title: Thoracic computerised tomography scans in one hundred eighteen orthopaedic patients during the COVID-19 pandemic: identification of chest lesions; added values; help in managing patients; burden on the computerised tomography scan department

text: PURPOSE: Based on the recent literature, chest computed tomography (CT) examination could aid for management of patients during COVID-19 pandemic. However, the role of chest CT in management of COVID-19 patients is not exactly the same for medical or surgical specialties. In orthopaedic or trauma emergency, abdomen, pelvis, cervical, dorsal, and lumbar spine CT are performed to investigate patients; the result is a thoracic CT scan incorporating usually the thorax; however, information about lung parenchyma can be obtained on this thorax CT, and manifestations of COVID-19 can be diagnosed. The objective of our study was to evaluate this role in orthopedic patients to familiarize orthopaedists with the value and limits of thoracic CT in orthopaedic surgery. MATERIALS AND METHODS: Among the 1397 chest CT scans performed during the pandemic period from 1 March 2020 to 10 May 2020, in two centres with orthopaedic surgery, we selected all the 118 thoracic or chest CT performed for patients who presented to the Emergency Department of the hospital with a diagnosis of trauma for orthopaedic surgical treatment. Thirty-nine of these 118 patients were tested with PCR for the diagnosis of COVID-19 infection. Depending on clinical status (symptomatic or non-symptomatic), the information useful for the orthopaedist surgeon and obtained from the Chest CT scan according to the result of the PCR (gold standard) was graded from 0 (no or low value) to 3 (high value). The potential risks of chest CT as exposure to radiation, and specific pathway were analyzed and discussed. A group of patients treated during a previous similar period (1 March 2018 to 15 April 2018) was used as control for evaluation of the increase of CT scanning during the COVID-19 pandemic. RESULTS: Among the 118 patients with chest CT, there were 16 patients with positive COVID-19 chest CT findings, and 102 patients with negative chest CT scan. With PCR results as reference, the sensitivity, specificity, positive predictive value of chest CT in indicating COVID-19 infection were 81%, 93%, and 86%, respectively (p = 0.001). A useful information for the orthopaedic surgeon (graded as 1 for 71 cases, as 2 for 5 cases, and as 3 for 11 cases) was obtained from 118 chest CT scans for 87 (74%) patients, while the CT was no value in 30 (25%) cases, and negative value in one (1%) case. Roughly 20% of the total number of CT scanner performed over the pandemic period was dedicated to COVID-19, but only 2% were for orthopaedic or trauma patients. However, this was ten times higher than during the previous control period of comparison. CONCLUSION: Although extremely valuable for surgery management, these results should not be overstated. The CT findings studied are not specific for COVID-19, and the positive predictive value of CT will be low unless disease prevalence is high, which was the case during this period.


Clinical phenotypes of critically ill COVID-19 patients


title: Potential lethal outbreak of coronavirus disease (COVID-19) among the elderly in retirement homes and long-term facilities, France, March 2020

text: Reports from the coronavirus disease (COVID-19) outbreak in China identified older age as a predictor of severity and mortality [1] A retrospective analysis of individual case data from China and elsewhere showed a very strong age gradient in the infection fatality ratio (IFR) and case fatality ratio (CFR) [2] In France, as at 15 March 2020, people older than 75 years accounted for 20% of the confirmed cases but 79% of the deaths [3] Cardiovascular diseases, hypertension and diabetes mellitus were the comorbidities most frequently associated with COVID-19, and many patients died of their original comorbidities [4,5] All these comorbidities are highly common among dependent elderly people housed in institutions Using simple calculation, we present here the impact of several worst-case scenarios in French institutions Potential number of deathsGo to section We studied different scenarios to simulate the potential death toll of an outbreak of COVID-19 in the French institutions in the absence of mitigation measures We extracted the age structure of residents from 40 “Habitat et Humanisme” institutions for dependent elderly people In France, at the end of 2017, 766,400 people above 60 years of age were housed in retirement homes for dependent elderly people, in long-term care facilities or received home-based care [6] While the calculation of IFR is based on the proportion of all infected cases, i e a precise estimation of the proportion of symptomatic and asymptomatic cases, we restricted our analysis to CFR The CFR, estimated from China and elsewhere, for 60–69 year-olds, 70–79 year-olds and those 80 years and older were, respectively, 3 6%, 8 0% and 14 8% [2] We applied the hypothesis that 30–50% of the institutions were infected, a final attack rate (AR) of 30–50% among the residents and applying age-specific fatality ratios, with their confidence intervals (CI), from [2] By the time the epidemic is over, the resulting death toll in these institutions could be equal to the yearly national death toll caused by seasonal influenza in those older than above 65 years (9,025 deaths on average between 2000 and 2009) or it could largely exceed that figure, depending on the final AR and the proportion of infected institutions (Table) [7] Among this frail population, part of this excess in mortality may be due to the acceleration of underlying unavoidable process and another part directly attributable to the infection


Commentary: Fool me once, shame on you, fool me twice, shame on me-preparing for acute aortic emergencies and the next wave of the COVID-19 pandemic


Coronavirus Disease (COVID-19) Pandemic: A Race Against Time


Emergency Endoscopy During the SARS-CoV-2 Pandemic in the North of Italy: Experience from St. Orsola University Hospital-Bologna


title: Learning to Forecast and Forecasting to Learn from the COVID-19 Pandemic

text: Accurate forecasts of COVID-19 is central to resource management and building strategies to deal with the epidemic. We propose a heterogeneous infection rate model with human mobility for epidemic modeling, a preliminary version of which we have successfully used during DARPA Grand Challenge 2014. By linearizing the model and using weighted least squares, our model is able to quickly adapt to changing trends and provide extremely accurate predictions of confirmed cases at the level of countries and states of the United States. We show that during the earlier part of the epidemic, using travel data increases the predictions. Training the model to forecast also enables learning characteristics of the epidemic. In particular, we show that changes in model parameters over time can help us quantify how well a state or a country has responded to the epidemic. The variations in parameters also allow us to forecast different scenarios such as what would happen if we were to disregard social distancing suggestions.


title: Forecast of the evolution of the contagious disease caused by novel coronavirus (2019-nCoV) in China

text: The outbreak of novel coronavirus (2019-nCoV) in China has caused a viral epidemic affecting tens of thousands of persons. Though the danger of this epidemic is evident, the statistical analysis of data offered in this paper indicates that the increase in new cases in China will stabilize in the coming days or weeks. Our forecast could serve to evaluate risks and control the evolution of this disease.


title: Challenges to Neurosurgery During the Coronavirus Disease 2019 (COVID-19) Pandemic

text: The coronavirus disease 2019 pandemic has presented a massive burden to most health care systems across the globe. The demand for intensive care unit capacity in particular has increased significantly, and hospitals in most affected regions have struggled to cope. The focus of health care activity has shifted to the pandemic, with a negative impact on the management of other conditions. Neurosurgery, like most specialties, has been drastically affected but, arguably, warrants special considerations because many of the treatments required are time-critical. Lack or delay of appropriate intervention may lead, for an individual patient, to permanent neurologic injury and a significant decline in function and quality of life, or even death. In this report, we consider the challenges that neurosurgeons currently face in relation to the pandemic and are likely to face in the foreseeable future. The challenges are multifaceted with practical, ethical, legal, and other implications. These include re-deployment of staff to areas outside neurosurgery, treatment priority setting, ethical decision-making and risk of moral injury, as well as medicolegal risks, financial uncertainties and implications for training, research, and global health work. As well as patients, these challenges will affect neurosurgeons as doctors and as humans. The international neurosurgical community has a moral duty to contribute to the global response to the COVID-19 crisis, but also to retain a duty to care for individual patients.


title: The Effect of the COVID-19 Pandemic on Physicians' Use and Perception of Telehealth: The Case of Lebanon

text: The COVID-19 pandemic forced physicians to quickly adapt and find ways to provide their usual offline services by using online tools. We aimed to understand how physicians adapted to the sudden need for telehealth and if their perception of telehealth changed due to their experience during the COVID-19 pandemic. We conducted an exploratory sequential mixed-methods study. We interviewed five Lebanese physicians and thematically analyzed the interviews. We developed a questionnaire based on the analysis results and administered it online to physicians in Lebanon. In total, 140 responses were collected. We found that, during the COVID-19 pandemic, physicians engaged in more telehealth activities in the realms of telemedicine, public awareness, continuing medical education, research, administration, and teaching. They also expanded their repertoire of information-technology tools. Our results also show that there was a significant shift in the physicians' perceptions, indicating greater openness and willingness to adopt telehealth services. However, a significant amount of skepticism and uncertainty regarding telemedicine remains, especially concerning its efficiency, safety, and the adequacy of existing regulations. Based on our findings, we offer recommendations for health IT policy makers, developers, and researchers, to sustain the continuity of telehealth activities beyond the COVID-19 pandemic.


title: Mechanism of thrombocytopenia in COVID-19 patients

text: Since December 2019, a novel coronavirus has spread throughout China and across the world, causing a continuous increase in confirmed cases within a short period of time. Some studies reported cases of thrombocytopenia, but hardly any studies mentioned how the virus causes thrombocytopenia. We propose several mechanisms by which coronavirus disease 2019 causes thrombocytopenia to better understand this disease and provide more clinical treatment options.


title: Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020

text: There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who development of encephalopathy and encephalitis. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.


title: Diabetes self-management amid COVID-19 pandemic

text: BACKGROUND AND AIMS: COVID-19 pandemic has challenged the physician-centered approach of diabetes care in India that is primarily based on routine clinic visits. We aim to review the various aspects of patient-centered care via diabetes self-management education based on available literature. METHODS: This is a narrative review using Pubmed, EMBASE and Google Scholar search till March 29, 2020. Search terms were "COVID-19", "diabetes self-care", "diabetes self-management education", "DSME", "diabetes self-management in India", "diabetes self-care in India" and "DSME in India". RESULTS: We have discussed an educational plan on diabetes self-management that can be adopted for people with diabetes mellitus in our country amid the ongoing pandemic. We have also identified the barriers to diabetes self-management in the current scenario and suggested possible solutions to overcome those. CONCLUSIONS: We have reemphasized the need for a simultaneous patient-centered approach in routine diabetes care that has to be coordinated by a multidisciplinary team amid the ongoing COVID-19 pandemic.


Compassion, resilience and COVID-19


title: Site-specific glycan analysis of the SARS-CoV-2 spike

text: The emergence of the betacoronavirus, SARS-CoV-2, the causative agent of COVID-19, represents a significant threat to global human health. Vaccine development is focused on the principal target of the humoral immune response, the spike (S) glycoprotein, which mediates cell entry and membrane fusion. SARS-CoV-2 S gene encodes 22 N-linked glycan sequons per protomer, which likely play a role in protein folding and immune evasion. Here, using a site-specific mass spectrometric approach, we reveal the glycan structures on a recombinant SARS-CoV-2 S immunogen. This analysis enables mapping of the glycan-processing states across the trimeric viral spike. We show how SARS-CoV-2 S glycans differ from typical host glycan processing, which may have implications in viral pathobiology and vaccine design.


Online management of rheumatoid arthritis during COVID-19 pandemic


title: [Analysis of bronchoscope-guided tracheal intubation in 12 cases with coronavirus disease 2019 under the personal protective equipment with positive pressure protective hood]

text: Endotracheal intubation is an independent risk factor for respiratory infectious diseases. We conducted a retrospective study in 12 cases with COVID-19 who underwent endotracheal intubation at ICU of the Guangzhou eighth hospital from January 20 to February 10, 2020. The intubation procedure, anesthetic regimen, and complication were collected and analyzed. The 9 healthcare workers who involved in intubation received virus nucleic acid test and 14 days temperature monitoring. All 12 patients were successfully intubated under the guidance of bronchoscope, without any complications. Midazolam, Propofol and Morphine or fentanyl were used for sedation and analgesia, avoiding patients cough and agitated during the procedure. The 9 healthcare workers were protected under the Personal Protective Equipment(PPE) with positive pressure protective hood. The detection of oropharyngeal swab virus nucleic acid were negative in all 9 healthcare workers, none of them had fever or any respiratory symptoms. The PPE with positive pressure protective hood should be needed to perform bronchoscope-guided endotracheal intubation in patients with COVID-19, it could strengthen to protect healthcare workers from virus exposure.


title: Coronavirus (COVID-19) Infection-Induced Chilblains: A Brisk Perieccrine Inflammatory Response

text: The varying cutaneous and pathological manifestations of coronavirus 2 (SARS-CoV-2 or COVID-19) may have prognostic implications. Acral ischemic findings present with a hypercoagulable state in critically ill COVID-19 patients. Pathologically confirmed varicella-like exanthem and perniosis COVID-19 cases have correlated with paucisymptomatic and asymptomatic patients in previous reports. We present the second case of biopsy-proven COVID-19 infection-induced chilblains (pernio) in a paucisymptomatic patient with a brisk perieccrine lymphocytic response. Based on an antecedent pathological study, we know coronavirus particles have been seen in the eccrine gland associated with a brisk peri-inflammatory response. The prominent perieccrine inflammation is helpful in the diagnosis of COVID-19 infections. Currently, nonischemic pathological findings correlate with a good prognosis based on the paucisymptomatic or asymptomatic nature of their disease courses. Patients presenting with suspected COVID-19 infection-induced chilblains who are paucisymptomatic or asymptomatic should be isolated and immediately tested with polymerase chain reaction (PCR) testing (as there is a delay in diagnosis based on the poor sensitivity of the current rapid test). We continue to stress the importance of early diagnosis and quarantining to prevent spread to the older and immunocompromised patients.


COVID-19 and diabetes: Can DPP4 inhibition play a role?


title: Exponential-growth prediction bias and compliance with safety measures in the times of COVID-19

text: We conduct a unique, Amazon MTurk-based global experiment to investigate the importance of an exponential-growth prediction bias (EGPB) in understanding why the COVID-19 outbreak has exploded. The scientific basis for our inquiry is the well-established fact that disease spread, especially in the initial stages, follows an exponential function meaning few positive cases can explode into a widespread pandemic if the disease is sufficiently transmittable. We define prediction bias as the systematic error arising from faulty prediction of the number of cases x-weeks hence when presented with y-weeks of prior, actual data on the same. Our design permits us to identify the root of this under-prediction as an EGPB arising from the general tendency to underestimate the speed at which exponential processes unfold. Our data reveals that the"degree of convexity"reflected in the predicted path of the disease is significantly and substantially lower than the actual path. The bias is significantly higher for respondents from countries at a later stage relative to those at an early stage of disease progression. We find that individuals who exhibit EGPB are also more likely to reveal markedly reduced compliance with the WHO-recommended safety measures, find general violations of safety protocols less alarming, and show greater faith in their government's actions. A simple behavioral nudge which shows prior data in terms of raw numbers, as opposed to a graph, causally reduces EGPB. Clear communication of risk via raw numbers could increase accuracy of risk perception, in turn facilitating compliance with suggested protective behaviors.


The reproductive number R0 of COVID-19 in Peru: An opportunity for effective changes


title: Protecting health during COVID-19 and beyond: A global examination of paid sick leave design in 193 countries

text: Well-designed paid sick leave is critical to ensure workers stay home when sick to prevent the spread of SARS-CoV-2 and other infectious pathogens, both when the economy is open and during an economic shutdown. To assess whether paid sick leave is available in countries around the world, we created and analysed a database of legislative guarantees of paid leave for personal illness in 193 UN member states. Original labour and social security legislation and global information on social security systems for each country were obtained and analysed by a multilingual research team using a common coding framework. While strong models exist across low- middle- and high-income countries, critical gaps that jeopardise health and economic security remain. 27% of countries do not guarantee paid sick leave from the first day of illness, essential to encouraging workers to stay home when they are sick and prevent spread. 58% of countries do not have explicit provisions to ensure self-employed and gig economy workers have access to paid sick leave benefits. Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new pathogens.


Fighting the battle against SARS-CoV-2 as gastroenterologists in Italy


title: Rhabdomyolysis as an initial presentation in a patient diagnosed with COVID-19

text: The presence of rhabdomyolysis secondary to multiple infections has been reported, predominantly viral, but also bacterial and fungal. It is well known that COVID-19 can present a wide variety of complications during the course of infection; however, the presence of rhabdomyolysis as an initial condition has not been reported so far. We report a case of rhabdomyolysis as an initial presentation in a patient diagnosed with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection.


Dyspnea rather than fever is a risk factor for predicting mortality in patients with COVID-19


title: Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy

text: Introduction: In late February 2020, due to the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the Italian Government closed down all educational and sport activities. In March, it introduced further measures to stop the spread of coronavirus disease (COVID-19), placing the country in a state of almost complete lockdown. We report the impact of these restrictions on glucose control among people with type 1 diabetes (T1D). Methods: Data were collected on 33 individuals with T1D who were monitoring their glucose levels using a flash glucose monitoring device and remotely connected to the diabetes clinic on a cloud platform. We retrieved information on average glucose, standard deviation and percentage time in hypoglycaemia (< 70 mg/dl), glucose range (70-180 mg/dl) and hyperglycaemia (> 180 mg/dl). We compared glycaemic measures collected during lockdown to those collected before the SARS-CoV-2 epidemic and to the periods immediately before lockdown. Results: In 20 patients who had stopped working and were at home as a result of the lockdown, overall glycaemic control improved during the first 7 days of the lockdown as compared to the weeks before the spread of SARS-CoV-2. Average glucose declined from 177 ± 45 mg/dl (week before lockdown) to 160 ± 40 mg/dl (lockdown; p = 0.005) and the standard deviation improved significantly. Time in range increased from 54.4 to 65.2% (p = 0.010), and time in hyperglycaemia decreased from 42.3 to 31.6% (p = 0.016). The number of scans per day remained unchanged. In 13 patients who continued working, none of the measures of glycaemic control changed during lockdown. Conclusion: Despite the limited possibility to exercise and the incumbent psychologic stress, glycaemic control improved in patients with T1D who stopped working during the lockdown, suggesting that slowing down routine daily activities can have beneficial effects on T1D management, at least in the short term.


title: Topological analysis of SARS CoV-2 main protease

text: There is an urgent necessity of effective medication against severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), which is producing the COVID-19 pandemic across the world. Its main protease (Mpro) represents an attractive pharmacological target due to its involvement in essential viral functions. The crystal structure of free Mpro shows a large structural resemblance with the main protease of SARS CoV (nowadays known as SARS CoV-1). Here, we report that average SARS CoV-2 Mpro is 1900% more sensitive than SARS CoV-1 Mpro in transmitting tiny structural changes across the whole protein through long-range interactions. The largest sensitivity of Mpro to structural perturbations is located exactly around the catalytic site Cys-145 and coincides with the binding site of strong inhibitors. These findings, based on a simplified representation of the protein as a residue network, may help in designing potent inhibitors of SARS CoV-2 Mpro.


title: SARS-CoV-2 in the semen: where does it come from?

text: A recent report by Li et al., described the presence of SARS-CoV-2 in semen samples of six patients, including two subjects who were recovering from the clinical disease. This finding re-opened the discussion on possible male genital tract infection, virus shedding in semen, sexual transmission and safety of fertility treatments during the pandemic period [1]. As stated by the Authors themselves, the small sample size and short follow up dictate caution in the interpretation of their results.


A simple negative-pressure protective barrier for extubation of COVID-19 patients


Active and Effective Measures for the Care of Patients With Cancer During the COVID-19 Spread in China


title: Investigation of the mental health of patients with novel coronavirus pneumonia/ 中华神经科杂志

text: Objective@#To evaluate the status and influencing factors of the mental health of patients with COVID-19 during isolation treatment.@* Methods@#From February 2nd to 16th, 2020, 106 COVID-19 patients were anonymously investigated for their mental health status using onlinequestionnaires (including Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-15 scales). The patients were from Tongji Hospital Affiliated to Tongji Medical College ofHuazhong University of Science and Technology. After data processing, SPSS19.0 was used for statistical analysis.@* Results@#Of the 106 COVID-19 patients, 46 were male and 60 were female, with an age of (35.90±11.92) years. The detection rates of depression, anxiety and somatic symptoms in those patients were 49.06% (52/106) , 56.60% (60/106) and 69.81% (74/106) respectively. The severe cases of depression (scale score greater than 19) , anxiety (scale score greater than 14) and somatic symptoms (scale score greater than 14) accounted for 9.43% (10/106) , 15.09% (16/106) and 20.75% (22/106) respectively. In addition, 67.92% (72/106) of the patients had sleep problems, 24.53% (26/106) had self-mutilating or suicidal thoughts, and 28.30% (30/106) required psychological counseling—all of which were at significantly higher percentages than those of the general population. Only 39.62% (42/106) of the examined patients had neither deression nor anxiety. By using the non-parametric test of rank conversion for analysis, and the results showed that both married patients and nucleic-acid-positive patients had more severe depressions, and both married patients and anoxemicpatients had more severe somatic symptoms.@*Conclusion@#This mental health assessment showed that depression, anxiety, and various somatic symptoms exist among the COVID-19 patients, and therefore early identification and intervention should be conducted to avoid extreme events such asself-mutilating or suicidal impulsivity, with a greater focus on both married patients and patients with severe symptoms.


title: Surgical tracheostomies in Covid-19 patients: important considerations and the "5Ts" of safety

text: The coronavirus disease (covid19) pandemic (caused by the SARS-CoV-2 virus) is the greatest healthcare challenge in a generation. Clinicians are modifying the way they approach day-to-day procedures. Safety and reduction of transmission risk is paramount. Surgical tracheostomies in covid19 patients are aerosol generating procedures linked with a significant risk of viral contamination. Here, we describe our local approach for these procedures, introducing the "5Ts" of safe tracheostomy practice: Theatre set-up, Team Briefing, Transfer of patient, Tracheostomy Procedure, Team Doffing and De-brief. We identify the critical steps of the procedure and explain how we overcome the risks associated with breaking the transfer circuit to attach the patient to the theatre ventilator. We explain our technique to reduce secretion spillage when opening the trachea. We emphasise the importance of closed tracheal suctioning and mouth suctioning prior to patient transfer. We highlight the importance of maintaining a closed circuit throughout the procedure and describe tips on how to achieve this. We summarise the steps of our protocol in an "easy to reproduce" way. Finally, we emphasise the importance of communication in a constantly changing environment and challenging circumstances.


COVID-19 experience reports: an emerging trend in scholarly communication


Key Highlights From the Canadian Thoracic Society's Position Statement on Optimizing the Management of Sleep Disordered Breathing During the COVID-19 Pandemic


title: Psychological needs and response during the COVID-19 pandemic in Lebanon

text: Lebanon was 1 of the countries to be affected early by the COVID-19 pandemic while in the midst of political upheaval. The stress implicated by this dual challenge allowed for mental health to take a center stage, prompting a nationwide official and informal response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Re-starting Travel in the Era of COVID-19: Preparing Anew


The COVID-19 pandemic


Detection of Covid-19 in Children in Early January 2020 in Wuhan, China


title: Statistical Disclosure Control via Information Theory

text: Differential privacy is a strong privacy model based on indistinguishability of statistical outputs of two neighboring datasets, which represent two states that an individual's information is within or without a dataset. However, when the informations of different individuals are dependent, the representation would lose its foundation. In order to remedy the drawback of differential privacy, we revisit the Dalenius' paper [1] that motivates differential privacy, and introduce a new privacy model to control individual's information disclosure. The rationality of the privacy model is based on the information theory, i.e., the mutual information of one individual's information and the statistical outputs is upper bounded by a small value. The new privacy model accurately captures the weakness of differential privacy when dealing with dependent informations. Furthermore, the new privacy model gets on well with differential privacy. When the informations of individuals are independent, we prove that a mechanism that satisfies $\epsilon$-differential privacy would ensure to satisfy the new privacy model. When the informations of individuals are dependent, we prove that the group privacy method to achieve differential privacy in dependent case can be used to achieve the new privacy model. When the dependence extents of the informations of individuals are weak, we find differentially private mechanism which can satisfy the new privacy model with noise magnitude far less than the mechanism based on the group privacy based method. These results imply that the new model inherits (almost) all of the mechanisms of differential privacy.


title: Coronavirus disease 2019 (COVID-19) pneumonia in a hemodialysis patient: A case report

text: RATIONALE: The 2019 novel coronavirus disease (COVID-19) causes a novel, atypical pneumonia that has brought huge public health challenges across the globe. There is limited data about patients with end-stage renal disease who also suffer from COVID-19. In this report, we discuss the case of a hemodialysis patient who developed COVID-19 pneumonia in the clinical course. PATIENT CONCERNS: A 79-year-old man who had end-stage renal disease (ESRD) and was taking regular hemodialysis was admitted to hospital for a fever and dry cough. The patient, who also had cardiovascular disease, had no history of contact with COVID-2019 patients. DIAGNOSIS: The patient was diagnosed with COVID-2019 by the reverse-transcriptase polymerase chain reaction (RT-PCR), and his pharyngeal swab for SARS-CoV-2 was positive. INTERVENTION: The treatment was mainly supportive and the patient was intensively monitored. He was treated with oxygen, broad-spectrum antibiotics, antiviral drugs, and methylprednisolone. The patient took continuous renal replacement therapy (CRRT) every 2 days. OUTCOMES: After 19 days, an RT-PCR assay for SARS-CoV-2 was negative, and computed tomography (CT) of the patient's thorax indicated that the pulmonary inflammatory exudation was absorbed and pulmonary infection improved significantly. He was discharged on day 29 after recovering from COVID-2019 pneumonia. LESSONS: The courses of disease and treatment options for this individual were significantly more complicated than those for ordinary patients. Therefore, it was necessary to monitor the condition of the patient closely and to protect the dialysis unit staff from being infected. Compared with other severe COVID-2019 cases, this patient recovered more quickly following treatment, which was likely due to the removal of inflammatory mediators by CRRT. This implies that blood purification might be an important option for hemodialysis patients with COVID-19.


Commentary: Let's start again!


title: Overview of transnational recommendations for COVID-19 transmission control in dental care settings

text: On 11 March 2020, the World Health Organization (WHO) declared the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) as a pandemic. Until an effective treatment or a vaccine is developed, the current recommendations are to contain the disease, and control its transmission. It is now clear that the primary mode of SARS-CoV-2 transmission is aerosol/droplet spread, and by contacting virus-contaminated surfaces acting as fomites (inanimate vectors). Furthermore, recent data indicate that the live virus particles are present in saliva, and, more alarmingly, asymptomatic individuals may transmit the infection. By virtue of the nature of the practice of dentistry where intrinsically, a high volume of aerosols is produced, as well as the close proximity of dentists and patients during treatment, dentists and allied health staff are considered the highest risk health professional group for acquiring SARS-CoV-2 during patient management. Therefore, several organizations and specialty associations have proposed guidelines and recommendations for limiting the transmission of SARS-COV-2 from carriers to dentists and vice versa. This paper aims to provide a review of these guidelines, and concludes with a brief look at how the practice of dentistry may be impacted by COVID-19, in the post-pandemic era.


title: Platelet functions and activities as potential hematologic parameters related to Coronavirus Disease 2019 (Covid-19)

text: Coronavirus disease 2019 (COVID-19) is a new infectious disease that currently lacks standardized and established laboratory markers to evaluate its severity. In COVID-19 patients, the number of platelets (PLTs) and dynamic changes of PLT-related parameters are currently a concern. The present paper discusses the potential link between PLT parameters and COVID-19. Several studies have identified a link between severe COVID-19 patients and specific coagulation index, in particular, high D-dimer level, prolonged prothrombin time, and low PLT count. These alterations reflect the hypercoagulable state present in severe COVID-19 patients, which could promote microthrombosis in the lungs, as well as in other organs. Further information and more advanced hematological parameters related to PLTs are needed to better estimate this link, also considering COVID-19 patients at different disease stages and stratified in different cohorts based on preexisting co-morbidity, age, and gender. Increasing the understanding of PLT functions in COVID-19 will undoubtedly improve our knowledge on disease pathogenesis, clinical management, and therapeutic options, but could also lead to the development of more precise therapeutic strategies for COVID-19 patients.


Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19


title: COVID-19 not detected in peritoneal fluid: a case of laparoscopic appendicectomy for acute appendicitis in a COVID-19-infected patient

text: PURPOSE: COVID-19 greatly affected millions and affected the way we practice with heightened posture in the way we treat surgical patients. Surgical consensus guidelines are recommending caution in the use of laparoscopy for the theoretical possibility of viral transmission from aerosolization of tissue and peritoneal fluid during surgery. However, there has yet to be proof of COVID-19 being present in peritoneal fluid, justifying the consensus statements. We aim to assess the presence of COVID-19 in peritoneal fluid. METHODS: We performed a laparoscopic appendicectomy for a COVID-19-infected patient with acute appendicitis. Peritoneal fluid and peritoneal washings were collected and sent for COVID-19 PCR. RESULTS: The peritoneal fluid sample collected on entry and at the end of the operation was negative for COVID-19 on PCR. The patient had an uneventful recovery from surgery. CONCLUSIONS: This case revealed that COVID-19 was not detected in peritoneal fluid and peritoneal washings in a patient infected with COVID-19. This study provides novel preliminary data in the investigation of COVID-19 transmission from laparoscopy-related aerosolization.


title: Patients with COVID-19 and neurological manifestations show undetectable SARS-CoV-2 RNA levels in the cerebrospinal fluid

text: We report that patients with COVID-19 displaying distinct neurological disorders have undetectable or extremely low levels of SARS-CoV-2 RNA in the cerebrospinal fluid, indicating that viral clearance precede the neurological involvement. This finding points to the need for the development of more sensitive molecular tests and the investigation of other neurotropic pathogens to exclude concurrent neuroinfection.


COVID-19, internists and resilience: the north-south Italy outbreak


title: How to manage lymphoid malignancies during novel 2019 coronavirus (CoVid-19) outbreak: a Brazilian task force recommendation

text: The novel Coronavirus (CoVid-19) outbreak is now consider a world pandemic, affecting more than 300,000 people worldwide. Cancer patients are in risk for severe disease, including a higher risk of intensive care unit (ICU) admission, need for invasive ventilation or death. Management of patients with lymphoid malignancies can be challenging during the outbreak, due to need of multiple hospital visits and admissions, immunosuppression and need for chemotherapy, radiotherapy and stem cell transplantation. In this article, we will focus on the practical management of patients with lymphoid malignancies during the COVID-19 pandemic, focusing on minimizing the risk for patients.


title: COVID-19 y enfermedad inflamatoria intestinal: preguntas surgidas de la atención y seguimiento de los pacientes durante la fase inicial de la pandemia (febrero-abril 2020)./ [COVID-19 and inflammatory bowel disease: questions arising from patient care and follow-up during the initial phase of the pandemic (February-April 2020)]

text: COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was described in China in late 2019. There are currently more than three million diagnosed cases, constituting a pandemic which has caused a worldwide crisis. The devastating effects of this infection are due to its highly contagious nature and although mild forms predominate, in absolute values, the rates for severe forms and mortality are very high. The information on the characteristics of the infection in inflammatory bowel disease is of special interest, as these patients have higher attendance at health centres, which may increase their risk of infection. Furthermore, the treatments used to control the inflammatory activity may modify the disease course of COVID-19. The Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) and the Spanish Nurses Working Group on Inflammatory Bowel Disease (GETEII) have prepared this document as a practical response to some common questions about the treatment of these patients.


Spine fellowship training reorganizing during a pandemic: perspectives from a tertiary orthopedic specialty center in the epicenter of outbreak


title: Corona Viruses and the Chemical Senses: Past, Present, and Future

text: A wealth of rapidly evolving reports suggests that olfaction and taste disturbances may be manifestations of the novel COVID-19 pandemic. While otolaryngological societies worldwide have started to consider chemosensory evaluation as a screening tool for COVID-19 infection, the true nature of the relationship between the changes in chemosensory ability and COVID-19 is unclear. Our goal with this review is to provide a brief overview of published and archived literature, as well as the anecdotal reports and social trends related to this topic up to April 29, 2020. We also aim to draw parallels between the clinical/chemosensory symptomology reported in association to past coronavirus pandemics (such as SARS and MERS) and the novel COVID-19. This review also highlights current evidence on persistent chemosensory disturbances after the infection has resolved. Overall, our analysis pinpoints the need for further studies: 1) to better quantify olfaction and taste disturbances associated with SARS-CoV-2 infection, compared to those of other viral and respiratory infections, 2) to understand the relation between smell, taste, and chemesthesis disturbances in COVID-19, and 3) to understand how persistent are these disturbances after the infection has resolved.


Surgical Response to COVID-19 Pandemic: A Singapore Perspective


Expression of ACE2, the SARS-CoV-2 Receptor, and TMPRSS2 in Prostate Epithelial Cells


QTc evaluation in COVID-19 patients treated with chloroquine/hydroxychloroquine


title: Could Sex/Gender Differences in ACE2 Expression in the Lungs Contribute to the Large Gender Disparity in the Morbidity and Mortality of Patients Infected With the SARS-CoV-2 Virus?

text: COVID-19 morbidity and mortality have significant gender disparities, with higher prevalence and mortality in men. SARS-CoV-2 enters the lungs through the ACE2 enzyme, a member of the renin-angiotensin system (RAS). Although there are no data for the lung, the expressions of RAS components in other tissues are modulated by sex hormones, androgens, and estrogens. However, there are no data on sex-specific differences in ACE2 expression. If there is a sex difference in the expression of ACE2 in the lung, this could theoretically explain the gender disparity in COVID-19 disease. More importantly, although modulation of ACE2 will certainly not provide a cure for the COVID-19 disease, modulation of ACE2 by sex hormone modulators, if they affect the expression of ACE2, could potentially be developed into a supportive therapy for COVID-19 patients.


The Swiss approach to the COVID-19 outbreak


title: Safety and Prognosis in Percutaneous vs Surgical Tracheostomy in 27 Patients With COVID-19

text: During the SARS-CoV-2 pandemic, patients in intensive care units who are undergoing long-term intubation may require tracheostomy. There is controversy about indication and health care professionals' safety regarding the conventional or percutaneous technique. We performed a prospective analysis of a series of 27 consecutive patients with COVID-19 comparing both tracheostomy techniques, safety, and prognosis clinical markers. The results show that the techniques are equally safe, without cases of infection in surgeons. The Sequential Organ Failure Assessment score before surgery and the progression in ventilation support during the first 72 hours after tracheostomy are optimal prognostic markers for these patients.


Authors' correction for Euro Surveill. 2020;25(17)


Optimizing response in surgical systems during and after COVID-19 pandemic: Lessons from China and the UK - Perspective


title: Atypical Presentation of Novel Coronavirus Disease 2019 in a Peritoneal Dialysis Patient

text: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a rapidly spreading disease causing increased morbidity and mortality across the globe. There is limited available knowledge regarding the natural history of the SARS-CoV-2 infection. Other factors that are also making this infection spread like a pandemic include global travelers, lack of proven treatment, asymptomatic carriers, potential reinfection, underprepared global health care systems, and lack of public awareness and efforts to prevent further spread. It is understood that certain preexisting medical conditions increase the risk of mortality with COVID-19; however, the outcome of this disease in traditionally vulnerable chronic illnesses such as end-stage renal disease is not well documented. We present a case of a 56-year-old African American lady with end-stage renal disease on the peritoneal dialysis who presented predominantly with nausea, vomiting, and subsequently found to have COVID-19. We use this case to illustrate an atypical presentation of the COVID-19 in a vulnerable patient and discuss the literature.


title: Correction to: Amid COVID-19: the importance of developing an positive adverse drug reaction (ADR) and medical device incident (MDI) reporting culture for Global Health and public safety

text: [This corrects the article DOI: 10.1186/s40545-020-00219-1.].


Re: Testing recommendation for COVID-19 (SARS-CoV-2) in patients planned for surgery - continuing the service and 'suppressing' the pandemic


title: High-resolution CT features of the COVID-19 infection in Nanchong City: Initial and follow-up changes among different clinical types

text: Objective: To discuss the high resolution computed tomography (HRCT) manifestations of coronavirus disease 2019 (COVID-19) patients among different clinical types on initial and follow-up CT. Methods: Seven COVID-19 patients admitted to the Affiliated Hospital of North Sichuan Medical Collage were enrolled. All patients underwent initial and follow-up chest HRCT. The main CT features and semi-quantitative score which represent disease severity among different clinical types were evaluated. Result: On initial CT, the main abnormalities observed in common and severe cases respectively were pure ground glass opacities (GGOs) and patchy consolidation surrounded by GGOs. Critical cases had multiple consolidation surrounded by wide range of GGOs distributed in the whole lung fields. The scope and density score in common (4.5 and 5), severe (9.5 and 9.5) and critical (19 and 12) cases were increased by gradient. On follow-up CT, common and severe types manifested as decreasing density of lesion, absorbed consolidation and GGOs. Critical cases showed progression of the disease. The extent and progression scores in common and severe patients were significantly decreased, while the range score of patients with critical disease reached the highest points, accompanied with an increase in the density score. Conclusion: CT scanning can accurately assess the severity of COVID-19, and help to monitor disease transformation during follow-up among different clinical conditions.


title: The novel coronavirus SARS-CoV-2: From a zoonotic infection to coronavirus disease 2019

text: The novel coronavirus (CoV), severe acute respiratory syndrome (SARS)-CoV-2 is an international public health emergency. Until now, the intermediate host and mechanisms of the interspecies jump of this virus are unknown. Phylogenetic analysis of all available bat CoV complete genomes was performed to analyze the relationships between bat CoV and SARS-CoV-2. To suggest a possible intermediate host, another phylogenetic reconstruction of CoV genomes obtained from animals that were hypothetically commercialized in the Chinese markets was also carried out. Moreover, mutation analysis was executed to suggest genomic regions that may have permitted the adaptation of SARS-CoV-2 to the human host. The phylogenetic analysis demonstrated that SARS-CoV-2 formed a cluster with the bat CoV isolate RaTG13. Possible CoV interspecies jumps among bat isolates were also observed. The phylogenetic tree reconstructed from CoV strains belonging to different animals demonstrated that SARS-CoV-2, bat RaTG13, and pangolin CoV genomes formed a monophyletic cluster, demonstrating that pangolins may be suggested as SARS-CoV-2 intermediate hosts. Three AA substitutions localized in the S1 portion of the S gene were observed, some of which have been correlated to structural modifications of the S protein which may facilitate SARS-CoV-2 tropism to human cells. Our analysis shows the tight relationship between SARS-CoV-2 and bat SARS-like strains. It also hypothesizes that pangolins might have been possible intermediate hosts of the infection. Some of the observed AA substitutions in the S-binding protein may serve as possible adaptation mutations in humans but more studies are needed to elucidate their function.


title: Covid-19 and People with HIV Infection: Outcomes for Hospitalized Patients in New York City

text: BACKGROUND: There have been limited data regarding the clinical impact of COVID-19 disease on people with HIV (PWH). In this study we compared outcomes for PWH with COVID-19 disease to a matched comparison group. DESIGN: We identified 88 PWH hospitalized with laboratory confirmed COVID-19 in our hospital system in New York between March 12 and April 23, 2020. We collected data on baseline clinical characteristics, laboratory values, HIV infection status, COVID-19 treatment, and outcomes from this group and matched comparators (one PWH to up to five patients by age, sex, race/ethnicity and calendar week of infection). We compared baseline clinical characteristics and outcomes (death, mechanical ventilation, hospital discharge) for these two groups, as well as cumulative incidence of death by HIV status. RESULTS: Patients did not differ significantly by HIV status by age, sex or race/ethnicity due to the matching algorithm. PWH hospitalized with COVID-19 had high proportions of HIV virologic control on antiretroviral therapy. PWH had greater proportions of smoking (p<0.001) and comorbid illness than demographically similar uninfected comparators. There was no difference in COVID-19 severity on admission by HIV status (p=0.15). Poor outcomes for hospitalized PWH were frequent but similar to proportions in comparators; 18% required mechanical ventilation and ultimately 21% died during follow-up (compared with 23% and 20% respectively). There was similar cumulative incidence of death over time by HIV status (p=0.94). INTERPRETATION: We found no differences in adverse outcomes associated with HIV infection for hospitalized COVID-19 patients compared to a demographically similar patient group.


title: Pyroptosis: Physiological roles in viral infection

text: The current review focuses on important aspects of pyroptosis, such as morphological features of inflammasomes, as well as on knowledge about coronavirus infection mechanisms and the association between SARS-CoV-2 infection and cell pyroptosis. The application of immunomodulation therapies to Covid-19 patients is the most promising treatment under investigation nowadays. The possibilities of assistance to help protecting patients from infections are also addressed in the present study.


title: Addressing the Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Hematopoietic Cell Transplantation: Learning Networks as a Means for Sharing Best Practices

text: The full impact of the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on the field of hematopoietic cell transplantation (HCT) is unknown. This perspective paper reviews the following: current COVID-19 epidemiology, diagnosis, and potential therapies; care considerations unique to HCT recipients; and the concept of a learning network to assimilate emerging guidelines and best practices and to optimize patient outcomes through facilitating shared learning and experience across transplantation centers.


title: Prolonged persistence of SARS-CoV-2 in the upper respiratory tract of asymptomatic infected individuals

text: BACKGROUND: Duration of persistence of SARS-CoV-2 in the upper respiratory tract of infected individuals has important clinical and epidemiological implications. AIM: We aimed to establish the duration and risk factors for persistence of SARS-CoV-2 in the upper respiratory tract of asymptomatic infected individuals. METHODS: Data of repeat rRT-PCR test done for SARS-CoV-2 infected individuals at our institute at Jodhpur, India was analysed from 19 March- 21 May 2020. Duration of virus persistence was estimated with parametric regression models based on Weibull, Log-normal, Log-logistic, Gamma and Generalized Gamma distributions. Factors associated with prolonged viral persistence were analysed with the best fitting model. RESULTS: 51 SARS-CoV-2 infected individuals with repeat rRT-PCR test were identified with 44 asymptomatics. The asymptomatic individuals had median virus persistence duration of 8.87 days (95%CI: 7.65 - 10.27) and 95 percentile duration of 20.70 days (95% CI: 16.08 -28.20). The overall median virus persistence including both symptomatic and asymptomatic individuals was found to be 9.18 days (95 CI 8.04 - 10.48). Around one-fourth asymptomatics (10/44) demonstrated SARS-CoV-2 persistence beyond 2 weeks. Age < 60 years and local transmission were found to be significantly associated with longer virus persistence among asymptomatic individuals on univariate regression but not in multivariate analysis. CONCLUSION: Recommended home isolation duration for SARS-CoV-2 infected individuals in India should be extended from 17 days to at least three weeks. Prolonged persistence of SARS-CoV-2 in a proportion of asymptomatic individuals merits attention with regard to ensuring universal infection prevention precautions irrespective of symptomatic status.


Pathologists and the coronavirus distraction effect


3D Printing of Face Shields During COVID-19 Pandemic: A Technical Note


Considerations for Statin Therapy in Patients with COVID-19


title: A fractional-order SEIHDR model for COVID-19 with inter-city networked coupling effects

text: In this paper, a mathematical model is proposed to analyze the dynamic behavior of COVID-19. Based on inter-city networked coupling effects, a fractional-order SEIHDR system with the real-data from 23 January to 18 March, 2020 of COVID-19 is discussed. Meanwhile, hospitalized individuals and the mortality rates of three types of individuals (exposed, infected and hospitalized) are firstly taken into account in the proposed model. And infectivity of individuals during incubation is also considered in this paper. By applying least squares method and predictor-correctors scheme, the numerical solutions of the proposed system in the absence of the inter-city network and with the inter-city network are stimulated by using the real-data from 23 January to $18-m$ March, 2020 where $m$ is equal to the number of prediction days. Compared with integer-order system ($\alpha=0$), the fractional-order model without network is validated to have a better fitting of the data on Beijing, Shanghai, Wuhan, Huanggang and other cities. In contrast to the case without network, the results indicate that the inter-city network system may be not a significant case to virus spreading for China because of the lock down and quarantine measures, however, it may have an impact on cities that have not adopted city closure. Meanwhile, the proposed model better fits the data from 24 February to 31, March in Italy, and the peak number of confirmed people is also predicted by this fraction-order model. Furthermore, the existence and uniqueness of a bounded solution under the initial condition are considered in the proposed system. Afterwards, the basic reproduction number $R_0$ is analyzed and it is found to hold a threshold: the disease-free equilibrium point is locally asymptotically stable when $R_0\le 1$, which provides a theoretical basis for whether COVID-19 will become a pandemic in the future.


title: Airway management considerations in patients with COVID-19

text: Approximately 12% to 15% of hospitalized patients with COVID-19 infection require invasive ventilation via endotracheal intubation. The key to minimizing risk of disease transmission during this aerosol-generating procedure is careful preparation, which includes having necessary equipment and medications on hand as well as an experienced intubation team who can troubleshoot any unforeseen complications. Personal protective equipment should be donned and doffed in the presence of an assistant (ie, "buddy" system).


title: Cuticular pheromones stimulate hygienic behavior in the honey bee (Apis mellifera)

text: The health of western honey bee (Apis mellifera) colonies is challenged by the parasitic mite Varroa destructor and the numerous harmful pathogens it vectors. Selective breeding for the naturally occurring social immune trait "hygienic behavior" has emerged as one sustainable approach to reducing the mites' impact on honey bees. To expand our understanding of hygienic triggers and improve hygienic selection tools, we tested the hypothesis that the cuticular compounds (Z)-10-tritriacontene and (Z)-6-pentadecene, previously associated with unhealthy honey bee brood and/or brood targeted for hygiene, are triggers of honey bee hygienic behavior independent of brood health. In support of our hypothesis, application of synthetic (Z)-10-tritriacontene and (Z)-6-pentadecene onto brood and brood cell caps significantly increased hygienic behavior compared to application of similarly structured hydrocarbon controls (Z)-16-dotriacontene and (Z)-7-pentadecene. Furthermore, we demonstrate a significant positive correlation between colony-level hygienic responses to (Z)-10-tritriacontene and the traditional freeze-killed brood assay for selection of hygienic honey bee stocks. These results confirm biological activity of (Z)-6-pentadecene and reveal (Z)-10-tritriacontene as a novel hygiene trigger. They also support development of improved tools for honey bee colony monitoring and hygienic selection, and thus may accelerate development of honey bee stocks with greater resistance to Varroa and associated pathogens.


title: Hidden threat lurking behind the alcohol sanitizers in COVID-19 outbreak

text: The ongoing COVID-19 pandemic has made various challenges for communications all over the world. Nowadays hand hygiene practices with alcohol sanitizers are an unavoidable reality for many people, which cause skin dryness and flaking. The current short communication has been explained about monitoring the quality control of alcohol concentrations and hand rub formulation, which needs more attention and should consider meticulous in this crisis.


title: Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases

text: BACKGROUND: The cutaneous manifestations of COVID-19 disease are poorly characterized. OBJECTIVES: To describe the cutaneous manifestations of COVID-19 disease and to relate them to other clinical findings. METHODS: We carried out a nationwide case collection survey of images and clinical data. Using a consensus we described five clinical patterns. We later described the association of these patterns with patient demographics, the timing in relation to symptoms of the disease, the severity and the prognosis. RESULTS: The lesions may be classified as acral areas of erythema with vesicles or pustules (pseudo-chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo-chilblain pattern frequently appears late in the evolution of the COVID-19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID-19. The severity of COVID-19 shows a gradient from less severe disease in acral lesions to more severe in the latter groups. The results are similar for confirmed and suspected cases, in terms of both clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo-chilblain and vesicular). CONCLUSIONS: We provide a description of the cutaneous manifestations associated with COVID-19 infection. These may help clinicians approach patients with the disease and recognize cases presenting with few symptoms. What is already known about this topic? Previous descriptions of cutaneous manifestations of COVID-19 were case reports and mostly lacked illustrations. What does this study add? We describe a large, representative sample of patients with unexplained skin manifestations and a diagnosis of COVID-19, using a consensus method to define morphological patterns associated with COVID-19. We describe five clinical patterns associated with different patient demographics, timing and prognosis, and provide illustrations of these patterns to allow for easy recognition.


The progression of computed tomographic (CT) images in patients with coronavirus disease (COVID-19) pneumonia: Running title: The CT progression of COVID-19 pneumonia


Supporting the well-being of healthcare workers during and after COVID-19


title: Performance of Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Assays in Different Stages of Infection: Comparison of Commercial Enzyme-Linked Immunosorbent Assays and Rapid Tests

text: We comparatively assessed sensitivities and specificities of 4 commercial enzyme-linked immunosorbent assays (ELISAs) and 2 rapid tests in 77 patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection, grouped by interval since symptom onset. Although test sensitivities were low (<40%) within the first 5 days after disease onset, immunoglobulin (Ig) M, IgA, and total antibody ELISAs increased in sensitivity to >80% between days 6 and 10 after symptom onset. The evaluated tests (including IgG and rapid tests) provided positive results in all patients at or after the 11th day after onset of disease. The specificities of the ELISAs were 83% (IgA), 98% (IgG), and 97% (IgM and total antibody).


Telemedicine and the challenge of epilepsy management at the time of COVID-19 pandemic


Neprilysin inhibitor-angiotensin II receptor blocker combination (sacubitril/valsartan): rationale for adoption in SARS-CoV-2 patients


COVID-19 - Considerations and Implications for Surgical Learners


title: Fear and Practice Modifications among Dentists to Combat Novel Coronavirus Disease (COVID-19) Outbreak

text: An outbreak of novel coronavirus disease (COVID-19) in China has influenced every aspect of life. Healthcare professionals, especially dentists, are exposed to a higher risk of getting infected due to close contact with infected patients. The current study was conducted to assess anxiety and fear of getting infected among dentists while working during the current novel coronavirus diseases (COVID-19) outbreak. In addition, dentists' knowledge about various practice modifications to combat COVID-19 has been evaluated. A cross-sectional study was conducted using an online survey from 10th to 17th March 2020. The well-constructed questionnaire was designed and registered at online website (Kwiksurveys) and validated. A total of 669 participants from 30 different countries across the world responded. After scrutiny, completed questionnaires (n = 650) were included in the study. Statistical analysis was performed using SPSS version 25. Chi-Square and Spearman correlation tests were applied to control confounders and assess the relation of dentists' response with respect to gender and educational level. More than two-thirds of the general dental practitioners (78%) from 30 countries questioned were anxious and scared by the devastating effects of COVID-19. A large number of dentists (90%) were aware of recent changes in the treatment protocols. However, execution of amended treatment protocol was recorded as 61%. The majority of the dentists (76%) were working in the hospital setting out of which 74% were from private, and 20% were from government setups. Individually we received a large number of responses from Pakistan and Saudi Arabia, but collectively more than 50% of the responses were from other parts of the world. Despite having a high standard of knowledge and practice, dental practitioners around the globe are in a state of anxiety and fear while working in their respective fields due to the COVID-19 pandemic impact on humanity. A number of dental practices have either modified their services according to the recommended guidelines to emergency treatment only or closed down practices for an uncertain period.


title: Peripapillary hyperreflective ovoid mass-like structures (PHOMS): OCTA may reveal new findings

text: PURPOSE: Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are novel and not well characterized findings occurring in several disorders of the optic nerve. The aim of this study is to present two cases of tilted disc syndrome (TDS) and one case with optic disc drusen undergoing a multimodal imaging approach. METHODS: In this case series, a qualitative evaluation of the OCTA findings in regions with PHOMS was performed. RESULTS: Structural OCT revealed the presence of PHOMS. OCTA identified the presence of a vascular complex within this hyperreflective structure. CONCLUSIONS: Assuming that PHOMS are thought to correspond to herniating nerve fibers or be secondary to axoplasmic stasis, this vascular complex may represent a displacement of the deeper vessels deputed at the irroration of the optic nerve into the retina or, alternatively, might be secondary to an increase in vascular endothelial growth factor (VEGF) levels and a subsequent development of neovessels.


Hospitalización por insuficiencia cardíaca durante la pandemia de COVID-19./ [Heart Failure hospitalization during COVID-19 pandemic]


Temporary Emergency Guidance to US Stroke Centers During the Coronavirus Disease 2019 (COVID-19) Pandemic: On Behalf of the American Heart Association/American Stroke Association Stroke Council Leadership


title: The impact of COVID-19 on heart failure hospitalization and management: report from a Heart Failure Unit in London during the peak of the pandemic

text: AIMS: To examine the impact of COVID-19 on acute heart failure (AHF) hospitalization rates, clinical characteristics and management of patients admitted to a tertiary Heart Failure Unit in London during the peak of the pandemic. METHODS AND RESULTS: Data from King's College Hospital, London, reported to the National Heart Failure Audit for England and Wales, between 2 March-19 April 2020 were compared both to a pre-COVID cohort and the corresponding time periods in 2017 to 2019 with respect to absolute hospitalization rates. Furthermore, we performed detailed comparison of patients hospitalized during the COVID-19 pandemic and patients presenting in the same period in 2019 with respect to clinical characteristics and management during the index admission. A significantly lower admission rate for AHF was observed during the study period compared to all other included time periods. Patients admitted during the COVID-19 pandemic had higher rates of New York Heart Association III or IV symptoms (96% vs. 77%, P = 0.03) and severe peripheral oedema (39% vs. 14%, P = 0.01). We did not observe any differences in inpatient management, including place of care and pharmacological management of heart failure with reduced ejection fraction. CONCLUSION: Incident AHF hospitalization significantly declined in our centre during the COVID-19 pandemic, but hospitalized patients had more severe symptoms at admission. Further studies are needed to investigate whether the incidence of AHF declined or patients did not present to hospital while the national lockdown and social distancing restrictions were in place. From a public health perspective, it is imperative to ascertain whether this will be associated with worse long-term outcomes.


Possible impact of COVID-19 on fertility and assisted reproductive technologies


title: Prioritizing vulnerable populations and women on the frontlines: COVID-19 in humanitarian contexts

text: The COVID-19 outbreak has been declared a global pandemic and cases are being reported among displaced populations that are particularly vulnerable to infection. Humanitarian workers on the frontlines of the response are working in some of the most challenging contexts and also face elevated risk of contracting COVID-19 and potential stigmatization or violence in the community. Women humanitarians may be at even greater risk, but their protection is dependent on organization-specific policies and procedures. Without gender balance in leadership positions, the specific needs of women may not be prioritized and women may not be included in decision-making or design of responses. Ensuring gender equitable access to personal protective equipment and information is imperative, but additional measures must be put into place to ensure the protection of women on the frontlines while reducing COVID-19 deaths and adverse health effects among displaced populations.


title: Impact of nonpharmacological interventions on COVID-19 transmission dynamics in India

text: Background: As of May 4, 2020, India has reported 42,836 confirmed cases and 1,389 deaths from COVID-19. India's multipronged response included nonpharmacological interventions (NPIs) like intensive case-based surveillance, expanding testing capacity, social distancing, health promotion, and progressive travel restrictions leading to a complete halt of international and domestic movements (lockdown). Objectives: We studied the impact of NPI on transmission dynamics of COVID-19 epidemic in India and estimated the minimum level of herd immunity required to halt it. Methods: We plotted time distribution, estimated basic (R0) and time-dependent effective (Rt) reproduction numbers using software R, and calculated doubling time, the growth rate for confirmed cases from January 30 to May 4, 2020. Herd immunity was estimated using the latest Rtvalue. Results: Time distribution showed a propagated epidemic with subexponential growth. Average growth rate, 21% in the beginning, reduced to 6% after an extended lockdown (May 3). Based on early transmission dynamics, R0was 2.38 (95% confidence interval [CI] =1.79-3.07). Early, unmitigated Rt= 2.51 (95% CI = 2.05-3.14) (March 15) reduced to 1.28 (95% CI = 1.22-1.32) and was 1.83 (95% CI = 1.71-1.93) at the end of lockdown Phase 1 (April 14) and 2 (May 3), respectively. Similarly, average early doubling time (4.3 days) (standard deviation [SD] = 1.86) increased to 5.4 days (SD = 1.03) and 10.9 days (SD = 2.19). Estimated minimum 621 million recoveries are required to halt COVID-19 spread if Rtremains below 2. Conclusion: India's early response, especially stringent lockdown, has slowed COVID-19 epidemic. Increased testing, intensive case-based surveillance and containment efforts, modulated movement restrictions while protecting the vulnerable population, and continuous monitoring of transmission dynamics should be a way forward in the absence of effective treatment, vaccine, and undetermined postinfection immunity.


Ultrasound on the Frontlines of COVID-19: Report From an International Webinar


title: Solvable delay model for epidemic spreading: the case of Covid-19 in Italy

text: We present a simple but realistic model for describing the diffusion of an infectious disease on a population of individuals. The dynamics is governed by a single functional delay differential equation, which, in the case of a large population, can be solved exactly, even in the presence of a time-dependent infection rate. This delay model has a higher degree of accuracy than that of the so-called SIR model, commonly used in epidemiology, which, instead, is formulated in terms of a set of three ordinary differential equations. We apply our model to describe the outbreak of the new virus COVID-19 in Italy, taking into account the containment measures implemented by the government in order to mitigate the spreading of the virus and the social costs for the population.


title: Interpreting COVID-19 and Virtual Care Trends: Cohort Study

text: BACKGROUND: The coronavirus disease (COVID-19) pandemic is rapidly spreading across the world. As of March 26, 2020, there are more than 500,000 cases and more than 25,000 deaths related to COVID-19, and the numbers are increasing by the hour. OBJECTIVE: The aim of this study was to explore the trends in confirmed COVID-19 cases in North Carolina, and to understand patterns in virtual visits related to symptoms of COVID-19. METHODS: We conducted a cohort study of confirmed COVID-19 cases and patients using an on-demand, statewide virtual urgent care center. We collected data from February 1, 2020, to March 15, 2020. Institutional Review Board exemption was obtained prior to the study. RESULTS: As of March, 18 2020, there were 92 confirmed COVID-19 cases and 733 total virtual visits. Of the total visits, 257 (35.1%) were related to COVID-19-like symptoms. Of the COVID-19-like visits, the number of females was 178 (69.2%). People in the age groups of 30-39 years (n=67, 26.1%) and 40-49 years (n=64, 24.9%) were half of the total patients. Additionally, approximately 96.9% (n=249) of the COVID-like encounters came from within the state of North Carolina. Our study shows that virtual care can provide efficient triaging in the counties with the highest number of COVID-19 cases. We also confirmed that the largest spread of the disease occurs in areas with a high population density as well as in areas with major airports. CONCLUSIONS: The use of virtual care presents promising potential in the fight against COVID-19. Virtual care is capable of reducing emergency room visits, conserving health care resources, and avoiding the spread of COVID-19 by treating patients remotely. We call for further adoption of virtual care by health systems across the United States and the world during the COVID-19 pandemic.


title: The application of privacy protection and artificial intelligence technology in the information auxiliary system of the prevention and control of COVID-19/ 中华医学科研管理杂志

text: Objective@#The outbreak of novel coronavirus raised many problems in the auxiliary information system of epidemic prevention and control, which including the need to prevent key data from being illegal modification, traceability, lack of decision support systems at different levels, barriers to cross regional cooperation and low automation of case diagnosis.@*Methods@#In this paper, artificial intelligence, security computing supporting privacy protection, block chain and other emerging technologies are introduced into the epidemic prevention and control auxiliary information system.@*Results@#This paper discusses how to utilize modern cryptography and block chain technology to establish a traceability system that could assure the security of epidemic information; design a distributed decision support system; solve the privacy-preserving problems of Federated Learning based on SGX technology, and present a group architecture to alleviate the performance cost of SGX.@*Conclusions@#The schemes above can help to achieve the security and traceability of epidemic information, also improve the automation and decision-making efficiency of the auxiliary information system for epidemic prevention and control.


title: Impacts of the COVID-19 pandemic on Iranian patients with epilepsy

text: OBJECTIVE: To investigate the effects of COVID-19 pandemic on patients' perceptions of hardship in obtaining their drugs and if this pandemic and the social restrictions in response to that has resulted in any changes in their seizure control status. We also investigated factors potentially associated with the perceptions of difficulty in obtaining their drugs (e.g., polytherapy vs. monotherapy, taking imported drugs, and seizure status worsening). METHODS: We surveyed a random sample of patients with epilepsy, who were registered in our database at Shiraz Epilepsy Center, Iran, on their perceptions on two issues: What has been your experience on obtaining your antiseizure medications in the past four weeks (compared to before)? Have you experienced any changes in your seizure control status in the past four weeks? RESULTS: We included 100 patients (53 male and 47 female patients). In response to the question "Have you had any difficulties in the past 4 weeks to obtain your drugs?", 31 people (31%) expressed hardship obtaining their drugs. In response to the question "How has been your seizure control status compared with before?", six people (6%) expressed worsening of their seizure control status in the past 4 weeks. None of the patients reported symptoms of coronavirus infection. CONCLUSION: About one-third of patients with epilepsy expressed significant hardship obtaining their drugs after the intensification of the COVID-19 outbreak in Iran. The current COVID-19 pandemic could be considered as a major shock to a nation that has already been under significant pressure (i.e., Iran).


title: A simple algorithm helps early identification of SARS-CoV-2 infection patients with severe progression tendency

text: OBJECTIVES: We aimed to develop a simple algorithm to help early identification of SARS-CoV-2 infection patients with severe progression tendency. METHODS: The univariable and multivariable analysis were computed to identify the independent predictors of COVID-19 progression. The prediction model was established in a retrospective training set of 322 COVID-19 patients and was re-evaluated in a prospective validation set of 317 COVID-19 patients. RESULTS: The multivariable analysis identified age (OR = 1.061, p = 0.028), lactate dehydrogenase (LDH) (OR = 1.006, p = 0.037), and CD4 count (OR = 0.993, p = 0.006) as the independent predictors of COVID-19 progression. Consequently, the age-LDH-CD4 algorithm was derived as (age × LDH)/CD4 count. In the training set, the area under the ROC curve (AUROC) of age-LDH-CD4 model was significantly higher than that of single CD4 count, LDH, or age (0.92, 0.85, 0.80, and 0.75, respectively). In the prospective validation set, the AUROC of age-LDH-CD4 model was also significantly higher than that of single CD4 count, LDH, or age (0.92, 0.75, 0.81, and 0.82, respectively). The age-LDH-CD4 ≥ 82 has high sensitive (81%) and specific (93%) for the early identification of COVID-19 patients with severe progression tendency. CONCLUSIONS: The age-LDH-CD4 model is a simple algorithm for early identifying patients with severe progression tendency following SARS-CoV-2 infection, and warrants further validation.


Paediatric care in the time of COVID-19 in countries with under-resourced healthcare systems


What's Important: COVID-19-Helpers, Not Heroes


Reply to comment on "Should anti-diabetic medications be reconsidered amid COVID-19 pandemic?"


title: Critical community size for COVID-19 -- a model based approach to provide a rationale behind the lockdown

text: Background: Restrictive mass quarantine or lockdown has been implemented as the most important controlling measure to fight against COVID-19. Many countries have enforced 2 - 4 weeks' lockdown and are extending the period depending on their current disease scenario. Most probably the 14-day period of estimated communicability of COVID-19 prompted such decision. But the idea that, if the susceptible population drops below certain threshold, the infection would naturally die out in small communities after a fixed time (following the outbreak), unless the disease is reintroduced from outside, was proposed by Bartlett in 1957. This threshold was termed as Critical Community Size (CCS). Methods: We propose an SEIR model that explains COVID-19 disease dynamics. Using our model, we have calculated country-specific expected time to extinction (TTE) and CCS that would essentially determine the ideal number of lockdown days required and size of quarantined population. Findings: With the given country-wise rates of death, recovery and other parameters, we have identified that, if at a place the total number of susceptible population drops below CCS, infection will cease to exist after a period of TTE days, unless it is introduced from outside. But the disease will almost die out much sooner. We have calculated the country-specific estimate of the ideal number of lockdown days. Thus, smaller lockdown phase is sufficient to contain COVID-19. On a cautionary note, our model indicates another rise in infection almost a year later but on a lesser magnitude.


title: Expression of the SARS-CoV-2 ACE2 Receptor in the Human Airway Epithelium

text: RATIONALE: Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease (COVID-19), a predominantly respiratory illness. The first step in SARS-CoV-2 infection is binding of the virus to angiotensin converting enzyme 2 (ACE2) on the airway epithelium. OBJECTIVES: The objective was to gain insight into the expression of ACE2 in the human airway epithelium. METHODS: Airway epithelium sampled by fiberoptic bronchoscopy of trachea, large airway epi-thelium (LAE) and small airway epithelium (SAE) of nonsmokers and smokers was analyzed for expression of ACE2 and other coronavirus infection-related genes using microarray, RNA-seq and 10x single cell transcriptome analysis, with associated examination of ACE2-related miRNA. MEASUREMENTS AND MAIN RESULTS: (1) ACE2 is expressed similarly in the trachea and LAE with lower expression in the SAE; (2) in the SAE, ACE2 is expressed in basal, intermediate, club, mu-cus and ciliated cells; (3) ACE2 is up-regulated in the SAE by smoking, significantly in males; (4) levels of miR-1246 expression could play a role in ACE2 up-regulation in the SAE of smokers; and (5) ACE2 is expressed in airway epithelium differentiated in vitro on air-liquid interface cultures from primary airway basal stem/progenitor cells; this can be replicated using LAE and SAE immortalized basal cell lines derived from healthy nonsmokers. CONCLUSIONS: ACE2, the gene encoding the receptor for SARS-CoV-2, is expressed in the human airway epithelium, with variations in expression relevant to the biology of initial steps in SARS-CoV-2 infection. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).


title: A cloth mask for under-resourced healthcare settings in the COVID19 pandemic

text: INTRODUCTION: COVID19 pandemic poses a global threat, with many unknowns. The potential for resource limited countries to suffer huge mortality is of major concern. Prevention and risk reduction strategies are paramount in the current absence of effective treatment or a vaccine. There is a global shortage of personal protective equipment. AIMS: This short paper describes the rationale for and development of a cloth homemade mask and has a step by step video. RESULTS: The template is reproducible around the world and is both washable and cheap. CONCLUSION: This article describes a simple way to make a cloth mask, suitable if medical masks are not available.


COVID-19: Respiratory support outside the intensive care unit


title: Evidence of economic segregation from mobility lockdown during COVID-19 epidemic

text: In response to the COVID-19 pandemic, National governments have applied lockdown restrictions to reduce the infection rate. We perform a massive analysis on near real-time Italian data provided by Facebook to investigate how lockdown strategies affect economic conditions of individuals and local governments. We model the change in mobility as an exogenous shock similar to a natural disaster. We identify two ways through which mobility restrictions affect Italian citizens. First, we find that the impact of lockdown is stronger in municipalities with higher fiscal capacity. Second, we find a segregation effect, since mobility restrictions are stronger in municipalities for which inequality is higher and where individuals have lower income per capita.


COVID-19, guests and crews of cruise: observation on Thai citizens


title: Assessment of Specimen Pooling to Conserve SARS CoV-2 Testing Resources

text: OBJECTIVES: To establish the optimal parameters for group testing of pooled specimens for the detection of SARS-CoV-2. METHODS: The most efficient pool size was determined to be five specimens using a web-based application. From this analysis, 25 experimental pools were created using 50 µL from one SARS-CoV-2 positive nasopharyngeal specimen mixed with 4 negative patient specimens (50 µL each) for a total volume of 250 µL. Viral RNA was subsequently extracted from each pool and tested using the CDC SARS-CoV-2 RT-PCR assay. Positive pools were consequently split into individual specimens and tested by extraction and PCR. This method was also tested on an unselected group of 60 nasopharyngeal specimens grouped into 12 pools. RESULTS: All 25 pools were positive with cycle threshold (Ct) values within 0 and 5.03 Ct of the original individual specimens. The analysis of 60 specimens determined that 2 pools were positive followed by identification of 2 individual specimens among the 60 tested. This testing was accomplished while using 22 extractions/PCR tests, a savings of 38 reactions. CONCLUSIONS: When the incidence rate of SARS-CoV-2 infection is 10% or less, group testing will result in the saving of reagents and personnel time with an overall increase in testing capability of at least 69%.


title: Towards reduction in bias in epidemic curves due to outcome misclassification through Bayesian analysis of time-series of laboratory test results: case study of COVID-19 in Alberta, Canada and Philadelphia, USA

text: BACKGROUND: Despite widespread use, the accuracy of the diagnostic test for SARS-CoV-2 infection is poorly understood. The aim of our work was to better quantify misclassification errors in identification of true cases of COVID-19 and to study the impact of these errors in epidemic curves using publicly available surveillance data from Alberta, Canada and Philadelphia, USA. METHODS: We examined time-series data of laboratory tests for SARS-CoV-2 viral infection, the causal agent for COVID-19, to try to explore, using a Bayesian approach, the sensitivity and specificity of the diagnostic test. RESULTS: Our analysis revealed that the data were compatible with near-perfect specificity, but it was challenging to gain information about sensitivity. We applied these insights to uncertainty/bias analysis of epidemic curves under the assumptions of both improving and degrading sensitivity. If the sensitivity improved from 60 to 95%, the adjusted epidemic curves likely falls within the 95% confidence intervals of the observed counts. However, bias in the shape and peak of the epidemic curves can be pronounced, if sensitivity either degrades or remains poor in the 60-70% range. In the extreme scenario, hundreds of undiagnosed cases, even among the tested, are possible, potentially leading to further unchecked contagion should these cases not self-isolate. CONCLUSION: The best way to better understand bias in the epidemic curves of COVID-19 due to errors in testing is to empirically evaluate misclassification of diagnosis in clinical settings and apply this knowledge to adjustment of epidemic curves.


title: Community Susceptibility and Resiliency to COVID-19 Across the Rural-Urban Continuum in the United States

text: PURPOSE: This study creates a COVID-19 susceptibility scale at the county level, describes its components, and then assesses the health and socioeconomic resiliency of susceptible places across the rural-urban continuum. METHODS: Factor analysis grouped 11 indicators into 7 distinct susceptibility factors for 3,079 counties in the conterminous United States. Unconditional mean differences are assessed using a multivariate general linear model. Data from 2018 are primarily taken from the US Census Bureau and CDC. RESULTS: About 33% of rural counties are highly susceptible to COVID-19, driven by older and health-compromised populations, and care facilities for the elderly. Major vulnerabilities in rural counties include fewer physicians, lack of mental health services, higher disability, and more uninsured. Poor Internet access limits telemedicine. Lack of social capital and social services may hinder local pandemic recovery. Meat processing facilities drive risk in micropolitan counties. Although metropolitan counties are less susceptible due to healthier and younger populations, about 6% are at risk due to community spread from dense populations. Metropolitan vulnerabilities include minorities at higher health and diabetes risk, language barriers, being a transportation hub that helps spread infection, and acute housing distress. CONCLUSIONS: There is an immediate need to know specific types of susceptibilities and vulnerabilities ahead of time to allow local and state health officials to plan and allocate resources accordingly. In rural areas it is essential to shelter-in-place vulnerable populations, whereas in large metropolitan areas general closure orders are needed to stop community spread. Pandemic response plans should address vulnerabilities.


title: Continuous hydroxychloroquine or colchicine therapy does not prevent infection with SARS-CoV-2: Insights from a large healthcare database analysis

text: BACKGROUND: Some disease-modifying agents commonly used to treat patients with rheumatic diseases/autoimmune disorders, such as hydroxychloroquine and colchicine, are under investigation as potential therapies for the "coronavirus disease 2019" (COVID-19). However, the role of such agents as prophylactic tools is still not clear. METHODS: This is a retrospective study based on a large healthcare computerized database including all patients that were screened for the "Severe Acute Respiratory Syndrome Coronavirus type 2" (SARS-CoV-2) in the study period from February 23rd 2020 to March 31st 2020. A comparison was conducted between subjects tested positive for SARS-CoV-2 and those found negative in terms of rate of administration of hydroxychloroquine/colchicine therapy. RESULTS: An overall sample of 14,520 subjects were screened for SARS-CoV-2 infection and 1317 resulted positive. No significant difference was found in terms of rates of usage of hydroxychloroquine or colchicine between those who were found positive for SARS-CoV-2 and those who were found negative (0.23% versus 0.25% for hydroxychloroquine, and 0.53% versus 0.48% for colchicine, respectively). CONCLUSION: These findings raise doubts regarding the protective role of these medications in the battle against SARS-CoV-2 infection.


title: [Health protection guideline of conference designated hotel during COVID-19 outbreak]

text: This guideline stipulates the management requirements, personal protection and comprehensive security of conference designated hotels. It is applicable to the unified standard prevention and control of conference designated hotels during COVID-19 outbreak.


title: Oncology clinical trials during the COVID-19 outbreak: Lessons learnt during the crisis and future opportunities

text: The COVID-19 pandemic affected many activities in the healthcare system including oncology drug development. Clinical trial recruitment was temporary halted in many centres to reduce patients and healthcare workers' potential exposure to the virus. Conversely, to continue offering treatments for patients already on effective therapies, multiple actions were timely put in place, resulting in simplification of trial-related procedures for patients and clinicians' best interest, reduction of the operational burden and effective communication. Here, we suggest maintaining effective measures for future trial simplification and to expedite drug development.


Management of breast cancer in an EUSOMA-accredited Breast Unit in Lombardy, Italy, during the COVID-19 pandemic


Healthcare virtualization amid COVID-19 pandemic: an emerging new normal


Gir ACE-hemmere og angiotensinreseptorantagonister økt risiko for alvorlig covid-19?/ Gir ACE-hemmere og angiotensinreseptorantagonister økt risiko for alvorlig covid-19?/ Do ACE inhibitors and angiotensin receptor antagonists increase the risk of severe COVID-19?


'Hospital life does have its perks'


Is targeting Akt a viable option to treat advanced-stage COVID-19 patients?


title: Pneumococcal superinfection in COVID-19 patients: A series of 5 cases

text: BACKGROUND: In the context of the COVID-19 pandemic the risk of misdiagnosis of other causes of respiratory infection is likely. In this work we aim to describe the clinical characteristics, treatment and outcome of pneumococcal infection in COVID-19 patients. PATIENTS AND METHODS: Every COVID-19 patient presenting with concomitant pneumococcal pneumonia during March 2020 in a tertiary teaching Hospital In Barcelona, Spain. RESULTS: Five patients with PCR confirmed COVID19 or clinical and radiological suspicion were diagnosed of pneumococcal infection. In all cases chest X-ray were abnormal, with unilateral or bilateral infiltrates. Procalcitonin showed to be not sensitive enough to detect pneumococcal infection. Antibiotherapy was promptly started in all five cases with subsequent satisfactory evolution. CONCLUSION: International guidelines do not include the universal screening for bacterial co-infection. Radiological pattern of COVID-19 can be indistinguishable from that of pneumococcus pneumonia and frequency of co-infection is not well stablished, therefore clinicians should be aware of the possible SARS-CoV-2-pneumococcus association to avoid misdiagnosis and delay antibiotic therapy.


Coronavirus 19 presenting with atypical Sweet's syndrome


title: Lockdown for CoViD-2019 in Milan: What are the effects on air quality?

text: Based on the rapid spread of the CoViD-2019, a lockdown was declared in the whole Northern Italy by the Government. The application of increasingly rigorous containment measures allowed to reduce the impact of the CoViD-2019 pandemic on the Italian National Health System but at the same time these restriction measures gave also the opportunity to assess the effect of anthropogenic activities on air pollutants in an unprecedented way. This paper aims to study the impact of the partial and total lockdown (PL and TL, respectively) on air quality in the Metropolitan City of Milan. As results, the severe limitation of people movements following the PL and the subsequent TL determined a significant reduction of pollutants concentration mainly due to vehicular traffic (PM10, PM2.5, BC, benzene, CO, and NOx). The lockdown led to an appreciable drop in SO2 only in the city of Milan while it remained unchanged in the adjacent areas. Despite the significant decrease in NO2 in the TL, the O3 exhibited a significant increase, probably, due to the minor NO concentration. In Milan and SaA the increase was more accentuated, probably, due to the higher average concentrations of benzene in Milan than the adjacent areas that might have promoted the formation of O3 in a more significant way.


title: Space-time dependence of corona virus (COVID-19) outbreak

text: We analyse the data for the global corona virus (COVID-19) outbreak using the results of a previously studied Susceptible-Infected-Removed (SIR) model of epidemic spreading on Euclidean networks. We also directly study the correlation of the distance from the epicenter and the number of cases. An inverse square law is seen to exist approximately. The studies are made for China and the rest of the world separately.


Endoscopic sinus and skullbase surgery in pediatric patients during the COVID-19 pandemic


title: Laboratory tests and outcome for patients with COVID-19: A systematic review and meta-analysis

text: BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (COVID-19) poses substantial challenges for health care systems. With a vastly expanding amount of publications on COVID-19, clinicians need evidence synthesis to produce guidance for handling patients with COVID-19. In this systematic review and meta-analysis, we examine which routine laboratory tests are associated with severe COVID-19 disease. CONTENT: PubMed (Medline), Scopus, and Web of Science were searched until the 22nd of March 2020 for studies on COVID-19. Eligible studies were original articles reporting on laboratory tests and outcome of patients with COVID-19. Data were synthesised and we conducted random effects meta-analysis and estimated mean difference (MD) and standard mean difference at biomarker level for disease severity. Risk of bias and applicability concern was evaluated using the Quality Assessment of Diagnostic Accuracy Studies -2. SUMMARY: 45 studies were included, of which 21 publications were used for the meta-analysis. Studies were heterogeneous, but had low risk of bias and applicability concern in terms of patient selection and reference standard. Severe disease was associated with higher white blood cell count (MD 1.28 x 109/L), neutrophil count (MD 1.49 x 109/L), C-reactive protein (MD 49.2 mg/L), lactate dehydrogenase (MD 196 U/L), D-dimer (SMD 0.58), and aspartate aminotransferase (MD 8.5 U/L), all p < 0.001. Furthermore, low lymphocyte count (MD -0.32 x 109/L), platelet count (MD -22.4 x 109/L), and haemoglobin (MD -4.1 g/L), all p < 0.001, were also associated with severe disease. In conclusion, several routine laboratory tests are associated with disease severity in COVID-19.


Obesity and stroke in the COVID19 era