title: 2020 - the year of the nurse and midwife: a call for action to scale up and strengthen the nursing and midwifery workforce in the Eastern Mediterranean Region

text: The World Health Organization (WHO) has declared 2020 as the Year of the Nurse and the Midwife. World Health Day on 7 April is dedicated to supporting nurses and midwives and highlights the central role of these professions in advancing universal health coverage, achieving health-related sustainable development goals, and the Eastern Mediterranean Region Vision 2023: Health for All by All.This year, we sadly mark World Health Day in the face of the devastating COVID-19 pandemic, which has brought to attention more than ever the crucial and invaluable role of health workers, who are working tirelessly day and night to care for patients and save lives. In fighting COVID-19, not only might they become infected and put their own lives at risk, but they also face distress and burnout because of long working hours. In addition, many health workers have to be away from their homes for prolonged periods, for fear of putting their own families at risk of acquiring the infection. Even before the pandemic, the safety and security of health workers in the Eastern Mediterranean Region has been a significant concern, as more than half of the countries of the Region face acute and protracted crises, and 70- 80% of total recorded attacks on health facilities globally occur in the Eastern Mediterranean Region.


title: Low Rate of COVID-19 pneumonia in Kidney Transplant Recipients - A Battle Between Infection and Immune Response?

text: BACKGROUND: With COVID-19 pandemic, concerns about kidney transplant recipients are rising. However, the incidence, clinical course, outcome, and predictive factors of disease severity are obscured. METHODS: We describe clinical and laboratory manifestations, radiologic findings, clinical course, and finally outcome of kidney transplant recipients with COVID-19 pneumonia. RESULTS: Of 2493 kidney transplant recipients under follow up in our clinic, 19 cases (4 cases diagnosed based on radiologic findings) were admitted. The mean age of patients was 47.6 ± 12.4 years, and the mean time from transplantation was 115.6 ± 70.3 months. Lymphopenia and eosinopenia were 84.2% and 78.9%, respectively. Nine patients did not survive the hospital course. History of acute rejection during the past 12 months, diabetes, higher N/L ratio, lower platelet count, elevated N/L x CRP, higher levels of LDH, positive D-dimer, higher troponin, and prolonged PT were associated with mortality. Among patients with positive COVID-19 test, history of acute rejection, low platelet count, and positive D-dimer were associated with poor outcome. Treatment with cyclosporine was associated with better clinical outcome. CONCLUSIONS: Low rate of admission in transplant recipients specially in the very first years of transplantation might be due to protective effects of immunosuppressive agents against cytokine storm or modification of immunity function. We suggest evaluation of T cells number, function and cytokine profile as a guide to manage COVID-19 mainly in patients with higher risk of mortality.


title: Barrier device prototype for open tracheotomy during COVID-19 pandemic

text: OBJECTIVE: To present a low-cost prototype for a barrier enclosure device which can be used during open surgeries such as tracheotomy. METHODS: We provide detailed description of a novel device called COVID-Box, developed by The Surgical Airway Team for COVID-19 Pandemic, a temporary task force formed by Walter Cantídio University Hospital. Safety guidelines for performing tracheotomies in COVID-19 patients are also stated. RESULTS: Our prototype device provides greater hand mobility than previous barrier devices reported, making it more suitable for airway surgical procedures, such as tracheotomy. The curved shaped format and the customizable access ports provides ergonomics, without compromising safety. CONCLUSION: The COVID-Box appears to be an efficient, reproduceable, low-cost barrier enclosure device that can be used for open tracheotomies in ICU patients during the COVID-19 pandemic.


title: Does zinc supplementation enhance the clinical efficacy of chloroquine/hydroxychloroquine to win today's battle against COVID-19?

text: Currently, drug repurposing is an alternative to novel drug development for the treatment of COVID-19 patients. The antimalarial drug chloroquine (CQ) and its metabolite hydroxychloroquine (HCQ) are currently being tested in several clinical studies as potential candidates to limit SARS-CoV-2-mediated morbidity and mortality. CQ and HCQ (CQ/HCQ) inhibit pH-dependent steps of SARS-CoV-2 replication by increasing pH in intracellular vesicles and interfere with virus particle delivery into host cells. Besides direct antiviral effects, CQ/HCQ specifically target extracellular zinc to intracellular lysosomes where it interferes with RNA-dependent RNA polymerase activity and coronavirus replication. As zinc deficiency frequently occurs in elderly patients and in those with cardiovascular disease, chronic pulmonary disease, or diabetes, we hypothesize that CQ/HCQ plus zinc supplementation may be more effective in reducing COVID-19 morbidity and mortality than CQ or HCQ in monotherapy. Therefore, CQ/HCQ in combination with zinc should be considered as additional study arm for COVID-19 clinical trials.


title: Developing training for uniportal video-assisted thoracic surgery: a commentary

text: OBJECTIVES: Today, thoracic surgeons have many possible pathways to advance their training in video-assisted thoracic surgery (VATS). For uniportal VATS (uVATS) in particular, what are the training options available and does regulating training matter? METHODS: The relevant literature pertaining to uVATS training is reviewed. RESULTS: Current options for surgeons looking to train in uVATS range from videos on the internet, through 'experts' demonstrating live surgery, to symposia and hands-on wet labs being held in all regions of the world. All have merits, and the aspiring VATS surgeon can choose from a range of preceptorship and proctorship modules to suit his/her own training needs. However, issues in the formalizing training in uVATS remains unresolved. Is there an ideal pathway through uVATS training? At what point can a trainee be considered to have 'graduated' to become an expert in uVATS? Who indeed trains the trainer, and certifies the competence of a training centre? CONCLUSIONS: Although a plethora of training options exist, formulation of a robust training curriculum can further bolster the status of uVATS as a sustainable surgical approach that can be delivered with consistent quality.


title: The COVID-19 AAGP Online Trainee Curriculum: Development and Method of Initial Evaluation

text: OBJECTIVE: One effect of the COVID-19 pandemic is the disruption of in-person clinical experiences within geriatric psychiatry residency education. Online resources for trainees are needed to fill resultant gaps. METHODS: The American Association of Geriatric Psychiatry (AAGP) Teaching and Training Committee leadership collaborated with geriatric psychiatry experts to develop a web-based geriatric psychiatry curriculum for psychiatry residents and other learners. In addition, we planned to obtain initial self-report outcomes of the curricular modules. RESULTS: The COVID-19 AAGP Online Trainee Curriculum (aagponline.org/covidcurriculum) consists of approximately 30 video-recorded lectures provided by AAGP member experts. A demographic survey and pre-/postsurvey attached to each module allow us to obtain learner characteristics and feedback on each module. CONCLUSIONS: The Curriculum has the potential to supplement psychiatry residency education during the pandemic and potentially raise the profile of AAGP, with the goal of inspiring interest within geriatric psychiatry. Results of the initial self-report evaluation should be available in 1 year.


Maxillofacial surgery and COVID-19, The Pandemic !!


Managing intravitreal injections in adults in COVID-19 and post-COVID-19 era- Initial experiences


title: Improving supervised prediction of aging-related genes via dynamic network analysis

text: Motivation: This study focuses on supervised prediction of aging-related genes from -omics data. Unlike gene expression methods that capture aging-specific information but study genes in isolation, or protein-protein interaction (PPI) network methods that account for PPIs but the PPIs are context-unspecific, we recently integrated the two data types into an aging-specific PPI subnetwork, which yielded more accurate aging-related gene predictions. However, a dynamic aging-specific subnetwork did improve prediction performance compared to a static aging-specific subnetwork, despite the aging process being dynamic. Results: So, here, we propose computational advances towards improving prediction accuracy from a dynamic aging-specific subnetwork. We develop a supervised learning model that when applied to a dynamic subnetwork yields extremely high prediction performance, with F-score of 91.4%, while the best model on any static subnetwork yields F-score of"only"74.3%. Hence, our predictive model could guide with high confidence the discovery of novel aging-related gene candidates for future wet lab validation. Contact: tmilenko@nd.edu


title: AI Chatbot Design during an Epidemic Like the Novel Coronavirus

text: Since the discovery of the Coronavirus (nCOV-19), it has become a global pandemic. At the same time, it has been a great challenge to hospitals or healthcare staff to manage the flow of the high number of cases. Especially in remote areas, it is becoming more difficult to consult a medical specialist when the immediate hit of the epidemic has occurred. Thus, it becomes obvious that if effectively designed and deployed chatbot can help patients living in remote areas by promoting preventive measures, virus updates, and reducing psychological damage caused by isolation and fear. This study presents the design of a sophisticated artificial intelligence (AI) chatbot for the purpose of diagnostic evaluation and recommending immediate measures when patients are exposed to nCOV-19. In addition, presenting a virtual assistant can also measure the infection severity and connects with registered doctors when symptoms become serious.


Covid-19: skin damage with prolonged wear of FFP3 masks


title: Online Change Point Detection in Molecular Dynamics With Optical Random Features

text: Proteins are made of atoms constantly fluctuating, but can occasionally undergo large-scale changes. Such transitions are of biological interest, linking the structure of a protein to its function with a cell. Atomic-level simulations, such as Molecular Dynamics (MD), are used to study these events. However, molecular dynamics simulations produce time series with multiple observables, while changes often only affect a few of them. Therefore, detecting conformational changes has proven to be challenging for most change-point detection algorithms. In this work, we focus on the identification of such events given many noisy observables. In particular, we show that the No-prior-Knowledge Exponential Weighted Moving Average (NEWMA) algorithm can be used along optical hardware to successfully identify these changes in real-time. Our method does not need to distinguish between the background of a protein and the protein itself. For larger simulations, it is faster than using traditional silicon hardware and has a lower memory footprint. This technique may enhance the sampling of the conformational space of molecules. It may also be used to detect change-points in other sequential data with a large number of features.


title: PeopleTraffic: a common framework for harmonizing privacy and epidemic risks

text: PeopleTraffic is a proposed initiative to develop a real-time, open-data population density mapping tool open to public institutions, private companies and the civil society, providing a common framework for infection spreading prevention. The system is based on a real-time people' locations gathering and mapping system from available 2G, 3G and 4G mobile networks operators, enforcing privacy-by-design through the adoption of an innovative data anonymizing algorithm inspired by quantum information de-localizing processes. Besides being originally targeted to help balancing social distancing regulations during the Phase-2 of the COVID-19 pandemics, PeopleTraffic would be beneficial for any infection spreading prevention event, e.g. supporting policy-makers in strategic decision-making.


title: Attention should be paid to the exposure risk of patients with chronic wounds on the way to hospital during corona virus disease 2019 epidemic prevention and control/ 中华烧伤杂志

text: Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are those over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%; among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus , cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of corona virus disease 2019 released by National Health Commission of China. It is an unavoidable fact that patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that there were not a few patients who go far afield because of various reasons when go to the hospital for treatment. During the period of epidemic prevention and control, this kind of "go far afield" style of seeking medical treatment may increase the exposure risk during transportation. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the "Five Measures" to encourage patients with chronic wounds to seek medical treatment proximately. The principle of this operation is that when seeking medical treatment, trying our best to reduce as much as possible the transportation distance for patients with chronic wounds to minimize the exposure risk during the epidemic period and eventually support the epidemic prevention and control campaign.


Rethinking race in medical decision making


title: Inferring the effective fraction of the population infected with Covid-19 from the behaviour of Lombardy, Madrid and London relative to the remainder of Italy, Spain and England

text: I use a very simple deterministic model for the spread of Covid-19 in a large population. Using this to compare the relative decay of the number of deaths per day between different regions in Italy, Spain and England, each applying in principle the same social distancing procedures across the whole country, I obtain an estimate of the total fraction of the population which had already become infected by April 10th. In the most heavily affected regions, Lombardy, Madrid and London, this fraction is higher than expected, i.e. $\approx 0.3$. This result can then be converted to a determination of the infection fatality rate $ifr$, which appears to be $ifr \approx 0.0025-0.005$, and even smaller in London, somewhat lower than usually assumed. Alternatively, the result can also be interpreted as an effectively larger fraction of the population than simple counting would suggest if there is a variation in susceptibility to infection with a variance of up to a value of about 2. The implications are very similar for either interpretation or for a combination of effects.


The importance of initial response during outbreaks: A perspective from observations on COVID-19


New-Onset Diabetes in Covid-19


title: Clinical characteristics of 28 patients with novel coronavirus pneumonia/ 中华传染病杂志

text: Objective@#To analysis the clinical characteristics and experiences in diagnosis and treatment of the patients with novel coronavirus pneumonia (NCP).@*Methods@#Clinical data of 28 patients with NCP in Nanning Fourth People's Hospital from January 22 to February 5 in 2020 were collected. The clinical manifestations, epidemiological history, laboratory tests, imaging examinations and treatments of patients were analyzed retrospectively.@*Results@#The 28 patients with confirmed viral pneumonia included 11 males and 17 females, ranging from 11 to 68 years. They all had history of epidemiological exposure and were all positive for 2019-nCoV nucleic acid in throat swabs. There were one mild case, 25 ordinary cases and two severe cases. There were four groups of family clusters. The illness onset ranged from 1 to 12 days after exposure, and the time from the symptom onset to the positive result of the nucleic acid test was 0 to 13 days. The clinical symptoms were mainly fever and cough, which progressed rapidly in a short period of time. Since the onset of illness, the peak values of axillary temperature of the 28 patients were 36.6~39.5 ℃, while five patients had no fever throughout the course of the disease with the peak temperature of ≤37 ℃. There were two patients presented with decreased white blood cell counts, five patients with elevated C reactive protein, six patients with abnormal alanine aminotransferase, three patients with abnormal aspartate aminotransferase,10 patients with elevated creatine kinase, three patients with elevated creatine kinase isoenzyme, four patients with elevated lactate dehydrogenase, and all with normal procalcitonin levels. The chest computed tomography examinations showed that the common features were ground glass shadows (21 cases), blurred edges (18 cases), speckles and patchy shadows (17 cases), thickening and disorder of some lung textures (7 cases), and visible band shadows (7 cases). Pulmonary lesions often progressed rapidly. One 11-year-old child was treated with alpha-interferon alone, and 27 patients were treated with alpha-interferon inhalation plus lopinavir/ritonavir with 4 withdrawal due to adverse reactions. Up to February 12, nine patients had been discharged from the hospital, who were ordinary cases, without death cases.@*Conclusions@#The NCP patients mostly present with fever and cough. Pulmonary lesions often progress rapidly. Respiratory pathogen testing should be conducted as early as possible and repeatedly. Disisolation should be cautious for suspected people who are negative for 2019-nCoV nucleic acid in pharynx swabs.


title: Liver injury is associated with severe coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis of retrospective studies

text: The coronavirus disease 2019 (COVID-19) outbreak is a major threat to human beings. Lung injury has been reported as the major outcome of COVID-19 infection. However, liver damage has also been considered to occur in severe cases. The current meta-analysis of retrospective studies was carried out to summarize available findings on the association between liver injury and severity of COVID-19 infection. Online databases including PubMed, Scopus, Web of Science, and Cochrane Library were searched to detect relevant publications up to 1 April 2020, using relevant keywords. To pool data, a fixed- or random-effects model was used depending on the heterogeneity between studies. Furthermore, publication bias test and sensitivity analysis were also applied. In total, 20 retrospective studies with 3428 COVID-19 infected patients (severe cases, n = 1455; mild cases, n = 1973), were included in this meta-analysis. Higher serum levels of aspartate aminotransferase (weighted mean difference, 8.84 U/L; 95% confidence interval [CI] 5.97 to 11.71; P < 0.001), alanine aminotransferase (weighted mean difference, 7.35 U/L; 95% CI, 4.77 to 9.93; P < 0.001), total bilirubin (weighted mean difference, 2.30 mmol/L; 95% CI, 1.24 to 3.36; P < 0.001), and lower serum levels of albumin (weighted mean difference, -4.24 g/L; 95% CI, -6.20 to -2.28; P < 0.001) were associated with a significant increase in the severity of COVID-19 infection. The incidence of liver injury, as assessed by serum analysis (aspartate aminotransferase, alanine aminotransferase, total bilirubin, and albumin levels), seems to be higher in patients with severe COVID-19 infection.


Oncology Dietitians Sound Alarm in Key Nutrition Needs of Cancer Patients During COVID-19 Pandemic


Psychosis in a patient with anxiety related to COVID-19: A case report


title: White Paper on 6G Drivers and the UN SDGs

text: The commercial launch of 6G communications systems and United Nations Sustainable Development Goals, UN SDGs, are both targeted for 2030. 6G communications is expected to boost global growth and productivity, create new business models and transform many aspects of society. The UN SDGs are a way of framing opportunities and challenges of a desirable future world and cover topics as broad as ending poverty, gender equality, climate change and smart cities. The relationship between these potentially mutually reinforcing forces is currently under-defined. Building on the vision for 6G, a review of megatrends, on-going activities on the relation of mobile communications to the UN SDGs and existing indicators, a novel linkage between 6G and the UN SDGs is proposed via indicators. The white paper has also launched the work of deriving new 6G related indicators to guide the research of 6G systems. The novel linkage is built on the envisaged three-fold role of 6G as a provider of services to help steer and support communities and countries towards reaching the UN SDGs, as an enabler of measuring tool for data collection to help reporting of indicators with hyperlocal granularity, and as a reinforcer of new ecosystems based on 6G technology enablers and 6G network of networks to be developed in line with the UN SDGs that incorporates future mobile communication technologies available in 2030. Related challenges are also identified. An action plan is presented along with prioritized focus areas within the mobile communication sector technology and industry evolution to best support the achievement of the UN SDGs.


title: Simpson's paradox in Covid-19 case fatality rates: a mediation analysis of age-related causal effects

text: We point out an instantiation of Simpson's paradox in Covid-19 case fatality rates (CFRs): comparing data of 44,672 cases from China with early reports from Italy (9th March), we find that CFRs are lower in Italy for every age group, but higher overall. This phenomenon is explained by a stark difference in case demographic between the two countries. Using this as a motivating example, we introduce basic concepts from mediation analysis and show how these can be used to quantify different direct and indirect effects when assuming a coarse-grained causal graph involving country, age, and mortality. As a case study, we then investigate total, direct, and indirect (age-mediated) causal effects between different countries and at different points in time. This allows us to separate age-related effects from others unrelated to age, and thus facilitates a more transparent comparison of CFRs across countries throughout the evolution of the Covid-19 pandemic.


title: Current status of potential therapeutic candidates for the COVID-19 crisis

text: As of April 15, 2020, the ongoing coronavirus disease 2019 (COVID-2019) pandemic has swept through 213 countries and infected more than 1,870,000 individuals, posing an unprecedented threat to international health and the economy. There is currently no specific treatment available for patients with COVID-19 infection. The lessons learned from past management of respiratory viral infections have provided insights into treating COVID-19. Numerous potential therapies, including supportive intervention, immunomodulatory agents, antiviral therapy, and convalescent plasma transfusion, have been tentatively applied in clinical settings. A number of these therapies have provided substantially curative benefits in treating patients with COVID-19 infection. Furthermore, intensive research and clinical trials are underway to assess the efficacy of existing drugs and identify potential therapeutic targets to develop new drugs for treating COVID-19. Herein, we summarize the current potential therapeutic approaches for diseases related to COVID-19 infection and introduce their mechanisms of action, safety, and effectiveness.


Binding of SARS-CoV-2 and angiotensin-converting enzyme 2: clinical implications


title: Clinical Evaluation of Three Sample-To-Answer Platforms for the Detection of SARS-CoV-2

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has now spread across the globe. As part of the worldwide response, many molecular diagnostic platforms have been granted Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) to identify SARS-CoV-2 positive patients. Our objective was to evaluate three sample-to-answer molecular diagnostic platforms (Cepheid Xpert® Xpress SARS-CoV-2 [Xpert Xpress], Abbott ID NOW™ COVID-19 [ID NOW], GenMark ePlex® SARS-CoV-2 Test [ePlex]) to determine analytical sensitivity, clinical performance, and workflow for the detection of SARS-CoV-2 in nasopharyngeal swabs from 108 symptomatic patients. We found that the Xpert Xpress had the lowest limit of detection (100% detection at 100 copies/mL), followed by the ePlex (100% detection at 1,000 copies/mL), and the ID NOW (20,000 copies/mL). The Xpert Xpress also had highest positive percent agreement (PPA) when compared to our reference standard (98.3%) followed by the ePlex (91.4%) and ID now (87.7%). All three assays showed 100% negative percent agreement (NPA). In the workflow analysis, the ID NOW produced the most rapid time to result per specimen (â¼17 minutes) as compared to the Xpert Xpress (â¼46 minutes) and the ePlex (â¼1.5 hours), but what the ID NOW gained in rapid results, it lost in analytical and clinical performance. The ePlex had the longest time to results and showed a slight improvement in PPA over the ID NOW. Information about the clinical and analytical performance of these assays, as well as workflow, will be critical in making informed and timely decisions on testing platform.


title: Enclosure with augmented airflow to decrease risk of exposure to aerosolized pathogens including coronavirus during endotracheal intubation. Can the reduction in aerosolized particles be quantified?

text: INTRODUCTION: As the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) has impacted hospital routines in recent weeks, recommendations to reduce healthcare worker infections are being developed. METHODS: We report preliminary experience with the efficacy of an enclosure with augmented airflow to decrease the risk of exposure to aerosolized pathogens during airway management including endotracheal intubation. A particle generator was used to test the efficacy of the reduction of aerosolized particles by measuring their concentration within the enclosure and in the environment. RESULTS: No reduction in the concentration of aerosolized particles was noted with the enclosure flap open, whether the interior suction was on or off. However, with the enclosure closed and no augmented airflow (suction off), the particle concentration decreased to 1.2% of baseline. The concentration decreased even further, to 0.8% of baseline with the enclosure closed with augmented airflow (suction on). DISCUSSION: Aerosolized particulate contamination in the operating room can be decreased using a clear plastic enclosure with minimal openings and augmented airflow. This may serve to decrease the exposure of healthcare providers to aerosolized pathogens.


title: The psychological impact of quarantine and how to reduce it: rapid review of the evidence

text: The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.


Rapid sequence spinal must be the new norm for an emergency LSCS in this Covid pandemic


Guillain-Barré syndrome as a complication of SARS-CoV-2 infection


title: A cross-sectional survey on the psychological impact of the COVID-19 pandemic on inflammatory bowel disease patients in Saudi Arabia

text: Background/Aims: The coronavirus (COVID-19) pandemic has caused significant disruption to patients with chronic illnesses. We explored the emotional state, perception, and concerns of Saudi patients with inflammatory bowel disease (IBD) during the crisis. Materials and Methods: We conducted a cross-sectional survey from 30 March to 5 April, 2020 using a pre-designed questionnaire distributed through social media platforms to IBD patients. The five-part questionnaire included an assessment of psychological wellbeing using a previously validated Arabic version of the Hospital Anxiety and Depression Scale (HADS), which includes domains for anxiety (HADS-A) and depression (HADS-D). A logistic regression analysis was used to uncover possible associations between patient characteristics and anxiety and depression. Results: The data from 1156 IBD patients were analyzed. Normal, borderline, and HADS-A scores consistent with a diagnosis of anxiety were reported by 423 (36.6%), 174 (15.1%), and 559 (48.4%) patients, respectively. However, 635 (69%) patients had normal scores and 273 (30.1%) had borderline HADS-D scores; no patients reported scores consistent with depression. Based on a multiple logistic regression analysis, patients educated till a high school diploma (OR = 2.57, 95% CI: 0.09-6.05, P = 0.03) and that had indeterminate colitis (OR = 2.23, 95% CI: 1.27-3.89, P = 0.005) were more likely to express anxiety. Conclusions: Many patients expressed symptoms of anxiety, although not depression. Female patients, patients educated till a high school diploma, and those with indeterminate colitis were more likely to have anxiety. IBD patients require greater attention during a pandemic to avoid adverse disease-related outcomes.


title: Computational screening of antagonists against the SARS-CoV-2 (COVID-19) coronavirus by molecular docking

text: In the current spread of novel coronavirus (SARS-CoV-2), antiviral drug discovery is of great importance. AutoDock Vina was used to screen potential drugs by molecular docking with the structural protein and non-structural protein sites of new coronavirus. Ribavirin, a common antiviral drug, remdesivir, chloroquine and luteolin were studied. Honeysuckle is generally believed to have antiviral effects in traditional Chinese medicine. In this study, luteolin (the main flavonoid in honeysuckle) was found to bind with a high affinity to the same sites of the main protease of SARS-CoV-2 as the control molecule. Chloroquine has been proved clinically effective and can bind to the main protease; this may be the antiviral mechanism of this drug. The study was restricted to molecular docking without validation by molecular dynamics simulations. Interactions with the main protease may play a key role in fighting against viruses. Luteolin is a potential antiviral molecule worthy of attention.


Acupuntura aplicada à medicina equina


title: Policy Lessons From Early Reactions to the COVID-19 Virus in China

text: The World Health Organization (WHO) declared the COVID-19 virus outbreak to be a Public Health Emergency of International Concern on January 30, 2020. Although the Chinese central government implemented significant measures to control the epidemic from January 20 within China, the crisis had already escalated dramatically.Between December 1, 2019, and January 20, 2020, a total of 51 days passed before the Chinese central government took full control. Several major factors combined to cause what had been in retrospect a clear break in the governmental information chain between December 1 and January 20. The management of this epidemic also illustrated key organizational limitations of the current Chinese health system, in particular provincial-level senior officials' lack of knowledge and awareness of potential public health risks and insufficient emergency medical material storage and logistics arrangements.We review the specific disease control actions that the Chinese central government took between January 20 and January 27, the major reasons why the governmental information chain had broken before January 20, and key structural health system limitations highlighted as the epidemic expanded.


Nature bites back


How the Italian NHS Is Fighting Against the COVID-19 Emergency


Letter to the Editor Re: Coronavirus disease 2019: The harms of exaggerated information and non-evidence-based measures


title: Diabetes as a risk factor for greater COVID-19 severity and in-hospital death: A meta-analysis of observational studies

text: AIMS: To estimate the prevalence of established diabetes and its association with the clinical severity and in-hospital mortality associated with COVID-19. DATA SYNTHESIS: We systematically searched PubMed, Scopus and Web of Science, from 1st January 2020 to 15th May 2020, for observational studies of patients admitted to hospital with COVID-19. Meta-analysis was performed using random-effects modeling. A total of 83 eligible studies with 78,874 hospitalized patients with laboratory-confirmed COVID-19 were included. The pooled prevalence of established diabetes was 14.34% (95% CI 12.62-16.06%). However, the prevalence of diabetes was higher in non-Asian vs. Asian countries (23.34% [95% CI 16.40-30.28] vs. 11.06% [95% CI 9.73-12.39]), and in patients aged ≥60 years vs. those aged <60 years (23.30% [95% CI 19.65-26.94] vs. 8.79% [95% CI 7.56-10.02]). Pre-existing diabetes was associated with an approximate twofold higher risk of having severe/critical COVID-19 illness (n = 22 studies; random-effects odds ratio 2.10, 95% CI 1.71-2.57; I2 = 41.5%) and ~threefold increased risk of in-hospital mortality (n = 15 studies; random-effects odds ratio 2.68, 95% CI 2.09-3.44; I2 = 46.7%). Funnel plots and Egger's tests did not reveal any significant publication bias. CONCLUSIONS: Pre-existing diabetes is significantly associated with greater risk of severe/critical illness and in-hospital mortality in patients admitted to hospital with COVID-19.


title: Successful implementation of preventive measures leads to low relevance of SARS-CoV-2 in liver transplant patients: Observations from a German outpatient department

text: BACKGROUND: Immunosuppressed liver transplant (LT) patients are considered to be at high risk for any kind of infection. What the outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) means for the transplant cohort is a question that, as of now, cannot easily be answered. Data on prevalence, relevance of the novel virus, and clinical course of the infection in stable LT patients are limited. METHODS: Nasopharyngeal swabs were performed in our outpatient department during the shutdown between March and April 2020 in Germany. RESULTS: The prevalence of SARS-CoV-2 was 3%. Three out of a cohort of 101 LT patients were asymptomatic for respiratory diseases. Respiratory complaints were common and not associated with SARS-CoV-2 infection. The overall monthly mortality rate was 0.22% and did not show alterations during the shutdown in Germany. CONCLUSIONS: If preventive measures are applied, LT patients do not seem to be at a higher risk for SARS-CoV-2 infection. Telemedicine in the outpatient setting may help to maintain distance and to reduce direct patient contact. However, standard of care must be guaranteed for patients with relevant comorbidities in spite of pandemics, because complications may arise from preexisting conditions.


Ultrarapid diagnosis, microscope imaging, genome sequencing, and culture isolation of SARS-CoV-2


Neurointervention for emergent large vessel occlusion during the COVID-19 pandemic


title: Characterizing the spread of CoViD-19

text: Since the beginning of the epidemic, daily reports of CoViD-19 cases, hospitalizations, and deaths from around the world have been publicly available. This paper describes methods to characterize broad features of the spread of the disease, with relatively long periods of constant transmission rates, using a new population modeling framework based on discrete-time difference equations. Comparative parameters are chosen for their weak dependence on model assumptions. Approaches for their point and interval estimation, accounting for additional sources of variance in the case data, are presented. These methods provide a basis to quantitatively assess the impact of changes to social distancing policies using publicly available data. As examples, data from Ontario and German states are analyzed using this framework. German case data show a small increase in transmission rates following the relaxation of lock-down rules on May 6, 2020. By combining case and death data from Germany, the mean and standard deviation of the time from infection to death are estimated.


title: COVID-19 causes record decline in global CO2 emissions

text: The considerable cessation of human activities during the COVID-19 pandemic has affected global energy use and CO2 emissions. Here we show the unprecedented decrease in global fossil CO2 emissions from January to April 2020 was of 7.8% (938 Mt CO2 with a +6.8% of 2-{\sigma} uncertainty) when compared with the period last year. In addition other emerging estimates of COVID impacts based on monthly energy supply or estimated parameters, this study contributes to another step that constructed the near-real-time daily CO2 emission inventories based on activity from power generation (for 29 countries), industry (for 73 countries), road transportation (for 406 cities), aviation and maritime transportation and commercial and residential sectors emissions (for 206 countries). The estimates distinguished the decline of CO2 due to COVID-19 from the daily, weekly and seasonal variations as well as the holiday events. The COVID-related decreases in CO2 emissions in road transportation (340.4 Mt CO2, -15.5%), power (292.5 Mt CO2, -6.4% compared to 2019), industry (136.2 Mt CO2, -4.4%), aviation (92.8 Mt CO2, -28.9%), residential (43.4 Mt CO2, -2.7%), and international shipping (35.9Mt CO2, -15%). Regionally, decreases in China were the largest and earliest (234.5 Mt CO2,-6.9%), followed by Europe (EU-27&UK) (138.3 Mt CO2, -12.0%) and the U.S. (162.4 Mt CO2, -9.5%). The declines of CO2 are consistent with regional nitrogen oxides concentrations observed by satellites and ground-based networks, but the calculated signal of emissions decreases (about 1Gt CO2) will have little impacts (less than 0.13ppm by April 30, 2020) on the overserved global CO2 concertation. However, with observed fast CO2 recovery in China and partial re-opening globally, our findings suggest the longer-term effects on CO2 emissions are unknown and should be carefully monitored using multiple measures.


The clinical feature of silent infections of novel coronavirus infection (COVID-19) in Wenzhou


title: Individualized prediction nomograms for disease progression in mild COVID-19

text: The coronavirus disease 2019 (COVID-19) has evolved into a pandemic rapidly. The majority of COVID-19 patients are with mild syndromes. This study aimed to develop models for predicting disease progression in mild cases. The risk factors for the requirement of oxygen support in mild COVID-19 were explored using multivariate logistic regression. Nomogram as visualization of the models was developed using R software. A total of 344 patients with mild COVID-19 were included in the final analysis, 45 of whom progressed and needed high-flow oxygen therapy or mechanical ventilation after admission. There were 188 (54.7%) males, and the average age of the cohort was 52.9 ± 16.8 years. When the laboratory data were not included in multivariate analysis, diabetes, coronary heart disease, T ≥ 38.5â and sputum were independent risk factors of progressive COVID-19 (Model 1). When the blood routine test was included the CHD, T ≥ 38.5â and neutrophil-to-lymphocyte ratio were found to be independent predictors (Model 2). The area under the receiver operator characteristic curve of model 2 was larger than model 1 (0.872 vs 0.849, P = .023). The negative predictive value of both models was greater than 96%, indicating they could serve as simple tools for ruling out the possibility of disease progression. In conclusion, two models comprised common symptoms (fever and sputum), underlying diseases (diabetes and coronary heart disease) and blood routine test are developed for predicting the future requirement of oxygen support in mild COVID-19 cases.


title: US Equity Risk Premiums during the COVID-19 Pandemic

text: We study equity risk premiums in the United States during the COVID-19 pandemic.


title: Feline sporotrichosis: a case series of itraconazole-resistant Sporothrix brasiliensis infection

text: The treatment of feline sporotrichosis is a challenge for veterinary clinicians since refractory cases may occur, due either to patient and/or to pharmacological management errors or due to the development of antifungal resistance. Thus, we aimed to describe the therapeutic history of feline cases infected by itraconazole-resistant Sporothrix brasiliensis in an endemic region of Southern Brazil. Medical records of cats attended at the Veterinary Clinic Hospital (Pelotas/RS, Brazil) between 2016 and 2017 were reviewed. Twelve cases of infection by S. brasiliensis with that showed high minimum inhibitory concentration (MIC) values (≥ 4 µg/mL) to itraconazole by M38-A2 of CLSI were selected. At the hospital consultation, disseminated (cats 1-l0, 12) and localized (cat 11) skin lesions remained in the cats, even after treatment with fluconazole, ketoconazole (02/12), and itraconazole (ITZ, 09/12) performed before this study. High doses (25-100 mg/kg/day) of ITZ for up to 4 months (03/12, cats 2, 6, 12) or over 12 months (05/12, cats 1, 5, 7, 8, 11) did not provide a clinical cure, except for the association of ITZ plus potassium iodide (01/12, cat 12) for 3 months, which proved useful in infections with itraconazole-resistant S. brasiliensis. However, the combined issues of abandonment of therapy by owners for financial reasons, difficulties surrounding therapy administration (03/12, cats 6, 11, 12), and the inappropriate choice of medication (01/12, cat 6), together reflect the reality of this endemic region, which greatly compromises clinical healing. This study highlighted the occurrence of refractory cases by itraconazole-resistant S. brasiliensis in cats from Southern Brazil, as well as the abandonment of treatment and therapeutic errors. We warn of the need for antifungal susceptibility tests to adapt therapeutic protocols in feline sporotrichosis.


title: Structural analysis of SARS-CoV-2 and prediction of the human interactome

text: Specific elements of viral genomes regulate interactions within host cells. Here, we calculated the secondary structure content of>2500 coronaviruses and computed>100000 human protein interactions with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We found that the 3 and 5 prime ends are the most structured elements in the viral genome and the 5 prime end has the strongest propensity to associate with human proteins. The domain encompassing nucleotides 23000-24000 is highly conserved both at the sequence and structural level, while the region upstream varies significantly. These two sequences code for a domain of the viral protein Spike S that interacts with the human receptor angiotensin-converting enzyme 2 (ACE2) and has the potential to bind sialic acids. Our predictions indicate that the first 1000 nucleotides in the 5 prime end can interact with proteins involved in viral RNA processing such as double-stranded RNA specific editases and ATP-dependent RNA-helicases, in addition to other high-confidence candidate partners. These interactions, previously reported to be also implicated in HIV, reveal important information on host-virus interactions. The list of transcriptional and post-transcriptional elements recruited by SARS-CoV-2 genome provides clues on the biological pathways associated with gene expression changes in human cells.


Says who? The significance of sampling in mental health surveys during COVID-19


Lockdown-the only solution to defeat COVID-19


title: Diagnostic Testing for Severe Acute Respiratory Syndrome-Related Coronavirus 2: A Narrative Review

text: Diagnostic testing to identify persons infected with severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection is central to control the global pandemic of COVID-19 that began in late 2019. In a few countries, the use of diagnostic testing on a massive scale has been a cornerstone of successful containment strategies. In contrast, the United States, hampered by limited testing capacity, has prioritized testing for specific groups of persons. Real-time reverse transcriptase polymerase chain reaction-based assays performed in a laboratory on respiratory specimens are the reference standard for COVID-19 diagnostics. However, point-of-care technologies and serologic immunoassays are rapidly emerging. Although excellent tools exist for the diagnosis of symptomatic patients in well-equipped laboratories, important gaps remain in screening asymptomatic persons in the incubation phase, as well as in the accurate determination of live viral shedding during convalescence to inform decisions to end isolation. Many affluent countries have encountered challenges in test delivery and specimen collection that have inhibited rapid increases in testing capacity. These challenges may be even greater in low-resource settings. Urgent clinical and public health needs currently drive an unprecedented global effort to increase testing capacity for SARS-CoV-2 infection. Here, the authors review the current array of tests for SARS-CoV-2, highlight gaps in current diagnostic capacity, and propose potential solutions.


title: Pharmacokinetics of Favipiravir in Critically Ill Patients With COVID-19

text: Since December 2019, a novel coronavirus (severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)) infection has been rapidly spreading worldwide and causing the respiratory illness, coronavirus disease 2019 (COVID-19). The antiretroviral drug favipiravir (FPV) has been experimentally used for COVID-19 treatment since March 2020 in Japan. However, the pharmacokinetics of FPV in critically ill patients is unknown. We measured the serum concentration of FPV using high-performance liquid chromatography in patients with severe COVID-19 who were admitted to the intensive care unit and placed on mechanical ventilation. The patients were administered 1,600 mg of FPV twice daily on day 1, followed by 600 mg twice daily from day 2 to day 5 (or more if needed). Suspensions of FPV tablets were administered through a nasogastric tube. Seven patients were enrolled in this study. Forty-nine blood samples were obtained from the eligible patients to evaluate FPV concentration. The FPV trough (after 8-12 hours) concentrations of most samples were lower than the lower limit of quantification (1 µg/mL) and half-maximal effective concentration (9.7 µg/mL) against SARS-CoV-2 previously tested in vitro. FPV trough concentration in critically ill patients was much lower than that of healthy subjects in a previous clinical trial, which is a cause for great concern. Further study is required to determine the optimal strategy for treatment of patients with severe COVID-19.


title: Anosmia as a prominent symptom of COVID-19 infection

text: According to WHO recommendations, everyone must protect themselves against Coronavirus disease 2019 (COVID-19), which will also protect others. Due to the lack of current effective treatment and vaccine for COVID-19, screening, rapid diagnosis and isolation of the patients are essential (1, 2). Therefore, identifying the early symptoms of COVID-19 is of particular importance and is a health system priority. Early studies from COVID-19 outbreak in China have illustrated several non-specific signs and symptoms in infected patients, including fever, dry cough, dyspnea, myalgia, fatigue, lymphopenia, and radiographic evidence of pneumonia (3, 4). Recently, a probability of association between COVID-19 and altered olfactory function has been reported in South Korea, Iran, Italy, France, UK and the United States (5-8). However, to our knowledge, the definite association between COVID-19 and anosmia has not been published.


Oncology Care Delivery in the COVID-19 Pandemic: An Opportunity to Study Innovations and Outcomes


title: Considerations for pharmacoepidemiological analyses in the SARS-CoV-2 pandemic

text: The coronavirus disease 2019 (COVID-19) pandemic has triggered several hypotheses regarding use of specific medicines and risk of infection as well as prognosis. Under these unique circumstances, rapid answers require quick engagement in data collection and analyses; however, appropriate design and conduct of pharmacoepidemiologic studies are needed to generate valid and reliable evidence. In this paper, endorsed by the International Society for Pharmacoepidemiology, we provide methodological considerations for the conduct of pharmacoepidemiological studies in relation to the pandemic across eight domains: (1) timeliness of evidence, including the need to prioritise some questions over others in the acute phase of the pandemic; (2) the need to align observational and interventional research on efficacy; (3) the specific challenges related to "real-time epidemiology" during an ongoing pandemic; (4) what design to use to answer a specific question; (5) considerations on the definition of exposures; (6) what covariates to collect; (7) considerations on the definition of outcomes; and (8) the need for transparent reporting.


An updated meta-analysis of AST and ALT levels and the mortality of COVID-19 patients


Have deaths from COVID-19 in Europe plateaued due to herd immunity?


Mobile phones: A forgotten source of SARS-CoV-2 transmission


The role of emergency medical services in containing COVID-19


One Bioethics for Covid 19?


title: Statistical Evaluation of Clinical Trials Under COVID-19 Pandemic

text: When conducting clinical trials under COVID-19 pandemic, protocol deviations and/or protocol violations are inevitably encountered due to possible environment change which may have an impact on the accuracy and reliability of clinical evaluation of the test treatment under investigation. Protocol deviations and/or violations include, but are not limited to, eligibility criteria, testing procedure, dose and dose regiment, treatment duration and clinical operation of the intended trial. FDA published guidance in March 2020 to assist investigators and institutional boards (IRBs) in assuring the safety of trial participants, maintaining compliance with good clinical practice, and minimizing risks to trial integrity during the COVID-19 pandemic. The purpose of this article is to proposal methods for statistical evaluation in terms of (i) possible shift in target patient population and (ii) assessment of reproducibility of clinical studies conduct under COVID-19 pandemic environment. The proposed methods can be used to determine whether the clinical results of the intended trials are acceptable from both statistical and regulatory perspectives.


title: Antiphospholipid antibodies in patients with COVID-19: a relevant observation?

text: BACKGROUND: High incidence of thrombosis in COVID-19 patients indicates a hypercoagulable state. Hence, exploring the involvement of antiphospholipid antibodies (aPL) in these patients is of interest. OBJECTIVES: To illustrate the incidence of criteria (lupus anticoagulant (LAC), anticardiolipin (aCL) IgG/IgM, antibeta2-glycoprotein I antibodies (aß2GPI) IgG/IgM) and non-criteria (anti-prothrombin/phosphatidyl serine (aPS/PT), aCL and aß2GPI IgA) aPL in a consecutive cohort of critically ill SARS-CoV-2 patients, their association with thrombosis, antibody profile and titers of aPL. PATIENTS/METHODS: Thirty one consecutive confirmed COVID-19 patients admitted to the Intensive Care Unit were included. aPL were measured at one time point, with part of the aPL positive patients retested after one month. RESULTS: Sixteen patients were single LAC positive, two triple positive, one double positive, one single aCL and three aCL IgG and LAC positive. Seven out of 9 thrombotic patients had at least one aPL. 16 out of 22 patients without thrombosis were aPL positive, amongst them two triple positives. Nine out of ten retested LAC positive patients were negative on a second occasion, as well as the double positive patient. Seven patients were aPS/PT positive associated to LAC. Three patients were aCL and aß2GPI IgA positive. CONCLUSION: Our observations support the frequent single LAC positivity during (acute phase) observed in COVID-19 infection, however not clearly related to thrombotic complications. Triple aPL positivity and high aCL/aß2GPI titers are rare. Repeat testing suggests aPL to be mostly transient. Further studies and international registration of aPL should improve understanding the role of aPL in thrombotic COVID-19 patients.


title: SRED-ARCE Recommendations for Minimally Invasive Interventions During the COVID-19 Pandemic in Romania

text: The Romanian Society of Digestive Endoscopy (SRED) and the Romanian Association of Endoscopic Surgery (ARCE) have decided to establish a joint working group to elaborate specific recommendations for organizing the diagnostic and the minimally invasive interventional procedures, in the context of the COVID-19 pandemic. The recommendations are based on the guidelines of the international societies of endoscopy and gastroenterology (ESGE / BSG / ASGE / ACG / AGA), respectively endoscopic surgery (EAES SAGES) (4-8), on the experience of countries severely affected by the pandemic (Italy, France, Spain, USA, Germany, etc.) and they will be applied within the limits of measures imposed at local and governmental level by the competent authorities. On the other hand, these recommendations should have a dynamic evolution, depending on the upward or downward trend of the COVID-19 pandemic at regional and local level, but also according to the findings of professional and academic societies, requiring regular reviews based on the publica tion of further recommendations or international clinical trials. The objectives of the SRED and ARCE recommendations target the endoscopic and laparoscopic surgery activities, to support their non discriminatory used for diagnostic or therapeutic purposes, pursuing the demonstrated benefits of these procedures, in safe conditions for patients and medical staff.


COVID-19 Digestive Symptoms Mimicking Internal Hernia Presentation After Roux-en-Y-Gastric Bypass; Comment on "Internal Hernia in the Times of COVID-19: to Laparoscope or Not to Laparoscope?"


A dearth of specifications regarding primary diagnostic monitors (PDMs) for nuclear medicine leaves us with little guidance during the COVID-19 pandemic


A case series of Monoclonal Gammopathy of Undetermined Significance and COVID-19


Characteristics Associated with Hospitalization Among Patients with COVID-19-Metropolitan Atrlant, Georgia, March-April 2020


Cannabinoids drive Th17 cell differentiation in patients with rheumatic autoimmune diseases


title: Prediction of COVID-19 transmission dynamics using a mathematical model considering behavior changes in Korea

text: OBJECTIVES: Since the report of the first confirmed case in Daegu on February 18, 2020, local transmission of coronavirus disease 2019 (COVID-19) in Korea has continued. In this study, we aimed to identify the pattern of local transmission of COVID-19 using mathematical modeling and predict the epidemic size and the timing of the end of the spread. METHODS: We modeled the COVID-19 outbreak in Korea by applying a mathematical model of transmission that factors in behavioral changes. We used the Korea Centers for Disease Control and Prevention data of daily confirmed cases in the country to estimate the nationwide and Daegu/Gyeongbuk area-specific transmission rates as well as behavioral change parameters using a least-squares method. RESULTS: The number of transmissions per infected patient was estimated to be about 10 times higher in the Daegu/Gyeongbuk area than the average of nationwide. Using these estimated parameters, our models predicts that about 13,800 cases will occur nationwide and 11,400 cases in the Daegu/Gyeongbuk area until mid-June. CONCLUSIONS: We mathematically demonstrate that the relatively high per-capita rate of transmission and the low rate of changes in behavior have caused a large-scale transmission of COVID-19 in the Daegu/Gyeongbuk area in Korea. Since the outbreak is expected to continue until May, non-pharmaceutical interventions that can be sustained over the long term are required.


JCD June 2020 Editorial Page


title: COVID-19: Unmasking Telemedicine

text: Telemedicine adoption has rapidly accelerated since the onset of the COVID-19 pandemic.1 Telemedicine provides increased access to medical care and helps to mitigate risk by conserving personal protective equipment and providing for social/physical distancing in order to continue to treat patients with a variety of allergic and immunologic conditions. During this time, many allergy and immunology clinicians have needed to adopt telemedicine expeditiously in their practices while studying the complex and variable issues surrounding its regulation and reimbursement. Some concerns have been temporarily alleviated since March 2020 to aid with patient care in the setting of COVID-19. Other changes are ongoing at the time of this publication. Members of the Telemedicine Work Group in the American Academy of Allergy, Asthma & Immunology (AAAAI) completed a telemedicine literature review of online and Pub Med resources through May 9, 2020 to detail Pre-COVID-19 telemedicine knowledge and outline up to date telemedicine material. This work group report was developed to provide guidance to allergy/immunology clinicians as they navigate the swiftly evolving telemedicine landscape.


title: A Bayesian approach for detecting a disease that is not being modeled

text: Over the past decade, outbreaks of new or reemergent viruses such as severe acute respiratory syndrome (SARS) virus, Middle East respiratory syndrome (MERS) virus, and Zika have claimed thousands of lives and cost governments and healthcare systems billions of dollars. Because the appearance of new or transformed diseases is likely to continue, the detection and characterization of emergent diseases is an important problem. We describe a Bayesian statistical model that can detect and characterize previously unknown and unmodeled diseases from patient-care reports and evaluate its performance on historical data.


Acute respiratory distress syndrome and steroids in the shadow of coronavirus disease 2019


Sozialmedizin in Zeiten der Corona-Pandemie


title: Early Outcomes with Utilization of Tissue Plasminogen Activator in COVID-19 Associated Respiratory Distress: A series of five cases

text: BACKGROUND: Coronavirus patients demonstrate varying degrees of respiratory insufficiency; many will progress to respiratory failure with a severe version of acute respiratory distress syndrome (ARDS) refractory to traditional supportive strategies. Providers must consider alternative therapies to deter or prevent the cascade of decompensation to fulminant respiratory failure. METHODS: This is a case-series of five COVID-19 positive patients who demonstrated severe hypoxemia, declining respiratory performance, and escalating oxygen requirements. Patients met the following criteria: COVID-19 positivity, worsening respiratory performance, severe hypoxemia (PaO2<80) despite traditional supportive measures, escalating supplemental oxygen requirements and D-dimer greater than 1.5µg/mL. All patients received protocol directed thrombolytic therapy with Tissue Plasminogen Activator (tPA). RESULTS: All five patients improved without deleterious effects of thrombolytic therapy. Patient one was on maximum ventilator support, paralytics, and prone positioning without improvement. During tPA administration his P/F ratio improved from 69 to 127. Ventilator support was weaned immediately on post-treatment day 1 and he was extubated on post treatment day 12. Our second through fifth patients were not intubated at time of initiation of tPA therapy. These patients each required significant oxygen supplementation trending toward intubation. After tPA therapy, all patients demonstrated a noticeable increase in PaO2 values overtime. Three of these patients avoided intubation due to COVID-19 associated respiratory failure. CONCLUSIONS: Administration of thrombolytics was followed by overall improvement in patients' oxygen requirements, and in three cases, prevented progression to mechanical ventilation, without deleterious effects. Clinical trials of thrombolytic therapy would further serve to underscore the efficacy and utility of this therapy. LEVEL OF EVIDENCE: Level V- Case series of therapeutic effect.


COVID-19 epidemic: disentangling the re-emerging controversy about medical facemasks from an epidemiological perspective


Airtight, flexible, disposable barrier for extubation


title: SIR Model-based Prediction of Infected Population of Coronavirus in Hubei Province

text: After the sudden outbreak of Coronavirus in Wuhan, continuous and rich data of the epidemic has been made public as the vital fact for decision support in control measures and aggressive implementation of containment strategies and plans. With the further growth and spreading of the virus, future resource allocation and planning under updated strategies and measures rely on careful study of the epidemic data and characteristics for accurate prediction and estimation. By using the SIR model and reported data, key parameters are obtained from least sum of squared errors for an accurate prediction of epidemic trend in the last four weeks.


title: The diagnostic value of detecting sudden smell loss among asymptomatic COVID-19 patients in early stage: The possible early sign of COVID-19

text: IMPORTANCE: The newly emerged coronavirus disease 19 (COVID-19), is threatening the world. Olfactory or gustatory dysfunction is reported as one of the symptoms worldwide. As reported so far, different clinical features have been reported according to outbreak sites and gender; most of the patients, who complained of anosmia or hyposmia, were Europeans. We had a fast review for novel articles about COVID-19 infection and olfactory function. OBSERVATIONS: Rapid reviews for COVID-19 or other viral infection and olfactory and/or gustatory dysfunctions were done in this review. Up to date, a lot of reports have shown that olfactory dysfunction is related to viral infections but no exact mechanism, clinical course, and definite treatment have been discovered, which is also same in COVID-19. In general, intranasal steroid (INS) and oral steroid for short time help improve the recovery of the olfactory function in case of olfactory dysfunction after virus infection. Considering severe respiratory complications and immunocompromised state of COVID-19, the use of steroid should be limited and cautious because we do not have enough data to support the usage of steroid to treat olfactory dysfunction in the clinical course of COVID-19. CONCLUSIONS AND RELEVANCE: In the days of pandemic COVID-19, we should keep in mind that olfactory dysfunctions, even without other upper respiratory infection or otolaryngologic symptoms, might be the early signs of COVID-19.


title: The role of cardiac imaging in hospitalized COVID-19-positive patients

text: COVID-19 infection is associated with several cardiac complications with high rates of adverse outcomes. Cardiac imaging has different utility in different clinical scenarios, and the importance of minimizing healthcare worker exposure should be considered. Cardiac imaging should only be ordered if its benefits outweigh its risks, with anticipated changes in acute treatment and outcomes, and no suitable alternative of sufficient adequacy is available. Indications for advanced cardiac imaging for COVID-19 patients in the acute phase are limited, although follow-up imaging in the convalescent stage may provide prognostic importance in recovered COVID-19 patients with positive troponin or decompensated heart failure.


SARS-CoV-2 and Multiple Sclerosis: Not All Immune Depleting DMTs are Equal or Bad


title: Convalescent plasma for persisting Covid-19 following therapeutic lymphocyte depletion: a report of rapid recovery

text: We read with deep interest the report by Tepasse and colleagues1 , concerning two cases of persisting viremia in Covid-19 with fatal outcome. Whilst SARS-CoV-2 infection in the early stages of infection has been well described, less is known about the development of antibodies to SARS-CoV-2, clearance of RNA shedding and clinical outcome of COVID-19.


Disparities in the Population at Risk of Severe Illness From COVID-19 by Race/Ethnicity and Income


Rapid outbreak response requires trust


COVID-19 infection in a patient with multiple sclerosis treated with fingolimod


Rethinking respiratory function laboratories in the era of coronavirus disease 2019: Considerations for today and the day after


Musings on the current state of COVID-19 modeling and reporting


title: Artificial Intelligence-based Clinical Decision Support for COVID-19 -- Where Art Thou?

text: The COVID-19 crisis has brought about new clinical questions, new workflows, and accelerated distributed healthcare needs. While artificial intelligence (AI)-based clinical decision support seemed to have matured, the application of AI-based tools for COVID-19 has been limited to date. In this perspective piece, we identify opportunities and requirements for AI-based clinical decision support systems and highlight challenges that impact"AI readiness"for rapidly emergent healthcare challenges.


Implications of COVID-19 on the General Surgery Match


Gastrointestinal cancer surgery and enhanced recovery after surgery (ERAS) during COVID-19 outbreak


title: Representation of specialties in Coronavirus Disease 2019 (COVID-19) research: analysis of published literature in the first 3 months

text: OBJECTIVE: Coronavirus disease 2019 (COVID-19) has infected more than 1.5 million patients worldwide and is associated with high morbidity and mortality. The volume of research published in a specialty, which may shed light on the perceived impact that a topic plays within that discipline, is unknown for the present pandemic. MATERIALS AND METHODS: We analyzed all articles published in the first 3 months on COVID-19 and categorized them by journal type and article content. RESULTS: There was a ~100-fold difference in articles published on COVID when categorized by journal type and ~65-fold difference when grouped by article content. CONCLUSIONS: There is a wide variation in research published withing various specialties regarding COVID-19. Researchers across specialties need to urgently realize the impact of COVID-19 and publish articles that can help improve understanding of this ongoing pandemic.


Cardiothoracic Surgery at the Time of the Coronavirus Disease-2019 Pandemic: Lessons From the East (and From a Previous Epidemic) for Western Battlefields


title: Coronavirus Disease 2019 (COVID-19) and Pregnancy: Combating Isolation to Improve Outcomes

text: With the current global coronavirus disease 2019 (COVID-19) pandemic, new challenges arise as social distancing and isolation have become the standard for safety. Evidence supports the protective benefits of social connections and support during pregnancy and labor; there are increased maternal, fetal, and pregnancy risks when pregnant and laboring women lack support. As health care professionals take appropriate precautions to protect patients and themselves from infection, there must be a balance to ensure that we do not neglect the importance of social and emotional support during important milestones such as pregnancy and childbirth. Resources are available to help pregnant women, and technology represents an opportunity for innovation in providing care.


title: Effects of heterogeneous self-protection awareness on resource-epidemic coevolution dynamics

text: Recent studies have demonstrated that the allocation of individual resources has a significant influence on the dynamics of epidemic spreading. In the real scenario, individuals have a different level of awareness for self-protection when facing the outbreak of an epidemic. To investigate the effects of the heterogeneous self-awareness distribution on the epidemic dynamics, we propose a resource-epidemic coevolution model in this paper. We first study the effects of the heterogeneous distributions of node degree and self-awareness on the epidemic dynamics on artificial networks. Through extensive simulations, we find that the heterogeneity of self-awareness distribution suppresses the outbreak of an epidemic, and the heterogeneity of degree distribution enhances the epidemic spreading. Next, we study how the correlation between node degree and self-awareness affects the epidemic dynamics. The results reveal that when the correlation is positive, the heterogeneity of self-awareness restrains the epidemic spreading. While, when there is a significant negative correlation, strong heterogeneous or strong homogeneous distribution of the self-awareness is not conducive for disease suppression. We find an optimal heterogeneity of self-awareness, at which the disease can be suppressed to the most extent. Further research shows that the epidemic threshold increases monotonously when the correlation changes from most negative to most positive, and a critical value of the correlation coefficient is found. When the coefficient is below the critical value, an optimal heterogeneity of self-awareness exists; otherwise, the epidemic threshold decreases monotonously with the decline of the self-awareness heterogeneity. At last, we verify the results on four typical real-world networks and find that the results on the real-world networks are consistent with those on the artificial network.


Colchicin treatment of COVID-19 presenting with cutaneous rash and myopericarditis


Heart failure related hospitalisation and management during COVID-19 pandemic: are we ready to reflect? - REPLY


Acute kidney injury associated with COVID-19: another extrapulmonary manifestation


Impacto psicológico del confinamiento en la población infantil y como mitigar sus efectos: revisión rápida de la evidencia./ [Psychological impact of lockdown (confinement) on young children and how to mitigate its effects: Rapid review of the evidence]


title: Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care

text: The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease has gripped the entire international community and caused widespread public health concerns. Despite global efforts to contain the disease spread, the outbreak is still on a rise because of the community spread pattern of this infection. This is a zoonotic infection, similar to other coronavirus infections, that is believed to have originated in bats and pangolins and later transmitted to humans. Once in the human body, this coronavirus (SARS-CoV-2) is abundantly present in nasopharyngeal and salivary secretions of affected patients, and its spread is predominantly thought to be respiratory droplet/contact in nature. Dental professionals, including endodontists, may encounter patients with suspected or confirmed SARS-CoV-2 infection and will have to act diligently not only to provide care but at the same time prevent nosocomial spread of infection. Thus, the aim of this article is to provide a brief overview of the epidemiology, symptoms, and routes of transmission of this novel infection. In addition, specific recommendations for dental practice are suggested for patient screening, infection control strategies, and patient management protocol.


An update on CT chest findings in coronavirus disease-19 (COVID-19)


Smell and taste disorders: warning signs for SARS-CoV-2 infection


Psychiatry and COVID-19: The Role of Chlorpromazine


title: War on Terror Cells: Strategies to Eradicate "Novel Coronavirus" Effectively

text: Brain-eating amoebae are known to harbor a plethora of viral, bacterial, protozoal, and fungal pathogens and safeguard these pathogens against disinfectants. Due to their ubiquitous distribution in the environment and their status as the trojan horse of the microbial world, amoebae can provide novel coronavirus a means to susceptible hosts and possible transmission to the central nervous system. Here, we hypothesize that pursuing the host that harbor "terror cells" is a valuable approach in eradicating novel coronavirus in affected communities.


Cardiac injury and mortality in COVID-19: A reappraisal


title: Is social connectedness a risk factor for the spreading of COVID-19 among older adults? The Italian paradox

text: Italy was one of the first European countries affected by the new coronavirus (COVID-19) pandemic, with over 105,000 infected people and close to 13,000 deaths, until March 31st. The pandemic has hit especially hard because of the country's demographic structure, with a high percentage of older adults. The authors explore the possibility, recently aired in some studies, of extensive intergenerational contact as a possible determinant of the severity of the pandemic among the older Italian adults. We analyzed several variables to test this hypothesis, such as the percentage of infected patients aged >80 years, available nursing home beds, COVID-19 incidence rate, and the number of days from when the number of positive tests exceeded 50 (epidemic maturity). We also included in the analysis mean household size and percentage of households comprising one person, in the region. Paradoxically, the results are opposite of what was previously reported. The pandemic was more severe in regions with higher family fragmentation and increased availability of residential health facilities.


title: Immunosenescence in chronic HIV infected patients impairs essential functions of their natural killer cells

text: The HIV/AIDS pandemic still represents an important global health issue. There is no sterilizing cure, therefore a continuous treatment is necessary, which caused the emerged idea of HIV as a chronic inflammatory disease that may also affect healthy aging. Considering that the activation profile of some innate cells such as natural killer cells has previously been associated to HIV progression, it remains to be better defined this activation status of NK cells considering the time of HIV infection. In this study, we characterized NK cell phenotype and function during acute and chronic HIV infection and also investigated markers of immunosenescence in these cells. Our results showed that chronic infected patients remained with elevated levels of some plasma inflammatory molecules (IP-10, sCD14) and a concurrent expansion of the non-functional NK cell subset (CD3-CD56-CD16+). NK cells from the chronic infected group displayed an activated profile with higher levels of cytokines and chemokines production (TNF-α, IL-12, IFN-α2, IFN-Î³, IL-6, RANTES, MCP-1, IL-10, IL-4 and IL-5). The production of these molecules was positively correlated to the time of infection. Moreover, we noted a possible association of higher global DNA methylation frequency of NK cells in two HIV patients in the advanced stage of disease. Chronic infected patients also showed a trend towards higher production of reactive oxygen species by their NK cells which altogether suggest the evolution of these cells to a senescent state that might be further evaluated.


title: COVID-19 spike-host cell receptor GRP78 binding site prediction

text: OBJECTIVES: Understanding the novel coronavirus (COVID-19) mode of host cell recognition may help to fight the disease and save lives. The spike protein of coronaviruses is the main driving force for host cell recognition. METHODS: In this study, the COVID-19 spike binding site to the cell-surface receptor (Glucose Regulated Protein 78 (GRP78)) is predicted using combined molecular modeling docking and structural bioinformatics. The COVID-19 spike protein is modeled using its counterpart, the SARS spike. RESULTS: Sequence and structural alignments show that four regions, in addition to its cyclic nature have sequence and physicochemical similarities to the cyclic Pep42. Protein-protein docking was performed to test the four regions of the spike that fit tightly in the GRP78 Substrate Binding Domain ß (SBDß). The docking pose revealed the involvement of the SBDß of GRP78 and the receptor-binding domain of the coronavirus spike protein in recognition of the host cell receptor. CONCLUSIONS: We reveal that the binding is more favorable between regions III (C391-C525) and IV (C480-C488) of the spike protein model and GRP78. Region IV is the main driving force for GRP78 binding with the predicted binding affinity of -9.8â¯kcal/mol. These nine residues can be used to develop therapeutics specific against COVID-19.


title: Three challenges that the COVID-19 pandemic represents for psychiatry

text: The evolving COVID-19 pandemic and its likely consequences add to the already substantial psychosocial burden caused by global problems, existential threats and heightened uncertainty, which are increasingly confronting communities worldwide. Here we briefly outline three challenges for clinical psychiatry and research, related to coping with the social epidemiology of negative moods, stress and socially mediated traumatic experiences brought on by these adverse developments.


title: Evaluation of the efficacy and safety of intravenous remdesivir in adult patients with severe COVID-19: study protocol for a phase 3 randomized, double-blind, placebo-controlled, multicentre trial

text: BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by a novel corinavirus (later named SARS-CoV-2 virus), was fistly reported in Wuhan, Hubei Province, China towards the end of 2019. Large-scale spread within China and internationally led the World Health Organization to declare a Public Health Emergency of International Concern on 30th January 2020. The clinical manifestations of COVID-19 virus infection include asymptomatic infection, mild upper respiratory symptoms, severe viral pneumonia with respiratory failure, and even death. There are no antivirals of proven clinical efficacy in coronavirus infections. Remdesivir (GS-5734), a nucleoside analogue, has inhibitory effects on animal and human highly pathogenic coronaviruses, including MERS-CoV and SARS-CoV, in in vitro and in vivo experiments. It is also inhibitory against the COVID-19 virus in vitro. The aim of this study is to assess the efficacy and safety of remdesivir in adult patients with severe COVID-19. METHODS: The protocol is prepared in accordance with the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. This is a phase 3, randomized, double-blind, placebo-controlled, multicentre trial. Adults (≥ 18 years) with laboratory-confirmed COVID-19 virus infection, severe pneumonia signs or symptoms, and radiologically confirmed severe pneumonia are randomly assigned in a 2:1 ratio to intravenously administered remdesivir or placebo for 10 days. The primary endpoint is time to clinical improvement (censored at day 28), defined as the time (in days) from randomization of study treatment (remdesivir or placebo) until a decline of two categories on a six-category ordinal scale of clinical status (1 = discharged; 6 = death) or live discharge from hospital. One interim analysis for efficacy and futility will be conducted once half of the total number of events required has been observed. DISCUSSION: This is the first randomized, placebo-controlled trial in COVID-19. Enrolment began in sites in Wuhan, Hubei Province, China on 6th February 2020. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04257656. Registered on 6 February 2020.


title: Home Surgical Skill Training Resources for Obstetrics and Gynecology Trainees During a Pandemic

text: The coronavirus disease 2019 (COVID-19) pandemic has created a unique educational circumstance in which medical students, residents, and fellows find themselves with a gap in their surgical training. We reviewed the literature, and nine categories of resources were identified that may benefit trainees in preventing skill decay: laparoscopic box trainers, virtual reality trainers, homemade simulation models, video games, online surgical simulations, webinars, surgical videos, smartphone applications, and hobbies including mental imagery. We report data regarding effectiveness, limitations, skills incorporated, cost, accessibility, and feasibility. Although the cost and accessibility of these resources vary, they all may be considered in the design of remote surgical training curricula during this unprecedented time of the COVID-19 pandemic.


title: Avaliação microbiológica e higienicossanitária do leite in natura comercializado na cidade de Teresina, PI

text: O leite é um dos alimentos mais consumidos no mundo, pois é completo, rico em nutrientes necessários para saúde dos seres vivos. Este alimento exige controle e preocupação com a segurança da matéria-prima e do produto beneficiado. O presente estudo objetivou verificar a qualidade microbiológica do leite comercializado in natura na cidade de Teresina - Piauí bem como as condições higienicossanitárias dos ambientes que o comercializa. Foram analisadas seis amostras de leite in natura comercializadas em duas vacarias, sendo três amostras de cada vacaria. Para análise das amostras foi utilizada a técnica de Pour plate em ágar padrão para determinação de UFC/mL e Caracterização através da bacterioscopia e preenchimento do checklist para avaliação das condições higienicossanitárias. Os resultados foram comparados com a RDC n° 62/2011 e revelaram crescimento em todas as amostras analisadas, observou-se que na primeira diluição da amostra 1, houve contaminação por mesófilos acima dos limites permitidos, porém, quando obtida a média das colônias, percebeu-se que estava dentro do valor estabelecido pela Normativa. Já a vacaria 2, apresentou contaminação acima dos valores permitidos em todas as amostras. O checklist utilizado nesse estudo permitiu pontuar questões importantes sobre as condições de higiene das vacarias que comercializam o leite in natura em Teresina-PI. A partir dele verificou-se que recomendações e pontos importantes preconizados pela legislação para a produção do leite de boa qualidade são desrespeitados como por exemplo, cuidados com o local, os animais e os utensílios de ordenha, a limpeza do local de ordenha, dos equipamentos e os cuidados de coleta e armazenamento. Os resultados ressaltam a importância de boas práticas na produção do leite bem como a melhoria nas condições higiênicas das instalações, pois a higienização é um fator determinante na redução da quantidade de micro-organismos contaminantes.(AU)


Covid-19: UK pledges to reintroduce contact tracing to fight virus


title: Evolving geographic diversity in SARS-CoV2 and in silico analysis of replicating enzyme 3CLpro targeting repurposed drug candidates

text: BACKGROUND: Severe acute respiratory syndrome (SARS) has been initiating pandemics since the beginning of the century. In December 2019, the world was hit again by a devastating SARS episode that has so far infected almost four million individuals worldwide, with over 200,000 fatalities having already occurred by mid-April 2020, and the infection rate continues to grow exponentially. SARS coronavirus 2 (SARS-CoV-2) is a single stranded RNA pathogen which is characterised by a high mutation rate. It is vital to explore the mutagenic capability of the viral genome that enables SARS-CoV-2 to rapidly jump from one host immunity to another and adapt to the genetic pool of local populations. METHODS: For this study, we analysed 2301 complete viral sequences reported from SARS-CoV-2 infected patients. SARS-CoV-2 host genomes were collected from The Global Initiative on Sharing All Influenza Data (GISAID) database containing 9 genomes from pangolin-CoV origin and 3 genomes from bat-CoV origin, Wuhan SARS-CoV2 reference genome was collected from GeneBank database. The Multiple sequence alignment tool, Clustal Omega was used for genomic sequence alignment. The viral replicating enzyme, 3-chymotrypsin-like cysteine protease (3CLpro) that plays a key role in its pathogenicity was used to assess its affinity with pharmacological inhibitors and repurposed drugs such as anti-viral flavones, biflavanoids, anti-malarial drugs and vitamin supplements. RESULTS: Our results demonstrate that bat-CoV shares > 96% similar identity, while pangolin-CoV shares 85.98% identity with Wuhan SARS-CoV-2 genome. This in-depth analysis has identified 12 novel recurrent mutations in South American and African viral genomes out of which 3 were unique in South America, 4 unique in Africa and 5 were present in-patient isolates from both populations. Using state of the art in silico approaches, this study further investigates the interaction of repurposed drugs with the SARS-CoV-2 3CLpro enzyme, which regulates viral replication machinery. CONCLUSIONS: Overall, this study provides insights into the evolving mutations, with implications to understand viral pathogenicity and possible new strategies for repurposing compounds to combat the nCovid-19 pandemic.


title: Racial Impact on Infections and Deaths due to COVID-19 in New York City

text: Redlining is the discriminatory practice whereby institutions avoided investment in certain neighborhoods due to their demographics. Here we explore the lasting impacts of redlining on the spread of COVID-19 in New York City (NYC). Using data available through the Home Mortgage Disclosure Act, we construct a redlining index for each NYC census tract via a multi-level logistical model. We compare this redlining index with the COVID-19 statistics for each NYC Zip Code Tabulation Area. Accurate mappings of the pandemic would aid the identification of the most vulnerable areas and permit the most effective allocation of medical resources, while reducing ethnic health disparities.


title: Clinical features of hemodialysis patients with COVID-19: a single-center retrospective study on 32 patients

text: OBJECTIVE: We retrospectively analyzed the data of 32 hemodialysis patients with COVID-19 to clarify the epidemiological characteristics of this special population. METHOD: The data of 32 hemodialysis patients with COVID-19, including epidemiological, demographic, clinical, laboratory, and radiological, were collected from the Blood Purification Department of Wuhan Fourth Hospital from February 3 to 16, 2020. RESULTS: Of the 32 patients, 23 were male, and the median age was 58 years; the median dialysis vintage was 33 months. Two groups were divided according to the patient's primary renal disease: group 1 (16 patients with diabetic nephropathy), group 2 (12 patients with primary glomerulonephritis, 2 with obstructive kidney disease, 1 with hypertensive renal damage, and 1 with polycystic kidney). No significant differences were observed between the two groups in epidemiological characteristics, blood cell counts, and radiological performance. Hemodialysis patients are susceptible to COVID-19 at all ages, and patients with diabetes may be a high-risk population (50%). Common symptoms included fever (15 cases), cough (21 cases), and fatigue (7 cases). The blood lymphocyte count decreased in 84.6% of the patients (median: 0.765 × 109/L). Chest CT revealed ground-glass-like lesions in 18 cases, unilateral lung patchiness in 7 cases, bilateral lung patchiness in 7 cases, and pleural effusion in 2 cases. CONCLUSION: Only 46.875% of the hemodialysis patients with COVID-19 had fever in the early stage; and diabetics may be the most susceptible population. A decrease in blood lymphocyte count and ground-glass opacity on chest CT scan is beneficial in identifying the high-risk population.


title: Cohort study of chest CT and clinical changes in 29 patients with coronavirus disease 2019 (COVID-19)

text: OBJECTIVES: To investigate the imaging findings and clinical time course of COVID-19 pneumonia. METHODS: A total of 113 baseline and follow-up CT scans from 24 January 2020 to 18 February 2020 were longitudinally collected from 29 confirmed COVID-19 patients in a single center. The changes in the clinical and laboratory characteristics, imaging features, lesion-to-muscle ratio (LMR), and pulmonary inflammation index (PII) at baseline, 1-6 days, 7-13 days, and ≥ 14 days were compared. RESULTS: Of the 29 COVID-19 patients enrolled, the baseline chest CT scan was obtained 3 ± 2 (0-9) days after the onset of symptoms, and each patient had an average of 4 ± 1 (3-5) CT scans with a mean interval of 5 ± 2 (1-14) days. The percentage of patients with fever, cough, shortness of breath, and myalgia obviously decreased at 7-13 days with regular treatment (p < 0.05). The lymphocyte count, C-reactive protein, interleukin-6, and oxygenation index worsened within 1-6 days but improved sharply at 7-13 days. Compared with those at the other three time points, the LMR, PII, and number of involved lobes at 1-6 days were the highest, and gradually improved after 7-13 days. CONCLUSIONS: Lung lesion development on chest CT reflects the clinical time course of COVID-19 progression over 1-6 days, followed by clinical improvement and the resorption of lesions. CT imaging may be indicated when patients fail to improve within a week of treatment, but repeated chest CT may be unnecessary when the patients show improvements clinically. KEY POINTS: â¢ Chest CT reflects the development of coronavirus disease 2019 pneumonia (COVID-19). â¢ COVID-19 usually shows progressive lesions over up to 9 days with subsequent resorption. â¢ Unusual clinical time course of COVID-19 may indicate repeated chest CT.


Cardiovascular surgery in the COVID-19 pandemic


title: Inferring change points in the spread of COVID-19 reveals the effectiveness of interventions

text: As COVID-19 is rapidly spreading across the globe, short-term modeling forecasts provide time-critical information for decisions on containment and mitigation strategies. A major challenge for short-term forecasts is the assessment of key epidemiological parameters and how they change when first interventions show an effect. By combining an established epidemiological model with Bayesian inference, we analyze the time dependence of the effective growth rate of new infections. Focusing on COVID-19 spread in Germany, we detect change points in the effective growth rate that correlate well with the times of publicly announced interventions. Thereby, we can quantify the effect of interventions, and we can incorporate the corresponding change points into forecasts of future scenarios and case numbers. Our code is freely available and can be readily adapted to any country or region.


text: As coronavirus disease 2019 (COVID-19) is rapidly spreading across the globe, short-term modeling forecasts provide time-critical information for decisions on containment and mitigation strategies. A major challenge for short-term forecasts is the assessment of key epidemiological parameters and how they change when first interventions show an effect. By combining an established epidemiological model with Bayesian inference, we analyzed the time dependence of the effective growth rate of new infections. Focusing on COVID-19 spread in Germany, we detected change points in the effective growth rate that correlate well with the times of publicly announced interventions. Thereby, we could quantify the effect of interventions and incorporate the corresponding change points into forecasts of future scenarios and case numbers. Our code is freely available and can be readily adapted to any country or region.


COVID-19 and Obesity-the Management of Pre- and Post-bariatric Patients Amidst the COVID-19 Pandemic


title: Pandémie COVID-19 : impact sur le systeme cardiovasculaire. Données disponibles au 1er avril 2020./ [COVID-19 pandemia: Impact on the cariovascular system. Data of 1st April 2020]

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells with angiotensin receptors, leading to pneumonia linked to COVID-19. The virus has a double impact on the cardiovascular system, the infection will be more intense if the host has cardiovascular co-morbidities and the virus can cause life-threatening cardiovascular lesions. Therapies associated with COVID-19 may have adverse cardiovascular effects. Therefore, special attention should be given to cardiovascular protection during COVID-19 infection.


title: A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

text: INTRODUCTION AND HYPOTHESIS: The COVID-19 pandemic and the desire to "flatten the curve" of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. METHODS: We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. RESULTS: Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission. CONCLUSIONS: We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.


Special care dentistry in the world of COVID-19


title: [Preliminary report on the Covid-19 outbreak in Valle d'Aosta dialysis centers]

text: Valle d'Aosta, Italy's smallest region, faced a Covid-19 epidemic trend of absolute relevance. In line with data concerning the local general population, the predominance of the illness among uremic patients has been high. The authors report here preliminary data on the spread of this disease within the region and on the clinical trend of the infected patients who needed to be hospitalised.


title: Identification of bioactive compounds from Glycyrrhiza glabra as possible inhibitor of SARS-CoV-2 spike glycoprotein and non-structural protein-15: a pharmacoinformatics study

text: At present, the world is facing a pandemic named as COVID-19, caused by SARS-CoV-2. Traditional Chinese medicine has recommended the use of liquorice (Glycyrrhiza species) in the treatment of infections caused by SARS-CoV-2. Therefore, the present investigation was carried out to identify the active molecule from the liquorice against different protein targets of COVID-19 using an in-silico approach. The molecular docking simulation study of 20 compounds along with two standard antiviral drugs (Lopinavir and Rivabirin) was carried out with the help of Autodock vina software using two protein targets from COVID-19 i.e. spike glycoprotein (PDB ID: 6VSB) and Non-structural Protein-15 (Nsp15) endoribonuclease (PDB ID: 6W01). From the observed binding energy and the binding interactions, glyasperin A showed high affinity towards Nsp15 endoribonuclease with uridine specificity, while glycyrrhizic acid was found to be best suited for the binding pocket of spike glycoprotein and also prohibited the entry of the virus into the host cell. Further, the dynamic behavior of the best-docked molecules inside the spike glycoprotein and Nsp15 endoribonuclease were explored through all-atoms molecular dynamics (MD) simulation study. Several parameters from the MD simulation have substantiated the stability of protein-ligand stability. The binding free energy of both glyasperin A and glycyrrhizic acid was calculated from the entire MD simulation trajectory through the MM-PBSA approach and found to high binding affinity towards the respective protein receptor cavity. Thus, glyasperin A and glycyrrhizic acid could be considered as the best molecule from liquorice, which could find useful against COVID-19.Communicated by Ramaswamy H. Sarma.


title: A Case of Breakthrough COVID-19 during Hydroxychloroquine Maintenance

text: There have been controversies on the prophylactic effect of hydroxychloroquine against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). We describe a patient, 60-year old Korean woman, with coronavirus disease 2019 (COVID-19) who had been taking hydroxychloroquine for 6 months. Her serum and saliva concentrations of hydroxychloroquine were 280 µg/L and 4,890 µg/L, respectively. The present case raises concerns on hydroxychloroquine's role as a prophylactic agent for COVID-19.


Premières réflexions sur la COVID-19


Hyponatremia, IL-6, and SARS-CoV-2 (COVID-19) infection: may all fit together?