title: Repair of Acute Respiratory Distress Syndrome by Stromal Cell Administration in COVID-19 (REALIST-COVID-19): A structured summary of a study protocol for a randomised, controlled trial

text: OBJECTIVES: The primary objective of the study is to assess the safety of a single intravenous infusion of Mesenchymal Stromal Cells (MSCs) in patients with Acute Respiratory Distress Syndrome (ARDS) due to COVID-19. Secondary objectives are to determine the effects of MSCs on important clinical outcomes, as described below. TRIAL DESIGN: REALIST COVID 19 is a randomised, placebo-controlled, triple blinded trial. PARTICIPANTS: The study will be conducted in Intensive Care Units in hospitals across the United Kingdom. Patients with moderate to severe ARDS as defined by the Berlin definition, receiving invasive mechanical ventilation and with a diagnosis of COVID-19 based on clinical diagnosis or PCR test will be eligible. Patients will be excluded for the following reasons: more than 72 hours from the onset of ARDS; age < 16 years; patient known to be pregnant; major trauma in previous 5 days; presence of any active malignancy (other than non-melanoma skin cancer); WHO Class III or IV pulmonary hypertension; venous thromboembolism currently receiving anti-coagulation or within the past 3 months; patient receiving extracorporeal life support; severe chronic liver disease (Child-Pugh > 12); Do Not Attempt Resuscitation order in place; treatment withdrawal imminent within 24 hours; prisoners; declined consent; non-English speaking patients or those who do not adequately understand verbal or written information unless an interpreter is available; previously enrolled in the REALIST trial. INTERVENTION AND COMPARATOR: Intervention: Allogeneic donor CD362 enriched human umbilical cord derived mesenchymal stromal cells (REALIST ORBCEL-C) supplied as sterile, single-use cryopreserved cell suspension of a fixed dose of 400 x106 cells in 40ml volume, to be diluted in Plasma-Lyte 148 to a total volume of 200mls for administration. Comparator (placebo): Plasma-Lyte 148 Solution for Infusion (200mls). The cellular product (REALIST ORBCEL-C) was developed and patented by Orbsen Therapeutics. MAIN OUTCOMES: The primary safety outcome is the incidence of serious adverse events. The primary efficacy outcome is Oxygenation Index (OI) at day 7. Secondary outcomes include: OI at days 4 and 14; respiratory compliance, driving pressure and PaO2/FiO2 ratio (PF ratio) at days 4, 7 and 14; Sequential Organ Failure Assessment (SOFA) score at days 4, 7 and 14; extubation and reintubation; ventilation free days at day 28; duration of mechanical ventilation; length of ICU and hospital stay; 28-day and 90-day mortality. RANDOMISATION: After obtaining informed consent, patients will be randomised via a centralised automated 24-hour telephone or web-based randomisation system (CHaRT, Centre for Healthcare Randomised Trials, University of Aberdeen). Randomisation will be stratified by recruitment centre and by vasopressor use and patients will be allocated to REALIST ORBCEL-C or placebo control in a 1:1 ratio. BLINDING (MASKING): The investigator, treating physician, other members of the site research team and participants will be blinded. The cell therapy facility and clinical trials pharmacist will be unblinded to facilitate intervention and placebo preparation. The unblinded individuals will keep the treatment information confidential. The infusion bag will be masked at the time of preparation and will be administered via a masked infusion set. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A sample size of 60 patients with 30 patients randomised to the intervention and 30 to the control group. If possible, recruitment will continue beyond 60 patients to provide more accurate and definitive trial results. The total number of patients recruited will depend on the pandemic and be guided by the data monitoring and ethics committee (DMEC). TRIAL STATUS: REALIST Phase 1 completed in January 2020 prior to the COVID-19 pandemic. This was an open label dose escalation study of REALIST ORBCEL-C in patients with ARDS. The COVID-19 pandemic emerged as REALIST Phase 2 was planned to commence and the investigator team decided to repurpose the Phase 2 trial as a COVID-19 specific trial. This decision was discussed and approved by the Trial Steering Committee (TSC) and DMEC. Submissions were made to the Research Ethics Committee (REC) and MHRA to amend the protocol to a COVID-19 specific patient population and the protocol amendment was accepted by the REC on 27th March 2020 and MHRA on 30th March 2020 respectively. Other protocol changes in this amendment included an increase in the time of onset of ARDS from 48 to 72 hours, inclusion of clinical outcomes as secondary outcomes, the provision of an option for telephone consent, an indicative sample size and provision to continue recruitment beyond this indicative sample size. The current protocol in use is version 4.0 23.03.2020 (Additional file 1). Urgent Public Health status was awarded by the NIHR on 2 April 2020 and the trial opened to recruitment and recruited the first participant the same day. At the time of publication the trial was open to recruitment at 5 sites across the UK (Belfast Health and Social Care Trust, King's College London, Guys and St Thomas' Hospital London, Birmingham Heartlands Hospital and the Queen Elizabeth Hospital Birmingham) and 12 patients have been recruited across these sites. Additional sites are planned to open and appropriate approvals for these are being obtained. It is estimated recruitment will continue for 6 months. TRIAL REGISTRATION: ClinicalTrials.gov NCT03042143 (Registered 3 Feb 2017). EudraCT 2017-000585-33 (Registered 28 Nov 2017). FULL PROTOCOL: The full protocol (version 4.0 23.03.2020) is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Viral Transportation in Covid-19 Pandemic: Inactivated Virus Transportation Should Be Implemented for Safe Transportation and Handling at Diagnostics Laboratories


Importance of Sleep for Health and Wellbeing Amidst COVID-19 Pandemic


title: EASAPS/ESPRAS-Überlegungen zur Rückkehr in den plastisch-chirurgischen Alltag während der COVID-19-Pandemie  eine europäische Sichtweise./ ï»¿EASAPS/ESPRAS Considerations in getting back to work in Plastic Surgery with the COVID-19 Pandemic - A European point of view

text: The aim of this paper is to summarize the results of a consensus process and a European webinar of the two societies, European Association of Societies of Aesthetic Surgery (EASAPS) and the European Society of Plastic, Reconstructive and Aesthetic Societies (ESPRAS) on what is considered safe practice based on the scientific knowledge we have today. This review of the current situations gives considerations which have to be taken into account when getting back to work in plastic surgery with COVID-19 in Europe. At all times, one should be familiar the local and regional infection rates in the community, with particular emphasis on the emergence of second and third waves of the pandemic. Due to the fast-evolving nature of the COVID-19 pandemic the recommendations aim to be rather considerations than fixed guidelines and might need to be revised in near future.


title: Epidemiology of COVID-19 in older persons, Wuhan, China

text: BACKGROUND: The epidemiological characteristics of older patients with COVID-19 was far from clear. OBJECTIVE: To explore the epidemiology of older patients with COVID-19 in Wuhan, China. DESIGN: A retrospective cross-sectional study. SETTING: A population-based study. SUBJECTS: The resident older patients (older than 65 years old) diagnosed with COVID-19. METHODS: Citywide case series reported to Wuhan Center for Disease Control and Prevention from 12 December 2019 to 17 March 2020 were included. The epidemic curves were constructed by dates of disease onset. RESULTS: 14238 confirmed COVID-19 cases were older persons. The number of male cases were slightly less than female cases (1:1.01). The attack rate of COVID-19 in the older persons was 11.49 in Wuhan. There was a rapid increase of disease at the early stage of the epidemic and then a gradual and steady decrease was performed. 3,723 (26.15%) and 734 (5.16%) patients were diagnosed as severe and critical cases, respectively. The attributable crude fatality ratio of COVID-19 in the older population was 222.57/100,000, and the crude fatality ratio of COVID was 19.37%. The proportion of severe and critical cases, and fatality ratio were both higher in downtown area and increased with age. CONCLUSIONS: The older persons are sensitive to COVID-19. The proportion of severe and critical cases and fatality ratio are higher than that in children and younger adults. Strengthen the protection and control strategies for the older adults is of priorities. More detailed epidemiological and clinical information should be measured in further studies.


title: Rapid Development of an Outpatient-To-Inpatient Crash Curriculum for COVID Providers

text: The COVID-19 pandemic has caused critical staff shortages and thus required innovative approaches to bring providers into the hospital workforce (1), including those who may not have performed inpatient general medicine care for many years. Our educational group felt an urgent need to create educational content to re-familiarize these anxious providers with common inpatient scenarios. Our goal was to rapidly author and distribute high-yield educational resources to non-inpatient medical providers who could be pulled to cover inpatient general medicine services.


Rapid development of an outpatient-to-inpatient crash curriculum for COVID-19 providers


title: Extensions and adaptations of existing medical information system in order to reduce social contacts during COVID-19 pandemic

text: OBJECTIVE: The main objective of this paper is the reduction of the COVID-19 pandemic spread by increasing the degree of social distancing by using and upgrading the existing Medical Information System (MIS). MATERIAL AND METHODS: The existing MIS MEDIS.NET, currently used in the largest health center in the Balkans, has been adapted and further developed. RESULTS: During the adaptation of existing MIS MEDIS.NET 4 new and 9 existing modules were developed. A quick questionnaire for the smart triage of patients was also implemented. DISCUSSION: The adapted MIS successfully influenced the reduction of social contacts within the Health Center Nis. The need for the arrival of children and their parents to receive appropriate health certificates for the school enrolment is reduced. The therapy of chronic patients has been prolonged for 6 months via an electronic prescription. An online service for the communication between patients and the chosen physicians is provided. Possible social contacts and exposure to the viral environment of patients are reduced by making appointments in extended slots and at determined physical locations. Patients are notified per SMS or email about the availability of chosen and physician on duty. The social distancing of patients and physicians is also established by sending laboratory analyses per email or SMS. Keeping the central registry for COVID-19 is enabled throughout the country. CONCLUSION: The smart adaptation of MIS, and its collaboration with other state systems can significantly influence the reduction of social contacts and thus mitigate the consequences of COVID-19 pandemic.


Risk factors for viral RNA shedding in COVID-19 patients


Risk Factors for Viral RNA Shedding in COVID-19 Patients


Psychological impact of 'Lockdown' due to COVID-19 pandemic in Nepal: An online survey


title: Prognostic value of C-reactive protein in patients with COVID-19

text: BACKGROUND: Elevated serum C-reactive protein (CRP) level was observed in most patients with COVID-19. METHODS: Data of COVID-19 patients with clinical outcome in a designated hospital in Wuhan, China, were retrospectively collected and analyzed from Jan 30 to Feb 20, 2020. The prognostic value of admission CRP was evaluated in patients with COVID-19. RESULTS: Out of 298 patients enrolled, 84 died and 214 recovered. Most non-survivors tended to be males, old aged, or with chronic diseases. Compared to survivors, non-survivors showed significantly elevated white blood cell and neutrophil count, neutrophil to lymphocyte ratio (NLR), systemic immune-inflammation index (SII, defined by platelet count multiply by NLR), CRP, procalcitonin, and D-dimer, and decreased red blood cell, lymphocyte, and platelet count. Age, neutrophil count, platelet count, and CRP were identified as independent predictors of adverse outcome. The area under the receiver operating characteristic (ROC) curve (AUC) of CRP (0.896) was significantly higher than that of age (0.833), neutrophil count (0.820), and platelet count (0.678) in outcome prediction (all p<0.05). With a cut-off value of 41.4, CRP exhibited sensitivity 90.5%, specificity 77.6%, positive predictive value 61.3%, and negative predictive value 95.4%. Subgroup analysis revealed that CRP remained robust accuracy in adverse outcome prediction in patients with different disease severity (AUC 0.832, z=10.23, p<0.001; AUC 0.989, z=44.04, p<0.001). CRP was also an independent discriminator of severe/critical illness on admission (AUC 0.783, z=10.69, p<0.001). CONCLUSIONS: In patients with COVID-19, admission CRP correlated with disease severity and tended to be a good predictor of adverse outcome.


title: Epidemiological survey on a family aggregation COVID-19 in Y County, Chenzhou City, Hunan/ 上海预防医学

text: Objective To investigate epidemic characteristics of a family aggregation COVID-19, and to provide scientific basis for prevention and control of family aggregation epidemic. Methods] Field epidemiological methods were used to investigate the cases and close contacts of a family aggregation COVID-19 in Y County, Chenzhou City, Hunan Province. Descriptive statistical analysis was used on epidemiological data . The 2019-nCoV nucleic acid was detected by real-time fluorescence quantitative RT-PCR. Results It was found that Ms. Deng was infected with COVID-19 and became the infectious source of the family aggregation epidemic , who had lived in Wuhan Hubei Province. Her boyfriend Mr. Cao became a second-generation case of COVID-19..Another two asymptomatic but infected persons were family members living with Ms.Deng . Conclusion COVID-19 easily spreads within families. The awareness of family members' protection, the education of new coronavirus pneumonia prevention and control in key groups should be strengthened to avoid the occurrence and spread of family aggregation epidemic.


title: COVID-19 pandemic and lacrimal practice: Multipronged resumption strategies and getting back on our feet

text: The aim of this review was to propose multi-pronged resumption strategies for lacrimal practice in an effort to plan a sustainable recommencement of elective surgeries after we emerge from the peak of COVID-19 pandemic. The strategies for lacrimal practice were classified into 7 subtypes, and each of the blueprints were reassessed based on existing information on resumption strategies of elective surgeries from other specialties in COVID-19 era. The specific needs of lacrimal practice were then added to construct algorithms summarizing the resumption strategies. The basic principle of 'primum non nocere' needs to be followed. The overall proposed plan advocates the transition to a more sustainable health care reality in a world where we would still co-exist with COVID-19. A comprehensive effort involving screening, laboratory testing, appropriate triage, effective personal protection and specific precautionary measures for lacrimal clinics and operating room are needed to be able to safely resume elective surgery when the pandemic peak declines. To predict the timing of the resumption of elective surgeries is quite complex and influenced by several geographic, political and economic factors. It is equally important to remember that COVID-19 crisis is a dynamic situation and constantly evolving, hence the strategies provided are subject to change. Strict adherence to standard COVID-19 guidelines combined with effective testing and personal protection strategies can ensure slow yet smooth and safe return to full lacrimal practice after the COVID-19 pandemic calms down. The local government directives, individual and institutional discretion are advised.


title: Understanding the Anemic Global Response to COVID-19

text: The COVID-19 outbreak is the most serious test of the international system since the 2008 global financial crisis. Rather than cooperate to contain and respond to a common threat, the world's leading powers, the United States and China, increasingly blamed each other through wildly speculative theories about the origins of the virus. The World Health Organization (WHO) sought to coordinate a global response but it has been hamstrung and come under attack. Given past cooperation between major powers to mobilize and eradicate smallpox and previous U.S. leadership to fight HIV/AIDS and the 2014 West African Ebola crisis, the limited cooperation and lack of leadership are puzzling. What explains the anemic global response to date? This paper draws from structural international relations theory to suggest a partial but somewhat dissatisfying answer. International organizations are inherently weak faced with opposition by major powers. The international system simultaneously incentivizes states to cooperate and address common threats but at the same time encourages countries to take care of themselves, potentially at the expense of others. Which of these motives dominates cannot be explained by structural theory, requiring us to look to other factors such as the attributes of states or of leaders themselves.


Prescription Restrictions on Hydroxychloroquine Among the Largest Florida Pharmacy Chains During the COVID-19 Pandemic: An Observational Study


title: The Role of Dental Professionals in Pandemic Events and Disasters Response

text: In the past 20 years, major public health emergencies and natural disasters such as the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003, the Wenchuan earthquake in 2008, and the new coronavirus in 2019 (COVID-19), which caused massive casualties, infections and mass panic. These could also result in complex demands of medical resources and information disposal, and a shortage of human resources in emergency response. To address the potential shortage of human resources in emergency response, Chinese dental professionals have done some useful work in these incidents. From the work, deficiencies in emergency response training and in the expansion of rescue capabilities were identified and improvements were made.


Cardiological society of India position statement on COVID-19 and heart failure


title: Safe use of paracetamol and high-dose NSAID analgesia in dentistry during the COVID-19 pandemic

text: With dental services currently altered, dentists are being asked to provide advice, analgesia and antibiotics in situations where they would normally be offering operative care. Dentists are familiar with using analgesia for short courses for their patients, but using higher-dose regimes and for periods of over two weeks brings special challenges. This paper reviews the areas where special precautions are needed when using analgesia in the current situation.


title: Self-reported needs of patients with Parkinson's disease during COVID-19 emergency in Italy

text: Because of COVID-19 outbreak, regular clinical services for Parkinson's disease (PD) patients have been suddenly suspended, causing worries, confusion and unexpected needs in such frail population. Here, we reviewed the messages spontaneously sent by patients to an Italian PD clinic during the first two weeks of COVID-19 lockdown (9-21 March 2020), in order to highlight their main needs and then outline appropriate strategies of care for this critical period. One hundred sixty-two messages were analysed. Forty-six percent queried about clinical services; 28% communicated an acute clinical worsening for which a therapeutic change was done in 52% of cases; 17% (those patients with younger age and milder disease) asked about the relationship between PD and COVID-19; 8% informed about an intercurrent event. Our analysis suggests that PD patients' needs during COVID-19 emergency include appropriate and complete information, a timely update on changes in clinical services, and the continuity of care, even in a remote mode. By addressing these issues, acute clinical worsening, complications and subsequent therapeutic changes could be prevented. In this perspective, telecommunication systems and virtual medicine should be implemented.


title: COVID-19: A Closer Lens

text: Generations of nurses to come, now called heroes in the media, will have challenges in providing care for persons during this global pandemic. COVID-19 has impacted all demographics, regardless of race, gender, or socioeconomic class globally. African Americans have experienced a disproportionate number of deaths related to COVID-19 in the New Orleans and surrounding Metropolitan areas. According to the Louisiana Department of Health (2020), fifty-seven percent (57.40%) of the deaths in Louisiana related to COVID-19 have been African American (Black) and fifty-five percent (55.2%) have been males as of May 11, 2020. Social determinants of health are the conditions in which people age and the conditions they are born, grow, age and work. These conditions include neighborhoods, schools, and places of employment. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels (World Health Organization, 2020). Years later the same community that comprised "pre-and post-Katrina" are now facing this pandemic.


Biceps Pulley: Normal Anatomy and Associated Lesions at MR Arthrography


title: The dramatic COVID-19 outbreak in italy is responsible of a huge drop in urological surgical activity: A multicenter observational study

text: OBJECTIVE: Italy is facing the COVID-19 outbreak with an abrupt reorganization of its national health-system, in order to augment care provision to symptomatic patients. The sudden shift of personnel and resources towards COVID-19 care has led to the reduction of surgery, with possible severe drawbacks. The aim of the study is to describe the trend in surgical volume in urology, in Italy. MATERIALS AND METHODS: Thirty-three urological units with physicians affiliated to the AGILE consortium were involved in a survey. Urologists were asked to report the amount of surgical elective procedures week-by-week, from the beginning of the emergency to the following month. RESULTS: The 33 hospitals involved in the study account, globally, for 22,945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed an overall amount of 1,213 procedures per week, half of which were oncological. One month later, the amount of surgery declined by 78%. Lombardy, the first region with positive-cases, experienced a 94% reduction. The decrease in oncological and non-oncological surgical activity was 35,9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions. CONCLUSION: Italy, the country with the highest fatality rate from COVID-19, is experiencing a sudden decline in surgical activity. It is inversely related to the increase in COVID-19 care, with potential harm particularly in the oncological field. The Italian experience can be helpful for future surgical pre-planning in other countries not so hardly hit by the disease yet.


Children are not COVID-19 super spreaders: time to go back to school


title: Early Impact of COVID-19 on the Conduct of Oncology Clinical Trials and Long-Term Opportunities for Transformation: Findings From an American Society of Clinical Oncology Survey

text: The coronavirus disease 2019 (COVID-19) pandemic has disrupted all aspects of clinical care, including cancer clinical trials. In March 2020, ASCO launched a survey of clinical programs represented on its Cancer Research Committee and Research Community Forum Steering Group and taskforces to learn about the types of changes and challenges that clinical trial programs were experiencing early in the pandemic. There were 32 survey respondents; 14 represented academic programs, and 18 represented community-based programs. Respondents indicated that COVID-19 is leading programs to halt or prioritize screening and/or enrollment for certain clinical trials and cease research-only visits. Most reported conducting remote patient care where possible and remote visits and monitoring with sponsors and/or contract research organizations (CROs); respondents viewed this shift positively. Numerous challenges with conducting clinical trials were reported, including enrollment and protocol adherence difficulties with decreased patient visits, staffing constraints, and limited availability of ancillary services. Interactions with sponsors and CROs about modifying trial procedures were also challenging. The changes in clinical trial procedures identified by the survey could serve as strategies for other programs attempting to maintain their clinical trial portfolios during the COVID-19 pandemic. Additionally, many of the adaptations to trials made during the pandemic provide a long-term opportunity to improve and transform the clinical trial system. Specific improvements could be expanded use of more pragmatic or streamlined trial designs, fewer clinical trial-related patient visits, and minimized sponsor and CRO visits to trial programs.


title: Research Progress of Coronavirus Based on Bibliometric Analysis

text: BACKGROUND: COVID-19 has become one of the most serious global epidemics in the 21st Century. This study aims to explore the distribution of research capabilities of countries, institutions, and researchers, and the hotspots and frontiers of coronavirus research in the past two decades. In it, references for funding support of urgent projects and international cooperation among research institutions are provided. METHOD: the Web of Science core collection database was used to retrieve the documents related to coronavirus published from 2003 to 2020. Citespace.5.6.R2, VOSviewer1.6.12, and Excel 2016 were used for bibliometric analysis. RESULTS: 11,036 documents were retrieved, of which China and the United States have contributed the most coronavirus studies, Hong Kong University being the top contributor. Regarding journals, the Journal of Virology has contributed the most, while in terms of researchers, Yuen Kwok Yung has made the most contributions. The proportion of documents published by international cooperation has been rising for decades. Vaccines for SARS-CoV-2 are under development, and clinical trials of several drugs are ongoing. CONCLUSIONS: international cooperation is an important way to accelerate research progress and achieve success. Developing corresponding vaccines and drugs are the current hotspots and research directions.


title: Public discourse and sentiment during the COVID-19 pandemic: using Latent Dirichlet Allocation for topic modeling on Twitter

text: The study aims to understand Twitter users' discourse and psychological reactions to COVID-19. We use machine learning techniques to analyze about 1.9 million Tweets (written in English) related to coronavirus collected from January 23 to March 7, 2020. A total of salient 11 topics are identified and then categorized into ten themes, including"updates about confirmed cases,""COVID-19 related death,""cases outside China (worldwide),""COVID-19 outbreak in South Korea,""early signs of the outbreak in New York,""Diamond Princess cruise,""economic impact,""Preventive measures,""authorities,"and"supply chain."Results do not reveal treatments and symptoms related messages as prevalent topics on Twitter. Sentiment analysis shows that fear for the unknown nature of the coronavirus is dominant in all topics. Implications and limitations of the study are also discussed.


title: Lymphocyte Subset Counts in COVID-19 Patients: A Meta-Analysis

text: A reduced peripheral blood absolute lymphocyte count with an elevated neutrophil count has been a consistent observation in hospitalized COVID-19 patients. In this brief meta-analysis, the reduction of lymphocyte subset counts in COVID-19 patients was investigated across 20 peer-reviewed studies meeting criteria for reporting lymphocyte subset counts and COVID-19 disease severity. CD4+ T cell, CD8+ T cell, B cell, NK cell and total lymphocyte cell counts all showed statistically significant reduction in patients with severe/critical COVID-19 disease compared to mild/moderate disease. T cell subsets showed the largest standardized magnitude of change. In some studies, multivariate analysis has shown that CD4 and/or CD8 T cells counts are independently predictive of patient outcomes.


Verteilung medizinischer Ressourcen in der Corona-Krise: Wer darf überleben?


Covid-19: Akkurat passe ulv./ Covid-19: Akkurat passe ulv./ Covid-19: The right amount of wolf


Testing for COVID-19 in lung cancer patients


title: A prospect on the use of antiviral drugs to control local outbreaks of COVID-19

text: BACKGROUND: Current outbreaks of COVID-19 are threatening the health care systems of several countries around the world. Control measures, based on isolation, contact tracing, and quarantine, can decrease and delay the burden of the ongoing epidemic. With respect to the ongoing COVID-19 epidemic, recent modeling work shows that these interventions may be inadequate to control local outbreaks, even when perfect isolation is assumed. The effect of infectiousness prior to symptom onset combined with asymptomatic infectees further complicates the use of contact tracing. We aim to study whether antivirals, which decrease the viral load and reduce infectiousness, could be integrated into control measures in order to augment the feasibility of controlling the epidemic. METHODS: Using a simulation-based model of viral transmission, we tested the efficacy of different intervention measures to control local COVID-19 outbreaks. For individuals that were identified through contact tracing, we evaluate two procedures: monitoring individuals for symptoms onset and testing of individuals. Additionally, we investigate the implementation of an antiviral compound combined with the contact tracing process. RESULTS: For an infectious disease in which asymptomatic and presymptomatic infections are plausible, an intervention measure based on contact tracing performs better when combined with testing instead of monitoring, provided that the test is able to detect infections during the incubation period. Antiviral drugs, in combination with contact tracing, quarantine, and isolation, result in a significant decrease of the final size and the peak incidence, and increase the probability that the outbreak will fade out. CONCLUSION: In all tested scenarios, the model highlights the benefits of control measures based on the testing of traced individuals. In addition, the administration of an antiviral drug, together with quarantine, isolation, and contact tracing, is shown to decrease the spread of the epidemic. This control measure could be an effective strategy to control local and re-emerging outbreaks of COVID-19.


COVID-19 type III hypersensitivity reaction


title: Primary exposure to SARS-CoV-2 protects against reinfection in rhesus macaques

text: Coronavirus disease 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. It currently remains unclear whether convalescing patients have a risk of reinfection. We generated a rhesus macaque model of SARS-CoV-2 infection that was characterized by interstitial pneumonia and systemic viral dissemination mainly in the respiratory and gastrointestinal tracts. Rhesus macaques reinfected with the identical SARS-CoV-2 strain during the early recovery phase of the initial SARS-CoV-2 infection did not show detectable viral dissemination, clinical manifestations of viral disease, or histopathological changes. Comparing the humoral and cellular immunity between primary infection and rechallenge revealed notably enhanced neutralizing antibody and immune responses. Our results suggest that primary SARS-CoV-2 exposure protects against subsequent reinfection in rhesus macaques.


title: Analysis of Spatial-temporal Behavior Pattern of the Share Bike Usage during COVID-19 Pandemic in Beijing

text: During the epidemics of COVID-19, the whole world is experiencing a serious crisis on public health and economy. Detailed information in the behavior of residents during epidemic benefits emergency management when one tries to design intervention strategies and resilience measures. From the perspective of movements, the widely used Bike Sharing System (BSS) in China is capable of characterizing the behavior patterns over time&space within big cities. Although share bikes are playing an important role as data sources in data mining, they could be of help but are rarely reported in pandemic-related researches. Based on the share bike records in Beijing, we constructed a behavior pattern analysis framework, then analyzed the spatiotemporal behavior patterns of residents, figured out the key time nodes of different pandemic periods, and demonstrated the variations in mobility due to the onset of the COVID-19 threat and administrative restrictions. The impact of the pandemic was assessed by performing co-location analysis between share bike usage and POIs (Point Of Interest). Classification of POIs is helpful to distinguish the behavior patterns generated by various the productive and social activities. Discussions with evolving confirmed COVID-19 cases suggest the effectiveness and necessity of the public interventions in the COVID-19 containment during the resilience period. These findings provide critical information on how to respond to the current COVID-19 outbreak and other epidemic events.


title: Imaging of coronavirus disease 2019: A Chinese expert consensus statement

text: Coronavirus disease 2019 (COVID-19) is highly contagious, mainly causing inflammatory lesions in the lungs, and can also cause damage to the intestine and liver. The rapid spread of the virus that causes coronavirus disease 2019 (COVID-19) pneumonia has posed complex challenges to global public health. Early detection, isolation, diagnosis, and treatment are the most effective means of prevention and control. At present, the epidemic situation of new coronavirus infection has tended to be controlled in China, and it is still in a period of rapid rise in much of the world. The current gold standard for the diagnosis of COVID-19 is the detection of coronavirus nucleic acids, but imaging has an important role in the detection of lung lesions, stratification, evaluation of treatment strategies, and differentiation of mixed infections. This Chinese expert consensus statement summarizes the imaging features of COVID-19 pneumonia and may help radiologists across the world to understand this disease better.


title: Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (COVID-19)

text: The outbreak of the coronavirus disease 2019 (Covid-19) has become an evolving worldwide health crisis. With the rising prevalence of obesity and diabetes has come an increasing awareness of their impacts on infectious diseases, including increased risk for various infections, post-infection complications and mortality from critical infections. Although epidemiological and clinical characteristics of Covid-19 have been constantly reported, no article has systematically illustrated the role of obesity and diabetes in Covid-19, or how Covid-19 affects obesity and diabetes, or special treatment in these at-risk populations. Here, we present a synthesis of the recent advances in our understanding of the relationships between obesity, diabetes and Covid-19 along with the underlying mechanisms, and provide special treatment guidance for these at-risk populations.


The value of targeting recombination as a strategy against coronavirus diseases


title: Risks of ACE Inhibitor and ARB Usage in COVID-19: Evaluating the Evidence

text: Concerns have been raised regarding the safety of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in patients with coronavirus disease of 2019 (COVID-19), based on the hypothesis that such medications may raise expression of ACE2, the receptor for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). We conducted a literature review of studies (n = 12) in experimental animals and human subjects (n = 12) and evaluated the evidence regarding the impact of administration of ACEIs and ARBs on ACE2 expression. We prioritized studies that assessed ACE2 protein expression data, measured directly or inferred from ACE2 activity assays. The findings in animals are inconsistent with respect to an increase in ACE2 expression in response to treatment with ACEIs or ARBs. Control/sham animals show little to no effect in the plurality of studies. Those studies that report increases in ACE2 expression tend to involve acute injury models and/or higher doses of ACEIs or ARBs than are typically administered to patients. Data from human studies overwhelmingly imply that administration of ACEIs/ARBs does not increase ACE2 expression. Available evidence, in particular, data from human studies, does not support the hypothesis that ACEI/ARB use increases ACE2 expression and the risk of complications from COVID-19. We conclude that patients being treated with ACEIs and ARBs should continue their use for approved indications.


Lessons learned from COVID-19 epidemic in Iran: The role of medical education


title: Immersion in an emergency department triage center during the Covid-19 outbreak: first report of the Liège University hospital experience

text: OBJECTIVES: Since the beginning of the novel coronavirus outbreak, different strategies have been explored to stem the spread of the disease and appropriately manage patient flow. Triage, an effective solution proposed in disaster medicine, also works well to manage Emergency Department (ED) flow. The aim of this study was to describe the role of an ED Triage Center for patients with suspected novel coronavirus disease (Covid-19) and characterize the patient flow. METHODS: In March 2020, we established a Covid-19 triage center close to the Liège University EDs. From March 2 to March 23, we planned to analyze the specific flow of patients admitted to this triage zone and their characteristics in terms of inner specificities, work-up and management. During this period, all patients presented to the ED with symptoms suggestive of Covid-19 were included in the study. RESULTS: A total amount of 1071 patients presented to the triage center during the study period. 41.50% of the patients presented with flu-like symptoms. In 82.00% of the cases, no risk factor of virus transmission was found. The SARS-Cov2 positive patients represented 29.26% of the screened patients. 83.00% of patients were discharged home while 17.00% were admitted to the hospital. CONCLUSION: Our experience suggests that triage centers for the assessment and management of Covid-19 suspected patients is an essential key strategy to prevent the spread of the disease among non-symptomatic patients who present to the EDs for care. This allows for a disease-centered work-up and safer diversion of Covid-19 patients to specific hospital units.


Drive-Through COVID-19 Testing During the 2020 Pandemic: A Safe, Efficient, and Scalable Model for Pediatric Patients and Health Care Workers


Increased rates of hand ischemia following arterial cannulation in patients with severe COVID19-related pneumonia


Mechano-genomic regulation of coronaviruses and its interplay with ageing


title: Some numerical observations about the COVID-19 epidemic in Italy

text: We give some numerical observations on the total number of infected by the SARS-CoV-2 in Italy. The analysis is based on a tanh formula involving two parameters. A polynomial correlation between the parameters gives an upper bound for the time of the peak of new infected. A numerical indicator of the temporal variability of the upper bound is introduced. The result and the possibility to extend the analysis to other countries are discussed in the conclusions.


Epidemiological and Clinical Characteristics of 99 Cases of 2019-Novel Coronavirus (2019-nCoV) Pneumonia in Wuhan, China


Rethinking the role of senior medical students in the COVID-19 response


title: Epidemic Models as Scaling Limits of Individual Dynamics

text: Infection spread among individuals is modelled with a continuous time Markov chain, in which subject interactions depend on their distance in space. The well known SIR model and non local variants of the latter are then obtained as large scale limits of the individual based model in two different scaling regimes of the interaction.


title: Association of Obesity with Disease Severity Among Patients with Coronavirus Disease 2019

text: OBJECTIVE: The aim of this study was to explore the potential association of obesity and other chronic diseases with severe outcomes, such as intensive care unit (ICU) admission and invasive mechanical ventilation (IMV), in patients hospitalized with coronavirus disease 2019 (COVID-19). METHODS: This study analyzed a retrospective cohort of 103 patients hospitalized with COVID-19. Demographic data, past medical history, and hospital course were collected and analyzed. A multivariate logistic regression analysis was implemented to examine associations. RESULTS: From February 17 to April 5, 103 consecutive patients were hospitalized with COVID-19. Among them, 44 patients (42.7%) were admitted to the ICU, and 29 (65.9%) required IMV. The prevalence of obesity was 47.5% (49 of 103). In a multivariate analysis, severe obesity (BMI ≥ 35 kg/m2 ) was associated with ICU admission (adjusted odds ratio [aOR]: 5.39, 95% CI: 1.13-25.64). Moreover, patients who required IMV were more likely to have had heart disease (aOR: 3.41, 95% CI: 1.05-11.06), obesity (BMI = 30-34.9 kg/m2 ; aOR: 6.85, 95% CI: 1.05-44.82), or severe obesity (BMI ≥ 35 kg/m2 ; aOR: 9.99, 95% CI: 1.39-71.69). CONCLUSIONS: In our analysis, severe obesity (BMI ≥ 35 kg/m2 ) was associated with ICU admission, whereas history of heart disease and obesity (BMI ≥ 30 kg/m2 ) were independently associated with the use of IMV. Increased vigilance and aggressive treatment of patients with obesity and COVID-19 are warranted.


title: The Impact of Video-Mediated Communication on Closed Wound Assessments in Postoperative Consultations: Conversation Analytical Study

text: BACKGROUND: Research on the use of video-mediated technology for medical consultations is increasing rapidly. Most research in this area is based on questionnaires and focuses on long-term conditions. The few studies that have focused on physical examinations in video consultations indicated that it poses challenges for the participants. The specific activity of wound assessment through video in postsurgery consultations has not yet been studied. Furthermore, a comparative analysis of face-to-face and video settings on the moment-to-moment organization of such an activity is original. OBJECTIVE: The aim of this study was to examine the impact of video technology on the procedure of postsurgery wound assessment and its limits. METHODS: We recorded 22 postoperative video consultations and 17 postoperative face-to-face consultations. The primary purpose of the consultation was to inform the patient about the final pathology results of the resected specimen, and the secondary purpose was to check on the patient's recovery, including an assessment of the closed wound. The recordings were transcribed in detail and analyzed using methods of conversation analysis. RESULTS: The way that an assessment of the wound is established in video consultations differs from the procedure in face-to-face consultations. In the consultation room, wound assessments overwhelmingly (n=15/17) involve wound showings in the context of surgeons reporting their observations formatted with evidentials ("looks neat") and subsequently assessing what these observations imply or what could be concluded from them. In contrast, wound assessments in video consultations do not tend to involve showing the wound (n=3/22) and, given the technological restrictions, do not involve palpation. Rather, the surgeon invites the patient to assess the wound, which opens up a sequence of patient and physician assessments where diagnostic criteria such as redness or swollenness are made explicit. In contrast to observations in regular consultations, these assessments are characterized by epistemic markers of uncertainty ("I think," "sounds...good") and evidentials are absent. Even in cases of a potential wound problem, the surgeon may rely on questioning the patient rather than requesting a showing. CONCLUSIONS: The impact of video technology on postoperative consultations is that a conclusive wound assessment is arrived at in a different way when compared to face-to-face consultations. In video consultations, physicians enquire and patients provide their own observations, which serve as the basis for the assessment. This means that, in video consultations, patients have a fundamentally different role. These talking-based assessments are effective unless, in cases of a potential problem, patient answers seem insufficient and a showing might be beneficial.


title: Novel coronavirus pandemic: A clinical overview

text: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emergent public health crisis threatening the current world health establishment. The SARS-Co-2 was first identified in Wuhan, Hubei Province, China, in December 2019. There have been about 6.5 million reported cases of coronavirus disease 2019 (COVID-19) and about 350 000 reported deaths throughout the world within the last 6 months from the onset of the epidemic. The virus is primarily transmitted by inhalation or contact with infected droplets. The COVID-19 patient usually presents with fever, cough, sore throat and breathlessness. Currently, available data indicate that the majority of people with the disease have mild symptoms, while about 20% present with moderate-to-severe disease. About 5% of these may progress to pneumonia, acute respiratory distress syndrome and multi-organ dysfunction. To date, there is no recommended medical treatment, and supportive measures are a crucial part of management. The case fatality rate of SARS-CoV-2 is lower than that of its two coronavirus predecessors, that is, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). The full impact of this new pandemic on health, social and economic well-being of humankind is yet to be ascertained.


title: A tale of two crises: The compounded effect of COVID-19 and anti-immigration policy in the United States

text: The COVID-19 pandemic is highlighting some important sources of health disparities that assail our society's most vulnerable people, particularly undocumented immigrants and asylum seekers. The focus of this commentary is on uncovering those sources of health disparities and making a call for action. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Optimizing teledermatology visits for dermatology resident education during the COVID-19 pandemic


School Superintendents Confront COVID-19-"There Are No Good Options for Next Year"


Social Justice, Triage, and COVID-19: Ignore Life-years Saved


title: Management strategies of autoimmune bullous diseases during the outbreak of 2019 Novel Coronavirus disease (COVID-19)

text: Since late December 2019, an outbreak of the novel coronavirus disease, which is mainly characterized by pulmonary lesions, has spread quickly worldwide. With the spread of the novel coronavirus, the outpatient lines of hospitals have mostly shut down, which means that routine clinical diagnosis and treatment for autoimmune bullous diseases patients have been disturbed. Due to the serious condition of autoimmune bullous diseases patients, they are prone to immune suppression and circulatory failure, and are more susceptible to infection than healthy individuals. These patients should thus be a priority group for novel coronavirus disease prevention. In this context, the protection and control measures for autoimmune bullous diseases patients against the novel coronavirus are of serious concern. Clinicians should strengthen their communication with patients, pay attention to changes in patients' conditions, and carefully adjust the treatment strategy, while protecting against the novel coronavirus infection, to ensure the continuity, safety, and effectiveness of autoimmune bullous diseases treatment.


title: Immunoinformatics-guided designing of epitope-based subunit vaccines against the SARS Coronavirus-2 (SARS-CoV-2)

text: SARS Coronavirus-2 (SARS-CoV-2) pandemic has become a global issue which has raised the concern of scientific community to design and discover a counter-measure against this deadly virus. So far, the pandemic has caused the death of hundreds of thousands of people upon infection and spreading. To date, no effective vaccine is available which can combat the infection caused by this virus. Therefore, this study was conducted to design possible epitope-based subunit vaccines against the SARS-CoV-2 virus using the approaches of reverse vaccinology and immunoinformatics. Upon continual computational experimentation, three possible vaccine constructs were designed and one vaccine construct was selected as the best vaccine based on molecular docking study which is supposed to effectively act against the SARS-CoV-2. Thereafter, the molecular dynamics simulation and in silico codon adaptation experiments were carried out in order to check biological stability and find effective mass production strategy of the selected vaccine. This study should contribute to uphold the present efforts of the researches to secure a definitive preventative measure against this lethal disease.


Circumnavigating the challenges of COVID-19 in oncology


Covid-19 and Kawasaki syndrome


title: Correction to: Treatment of severely ill COVID-19 patients with anti-interleukin drugs (COV-AID): A structured summary of a study protocol for a randomised controlled trial

text: An amendment to this paper has been published and can be accessed via the original article.


title: Two X-linked agammaglobulinemia patients develop pneumonia as COVID-19 manifestation but recover

text: BACKGROUND: The recent SARS-CoV-2 pandemic, which has recently affected Italy since February 21, constitutes a threat to normal subjects, as the coronavirus disease-19 (COVID-19) can manifest with a broad spectrum of clinical phenotypes ranging from asymptomatic cases to pneumonia or even death. There is evidence that older age and several comorbidities can affect the risk to develop severe pneumonia and possibly the need of mechanic ventilation in subjects infected with SARS-CoV-2. Therefore, we evaluated the outcome of SARS-CoV-2 infection in patients with inborn errors of immunity (IEI) such as X-linked agammaglobulinemia (XLA). METHODS: When the SARS-CoV-2 epidemic has reached Italy, we have activated a surveillance protocol of patients with IEI, to perform SARS-CoV-2 search by nasopharyngeal swab in patients presenting with symptoms that could be a manifestation of COVID-19, such as fever, cough, diarrhea, or vomiting. RESULTS: We describe two patients with X-linked agammaglobulinemia (XLA) aged 34 and 26 years with complete absence of B cells from peripheral blood who developed COVID-19, as diagnosed by SARS-CoV-2 detection by nasopharyngeal swab, while receiving immunoglobulin infusions. Both patients developed interstitial pneumonia characterized by fever, cough, and anorexia and associated with elevation of CRP and ferritin, but have never required oxygen ventilation or intensive care. CONCLUSION: Our report suggests that XLA patients might present with high risk to develop pneumonia after SARS-CoV-2 infection, but can recover from infection, suggesting that B-cell response might be important, but is not strictly required to overcome the disease. However, there is a need for larger observational studies to extend these conclusions to other patients with similar genetic immune defects.


title: Clinical characteristics of COVID-19 in children compared with adults in Shandong Province, China

text: AIMS AND BACKGROUND: The COVID-19 outbreak spread in China and is a threat to the world. We reported on the epidemiological, clinical, laboratory, and radiological characteristics of children cases to help health workers better understand and provide timely diagnosis and treatment. METHODS: Retrospectively, two research centers' case series of 67 consecutive hospitalized cases including 53 adult and 14 children cases with COVID-19 between 23 Jan 2020 and 15 Feb 2020 from Jinan and Rizhao were enrolled in this study. Epidemiological, clinical, laboratory, and radiological characteristics of children and adults were analyzed and compared. RESULTS: Most cases in children were mild (21.4%) and conventional cases (78.6%), with mild clinical signs and symptoms, and all cases were of family clusters. Fever (35.7%) and dry cough (21.4%) were described as clinical manifestations in children cases. Dry cough and phlegm were not the most common symptoms in children compared with adults (p = 0.03). In the early stages of the disease, lymphocyte counts did not significantly decline but neutrophils count did in children compared with adults (p = 0.02). There was a lower level of CRP (p = 0.00) in children compared with adults. There were 8 (57.1%) asymptomatic cases and 6 (42.9%) symptomatic cases among the 14 children cases. The age of asymptomatic patients was younger than that of symptomatic patients (p = 0.03). Even among asymptomatic patients, 5 (62.5%) cases had lung injuries including 3 (60%) cases with bilateral involvement, which was not different compared with that of symptomatic cases (p = 0.58, p = 0.74). CONCLUSIONS: The clinical symptoms of children are mild, there is substantial lung injury even among children, but that there is less clinical disease, perhaps because of a less pronounced inflammatory response, and that the occurrence of this pattern appears to inversely correlate with age.


title: Systematic rapid living review on rehabilitation needs due to Covid-19: update to April 30th 2020

text: BACKGROUND: This paper adds to the series of systematic rapid living reviews, started in April 2020, to provide the rehabilitation community with updates on the latest scientific literature on rehabilitation needs due to Covid-19 pandemic. OBJECTIVES: To present the results of a systematic scientific literature search performed on papers published from April 1st to April 30th, 2020. METHODS: A systematic search was performed on PubMed, Embase, Scopus, CINAHL, PEDro, Web of Science and the main international guideline databases for articles published (including Epub), in English, from April 1st to April 30th, 2020. Papers were included if they reported on one of the following: 1) prevalence and features of the emerging disability after Covid-19; 2) rehabilitation strategies applied for Covid-19 patients, regardless of setting or stage; 3) information about rehabilitation services after Covid-19; 4) impact on diseases of rehabilitative interest; 5) complications of rehabilitative interest. RESULTS: Out of 445 articles retrieved for the time frame, 50 were finally included for qualitative analysis. They consist of 7 guidelines, 1 scoping review, 1 randomized controlled trial, 4 descriptive studies (qualitative), 1 case series, 1 case report, and 35 expert opinions. CONCLUSIONS: This systematic rapid living review showed an increasing evidence on rehabilitation needs due to COVID-19 outbreak during April 2020. The main novelties include: 1) the first appearance of epidemiological data on the likely high incidence of neurological complications/disabling sequelae in patients hospitalized for COVID-19; 2) rapid guidelines on the management of chronically disabled patients in the COVID-19 era; 3) advices to provide COVID-19 patients with early respiratory rehabilitation in the acute phase, and with telemonitoring and telerehabilitation in the post-acute phase. Although the overall quality of studies has increased, prospective cohort studies on disability course in COVID-19 pandemic and experimental studies on the effects of rehabilitation are still warranted.


SARS-CoV-2 Infection among Travelers Returning from Wuhan, China


ACE2 at the centre of COVID-19 from paucisymptomatic infections to severe pneumonia


Reduced hospital admissions for ACS - more collateral damage from COVID-19


A Spanish-translated clinical algorithm for management of suspected SARS-CoV-2 infection in pregnant women


title: Thrombotic risk in COVID-19: a case series and case-control study

text: BACKGROUND: A possible association between COVID-19 infection and thrombosis, either as a direct consequence of the virus or as a complication of inflammation, is emerging in the literature. Data on the incidence of venous thromboembolism (VTE) are extremely limited. METHODS: We describe three cases of thromboembolism refractory to heparin treatment, the incidence of VTE in an inpatient cohort, and a case-control study to identify risk factors associated with VTE. RESULTS: We identified 274 confirmed (208) or probable (66) COVID-19 patients. 21 (7.7%) were diagnosed with VTE. D-dimer was elevated in both cases (confirmed VTE) and controls (no confirmed VTE) but higher levels were seen in confirmed VTE cases (4.1 vs 1.2 µg/mL, P<0.001). CONCLUSION: Incidence of VTE is high in patients hospitalised with COVID-19. Urgent clinical trials are needed to evaluate the role of anticoagulation in COVID-19. Monitoring of D-dimer and anti-factor Xa levels may be beneficial in guiding management.


In-hospital treatment of COVID-19 patients


title: Deep thought of COVID-19 based on Diamond Princess's quarantine and home quarantine

text: Not Available.


Mapping the T cell response to COVID-19


title: Sunlight exposure increased Covid-19 recovery rates: A study in the central pandemic area of Indonesia

text: This study aims to present the correlation between sunlight exposure and Covid-19 statuses in Jakarta, Indonesia. The secondary data analysis was derived from surveillance data for Covid-19 from government authorities, including the Ministry of Health, the Meteorological, Climatological, and Geophysical Agency, and the local government of Jakarta. Three statuses related to Covid-19 were examined in the study: incidence, death, and recovered. Meanwhile, sunlight exposure was presented as daily duration of it. Only the number of recovered patients correlated significantly with sunlight exposure (p-value = .025; r = 0.350). This study's findings showed that sunlight exposure was associated with recovery from Covid-19.


title: 25-Hydroxyvitamin D Concentrations Are Lower in Patients with Positive PCR for SARS-CoV-2

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), with a clinical outcome ranging from mild to severe, including death. To date, it is unclear why some patients develop severe symptoms. Many authors have suggested the involvement of vitamin D in reducing the risk of infections; thus, we retrospectively investigated the 25-hydroxyvitamin D (25(OH)D) concentrations in plasma obtained from a cohort of patients from Switzerland. In this cohort, significantly lower 25(OH)D levels (p = 0.004) were found in PCR-positive for SARS-CoV-2 (median value 11.1 ng/mL) patients compared with negative patients (24.6 ng/mL); this was also confirmed by stratifying patients according to age >70 years. On the basis of this preliminary observation, vitamin D supplementation might be a useful measure to reduce the risk of infection. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations and to confirm our preliminary observation.


title: Contributions to the systematic of Pimelodidae (Osteichthyes, Siluriformes): basic and molecular cytogenetics on seven species of Pimelodus from three Brazilian hydrographic systems

text: Pimelodidae harbors several species and is widely distributed throughout the Neotropical region. Pimelodus is the genus with the largest number of species, however it is a polyphyletic group. Cytogenetic analyzes of the valid species still covers less than half of them. Herein, seven Pimelodus species from three Brazilian hydrographic systems were analyzed through basic (Giemsa, AgNORs and C banding) and molecular (5S and 18S rDNA-FISH) cytogenetic methods. All species had 2n=56 chromosomes with different karyotype formulas observed among the species. AgNORs were corresponding to 18S rDNA and localized on long arm of one chromosome pair in all species. Heterochromatin distribution follows the pattern commonly verified in the family and allows to identify each one of the studied species. 5S rDNA marker was interspecifically variable in number and position of cistrons. Pimelodus ortmanni had B chromosomes varying intra and inter-individually. We performed a discussion on our own and available cytogenetic data for Pimelodidae, and the associating of them with available phylogeny enable us identifying features that distinguish subgroups within Pimelodidae, such as NORs location (terminal/long arm for species belonging to "Iheringichthys-Parapimelodus" and "Pimelodus maculatus" subclades) and location of 5S rDNA sites (pericentromeric/interstitial/ long arm for species belonging to Pimelodus group).(AU)


title: An "alarming" and "exceptionally high" rate of COVID-19 retractions?

text: More than 20 papers about COVID-19 have been retracted at the time of this writing. It is premature, however, to conclude that such work is being retracted at higher rates than the rest of the literature.


title: Coronavirus Disease Exposure and Spread from Nightclubs, South Korea

text: At least 246 cases of coronavirus disease (COVID-19) have been linked to nightclubs in Seoul, South Korea. During the April 30-May 5 holiday, young adults from across the country who visited nightclubs in Seoul contracted COVID-19 and spread it nationally. Nightclubs were temporarily closed to limit COVID-19 spread.


Covid-19: A&E visits in England fall by 25% in week after lockdown


WHO must prioritise the needs of older people in its response to the covid-19 pandemic


Thousands of coronavirus tests are going unused in US labs


title: COVID-19 pandemic from an ophthalmology point of view

text: Coronavirus disease 2019 (COVID-19) is caused by a highly contagious RNA virus termed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Ophthalmologists are at high-risk due to their proximity and short working distance at the time of slit-lamp examination. Eye care professionals can be caught unaware because conjunctivitis may be one of the first signs of COVID-19 at presentation, even precluding the emergence of additional symptoms such as dry cough and anosmia. Breath and eye shields as well as N95 masks, should be worn while examining patients with fever, breathlessness, or any history of international travel or travel from any hotspot besides maintaining hand hygiene. All elective surgeries need to be deferred. Adults or children with sudden-onset painful or painless visual loss, or sudden-onset squint, or sudden-onset floaters or severe lid oedema need a referral for urgent care. Patients should be told to discontinue contact lens wear if they have any symptoms of COVID-19. Cornea retrieval should be avoided in confirmed cases and suspects, and long-term preservation medium for storage of corneas should be encouraged. Retinal screening is unnecessary for coronavirus patients taking chloroquine or hydroxychloroquine as the probability of toxic damage to the retina is less due to short-duration of drug therapy. Tele-ophthalmology and artificial intelligence should be preferred for increasing doctor-patient interaction.


Anestesia espinhal em pacientes com COVID19, mais pesquisa é necessária./ [Spinal anesthesia in COVID-19 patients, more research is needed]


title: YouTube as source of information on 2019 novel coronavirus outbreak: a cross sectional study of English and Mandarin content

text: BACKGROUND: The current 2019 novel coronavirus outbreak is rapidly evolving. YouTube has been recognized as a popular source of information in previous disease outbreaks. We analyzed the content on YouTube about n-CoV in English and Mandarin languages. METHODS: YouTube was searched using the terms '2019 novel coronavirus', 'Wuhan virus' and '' (Mandarin for Wuhan virus) on 1st and 2nd February 2020. First 50 videos in each group were analyzed. Videos in other languages, duplicate videos, those without an audio and duration >15 min were excluded .72 videos in English and 42 in Mandarin were reviewed. 2 reviewers classified the videos as useful, misleading or news based on pre specified criterion. Inter-observer agreement was evaluated with kappa coefficient. Modified DISCERN index for reliability and medical information and content index (MICI) score were used for content analysis. RESULTS: These videos attracted cumulative 21,288,856 views. 67% of English and 50% Mandarin videos had useful information. The viewership of misleading Mandarin videos was higher than the useful ones. WHO accounted for only 4% of useful videos. Mean DISCERN score for reliability was 3.12/5 and 3.25/5 for English and Mandarin videos respectively. Mean cumulative MICI score of useful videos was low (6.71/25 for English and 6.28/25 for Mandarin). CONCLUSIONS: YouTube viewership during 2019 n-CoV outbreak is higher than previous outbreaks. The medical content of videos is suboptimal International health agencies are underrepresented. Given its popularity, YouTube should be considered as important platform for information dissemination.


title: memeBot: Towards Automatic Image Meme Generation

text: Image memes have become a widespread tool used by people for interacting and exchanging ideas over social media, blogs, and open messengers. This work proposes to treat automatic image meme generation as a translation process, and further present an end to end neural and probabilistic approach to generate an image-based meme for any given sentence using an encoder-decoder architecture. For a given input sentence, an image meme is generated by combining a meme template image and a text caption where the meme template image is selected from a set of popular candidates using a selection module, and the meme caption is generated by an encoder-decoder model. An encoder is used to map the selected meme template and the input sentence into a meme embedding and a decoder is used to decode the meme caption from the meme embedding. The generated natural language meme caption is conditioned on the input sentence and the selected meme template. The model learns the dependencies between the meme captions and the meme template images and generates new memes using the learned dependencies. The quality of the generated captions and the generated memes is evaluated through both automated and human evaluation. An experiment is designed to score how well the generated memes can represent the tweets from Twitter conversations. Experiments on Twitter data show the efficacy of the model in generating memes for sentences in online social interaction.


title: Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France

text: BACKGROUND: In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19. METHODS: We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and >10 day hospitalization) and viral shedding persistence (>10 days). RESULTS: A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years - range 14-95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74-95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta-blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision). CONCLUSION: Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients.


No evidence of clinical benefits of early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: Comment on "Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France"


title: Development and execution of a pandemic preparedness plan: Therapeutic medical physics and radiation dosimetry during the COVID-19 crisis

text: The SARS-CoV-2 coronavirus pandemic has spread around the world including the United States. New York State has been hardest hit by the virus with over 380 000 citizens with confirmed COVID-19, the illness associated with the SARS-CoV-2 virus. At our institution, the medical physics and dosimetry group developed a pandemic preparedness plan to ensure continued operation of our service. Actions taken included launching remote access to clinical systems for all dosimetrists and physicists, establishing lines of communication among staff members, and altering coverage schedules to limit on-site presence and decrease risk of infection. The preparedness plan was activated March 23, 2020, and data were collected on treatment planning and chart checking efficiency for 6 weeks. External beam patient load decreased by 25% during the COVID-19 crisis, and special procedures were almost entirely eliminated excepting urgent stereotactic radiosurgery or brachytherapy. Efficiency of treatment planning and chart checking was slightly better than a comparable 6-week interval in 2019. This is most likely due to decreased patient load: Fewer plans to generate and more physicists available for checking without special procedure coverage. Physicists and dosimetrists completed a survey about their experience during the crisis and responded positively about the preparedness plan and their altered work arrangements, though technical problems and connectivity issues made the transition to remote work difficult. Overall, the medical physics and dosimetry group successfully maintained high-quality, efficient care while minimizing risk to the staff by minimizing on-site presence. Currently, the number of COVID-19 cases in our area is decreasing, but the preparedness plan has demonstrated efficacy, and we will be ready to activate the plan should COVID-19 return or an unknown virus manifest in the future.


How likely are COVID-19 interventions to benefit the sickest patients?


Caring for cardiac patients amidst the SARS-CoV-2 pandemic: The scrambled pieces of the puzzle


Religious tourism and mass religious gatherings - The potential link in the spread of COVID-19. Current perspective and future implications


title: Large-scale ligand-based virtual screening for SARS-CoV-2 inhibitors using deep neural networks

text: Due to the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there is an urgent need for novel therapies and drugs. We conducted a large-scale virtual screening for small molecules that are potential CoV-2 inhibitors. To this end, we utilized"ChemAI", a deep neural network trained on more than 220M data points across 3.6M molecules from three public drug-discovery databases. With ChemAI, we screened and ranked one billion molecules from the ZINC database for favourable effects against CoV-2. We then reduced the result to the 30,000 top-ranked compounds, which are readily accessible and purchasable via the ZINC database. Additionally, we screened the DrugBank using ChemAI to allow for drug repurposing, which would be a fast way towards a therapy. We provide these top-ranked compounds of ZINC and DrugBank as a library for further screening with bioassays at https://github.com/ml-jku/sars-cov-inhibitors-chemai.


title: Clinical Features of Maintenance Hemodialysis Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

text: BACKGROUND AND OBJECTIVES: Previous reports on the outbreak of coronavirus disease 2019 were on the basis of data from the general population. Our study aimed to investigate the clinical features of patients on maintenance hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this retrospective, single-center study, we included 49 hospitalized patients on maintenance hemodialysis and 52 hospitalized patients without kidney failure (controls) with confirmed coronavirus disease 2019 at Tongren Hospital of Wuhan University from January 30, 2020 to March 10, 2020. Demographic, clinical, laboratory, and radiologic characteristics and treatment and outcomes data were analyzed. The final date of follow-up was March 19, 2020. RESULTS: The median age of 101 patients was 62 years (interquartile range, 49-72). All patients were local residents of Wuhan. In terms of common symptoms, there were differences between patients on hemodialysis and controls (fatigue [59% versus 83%], dry cough [49% versus 71%], and fever [47% versus 90%]). Lymphocyte counts were decreased (0.8×109/L [patients on hemodialysis] versus 0.9×109/L [controls], P=0.02). Comparing patients on hemodialysis with controls, creatine kinase-muscle and brain type, myoglobin, hypersensitive troponin I, B-type natriuretic peptide, and procalcitonin were increased, and the percentage of abnormalities in bilateral lung was higher in computed tomographic scan (82% versus 69%, P=0.15) and unilateral lung was lower (10% versus 27%, P=0.03). Common complications including shock, acute respiratory distress syndrome, arrhythmia, and acute cardiac injury in patients on hemodialysis were significantly higher. Compared with controls, more patients on hemodialysis received noninvasive ventilation (25% versus 6%, P=0.008). As of March 19, 2020, three patients on hemodialysis (6%) were transferred to the intensive care unit and received invasive ventilation. Seven patients on hemodialysis (14%) had died. CONCLUSIONS: The main symptoms of coronavirus disease 2019 pneumonia, including fever and cough, were less common in patients on hemodialysis. Patients on hemodialysis with coronavirus disease 2019 were at higher risk of death.


title: Targeting Learning: Robust Statistics for Reproducible Research

text: Targeted Learning is a subfield of statistics that unifies advances in causal inference, machine learning and statistical theory to help answer scientifically impactful questions with statistical confidence. Targeted Learning is driven by complex problems in data science and has been implemented in a diversity of real-world scenarios: observational studies with missing treatments and outcomes, personalized interventions, longitudinal settings with time-varying treatment regimes, survival analysis, adaptive randomized trials, mediation analysis, and networks of connected subjects. In contrast to the (mis)application of restrictive modeling strategies that dominate the current practice of statistics, Targeted Learning establishes a principled standard for statistical estimation and inference (i.e., confidence intervals and p-values). This multiply robust approach is accompanied by a guiding roadmap and a burgeoning software ecosystem, both of which provide guidance on the construction of estimators optimized to best answer the motivating question. The roadmap of Targeted Learning emphasizes tailoring statistical procedures so as to minimize their assumptions, carefully grounding them only in the scientific knowledge available. The end result is a framework that honestly reflects the uncertainty in both the background knowledge and the available data in order to draw reliable conclusions from statistical analyses - ultimately enhancing the reproducibility and rigor of scientific findings.


title: Clinical and Autoimmune Characteristics of Severe and Critical Cases of COVID-19

text: In this study we report on the clinical and autoimmune characteristics of severe and critical novel coronavirus pneumonia caused by severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2). The clinical, autoimmune, and laboratory characteristics of 21 patients who had laboratory-confirmed severe and critical cases of coronavirus disease 2019 (COVID-19) from the intensive care unit of the Huangshi Central Hospital, Hubei Province, China, were investigated. A total of 21 patients (13 men and 8 women), including 8 (38.1%) severe cases and 13 (61.9%) critical cases, were enrolled. Cough (90.5%) and fever (81.0%) were the dominant symptoms, and most patients (76.2%) had at least one coexisting disorder on admission. The most common characteristics on chest computed tomography were ground-glass opacity (100%) and bilateral patchy shadowing (76.2%). The most common findings on laboratory measurement were lymphocytopenia (85.7%) and elevated levels of C-reactive protein (94.7%) and interleukin-6 (89.5%). The prevalence of anti-52 kDa SSA/Ro antibody, anti-60 kDa SSA/Ro antibody, and antinuclear antibody was 20%, 25%, and 50%, respectively. We also retrospectively analyzed the clinical and laboratory data from 21 severe and critical cases of COVID-19. Autoimmune phenomena exist in COVID-19 subjects, and the present results provide the rationale for a strategy of preventing immune dysfunction and optimal immunosuppressive therapy.


title: Case fatality risk of the first pandemic wave of novel coronavirus disease 2019 (COVID-19) in China

text: OBJECTIVE: To assess the case fatality risk (CFR) of COVID-19 in mainland China, stratified by region and clinical category, and estimate key time-to-event intervals. METHODS: We collected individual information and aggregated data on COVID-19 cases from publicly available official sources from December 29, 2019 to April 17, 2020. We accounted for right-censoring to estimate the CFR and explored the risk factors for mortality. We fitted Weibull, gamma, and lognormal distributions to time-to-event data using maximum-likelihood estimation. RESULTS: We analyzed 82,719 laboratory-confirmed cases reported in mainland China, including 4,632 deaths, and 77,029 discharges. The estimated CFR was 5.65% (95%CI: 5.50%-5.81%) nationally, with highest estimate in Wuhan (7.71%), and lowest in provinces outside Hubei (0.86%). The fatality risk among critical patients was 3.6 times that of all patients, and 0.8-10.3 fold higher than that of mild-to-severe patients. Older age (OR 1.14 per year; 95%CI: 1.11-1.16), and being male (OR 1.83; 95%CI: 1.10-3.04) were risk factors for mortality. The time from symptom onset to first healthcare consultation, time from symptom onset to laboratory confirmation, and time from symptom onset to hospitalization were consistently longer for deceased patients than for those who recovered. CONCLUSIONS: Our CFR estimates based on laboratory-confirmed cases ascertained in mainland China suggest that COVID-19 is more severe than the 2009 H1N1 influenza pandemic in hospitalized patients, particularly in Wuhan. Our study provides a comprehensive picture of the severity of the first wave of the pandemic in China. Our estimates can help inform models and the global response to COVID-19.


A Rapid Fatal Evolution of Coronavirus Disease-19 in a Patient With Advanced Lung Cancer With a Long-Time Response to Nivolumab


title: Heat warning and public and workers' health at the time of COVID-19 pandemic

text: The humanity is currently facing the COVID-19 pandemic challenge, the largest global health emergency after the Second World War. During summer months, many countries in the northern hemisphere will also have to counteract an imminent seasonal phenomenon, the management of extreme heat events. The novelty this year concerns that the world population will have to deal with a new situation that foresees the application of specific measures, including adjunctive personal protective equipment (i.e. facemasks and gloves), in order to reduce the potential transmission of the SARS-CoV-2 virus. These measures should help to decrease the risk of the infection transmission but will also represent an aggravating factor to counteract the heat effects on the population health both at occupational and environmental level. The use of a specific heat health warning system with personalized information based on individual, behavioural and environmental characteristics represents a necessary strategy to help a fast adaptation of the population at a time where the priority is to live avoiding SARS-CoV-2 infection.


The Obstacle Course of Reperfusion for ST-Segment-Elevation Myocardial Infarction in the COVID-19 Pandemic


COVID-19 and the healthcare workers


Likelihood of survival of coronavirus disease 2019


title: Transmission of pathogen-laden expiratory droplets in a coach bus

text: Droplet dispersion carrying viruses/bacteria in enclosed/crowded buses may induce transmissions of respiratory infectious diseases, but the influencing mechanisms have been rarely investigated. By conducting high-resolution CFD simulations, this paper investigates the evaporation and transport of solid-liquid mixed droplets (initial diameter 10 µm and 50 µm, solid to liquid ratio is 1:9) exhaled in a coach bus with 14 thermal manikins. Five air-conditioning supply directions and ambient relative humidity (RH = 35 % and 95 %) are considered. Results show that ventilation effectiveness, RH and initial droplet size significantly influence droplet transmissions in coach bus. 50 µm droplets tend to evaporate completely within 1.8 s and 7 s as RH = 35 % and 95 % respectively, while 0.2 s or less for 10 µm droplets. Thus 10 µm droplets diffuse farther with wider range than 50 µm droplets which tend to deposit more on surfaces. Droplet dispersion pattern differs due to various interactions of gravity, ventilation flows and the upward thermal body plume. The fractions of droplets suspended in air, deposited on wall surfaces are quantified. This study implies high RH, backward supply direction and passengers sitting at nonadjacent seats can effectively reduce infection risk of droplet transmission in buses. Besides taking masks, regular cleaning is also recommended since 85 %-100 % of droplets deposit on object surfaces.


title: The good, the bad & the hoax: when publication instantaneously impacts treatment strategies for COVID-19

text: The COVID-19 pandemic is an unprecedented situation with physicians awaiting information on therapeutic advances to an extent hardly ever seen in medical history. .


NAFLD or comorbidities, that is the question


title: [Diagnostic imaging findings in COVID-19]

text: This is a review of diagnostic imaging findings in coronavirus disease-2019 (COVID-19). CT findings are frequently bilateral, multilobar and peripheral ground-glass opacities with vascular enlargements. Consolidations often appear during progression as well as crazy paving and reticulation. Lymphadenopathy, pleural effusions and pneumothorax are rare and should raise concern for other disease. Initially the CT can be normal, and the diagnostic performance for COVID-19 is not optimal. However, findings of characteristic ground-glass opacities during the ongoing epidemic should lead to considerations, that the patient may have COVID-19.


Increased sFLT1/PlGF ratio in COVID-19: a novel link to Angiotensin II-mediated endothelial dysfunction


title: Possible aerosol transmission of COVID-19 and special precautions in dentistry

text: Since its emergence in December 2019, corona virus disease 2019 (COVID-19) has impacted several countries, affecting more than 90 thousand patients and making it a global public threat. The routes of transmission are direct contact, and droplet and possible aerosol transmissions. Due to the unique nature of dentistry, most dental procedures generate significant amounts of droplets and aerosols, posing potential risks of infection transmission. Understanding the significance of aerosol transmission and its implications in dentistry can facilitate the identification and correction of negligence in daily dental practice. In addition to the standard precautions, some special precautions that should be implemented during an outbreak have been raised in this review.


title: Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity

text: The novel coronavirus (2019-nCoV) infection caused pneumonia. we retrospectively analyzed the virus presence in the pharyngeal swab, blood, and the anal swab detected by real-time PCR in the clinical lab. Unexpectedly, the 2109-nCoV RNA was readily detected in the blood (6 of 57 patients) and the anal swabs (11 of 28 patients). Importantly, all of the 6 patients with detectable viral RNA in the blood cohort progressed to severe symptom stage, indicating a strong correlation of serum viral RNA with the disease severity (p-value = 0.0001). Meanwhile, 8 of the 11 patients with annal swab virus-positive was in severe clinical stage. However, the concentration of viral RNA in the anal swab (Ct value = 24 + 39) was higher than in the blood (Ct value = 34 + 39) from patient 2, suggesting that the virus might replicate in the digestive tract. Altogether, our results confirmed the presence of virus RNA in extra-pulmonary sites.


title: Management of Pemphigus in COVID-19 Pandemic Era;a Review Article

text: The novel coronavirus is rapidly spreading around the world Since the public announcement of the COVID-19 outbreak, several concerns have been raised by dermatologists as well as pemphigus patients who take immunosuppressive drugs In this paper, we review the literature about the common treatment of pemphigus with a focus on the lessons from similar epidemics to find a proper suggestion to manage pemphigus in the COVID-19 pandemic era The effect of many of the drugs used for treatment of Pemphigus vulgaris (PV) on COVID-19 is not clear We also do not have data on the impact of this autoimmune disease, which may involve the mucous membranes, on the acquisition or course of COVID-19 We are currently in the midst of a pandemic and evaluating the effect of COVID-19 on the population of susceptible patients suffering from auto-immune diseases like pemphigus is essential The evidence on best ways to manage patients with underlying conditions, such as pemphigus, during the outbreak of COVID-19 is evolving and the data is updated every day


title: Transmission and clinical characteristics of coronavirus disease 2019 in 104 outside-Wuhan patients, China

text: Cases of coronavirus disease 2019 (COVID-19) emigrating from Wuhan escalated the risk of spreading the disease in other cities. This report focused on outside-Wuhan patients to assess the transmission and clinical characteristics of this illness. Contact investigation was conducted on each patient who was admitted to the assigned hospitals in Hunan Province (geographically adjacent to Wuhan) from 22 January to 23 February 2020. Cases were confirmed by the polymerase chain reaction test. Demographic, clinical, and outcomes were collected and analyzed. Of the 104 patients, 48 (46.15%) were cases who immigrated from Wuhan; 93 (89.42%) had a definite contact history with infection. Family clusters were the major body of patients. Transmission along the chain of three "generations" was observed. Five asymptomatic infected cases were found and two of them infected their relatives. Mean age was 43 (range, 8-84) years, and 49 (47.12%) were male. The median incubation period was 6 (range, 1-32) days, which of 8 patients ranged from 18 to 32 days, 96 (92.31%) were discharged, and 1 (0.96%) died. The average hospital stay was 10 (range, 8-14) days. Family but not community transmission became the main body of infections in the two centers, suggesting the timely control measures after the Wuhan shutdown worked well. Asymptomatic transmission demonstrated here warned us that it may lead to the widespread of COVID-19. A 14-day quarantine may need to be prolonged.


title: Controls to Minimize Disruption of the Pharmaceutical Supply Chain during the Covid-19 Pandemic

text: This article reviews currently available scientific literature related to the epidemiology, infectivity, survival, and susceptibility to disinfectants of Coronaviruses, in the context of the controls established to meet Good Manufacturing Practice regulations and guidance, and the public health guidance issued specifically to combat the Covid-19 pandemic. The possible impact of the COVID-19 pandemic on the pharmaceutical supply chain is assessed and recommendations are listed for risk mitigation steps to minimize supply disruption to pharmaceutical drug products. Areas addressed include a brief history of the COVID-19 viral pandemic, a description of the virus, the regulatory response to the pandemic, the screening of employees, the persistence on inanimate surfaces, cleaning and disinfection of manufacturing facilities, use of GMP-mandated personal protective equipment to counter the spread of the disease, the role of air changes in viral clearance, approaches to risk assessment and mitigation. Biological medicinal products have a great record of safety, yet the cell cultures used for production can be susceptible to viruses, and contamination events have occurred. Studies on SARS-CoV-1 for its ability to replicate in various mammalian cell lines used for biopharmaceutical manufacturing suggest SARS-CoV-2 poses low risk and any contamination would be detected by currently used adventitious virus testing. The consequences of the potential virus exposure of manufacturing processes, as well as the effectiveness of mitigation efforts are discussed. The pharmaceutical supply chain is complex, traversing many geographies and companies that range from large multinationals to mid and small size operations. This paper recommends practices that can be adopted by all companies, irrespective of their size, geographic location, or position in the supply chain.


Rapid and sensitive detection of SARS-CoV-2 RNA using the SimplexaTM COVID-19 direct assay


title: Rapid and sensitive detection of SARS-CoV-2 RNA using the Simplexa™ COVID-19 direct assay

text: BACKGROUND: So far, one of the major drawbacks of the available molecular assays for the diagnosis of severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) is the need for viral nucleic acid extraction from clinical specimens. OBJECTIVE: The aim of this study was to evaluate the performances of a newly designed real-time RT-PCR (Simplexa™ COVID-19 Direct assay), that is established with an all-in-one reagent mix and no separate extraction required. RESULTS: The lower limit of detection (LOD) for both target genes resulted the same: 3.2 (CI: 2.9-3.8) log10 cp/mL and 0.40 (CI: 0.2-1.5) TCID50/mL for S gene while 3.2 log10 (CI: 2.9-3.7) log10 cp/mL and 0.4 (CI: 0.2-1.3) TCID50/mL for ORF1ab. The LOD obtained with extracted viral RNA for both S gene or ORF1ab was 2.7 log10 cp/mL. Crossreactive analysis performed in 20 nasopharyngeal swabs confirmed a 100% of clinical specificity of the assay. Clinical performances of Simplexa™ COVID-19 Direct assay were assessed in 278 nasopharyngeal swabs tested in parallel with Corman's method. Concordance analysis showed an "almost perfect" agreement in SARS-CoV-2 RNA detection between the two assays, being κ = 0.938; SE = 0.021; 95% CI = 0.896-0.980. CONCLUSIONS: The high sensitivity and specificity of this new assay indicate that it is promising for laboratory diagnosis, enabling highspeed detection in just over one hour, which is significantly faster than the up to five hours currently required by traditional extraction followed by amplification technologies, thus allowing prompt decision making regarding isolation of infected patients.


title: The impact of COVID-19 on the provision of cardiac surgical services

text: The global pandemic caused by COVID-19 has had a significant global impact on healthcare systems. One implication of this pandemic is the cancellation of elective cardiac surgeries and the centralization of services. As a result, hospitals in Europe, North America, and the United Kingdom have had to alter the services offered to patients to be able to cope with service provision for COVID infected patients. Data should be collected during this period to provide a good insight following the lockdown period to understand the implication of such service alteration. Future research should also focus on the effects on long-term mortality and morbidity as well as financial implications on hospitals as a result of these changes.


Coronavirus lockdowns have changed the way Earth moves


Coronavirus disease 2019 (COVID-19) and acute cardiovascular disease management: A Chinese perspective on striking the balance


title: Tracheotomia az új típusú koronavírus okozta járvány idején(A COVID-19-pandémia orvosszakmai kérdései)./ Tracheostomy during novel corona virus pandemic

text: Recently, 6 percent of COVID-19 patients required prolonged mechanical ventilation due to severe respiratory failure. Early tracheostomy prevents the risk of postintubation upper airway stenosis. In the pandemic, all surgical interventions that generate aerosol increase the risk of contamination of the medical staff, for which reason the "traditional" indications of tracheostomy have to be revised. Authors present their recommendations based on international experiences. Orv Hetil. 2020; 161(19): 767-770.


title: Seven recommendations to rescue the patients and reduce the mortality from COVID-19 infection: An immunological point of view

text: Now COVID-19 is causing a severe public health emergency and the mortality is rapidly increasing all over the world. In the current pandemic era, although there have been many efforts to diagnose a number of patients with symptoms or close contacts, there is no definite guideline for the initial therapeutic approach for them and therefore, many patients have been dying due to a hyperinflammatory immunological reaction labeled as "cytokine storm". Severe patients are hospitalized and the treatment is done, though they have not been established yet. Currently, however, no treatment is provided for those who are isolated at home or shelter until they get severe symptoms, which will increase the harms to the patients. In this review, we discuss some important points dedicated to the management of patients with COVID-19, which should help reducing morbidity and mortality. In this era, we suggest 7 recommendations to rescue the patients and to reduce the morbidity and mortality due to COVID-19 based on the immunological point of view.


title: COVID-19 diagnosis by routine blood tests using machine learning

text: Physicians taking care of patients with coronavirus disease (COVID-19) have described different changes in routine blood parameters. However, these changes, hinder them from performing COVID-19 diagnosis. We constructed a machine learning predictive model for COVID-19 diagnosis. The model was based and cross-validated on the routine blood tests of 5,333 patients with various bacterial and viral infections, and 160 COVID-19-positive patients. We selected operational ROC point at a sensitivity of 81.9% and specificity of 97.9%. The cross-validated area under the curve (AUC) was 0.97. The five most useful routine blood parameters for COVID19 diagnosis according to the feature importance scoring of the XGBoost algorithm were MCHC, eosinophil count, albumin, INR, and prothrombin activity percentage. tSNE visualization showed that the blood parameters of the patients with severe COVID-19 course are more like the parameters of bacterial than viral infection. The reported diagnostic accuracy is at least comparable and probably complementary to RT-PCR and chest CT studies. Patients with fever, cough, myalgia, and other symptoms can now have initial routine blood tests assessed by our diagnostic tool. All patients with a positive COVID-19 prediction would then undergo standard RT-PCR studies to confirm the diagnosis. We believe that our results present a significant contribution to improvements in COVID-19 diagnosis.


Tomar medidas preventivas inmediatamente: evidencia de China sobre el COVID-19./ [Taking preventive measures immediately: evidence from China on COVID-19]