Published: May 2020

Face masks are one of the currently available options for preventing the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused the 2019 pandemic. However, with the increasing demand for protection, face masks are becoming limited in stock, and the concerned individuals and healthcare workers from many countries are now facing the issue of the reuse of potentially contaminated masks. Although various technologies already exist for the sterilization of medical equipment, most of them are not applicable for eliminating virus from face masks. Thus, there is an urgent need to develop a fast and easy method of disinfecting contaminated face masks. In this study, using a human coronavirus (HCoV-229E) as a surrogate for SARS-CoV-2 contamination on face masks, we show that the virus loses its infectivity to a human cell line (MRC-5) when exposed for a short period of time (1 min) to ozone gas produced by a dielectric barrier discharge plasma generator. Scanning electron microscopy and particulate filtration efficiency (PFE) tests revealed that there was no structural or functional deterioration observed in the face masks even after they underwent excessive exposure to ozone (five 1-minute exposures). Interestingly, for face masks exposed to ozone gas for 5 min, the amplification of HCoV-229E RNA by reverse transcription polymerase chain reaction suggested a loss of infectivity under the effect of ozone, primarily owing to the damage caused to viral envelopes or envelope proteins. Ozone gas is a strong oxidizing agent with the ability to kill viruses on hard-to-reach surfaces, including the fabric structure of face masks. These results suggest that it may be possible to rapidly disinfect contaminated face masks using a plasma generator in a well-ventilated place.
Perforated appendicitis: can it be a bedside diagnosis?
Authors: Tariq Maham , Malik Sara , yaqoob Eesha , Changez Mehwish , Javed Saad , Ghazanfor Ramlah , Khadija Ghulam , Malik Javaria , Ahmad Bilal , Ghazanfor Khawaja Rafay
Published: May 2020

INTRODUCTION

Appendicitis remains one of the most common causes of acute abdomen worldwide. It presents as a spectrum of disease ranging from an acutely inflamed appendix to a perforated one. where acutely inflamed can be managed conservatively, a perforated appendix always needs surgery to prevent complications like pelvic abscesses. Bedside diagnosis remains relevant in our setup.

AIMS AND OBJECTIVES

To determine whether history, clinical examination, and basic laboratory investigations can help in confident bedside diagnosis of perforated appendicitis especially in the absence of sophisticated diagnostic modalities.

MATERIALS AND METHODS

A retrospective case-control study was conducted. Hospital records of patients who underwent open appendectomy in the year 2016 were reviewed. Two groups of 100 patients each were made based on per operative findings. Appendices having macroscopic holes in the base or tip were labeled as perforated. Group A had acutely inflamed appendix and group b had perforated appendix. Patients’ demographic details were taken from hospital admission tickets. Findings of history and examination were retrieved from treating resident and operating surgeon's notes. Data were analyzed through SPSS.

RESULTS

Out of 200 patients the total number of males was 102 (51%) and females were 98 (49%). Mean age was 24.13+9.73 in males and 18.7+ 6.4 in females of group A and 26.0+10.1 in males and 20.56+7.53 in females of Group B. Group B showed a significant delay in presentation to emergency after the onset of pain (P = 0.022). Upon history and clinical examination, the presence of anorexia, malaise, generalized abdominal pain, guarding, mass in right iliac fossa were significantly associated with perforation. Whereas gender, fever, vomiting, and dysuria showed no association with perforation.

CONCLUSION

Bedside conventional methods of history taking and examination remain a useful tool in anticipating perforated appendicitis. This helps surgeons in planning incisions and prioritizing patients on heavy operating lists. This remains especially relevant in resource-constrained setups where sophisticated modalities like CT scans are largely unavailable.
Patterns of 2,4-Dinitrophenol Use as Discussed on Social Media
Authors: Chary Michael , Ellango Karun , Burns Michele
Published: May 2020

Importance

The usage of social media is associated with worsening perceptions of body image and increasing access to, and use of, toxic weight loss supplements. Little is known about the effect of nonlethal doses of one mechanistically unique supplement, 2,4-dinitrophenol (DNP). DNP has been banned by the FDA making human studies difficult, but the public still consumes DNP leading to a gap in our knowledge on the effects of DNP. Here we use social media to investigate the use of DNP, providing the largest characterization of its usage to date.

Objective

Determine the doses of DNP generally consumed, adverse effects at those doses, and coingestants.

Design

Cross-sectional analysis of Internet posts.

Setting

Our study collected publicly available data from 2017–2018 from Internet discussion forums (also called bulletin boards) dedicated to the discussion of weight loss and body building.

Participants

Participants are anonymous posters on these Internet forums.

Main Measures

Our main measure was the distribution of reported doses of DNP consumed. Our secondary measure was the frequency of adverse effects reported at those doses.

Results

We collected 661 posts across 5 online forums. The most commonly ingested dose reported was 150 mg (1-2 pills, depending on formulation), followed by 300 mg (2-3 pills). The most commonly reported adverse effects were sweating and a sensation of warmth, followed by yellow discoloration of secretions. The most common coingestants were antihistamines, cetirizine and loratadine.

Conclusions and Relevance

2,4-dinitrophenol is a mechanistically unique weight loss agent reported to be associated with sweating and a sensation of warmth at the most commonly reported ingested doses. Common co-ingestants are antihistamines, although itching was not directly reported as a side effect. Coingestion of an antihistamine, which can lessen the body’s ability to dissipate heat, could worsen the side effects of DNP. This is the first formal description derived from social media of DNP usage at nonlethal doses. Further investigation is needed to determine the therapeutic index of DNP. Less toxic derivatives may provide a starting point for pharmacological adjuncts to weight-loss.
Estradiol, des-acylated, and total ghrelin levels might be associated with epithelial ovarian cancer in postmenopausal women
Authors: Fooladi Saba , Akbari Hamed , Abolhassani Moslem , Sadeghi Erfan , Fallah Hossein
Published: May 2020

Background

The present study aimed to investigate the association between estradiol, acylated, des-acylated, total ghrelin levels along with pathological parameters and epithelial ovarian cancer (EOC) odds in postmenopausal women.

Methods

A case-control study was carried out on 45 EOC patients and 33 age-matched postmenopausal women as the control group. Plasma levels of estradiol, acylated, des-acylated, and total ghrelin were measured by ELISA method.

Results

Estradiol’s plasma levels were significantly higher in EOC patients compared to control women (P < 0.001). Although acylated, des-acylated, and total ghrelin levels were not associated with EOC in logistic regression models, estradiol levels were significantly related to the increase in EOC odds (OR: 1.083, 95% CI: 1.037-1.13, P < 0.001). However, estradiol levels in the two first quartiles (Q1, Q2) were associated with decreased odds of EOC (OR: 0.011, 95% CI: 0.001-0.118, P < 0.001, and OR: 0.030, 95% CI: 0.003-0.284, P = 0.002, respectively). For those patients in the third quartile of plasma des-acylated and total ghrelin compared to those in the highest (Q4), the multivariate odds ratios of EOC were respectively 0.192 and 0.25.

Conclusions

In conclusion, higher concentrations of des-acylated and total ghrelin might be associated with the decreased EOC odds. Furthermore, the findings suggest that high levels of estradiol might be a potential odds factor in EOC, however, lower estradiol levels may have a protective effect on EOC development.
Liver Chemistries in COVID-19 Patients with Survival or Death: A Meta-Analysis
Authors: Xing Qing-Qing , Dong Xuan , Ren Yan-Dan , Chen Wei-Ming , Zeng Dan-Yi , Cai Yan-Yan , Hong Mei-Zhu , Pan Jin-Shui
Published: May 2020

Background and Aims

Although abnormal liver chemistries are linked to higher risk of death related to coronavirus disease (COVID-19), liver manifestations may be diverse and even confused. Thus, we performed a meta-analysis of published liver manifestations and described the liver damage in COVID-19 patients with death or survival.

Methods

We searched PubMed, Google Scholar, medRxiv, bioRxiv, Cochrane Library, Embase, and three Chinese electronic databases through April 22, 2020. We analyzed pooled data on liver chemistries stratified by the main clinical outcome of COVID-19 using a fixed or random-effects model.

Results

In the meta-analysis of 18 studies, which included a total of 2,862 patients, the pooled mean alanine aminotransferase (ALT) was 30.9 IU/L in the COVID-19 patients with death and 26.3 IU/L in the COVID-19 patients discharged alive (p < 0.0001). The pooled mean aspartate aminotransferase (AST) level was 45.3 IU/L in the COVID-19 patients with death while 30.1 IU/L in the patients discharged alive (p < 0.0001). Compared with the discharged alive cases, the dead cases tended to have lower albumin levels but longer prothrombin time, and international standardized ratio.

Conclusions

In this meta-analysis, according to the main clinical outcome of COVID-19, we comprehensively described three patterns of liver impairment related to COVID-19, hepatocellular injury, cholestasis, and hepatocellular disfunction. Patients died from COVID-19 tend to have different liver chemistries from those are discharged alive. Close monitoring of liver chemistries provides an early warning against COVID-19 related death.

Lay Summary

Abnormal liver chemistries are linked to higher risk of death related to coronavirus disease (COVID-19). We performed a meta-analysis of 18 studies that included a total of 2,862 patients with COVID-19. We noted that patients died from COVID-19 tend to have different liver chemistries from those are discharged alive and close monitoring of liver chemistries provides early warning against COVID-19 related death.
COVID-19 severe pneumonia in Mexico City – First experience in a Mexican hospital
Authors: Valente-Acosta B , Hoyo-Ulloa I , Espinosa-Aguilar L , Mendoza-Aguilar R , Garcia-Guerrero J , Ontañon-Zurita D , Gomez-Gomez B , Fueyo-Rodríguez O , Vera-Zertuche JM , Anzola-Arias RJ , Jiménez-Ceja JV , Horta-Carpinteyro D , Olvera-Guzman C , Aguirre-Sanchez J , Franco-Granillo J , Jauregui-Camargo L , Sada-Díaz E , Saavedra-Perez-Salas R , Palomar-Lever A , Moreno-Sánchez F
Published: May 2020

Background

Coronavirus Disease 2019 (Covid-19) pandemic since its first confirmed case, has changed the world. The need for accurate and truthful information is vital. Mexico and Latin America have been widely affected, so having local epidemiological data, will be of great clinical utility.

Methods

A total of 33 hospitalized patients with Covid-19 pneumonia (either severe or critical) were identified from electronic health record in a third level care private hospital in Mexico City from March 13rd to April 13rd, 2020. We conducted a descriptive study of patients for characterization of the clinical, laboratory and radiologic findings, as well as complications.

Results

The mean age was 60.6±12.68 years and 23 (69.7%) were males. Twenty-three patients (69.6%) were overweight or obese. The median duration of symptoms before admission was 7 days. All the patients required mechanical invasive ventilation. The median duration of the mechanical ventilation was 12±2.6 days and all patients were extubated except one. All patients were started on antiviral treatment in the first 24 hours after admission once the diagnosis of Covid19 pneumonia was made. There was no difference between the treatment option and the length of stay. The extubation rate was higher (91.6%) than in other series, with no fatalities even though they were treated with different regimens.

Conclusions

This one-centre experience describes the epidemiology, treatment and outcome of 33 patients with severe or critical COVID pneumonia admitted to the ICU. Most patients in our series were overweight or obese male, which we observed were of higher risk to present critical pneumonia, as well as high levels of Interleukin-6. The foregoing is relevant, due to the high incidence of these comorbidities in our country.
Impact of mitigating interventions and temperature on the instantaneous reproduction number in the COVID-19 epidemic among 30 US metropolitan areas
Authors: Yu Xinhua
Published: May 2020

Background

After more than four months into the coronavirus disease (COVID-19) epidemic, over 347,500 people had died worldwide. The current study aims to evaluate how mitigating interventions affected the epidemic process in the 30 largest metropolitan areas in the US and whether temperature played a role in the epidemic process.

Methods

Publicly available data for the time series of COVID-19 cases and deaths and weather were analyzed at the metropolitan level. The time-varying reproductive numbers (Rt) based on retrospective moving average were used to explore the trends. Student t tests were used to compare temperature and peak Rtcross-sectionally.

Results

We found that virus transmissibility, measured by instantaneous reproduction number (Rt), had declined since the end of March for all areas and almost all of them reached a Rtof 1 or below after April 15, 2020. However, the Rts remained around 1 for most areas since then and some small and short rebounds were presented in some areas, suggesting a persistent epidemic in those areas. The timing of the main decline was concurrent with the implementation of mitigating interventions. Cities with warm temperature also tended to have a lower peak Rtthan that of cities with cold temperature. However, large geographic variations existed.

Conclusions

Aggressive interventions might have mitigated the current epidemic of COVID-19, while temperature might have some weak effects on the virus transmission. We may need to prepare for a possible return of the coronavirus outbreak.
Fast SARS-CoV-2 detection protocol based on RNA precipitation and RT-qPCR in nasopharyngeal swab samples
Authors:   COVID-19 Basque Inter-institutional Group (coBIG),   coordinators and participants:, Guruceaga Xabier , Sierra Amanda , Marino Daniel , Santin Izortze , Nieto-Garai Jon Ander , Bilbao Jose Ramón , Lorizate Maier , Aspichueta Patricia , Gaminde-Blasco Adhara , Bozal-Leorri Adrian , Marín-Peña Agustín , Castellanos-Rubio Ainara , Iglesias-Ara Ainhoa , Rementeria Aitor , Bernal-Chico Ana , Ramirez-Garcia Andoni , Olazagoitia-Garmendia Ane , Benito-Vicente Asier , Martín César , Castellanos Eider Bilbao , Rueda-Alaña Eneritz , Cavaliere Fabio , de Nanclares Guiomar Perez , Aurrekoetxea Igor , Garcia-Santisteban Iraia , Bernales Irantzu , Gonzalez-Moro Itziar , Tønnesen Jan , Baleriola Jimena , Vallejo-Rodríguez Jon , Aparicio-Fernandez Leire , Martin-Souto Leire , Mendoza Luis Manuel , Areitio Maialen , Sebastian-delaCruz Maialen , Ortiz-Zarragoitia Maren , Serrano-Regal Mari Paz , Basaras Miren , Fernandez-Jimenez Nora , Pampliega Olatz , Alegre Santos Alonso , Marcos Susi , Fuertes-Mendizabal Teresa , Galicia-Garcia Unai , Perez-Cuesta Uxue , Torrano Verónica , Sierra-Torre Virginia , Buqué Xabier , Mayor Ugo
Published: May 2020

The SARS-CoV-2 pandemic has evolved far more aggressively in countries lacking a robust testing strategy to identify infected individuals. Given the global demand for fast and reliable diagnosis to determine the carrier individuals, a stock-out scenario for a number of essential reagents/kits used along the diagnostic process has been foreseen by many organizations. Having identified the RNA extraction step as one of the key bottlenecks, we tested several alternatives that avoid the use of commercial kits for this step. The analysis showed that 2-propanol precipitation of the viral RNA, followed by one-step RT-qPCR results in a sensitivity and specificity comparable to that provided currently by automatized systems such as the COBAS 6800 system. Therefore, this simple protocol allows SARS-CoV-2 testing independently of commercial kit providers in a time and cost-effective manner. It can be readily implemented in research and/or diagnostic laboratories worldwide, provided that patient confidentiality and researcher safety are ensured. Scaling up the testing capabilities of hospitals and research facilities will identify larger numbers of infected individuals to paint a clear picture of the COVID-19 prevalence, a pre-requisite for informed policy decision making.
How urgent do intravitreal anti-VEGF injections need to be to justify the risk of transmitting COVID-19? Proof-of-concept calculations to determine the Health Adjusted Life-Year (HALY) trade-off
Authors: Boyd Matt James , Scott Daniel Andrew Richard , Squirrell David Michael , Wilson Graham Ashley
Published: May 2020

Background

Clinical ophthalmological guidelines encourage the assessment of potential benefits and harms when deciding whether to perform elective ophthalmology procedures during the COVID-19 pandemic, in order to minimize the risk of disease transmission.

Method

We performed probability calculations to estimate COVID-19 infection status and likelihood of disease transmission among neovascular age-related macular degeneration patients and health care workers during anti-VEGF procedures, at various community prevalence levels of COVID-19. We then applied the expected burden of COVID-19 illness and death expressed through health-adjusted life-years (HALYs) lost. We compared these results to the expected disease burden of severe visual impairment if sight protecting anti-VEGF injections were not performed.

Results

Our calculations suggest a wide range of contexts where the benefits of treatment to prevent progression to severe visual impairment or blindness are greater than the expected harms to the patient and immediate health care team due to COVID-19. For example, with appropriate protective equipment the benefits of treatment outweigh harms when the chance of progression to severe visual impairment is >0.044% for all scenarios where COVID-19 prevalence was one per thousand, even when the attack rate in the clinical setting is very high (5-43%).

Conclusion

Unless COVID-19 prevalence is very high, the reduced disease burden from avoiding visual impairment outweighs the expected HALYs lost from COVID-19 transmission. This finding is driven by the fact that HALYs lost when someone suffers severe visual impairment for 5 years are equivalent to nearly 400 moderate cases of infectious disease lasting 2 weeks each.
Anti-CELA1 KF4 Antibody Prevents Emphysema by Inhibiting Stretch-Mediated Remodeling
Authors: Ojha Mohit , Smith Noah , Joshi Rashika , Goodman Emily , Fan Qiang , Schuman Richard , Porollo Aleksey , Zemans Rachel L. , Batie Matthew R. , Borchers Michael T. , Ammerman Samuel , Varisco Brian M.
Published: May 2020

Emphysema is a major contributor to the morbidity and mortality of chronic obstructive pulmonary disease (COPD), and there are no disease modifying therapies. Three leading pathophysiologic models are the altered protease/antiprotease balance model, the biomechanical model in which loss of one alveolar wall increases strain on adjacent wall predisposing them to failure, and the accelerated aging model.Chymotrypsin-like elastase 1(CELA1) is a novel serine protease with a physiological role in reducing postnatal lung elastance that mechanistically links these three models.CELA1is expressed by alveolar type 2 (AT2) cells and is found adjacent to lung elastin fibers. The KF4 antibody neutralizes CELA1 by binding to its catalytic triad. CELA1 binding to lung elastin fibers increases 4-fold with strain, and application of biaxial strain induces lung elastase activity which is blocked with the KF4 anti-CELA1 antibody.Cela1−/−mice were protected from airspace simplification in hyperoxia, elastase and cigarette-smoke induced emphysema, and age-related airspace simplification.CELA1mRNA was correlated with human lung elastolytic activity, and anti-CELA1 KF4 antibody protected mice from hyperoxia-induced alveolar simplification and elastase emphysema. CELA1-mediated lung matrix remodeling in response to strain is an important contributor to postnatal airspace simplification. Matrix stabilization by KF4 represents a potential therapeutic approach to preventing emphysema progression.

One Sentence Summary

Neutralization of chymotrypsin-like elastase 1 prevents strain-induced emphysema.
The effect of a national lockdown in response to COVID-19 pandemic on the prevalence of clinical symptoms in the population
Authors: Keshet Ayya , Gavrieli Amir , Rossman Hagai , Shilo Smadar , Meir Tomer , Karady Tal , Lavon Amit , Kolobkov Dmitry , Kalka Iris , Shoer Saar , Godneva Anastasia , Cohen Ori , Kariv Adam , Hoch Ori , Zer-Aviv Mushon , Castel Noam , Zohar Anat Ekka , Irony Angela , Geiger Benjamin , Dor Yuval , Hizi Dorit , Balicer Ran , Shalev Varda , Segal Eran
Published: May 2020

The vast and rapid spread of COVID-19 calls for immediate action from policy-makers, and indeed various lockdown measures were implemented in many countries. Here, we utilized nationwide surveys that assess COVID-19 associated symptoms to analyze the effect of the lockdown policy in Israel on the prevalence of clinical symptoms in the population. Daily symptom surveys were distributed online and included fever, respiratory symptoms, gastrointestinal symptoms, anosmia and Ageusia. A total of 1,456,461 survey responses were analyzed. We defined a single measure of symptoms, Symptoms Average (SA), as the mean number of symptoms reported by responders. Data were collected between March 15th to May 11th, 2020. Notably, following severe lockdown measures, we found that between March 15th and April 20th, SA sharply declined by 83.8%, as did every individual symptom, including the most common symptoms reported by our responders, cough and rhinorrhea and\or nasal congestion, which decreased by 74.1% and 69.6%, respectively. Individual symptoms exhibit differences in reduction dynamics, suggesting differences in the medical conditions that they represent or in the nature of the symptoms themselves. The reduction in symptoms was observed in all the cities in Israel, and in several stratifications of demographic characteristics. Between April 20th and May 11th, following several subsequent lockdown relief measures, the decrease in SA and individual symptoms halted and they remain relatively stable with no significant change. Overall, these results demonstrate a profound decrease in a variety of clinical symptoms following the implementation of a lockdown in Israel. As our survey symptoms are not specific to COVID-19 infection, this effect likely represents an overall nationwide reduction in the prevalence of infectious diseases, including COVID-19. This quantification may be of major interest for COVID-19 pandemic, as many countries consider implementation of lockdown strategies.
Communicating with patients and families about difficult matters: A rapid review in the context of the COVID-19 pandemic
Authors: Ekberg Stuart , Parry Ruth , Land Victoria , Ekberg Katie , Pino Marco , Antaki Charles
Published: May 2020

Background

Pandemics pose significant challenges for healthcare systems, including an increase in difficult discussions about future illness progression and end of life.

Objectives

To synthesise existing evidence about communication practices used to discuss difficult matters, including prognosis and end of life, and to use this evidence to make recommendations for clinical practice. The aim of this study was to use rapid review methods to update findings from a previous systematic review published in 2014.

Data sources

MEDLINE, EMBASE, CINAHL, PsycINFO, Sociological Abstracts, Web of Science, Scopus, ASSIA and Amed.

Study eligibility criteria

Studies using conversation analysis or discourse analysis to examine recordings of actual conversations about difficult matters relating to future illness progression and end of life.

Study appraisal and synthesis methods

Data appraisal and extraction procedures used in the 2014 review were modified for this rapid review.

Results

Following screening, 18 sources were deemed to meet eligibility criteria, which were added to the 19 sources included in the 2014 systematic review. Synthesis of study findings identified 11 communication practices: providing opportunities for patient or family members to propose matters to discuss (7 out of 37 included sources); seeking a patient or family member’s perspective (6/37); discussing the future indirectly (11/37); discussing the future explicitly (7/37) linking to something previously said or done (11/37); using hypothetical scenarios (13/37); framing a difficult matter as universal (5/37); acknowledging uncertainty (3/37); exploring options (2/37); displaying sensitivity (7/37); emphasising the positive (7/37).

Limitations

Dividing work amongst the study authors to enable rapid review may have created inconsistencies.

Conclusions and implications of key findings

This synthesis of high-quality evidence from actual clinical practice supports a series of recommendations for communicating about difficult matters during and beyond the COVID-19 pandemic.
Epidemic analysis of COVID-19 Outbreak and Counter-Measures in France
Authors: Unlu Eren , Léger Hippolyte , Motornyi Oleksandr , Rukubayihunga Alia , Ishacian Thibaud , Chouiten Mehdi
Published: May 2020

The COVID-19 pandemic has triggered world-wide attention among data scientists and epidemiologists to analyze and predict the outcomes, by using previous statistical epidemic models. We propose to use a variant of the well known SEIR model to analyze the spread of COVID-19 in France, by taking in to account the national lockdown declared in March 11, 2020. Particle Swarm Optimisation (PSO) is used to find optimal parameters for the model in the case of France. We propose to fit the model based only on the number of daily fatalities, where an R2 score based error metric is used. As the official number of confirmed cases is not reliable due to the lack of widespread testing, especially in the first phases of the outbreak, we show that basing the model optimisation on the number of fatalities can provide legitimate results.
Review and methodological analysis of trials currently testing treatment and prevention options for COVID-19 globally
Authors: Fragkou Paraskevi C. , Belhadi Drifa , Peiffer-Smadja Nathan , Moschopoulos Charalampos D. , Lescure François-Xavier , Janocha Hannah , Karofylakis Emmanouil , Yazdanpanah Yazdan , Mentré France , Skevaki Chrysanthi , Laouénan Cédric , Tsiodras Sotirios
Published: May 2020

Background

As COVID-19 cases continue to rise globally within an unprecedented short period of time, solid evidence from large randomised controlled trials is still lacking. Currently, numerous trials testing potential treatment and preventative options are undertaken globally.

Objectives

We summarised all currently registered clinical trials examining treatment and prevention options for COVID-19. Additionally, we evaluated the quality of the retrieved interventional studies.

Data sources

Clinicaltrials.gov, the Chinese Clinical Trial Registry and the European Union Clinical Trials Register were systematically searched.

Study eligibility criteria

Registered clinical trials examining treatment and/or prevention options for COVID-19 were included. No language, country or study design restrictions were applied. We excluded withdrawn or cancelled studies and trials not reporting therapeutic or preventative strategies for COVID-19.

Participants and interventions

No restrictions in terms of participants’ age and medical background or type of intervention were enforced.

Methods

The registries were searched using the term “coronavirus” or “COVID-19” from their inception until 26th March 2020. Additional manual search of the registries was also performed. Eligible studies were summarised and tabulated. Interventional trials were methodologically analysed, excluding expanded access studies and trials testing Traditional Chinese Medicine.

Results

In total, 309 trials evaluating therapeutic management options, 23 studies assessing preventive strategies and 3 studies examining both were retrieved. Interventional treatment studies were mostly randomised (n=150, 76%) and open-label (n=73, 37%) with a median number of planned inclusions of 90 (IQR 40-200). Major categories of interventions that are currently being investigated are discussed.

Conclusion

Numerous clinical trials have been registered since the onset of the COVID-19 pandemic. Summarised data on these trials will assist physicians and researchers to promote patient care and guide future research efforts for COVID-19 pandemic containment. However, up to the end of March, 2020, significant information on reported trials was often lacking.