title: Molecular docking studies on Jensenone from eucalyptus essential oil as a potential inhibitor of COVID 19 corona virus infection

text: COVID-19, a member of corona virus family is spreading its tentacles across the world due to lack of drugs at present. However, the main viral proteinase (Mpro/3CLpro) has recently been regarded as a suitable target for drug design against SARS infection due to its vital role in polyproteins processing necessary for coronavirus reproduction. The present in silico study was designed to evaluate the effect of Jensenone, a essential oil component from eucalyptus oil, on Mpro by docking study. In the present study, molecular docking studies were conducted by using 1-click dock and swiss dock tools. Protein interaction mode was calculated by Protein Interactions Calculator.The calculated parameters such as binding energy, and binding site similarity indicated effective binding of Jensenone to COVID-19 proteinase. Active site prediction further validated the role of active site residues in ligand binding. PIC results indicated that, Mpro/ Jensenone complexes forms hydrophobic interactions, hydrogen bond interactions and strong ionic interactions. Therefore, Jensenone may represent potential treatment potential to act as COVID-19 Mpro inhibitor. However, further research is necessary to investigate their potential medicinal use.


title: Vitamin D Supplementation in Influenza and COVID-19 Infections Comment on: "Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths" Nutrients 2020, 12(4), 988

text: There is an ongoing debate on the use of vitamin D supplementation in reducing the risk of influenza and COVID-19 infections and deaths. A recently published article highlights a relationship between vitamin D supplementation and reduced risk of COVID-19 and influenza. This comment aims to discuss the evidence on the use of Vitamin D in people who are at risk of developing COVID-19, focusing on safety issues of the Vitamin D supplementation.


What the Diamond Princess taught the world about covid-19


title: Covid-19: analysis of a modified SEIR model, a comparison of different intervention strategies and projections for India

text: Modeling accurately the evolution and intervention strategies for the Covid-19 pandemic is a challenging problem. We present here an analysis of an extended Susceptible-Exposed-Infected-Recovered (SEIR) model that accounts for asymptomatic carriers, and explore the effect of different intervention strategies such as social distancing (SD) and testing-quarantining (TQ). The two intervention strategies (SD and TQ) try to reduce the disease reproductive number $R_0$ to a target value $R_0^{\rm target}<1$, but in distinct ways, which we implement in our model equations. We find that for the same target $R_0^{\rm target}<1$, TQ is more efficient in controlling the pandemic than lockdowns that only implement SD. However, for TQ to be effective, it has to be based on contact tracing and the ratio of tests/day to the number of new cases/day has to be scaled with the mean number of contacts of an infectious person, which would be high in densely populated regions with low levels of SD. We point out that, apart from $R_0$, an important quantity is the largest eigenvalue of the linearised dynamics which provides a more complete understanding of the disease progression, both pre- and post- intervention, and explains observed data for many countries. Weak intervention strategies (that reduce $R_0$ but not to a value less than $1$) can reduce the peak values of infections and the asymptotic affected population. We provide simple analytic expressions for these in terms of the disease parameters and apply them in the Indian context to obtain heuristic projections for the course of the pandemic. We find that the predictions strongly depend on the assumed fraction of asymptomatic carriers.


COVID-19 and alcohol in Australia: Industry changes and public health impacts


Anticipating the 'Second Wave' of Health Care Strain in COVID19 Pandemic


COVID-19 platform trial delivers


Interrogation of the safety and efficacy of home-use light-based devices


title: Pharmacological (or Synthetic) and Nutritional Agonists of PPAR-Î³ as Candidates for Cytokine Storm Modulation in COVID-19 Disease

text: The cytokine storm is an abnormal production of inflammatory cytokines, due to the over-activation of the innate immune response. This mechanism has been recognized as a critical mediator of influenza-induced lung disease, and it could be pivotal for COVID-19 infections. Thus, an immunomodulatory approach targeting the over-production of cytokines could be proposed for viral aggressive pulmonary disease treatment. In this regard, the peroxisome proliferator-activated receptor (PPAR)-Î³, a member of the PPAR transcription factor family, could represent a potential target. Beside the well-known regulatory role on lipid and glucose metabolism, PPAR-Î³ also represses the inflammatory process. Similarly, the PPAR-Î³ agonist thiazolidinediones (TZDs), like pioglitazone, are anti-inflammatory drugs with ameliorating effects on severe viral pneumonia. In addition to the pharmacological agonists, also nutritional ligands of PPAR-Î³, like curcuma, lemongrass, and pomegranate, possess anti-inflammatory properties through PPAR-Î³ activation. Here, we review the main synthetic and nutritional PPAR-Î³ ligands, proposing a dual approach based on the strengthening of the immune system using pharmacological and dietary strategies as an attempt to prevent/treat cytokine storm in the case of coronavirus infection.


SARS-CoV-2 infection of kidney organoids prevented with soluble human ACE2


Unexpected severe thrombocytopenia in the COVID-19 positive parturient


title: A comprehensive analysis of bio-inspired design of femoral stem on primary and secondary stabilities using mechanoregulatory algorithm

text: The coated porous section of stem surface is initially filled with callus that undergoes osseointegration process, which develops a bond between stem and bone, lessens the micromotions and transfers stresses to the bone, proximally. This phenomenon attributes to primary and secondary stabilities of the stems that exhibit trade-off the stem stiffness. This study attempts to ascertain the influence of stem stiffness on peri-prosthetic bone formation and stress shielding when in silico models of solid CoCr alloy and Ti alloy stems, and porous Ti stems (53.8 GPa and 31.5 GPa Young's moduli) were implanted. A tissue differentiation predictive mechanoregulation algorithm was employed to estimate the evolutionary bond between bone and stem interfaces with 0.5-mm- and 1-mm-thick calluses. The results revealed that the high stiffness stems yielded higher stress shielding and lower micromotions than that of low stiffness stems. Contrarily, bone formation around solid Ti alloy stem and porous Ti 53.8 GPa stem was augmented in 0.5-mm- and 1-mm-thick calluses, respectively. All designs of stems exhibited different rates of bone formation, diverse initial micromotions and stress shielding; however, long-term bone formation was coherent with different stress shielding. Therefore, contemplating the secondary stability of the stems, low stiffness stem (Ti 53.8 GPa) gave superior biomechanical performance than that of high stiffness stems.


title: Rapid Deployment of Chiropractic Telehealth at 2 Worksite Health Centers in Response to the COVID-19 Pandemic: Observations from the Field

text: OBJECTIVE: The purpose of this paper is to describe the rapid deployment of telehealth, particularly real time video conference, for chiropractic services as a response to COVID-19. METHODS: Two health centers at 2 campuses of a large California corporation have chiropractic care integrated into physical medicine services. Care was suspended beginning on March 17, 2020 to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among patients and staff. On March 19, the Governor of California issued a stay at home order. With musculoskeletal problems being common in the employee patient population, telehealth services were quickly developed to continue chiropractic care for patients. Using existing infrastructure, several members of the health center team developed chiropractic telehealth operations within 2 days. RESULTS: Musculoskeletal telehealth services included examinations, risk assessment, advice, and rehabilitative exercises. These telehealth visits facilitated care that would have otherwise been unavailable to employees. Patients reported that the appointments were helpful, addressed their concerns, and provided a safe method to see their doctor. Regular interprofessional teamwork and relations between the clinic operator and client company were key contributors to operationalizing this service in our integrated healthcare environment. CONCLUSION: We were able to quickly implement real time video conferencing and other forms of telehealth for chiropractic services at 2 worksite health centers. This paper includes information and insights to providers about setting up similar telehealth systems so they may also provide this benefit for patients in their communities during pandemics or disasters.


title: From Bad to Worse: Airline Boarding Changes in Response to COVID-19

text: Airlines have introduced a back-to-front boarding process in response to the COVID-19 pandemic. It is motivated by the desire to reduce passengers' likelihood of passing close to seated passengers when they take their seats. However, our prior work on the risk of Ebola spread in airplanes suggested that the driving force for increased exposure to infection transmission risk is the clustering of passengers while waiting for others to stow their luggage and take their seats. In this work, we examine whether the new boarding processes lead to increased or decreased risk of infection spread. We also study the reasons behind the risk differences associated with different boarding processes. We accomplish this by simulating the new boarding processes using pedestrian dynamics and compare them against alternatives. Our results show that back-to-front boarding roughly doubles the infection exposure compared with random boarding. It also increases exposure by around 50% compared to a typical boarding process prior to the outbreak of COVID-19. While keeping middle seats empty yields a substantial reduction in exposure, our results show that the different boarding processes have similar relative strengths in this case as with middle seats occupied. We show that the increased exposure arises from the proximity between passengers moving in the aisle and while seated. Our results suggest that airlines either revert to their earlier boarding process or adopt the better random process.


COVID-19 Q&A: Keeping a cancer core going


title: Prevención y tratamiento del Covid-19 en la población pediátrica desde una perspectiva familiar y comunitaria./ [Prevention and treatment of Covid-19 in the pediatric population from the family and community perspective]

text: Based on the report on the situation of COVID-19 in Spain, dated April 3, 2020, the confirmed cases amount to 117,710, of which 343 are under 14 years of age (<1%). It is essential to know the specificity of this process in the child population, as well the specific recommendations for proper prevention and care of children during the COVID-19 Pandemic. Our objective is to analyze the scientific evidence on the specific recommendations for pediatric care in cases of COVID-19 from the family and community settings.The main recommendations and preventive measures in primary health care settings and at home have been selected and analyzed from an integrative approach that includes the biopsychosocial aspects of the child during confinement.The importance of caring for children in the face of the disease lies above all in ensuring the correct measures for the prevention of contagion due to the condition of acting as possible carriers during an incubation period of up to 21 days. The recommendation is that children actively participate in routine preventive actions to contain the spread of the disease. At the household level, isolation is an important challenge for families where there are manifestations of uncertainty, fear and helplessness in the face of changes and among the recommendations are establishing routines and order through schedules of activities and leisure together with hygiene measures.Given the rapidity with which the COVID-19 pandemic has occurred, there is little evidence at the moment. Research on prevention and treatment in the pediatric age needs to be developed to improve the available recommendations.


title: Clinical Pharmacology Perspectives on the Antiviral Activity of Azithromycin and Use in COVID-19

text: Azithromycin (AZ) is a broad-spectrum macrolide antibiotic with a long half-life and a large volume of distribution. It is primarily used for the treatment of respiratory, enteric, and genitourinary bacterial infections. AZ is not approved for the treatment of viral infections, and there is no well-controlled, prospective, randomized clinical evidence to support AZ therapy in coronavirus disease 2019 (COVID-19). Nevertheless, there are anecdotal reports that some hospitals have begun to include AZ in combination with hydroxychloroquine or chloroquine (CQ) for treatment of COVID-19. It is essential that the clinical pharmacology (CP) characteristics of AZ be considered in planning and conducting clinical trials of AZ alone or in combination with other agents, to ensure safe study conduct and to increase the probability of achieving definitive answers regarding efficacy of AZ in the treatment of COVID-19. The safety profile of AZ used as an antibacterial agent is well established.1 This work assesses published in vitro and clinical evidence for AZ as an agent with antiviral properties. It also provides basic CP information relevant for planning and initiating COVID-19 clinical studies with AZ, summarizes safety data from healthy volunteer studies, and safety and efficacy data from phase II and phase II/III studies in patients with uncomplicated malaria, including a phase II/III study in pediatric patients following administration of AZ and CQ in combination. This paper may also serve to facilitate the consideration and use of a priori-defined control groups for future research.


Hypofractionation in COVID-19 radiotherapy: A mix of evidence based medicine and of opportunities


Covid-19: GP surgeries close for two weeks after staff test positive


title: Adult congenital heart disease and the COVID-19 pandemic

text: Adults with congenital heart disease (ACHD) may be at high risk in the case of COVID-19. Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease prevention and management. Based on anatomy and additional physiological factors including symptoms, exercise capacity, heart failure, pulmonary hypertension and cyanosis, we propose a pragmatic approach to categorising patients into low-risk, intermediate-risk and high-risk groups. We regard especially patients with complex cyanotic conditions, those with palliated univentricular hearts, heart failure, severe valvular disease or pulmonary hypertension as high-risk patients. To avoid infection, we recommend self-isolation and exemption from work for these cohorts. Infected ACHD patients with low or moderate risk and without signs of deterioration may be remotely followed and cared for at home while in self isolation. High-risk patients or those with signs of respiratory or cardiovascular impairment require admission ideally at a tertiary ACHD centre. Especially patients with complex, cyanotic disease, heart failure and arrhythmias require particular attention. Treatment in patients with cyanotic heart disease should be guided by the relative degree of desaturation compared with baseline and lactate levels rather than absolute oxygen saturation levels. Patients with right heart dilatation or dysfunction are potentially at increased risk of right heart failure as mechanical ventilation and acute respiratory distress syndrome can lead to increase in pulmonary arterial pressures.


How Might Social Distancing Impact Gay, Bisexual, Queer, Trans and Two-Spirit Men in Canada?


A probable atypical skin manifestation of COVID-19 infection


title: Moral Injury in Times of COVID-19

text: Health care providers are facing increased risk of moral distress during the COVID-19 pandemic because of changes in clinical practice and resource allocation procedures. Health care systems that employ a proactive approach in mitigating the lasting effects of moral distress will fare better in the long run. Psychologists are well poised to apply timely psychological first aid to the crisis needs of patients, colleagues, and even themselves. Key interventions are detailed, including creating and promoting safety, calmness, connectedness, self-efficacy, and hope.


title: Contact Tracing Mobile Apps for COVID-19: Privacy Considerations and Related Trade-offs

text: Contact tracing is an essential tool for public health officials and local communities to fight the spread of novel diseases, such as for the COVID-19 pandemic. The Singaporean government just released a mobile phone app, TraceTogether, that is designed to assist health officials in tracking down exposures after an infected individual is identified. However, there are important privacy implications of the existence of such tracking apps. Here, we analyze some of those implications and discuss ways of ameliorating the privacy concerns without decreasing usefulness to public health. We hope in writing this document to ensure that privacy is a central feature of conversations surrounding mobile contact tracing apps and to encourage community efforts to develop alternative effective solutions with stronger privacy protection for the users. Importantly, though we discuss potential modifications, this document is not meant as a formal research paper, but instead is a response to some of the privacy characteristics of direct contact tracing apps like TraceTogether and an early-stage Request for Comments to the community. Date written: 2020-03-24 Minor correction: 2020-03-30


title: Addressing trauma and stress in the COVID-19 pandemic: Challenges and the promise of integrated primary care

text: Integrated primary care settings are ideal locations for treatment of posttraumatic stress concerns as primary care is the principal access point for mental health treatment in the United States. The COVID-19 global pandemic will increase the necessity of posttraumatic stress-related psychological care for vulnerable populations and frontline providers through traditional and virtual methods; integrated primary care settings are rapidly adapting to meet this need. Integrating more behavioral health clinicians into primary care clinics will provide better access to whole-person care when it is needed most. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Cytokine release syndrome in severe COVID-19


title: The Greek study in the effects of colchicine in COvid-19 complications prevention (GRECCO-19 study): Rationale and study design

text: OBJECTIVE: Colchicine has been utilized safely in a variety of cardiovascular clinical conditions. Among its potential mechanisms of action is the non-selective inhibition of NLRP3 inflammasome which is thought to be a major pathophysiologic component in the clinical course of patients with COVID-19. GRECCO-19 will be a prospective, randomized, open-labeled, controlled study to assess the effects of colchicine in COVID-19 complications prevention. METHODS: Patients with laboratory confirmed SARS-CoV-2 infection (under RT PCR) and clinical picture that involves temperature >37.5 oC and at least two out of the: i. sustained coughing, ii. sustained throat pain, iii. Anosmia and/or ageusia, iv. fatigue/tiredness, v. PaO2<95 mmHg will be included. Patients will be randomised (1:1) in colchicine or control group. RESULTS: Trial results will be disseminated through peer-reviewed publications and conference presentations. CONCLUSION: GRECCO-19 trial aims to identify whether colchicine may positively intervene in the clinical course of COVID-19. (ClinicalTrials.gov Identifier: NCT04326790).


Liver injury in critically ill patients with COVID-19: a case series


Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China


title: Inhibitors of the renin-angiotensin system: The potential role in the pathogenesis of COVID-19

text: Coronavirus disease 2019 (COVID-19), which initially began in China, has spread to other countries of Asia, Europe, America, Africa and Oceania, with the number of confirmed cases and suspected cases increasing each day. According to recently published research, it was found that the majority of the severe cases were elderly, and many of them had at least one chronic disease, especially cardiovascular diseases. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are the most widely used drugs for cardiovascular diseases. The clinical effect of ACEIs/ARBs on patients with COVID-19 is still uncertain. This paper describes their potential role in the pathogenesis of COVID-19, which may provide useful in the advice of cardiologists and physicians.


title: Impact of COVID-19 on Canadian medical oncologists and cancer care: Canadian Association of Medical Oncologists survey report

text: Background: The covid-19 pandemic has presented unprecedented professional and personal challenges for the oncology community. Under the auspices of the Canadian Association of Medical Oncologists, we conducted an online national survey to better understand the impact of the pandemic on the medical oncology community in Canada. Methods: An English-language multiple-choice survey, including questions about demographics, covid-19 risk, use of personal protective equipment (ppe), personal challenges, and chemotherapy management was distributed to Canadian medical oncologists. The survey was open from 30 March to 4 April 2020, and attracted 159 responses. Results: More than 70% of medical oncologists expressed moderate-to-extreme concern about personally contracting covid-19 and about family members or patients (or both) contracting covid-19 from them. Despite that high level of concern, considerable variability in the use of ppe in direct cancer care was reported at the time of this survey, with 33% of respondents indicating no routine ppe use at their institutions and 69% indicating uncertainty about access to adequate ppe. Of the respondents, 54% were experiencing feelings of nervousness or anxiety on most days, and 52% were having feelings of depression or hopelessness on at least some days. Concern about aging parents or family and individual wellness represented the top personal challenges identified. The management of cancer patients has been affected, with adoption of telemedicine reported by 82% of respondents, and cessation of clinical trial accrual reported by 54%. The 3 factors deemed most important for treatment decision-making wereâ cancer prognosis and anticipated benefit from treatment,â risk of treatment toxicity during scarce health care access, andâ patient risk of contracting covid-19. Conclusions: This report describes the results of the first national survey assessing the impact of the covid-19 on Canadian medical oncologists and how they deliver systemic anticancer therapies. We hope that these data will provide a framework to address the challenges identified.


title: Hydroxychloroquine and the treatment of Sjogren syndrome, chronic ulcerative stomatitis, and oral lichen planus in the age of COVID-19

text: The Food and Drug Administration has recently approved the off-label use of hydroxychloroquine (HCQ) for the treatment of coronavirus disease 2019 (COVID-19) infections. However, a recent study not only failed to demonstrate HCQ efficacy but also documented a serious side effect of COVID-19 therapy with HCQ: QT prolongation and secondary arrhythmia. HCQ has been used as an off-label drug and deemed safe and effective for the treatment of oral lesions, such as Sjogren syndrome (SS), chronic ulcerative stomatitis (CUS), and oral lichen planus (OLP). Because HCQ may be appropriately used for the off-label treatment of SS, CUS, and OLP, relevant safety concerns regarding HCQ therapy with regard to dosage, drug-to-drug interactions, and QT prolongation and secondary arrhythmia are discussed here. Because of the possibility of decreased pharmacy supplies of HCQ, replacement drugs with respect to patients with SS, CUS, and OLP being successfully treated with HCQ are also discussed.


title: Telemedicine for Outpatient Neurosurgical Oncology Care: Lessons Learned for the Future During the COVID-19 Pandemic

text: BACKGROUND: The coronavirus 2019 (COVD-19) pandemic has drastically disrupted the delivery of neurosurgical care, especially for the already at-risk neuro-oncology population. The sudden change to clinic visits has rapidly spurned the implementation of telemedicine. A recommendation care paradigm of neuro-oncologic patients limited by telemedicine has not been reported. METHODS: A summary of a multi-institution experience detailing the potential benefits, pitfalls, and the necessary considerations to outpatient care of neurosurgical oncology patients. RESULTS: There are limitations and advantages to incorporating telemedicine into the outpatient care of neuro-oncology patients. Telemedicine-specific considerations for each step and stakeholder of the appointment (physician, patient, scheduling, previsit, imaging, and physical examination) are examined. CONCLUSIONS: Telemedicine, pushed to prominence during this COVID-19 pandemic, is a powerful and possibly preferential tool for the future of outpatient neuro-oncologic care.


title: Factors associated with the duration of hospitalisation among COVID-19 patients in Vietnam: A survival analysis

text: BACKGROUND: The median duration of hospital stays due to COVID-19 has been reported in several studies on China as 10-13 days. Global studies have indicated that the length of hospitalisation depends on different factors, such as the time elapsed from exposure to symptom onset, and from symptom onset to hospital admission, as well as specificities of the country under study. The goal of this paper is to identify factors associated with the median duration of hospital stays of COVID-19 patients during the second COVID-19 wave that hit Vietnam from 5 March to 8 April 2020. METHOD: We used retrospective data on 133 hospitalised patients with COVID-19 recorded over at least two weeks during the study period. The Cox proportional-hazards regression model was applied to determine the potential risk factors associated with length of hospital stay. RESULTS: There were 65 (48.9%) females, 98 (73.7%) patients 48 years old or younger, 15 (11.3%) persons with comorbidities, 21 (16.0%) severely ill patients and 5 (3.8%) individuals with life-threatening conditions. Eighty-two (61.7%) patients were discharged after testing negative for the SARS-CoV-2 virus, 51 were still in the hospital at the end of the study period and none died. The median duration of stay in a hospital was 21 (IQR: 16-34) days. The multivariable Cox regression model showed that age, residence and sources of contamination were significantly associated with longer duration of hospitalisation. CONCLUSION: A close look at how long COVID-19 patients stayed in the hospital could provide an overview of their treatment process in Vietnam, and support the country's National Steering Committee on COVID-19 Prevention and Control in the efficient allocation of resources over the next stages of the COVID-19 prevention period.


title: Colorectal cancer patient reported outcome measures during COVID-19

text: The urgent reorganisation of clinical services in response to the early stages of the COVID-19 pandemic has had a significant impact on the delivery of Colorectal Cancer (CRC) surgery. Both patients and surgeons had difficult decisions to make including individual risk assessment, issues pertaining to informed consent and the safety of laparoscopic surgery.


title: High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

text: PURPOSE: As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis. METHODS: IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized. RESULTS: Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed. CONCLUSION: This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implant-based breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.


title: Smell and taste symptom-based predictive model for COVID-19 diagnosis

text: BACKGROUND: The presentation of coronavirus 2019 (COVID-19) overlaps with common influenza symptoms. There is limited data on whether a specific symptom or collection of symptoms may be useful to predict test positivity. METHODS: An anonymous electronic survey was publicized through social media to query participants with COVID-19 testing. Respondents were questioned regarding 10 presenting symptoms, demographic information, comorbidities, and COVID-19 test results. Stepwise logistic regression was used to identify predictors for COVID-19 positivity. Selected classifiers were assessed for prediction performance using receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 145 participants with positive COVID-19 testing and 157 with negative results were included. Participants had a mean age of 39 years, and 214 (72%) were female. Smell or taste change, fever, and body ache were associated with COVID-19 positivity, and shortness of breath and sore throat were associated with a negative test result (p < 0.05). A model using all 5 diagnostic symptoms had the highest accuracy with a predictive ability of 82% in discriminating between COVID-19 results. To maximize sensitivity and maintain fair diagnostic accuracy, a combination of 2 symptoms, change in sense of smell or taste and fever was found to have a sensitivity of 70% and overall discrimination accuracy of 75%. CONCLUSION: Smell or taste change is a strong predictor for a COVID-19-positive test result. Using the presence of smell or taste change with fever, this parsimonious classifier correctly predicts 75% of COVID-19 test results. A larger cohort of respondents will be necessary to refine classifier performance.


title: An Evolving Approach to the Laboratory Assessment of COVID-19

text: As the COVID-19 outbreak has evolved in each country, the approach to the laboratory assessment of SARS-CoV-2 infection has had to evolve as well. This review addresses the evolving approach to the laboratory assessment of COVID-19 and discusses how algorithms for testing have been driven, in part, by the demand for testing overwhelming the capacity to accomplish such testing. This review focused on testing in the United States as this testing is evolving whereas in China and other countries such as South Korea testing is widely available and includes both molecular testing for SARS-CoV-2 as well as serological testing using both ELISA methodology and lateral flow immunoassay methodology. Although commercial testing systems are becoming available, there will likely be insufficient numbers of such tests due to high demand. Serological testing will be the next testing issue as the COVID-19 begins to subside. This will allow immunity testing as well as will allow the parameters of the COVID-19 outbreak to be defined. This article is protected by copyright. All rights reserved.


How emergency departments prepare for virus disease outbreaks like COVID-19


title: Strategies to Inform Allocation of Stockpiled Ventilators to Healthcare Facilities During a Pandemic

text: During a severe pandemic, especially one causing respiratory illness, many people may require mechanical ventilation. Depending on the extent of the outbreak, there may be insufficient capacity to provide ventilator support to all of those in need. As part of a larger conceptual framework for determining need for and allocation of ventilators during a public health emergency, this article focuses on the strategies to assist state and local planners to allocate stockpiled ventilators to healthcare facilities during a pandemic, accounting for critical factors in facilities' ability to make use of additional ventilators. These strategies include actions both in the pre-pandemic and intra-pandemic stages. As a part of pandemic preparedness, public health officials should identify and query healthcare facilities in their jurisdiction that currently care for critically ill patients on mechanical ventilation to determine existing inventory of these devices and facilities' ability to absorb additional ventilators. Facilities must have sufficient staff, space, equipment, and supplies to utilize allocated ventilators adequately. At the time of an event, jurisdictions will need to verify and update information on facilities' capacity prior to making allocation decisions. Allocation of scarce life-saving resources during a pandemic should consider ethical principles to inform state and local plans for allocation of ventilators. In addition to ethical principles, decisions should be informed by assessment of need, determination of facilities' ability to use additional ventilators, and facilities' capacity to ensure access to ventilators for vulnerable populations (eg, rural, inner city, and uninsured and underinsured individuals) or high-risk populations that may be more susceptible to illness.


title: Indomethacin and resveratrol as potential treatment adjuncts for SARS-CoV-2/COVID-19

text: The ongoing pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2, also known as COVID-19) has led to unprecedented challenges for the global healthcare system. This novel coronavirus disease phenotype ranges from asymptomatic carriage to fulminant cytokine storm with respiratory failure, polyorgan dysfunction and death. Severe disease is characterised by exuberant inflammation resulting from high circulating cytokines such as interleukin-6 and tumour necrosis factor. These inflammatory mediators are responsible for the detrimental effects on the immune, hematologic, respiratory, renal, gastrointestinal and other body systems. In addition to inhibition of viral replication, blunting this inflammatory response before overt cytokine storm is important to improve outcomes. Although there are upcoming promising agents such as remdesivir and convalescent plasma, inexpensive, safe and widely available adjunct treatments to ameliorate disease burden would be welcome. Two potential anti-inflammatory agents include indomethacin, which has been shown in experimental models to decrease canine coronavirus levels in dogs and exhibit antiviral activity against several other viruses and the polyphenol, resveratrol, a potent antioxidant that has shown antiviral activity against several viruses.


Therapie von PatientInnen mit COVID-19./ [Management of Patients with COVID-19 - Recommendations from a Palliative Care Perspective]


Viewpoint: The COVID-19 and climate crises


Thoracic radiation therapy during COVID-19: provisional guidelines from a comprehensive cancer center within a pandemic epicenter


The many uncertainties of COVID-19


title: Molecular Mechanism of Evolution and Human Infection with SARS-CoV-2

text: The outbreak of a novel coronavirus, which was later formally named the severe acute respiratory coronavirus 2 (SARS-CoV-2), has caused a worldwide public health crisis. Previous studies showed that SARS-CoV-2 is highly homologous to SARS-CoV and infects humans through the binding of the spike protein to ACE2. Here, we have systematically studied the molecular mechanisms of human infection with SARS-CoV-2 and SARS-CoV by protein-protein docking and MD simulations. It was found that SARS-CoV-2 binds ACE2 with a higher affinity than SARS-CoV, which may partly explain that SARS-CoV-2 is much more infectious than SARS-CoV. In addition, the spike protein of SARS-CoV-2 has a significantly lower free energy than that of SARS-CoV, suggesting that SARS-CoV-2 is more stable and may survive a higher temperature than SARS-CoV. This provides insights into the evolution of SARS-CoV-2 because SARS-like coronaviruses have originated in bats. Our computation also suggested that the RBD-ACE2 binding for SARS-CoV-2 is much more temperature-sensitive than that for SARS-CoV. Thus, it is expected that SARS-CoV-2 would decrease its infection ability much faster than SARS-CoV when the temperature rises. These findings would be beneficial for the disease prevention and drug/vaccine development of SARS-CoV-2.


title: National Geriatric Network Rapidly Addresses Trainee Telehealth Needs in Response to COVID-19

text: BACKGROUND/OBJECTIVES: COVID-19 has pushed many geriatric healthcare providers to attempt video visits for the first time. While the Veterans Health Administration (VA) is a pioneer in telemedicine, rapid shifts to nearly exclusive use of telehealth for healthcare delivery and changes regarding trainee engagement in telehealth served as the impetus for rapidly assessing telehealth training needs. DESIGN/SETTING/PARTICIPANTS: Trainees (n=89) representing 12 disciplines affiliated with VA Geriatric Research Education and Clinical Centers (GRECCs) were surveyed regarding prior experience conducting video-to-home visits and training needs. RESULTS: Two-thirds had received some telehealth training. However, the majority had never done a video-to-home visit and, regardless of telehealth experience, reported low confidence. Based on open-ended questions exploring training needs, educational resources were rapidly developed and disseminated. INTERVENTION: Within one week of the assessment, a nuts-and-bolts guide regarding remote access, technology requirements, video conferencing platforms, and managing emergencies was sent to the national network of GRECC Associate Directors for Education for dissemination among discipline-specific training directors at their sites. Subsequently, this resource was submitted to the national VA COVID Strong Practices SharePoint site. Additionally, an interdisciplinary team of geriatric specialists with extensive video-to-home experience organized a national webinar, which peaked at just over 700 participants. "GRECC Connect," a network of geriatric specialty teams funded to improve care access for rural older Veterans using telehealth, and Associated Health Training programs at each GRECC, facilitated rapid development and dissemination of both resources. CONCLUSION: We rapidly identified and responded to telehealth training needs of geriatrics trainees to optimize care for rural older adults as part of a rapid response to COVID-19. While the webinar and nuts-and-bolts resources were developed within the VA context, they have demonstrated high demand and broader applicability. Results should continue to inform curriculum development efforts to address telehealth training gaps within and outside the VA. This article is protected by copyright. All rights reserved.


Histological pattern in COVID-19-induced viral rash


title: SARS-CoV-2 is transmitted via contact and via the air between ferrets

text: SARS-CoV-2, a coronavirus that emerged in late 2019, has spread rapidly worldwide, and information about the modes of transmission of SARS-CoV-2 among humans is critical to apply appropriate infection control measures and to slow its spread. Here we show that SARS-CoV-2 is transmitted efficiently via direct contact and via the air (via respiratory droplets and/or aerosols) between ferrets, 1 to 3 days and 3 to 7 days after exposure respectively. The pattern of virus shedding in the direct contact and indirect recipient ferrets is similar to that of the inoculated ferrets and infectious virus is isolated from all positive animals, showing that ferrets are productively infected via either route. This study provides experimental evidence of robust transmission of SARS-CoV-2 via the air, supporting the implementation of community-level social distancing measures currently applied in many countries in the world and informing decisions on infection control measures in healthcare settings.


Anti-Chinese sentiment during the 2019-nCoV outbreak


COVID-19 and mental health of older adults in the Philippines: a perspective from a developing country


SARS-CoV-2 viral loads and serum IgA/IgG immune responses in critically ill COVID-19 patients


Hidroxicloroquina y azitromicina: riesgo cardiovascular, prolongación de QTc y muerte súbita en el nuevo escenario de la pandemia por COVID-19/ Hydroxychloroquine and azithromycin: cardiovascular risk, QTc prolongation and sudden death in the new COVID-19 outbreak


Timely psychological care for patients with severe mental illness during COVID-19 epidemic


title: Quantitative Relationship between Population Mobility and COVID-19 Growth Rate based on 14 Countries

text: This study develops a framework for quantification of the impact of changes in population mobility due to social distancing on the COVID-19 infection growth rate. Using the Susceptible-Infected-Recovered (SIR) epidemiological model we establish that under some mild assumptions the growth rate of COVID-19 deaths is a time-delayed approximation of the growth rate of COVID-19 infections. We then hypothesize that the growth rate of COVID-19 infections is a function of population mobility, which leads to a statistical model that predicts the growth rate of COVID-19 deaths as a delayed function of population mobility. The parameters of the statistical model directly reveal the growth rate of infections, the mobility-dependent transmission rate, the mobility-independent recovery rate, and the critical mobility, below which COVID-19 growth rate becomes negative. We fitted the proposed statistical model on publicly available data from 14 countries where daily death counts exceeded 100 for more than 3 days as of May 6th, 2020. The publicly available Google Mobility Index (GMI) was used as a measure of population mobility at the country level. Our results show that the growth rate of COVID-19 deaths can be accurately estimated 20 days ahead as a quadratic function of the transit category of GMI (adjusted R-squared = 0.784). The estimated 95% confidence interval for the critical mobility is in the range between 36.1% and 47.6% of the pre-COVID-19 mobility. This result indicates that a significant reduction in population mobility is needed to reverse the growth of COVID-19 epidemic. Moreover, the quantitative relationship established herein suggests that a readily available, population-level metric such as GMI can be a useful indicator of the course of COVID-19 epidemic.


title: Effect of VEGFC on lymph flow and inflammation-induced alveolar bone loss

text: The lymphatic system plays a crucial role in the maintenance of tissue fluid homeostasis and the immunological response to inflammation. The effects of lymphatic drainage dysfunction on periodontitis have not been well-studied. Here we show that lymphatic vessel endothelial receptor 1 (LYVE1)+ /podoplanin (PDPN)+ lymphatic vessels (LVs) are increased in the periodontal tissues, with accumulation close to the alveolar bone surface, in two murine periodontitis models: rheumatoid arthritis (RA)-associated periodontitis and ligature-induced periodontitis. Further, PDPN+ / alpha-smooth muscle actin (αSMA)- lymphatic capillaries are increased, whereas PDPN+ / αSMA+ collecting LVs are decreased significantly in the inflamed periodontal tissues. Both mouse models of periodontitis have delayed lymph flow in periodontal tissues, increased TRAP-positive osteoclasts, and significant alveolar bone loss. Importantly, the local administration of adeno-associated virus for vascular endothelial growth factor C, the major growth factor that promotes lymphangiogenesis, increases the area and number of PDPN+ / αSMA+ collecting LVs, promotes local lymphatic drainage, and reduces alveolar bone loss in both models of periodontitis. Lastly, LYVE1+ / αSMA- lymphatic capillaries are increased, whereas LYVE1+ / αSMA+ collecting LVs are decreased significantly in gingival tissues of patients with chronic periodontitis compared with those of clinically healthy controls. Thus, our findings reveal an important role of local lymphatic drainage in periodontal inflammation-mediated alveolar bone loss. This article is protected by copyright. All rights reserved.


Putative contributions of circadian clock and sleep in the context of SARS-CoV-2 infection


title: Strategies for prevention and control of the 2019 novel coronavirus disease in the department of kidney transplantation

text: To summarize measures for the prevention and control of the 2019 novel coronavirus disease (COVID-19) in the department of kidney transplantation. We retrospectively analyzed the clinical data of outpatients and inpatients in the department of kidney transplantation from January 20 to March 1, 2020, and followed up the in-home kidney transplant recipients and those waiting for kidney transplantation through the Internet platform. Our department had formulated detailed prevention and control measures, mainly including kidney transplant outpatient management, kidney transplantation ward management, management of kidney transplant surgery, dialysis management of patients waiting for kidney transplantation, personal protection of medical staff, and follow-up management of discharged patients after kidney transplantation. During the epidemic period, there were no COVID-19 cases among 68 outpatient examined kidney transplant recipients, 32 hospitalized kidney transplant recipients, 19 patients waiting for kidney transplantation in hospital, and 30 medical staff. There were no COVID-19 cases among 160 follow-up recipients after kidney transplantation and 60 patients waiting for kidney transplantation. During the epidemic period, we implemented strict prevention and control measures and adjusted working methods and procedures to ensure safe and orderly work of the department.


Roles of Clinical Pharmacists in Caring for Patients with Inflammatory Bowel Disease during COVID-19


title: Xanthomonas diversity, virulence and plant-pathogen interactions

text: Xanthomonas spp. encompass a wide range of plant pathogens that use numerous virulence factors for pathogenicity and fitness in plant hosts. In this Review, we examine recent insights into host-pathogen co-evolution, diversity in Xanthomonas populations and host specificity of Xanthomonas spp. that have substantially improved our fundamental understanding of pathogen biology. We emphasize the virulence factors in xanthomonads, such as type III secreted effectors including transcription activator-like effectors, type II secretion systems, diversity resulting in host specificity, evolution of emerging strains, activation of susceptibility genes and strategies of host evasion. We summarize the genomic diversity in several Xanthomonas spp. and implications for disease outbreaks, management strategies and breeding for disease resistance.


COVID19: The need for public health in a time of emergency


Ivermectin and COVID-19: A report in Antiviral Research, widespread interest, an FDA warning, two letters to the editor and the authors' responses


title: Clinical presentation and initial management critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brescia, Italy

text: PURPOSE: An ongoing pandemic of COVID-19 that started in Hubei, China has resulted in massive strain on the healthcare infrastructure in Lombardy, Italy. The management of these patients is still evolving. MATERIALS AND METHODS: This is a single-center observational cohort study of critically ill patients infected with COVID-19. Bedside clinicians abstracted daily patient data on history, treatment, and short-term course. We describe management and a proposed severity scale for treatment used in this hospital. RESULTS: 44 patients were enrolled; with incomplete information on 11. Of the 33 studied patients, 91% were male, median age 64; 88% were overweight or obese. 45% were hypertensive, 12% had been taking an ACE-inhibitor. Noninvasive ventilation was performed on 39% of patients for part or all or their ICU stay with no provider infection. Most patients received antibiotics for pneumonia. Patients also received lopinivir/ritonavir (82%), hydroxychloroquine (79%), and tocilizumab (12%) according to this treatment algorithm. Nine of 10 patients survived their ICU course and were transferred to the floor, with one dying in the ICU. CONCLUSIONS: ICU patients with COVID-19 frequently have hypertension. Many could be managed with noninvasive ventilation, despite the risk of aerosolization. The use of a severity scale augmented clinician management.


title: Perspectives of physicians in general and ophthalmologists in particular about restarting services post-COVID-19 lockdown

text: Purpose: To assess the perspectives of physicians in general and ophthalmologists in particular about restarting elective out-patient (OP) and operating (OT) services after relaxation of lockdown for COVID-19. Methods: An online survey, containing 31 questions, was conducted among medical doctors using a secure Google forms link. The survey was open for 48 hours from 16th-18th April 2020. Results: Responses were received from 556 physicians (including 266 ophthalmologists). About a third (n = 205) wanted to start OP immediately after lockdown. In OP, mask of any kind for patient (60.8%), 3-ply for assistants (52.7%) and N95 for doctors (72.7%) were most common preferences. In OP, 31.5% and 46.6% felt full PPE and gloves alone were sufficient respectively. Ophthalmologists were more likely to start immediately after lockdown compared to other specialists (P = 0.004). Among 299 surgeons, an almost equal number (27%) wanted to start routine OT services immediately and 2 weeks post lockdown. A large majority (76.9%) would mandate COVID-19 tests before elective surgeries. In OT, 34.1% wanted N95 for surgical team and 3-ply for patient, 23.4% wanted 3-ply masks for everyone. 40.5% felt additional personal protective equipment (PPE) is not required and 33.1% felt that full PPE is required for everyone in OT. Ophthalmic surgeons preferred 3-ply masks and were less inclined to use full PPE (P < 0.001). Conclusion: Perspectives of doctors vary, especially with regarding to timing of restarting services and precautions to be taken in the OT. Ophthalmologists may tend to err on the side of taking lesser stringent precautions when restarting services post lockdown.


title: Can Teledentistry Improve the Monitoring of Patients during the Covid-19 Dissemination? A Descriptive Pilot Study

text: The aim of this pilot study was to describe the advantages of telemedicine (TM) in dental practice during the current national emergency condition due to the Covid-19 dissemination. At Department of Oral Surgery and Pathology-Magna Graecia University of Catanzaro, regional reference center for Covid-19-two groups of patients were determined: patients with urgent conditions (group U) and patients in follow-up (group F). Both groups were instructed to implement remote consultations using a messaging service (WhatsApp Messenger, WhatsApp Inc., Mountain View, California, USA) to send photos. A total of 418 photos were collected by 57 patients. Thirty-four photos were obtained by five patients in the U group after surgical procedures. All patients sent photos on the established evening, except for two patients who sent two photos outside the set days. In the F group, 384 photos were collected by 52 patients. None of them sent more photos than the number that was established by the protocol. Telemedicine allowed a monitoring of all patients, reducing costs and limiting human contact, decreasing the risk of Covid-19 dissemination.


COVID-19: The environmental implications of shedding SARS-CoV-2 in human faeces


title: Disaster Preparedness and Social Justice in a Public Health Emergency

text: The United States is now experiencing public health catastrophe on a scale we have not seen for more than a century. COVID-19 puts into stark relief our mutual obligations that reflect our interdependence as participants in a common society. Drawing on the work of Amartya Sen concerning famine and related challenges, I discuss the accompanying implications for social justice. Social justice in catastrophe requires strong social insurance structures and legal protections for the most vulnerable people, who would otherwise lack economic resources and political influence to protect their essential interests. Social justice also requires greater and more-sustained attention to disaster preparedness and public health infrastructure-both of which are characteristically neglected, in part because the public health enterprise is identified with politically weak and often stigmatized populations.


title: The role of integrated mental and community physical healthcare trusts in responding to the COVID-19 pandemic in the UK

text: For several decades, mental health services within the UK's National Health Service were provided by specialist mental health trusts. More recently many of these trusts have integrated community physical health services into their operations. We describe here how two integrated mental health trusts in England were able to make an enhanced response to the COVID-19 pandemic.


title: Unraveling the mystery of Covid-19 cytokine storm: From skin to organ systems

text: COVID-19 is a global pandemic that emerged from Wuhan, China. Besides pneumonia and acute respiratory distress syndrome, the disease leads to multisystem involvement in the form of myocarditis, arrhythmias, cardiac arrest, gastrointestinal symptoms, hypoxemic brain injury, acute liver, and renal function impairment. There are also reports of cutaneous lesions in form of urticarial and maculopapular rashes, chilblain like fingers and toes (covid feet), livedoid vasculopathy, and chicken-pox like or varicelliform vesicles. Clinically, many of these skin lesions are likely secondary to occlusion of small to medium blood vessels due to microthrombi formation or due to viral laden antigen-antibody immune complexes; and same explanation may hold true for possible hypoxemic injury simultaneously occurring in other vital organs like lungs, heart, brain, and kidneys. The histopathology, immunoflorescence and RT-PCR analysis of skin biopsies can provide useful insights for ascertaining the pathogenesis of this complex viral syndrome. Apparently, it is interplay of disarmed cellular immunity and over-activated humoral immunity that culminates in end-organ changes. The morbidity and mortality can be significantly reduced by upgrading the cellular immunity and downgrading the humoral response; along with prevention of hypoxemic and reperfusion injuries by using antivirals, immunomodulators, antioxidants, anti-platelets, and anticoagulants in judicious and phased manner.


title: Unraveling the mystery of Covid-19 Cytokine storm: From skin to organ systems

text: COVID-19 is a global pandemic that emerged from Wuhan, China. Besides pneumonia and acute respiratory distress syndrome, the disease leads to multisystem involvement in the form of myocarditis, arrhythmias, cardiac arrest, gastrointestinal symptoms, hypoxemic brain injury, acute liver and renal function impairment. There are also reports of cutaneous lesions in form of urticarial and maculopapular rashes, chilblain like fingers and toes (covid feet), livedoid vasculopathy and chicken-pox like or varicelliform vesicles. Clinically, many of these skin lesions are likely secondary to occlusion of small to medium blood vessels due to microthrombi formation or due to viral laden antigen-antibody immune complexes; and same explanation may hold true for possible hypoxemic injury simultaneously occurring in other vital organs like lungs, heart, brain and kidneys. The histopathology, immunoflorescence and RT-PCR analysis of skin biopsies can provide useful insights for ascertaining the pathogenesis of this complex viral syndrome. Apparently, it is interplay of disarmed cellular immunity and over-activated humoral immunity that culminates in end-organ changes. The morbidity and mortality can be significantly reduced by upgrading the cellular immunity and downgrading the humoral response; along with prevention of hypoxemic and reperfusion injuries by using antivirals, immunomodulators, antioxidants, anti-platelets and anticoagulants in judicious and phased manner. This article is protected by copyright. All rights reserved.


エレン・ブラウン氏との対話 お金の仕組みの摩訶不思議(第9回)新型コロナウイルスで米中戦争開始 メキシコ大統領は新自由主義経済に挑戦


title: Unprecedented pandemic, unprecedented shift, and unprecedented opportunity

text: The COVID-19 pandemic is currently spreading across the world in an unprecedented way. "Social distancing" has become the latest buzzword in the headlines of media covering the COVID-19 pandemic As a result, the widely implemented social distancing measures has generated one unprecedented shift that pushes various types of human social interactions from dominantly offline to dominantly online. This becomes a "new normal" in our daily life. For our research community of studying technology-related behavior, the COVID-19 pandemic provides an unprecedented opportunity to join the worldwide efforts to fight against the current pandemic and Human Behavior and Emerging Technologies calls for studies examining how humans behavior with emerging technologies in extreme events such as the COVID-19 pandemic.


title: Epidemiological research priorities for public health control of the ongoing global novel coronavirus (2019-nCoV) outbreak

text: Infections with 2019-nCoV can spread from person to person, and in the earliest phase of the outbreak the basic reproductive number was estimated to be around 2 2, assuming a mean serial interval of 7 5 days [2] The serial interval was not precisely estimated, and a potentially shorter mean serial interval would have corresponded to a slightly lower basic reproductive number Control measures and changes in population behaviour later in January should have reduced the effective reproductive number However, it is too early to estimate whether the effective reproductive number has been reduced to below the critical threshold of 1 because cases currently being detected and reported would have mostly been infected in mid- to late-January Average delays between infection and illness onset have been estimated at around 5–6 days, with an upper limit of around 11-14 days [2,5], and delays from illness onset to laboratory confirmation added a further 10 days on average [2]


An invited commentary on "Impact of the Coronavirus (COVID-19) pandemic on surgical practice-part 1". Impact of the Coronavirus (COVID-19) pandemic on surgical practice: Time to embrace telehealth in surgery


An invited commentary on "Impact of the Coronavirus (COVID-19) pandemic on surgical practice-part 1". Impact of the Coronavirus (COVID-19) pandemic on surgical practice: Time to embrace telehealth in surgery Metastatic melanoma treatment with checkpoint inhibitors in the COVID-19 era: experience from an Italian Skin Cancer Unit


Guest Editorial


Donning the powered air-purifying respirator in an emergency obstetric setting amid the COVID-19 outbreak in Singapore: a balance between safety and urgency


title: The impact of unplanned school closure on children's social contact: rapid evidence review

text: BackgroundEmergency school closures are often used as public health interventions during infectious disease outbreaks to minimise the spread of infection. However, if children continue mixing with others outside the home during closures, the effect of these measures may be limited.AimThis review aimed to summarise existing literature on children's activities and contacts made outside the home during unplanned school closures.MethodsIn February 2020, we searched four databases, MEDLINE, PsycInfo, Embase and Web of Science, from inception to 5 February 2020 for papers published in English or Italian in peer-reviewed journals reporting on primary research exploring children's social activities during unplanned school closures. Main findings were extracted.ResultsA total of 3,343 citations were screened and 19 included in the review. Activities and social contacts appeared to decrease during closures, but contact remained common. All studies reported children leaving the home or being cared for by non-household members. There was some evidence that older child age (two studies) and parental disagreement (two studies) with closure were predictive of children leaving the home, and mixed evidence regarding the relationship between infection status and such. Parental agreement with closure was generally high, but some disagreed because of perceived low risk of infection and issues regarding childcare and financial impact.ConclusionEvidence suggests that many children continue to leave home and mix with others during school closures despite public health recommendations to avoid social contact. This review of behaviour during unplanned school closures could be used to improve infectious disease modelling.


title: A survey on the impact of the COVID-19 pandemic on motility and functional investigations in Europe and considerations for recommencing activities in the early recovery phase

text: BACKGROUND: The COVID-19 pandemic, declared by WHO on March 13, 2020, had a major global impact on the healthcare system and services. In the acute phase, the presence of the SARS-CoV-2 virus in the aerodigestive tract limited activities in the gastroenterology clinic and procedures to emergencies only. Motility and function testing was interrupted and as we enter the recovery phase, restarting these procedures requires a safety-focused approach with adequate infection prevention for patients and healthcare professionals. METHODS: We summarized knowledge on the presence of the SARS-CoV-2 virus in the aerodigestive tract and the risk of spread with motility and functional testing. We surveyed 39 European centers documenting how the pandemic affected activities and which measures they are considering for restarting these measurements. We propose recommendations based on current knowledge as applied in our center. RESULTS: Positioning of catheters for gastrointestinal motility tests carries a concern for aerosol-borne infection of healthcare workers. The risk is low with breath tests. The surveyed centers stopped almost all motility and function tests from the second half of March. The speed of restarting and the safety measures taken varied highly. CONCLUSIONS AND INFERENCES: Based on these findings, we provided recommendations and practical relevant information for motility and function test procedures in the COVID-19 pandemic era, to guarantee a high-quality patient care with adequate infection prevention.


Cardiovascular disease and the impact of COVID-19


Response to Letters to the Editor about the Safe Handling of Containers of Expressed Human Milk in all Settings During the SARS-CoV-2 (COVID-19) Pandemic


title: Coronavirus Disease 2019 (COVID-19) and its implications for cardiovascular care: expert document from the German Cardiac Society and the World Heart Federation

text: Coronavirus diseases 2019 (COVID-19) has become a worldwide pandemic affecting people at high risk and particularly at advanced age, cardiovascular and pulmonary disease. As cardiovascular patients are at high risk but also have dyspnea and fatigue as leading symptoms, prevention, diagnostics and treatment in these patients are important to provide adequate care for those with or without COVID-19 but most importantly when comorbid cardiovascular conditions are present. Severe COVID-19 with acute respiratory distress (ARDS) is challenging as patients with elevated myocardial markers such as troponin are at enhanced high risk for fatal outcomes. As angiotensin-converting enzyme 2 (ACE2) is regarded as the viral receptor for cell entry and as the Coronavirus is downregulating this enzyme, which provides cardiovascular and pulmonary protection, there is ongoing discussions on whether treatment with cardiovascular drugs, which upregulate the viral receptor ACE2 should be modified. As most of the COVID-19 patients have cardiovascular comorbidities like hypertension, diabetes, coronary artery disease and heart failure, which imposes a high risk on these patients, cardiovascular therapy should not be modified or even withdrawn. As cardiac injury is a common feature of COVID-19 associated ARDS and is linked with poor outcomes, swift diagnostic management and specialist care of cardiovascular patients in the area of COVID-19 is of particular importance and deserves special attention.


title: Blood donation and the global COVID-19 pandemic: areas for social science research

text: In the context of the global COVID-19 pandemic, blood collection agencies (BCAs) around the world are operating under unprecedented conditions. As social scientists in donor research in Canada, Australia, and the Netherlands, we provide some early observations on donor and public responses to the pandemic and identify areas for donor research moving forward. Given the significant variation among countries and BCAs, we cannot claim to present an exhaustive list that will apply to all countries and BCAs; however, we consider the following topic areas to be important based on our observations and knowledge of donation scholarship.


"COVIDphobia" influences early otolaryngology diagnoses


title: COVID-19 Related Misinformation on Social Media: A Qualitative Study from Iran

text: BACKGROUND: Background: During outbreaks of diseases a great amount of health threatening misinformation is produced and released. In the web-2 era much of this misinformation is disseminated via social media where information could spread easily and quickly. Monitoring social media content provides crucial insights for health managers to manage the crisis. OBJECTIVE: Objective: Given the misinformation surrounding COVID-19 outbreak, this study was aimed to analyze contents of the most commonly used social networks in Iran that is among the affected countries. METHODS: Methods: A social media monitoring conducted through a qualitative design to analyze the discussions of social media users about the content related to COVID-19 transferred via Iranian medical faculty members` groups in Telegram and Whats App during Feb 20 to March 20, 2020 emphasizing the misinformation. Discourse analysis was applied and the written dialogues and discussions regarding misinformation about different aspects of the outbreak between medical faculty members all over the country were analyzed. RESULTS: Results: Cultural factors, demand pressure for information during the crisis, the easiness of information dissemination via social networks, marketing incentives and the poor legal supervision of online contents are the main reasons of misinformation dissemination. Disease statistics; treatments, vaccines and medicines; prevention and protection methods; dietary recommendations and disease transmission ways are the main subjective categories of releasing misinformation regarding novel coronavirus outbreak. Consequences of misinformation dissemination regarding disease include psychosocial; economic; health status; health system and ethical ones. Active and effective presence of health professionals and authorities on social media during the crisis and the improvement of public health literacy in the long term are the most recommended strategies for dealing with issues related to misinformation. CONCLUSIONS: Conclusion: This study contributes the management of COVID-19 outbreak trough providing applicable insights for health managers to manage public information in this challenging time.


Recommandations de la Société française de chirurgie oncologique (SFCO) pour l'organisation de la chirurgie oncologique durant l'épidémie de COVID-19./ [French Society for Surgical Oncology (SFCO) guidelines for the management of surgical oncology in the pandemic context of COVID 19]


title: Infectious bronchitis virus inhibits activation of the TLR7 pathway, but not the TLR3 pathway

text: Various strains of infectious bronchitis virus (IBV) cause different forms of infectious bronchitis with different clinical signs. Here, primary chicken embryo kidney (CEK) cells and specific-pathogen-free (SPF) chickens were infected with three pathogenic IBV strains, and it was observed that the TLR7-MYD88 pathway was inhibited but the TLR3-TIRF pathway was activated. After treatment with poly(I:C)-LMW, poly (I:C)-LMW/LyoVec, and Imiquimod, the replication of IBV was significantly suppressed after 24 h. However, treatment with TLR3 pathway inhibitors such as Pepinh-TRIF, celastrol, chloroquine, and BX795 resulted in increased replication of IBV after 36 h. These results also showed that chloroquine and celastrol were most effective inhibitors of the antiviral response at 48 hpi.


title: Coinfection with SARS-CoV-2 and other respiratory pathogens in COVID-19 patients in Guangzhou, China

text: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; previously provisionally named 2019 novel coronavirus or 2019-nCoV) disease (COVID-19) in China at the end of 2019 has caused a global pandemic and remains as a major public health issue This article is protected by copyright. All rights reserved.


title: Metagenomic Nanopore sequencing of influenza virus direct from clinical respiratory samples

text: Influenza is a major global public health threat as a result of its highly pathogenic variants, large zoonotic reservoir, and pandemic potential Metagenomic viral sequencing offers the potential for a diagnostic test for influenza virus which also provides insights on transmission, evolution, and drug resistance and simultaneously detects other viruses We therefore set out to apply the Oxford Nanopore Technologies sequencing method to metagenomic sequencing of respiratory samples We generated influenza virus reads down to a limit of detection of 102 to 103 genome copies/ml in pooled samples, observing a strong relationship between the viral titer and the proportion of influenza virus reads (P=4 7×10-5) Applying our methods to clinical throat swabs, we generated influenza virus reads for 27/27 samples with mid-to-high viral titers (cycle threshold [CT] values, <30) and 6/13 samples with low viral titers (CT values, 30 to 40) No false-positive reads were generated from 10 influenza virus-negative samples Thus, Nanopore sequencing operated with 83% sensitivity (95% confidence interval [CI], 67 to 93%) and 100% specificity (95% CI, 69 to 100%) compared to the current diagnostic standard Coverage of full-length virus was dependent on sample composition, being negatively influenced by increased host and bacterial reads However, at high influenza virus titers, we were able to reconstruct >99% complete sequences for all eight gene segments We also detected a human coronavirus coinfection in one clinical sample While further optimization is required to improve sensitivity, this approach shows promise for the Nanopore platform to be used in the diagnosis and genetic analysis of influenza virus and other respiratory viruses


In the fight against the new coronavirus outbreak, we must also struggle with human bias


title: Navigating the Dynamics of Financial Embeddings over Time

text: Financial transactions constitute connections between entities and through these connections a large scale heterogeneous weighted graph is formulated. In this labyrinth of interactions that are continuously updated, there exists a variety of similarity-based patterns that can provide insights into the dynamics of the financial system. With the current work, we propose the application of Graph Representation Learning in a scalable dynamic setting as a means of capturing these patterns in a meaningful and robust way. We proceed to perform a rigorous qualitative analysis of the latent trajectories to extract real world insights from the proposed representations and their evolution over time that is to our knowledge the first of its kind in the financial sector. Shifts in the latent space are associated with known economic events and in particular the impact of the recent Covid-19 pandemic to consumer patterns. Capturing such patterns indicates the value added to financial modeling through the incorporation of latent graph representations.


Drug misuse rose 30% in past decade and covid-19 could worsen situation, UN report warns


title: Renin-angiotensin system and SARS-CoV-2 interaction: underlying mechanisms and potential clinical implications

text: Renin-angiotensin system (RAS) inhibition supposedly increases the expression of angiotensin converting enzyme 2, serving as a binding site for SARS-CoV-2. Concerns arose regarding therapy with RAS inhibition during the COVID-19 pandemic. However, the pharmacological restraining the classical RAS axis might be beneficial due to the reduction of deleterious effects of angiotensin II and enhancement of the anti-inflammatory angiotensin 1-7 pathway. Unless large controlled studies are performed, RAS inhibition remains the cornerstone therapy in populations with cardiovascular disorders.


Stroke in COVID-19 patients-A case series from Italy


title: Considerations for head and neck oncology practices during the coronavirus disease 2019 (COVID-19) pandemic: Wuhan and Toronto experience

text: The practices of head and neck surgical oncologists must evolve to meet the unprecedented needs placed on our health care system by the Coronavirus disease 2019 (COVID-19) pandemic. Guidelines are emerging to help guide the provision of head and neck cancer care, though in practice, it can be challenging to operationalize such recommendations. Head and neck surgeons at Wuhan University faced significant challenges in providing care for their patients. Similar challenges were faced by the University of Toronto during the severe acute respiratory syndrome (SARS) pandemic in 2003. Herein, we outline our combined experience and key practical considerations for maintaining an oncology service in the midst of a pandemic.


title: Then Tell Me What You Think About Morality: A Freedom of Expression Perspective on the CJEU's Decision in FACK JU GÖHTE (C-240/18 P)

text: This case note on the CJEU's decision in Fack Ju Göhte focuses on morality bars and freedom of expression in EU trade mark law. Based on the presumption that a refusal to register a trade mark for being contrary to accepted principles of morality interferes with freedom of expression, an empirical concept of morality appears incompatible with freedom of expression. However, the test for morality developed by the CJEU seems to employ such an empirical concept at least partially. In addition, the test seems to lack legal certainty. In light of freedom of expression, both represent a potential shortcoming of the decision.


title: Approaching Otolaryngology Patients During the COVID-19 Pandemic

text: Objective. To describe coronavirus disease 2019 (COVID-19) patient presentations requiring otolaryngology consultation and provide recommendations for protective measures based on the experience of ear, nose, and throat (ENT) departments in 4 Chinese hospitals during the COVID-19 pandemic. Study Design. Retrospective case series. Setting. Multicenter. Subjects and Methods. Twenty hospitalized COVID-19 patients requiring ENT consultation from 3 designated COVID-19 hospitals in Wuhan, Shanghai, and Shenzhen were identified. Data on demographics, comorbidities, COVID-19 symptoms and severity, consult reason, treatment, and personal protective equipment (PPE) use were collected and analyzed. Infection control strategies implemented for ENT outpatients and emergency room visits at the Eye and ENT Hospital of Fudan University were reported. Results. Median age was 63 years, 55% were male, and 95% were in severe or critical condition. Six tracheotomies were performed. Posttracheotomy outcomes were mixed (2 deaths, 2 patients comatose, all living patients still hospitalized). Other consults included epistaxis, pharyngitis, nasal congestion, hyposmia, rhinitis, otitis externa, dizziness, and tinnitus. At all hospitals, powered air-supply filter respirators (PAPRs) were used for tracheotomy or bleeding control. PAPR or N95-equivalent masks plus full protective clothing were used for other complaints. No inpatient ENT providers were infected. After implementation of infection control strategies for outpatient clinics, emergency visits, and surgeries, no providers were infected at the Eye and ENT Hospital of Fudan University. Conclusions and Relevance. COVID-19 patients require ENT consultation for many reasons, including tracheotomy. Otolaryngologists play an indispensable role in the treatment of COVID-19 patients but, due to their work, are at high risk of exposure. Appropriate protective strategies can prevent infection of otolaryngologists.


Surviving the trauma of COVID-19


title: From plague to coronavirus: vessel trajectory data from ship automatic identification systems for epidemic modeling1

text: In addition to moving people and goods, ships can spread disease. Vessel trajectory data from ship Automatic Identification Systems (AIS) is available online and can be extracted and analyzed, as we illustrate in the case of the current coronavirus epidemic. This data should be included in epidemiological models of disease transmission to complement air traffic data and inform operational responses.


Coronaviruses in animals and humans


Failing Another National Stress Test on Health Disparities


title: The history and value of face masks

text: In the human population, social contacts are a key for transmission of bacteria and viruses. The use of face masks seems to be critical to prevent the transmission of SARS-CoV-2 for the period, in which therapeutic interventions are lacking. In this review, we describe the history of masks from the middle age to modern times.


Structural Biology Aids the Research of New Anti-COVID-19 Drugs


title: Impact of industrial activities on atmospheric volatile organic compounds in Sihwa-Banwol, the largest industrial area in South Korea

text: The impact of industrial activities on atmospheric volatile organic compounds (VOCs) in the Sihwa-Banwol complexes, i.e., the largest industrial area in Korea, was investigated. More than 60 VOCs were determined from 850 samples collected from four sites in and around the complexes through a 2-year monitoring campaign from 2005 to 2007. The VOCs of particular concern found in the area were benzene, toluene, ethylbenzene, xylenes, trichloroethylene, and formaldehyde, given their toxicity, concentration, and detection frequency. Toluene was the most abundant one. The VOC concentration rankings were consistent with their emission rankings. Most VOCs had higher concentrations at the industrial sites than at residential sites, indicating a significant impact of industrial emissions. The ambient levels of benzene and formaldehyde were additionally affected by vehicular emissions and secondary formation, respectively. Overall, the VOC levels increased in winter and at night, because of the local weather conditions. In contrast, the formaldehyde concentration increased in summer, owing to its secondary formation in the atmosphere. The ambient VOC levels in Sihwa-Banwol were higher than those in other parts of Korea. Additionally, the cumulative cancer risks posed by the toxic VOCs exceeded a tolerable risk level of 1 × 10-4 in not only the industrial areas but also the residential areas. The sum of the non-cancer risks in both areas significantly exceeded the threshold criterion of 1. The large amounts of aromatic compounds emitted from the industrial complexes are believed to play a crucial role in the elevated levels of surface ozone in the Seoul metropolitan area during the summer season. Therefore, comprehensive measures for controlling the VOC emissions in the Sihwa-Banwol area need to be prioritized to reduce the health risks for residents of not only this area but also the capital Seoul and its surrounding areas.


Multidisciplinary guidance to manage comatose patients with severe COVID-19


title: First expert elicitation of knowledge on drivers of emergence of the COVID-19 in pets

text: Infection with the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) induces the coronavirus infectious disease 19 (COVID-19). Its pandemic form in human population and its probable animal origin, along with recent case reports in pets, make drivers of emergence crucial in domestic carnivore pets, especially cats, dogs and ferrets. Few data are available in these species; we first listed forty-six possible drivers of emergence of COVID-19 in pets, regrouped in eight domains (i.e. pathogen/disease characteristics, spatial-temporal distance of outbreaks, ability to monitor, disease treatment and control, characteristics of pets, changes in climate conditions, wildlife interface, human activity, and economic and trade activities). Secondly, we developed a scoring system per driver, then elicited scientific experts (N = 33) to: (i) allocate a score to each driver, (ii) weight the drivers scores within each domain and (iii) weight the different domains between them. Thirdly, an overall weighted score per driver was calculated; drivers were ranked in decreasing order. Fourthly, a regression tree analysis was used to group drivers with comparable likelihood to play a role in the emergence of COVID-19 in pets. Finally, the robustness of the expert elicitation was verified. Five drivers were ranked with the highest probability to play a key role in the emergence of COVID-19 in pets: availability and quality of diagnostic tools, human density close to pets, ability of preventive/control measures to avoid the disease introduction or spread in a country (except treatment, vaccination and reservoir(s) control), current species specificity of the disease causing agent and current knowledge on the pathogen. As scientific knowledge on the topic is scarce and still uncertain, expert elicitation of knowledge, in addition with clustering and sensitivity analyses, is of prime importance to prioritize future studies, starting from the top five drivers. The present methodology is applicable to other emerging pet diseases.


New therapeutic opportunities for COVID-19 patients with Tocilizumab: Possible correlation of interleukin-6 receptor inhibitors with osteonecrosis of the jaws


Personal protective equipment and possible routes of airborne spread during the COVID-19 pandemic


title: Clinical Utility of Buccal Swabs for Sars-Cov-2 Detection in Covid-19-Infected Children

text: SARS-CoV-2 was detected from at least 1 buccal specimen in 9 out of 11 COVID-19-infected children (81.8%). The viral loads in buccal specimens were substantially lower than those in nasopharyngeal specimens. Buccal swabs for SARS-CoV-2 are not good as screening specimens for COVID-19 in children.


title: Increased plasma level of apelin with NYHA grade II and III but not IV

text: The change in plasma apelin level in heart failure (HF) patients is controversial. We investigated the change in plasma apelin level in HF patients versus control and non-HF patients. The plasma level of apelin was measured by ELISA and plasma level of B-type natriuretic peptide (BNP) by fluorescence immunoassay. We included 101 patients with HF, 32 patients without HF and 20 controls. The three groups did not differ in general and clinical characteristics. Plasma levels of apelin and BNP were both higher in HF patients than non-HF patients and controls. Plasma levels of apelin and BNP were not correlated. Plasma level of BNP was increased with increasing New York Heart Association grade and apelin level was decreased. Apelin level was lower in HF patients with NYHA grade IV than in controls and non-HF patients. Apelin level had 75% diagnostic value for HF, and BNP level had 96.8% diagnostic value. At a cutoff of 6.44 ng/mL apelin level, sensitivity was 69.3%, and specificity 97.1%. However, the diagnostic of apelin for NYHA II patients was higher than that of BNP (99.6% vs. 96.1%). These results suggested that apelin might be particularly useful in association with BNP in mild HF patients.


title: Dataset on dynamics of Coronavirus on Twitter

text: In this data article, we provide a dataset of 8,982,694 Twitter posts around the coronavirus health global crisis. The data were collected through the Twitter REST API search. We used the rtweet R package to download raw data. The term searched was "Coronavirus" which included the word itself and its hashtag version. We collected the data over 23 days, from January 21 to February 12, 2020. The dataset is multilingual, prevailing English, Spanish, and Portuguese. We include a new variable created from other four variables; it is called "type" of tweets, which is useful for showing the diversity of tweets and the dynamics of users on Twitter. The dataset comprises seven databases which can be analysed separately. On the other hand, they can be crossed to set other researches, among them, trends and relevance of different topics, types of tweets, the embeddedness of users and their profiles, the retweets dynamics, hashtag analysis, as well as to perform social network analysis. This dataset can attract the attention of researchers related to different fields on knowledge, such as data science, social science, network science, health informatics, tourism, infodemiology, and others.


Venous cerebral thrombosis in COVID-19 patient


End-of-life care in the emergency department for the patient imminently dying of a highly transmissible acute respiratory infection (such as COVID-19)


Increased CD4/CD8 ratio as a risk factor for critical illness in coronavirus disease 2019 (COVID-19): a retrospective multicentre study


How we deal with the COVID-19 epidemic in an Italian paediatric onco-haematology clinic located in a region with a high density of cases


title: Addendum: Primary care management of the coronavirus (COVID-19)

text: No abstract available.


Management of inflammatory bowel disease during COVID-19 pandemic


title: Modeling the impact of mass influenza vaccination and public health interventions on COVID-19 epidemics with limited detection capability

text: The emerging coronavirus SARS-CoV-2 has caused a COVID-19 pandemic. SARS-CoV-2 causes a generally mild, but sometimes severe and even life-threatening infection, known as COVID-19. Currently, there exist no effective vaccines or drugs and, as such, global public authorities have so far relied upon non pharmaceutical interventions (NPIs). Since COVID-19 symptoms are aspecific and may resemble a common cold, if it should come back with a seasonal pattern and coincide with the influenza season, this would be particularly challenging, overwhelming and straining the healthcare systems, particularly in resource-limited contexts, and would increase the likelihood of nosocomial transmission. In the present study, we devised a mathematical model focusing on the treatment of people complaining of influenza-like-illness (ILI) symptoms, potentially at risk of contracting COVID-19 or other emerging/re-emerging respiratory infectious agents during their admission at the health-care setting, who will occupy the detection kits causing a severe shortage of testing resources. The model is used to assess the effect of mass influenza vaccination on the spread of COVID-19 and other respiratory pathogens in the case of a coincidence of the outbreak with the influenza season. Here, we show that increasing influenza vaccine uptake or enhancing the public health interventions would facilitate the management of respiratory outbreaks coinciding with the peak flu season, especially, compensate the shortage of the detection resources. However, how to increase influenza vaccination coverage rate remains challenging. Public health decision- and policy-makers should adopt evidence-informed strategies to improve influenza vaccine uptake.


title: Novel coronavirus disease 2019 (COVID-19) and neurodegenerative disorders

text: During the last few months, the whole humanity is experiencing largest and most severe sudden influx of COVID-19 outbreak caused by the novel coronavirus (CoV) originated from Wuhan, China. According to the WHO reports, total 3 862 676 positive cases and 265 961 deaths have been recorded worldwide due to COVID-19 infection as of May 9, 2020. CoVs are a large family of viruses (enveloped, single-stranded RNA viruses), which includes severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome-related coronavirus (MERS-CoV). New SARS CoV2 is the members of Betacoronavirus genus. These viruses cause infections in bats, camels and humans, and a few other associated species. Despite many neurologic complications associated with SARS-CoV-2 infection, it is still unclear whether these symptoms results from direct neural injury or due to some other reason. Currently, it appears that most of the neurological symptoms of COVID-19 are nonspecific and secondary to the systemic illness. A single case of acute hemorrhagic necrotizing encephalopathy has been reported. SARS-CoV-2 associated Guillain-Barré syndrome is an atypical case. Till today, no convincing evidence is available to confirm that the SARS-CoV-2 virus directly affects nerves system in humans. However, postinfection surveillance will be necessary to identify the possible post-COVID-19 neurologic syndromes.


title: Air Pollution and Covid-19: The Role of Particulate Matter in the Spread and Increase of Covid-19's Morbidity and Mortality

text: Sars-cov-2 virus (Covid-19) is a member of the coronavirus family and is responsible for the pandemic recently declared by the World Health Organization. A positive correlation has been observed between the spread of the virus and air pollution, one of the greatest challenges of our millennium. Covid-19 could have an air transmission and atmospheric particulate matter (PM) could create a suitable environment for transporting the virus at greater distances than those considered for close contact. Moreover, PM induces inflammation in lung cells and exposure to PM could increase the susceptibility and severity of the Covid-19 patient symptoms. The new coronavirus has been shown to trigger an inflammatory storm that would be sustained in the case of pre-exposure to polluting agents. In this review, we highlight the potential role of PM in the spread of Covid-19, focusing on Italian cities whose PM daily concentrations were found to be higher than the annual average allowed during the months preceding the epidemic. Furthermore, we analyze the positive correlation between the virus spread, PM, and angiotensin-converting enzyme 2 (ACE2), a receptor involved in the entry of the virus into pulmonary cells and inflammation.


Analysis of Characteristics in Death Patients with COVID-19 Pneumonia without Underlying Diseases


Adaptive neurology in COVID-19 times


Design and Impact of a COVID-19 Multidisciplinary Bundled Procedure Team


title: SARS-CoV-2 and HIV coinfection: clinical experience from Rhode Island, United States

text: INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected >6 million people worldwide since December 2019. Global reports of HIV/SARS-CoV-2 coinfection are limited. To better understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons with HIV and improve their care, we present an outpatient and inpatient clinical experience of HIV/SARS-CoV-2 coinfection from Rhode Island, US. METHODS: We describe outpatient and inpatient preparedness for the COVID-19 pandemic, and present a case series of all known patients with HIV/SARS-CoV-2 coinfection at The Miriam Hospital and Rhode Island Hospital, and The Miriam Hospital Infectious Diseases and Immunology Center, in Providence, Rhode Island, US. RESULTS AND DISCUSSION: The Infectious Diseases and Immunology Center rapidly prepared for outpatient and inpatient care of persons with HIV and SARS-CoV-2. Between 30 March and 20 May 2020, 27 patients with HIV were diagnosed with SARS-CoV-2. Twenty were male, six female and one transgender female; average age was 49 years; 13/27 were Hispanic and 6/27 were African American. All had HIV viral load <200 copies/mL and were on antiretroviral therapy with CD4 count range 87 to 1441 cells/µL. Twenty-six of the 27 had common COVID-19 symptoms for one to twenty-eight days and most had other co-morbidities and/or risk factors. Nine of the 27 were hospitalized for one to thirteen days; of those, three lived in a nursing home, six received remdesivir through a clinical trial or emergency use authorization and tolerated it well; eight recovered and one died. Overall, 17% of known Center people had HIV/SARS-CoV-2 coinfection, whereas the comparable state-wide prevalence was 9%. CONCLUSIONS: We highlight challenges of outpatient and inpatient HIV care in the setting of the COVID-19 pandemic and present the largest detailed case series to date from the United States on HIV/SARS-CoV-2 coinfection, adding to limited global reports. The aggregated clinical findings suggest that the clinical presentation and outcomes of COVID-19 appear consistent with those without HIV. Whether SARS-CoV-2 infection is more frequent among persons with HIV remains to be determined. More data are needed as we develop our understanding of how HIV and antiretroviral therapy are affected by or have an impact on this pandemic.


title: SEI1I2HRSVM model applied to the coronavirus pandemic (COVID-19) in Paraguay

text: In the present article a mathematical model is proposed to research the current coronavirus outbreak (SARS-CoV-2) in Paraguay, describing the multiple transmission paths in the infection dynamics, following the susceptible, exposed, infectious, hospitalized, with lost immunity and recovered individuals, as well as the role of the virus in the environment and deaths from COVID-19 or other reasons. In order to reflect the impact of the control measures adopted by the government and the population, the model employs variable transmission rates that change with the epidemiological status and environmental conditions. The model is validated, and its application is demonstrated with data publicly available.


title: Robust Recursive Partitioning for Heterogeneous Treatment Effects with Uncertainty Quantification

text: Subgroup analysis of treatment effects plays an important role in applications from medicine to public policy to recommender systems. It allows physicians (for example) to identify groups of patients for whom a given drug or treatment is likely to be effective and groups of patients for which it is not. Most of the current methods of subgroup analysis begin with a particular algorithm for estimating individualized treatment effects (ITE) and identify subgroups by maximizing the difference across subgroups of the average treatment effect in each subgroup. These approaches have several weaknesses: they rely on a particular algorithm for estimating ITE, they ignore (in)homogeneity within identified subgroups, and they do not produce good confidence estimates. This paper develops a new method for subgroup analysis, R2P, that addresses all these weaknesses. R2P uses an arbitrary, exogenously prescribed algorithm for estimating ITE and quantifies the uncertainty of the ITE estimation, using a construction that is more robust than other methods. Experiments using synthetic and semi-synthetic datasets (based on real data) demonstrate that R2P constructs partitions that are simultaneously more homogeneous within groups and more heterogeneous across groups than the partitions produced by other methods. Moreover, because R2P can employ any ITE estimator, it also produces much narrower confidence intervals with a prescribed coverage guarantee than other methods.


Emlékezés Robicsek Ferenc professzorra


Preparing ophthalmologists for the use of mechanical ventilation during the COVID-19 pandemic


COVID-19 Global Pandemic: Options for Management of Gynecologic Cancers


COVID-19 in the endoscopy ward: A potential risk for gastroenterologists


Protocols, Personal Protective Equipment Utilization and Psychological/Financial Stressors within Endoscopy Units in Mid-Pandemic: A Large Survey of Hospital-based and Ambulatory Endoscopy Centers in the U.S