title: Symptom burden and clinical profile of COVID-19 deaths: a rapid systematic review and evidence summary

text: The spread of pandemic COVID-19 has created unprecedented need for information. The pandemic is the cause of significant mortality and with this the need for rapidly disseminated information for palliative care professionals regarding the prevalence of symptoms, their intensity, their resistance or susceptibility to symptom control and the mode of death for patients. METHODS: We undertook a systematic review of published evidence for symptoms in patients with COVID-19 (with a specific emphasis on symptoms at end of life) and on modes of death. Inclusion: prospective or retrospective studies detailing symptom presence and/or cause or mode of death from COVID-19. RESULTS: 12 papers met the inclusion criteria and gave details of symptom burden: four of these specifically in the dying and two detailed the cause or mode of death. Cough, breathlessness, fatigue and myalgia are significant symptoms in people hospitalised with COVID-19. Dyspnoea is the most significant symptom in the dying. The mode of death was described in two papers and is predominantly through respiratory or heart failure. CONCLUSIONS: There remains a dearth of information regarding symptom burden and mode of death to inform decisions regarding end-of-life care in patients dying with COVID-19. Rapid data gathering on the mode of death and the profile of symptoms in the dying and their prevalence and severity in areas where COVID-19 is prevalent will provide important intelligence for clinicians. This should be done urgently, within ethical norms and the practicalities of a public health, clinical and logistical emergency.


title: Response to SARS-CoV-2 Pandemic in a Non-COVID-19 Designated Latin-American Neurosurgery Department

text: BACKGROUND: Mexico declared the first case of novel coronavirus disease (COVID-19) in February 2020. At the time we write this article, our country is facing a community spread phase, expecting a rapid increase in the number of cases and fatalities. The Fray Antonio Alcalde Civil Hospital of Guadalajara has been declared a non-COVID-19 hospital with the mission of providing care to patients already registered and also those transferred from neurosurgical departments of neighboring centers, which have been converted into COVID-19 only hospitals. METHODS: An organized response regarding personnel, surgical case selection, operating room behavior, and facility reorganization were designed to prevent an internal coronavirus outbreak in the neurosurgery department at the Fray Antonio Alcalde Civil Hospital of Guadalajara. RESULTS: Distancing actions by the staff and residents, including ward case discussions, neurosurgery rounds, and classes, will be carried out virtually. We classified neurosurgical patients into 4 groups depending on whether their condition demands care in 0-6 hours, 6-48 hours, 48 hours to 14 days, and >14 days. Subsequently, a questionnaire with epidemiologic, radiologic, clinical, and serologic criteria will be applied to determine the risk of COVID-19 infection to define to which area they are going to be transferred according to the different risk zones in our facility. CONCLUSIONS: Despite not being a COVID-19 center, we consider all patients at the neurosurgical ward and staff members as asymptomatic carriers or infected in the preclinical period. Specific measures must be taken to ensure the safety and care of neurosurgical patients and medical staff during the community spread phase.


title: Analysis of Maternal Coronavirus Infections and Neonates Born to Mothers with 2019-nCoV;a Systematic Review

text: Introduction: The emergence and fast spread of 2019 novel coronavirus (2019-nCoV) threatens the world as a new public health crisis This study aimed to clarify the impact of novel coronavirus disease (COVID-19) on pregnant patients and maternal and neonatal outcomes Methods: A comprehensive literature search was conducted in databases including PubMed, Scopus, Embase, ProQuest, and Science Direct All studies including original data;case reports, case series, descriptive and observational studies, and randomized controlled trials were searched from December 2019 until 19 March 2020 Results: The search identified 1472 results and 939 abstracts were screened 928 articles were excluded because studies did not include pregnant women Full texts of eleven relevant studies were reviewed and finally nine studies were included in this study The characteristics of 89 pregnant women and their neonates were studied Results revealed that low-grade fever and cough were the principal symptoms in all patients The main reported laboratory findings were lymphopenia, elevated C-Reactive Protein (CRP), Amino alanine transferase (ALT), and Aspartate amino transferase (AST) In all symptomatic cases, chest Computerized Tomography (CT) scans were abnormal Fetal distress, premature rupture of membranes and preterm labor were the main prenatal complications Two women needed intensive care unit admission and mechanical ventilation, one of whom developed multi-organ dysfunction and was on Extracorporeal Membrane Oxygenation (ECMO) No case of maternal death was reported up to the time the studies were published 79 mothers delivered their babies by cesarean section and five women had a vaginal delivery No fetal infection through intrauterine vertical transmission was reported Conclusions: Available data showed that pregnant patients in late pregnancy had clinical manifestations similar to non-pregnant adults It appears that the risk of fetal distress, preterm delivery and prelabor rupture of membranes (PROM) rises with the onset of COVID-19 in the third trimester of pregnancy There is also no evidence of intrauterine and transplacental transmission of COVID-19 to the fetus in the third trimester of pregnancies


title: Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome

text: AIM: The purpose of this study is to describe the main chest radiological features (CXR) of COVID-19 and correlate them with clinical outcome. MATERIALS AND METHODS: This is a retrospective study involving patients with clinical-epidemiological suspect of COVID-19 infection, who performed CXRs at the emergency department (ED) of our University Hospital from March 1 to March 31, 2020. All patients performed RT-PCR nasopharyngeal and throat swab, CXR at the ED and clinical-epidemiological data. RT-PCR results were considered the reference standard. The final outcome was expressed as discharged or hospitalized patients into a medicine department or intensive care unit (ICU). RESULTS: Patients that had a RT-PCR positive for COVID-19 infection were 234 in total: 153 males (65.4%) and 81 females (34.6%), with a mean age of 66.04 years (range 18-97 years). Thirteen CXRs were negative for radiological thoracic involvement (5.6%). The following alterations were more commonly observed: 135 patients with lung consolidations (57.7%), 147 (62.8%) with GGO, 55 (23.5%) with nodules and 156 (66.6%) with reticular-nodular opacities. Patients with consolidations and GGO coexistent in the same radiography were 35.5% of total. Peripheral (57.7%) and lower zone distribution (58.5%) were the most common predominance. Moreover, bilateral involvement (69.2%) was most frequent than unilateral one. Baseline CXR sensitivity in our experience is about 67.1%. The most affected patients were especially males in the age group 60-79 years old (45.95%, of which 71.57% males). RALE score was slightly higher in male than in female patients. ANOVA with Games-Howell post hoc showed significant differences of RALE scores for group 1 vs 3 (p < 0.001) and 2 vs 3 (p = 0.001). Inter-reader agreement in assigning RALE score was very good (ICC: 0.92-with 95% confidence interval 0.88-0.95). CONCLUSION: In COVID-19, CXR shows patchy or diffuse reticular-nodular opacities and consolidation, with basal, peripheral and bilateral predominance. In our experience, baseline CXR had a sensitivity of 68.1%. The RALE score can be used in the emergency setting as a quantitative method of the extent of SARS-CoV-2 pneumonia, correlating with an increased risk of ICU admission.


Old Threat, New Enemy: Is Your Interventional Radiology Service Ready for the Coronavirus Disease 2019?


The role of virtual support groups for patients with hidradenitis suppurativa during the COVID-19 pandemic


The impact of coronavirus (COVID-19) in the diagnosis and treatment of obsessive-compulsive disorder


title: Preserving Organizational Resilience, Patient Safety, and Staff Retention during COVID-19 Requires a Holistic Consideration of the Psychological Safety of Healthcare Workers

text: During the COVID-19 pandemic, healthcare workers are fighting a lethal virus with acute shortages of Personal Protective Equipment (PPE). These unprecedented circumstances have amplified the sources of emotional distress and worker burnout. However, many healthcare organizations (HCOs) in the United States, have opted for a "stoic approach" to healthcare worker support, i.e., no additional support beyond federal and state policy protections for the licensing and liability of healthcare workers. In this scenario, a key public health concern is sustaining an adequate healthcare workforce, both by way of quantity (adequate numbers) and quality (maximizing clinician resilience to provide safe care to large volumes of patients under challenging conditions). Therefore, it is imperative for HCO leaders to recognize that a limited view of worker psychological safety, without due consideration for the broader emotional distress created by the pandemic, could have the effect of restricting organizational resilience and adversely impacting patient safety and staff retention during and beyond the pandemic. This paper uses the organizational resilience framework to discuss the potential impact of a stoic approach to healthcare worker support on patient safety and staff retention in a hospital intensive care unit (ICU) during COVID-19. The discussion in turn, helps to develop recommendations for HCOs to overcome these challenges.


Chloroquine or hydroxychloroquine for COVID-19: why might they be hazardous?


title: Volunteerism during COVID-19

text: Health care workers have been asked to do their part to make a difference and give back to their community. This personal reflection is a result of an experience as a medical reserve corps nurse volunteer for a local health department in the northeastern United States. Volunteering resulted in positive social and personal benefits for me. It inspired a sense of pride in helping others and knowing that someone's well-being may be enhanced. The individuals whom I spoke with via the phone appreciated the concern for their health, and some individuals seemed to enjoy the interaction with another person, possibly due to their isolation. Descriptions of interactions via phone calls with coronavirus positive individuals are provided that support the benefits of volunteering. Volunteerism has personal value in its ability to inspire someone to continue to make an impact. Volunteerism allowed me to give to others and to gain a sense of purpose.


title: Detection of Bio-aerosols and COVID-19 Equivalent Particles Via On-chip Mid Infrared Photonic Spectroscopy

text: We propose an on-chip mid-infrared (MIR) photonic spectroscopy platform for aerosol characterization to obtain highly discriminatory information on the chemistry of aerosol particles. Sensing of aerosols is crucial for various environmental, climactic, warfare threat detection, and pulmonary healthcare applications. Further, there are a number of unintended situations for potential exposure to bioaerosols such as viruses, bacteria, and fungi. For instance, the current pandemic scenario of COVID-19 occurring across the world. Currently, chemical characterization of aerosols is performed using FTIR spectroscopy yielding chemical fingerprinting because most of the vibrational and rotational transitions of chemical molecules fall in the MIR range; and Raman spectroscopy. Both techniques use free space bench-top geometries. Here, we propose miniaturized on-chip MIR photonics-based aerosol spectroscopy consisting of a broadband spiral-waveguide sensor that significantly enhances particle-light interaction to improve sensitivity. The spiral waveguides are made of a chalcogenide glass material (Ge23Sb7S70) which shows a broad transparency over IR range. We demonstrate the sensing of N-methyl aniline-based aerosol particles with the device. We anticipate that the sensor will readily complement existing photonic resonator-based particle sizing and counting techniques to develop a unified framework for on-chip integrated photonic aerosol spectroscopy.


title: Data and Text Mining Help Identify Key Proteins Involved in the Molecular Mechanisms Shared by SARS-CoV-2 and HIV-1

text: Viruses can be spread from one person to another; therefore, they may cause disorders in many people, sometimes leading to epidemics and even pandemics. New, previously unstudied viruses and some specific mutant or recombinant variants of known viruses constantly appear. An example is a variant of coronaviruses (CoV) causing severe acute respiratory syndrome (SARS), named SARS-CoV-2. Some antiviral drugs, such as remdesivir as well as antiretroviral drugs including darunavir, lopinavir, and ritonavir are suggested to be effective in treating disorders caused by SARS-CoV-2. There are data on the utilization of antiretroviral drugs against SARS-CoV-2. Since there are many studies aimed at the identification of the molecular mechanisms of human immunodeficiency virus type 1 (HIV-1) infection and the development of novel therapeutic approaches against HIV-1, we used HIV-1 for our case study to identify possible molecular pathways shared by SARS-CoV-2 and HIV-1. We applied a text and data mining workflow and identified a list of 46 targets, which can be essential for the development of infections caused by SARS-CoV-2 and HIV-1. We show that SARS-CoV-2 and HIV-1 share some molecular pathways involved in inflammation, immune response, cell cycle regulation.


title: An improved mathematical prediction of the time evolution of the Covid-19 pandemic in Italy, with a Monte Carlo simulation and error analyses

text: We present an improved mathematical analysis of the time evolution of the Covid-19 pandemic in Italy and a statistical error analyses of its evolution, including a Monte Carlo simulation with a very large number of runs to evaluate the uncertainties in its evolution. A previous analysis was based on the assumption that the number of nasopharyngeal swabs would be constant. However, the number of daily swabs is now more than five times what it was when we did our previous analysis. Therefore, here we consider the time evolution of the ratio of the new daily cases to number of swabs, which is more representative of the evolution of the pandemic when the number of swabs is increasing or changing in time. We consider a number of possible distributions representing the evolution of the pandemic in Italy, and we test their prediction capability over a period of up to 6 weeks. The results show that a distribution of the type of Planck black body radiation law provides very good forecasting. The use of different distributions provides an independent possible estimate of the uncertainty. We then consider five possible trajectories for the number of daily swabs and we estimate the potential dates of a substantial reduction in the number of new daily cases. We then estimate the spread in a substantial reduction, below a certain threshold, of the daily cases per swab among the Italian regions. We finally perform a Monte Carlo simulation with 25,000 runs to evaluate a random uncertainty in the prediction of the date of a substantial reduction in the number of diagnosed daily cases per swab.


title: Cytokine Blood Filtration Responses in COVID-19

text: The real issue with the COVID-19 pandemic is that a rapidly increasing number of patients with life-threatening complications are admitted in hospitals and are not well-administered. Although a limited number of patients use the intensive care unit (ICU), they consume medical resources, safety equipment, and enormous equipment with little possibility of rapid recovery and ICU discharge. This work reviews effective methods of using filtration devices in treatment to reduce the level of various inflammatory mediators and discharge patients from the ICU faster. Extracorporeal technologies have been reviewed as a medical approach to absorb cytokines. Although these devices do not kill or remove the virus, they are a promising solution for treating patients and their faster removal from the ICU, thus relieving the bottleneck.


Ratio, rate, or risk?


A way toward ventilator-associated lower respiratory tract infection research: reply


title: The neurology of COVID-19 revisited: A proposal from the Environmental Neurology Specialty Group of the World Federation of Neurology to implement international neurological registries

text: A comprehensive review of the neurological disorders reported during the current COVID-19 pandemic demonstrates that infection with SARS-CoV-2 affects the central nervous system (CNS), the peripheral nervous system (PNS) and the muscle. CNS manifestations include: headache and decreased responsiveness considered initial indicators of potential neurological involvement; anosmia, hyposmia, hypogeusia, and dysgeusia are frequent early symptoms of coronavirus infection. Respiratory failure, the lethal manifestation of COVID-19, responsible for 264,679 deaths worldwide, is probably neurogenic in origin and may result from the viral invasion of cranial nerve I, progressing into rhinencephalon and brainstem respiratory centers. Cerebrovascular disease, in particular large-vessel ischemic strokes, and less frequently cerebral venous thrombosis, intracerebral hemorrhage and subarachnoid hemorrhage, usually occur as part of a thrombotic state induced by viral attachment to ACE2 receptors in endothelium causing widespread endotheliitis, coagulopathy, arterial and venous thromboses. Acute hemorrhagic necrotizing encephalopathy is associated to the cytokine storm. A frontal hypoperfusion syndrome has been identified. There are isolated reports of seizures, encephalopathy, meningitis, encephalitis, and myelitis. The neurological diseases affecting the PNS and muscle in COVID-19 are less frequent and include Guillain-Barré syndrome; Miller Fisher syndrome; polyneuritis cranialis; and rare instances of viral myopathy with rhabdomyolysis. The main conclusion of this review is the pressing need to define the neurology of COVID-19, its frequency, manifestations, neuropathology and pathogenesis. On behalf of the World Federation of Neurology we invite national and regional neurological associations to create local databases to report cases with neurological manifestations observed during the on-going pandemic. International neuroepidemiological collaboration may help define the natural history of this worldwide problem.


title: COVID-19 and digital inequalities: Reciprocal impacts and mitigation strategies

text: With more than three billion people in isolation, the status of digital spaces is switching from an amenity to a necessity, as they become not only the main way to access information and services, but also one of the only remaining vectors for economic, educational, and leisure activities as well as for social interactions to take place. However, not all are equals in terms of access to networks or connected devices, or when it comes to the skills required to navigate computerized spaces optimally. Digital inequalities were already existing, yet the COVID-19 crisis is exacerbating them dramatically. On the one hand, the crisis will worsen digital inequalities within the population. On the other hand, digital inequalities represent a major risk factor of vulnerability for exposure to the virus itself, and for the non-sanitary consequences of the crisis. Therefore, this paper aims at exploring the reciprocal impacts of the COVID-19 crisis and digital inequalities, and to propose operative solutions to help fight the nefarious consequences of the crisis. We first describe how digital inequalities are a determinant of health. We then investigate how COVID-19 can potentiate digital inequalities, and how digital inequalities potentiate vulnerability to COVID-19. Finally, in order to contribute to the mitigation of this crisis, we propose a set of multi-layered strategies focusing on actionability that can be implemented at multiple structural levels, ranging from governmental to corporate and community levels.


title: Mental health and COVID-19: is the virus racist?

text: COVID-19 has changed our lives and it appears to be especially harmful for some groups more than others. Black and Asian ethnic minorities are at particular risk and have reported greater mortality and intensive care needs. Mental illnesses are more common among Black and ethnic minorities, as are crisis care pathways including compulsory admission. This editorial sets out what might underlie these two phenomena, explaining how societal structures and disadvantage generate and can escalate inequalities in crises.


COVID-19 and child and adolescent psychiatry: an unexpected blessing for part of our population?


Inflammatory Bowel Disease and COVID-19-"Preventive" Sick Certificates as a Frequent Coping Strategy in the Face of the Pandemic


COVID-19 and diabetes


ISUOG Consensus Statement on rationalization of gynecological ultrasound services in context of SARS-CoV-2


Effects of the Global COVID-19 Pandemic on Early Childhood Development: Short- and Long-Term Risks and Mitigating Program and Policy Actions


Laparoscopic surgery in a patient with atypical presentation of COVID-19: salient points to reduce the perils of surgery


title: Sitagliptin Repositioning in SARS-CoV-2: Effects on ACE-2, CD-26, and Inflammatory Cytokine Storms in the Lung

text: No Abstract.


title: COVID-19 and Its Potential Effect on Patients With Rheumatic Diseases in Latin America

text: The COVID-19 (coronavirus disease 2019) pandemic has dramatically affected the entire world. Because of significant disparity levels in Latin American countries with deficient health care access and significant poverty, their population may end up among the most severely impacted. Patients with chronic conditions such as rheumatic diseases are quite vulnerable because of their high flaring risks and subsequent poor outcomes. Additionally, an overuse of antimalarials for the treatment of COVID-19 could lead to shortages in our region. Telemedicine, personal protective equipment use by patients and providers, web conferences, and comprehensive care are tools that will contribute to reduce the risk of infections and other complications in rheumatic disease patients, as well as to improve the knowledge and experience of rheumatologists at a global level.


title: Credibility of self-reported health parameters in elderly population

text: AIM: Examining the credibility of self-reported height, weight, and blood pressure by the elderly population using a tablet in a retirement residence, and examining the influence of health beliefs on the self-reporting credibility. BACKGROUND: Obesity is a major problem with rising prevalence in the western world. Hypertension is also a significant risk factor for cardiovascular diseases. Self-report, remotely from the clinic, becomes even more essential when patients are encouraged to avoid visiting the clinic as during the COVID-19 pandemic. Self-reporting of height and weight is suspected of leading to underestimation of obesity prevalence in the population; however, it has not been well studied in the elderly population.The Health Belief Model tries to predict and explain decision making of patients based on the patient's health beliefs. METHODS: Residents of a retirement home network filled a questionnaire about their health beliefs regarding hypertension and obesity and self-reported their height, weight, and blood pressure. Blood pressure, height, and weight were then measured and compared to the patients' self-reporting. FINDINGS: Ninety residents, aged 84.90 ± 5.88, filled the questionnaire. From a clinical perspective, the overall gap between the measured and the self-reported BMI (M = 1.43, SD = 2.72), which represents an absolute gap of 0.74 kilograms and 2.95 centimeters, is expected to have only a mild influence on the physician's clinical evaluation of the patient's medical condition. This can allow the physician to estimate their patient's BMI status before the medical consultation and physical examination upon the patient's self-reporting. Patients' dichotomous (normal/abnormal) self-report of their blood pressure condition was relatively credible: positive predictive value (PPV) of 77.78% for normal blood pressure (BP) and 78.57% for abnormal BP. The relatively high PPV of BP self-reporting demonstrates an option for the physician to recognize patients at risk. Regression analysis found no correlation between the anthropometric parameters and the Health Belief Model.


Toward a clinically based classification of disease severity for paediatric COVID-19 - Authors' reply


title: COVID-19 in Spain: Transplantation in the midst of the pandemic

text: Spain has been one of the most affected countries by the COVID-19 outbreak. As of April 28, 2020, the number of confirmed cases is 210 773, including 102 548 patients recovered, more than 10 300 admitted to the ICU, and 23 822 deaths, with a global case fatality rate of 11.3%. From the perspective of donation and transplantation, the Spanish system first focused on safety issues, providing recommendations for donor evaluation and testing, and to rule out SARS-CoV-2 infection in potential recipients prior to transplantation. Since the country entered into an epidemiological scenario of sustained community transmission and saturation of intensive care, developing donation and transplantation procedures has become highly complex. Since the national state of alarm was declared in Spain on March 13, 2020, the mean number of donors has declined from 7.2 to 1.2 per day, and the mean number of transplants from 16.1 to 2.1 per day. Increased mortality on the waiting list may become a collateral damage of this terrible pandemic.


title: Mental health burden for the public affected by the COVID-19 outbreak in China: Who will be the high-risk group?

text: In December, 2019, an outbreak of respiratory illness caused by Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China and spread rapidly to other parts of China and around the world. We aimed to identify high-risk groups whose mental health conditions were vulnerable to the COVID-19 outbreak. Data were collected from 7,236 self-selected participants measured by anxiety symptoms, depressive symptoms, and sleep quality. The overall prevalence of anxiety symptoms, depressive symptoms, and poor sleep quality were 35.1%, 20.1%, and 18.2%, respectively. People aged < 35 years reported a higher prevalence of anxiety symptoms and depressive symptoms than people aged ≥ 35 years. Healthcare workers have the highest rate of poor sleep compared to other occupations. Healthcare workers/younger people who spent a high level of time (≥ 3 hours/day) had a particular higher prevalence of anxiety symptoms than in those who spent less time (< 1 hours/day and 1-2 hours/day) on the outbreak. During the COVID-19 outbreak, healthcare workers and younger people were at an especially high-risk of displaying psychological impact when they spent too much time thinking about the outbreak. Continuous monitoring of the psychological consequences for high-risk population should become routine as part of targeted interventions during times of crisis.I.


title: Targeting Receptor Binding Domain and Cryptic Pocket of Spike glycoprotein from SARS-CoV-2 by biomolecular modeling

text: SARS-CoV-2, the causative agent of the disease known as Covid-19, has so far reported around 3,435,000 cases of human infections, including more than 239,000 deaths in 187 countries, with no effective treatment currently available. For this reason, it is necessary to explore new approaches for the development of a drug capable of inhibiting the entry of the virus into the host cell. Therefore, this work includes the exploration of potential inhibitory compounds for the Spike protein of SARS-CoV-2 (PDB ID: 6VSB), which were obtained from The Patogen Box. Later, they were filtered through virtual screening and molecular docking techniques, thus obtaining a top of 1000 compounds, which were used against a binding site located in the Receptor Binding Domain (RBD) and a cryptic site located in the N-Terminal Domain (NTD), resulting in good pharmaceutical targets for the blocking the infection. From the top 1000, the best compound (TCMDC-124223) was selected for the binding site. It interacts with specific residues that intervene in the recognition and subsequent entry into the host cell, resulting in a more favorable binding free energy in comparison to the control compounds (Hesperidine and Emodine). In the same way, the compound TCMDC-133766 was selected for the cryptic site. These identified compounds are potential inhibitors that can be used for the development of new drugs that allow effective treatment for the disease.


Covid-19: Trump fumes as adviser speaks out against lifting of US lockdowns


In Pursuit of PPE


title: Emerging pharmacotherapies for COVID-19

text: Novel Corona-virus Disease 2019 (nCOVID 19) is caused by a novel virulent corona virus and leads to potentially fatal virulent pneumonia and severe respiratory distress syndrome. It was initially declared as public health emergency if international concern by WHO followed by Pandemic on 12th March 2020. As of 10th April 2020, more than 1.5 million people are affected globally with around 95,000 deaths. Vaccines for this deadly virus are currently under development and many drugs used for other indications have been repurposed and investigated for prophylaxis and treatment of COVID 19. As per SOLIDARITY trial by WHO, some of the most promising candidates include chloroquine phosphate and hydroxychloroquine which are anti-malarial medications, Remdesivir, Lopinavir-Ritonavir combination with or without interferon which are anti-HIV drugs and convalescent plasma therapy. The current evidence of efficacy and ongoing research has been elaborated in the article. Besides, there has been evidence regarding inflammatory pathogenesis of this virus leading to cytokine storm in susceptible individuals. Thus, anti-proinflammatory cytokine drugs like Anakinra and Tocilizumab are undergoing multiple trials and some results are encouraging. Similarly, use of anti-inflammatory cytokines like IL-37 and IL-38 is hypothesised to be useful and is under research. The situation is still evolving and hence there is yet no definitive therapy but to conclude the use of repurposed medications can be a boon till a definitive therapy and vaccines are developed.


title: Exploration of strategies to reduce aerosol-spread during chest compressions: A simulation and cadaver model

text: OBJECTIVE: To evaluate the effect of strategies to reduce the spread of simulated aerosol during chest compressions on manikin and cadaver experimental models. METHODS: To evaluate aerosol-spread we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a further approach we applied nebulized detergents into the airways of human cadavers and detected the simulated spread on the same way. Among others we did recordings with undergoing compression-only-CPR, with a surgical mask or an oxygen mask on the patients face and with an inserted supraglottic airway device with and without a connected airway filter. RESULTS: Most aerosol-spread at the direction of the provider was visualized during compression-only-CPR. The use of a surgical mask and of an oxygen mask on the patient's face deflected the spread. Inserting a supraglottic airway device connected to an airway filter lead to a remarkable reduction of aerosol-spread. CONCLUSION: The early insertion of a supraglottic airway device connected to an airway filter before starting chest compression may be beneficial for staff protection during CPR.


title: Rehabilitación en época de confinamiento./ [Rehabilitation during the lockdown]

text: The health system is facing a global pandemic due to coronavirus disease 2019. Emergency plans often fail to consider specific rehabilitation issues, whether inpatient or outpatient, although the World Health Organization advises the inclusion of rehabilitation professionals as soon as possible. The contingency plans of rehabilitation services must be carried out in coordination with the other healthcare areas. This review was prepared with the current available evidence on coronavirus disease 2019 and was based on the experience of a specific environment, to plan the continuity of rehabilitation care for all patients and to help rehabilitation teams in this period of lockdown and uncertain lifting of restrictions.


title: COVID-19: An Early Review of Its Global Impact and Considerations for Parkinson's Disease Patient Care

text: While many infectious disorders are unknown to most neurologists, COVID-19 is very different. It has impacted neurologists and other health care workers, not only in our professional lives but also through the fear and panic within our own families, colleagues, patients and their families, and even in the wider public. COVID-19 affects all sorts of individuals, but the elderly with underlying chronic conditions are particularly at risk of severe disease, or even death. Parkinson's disease (PD) shares a common profile as an age-dependent degenerative disorder, frequently associated with comorbidities, particularly cardiovascular diseases, so PD patients will almost certainly fall into the high-risk group. Therefore, the aim of this review is to explore the risk of COVID-19 in PD based on the susceptibility to severe disease, its impact on PD disease severity, potential long-term sequelae, and difficulties of PD management during this outbreak, where neurologists face various challenges on how we can maintain effective care for PD patients without exposing them, or ourselves, to the risk of infection. It is less than six months since the identification of the original COVID-19 case on New Year's Eve 2019, so it is still too early to fully understand the natural history of COVID-19 and the evidence on COVID-19-related PD is scant. Though the possibilities presented are speculative, they are theory-based, and supported by prior evidence from other neurotrophic viruses closely related to SARS-CoV-2. Neurologists should be on high alert and vigilant for potential acute and chronic complications when encountering PD patients who are suspected of having COVID-19.


Plastic Surgery During the COVID-19 Pandemic: The Space, Equipment, Expertise Approach


title: Modeling the Heterogeneity in COVID-19's Reproductive Number and its Impact on Predictive Scenarios

text: The current COVID-19 pandemic is leading experts to assess the risks posed by the disease and compare policies geared towards stalling its evolution as a global pandemic. In this setting, the virus' basic reproductive number R_0, which characterizes the average number of secondary cases generated by each primary case, takes on a significant importance in the quantification of the potential scope of the pandemic. Yet, in most models, R_0 is assumed to be a universal constant for the virus across outbreak clusters and populations -- thus neglecting the inherent variability of the transmission process due to varying population densities, demographics, temporal factors, etc. In fact, it can be shown that the reproduction number is highly variable. Considering its expected value thus leads to biased or loose results in the reported predictive scenarios, especially as these are tailored to a given country or region. The goal of this paper is the examination of the impact of the reproductive number R's variability on important output metrics, and the percolation of this variability in projected scenarios so as to provide uncertainty quantification. In this perspective, instead of considering a single R_0, we consider a distribution of reproductive numbers R and devise a simple Bayesian hierarchical model that builds upon current methods for estimating the R to integrate its heterogeneity. We then simulate the spread of the epidemic, and the impact of different social distancing strategies using a probabilistic framework that models hospital occupancy. This shows the strong impact of this added variability on the reported results. We emphasize that our goal is not to replace benchmark methods for estimating the basic reproductive numbers, but rather to discuss the importance of the impact of R's heterogeneity on uncertainty quantification for the current COVID-19 pandemic.


Research on covid-19 is suffering "imperfect incentives at every stage"


title: Time-trend analysis of medicine sales and shortages during COVID-19 outbreak: Data from community pharmacies

text: BACKGROUND: COVID-19 is a worldwide public health concern. Disruptions in the drug market are expected and shortages might worsen. Community pharmacies can contribute to early identification and report of medicines' supply and demand issues. OBJECTIVE: The aim of this study is to characterize the impact of the COVID-19 outbreak on outpatient medicines' sales and shortages. METHODS: A retrospective, time-trend analysis of medicine sales, shortages and laboratory-confirmed COVID-19 cases was performed from February 1st to April 30th, 2020, and its homologous period (regarding sales only). A detailed analysis of 6 pharmaceutical substances was performed. All data were subjected to rescaling using the min-max normalization method, in order to become comparable. Data analysis was performed using Microsoft® Excel. RESULTS: The pandemic resulted in an increase in medicines' demand and reported shortages during the early stage of the outbreak. The maximum proportion of medicine sales was registered on March 13th, 2020, 4 days after the WHO declared COVID-19 a pandemic. By the end of March, sales have already dropped to proportions similar to those of 2019. The maximum proportion of drug shortages was reached about one week after the sales peak and by the end of the study period were below those recorded in the pre-COVID-19 period. The analyzed drugs were paracetamol, ascorbic acid, dapagliflozin plus metformin, rosuvastatin plus ezetimibe, formoterol, and hydroxychloroquine, as these pharmaceutical substances registered the highest growth rate in sales and shortages when compared to the same period in the previous year. Hydroxychloroquine showed the most different pattern trends on sales and shortages of these medicines. CONCLUSIONS: Pharmacies can provide timely and real-world data regarding sales and shortages. The adopted measures to guarantee the continuous supply of the medicine market seem to have worked. The long-term impacts of this pandemic are unknown and should continue to be closely monitored.


title: Metabolic Syndrome and COVID 19: Endocrine-Immune-Vascular Interactions Shapes Clinical Course

text: The ongoing coronavirus disease 2019 (COVID-19) pandemic is caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Individuals with metabolic syndrome are at increased risk for poor disease outcomes and mortality from COVID-19. The pathophysiologic mechanisms for these observations have not been fully elucidated. A critical interaction between SARS-CoV-2 and the angiotensin-converting enzyme 2 (ACE2) facilitates viral entry into the host cell. ACE2 is expressed in pancreatic islets, vascular endothelium, and adipose tissue, and the SARS-CoV-2 -ACE2 interaction in these tissues, along with other factors, govern the spectrum and the severity of clinical manifestations among COVID-19 patients with metabolic syndrome. Moreover, the pro-inflammatory milieu observed in patients with metabolic syndrome may contribute towards COVID-19-mediated host immune dysregulation, including sub-optimal immune responses, hyper-inflammation, microvascular dysfunction, and thrombosis. This review describes the spectrum of clinical features, the likely pathophysiologic mechanisms and potential implications for the management of metabolic syndrome in COVID-19 patients.


title: Digital Contact Tracing Using IP Colocation

text: The spread of an infectious disease through a population can be modeled using a network or a graph. In digital advertising, internet device graphs are graph data sets that organize identifiers produced by mobile phones, PCs, TVs, and tablets as they access media on the internet. Characterized by immense scale, they have become ubiquitous as they enable targeted advertising, content customization and tracking. This paper posits that internet device graphs, in particular those based on IP colocation, can provide significant utility in predicting and modeling the spread of infectious disease. Starting the week of March 16th, 2020, in the United States, many individuals began to `shelter-in-place' as schools and workplaces across the nation closed because of the COVID-19 pandemic. This paper quantifies the effect of the shelter-in-place orders on a large scale internet device graph with more than a billion nodes by studying the graph before and after orders went into effect. The effects are clearly visible. The structure of the graph suggests behavior least conducive to transmission of infection occurred in the US between April 12th and 19th, 2020. This paper also discusses the utility of device graphs for i) contact tracing, ii) prediction of `hot spots', iii) simulation of infectious disease spread, and iv) delivery of advertisement-based warnings to potentially exposed individuals. The paper also posits an overarching question: can systems and datasets amassed by entities in the digital ad ecosystem aid in the fight against COVID-19?


Protecting against COVID-19 aerosol infection during intubation


Statement on the prevention and treatment of COVID-19 in patients with pediatric cancer in Japan


Simple barrier device to minimize facial exposure of endoscopists during COVID-19 pandemic


title: MP Twitter Abuse in the Age of COVID-19: White Paper

text: As COVID-19 sweeps the globe, outcomes depend on effective relationships between the public and decision-makers. In the UK there were uncivil tweets to MPs about perceived UK tardiness to go into lockdown. The pandemic has led to increased attention on ministers with a role in the crisis. However, generally this surge has been civil. Prime minister Boris Johnson's severe illness with COVID-19 resulted in an unusual peak of supportive responses on Twitter. Those who receive more COVID-19 mentions in their replies tend to receive less abuse (significant negative correlation). Following Mr Johnson's recovery, with rising economic concerns and anger about lockdown violations by influential figures, abuse levels began to rise in May. 1,902 replies to MPs within the study period were found containing hashtags or terms that refute the existence of the virus (e.g. #coronahoax, #coronabollocks, 0.04% of a total 4.7 million replies, or 9% of the number of mentions of"stay home save lives"and variants). These have tended to be more abusive. Evidence of some members of the public believing in COVID-19 conspiracy theories was also found. Higher abuse levels were associated with hashtags blaming China for the pandemic.


COVID-19 pandemic and addiction: Current problems and future concerns


Ventricular arrhythmia risk due to chloroquine / hydroxychloroquine treatment for COVID-19: Should it be given


title: Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial

text: BACKGROUND: No specific antiviral drug has been proven effective for treatment of patients with severe coronavirus disease 2019 (COVID-19). Remdesivir (GS-5734), a nucleoside analogue prodrug, has inhibitory effects on pathogenic animal and human coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro, and inhibits Middle East respiratory syndrome coronavirus, SARS-CoV-1, and SARS-CoV-2 replication in animal models. METHODS: We did a randomised, double-blind, placebo-controlled, multicentre trial at ten hospitals in Hubei, China. Eligible patients were adults (aged ≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection, with an interval from symptom onset to enrolment of 12 days or less, oxygen saturation of 94% or less on room air or a ratio of arterial oxygen partial pressure to fractional inspired oxygen of 300 mm Hg or less, and radiologically confirmed pneumonia. Patients were randomly assigned in a 2:1 ratio to intravenous remdesivir (200 mg on day 1 followed by 100 mg on days 2-10 in single daily infusions) or the same volume of placebo infusions for 10 days. Patients were permitted concomitant use of lopinavir-ritonavir, interferons, and corticosteroids. The primary endpoint was time to clinical improvement up to day 28, defined as the time (in days) from randomisation to the point of a decline of two levels on a six-point ordinal scale of clinical status (from 1=discharged to 6=death) or discharged alive from hospital, whichever came first. Primary analysis was done in the intention-to-treat (ITT) population and safety analysis was done in all patients who started their assigned treatment. This trial is registered with ClinicalTrials.gov, NCT04257656. FINDINGS: Between Feb 6, 2020, and March 12, 2020, 237 patients were enrolled and randomly assigned to a treatment group (158 to remdesivir and 79 to placebo); one patient in the placebo group who withdrew after randomisation was not included in the ITT population. Remdesivir use was not associated with a difference in time to clinical improvement (hazard ratio 1·23 [95% CI 0·87-1·75]). Although not statistically significant, patients receiving remdesivir had a numerically faster time to clinical improvement than those receiving placebo among patients with symptom duration of 10 days or less (hazard ratio 1·52 [0·95-2·43]). Adverse events were reported in 102 (66%) of 155 remdesivir recipients versus 50 (64%) of 78 placebo recipients. Remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients who stopped placebo early. INTERPRETATION: In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits. However, the numerical reduction in time to clinical improvement in those treated earlier requires confirmation in larger studies. FUNDING: Chinese Academy of Medical Sciences Emergency Project of COVID-19, National Key Research and Development Program of China, the Beijing Science and Technology Project.


Una nueva zoonosis viral de preocupación global: COVID-19, enfermedad por coronavirus 2019/ A new viral zoonosis of global concern: Coronavirus COVID-19 disease in 2019


Una nueva zoonosis viral de preocupación global: COVID-19, enfermedad por coronavirus 2019


COVID-19 infection during the third trimester of pregnancy: Current clinical dilemmas


title: Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 - National Poison Data System, United States, January 1, 2020-March 31, 2020

text: On January 19, 2020, the state of Washington reported the first U.S. laboratory-confirmed case of coronavirus disease 2019 (COVID-19) caused by infection with SARS-CoV-2 (1). As of April 19, a total of 720,630 COVID-19 cases and 37,202 associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and four U.S. territories (2). CDC recommends, with precautions, the proper cleaning and disinfection of high-touch surfaces to help mitigate the transmission of SARS-CoV-2 (3). To assess whether there might be a possible association between COVID-19 cleaning recommendations from public health agencies and the media and the number of chemical exposures reported to the National Poison Data System (NPDS), CDC and the American Association of Poison Control Centers surveillance team compared the number of exposures reported for the period January-March 2020 with the number of reports during the same 3-month period in 2018 and 2019. Fifty-five poison centers in the United States provide free, 24-hour professional advice and medical management information regarding exposures to poisons, chemicals, drugs, and medications. Call data from poison centers are uploaded in near real-time to NPDS. During January-March 2020, poison centers received 45,550 exposure calls related to cleaners (28,158) and disinfectants (17,392), representing overall increases of 20.4% and 16.4% from January-March 2019 (37,822) and January-March 2018 (39,122), respectively. Although NPDS data do not provide information showing a definite link between exposures and COVID-19 cleaning efforts, there appears to be a clear temporal association with increased use of these products.


High Expression of ACE2 on Keratinocytes Reveals Skin as a Potential Target for SARS-CoV-2


Contact lens practice in the time of COVID-19


SARS-CoV-2 infection in conjunctival tissue - Authors' reply


title: Global dynamics of a SUIR model with predicting COVID-19

text: Since December 2019, A novel coronavirus (2019-nCoV) has been breaking out in China, which can cause respiratory diseases and severe pneumonia. Epidemic models relying on the incidence rate of new cases for forecasting epidemic outbreaks have received increasing attention. However, many prior works in this area mostly focus on the application of the traditional SIR model and disregard the transmission characteristics of 2019-nCoV, exceptionally the infectious of undiagnosed cases. Here, we propose a SUIR model based on the classical SIR model object to supervise the effective prediction, prevention, and control of infectious diseases. SUIR model adds a unique $U$ (Undiagnosed) state of the epidemic and divides the population into four states: S (Susceptible), U (Undiagnosed), I (Infectious and Uninfectious), and R (Recovered). This approach enables us to predict the incidence of 2019-nCoV effectively and the clear advantage of the model accuracy more reliable than the traditional SIR model.


title: Bailout Stigma

text: We develop a model of bailout stigma where accepting a bailout signals a firm's balance-sheet weakness and worsens its funding prospect. To avoid stigma, a firm with high-quality legacy assets either withdraws from subsequent financing after receiving a bailout or refuses a bailout altogether to send a favorable signal. The former leads to a short-lived stimulation with subsequent market freeze even worse than if there were no bailout. The latter revives the funding market, albeit with delay, to the level achievable without any stigma. Strikingly, a bailout offer is most effective when many firms reject it (to build a favorable reputation) rather than accept it.


title: Emerging practice patterns in vascular surgery during the COVID-19 pandemic

text: OBJECTIVE: Ever since the first positive test was identified on January 21, 2020, Washington State has been on the frontlines of the coronavirus disease 2019 (COVID-19) pandemic. Using information obtained from Italian surgeons in Milan and given the concerns regarding the increasing case numbers in Washington State, we implemented new vascular surgery guidelines, which canceled all nonemergent surgical procedures and involved significant changes to our inpatient and outpatient workflow. The consequences of these decisions are not yet understood. METHODS: The vascular surgery division at Harborview Medical Center immediately instituted new vascular surgery COVID-19 practice guidelines on March 17, 2020. Subsequent clinic, operative, and consultation volume data were collected for the next 4 weeks and compared with the historical averages. The Washington State case and death numbers and University of Washington Medical Center (UW Medicine) hospital case volumes were collected from publicly available sources. RESULTS: Since March 10, 2020, the number of confirmed positive COVID-19 cases within the UW Medicine system has increased 1867%, with floor and intensive care unit bed usage increasing by 120% and 215%, respectively. After instituting our new COVID-19 guidelines, our average weekly clinical volume decreased by 96.5% (from 43.1 patients to 1.5 patients per week), our average weekly surgical volume decreased by 71.7% (from 15 cases to 4.25 cases per week), and our inpatient consultation volume decreased to 1.81 consultations daily; 60% of the consultations were completed as telemedicine "e-consults" in which the patient was never evaluated in-person. The trainee surgical volume has also decreased by 86.4% for the vascular surgery fellow and 84.8% for the integrated resident. CONCLUSIONS: The COVID-19 pandemic has changed every aspect of "normal" vascular surgical practice in a large academic institution. New practice guidelines effectively reduced operating room usage and decreased staff and trainee exposure to potential infection, with the changes to clinic volume not resulting in an immediate increase in emergency department or inpatient consultations or acute surgical emergencies. These changes, although preserving resources, have also reduced trainee exposure and operative volume significantly, which requires new modes of education delivery. The lessons learned during the COVID-19 pandemic, if analyzed, will help us prepare for the next crisis.


COVID-19-Associated Hyperactive Intensive Care Unit Delirium With Proposed Pathophysiology and Treatment: A Case Report


title: COVID-19 in patients with lung cancer

text: BACKGROUND: Patients with lung cancers may have disproportionately severe COVID-19 outcomes. Understanding the patient-specific and cancer-specific features that impact severity of COVID-19 may inform optimal cancer care during this pandemic. PATIENTS AND METHODS: We examined consecutive patients with lung cancer and confirmed diagnosis of COVID-19 (n=102) at a single center from March 12-May 6, 2020. Thresholds of severity were defined a priori as hospitalization, ICU/intubation/DNI (a composite metric of severe disease including ICU stay, intubation and invasive mechanical ventilation, and/or transition to do not intubate [DNI]), or death. Recovery was defined as >14 days from COVID-19 test and >3 days since symptom resolution. HLA alleles were inferred from MSK-IMPACT (n=46) and compared to controls with lung cancer and no known non-COVID-19 (n=5166). RESULTS: COVID-19 was severe in patients with lung cancer (62% hospitalized, 25% died). Although severe, COVID-19 accounted for a minority of overall lung cancer-deaths during the pandemic (11% overall). Determinants of COVID-19 severity were largely patient-specific features, including smoking status and chronic obstructive pulmonary disease (Odds ratios for severe COVID-19 2.9, 95% CI 1.07-9.44 comparing the median [23.5 pack-years] to never and 3.87, 95% CI 1.35-9.68, respectively). Cancer-specific features, including prior thoracic surgery/radiation and recent systemic therapies did not impact severity. HLA supertypes were generally similar in mild or severe cases of COVID-19 compared to non-COVID-19 controls. Most patients recovered from COVID-19, including 25% patients initially requiring intubation. Among hospitalized patients, hydroxychloroquine did not improve COVID-19 outcomes. CONCLUSION: COVID-19 is associated with high burden of severity in patients with lung cancer. Patient-specific features, rather than cancer-specific features or treatments, are the greatest determinants of severity.


Development of a mobile responsive online learning module on psychosocial and mental health issues related to COVID 19


Tracking, tracing, trust: contemplating mitigating the impact of COVID-19 with technological interventions


title: Clinical Characteristics of Patients With Coronavirus Disease 2019 (COVID-19) Receiving Emergency Medical Services in King County, Washington

text: Importance: The ability to identify patients with coronavirus disease 2019 (COVID-19) in the prehospital emergency setting could inform strategies for infection control and use of personal protective equipment. However, little is known about the presentation of patients with COVID-19 requiring emergency care, particularly those who used 911 emergency medical services (EMS). Objective: To describe patient characteristics and prehospital presentation of patients with COVID-19 cared for by EMS. Design, Setting, and Participants: This retrospective cohort study included 124 patients who required 911 EMS care for COVID-19 in King County, Washington, a large metropolitan region covering 2300 square miles with 2.2 million residents in urban, suburban, and rural areas, between February 1, 2020, and March 18, 2020. Exposures: COVID-19 was diagnosed by reverse transcription-polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2 from nasopharyngeal swabs. Test results were available a median (interquartile range) of 5 (3-9) days after the EMS encounter. Main Outcomes and Measures: Prevalence of clinical characteristics, symptoms, examination signs, and EMS impression and care. Results: Of the 775 confirmed COVID-19 cases in King County, EMS responded to 124 (16.0%), with a total of 147 unique 911 encounters. The mean (SD) age was 75.7 (13.2) years, 66 patients (53.2%) were women, 47 patients (37.9%) had 3 or more chronic health conditions, and 57 patients (46.0%) resided in a long-term care facility. Based on EMS evaluation, 43 of 147 encounters (29.3%) had no symptoms of fever, cough, or shortness of breath. Based on individual examination findings, fever, tachypnea, or hypoxia were only present in a limited portion of cases, as follows: 43 of 84 encounters (51.2%), 42 of 131 (32.1%), and 60 of 112 (53.6%), respectively. Advanced care was typically not required, although in 24 encounters (16.3%), patients received care associated with aerosol-generating procedures. As of June 1, 2020, mortality among the study cohort was 52.4% (65 patients). Conclusions and Relevance: The findings of this cohort study suggest that screening based on conventional COVID-19 symptoms or corresponding examination findings of febrile respiratory illness may not possess the necessary sensitivity for early diagnostic suspicion, at least in the prehospital emergency setting. The findings have potential implications for early identification of COVID-19 and effective strategies to mitigate infectious risk during emergency care.


Is physiotherapy ready for the management of COVID-19 in Africa? - Snippets of anecdotal evidences in two African countries


Submissions and publications in corona times


title: Predictive factors of mortality in patients treated with tocilizumab for acute respiratory distress syndrome related to coronavirus disease 2019 (COVID-19)

text: COVID-19 patients (n = 34) suffering from ARDS were treated with tocilizumab (TCZ). Outcome was classified in two groups: "Death" and "Recovery". Predictive factors of mortality were studied. Mean age was 75.3, mean oxygen (O2) requirements 10.4 l/min. At baseline, all patients had multiple biological abnormalities (lymphopenia, increased CRP, ferritin, fibrinogen, D-dimer and liver enzymes). 24 patients (70.5%) recovered after TCZ therapy and 10 died (29.5%). Deceased subjects differed from patients in whom treatment was effective with regard to more pronounced lymphopenia (0.6 vs 1.0 G/l; p = 0.037), lower platelet number (156 vs 314 G/l; p = 0.0001), lower fibrinogen serum level (0.6 vs 1.0 G/l; p = 0.03), higher aspartate-amino-transferase (108 vs 57 UI/l; p = 0.05) and greater O2 requirements (11 vs 8 l/min; p = 0.003).


title: Mathematical Modelling to Assess the Impact of Lockdown on COVID-19 Transmission in India: Model Development and Validation

text: BACKGROUND: The World Health Organization has declared the novel coronavirus disease (COVID-19) to be a public health emergency; at present, India is facing a major threat of community spread. We developed a mathematical model for investigating and predicting the effects of lockdown on future COVID-19 cases with a specific focus on India. OBJECTIVE: The objective of this work was to develop and validate a mathematical model and to assess the impact of various lockdown scenarios on COVID-19 transmission in India. METHODS: A model consisting of a framework of ordinary differential equations was developed by incorporating the actual reported cases in 14 countries. After validation, the model was applied to predict COVID-19 transmission in India for different intervention scenarios in terms of lockdown for 4, 14, 21, 42, and 60 days. We also assessed the situations of enhanced exposure due to aggregation of individuals in transit stations and shopping malls before the lockdown. RESULTS: The developed model is efficient in predicting the number of COVID-19 cases compared to the actual reported cases in 14 countries. For India, the model predicted marked reductions in cases for the intervention periods of 14 and 21 days of lockdown and significant reduction for 42 days of lockdown. Such intervention exceeding 42 days does not result in measurable improvement. Finally, for the scenario of "panic shopping" or situations where there is a sudden increase in the factors leading to higher exposure to infection, the model predicted an exponential transmission, resulting in failure of the considered intervention strategy. CONCLUSIONS: Implementation of a strict lockdown for a period of at least 21 days is expected to reduce the transmission of COVID-19. However, a further extension of up to 42 days is required to significantly reduce the transmission of COVID-19 in India. Any relaxation in the lockdown may lead to exponential transmission, resulting in a heavy burden on the health care system in the country.


title: Correction: Contributions and challenges of general practitioners in China fighting against the novel coronavirus crisis

text: [This corrects the article DOI: 10.1136/fmch-2020-000361.].


The impact of COVID-19 on the clinical outcome of patients with cirrhosis deserves more attention and research


title: The expression level of angiotensin-converting enzyme 2 determines the severity of COVID-19: lung and heart tissue as targets

text: Researchers have reported some useful information about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to CoV disease 2019 (COVID-19). Several studies have been performed in order to develop antiviral drugs, from which a few have been prescribed to patients. Also, several diagnostic tests have been designed to accelerate the process of identifying and treating COVID-19. It has been well-documented that the surface of host cells is covered by some receptors, known as angiotensin-converting enzyme 2 (ACE2), which mediates the binding and entry of CoV. After entering, the viral RNA interrupts the cell proliferation system to activate self-proliferation. However, having all the information about the outbreakof the SARS-COV-2, it is not still clear which factors determine the severity of lung and heart function impairment induced by COVID-19. A major step in exploring SARS-COV-2 pathogenesis is to determine the distribution of ACE2 in different tissues . In this review, the structure and origin of CoV, the role of ACE2 as a receptor of SARS-COV-2 on the surface of host cells, and the ACE2 distribution in different tissues with a focus on lung and cardiovascular system have been discussed. It was also revealed that acute and chronic cardiovascular diseases (CVDs) may result in the clinical severity of COVID-19. In conclusion, this review may provide useful information in developing some promising strategies to end up with a worldwide COVID-19 pandemic.Communicated by Ramaswamy H. Sarma.


Diabetes and covid-19: a global health challenge


Covid-19: RCGP apologises for covid-19 "lifestyle" event title


Mental health and COVID-19 in Nepal: A case of a satellite clinic


Homeless, illegal immigrants and confined?


title: A Derivative Tracking Model for Wind Power Forecast Error

text: Reliable wind power generation forecasting is crucial for applications such as the allocation of energy reserves, optimization for electricity price, and operation scheduling of conventional power plants. We propose a data-driven model based on parametric Stochastic Differential Equations (SDEs) to capture the real asymmetric dynamics of wind power forecast errors. Our SDE framework features time-derivative tracking of the forecast, time-varying mean-reversion parameter, and an improved state-dependent diffusion term. The methodology we developed allows the simulation of future wind power production paths and to obtain sharp empirical confidence bands. All the procedures are agnostic of the forecasting technology, and they enable comparisons between different forecast providers. We apply the model to historical Uruguayan wind power production data and forecasts between April and December 2019.


Potential role of telemedicine in solving ST-segment elevation dilemmas in remote areas during the COVID-19 pandemic


title: COVID-19: emerging protective measures

text: The COVID-19 (Coronavirus disease 2019) spreads primarily through droplets of saliva or discharge from the nose. COVID-19 is predominantly considered as an unavoidable pandemic, and scientists are very curious about how to provide the best protection to the public before a vaccine can be made available. There is an urge to manufacture a greater number of masks to prevent any aerosol with microbes. Hence, we aim to develop an efficient viral inactivation system by exploiting active compounds from naturally occurring medicinal plants and infusing them into nanofiber-based respiratory masks. Our strategy is to develop fibrous filtration with three-layered masks using the compounds from medicinal plants for viral deactivation. These masks will be beneficial not just to healthcare workers but common citizens as well. In the absence of vaccination, productive masks can be worn to prevent transmission of airborne pathogenic aerosols and control diseases.


COVID-19 and programmatic assessment


title: Diet and body shape among populations of Bryconamericus iheringii (Otophysi: Characidae) across the Campos Sulinos ecosystem

text: Alterations in natural landscapes, mainly caused by anthropic pressures, have been threatening the world's biomes, including aquatic environments and its biota. This study describes the diet of Bryconamericus iheringii, and how its body shape relates to environmental variables in populations of 22 streams. A wide array of food items were found, mainly composed of allochthonous plants (50.5%) and autochthonous invertebrates (25.2%). Even though food items remained almost the same, the predominant food group significantly differed among streams, mainly in relation to environmental characteristics. There was variation in body shape primarily associated with body depth and length of the pre-dorsal region; however, these differences did not correspond with streams. PLS-CA analyses indicated that environmental characteristics, such as substrate type, percentage of marginal vegetation have some influence over food items availability but not on body shape. This may be because B. iheringii is a non-specialist species capable of prey switching based on availability due to an intermediate body shape suited for generalist feeding habits.(AU)


Il virus e il medico./ [The virus and the physician]


title: COVID-19 no estado do Ceará, Brasil: comportamentos e crenças na chegada da pandemia./ COVID-19 no estado do Ceará, Brasil: comportamentos e crenças na chegada da pandemia./ Covid-19 in the State of Ceará: behaviors and beliefs in the arrival of the pandemic

text: This study aimed to evaluate the behavioral aspects and beliefs of the population of Ceará in the face of the COVID-19 pandemic. An online questionnaire was conducted on sociodemographic aspects and opinions related to the pandemic. Absolute and relative frequencies were calculated, the association between variables was performed with Chi-square, and the level of significance was 5%. The final sample had 2,259 participants, and an association was observed between females and perceiving themselves with a high risk of infection (p = 0.044) and males with non-performance of voluntary quarantine (p < 0.001). People aged 80 years and over were partially quarantined due to the flow of people at home (p < 0.001). Participants with elementary school education had a lower risk of infection than participants with a higher level of education (p < 0.001). This group includes people who did voluntary quarantine the least (p < 0.001). Participants living in the inland region of the state had less direct contact with someone tested positive for the Coronavirus (p = 0.031) and are less reclusive (p < 0.001). We can conclude that the approach to the COVID-19 pandemic varies by social aspects, such as gender, age, education, and place of residence, as well as the belief system of the population of the State of Ceará.


Atypical Imaging Findings in Leukemia With SARS-CoV-2 Infection


title: Endocrine surgery during COVID-19 pandemic: do we need an update of indications in Italy?

text: The ongoing spread of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a significant threat to global health. As the coronavirus outbreak began spreading, hospitals were forced to relocate resources to treat the growing number of COVID-19 patients. As a consequence, doctors across the country canceled tens of thousands of nonurgent surgeries. However, recognizing that the COVID-19 situation may be highly variable and fluid in different communities across the country, elective surgery could be still allowed in some centers for patients included in the high-priority class. The majority of endocrine disorders requiring surgical treatment in patients identifiable as first-priority class, or needing hospitalization within 30 days, are generally represented by malignant thyroid tumors, hyperthyroidism, hyperparathyroidism, and some adrenal disorders. The need for urgent intervention is evaluated on a case-by-case basis according to the severity of the symptoms, the likelihood of progression, and global clinical judgment. On the basis of the above indications, during the last 4 weeks, we performed 18 planned surgical treatments in patients with thyroid cancer (total thyroidectomies, plus lymph node dissection if needed) or multinodular toxic goiter. In no case, postoperative ventilatory support was needed, and the average hospital stay was 3 days. The negative COVID-19 status for all the treated patients was appropriately evaluated beforehand. Nobody knows how long the current COVID-19 pandemic will be lasting. Certainly, we will be requested in the next future to incrementally offer surgical services for endocrine disorders that have been deferred for the COVID-19 pandemic.


title: Anesthesia management for cesarean section during novel coronavirous epidemic/ 中华麻醉学杂志

text: Thirty-six puerperas who underwent emergency cesarean section at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 24, 2020 to February 9, 2020, who all wore medical surgical masks, were retrospectively included in this study. Anesthesia management was performed under tertiary medical protection measures. A dedicated anesthesia equipment was separately sterilized. Narcotic drugs were used for one patient only, and disposable medical supplies were used for anesthetic supplies. Contact transmission should be avoided when a neonate required resuscitation, and early isolation and nucleic acid testing were provided for the neonates. The rate of suspected cases of novel coronavirus (2019-nCoV) was 11% , and the rate of clinically diagnosed cases was 17% before surgery. The rate of clinically diagnosed cases of 2019-nCoV was 22%, the rate of confirmed cases was 8%, and the total positive rate of diagnosis was 31% after surgery. The rate of neuraxial anesthesia was 86%, the rate of general anesthesia was 14%, the time of spinal puncture was (15±7) min, the time of tracheal intubation under general anesthesia was (2.1±1.3) min, the operation time was (95±36) min, and blood loss was (276±166) ml. The Apgar score of newborns was 8.8 ± 0.5. There was 1 neonate whose mother was diagnosed as having 2019 novel coronavirous disease after operation, an oropharyngeal swab specimen was obtained at 36 h of birth, and the swab was tested positive for 2019-nCoV by nucleic acid testing. As of February 10, 2020, an anesthesiologist involved in the operation was diagnosed to have infection by 2019-nCoV. In conclusion, diagnosis of 2019 novel coronavirous disease during pregnancy is more difficult, it is necessary to perform anesthesia management for cesarean section under tertiary medical protection. Although the difficulty in anesthesia operation is increased under tertiary medical protection, anesthesiologists can carry out standardized anesthesia management and guarantee the safety of maternal and infants and anesthesiologists themselves as long as they are rigorously trained and adhere to protective protocols.


title: Pediatric otolaryngology workflow changes in a community hospital setting to decrease exposure to novel coronavirus

text: OBJECTIVES: To develop a workflow algorithm for physicians and staff to decrease cross contamination and minimize exposure to Coronavirus Disease -19 (COVID-19) in pediatric otolaryngology at a community pediatric hospital. METHODS: PubMed and Google Scholar searches were carried out using the keywords. Pertinent clinical information related to pediatric otolaryngology was reviewed from journals, Texas Medical Board guidelines as well as institutional guidelines. Updated information from the Centers for Disease Control through social media was identified via Google search. STUDY DESIGN: Safety measures and clinical work-flow protocols were developed to protect patients, families, and staff. Protocols included a rotation schedule for providers and ancillary staff, guidelines for in-clinic visits and alteration to surgical block and surgical case cadence to minimize exposure of providers and staff to COVID-19. Algorithms and guidelines were reviewed and revisions made at each phase of the pandemic related to in-clinic visits, telemedicine visits, and surgical cases. CONCLUSION: In the era of the COVID-19 pandemic, otolaryngologists and pediatric otolaryngologists are amongst sub-specialties with an increased risk of exposure. It is imperative that a modification in clinical workflow is created to minimize the risk of exposure to providers and staff while continuing to provide care to patients. PRACTICE IMPLICATIONS: The COVID-19 pandemic continues to evolve and change rapidly. The described guidelines and workflow algorithm serve as tools to help pediatric otolaryngologists protect themselves and their staff and patients during this global crisis.


The Impact of COVID-19 Outbreak on Uro-oncological Practice Across Europe: Which Burden of Activity Are We Facing Ahead?


title: Impact of Spanish Public Health Measures on Emergency Visits and COVID- 19 diagnosed cases during the pandemic in Madrid

text: OBJECTIVE: Changes in Public Health recommendations may have changed the number of emergency visits and COVID-19 diagnosed cases in an Emergency Department in Madrid. METHODS: This retrospective case series study included all consecutive patients in a tertiary and urban ED in Madrid from 1st to 31st March. The sample was divided: NonCOVID-19, Non-investigated COVID-19, Possible COVID-19, Probable COVID-19, Confirmed COVID-19. Differences between public health periods were tested by ANOVA for each cohort, and by ANCOVA including the number of PCR tests (%) as covariate. RESULTS: A total of 7,163 (4,071 Non-COVID-19, 563 Non-investigated COVID-19, 870 Possible, 648 Probable and 1,011 Confirmed COVID-19) cases were included. Public Health measurements applied during each period showed a clear effect on the case proportion for the five cohorts. CONCLUSIONS: The variability of case definitions and diagnostic test criteria may have impact on the number of emergency visits and COVID-19 diagnosed cases in Emergency Department.


title: Can AI help in screening Viral and COVID-19 pneumonia?

text: Coronavirus disease (COVID-19) is a pandemic disease, which has already caused thousands of causalities and infected several millions of people worldwide. Any technological tool enabling rapid screening of the COVID-19 infection with high accuracy can be crucially helpful to healthcare professionals. The main clinical tool currently in use for the diagnosis of COVID-19 is the Reverse transcription polymerase chain reaction (RT-PCR), which is expensive, less-sensitive and requires specialized medical personnel. X-ray imaging is an easily accessible tool that can be an excellent alternative in the COVID-19 diagnosis. This research was taken to investigate the utility of artificial intelligence (AI) in the rapid and accurate detection of COVID-19 from chest X-ray images. The aim of this paper is to propose a robust technique for automatic detection of COVID-19 pneumonia from digital chest X-ray images applying pre-trained deep-learning algorithms while maximizing the detection accuracy. A public database was created by the authors combining several public databases and also by collecting images from recently published articles. The database contains a mixture of 423 COVID-19, 1485 viral pneumonia, and 1579 normal chest X-ray images. Transfer learning technique was used with the help of image augmentation to train and validate several pre-trained deep Convolutional Neural Networks (CNNs). The networks were trained to classify two different schemes: i) normal and COVID-19 pneumonia; ii) normal, viral and COVID-19 pneumonia with and without image augmentation. The classification accuracy, precision, sensitivity, and specificity for both the schemes were 99.7%, 99.7%, 99.7% and 99.55% and 97.9%, 97.95%, 97.9%, and 98.8%, respectively.


title: Neurological manifestations of COVID-19

text: Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) has turned out to be a formidable pandemic. Upcoming evidence from confirmed cases of COVID-19 suggests an anticipated incursion of patients with neurological manifestations in the weeks to come. An expression of the angiotensin-converting enzyme 2 (ACE 2), the cellular receptor for SARS-CoV-2 over the glial cells and neurons have made the brain a potential target. Neurotoxicity may occur as a result of direct, indirect and post-infectious complications. Attention to neurological deficits in COVID-19 is fundamental to ensure appropriate, timely, beneficial management of the affected patients. Most common neurological manifestations seen include dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizures. Anosmia and ageusia have recently been hinted as significant early symptoms in COVID-19. As cases with neurological deficits in COVID-19 emerge, the overall prognosis is yet unknown.


A case of COVID-19 lung infection first detected by [18F]FDG PET-CT


Covid-19 and urology


title: Metronomic oral vinorelbine and lung cancer therapy during the COVID 19 pandemic: A single-center experience

text: COVID 19 pandemic is a worldwide health emergency. Every single Hospital and Department was forced to radically modify clinical practice decreasing or stopping daily activities. Oncological patients had to carry on treatments in order to prevent disease progression and improve their quality of life. However, many health workers may be a potential source of infection if not tested with swabs but this diagnostic procedure was not suitable universally in Italy. Aiming to reduce hospitalization of our patients with advanced lung cancer, vinorelbine in its metronomic formulation is one of the best strategy. Here, we report the experience with oral vinorelbine in a few patients of our Oncology Department.


Covid-19: Patients should self-isolate for two weeks before elective care, trusts are told


Risk of COVID-19 in Patients With Cancer-Reply


Joint Statement on Minimally Invasive Gynecologic Surgery during the COVID-19 Pandemic


title: Good or bad: Application of RAAS inhibitors in COVID-19 patients with cardiovascular comorbidities

text: The coronavirus disease 2019 (COVID-19) pandemic is caused by a newly emerged coronavirus (CoV) called Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). COVID-19 patients with cardiovascular disease (CVD) comorbidities have significantly increased morbidity and mortality. The use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor type 1 blockers (ARBs) improve CVD outcomes; however, there is concern that they may worsen the prognosis of CVD patients that become infected with SARS-CoV-2 because the virus uses the ACE2 receptor to bind to and subsequently infect host cells. Thus, some health care providers and media sources have questioned the continued use of ACE inhibitors and ARBs. In this brief review, we discuss the effect of ACE inhibitor-induced bradykinin on the cardiovascular system, on the renin-angiotensin-aldosterone system (RAAS) regulation in COVID-19 patients, and analyze recent clinical studies regarding patients treated with RAAS inhibitors. We propose that the application of RAAS inhibitors for COVID-19 patients with CVDs may be beneficial rather than harmful.


Impact of COVID-19 outbreak on the management of patients with severe IBD: a domino effect


The effect of COVID-19 pandemic on oral medicine services in a tertiary referral center


COVID-19 Among African Americans: From Preliminary Epidemiological Surveillance Data to Public Health Action


title: Remote health monitoring in the time of COVID-19

text: Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is rapidly spreading across the globe. The clinical spectrum of SARS-CoV-2 pneumonia ranges from mild to critically ill cases and requires early detection and monitoring, within a clinical environment for critical cases and remotely for mild cases. The fear of contamination in clinical environments has led to a dramatic reduction in on-site referrals for routine care. There has also been a perceived need to continuously monitor non-severe COVID- 19 patients, either from their quarantine site at home, or dedicated quarantine locations (e.g., hotels). Thus, the pandemic has driven incentives to innovate and enhance or create new routes for providing healthcare services at distance. In particular, this has created a dramatic impetus to find innovative ways to remotely and effectively monitor patient health status. In this paper we present a short review of remote health monitoring initiatives taken in 19 states during the time of the pandemic. We emphasize in the discussion particular aspects that are common ground for the reviewed states, in particular the future impact of the pandemic on remote health monitoring and consideration on data privacy.


title: Risks from Deferring Treatment for Genitourinary Cancers: A Collaborative Review to Aid Triage and Management During the COVID-19 Pandemic

text: CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic is leading to delays in the treatment of many urologic cancers. OBJECTIVE: To provide a contemporary picture of the risks from delayed treatment for urologic cancers to assist with triage. EVIDENCE ACQUISITION: A collaborative review using literature published as of April 2, 2020. EVIDENCE SYNTHESIS: Patients with low-grade non-muscle-invasive bladder cancer are unlikely to suffer from a 3-6-month delay. Patients with muscle-invasive bladder cancer are at risk of disease progression, with radical cystectomy delays beyond 12 wk from diagnosis or completion of neoadjuvant chemotherapy. Prioritization of these patients for surgery or management with radiochemotherapy is encouraged. Active surveillance should be used for low-risk prostate cancer (PCa). Treatment of most patients with intermediate- and high-risk PCa can be deferred 3-6 mo without change in outcomes. The same may be true for cancers with the highest risk of progression. With radiotherapy, neoadjuvant androgen deprivation therapy (ADT) is the standard of care. For surgery, although the added value of neoadjuvant ADT is questionable, it may be considered if a patient is interested in such an approach. Intervention may be safely deferred for T1/T2 renal masses, while locally advanced renal tumors (≥T3) should be treated expeditiously. Patients with metastatic renal cancer may consider vascular endothelial growth factor targeted therapy over immunotherapy. Risks for delay in the treatment of upper tract urothelial cancer depend on grade and stage. For patients with high-grade disease, delays of 12 wk in nephroureterectomy are not associated with adverse survival outcomes. Expert guidance recommends expedient local treatment of testis cancer. In penile cancer, adverse outcomes have been observed with delays of ≥3 mo before inguinal lymphadenectomy. Limitations include a paucity of data and methodologic variations for many cancers. CONCLUSIONS: Patients and clinicians should consider the oncologic risk of delayed cancer intervention versus the risks of COVID-19 to the patient, treating health care professionals, and the health care system. PATIENT SUMMARY: The coronavirus disease 2019 pandemic has led to delays in the treatment of patients with urologic malignancies. Based on a review of the literature, patients with high-grade urothelial carcinoma, advanced kidney cancer, testicular cancer, and penile cancer should be prioritized for treatment during these challenging times.


Challenges in chronic paediatric disease during the COVID-19 pandemic: diagnosis and management of inflammatory bowel disease in children


title: Respiratory and pulmonary complications in head and neck cancer patients: Evidence-based review for the COVID-19 era

text: BACKGROUND: Pulmonary complications and infections frequently affect patients with head and neck squamous cell carcinoma (HNSCC). Common characteristics can predispose these patients to the development of severe respiratory illness, which may be particularly relevant during the 2019 coronavirus disease (COVID-19) pandemic. METHODS: A scoping review was performed to assess the impact of pulmonary comorbidities and adverse respiratory outcomes in HNSCC patients. RESULTS: Advanced age, history of tobacco and alcohol abuse, and cardiopulmonary comorbidities are significant risk factors for the development of adverse respiratory outcomes. Treatment toxicities from radiation or chemoradiation therapy significantly increase these risks. CONCLUSION: Respiratory complications are a frequent cause of morbidity and mortality among HNSCC patients, and the COVID-19 pandemic may disproportionately affect this population. Interventions designed to decrease smoking and alcohol use, improve oral hygiene, and aggressively manage medical comorbidities are important to the long-term management and health of these patients.


A plunge in the number of traumatic traffic injuries in an emergency center in Anhui province, China


Novel coronavirus (2019-nCov): do you have enough intensive care units?


First NGS-based COVID-19 diagnostic


title: Management of primary skin cancer during a pandemic: Multidisciplinary recommendations

text: During the coronavirus disease 2019 (COVID-19) pandemic, providers and patients must engage in shared decision making regarding the pros and cons of early versus delayed interventions for localized skin cancer. Patients at highest risk of COVID-19 complications are older; are immunosuppressed; and have diabetes, cancer, or cardiopulmonary disease, with multiple comorbidities associated with worse outcomes. Physicians must weigh the patient's risk of COVID-19 complications in the event of exposure against the risk of worse oncologic outcomes from delaying cancer therapy. Herein, the authors have summarized current data regarding the risk of COVID-19 complications and mortality based on age and comorbidities and have reviewed the literature assessing how treatment delays affect oncologic outcomes. They also have provided multidisciplinary recommendations regarding the timing of local therapy for early-stage skin cancers during this pandemic with input from experts at 11 different institutions. For patients with Merkel cell carcinoma, the authors recommend prioritizing treatment, but a short delay can be considered for patients with favorable T1 disease who are at higher risk of COVID-19 complications. For patients with melanoma, the authors recommend delaying the treatment of patients with T0 to T1 disease for 3 months if there is no macroscopic residual disease at the time of biopsy. Treatment of tumors ≥T2 can be delayed for 3 months if the biopsy margins are negative. For patients with cutaneous squamous cell carcinoma, those with Brigham and Women's Hospital T1 to T2a disease can have their treatment delayed for 2 to 3 months unless there is rapid growth, symptomatic lesions, or the patient is immunocompromised. The treatment of tumors ≥T2b should be prioritized, but a 1-month to 2-month delay is unlikely to worsen disease-specific mortality. For patients with squamous cell carcinoma in situ and basal cell carcinoma, treatment can be deferred for 3 months unless the individual is highly symptomatic.


title: The role of imaging in the detection and management of COVID-19: a review

text: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading rapidly around the world, resulting in a massive death toll. Lung infection or pneumonia is the common complication of COVID-19, and imaging techniques, especially computed tomography (CT), have played an important role in diagnosis and treatment assessment of the disease. Herein, we review the imaging characteristics and computing models that have been applied for the management of COVID-19. CT, positron emission tomography - CT (PET/CT), lung ultrasound, and magnetic resonance imaging (MRI) have been used for detection, treatment, and follow-up. The quantitative analysis of imaging data using artificial intelligence (AI) is also explored. Our findings indicate that typical imaging characteristics and their changes can play crucial roles in the detection and management of COVID-19. In addition, AI or other quantitative image analysis methods are urgently needed to maximize the value of imaging in the management of COVID-19.


The impact of high-flow nasal cannula (HFNC) on coughing distance: implications on its use during the novel coronavirus disease outbreak


Editorial: Impacts of COVID-19 on agricultural and food systems worldwide and on progress to the sustainable development goals


title: Therapeutic uncertainties in people with cardiometabolic diseases and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19)

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) has been declared a pandemic by the World Health Organization and sent all countries scrambling to review emergency healthcare provisions. There is global evidence of each nation struggling to effectively manage the number of people being diagnosed with the virus. These are testing times which have not been experienced in recent generations and there are a number of insecurities regarding the management of people with COVID-19 and cardiometabolic diseases. This review highlights the current concerns related to COVID-19 and provides advice in terms of the therapeutic uncertainty and potential adverse harms associated with therapy when managing people, particularly those with cardiometabolic diseases, who have contracted or are at increased risk of contracting COVID-19.


Como a Acta Médica Portuguesa se Adaptou aos Tempos de Pandemia./ [How Acta Médica Portuguesa Adjusted to Pandemic Times]


BDA begins resolving associate pay disputes


title: Business disruptions from social distancing

text: Social distancing interventions can be effective against epidemics but are potentially detrimental for the economy. Businesses that rely heavily on face-to-face communication or close physical proximity when producing a product or providing a service are particularly vulnerable. There is, however, no systematic evidence about the role of human interactions across different lines of business and about which will be the most limited by social distancing. Here we provide theory-based measures of the reliance of U.S. businesses on human interaction, detailed by industry and geographic location. We find that 49 million workers work in occupations that rely heavily on face-to-face communication or require close physical proximity to other workers. Our model suggests that when businesses are forced to reduce worker contacts by half, they need a 12 percent wage subsidy to compensate for the disruption in communication. Retail, hotels and restaurants, arts and entertainment and schools are the most affected sectors. Our results can help target fiscal assistance to businesses that are most disrupted by social distancing.


title: Incidence of respiratory distress and its predictors among neonates admitted to the neonatal intensive care unit, Black Lion Specialized Hospital, Addis Ababa, Ethiopia

text: BACKGROUND: Although respiratory distress is one of the major causes of neonatal morbidity and mortality throughout the globe, it is a particularly serious concern for nations like Ethiopia that have significant resource limitations. Additionally, few studies have looked at neonatal respiratory distress and its predictors in developing countries, and thus we sought to investigate this issue in neonates who were admitted to the Neonatal Intensive Care Unit at Black Lion Specialized Hospital, Ethiopia. METHODS: An institution-based retrospective follow-up study was conducted with 571 neonates from January 2013 to March 2018. Data were collected by reviewing patients' charts using a systematic sampling technique with a pretested checklist. The data was then entered using Epi-data 4.2 and analyzed with STATA 14. Median time, Kaplan-Meier survival estimation curves, and log-rank tests were then computed. Bivariable and multivariable Gompertz parametric hazard models were fitted to detect the determinants of respiratory distress. The hazard ratio with a 95% confidence interval was subsequently calculated. Variables with reported p-values < 0.05 were considered statistically significant. RESULTS: The proportion of neonates with respiratory distress among those admitted to the Black Lion Specialized Hospital neonatal intensive care unit was 42.9% (95%CI: 39.3-46.1%) The incidence rate was 8.1/100 (95%CI: 7.3, 8.9). Significant predictors of respiratory distress in neonates included being male [Adjusted hazard ratio (HR): 2.4 (95%CI: 1.1, 3.1)], born via caesarean section [AHR: 1.9 (95%CI: 1.6, 2.3)], home delivery [AHR: 2.9 (95%CI: 1.5, 5,2)], maternal diabetes mellitus (AHR: 2.3 (95%CI: 1.4, 3.6)), preterm birth [AHR: 2.9 (95%CI: 1.6, 5.1)], and having an Apgar score of less than 7 [AHR: 3.1 (95%CI: 1.8, 5.0)]. CONCLUSIONS: In this study, the proportion of respiratory distress (RD) was high. Preterm birth, delivery by caesarean section, Apgar score < 7, sepsis, maternal diabetes mellitus, and home delivery were all significant predictors of this condition. Based on our findings this would likely include encouraging more hospital births, better control of diabetes in pregnancy, improved neonatal resuscitation and addressing ways to decrease the need for frequent caesarean sections.


title: Declined serum high density lipoprotein cholesterol is associated with the severity of COVID-19 infection

text: BACKGROUND: COVID-19 infection is epidemic worldwide. We describe the serum lipid profile of the patients with COVID-19 infection. METHODS: In this retrospective study, we collected the first clinical laboratory data of 114 patients on admission, and 80 healthy controls. Meanwhile, we monitored the serum lipid profile, COVID-19 nucleic acid and chest CT scan of a severe patient from the early stage of infection to the recovery period for a total of 80 days. RESULTS: Compared with the healthy controls, the patients had sharply decreased concentrations of total cholesterol, HDL-cholesterol and LDL-cholesterol (P<0.001). Among the patients, HDL-cholesterol concentration in severe groups was significantly lower than the common groups [1.01 (0.88-1.20) vs 1.21 (1.02-1.48) mmol/l, P<0.001]. The lipid profile of a severe patient showed that serum cholesterol concentration significantly decreased in the early stage and returned to be normal in the recovery period. Moreover, the change of HDL-cholesterol in this patient was consistent with the results of nucleic acid tests and chest CT scans. In correlation analysis, HDL-cholesterol concentration was negatively correlated with C-reactive protein (CRP, r=-0.396, P<0.001) and positively correlated with lymphocytes (r=0.336, P<0.001). The area under curve (AUC) in receiver operating characteristic (ROC) of HDL-cholesterol was 0.732 (P<0.001), and, the adjusted odd ratio (OR) of HDL-cholesterol was 0.023 (95% CI 0.002-0.227). CONCLUSIONS: Decreased serum HDL-cholesterol is associated with the severity of COVID-19 infection.


Letter: Hemorrhagic Conditions Affecting the Central Nervous System in COVID-19 Patients