title: Meditsinskaya reabilitatsiya patsientov s pnevmoniyami, assotsiirovannymi s novoi koronavirusnoi infektsiei COVID-19./ [Medical rehabilitation of patients with pneumonia associated with the new COVID-19 coronavirus infection]

text: Effective medical rehabilitation of patients with pneumonia caused by the new SARS-CoV-2 coronavirus is critical for the recovery and optimization of emergency and specialty care outcomes. In this regard, it is relevant to develop a scientifically based medical rehabilitation program for patients with the coronavirus infectious disease COVID-19, whose composition and structure includes methods and tools that have proven effectiveness. AIM: To develop evidence-based approaches to medical rehabilitation for patients with pneumonia associated with the new COVID-19 coronavirus infection. RESULTS: The clinical effects and suggested mechanisms of action of rehabilitation technologies in patients with pneumonia, including those associated with the new COVID-19 coronavirus infection, are considered in Detail. The most studied of the physical methods that have a proven effect are physical exercises, breathing exercises, the complex effect of factors of resort therapy, hydrotherapy, which affect the main clinical manifestations of the underlying disease, astheno-neurotic syndrome and increasing immunity. Clinical recommendations for medical rehabilitation are proposed and its promising methods are considered. CONCLUSION: Regular generalization and analysis of high-quality randomized controlled clinical trials to evaluate various physical methods of treatment of patients with pneumonia associated with the new COVID-19 coronavirus infection is Necessary, which serve as a basis for the development of future valid clinical recommendations. Timely and adequate specialized medical rehabilitation care is critical to maintaining the health, reducing disability and mortality of patients with pneumonia associated with the new COVID-19 coronavirus infection.


title: Impact of city lockdown on the air quality of COVID-19-hit of Wuhan city

text: A series of strict lockdown measures were implemented in the areas of China worst affected by coronavirus disease 19, including Wuhan, to prevent the disease spreading. The lockdown had a substantial environmental impact, because traffic pollution and industrial emissions are important factors affecting air quality and public health in the region. After the lockdown, the average monthly air quality index (AQI) in Wuhan was 59.7, which is 33.9% lower than that before the lockdown (January 23, 2020) and 47.5% lower than that during the corresponding period (113.6) from 2015 to 2019. Compared with the conditions before the lockdown, fine particulate matter (PM2.5) decreased by 36.9% and remained the main pollutant. Nitrogen dioxide (NO2) showed the largest decrease of approximately 53.3%, and ozone (O3) increased by 116.6%. The proportions of fixed-source emissions and transported external-source emissions in this area increased. After the lockdown, O3 pollution was highly negatively correlated with the NO2 concentration, and the radiation increase caused by the PM2.5 reduction was not the main reason for the increase in O3. This indicates that the generation of secondary pollutants is influenced by multiple factors and is not only governed by emission reduction.


title: [Covid-19 diagnosis : clinical recommendations and performance of nasopharyngeal swab-PCR]

text: The Covid-19 pandemic imposes new diagnostic strategies in order to optimize the medical care of our patients The current biblio-graphy, although of low quality, shows a sensitivity of 56 to 83 % for the Covid-19 PCR Even though one negative test can exclude a Covid-19 in the majority of cases, the NPV (Negative Predictive Value) decreases with increasing prevalence (pre-test probability) This finding suggests the need for strict auto-isolation of patients until the resolution of their symptoms For patients that present with typical symptoms, who have a presumed Covid-19 prevalence of -40-50 %, a negative test should be interpreted with caution and a repeat test may be needed


title: Standardized adult-gerontology acute care nurse practitioner point-of-care ultrasound training: A new perspective in the age of a pandemic

text: Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (GACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPPs.


title: Chirurgie endocrinienne au cours et au décours de l'épidémie de COVID-19: Recommandations de l'AFCE./ [Endocrine surgery during and after the COVID-19 epidemic: guidelines from AFCE]

text: The Covid-19 pandemic commands a major reorganization of the entire French healthcare system. In France, general rules have been issued nationally and implemented by each healthcare center, both public and private, throughout France. Guidelines drafted by an expert group led by the French-speaking Association of Endocrine Surgery (AFCE) propose specific surgical management principles for thyroid, parathyroid, endocrine pancreas and adrenal surgery during and after the Covid-19 epidemic.


title: Research progress on nucleic acid detection in Novel Coronavirus Pneumonia/ 中华检验医学杂志

text: The prevention and control of Novel Coronavirus Pneumonia caused by Novel Coronavirus is at a critical period. Nucleic acid detection, as the definite diagnosis tool, plays an important role in rapid diagnosis, therapeutic efficacy, epidemic prevention and control. However, the disease is outbreak, and the time of nucleic acid detection in clinical application is short. So the insufficient method verification and clinical evaluation has been made. "False negative" is observed in clinical practice, and the result of nucleic acid detection is not matched with the clinical diagnosis. Therefore, it is urgent to optimize the current methods and improve detection sensitivity. Based on latest studies of Novel Coronavirus, this article reviews the current status and application prospects of nucleic acid detection. Also, this article provides references for clinicians and researchers.


Coronavirus SARS-CoV-2: filtering fact from fiction in the infodemic: Q&A with virologist Professor Urs Greber


title: T-Basis: a Compact Representation for Neural Networks

text: We introduce T-Basis, a novel concept for a compact representation of a set of tensors, each of an arbitrary shape, which is often seen in Neural Networks. Each of the tensors in the set is modeled using Tensor Rings, though the concept applies to other Tensor Networks. Owing its name to the T-shape of nodes in diagram notation of Tensor Rings, T-Basis is simply a list of equally shaped three-dimensional tensors, used to represent Tensor Ring nodes. Such representation allows us to parameterize the tensor set with a small number of parameters (coefficients of the T-Basis tensors), scaling logarithmically with each tensor's size in the set and linearly with the dimensionality of T-Basis. We evaluate the proposed approach on the task of neural network compression and demonstrate that it reaches high compression rates at acceptable performance drops. Finally, we analyze memory and operation requirements of the compressed networks and conclude that T-Basis networks are equally well suited for training and inference in resource-constrained environments and usage on the edge devices.


title: Learning the Compositional Visual Coherence for Complementary Recommendations

text: Complementary recommendations, which aim at providing users product suggestions that are supplementary and compatible with their obtained items, have become a hot topic in both academia and industry in recent years. %However, it is challenging due to its complexity and subjectivity. Existing work mainly focused on modeling the co-purchased relations between two items, but the compositional associations of item collections are largely unexplored. Actually, when a user chooses the complementary items for the purchased products, it is intuitive that she will consider the visual semantic coherence (such as color collocations, texture compatibilities) in addition to global impressions. Towards this end, in this paper, we propose a novel Content Attentive Neural Network (CANN) to model the comprehensive compositional coherence on both global contents and semantic contents. Specifically, we first propose a \textit{Global Coherence Learning} (GCL) module based on multi-heads attention to model the global compositional coherence. Then, we generate the semantic-focal representations from different semantic regions and design a \textit{Focal Coherence Learning} (FCL) module to learn the focal compositional coherence from different semantic-focal representations. Finally, we optimize the CANN in a novel compositional optimization strategy. Extensive experiments on the large-scale real-world data clearly demonstrate the effectiveness of CANN compared with several state-of-the-art methods.


title: Contraception during Coronavirus-Covid 19 pandemia. Recommendations of the Board of the Italian Society of Contraception

text: Purpose: The Italian Society of Contraception identified as one of its priorities the need to give recommendations on management of contraception during Coronavirus-Covid 19 pandemiaMaterials and methods: A concise communication was produced which summarises in an easy-to-read format suitable for clinicians the management of the different contraceptives mostly used. Information how to manage contraception in different conditions is presented.Results: Women may, in general, continue to use either intrauterine and or hormonal contraceptives. The use of condom should be added to any hormonal contraceptive, when the contraceptive efficacy is reduced or when women stop the contraceptive method.Conclusion: At the present time, during the Coronavirus-Covid 19 pandemia, no data contraindicate the use of intrauterine or hormonal contraceptives. Conversely the use of an appropriate contraception is advocate to prevent unintended pregnancies.


title: In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

text: BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) first broke out in Wuhan (China) and subsequently spread worldwide. Chloroquine has been sporadically used in treating SARS-CoV-2 infection. Hydroxychloroquine shares the same mechanism of action as chloroquine, but its more tolerable safety profile makes it the preferred drug to treat malaria and autoimmune conditions. We propose that the immunomodulatory effect of hydroxychloroquine also may be useful in controlling the cytokine storm that occurs late-phase in critically ill SARS-CoV-2 infected patients. Currently, there is no evidence to support the use of hydroxychloroquine in SARS-CoV-2 infection. METHODS: The pharmacological activity of chloroquine and hydroxychloroquine was tested using SARS-CoV-2 infected Vero cells. Physiologically-based pharmacokinetic models (PBPK) were implemented for both drugs separately by integrating their in vitro data. Using the PBPK models, hydroxychloroquine concentrations in lung fluid were simulated under 5 different dosing regimens to explore the most effective regimen whilst considering the drug's safety profile. RESULTS: Hydroxychloroquine (EC50=0.72 µM) was found to be more potent than chloroquine (EC50=5.47 µM) in vitro. Based on PBPK models results, a loading dose of 400 mg twice daily of hydroxychloroquine sulfate given orally, followed by a maintenance dose of 200 mg given twice daily for 4 days is recommended for SARS-CoV-2 infection, as it reached three times the potency of chloroquine phosphate when given 500 mg twice daily 5 days in advance. CONCLUSIONS: Hydroxychloroquine was found to be more potent than chloroquine to inhibit SARS-CoV-2 in vitro.


Anaesthetic management of patients with COVID-19: infection prevention and control measures in the operating theatre. Comment on Br J Anaesth doi:10.1016/j.bja.2020.04.014


Pausing cancer screening during the severe acute respiratory syndrome coronavirus 2pandemic: Should we revisit the recommendations?


title: Clinical and laboratory predictors of in-hospital mortality in patients with COVID-19: a cohort study in Wuhan, China

text: BACKGROUND: This study aimed to develop mortality-prediction models for patients with Coronavirus disease 2019 (COVID-19). METHODS: The training cohort were consecutive patients with COVID-19 in the First People's Hospital of Jiangxia District in Wuhan from January 7, 2020 to February 11, 2020. We selected baseline clinical and laboratory data through the stepwise Akaike information criterion and ensemble XGBoost model to build mortality-prediction models. We then validated these models by randomly collecting COVID-19 patients in the Infection department of Union Hospital in Wuhan from January 1, 2020, to February 20, 2020. RESULTS: 296 patients with COVID-19 were enrolled in the training cohort, 19 of whom died during hospitalization and 277 were discharged from the hospital. The clinical model developed with age, history of hypertension and coronary heart disease showed AUC of 0.88 (95% CI, 0.80-0.95); threshold, -2.6551; sensitivity, 92.31%; specificity, 77.44% and negative predictive value (NPV), 99.34%. The laboratory model developed with age, high-sensitivity C-reactive protein (hsCRP), peripheral capillary oxygen saturation (SpO2), neutrophil and lymphocyte count, D-dimer, aspartate aminotransferase (AST) and glomerular filtration rate (GFR) had a significantly stronger discriminatory power than the clinical model (p=0.0157), with AUC of 0.98 (95% CI, 0.92-0.99); threshold, -2.998; sensitivity, 100.00%; specificity, 92.82% and NPV, 100.00%. In the subsequent validation cohort (N=44), the AUCs (95% CI) were 0.83 (0.68, 0.93) and 0.88 (0.75, 0.96) for clinical model and laboratory model, respectively. CONCLUSIONS: We developed two predictive models for the in-hospital mortality of patients with COVID-19 in Wuhan and validated in patients from another center.


Can Colchicine as an Old Anti-Inflammatory Agent Be Effective in COVID-19?


title: Cancer care during the spread of coronavirus disease 2019 (COVID-19) in Italy: young oncologists' perspective

text: Click here to listen to the Podcast.


Crushing lopinavir-ritonavir tablets may decrease the efficacy of therapy in COVID-19 patients


Re: The Magnetic Resonance Imaging in Active Surveillance (MRIAS) Trial: Use of Baseline Multiparametric Magnetic Resonance Imaging and Saturation Biopsy to Reduce the Frequency of Surveillance Prostate Biopsies


Patient perspective: Roger Boyes


title: Can Bioactive Lipids Inactivate Coronavirus (COVID-19)?

text: SARS-CoV-2, SARS and MERS are all enveloped viruses that can cause acute respiratory syndrome. Arachidonic acid (AA) and other unsaturated fatty acids (especially eicosapentaenoic acd, EPA and docosahexaenoic acid DHA) are known to inactivate enveloped viruses and inhibit proliferation of various microbial organisms. The pro-inflammatory metabolites of AA and EPA such as prostaglandins, leukotrienes and thromboxanes induce inflammation whereas lipoxins, resolvins, protectins and maresins derived from AA, EPA and DHA not only suppress inflammation but also enhance would healing and augment phagocytosis of macrophages and other immunocytes and decrease microbial load. In view of these actions, it is suggested that AA and other unsaturated fatty acids and their metabolites may serve as endogenous anti-viral compounds and their deficiency may render humans susceptible to SARS-CoV-2, SARS and MERS and other similar viruses' infections. Hence, oral or intravenous administration of AA and other unsaturated fatty acids may aid in enhancing resistance and recovery from SARS-CoV-2, SARS and MERS infections.


title: COVID-19-A Novel Zoonotic Disease: A Review of the Disease, the Virus, and Public Health Measures

text: A cluster of cases of pneumonia of unknown etiology emerged in Wuhan, China, at the end of December 2019. The cluster was largely associated with a seafood and animal market. A novel Betacoronavirus was quickly identified as the causative agent, and it is shown to be related genetically to SARS-CoV and other bat-borne SARS-related Betacoronaviruses. The number of cases increased rapidly and spread to other provinces in China, as well as to another 4 countries. To help control the spread of the virus, a "cordon sanitaire" was instituted for Wuhan on January 23, 2020, and subsequently extended to other cities in Hubei Province, and the outbreak declared a Public Health Emergency of International Concern by the Director General of the World Health Organization on January 30, 2020. The virus was named SARS-CoV-2 by the International Committee for the Taxonomy of Viruses, and the disease it causes was named COVID-19 by the World Health Organization. This article described the evolution of the outbreak, and the known properties of the novel virus, SARS-CoV-2 and the clinical disease it causes, and the major public health measures being used to help control it's spread. These measures include social distancing, intensive surveillance and quarantining of cases, contact tracing and isolation, cancellation of mass gatherings, and community containment. The virus is the third zoonotic coronavirus, after SARS-CoV and MERS-CoV, but appears to be the only one with pandemic potential. However, a number of important properties of the virus are still not well understood, and there is an urgent need to learn more about its transmission dynamics, its spectrum of clinical severity, its wildlife origin, and its genetic stability. In addition, more research is needed on possible interventions, particularly therapeutic and vaccines.


title: Optimizing high-yield production of SARS-CoV-2 soluble spike trimers for serology assays

text: The SARS-CoV-2 spike trimer is the primary antigen for several serology assays critical to determining the extent of SARS-CoV-2 exposure in the population. Until stable cell lines are developed to increase the titer of this secreted protein in mammalian cell culture, the low yield of spike protein produced from transient transfection of HEK293 cells will be a limiting factor for these assays. To improve the yield of spike protein and support the high demand for antigens in serology assays, we investigated several recombinant protein expression variables by altering the incubation temperature, harvest time, chromatography strategy, and final protein manipulation. Through this investigation, we developed a simplified and robust purification strategy that consistently yields 5 mg of protein per liter of expression culture for two commonly used forms of the SARS-CoV-2 spike protein. We show that these proteins form well-behaved stable trimers and are consistently functional in serology assays across multiple protein production lots.


Exercise as medicine for COVID-19: An ACE in the hole?


Severe acute respiratory syndrome coronavirus 2 detection in the female lower genital tract


title: Cultural orientation, power, belief in conspiracy theories, and intentions to reduce the spread of COVID-19

text: The current study investigated cultural and psychological factors associated with intentions to reduce the spread of COVID-19. Participants (n = 704) completed measures of individualism-collectivism, belief in conspiracy theories about COVID-19, feelings of powerlessness, and intentions to engage in behaviours that reduce the spread of COVID-19. Results revealed that vertical individualism negatively predicted intentions to engage in social distancing, directly and indirectly through both belief in COVID-19 conspiracy theories and feelings of powerlessness. Vertical collectivism positively predicted social distancing intentions directly. Horizontal collectivism positively predicted social distancing intentions indirectly through feelings of powerlessness. Finally, horizontal collectivism positively predicted hygiene-related intentions both directly and indirectly through lower feelings of powerlessness. These findings suggest that promoting collectivism may be a way to increase engagement with efforts to reduce the spread of COVID-19. They also highlight the importance of examining the interplay between culture and both personal feelings (powerlessness) and information consumption (conspiracy theories) during times of crisis.


COVID-19 travel restrictions and the International Health Regulations (2005)


title: Pediatric COVID-19: Systematic review of the literature

text: OBJECTIVES: There is limited data regarding the demographics and clinical features of SARS-CoV-2 infection in children. This information is especially important as pneumonia is the single leading cause of death in children worldwide. This Systematic Review aims to elucidate a better understanding of the global impact of COVID-19 on the pediatric population. METHODS: A systematic review of the literature was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to gain insight into pediatric COVID-19 epidemiology. Specifically, Pubmed and Google Scholar databases were searched to identify any relevant article with a focus on Pediatric Covid 19, Pediatric Covid-19, Pediatric SARS-COV-2, and Pediatric Coronavirus 19. References within the included articles were reviewed. All articles that met criteria where analyzed for demographics, clinical, laboratory, radiographic, treatment and outcomes data. RESULTS: Ten studies including two case series and 8 retrospective chart reviews, altogether describing a total of 2914 pediatric patients with COVID-19 were included in this systematic review. Of the patients whose data was available, 56% were male, the age range was 1â¯day to 17â¯years, 79% were reported to have no comorbidities, and of the 21% with comorbidities, the most common were asthma, immunosupression, and cardiovascular disease. Of pediatric patients that were tested and positive for an infection with SARS-CoV-2, patients were asymptomatic, 14.9% of the time. Patients presented with cough (48%), fever (47%) and sore throat/pharyngitis (28.6%), more commonly than with upper respiratory symptoms/rhinorrhea/sneezing/nasal congestion (13.7%), vomiting/nausea (7.8%) and diarrhea (10.1%). Median lab values including those for WBC, lymphocyte count and CRP, were within the reference ranges with the exception of procalcitonin levels, which were slightly elevated in children with COVID-19 (median procalcitonin levels ranged from 0.07 to 0.5â¯ng/mL. Computed tomography (CT) results suggest that unilateral CT imaging findings are present 36% of cases while 64% of pediatric patients with COVID-19 had bilateral findings. Of the studies with age specific hospitalization data available, 27.0% of patients hospitalized were infants under 1â¯year of age. Various treatment regimens including interferon, antivirals, and hydroxychloroquine therapies have been trialed on the pediatric population but there are currently no studies showing efficacy of one regimen over the other. The mortality rate of children that were hospitalized with COVID-19 was 0.0018%. CONCLUSION: In contrast to adults, most infected children appear to have a milder course and have better outcomes overall. Additional care may be needed for children with comorbidities and younger children. This review also suggests that unilateral CT chest imaging findings were seen in 36.4% pediatric COVID-19 patients. This is particularly concerning as the work-up of pediatric patients with cough may warrant a bronchoscopy to evaluate for airway foreign bodies. Extra precautions need to be taken with personal protective equipment for these cases, as aerosolizing procedures may be a method of viral transmission. LEVEL OF EVIDENCE: 4 (Systematic Review).


title: Clinical Characteristics of Hematological Patients Concomitant with COVID-19

text: The rapid spread of COVID-19 represented the most serious issue to public health globally. Hematological patients as immunocompromised hosts are vulnerable to SARS-CoV-2 infection. There is rare information available regarding the clinical features of hematological patients concomitant with COVID-19. In this study, 9 concomitant patients were analyzed for their clinical manifestations, the laboratory data, radiological findings and immunologic features. The median age was 50 years (range, 17-68) and 6 patients were male. 7 patients were infected via hospital-associated transmission and other 2 via community-associated transmission. Onset of COVID-19 in all patients occurred during routine treatments for their hematological diseases. 8 patients were classified as moderate and 1 patient as critically ill COVID-19. 4 patients died, 1 from leukemia progression, 2 from life-threatening secondary infection and the other one from respiratory failure caused by COVID-19. Abruptly elevated level of cytokines was often correlated with progressive hematological disease or concurrent bacterial infections. 2 patients had the atypical CT imaging findings of COVID-19. The median interval from the first CT scan imaging to improvement in survivors was 40 days (range 14-51 days). 4 out of 5 survivors had negative serological tests one month after symptoms onset. Positive viral load in 4 survivors lasted longer than 45 days. Our result indicated concomitant patients formed a distinct subgroup characterized by atypical clinical features, defective viral clearance and lower level of SARS-CoV-2-specific antibodies. Targeted therapies that impair host humoral immunity should be avoided. These findings will be helpful to tailor appropriate management for the concomitant patients.


title: Psoriatic arthritis and COVID-19 pandemic: Consequences in medical treatment?

text: The COVID-19 pandemic has a strong negative impact on human society worldwide. Patients with immune-mediated disease may be prone to an increased risk of infection and/or more severe course. We review the available data for patients with psoriatic arthritis (PSA) and systemic treatments. Current treatment options are summarized. Based upon the experience with COVID-19, the following problems are addressed: (a) Can systemic treatment reduce comorbidities of PsA that are also comorbidities for COVID-19? Does systemic medical treatment pose an increased risk of infection with SARS-CoV-2? Does systemic drug therapy have an impact on the risk of pulmonary fibrosis-a factor with strong negative impact on COVID-19 outcome? Small molecules, inhibitors of tumor necrosis factor alfa, interleukin, and JAK inhibitors are considered. The data are inhomogeneous for the multiple drugs used in PsA. Although the risk for severe upper airway tract infections during clinical controlled trials was mostly in the range of placebo, these data have been obtained before the COVID-19 pandemic and should be interpreted with caution. Some biologics demonstrated an antifibrotic activity in vitro and in animal disease models. None of the biologics is indicated during an active infection with fever. In nonsymptomatic PsA patients, systemic drug therapy can be continued.


SARS-CoV-2: is the liver merely a bystander to severe disease?


Virtual Nation: Telemedicine's Breakout Moment


title: Demand for Health Information on COVID-19 among Vietnamese

text: Due to the rapid spread of coronavirus, Vietnam introduced its first national partial lockdown on April 1st, 2020. The public relied on online sources, whether through official websites or phone-based applications, to acquire up-to-date health information, provide accurate instructions, and limit misinformation. This study aims to provide insight regarding the current level of awareness of the pandemic, and to identify associated factors in Vietnamese participants to recommend necessary interventions. A cross-sectional study was conducted using a web-based survey during the first week of the lockdown period. There were 341 observations collected using a snowball sampling technique. A Tobit multivariable regression model was used to identify factors associated with the demand for each category of health information. The most requested information was the latest updated news on the epidemic, followed by information about disease symptoms and updated news on the outbreak. The prevalence of diverse socioeconomic, demographic, and ethnic factors in Vietnam requires consideration of the specific health information needs of unique groups. Identifying group-specific demands would be helpful to provide proper information to fulfill each population group's needs.


title: Perspectives on Cardiopulmonary Critical Care for COVID-19 Patients: From Members of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation

text: The coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), marks a global event that will permanently reshape implementation of intensive care medicine. As of June 4, 2020, there are 6,606,455 reported cases of COVID-19 including 388,556 fatalities spanning 215 countries and territories, although epidemiological data remain incomplete. Early autopsy reports emphasize proximal airway and distal airspace involvement, including alveolar epithelial inflammation and capillary thickening.


Hyper-inflammatory Syndrome in a Child With COVID-19 Treated Successfully With Intravenous Immunoglobulin and Tocilizumab


title: Nutritional and Metabolic Support and the Treatment Strategy of Severe Corona Virus Disease 2019 (COVID-19)/ 中华急诊医学杂志

text: The digestive tract is a target organ attacked by COVID-19. It is also the earliest affected organ other than the lung and must bear side effects from the anti-virus chemotherapy such as LPV/r. In this article, we aim to provide practical recommendations for a nutritional and metabolic management strategy for severe corona virus disease-19 (COVID-19) patients. These recommendations are based on the newest pathophysiological findings on the risk factors of malnutrition for COVID-19. We also systematically retrieve literatures on nutritional therapy for acute lung injuries from international and Chinese databases according to evidence-based principles. Our suggestions are: 1) Physicians should be mindful of gut injury when they focus on respiratory support, by monitoring and managing the nutritional status; 2) Periodical and dynamic nutritional risk evaluation is needed; 3) For severe patients, the feeding target of calorie and protein should be down-regulated; 4)The using of ω-3 fatty acids products should be in accordance with pharmacological indications; the forms and dosage should be determined individually.


title: Eicosanoids: the Overlooked Storm in COVID-19?

text: Severe coronavirus-19 (COVID-19) symptoms, including systemic inflammatory response and multi-system organ failure, are now affecting thousands of infected patients and causing widespread mortality. Coronavirus infection causes tissue damage, which triggers the endoplasmic reticulum (ER) stress response and subsequent eicosanoid and cytokine storms. While pro-inflammatory eicosanoids including prostaglandins, thromboxanes, and leukotrienes are critical mediators of physiological processes such as inflammation, fever, allergy, and pain, their role in COVID-19 are poorly characterized. Arachidonic acid derived epoxyeicosatrienoic acids (EETs) could alleviate the systemic hyper-inflammatory response in COVID-19 infection by modulating ER stress and stimulating the resolution of inflammation. Soluble epoxide hydrolase (sEH) inhibitors, which increase endogenous EET levels, exhibit potent anti-inflammatory activity and inhibit various pathologic processes in preclinical disease models including pulmonary fibrosis, thrombosis, and acute respiratory distress syndrome. Therefore, targeting eicosanoids and sEH could be a novel therapeutic approach in combating COVID-19. In this review, we discuss the predominant role of eicosanoids in regulating the inflammatory cascade and propose the potential application of sEH inhibitors in alleviating COVID-19 symptoms. We also discuss the host-protective action of omega-3 fatty acid-derived epoxyeicosanoids and specialized pro-resolving mediators (SPMs) in regulating anti-inflammation and anti-viral response. Future studies determining the eicosanoid profile in COVID-19 patient or preclinical model are pivotal in providing the novel insight of coronavirus-host interaction and inflammation modulation.


SARS-CoV-2 Infection in Hospitalized Patients with Kidney Disease


Underutilization of health care for strokes during the COVID-19 outbreak


title: The overall mortality caused by COVID-19 in the European region is highly associated with demographic composition: A spatial regression-based approach

text: The demographic factors have a substantial impact on the overall casualties caused by the COVID-19. In this study, the spatial association between the key demographic variables and COVID-19 cases and deaths were analyzed using the spatial regression models. Total 13 (for COVID-19 case factor) and 8 (for COVID-19 death factor) key variables were considered for the modelling. Total five spatial regression models such as Geographically weighted regression (GWR), Spatial Error Model (SEM), Spatial Lag Model (SLM), Spatial Error_Lag model (SEM_SLM), and Ordinary Least Square (OLS) were performed for the spatial modelling and mapping of model estimates. The local R2 values, which suggesting the influences of the selected demographic variables on overall casualties caused by COVID-19, was found highest in Italy and the UK. The moderate local R2 was observed for France, Belgium, Netherlands, Ireland, Denmark, Norway, Sweden, Poland, Slovakia, and Romania. The lowest local R2 value for COVID-19 cases was accounted for Latvia and Lithuania. Among the 13 variables, the highest local R2 was calculated for total population (R2 = 0.92), followed by death crude death rate (R2 = 0.9), long time illness (R2 = 0.84), population with age>80 (R2 = 0.59), employment (R2 = 0.46), life expectancy at 65 (R2 = 0.34), crude birth rate (R2 = 0.31), life expectancy (R2 = 0.31), Population with age 65-80 (R2 = 0.29), Population with age 15-24 (R2 = 0.27), Population with age 25-49 (R2 = 0.27), Population with age 0-14 (R2 = 0.23), and Population with age 50-65 (R2 = 0.23), respectively.


title: A role for human leucocyte antigens in the susceptibility to SARS-Cov-2 infection observed in transplant patients

text: We analysed data from 80 patients who tested positive for SARS-CoV-2 RNA who had previously been HLA typed to support transplantation. Data were combined from two adjacent centres in Manchester and Leeds to achieve a sufficient number for early analysis. HLA frequencies observed were compared against two control populations: first, against published frequencies in a UK deceased donor population (n = 10,000) representing the target population of the virus, and second, using a cohort of individuals from the combined transplant waiting lists of both centres (n = 308), representing a comparator group of unaffected individuals of the same demographic. We report a significant HLA association with HLA- DQB1*06 (53% vs. 36%; p < .012; OR 1.96; 95% CI 1.94-3.22) and infection. A bias towards an increased representation of HLA-A*26, HLA-DRB1*15, HLA-DRB1*10 and DRB1*11 was also noted but these were either only significant using the UK donor controls, or did not remain significant after correction for multiple tests. Likewise, HLA-A*02, HLA-B*44 and HLA-C*05 may exert a protective effect, but these associations did not remain significant after correction for multiple tests. This is relevant information for the clinical management of patients in the setting of the current SARS-CoV-2 pandemic and potentially in risk-assessing staff interactions with infected patients.


title: Impact of the COVID-19 Pandemic on Fundamental Physics Research

text: The outbreak and pandemic of the COVID-19 has dramatically changed the world in almost every aspect. Its impact on the community of high energy physics is also apparent. In this analysis we show that social distancing has greatly changed the working style of the physics community. In the field of high energy physics the online communications and video conferences are becoming daily routine arrangements. However, such a change of working styles may need some time to get used to. The influence can be seen by scientific outcomes harvested from arXiv, INSPIRE databases and JHEP, PRD official websites.


Safety of dupilumab in atopic patients during COVID-19 outbreak


title: Dying individuals and suffering populations: applying a population-level bioethics lens to palliative care in humanitarian contexts: before, during and after the COVID-19 pandemic

text: BACKGROUND: Humanitarian crises and emergencies, events often marked by high mortality, have until recently excluded palliative care-a specialty focusing on supporting people with serious or terminal illness or those nearing death. In the COVID-19 pandemic, palliative care has received unprecedented levels of societal attention. Unfortunately, this has not been enough to prevent patients dying alone, relatives not being able to say goodbye and palliative care being used instead of intensive care due to resource limitations. Yet global guidance was available. In 2018, the WHO released a guide on 'Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises'-the first guidance on the topic by an international body. AIMS: This paper argues that while a landmark document, the WHO guide took a narrowly clinical bioethics perspective and missed crucial moral dilemmas. We argue for adding a population-level bioethics lens, which draws forth complex moral dilemmas arising from the fact that groups having differential innate and acquired resources in the context of social and historical determinants of health. We discuss dilemmas concerning: limitations of material and human resources; patient prioritisation; euthanasia; and legacy inequalities, discrimination and power imbalances. IMPLICATIONS: In parts of the world where opportunity for preparation still exists, and as countries emerge from COVID-19, planners must consider care for the dying. Immediate steps to support better resolutions to ethical dilemmas of the provision of palliative care in humanitarian and emergency contexts will require honest debate; concerted research effort; and international, national and local ethical guidance.


Hypoalbuminaemia in COVID-19 infection: A predictor of severity or a potential therapeutic target?


COVID-19 pandemics and oral health care for older adults


Betting on Pandemic


Renal dysfunction in hospitalised children with COVID-19


title: COVID-19: Media coverage and financial markets behavior-A sectoral inquiry

text: We analyze the relationship between sentiment generated by coronavirus-related news with volatility of equity markets. The ongoing coronavirus outbreak (COVID-19) resulted in unprecedented news coverage and outpouring of opinions in this age of swift propagation of information. Ensuing uncertainty in financial markets leads to heightened volatility in prices. We find that overwhelming panic generated by the news outlets are associated with increasing volatility in the equity markets. Our results for individual economic sectors demonstrate that panic-laden news contributed to a greater extent to volatility in the sectors perceived to be most affected by coronavirus outbreak.


title: Intramural Hematoma as Unexpected Complication of COVID-19 Infection

text: Novel coronavirus disease-2019 (COVID-19) is an ominous infectious disease that seems capable to attack any organ system, leading in the most severe cases to patient death. COVID-19 has been associated with multiple cardiovascular complications of inflammatory and immune origin, leading to a wide spectrum of vascular damage, myocardial injury, stroke, and pulmonary obstruction. We report the case of a patient with COVID-19 infection who developed an acute aortic syndrome with the characteristics of aortic intramural hematoma.


title: Contemporary and Future Concepts on Hypertension in African Americans: COVID-19 and Beyond

text: BACKGROUND: Cardiovascular disease related mortality is the leading cause of death in the United States, with hypertension being the most prevalent and potent risk factor. For decades hypertension has disproportionately affected African Americans, who also have a higher burden of associated comorbidities including diabetes and heart failure. METHODS: Current literature including guideline reports and newer studies on hypertension in African Americans in PubMed were reviewed. We also reviewed newer publications on the relationship between COVID-19 and cardiovascular disease. FINDINGS: While APOL1 has been theorized in the epidemiology of hypertension, the increased prevalence and associated risks are primarily due to environmental and lifestyle factors. These factors include poor diet, adverse lifestyle, and social determinants. Hypertension control can be achieved by lifestyle modifications such as low sodium diet, weight loss, and adequate physical activity. When lifestyle modifications alone do not adequately control hypertension, a common occurrence among African Americans who suffer with greater prevalence of resistant hypertension, pharmacological intervention is indicated. The efficacy of renal denervation, and the use of sodium-glucose cotransporter 2 and aminopeptidase A inhibitors, have been studied for treatment of resistant hypertension. Furthermore, the recent COVID-19 crisis has been particularly devastating among African Americans who demonstrate increased incidence and poorer health outcomes related to the disease. CONCLUSION: The disparities in outcomes, which are largely attributable to a greater prevalence of comorbidities such as hypertension and obesity, in addition to adverse environmental and socioeconomic factors, highlight the necessity of specialized clinical approaches and programs for African Americans to address longstanding barriers to equitable care.


title: Cardiovascular Safety of Potential Drugs for the Treatment of Coronavirus Disease 2019

text: Coronavirus disease 2019 (COVID-19) has become a global pandemic. It is still uncontrolled in most countries and no therapies are currently available. Various drugs are under investigation for its treatment. The disease is known to have worse outcomes in patients who have underlying cardiovascular disease. Chloroquine/hydroxychloroquine, azithromycin, remdesivir and lopinavir/ritonavir are currently being studied in trials and show some promise. Conduction disorders, heart failure, and mortality have been reported with the use of these drugs. It is important to have knowledge of potential cardiotoxic effects of these drugs before using them for COVID-19 patients for better allocation of healthcare resources and improvement in clinical outcomes.


title: Epidemic of COVID-19 in China and associated Psychological Problems

text: The world is experiencing pandemic of the COVID-19 now, a RNA virus that spread out from Wuhan, China. Two countries, China first and later Italy, have gone to full lock down due to rapid spread of this virus. Till to date, no epidemiological data on mental health problems due to outbreak of the COVID-19 and mass isolation were not available. To meet this need, the present study was undertaken to assess the mental health status of Chinese people. An online survey was conducted on a sample of 1074 Chinese people, majority of whom from Hubei province. Lack of adequate opportunities to conduct face to face interview, anxiety, depression, mental well-being and alcohol consumption behavior were assessed via self-reported measures. Results showed higher rate of anxiety, depression, hazardous and harmful alcohol use, and lower mental wellbeing than usual ratio. Results also revealed that young people aged 21-40 years are in more vulnerable position in terms of their mental health conditions and alcohol use. To address mental health crisis during this epidemic, it is high time to implement multi-faceted approach (i.e. forming multidisciplinary mental health team, providing psychiatric treatments and other mental health services, utilizing online counseling platforms, rehabilitation program, ensuring certain care for vulnerable groups, etc.).


title: Clinical characteristics of 194 cases of COVID-19 in Huanggang and Taian, China

text: PURPOSE: We aimed to report the clinical characteristics of 194 cases coronavirus disease-19 (COVID-19) in Huanggang, Hubei and Taian, Shandong. METHODS: We retrospectively investigated the clinical, laboratory characteristics and CT imaging of confirmed cases of COVID-19 from January 22 to February 28, 2020 in Huanggang Central Hospital and The Second Affiliated Hospital of Shandong First Medical University. Real time PCR was used to detect the new coronavirus in respiratory samples. Immunohistochemical staining was used to detect the expressions of ACE2 in tissues. RESULTS: Among the 194 patients infected with COVID-19, 108 patients were male, with a median age of 48.3 years. The average preclinical period was 7.44 day. Except for 37 severe or critically ill patients, the rest of the 157 patients exhibited mild or moderate symptoms. 190 (97.94%) patients were confirmed during the three times nucleic acid test. The main clinical symptom of the patients were fever, sore throat and cough, which accounted for 146 cases (75.26%), 98 (50.52%) and 86 cases (44.33%), respectively. 30 patients (15.46%) showed liver dysfunction. Imaging examination showed that 141 patients (72.68%) showed abnormal density shadow, while 53 cases (27.32%) had no obvious abnormality in the parenchyma of both lungs. Up to now, 109 cases have been discharged from the hospital, and 9 patients died. The ACE2 expression levels were up-regulated in patients of severe type and critically ill type. CONCLUSION: Clinical symptoms, laboratory tests and CT imaging should be combined for comprehensive analysis to diagnose COVID-19. ACE2 may be the receptor of COVID-19.


title: Interim Guidelines on Antiviral Therapy for COVID-19

text: Since the first case was reported in Wuhan, Hubei Province, China on December 12, 2019, Coronavirus disease 2019 (COVID-19) has spread widely to other countries since January 2020. As of April 16, 2020, 10635 confirmed cases have been reported, with 230 deaths in Korea. COVID-19 patients may be asymptomatic or show various clinical manifestations, including acute symptoms such as fever, fatigue, sore throat; pneumonia presenting as acute respiratory distress syndrome; and multiple organ failure. As COVID-19 has such varied clinical manifestations and case fatality rates, no standard antiviral therapy regimen has been established other than supportive therapy. In the present guideline, we aim to introduce potentially helpful antiviral and other drug therapies based on in vivo and in vitro research and clinical experiences from many countries.


Managing locally advanced adenoid cystic carcinoma of the head and neck during the COVID-19 pandemic crisis: Is this the right time for particle therapy?


title: Markets for Efficient Public Good Allocation

text: Public goods are often either over-consumed in the absence of regulatory mechanisms, or remain completely unused, as in the case of the Covid-19 pandemic, where social distance constraints are enforced to limit the number of people who can share public spaces. In this work, we plug this gap through market based mechanisms designed to efficiently allocate capacity constrained public goods. To design these mechanisms, we leverage the theory of Fisher markets, wherein each agent in the economy is endowed with an artificial currency budget that they can spend to avail public goods. While Fisher markets provide a strong methodological backbone to model resource allocation problems, their applicability is limited to settings involving two types of constraints - budgets of individual buyers and capacities of goods. The presence of additional physical constraints that arise in public goods allocation problems motivates the need for modifications to the Fisher market framework to account for these more general set of constraints. In our market mechanism, we specifically modify the Fisher market social optimization problem through a perturbation of the budgets of agents. The budget perturbations are set based on the dual variables of the additional physical constraints such that the KKT conditions of the newly defined social and individual optimization problems are equivalent. This establishes that our mechanism sets market clearing prices such that each agent obtains their maximum possible utilities subject to their constraints. Finally, to compute the perturbation constants we present a fixed point scheme, establish the existence of a unique fixed point and present numerical experiments to illustrate convergence guarantees. Thus, our mechanism, both theoretically and computationally, overcomes a fundamental limitation of Fisher markets, which only consider capacity and budget constraints.


title: Preliminary pragmatic lessons from the SARS-CoV-2 pandemic in France

text: The first wave of the SARS-CoV-2 pandemic required an unprecedented and historic increase in critical care capacity on a global scale in France. Authors and members from the ACUTE and REANIMATION committees of the French Society of Anaesthesia and Intensive Care (SFAR) wished to share experience and insights gained during the first weeks of this pandemic. These were summarised following the World Health Organization Response Checklist and detailed according to the subsequent subheadings: 1. Command and Control, 2. Communication, 3. Safety and Security, 4. Triage, 5. Surge Capacity, 6. Continuity of essential services, 7. Human resources, 8. Logistics and supply management, 9. Training/Preparation, 10. Psychological comfort for patients and next of kin, 11. Learning and 12. Post disaster recovery. These experience-based recommendations, consensual across all members from both committees of our national society, establish a practical framework for medical teams, either spared by the first wave of severe COVID patients or preparing for the second one.


How urinary stone emergencies changed in the time of COVID-19?


title: Prions: Roles in Development and Adaptive Evolution

text: Prions are often considered as anomalous proteins associated primarily with disease rather than as a fundamental source of diversity within biological proteomes. Whereas this longstanding viewpoint has its genesis in the discovery of the original namesake prions as causative agents of several complex diseases, the underlying assumption of a strict disease basis for prions could not be further from the truth. Prions and the spectrum of functions they comprise, likely represent one of the largest paradigm shifts concerning molecular-encoded phenotypic diversity since identification of DNA as the principle molecule of heredity. The ability of prions to recruit similar proteins to alternate conformations may engender a reservoir of diversity supplementing the genetic diversity resulting from stochastic mutations of DNA and subsequent natural selection. Here we present several currently known prions and how many of their functions as well as modes of transmission are intricately linked to adaptation from an evolutionary perspective. Further, the stability of some prion conformations across generations indicates that heritable prion-based adaptation is a reality.


title: Avaliação do índice de rigor mortis e da evolução do pH da musculatura de tilápias do Nilo (Oreochromis nilolicus) durante estocagem em gelo sob refrigeração

text: A avaliação do rigor mortis em peixes representa elevada importância para a cadeia produtiva, visto que a rápida instalação deste é um indicativo de estresse, tendo influência na qualidade do produto final. Considerando isso, este trabalho teve por objetivo avaliar o estabelecimento do pleno rigor mortis e o comportamento do pH de tilápias do Nilo (Oreochromis niloticus), abatidas por secção da medula e estocadas em gelo sob refrigeração (0°C± 3°C) em dois períodos distintos (seca e chuva). As amostras foram coletadas em pesque-pagues situados no Estado de São Paulo, correspondendo a 60 amostras. Verificou-se que não houve diferença significativa (p>0,05) entre os períodos analisados para o estabelecimento do pleno rigor mortis e do pH da musculatura dorsal da espécie analisada. Apesar de sutis diferenças para as amostras dos diferentes períodos, tanto nos valores da angulação mensurada, quanto do pH, verificou-se que, em ambos os casos, o tempo de estabelecimento do pleno rigor mortis (100%) foi de aproximadamente cinco horas e, sem a definição do pH final do músculo nesse tempo. Para tanto, independente do período o tempo de instalação do rigor mortis, o abate pelo método de secção medular, foi considerado uma boa opção para o abate de tilápias, porém são necessários trabalhos complementares.(AU)


Covid-19: Government must change course or risk further wave of infections, scientists warn


title: COVID-19 pandemic: A review based on current evidence

text: In December 2019, severe acute respiratory syndrome-coronavirus-2, a novel coronavirus, initiated an outbreak of pneumonia from Wuhan in China, which rapidly spread worldwide. The clinical characteristics of the disease range from asymptomatic cases or mild symptoms, which include nonspecific symptoms such as fever, cough, sore throat, headache, and nasal congestion to severe cases such as pneumonia, respiratory failure demanding mechanical ventilation to multi-organ failure, sepsis, and death. As the transmission rate is quite alarming, we require an effective therapeutic strategy to treat symptomatic patients and adopt the preventive measures in order to contain the infection and prevent community transmission. Coronavirus disease 2019 (COVID-19) pandemic is a public health emergency of international concern, hence repurposing of the drugs is an attractive and a feasible option because PK/PD profile, toxicity profile, and drug interactions are already known. This review emphasizes on the different aspects of COVID-19 such as the epidemiology, etiopathogenesis, diagnosis, and preventive measures to be adopted in order to fight this pandemic. It also highlights upon the ethics preparedness and challenges faced by a developing country like India during such an outbreak. The review focuses on the various approaches adopted till date for developing effective therapeutic strategies including combination of drugs, vaccine therapy, and convalescent plasma therapy to combat this viral outbreak.


title: Hydroxychloroquine vs. Azithromycin for Hospitalized Patients with Suspected or Confirmed COVID-19 (HAHPS): Protocol for a Pragmatic, Open Label, Active Comparator Trial

text: COVID-19 is a potentially fatal illness with no proven therapy beyond excellent supportive care. Treatments are urgently sought. Adaptations to traditional trial logistics and design to allow rapid implementation, evaluation of trials within a global trials context, flexible interim monitoring, and access outside traditional research hospitals (even in settings where formal placebos are unavailable) may be helpful. Thoughtful adaptations to traditional trial designs-especially within the global context of related studies-may also foster collaborative relationships among government, community, and the research enterprise. We describe here the protocol for a pragmatic, active comparator trial in as many as 300 patients comparing two current "off-label" treatments for COVID-19-hydroxychloroquine and azithromycin-in academic and non-academic hospitals in Utah. We developed the trial in response to local pressures for widespread, indiscriminate off-label use of these medications. We employ a hybrid Bayesian-frequentist design for interim monitoring to allow rapid, contextual assessment of the available evidence. We also developed an inference grid for the interpretation of the range of possible results from this trial within the context of parallel trials and prepared for network meta-analysis of the resulting data. This trial was prospectively registered (NCT04329832) before enrollment of the first patient.


title: First statement on preparation for the COVID-19 pandemic in large German Speaking University-based radiation oncology departments

text: The COVID-19 pandemic is challenging modern radiation oncology. At University Hospitals, we have a mandate to offer high-end treatments to all cancer patients. However, in times of crisis we must learn to prioritize resources, especially personnel. Compromising oncological outcome will blur all statistics, therefore all measures must be taken with great caution. Communication with our neighboring countries, within societies and between departments can help meet the challenge. Here, we report on our learning system and preparation measures to effectively tackle the COVID-19 challenge in University-Based Radiation Oncology Departments.


Heart Failure Collaboratory Statement on Clinical Trials in the Landscape of COVID-19


Ocular manifestation, eye protection, and COVID-19


Commercial Transport During a Pandemic: Network Analysis to Reconcile COVID-19 Diffusion and Vital Supply Chain Resilience


Are we now observing an increasing number of coinfections between SARS-CoV-2 and other respiratory pathogens?


title: Exploring the genetics, ecology of SARS-CoV-2 and climatic factors as possible control strategies against COVID-19

text: The world has been thrown into pandemonium due to the recent Coronavirus Disease-19 (COVID-19) pandemic Early available clinical data have indicated that geriatric persons cum those with co-morbidity such as cardiovascular, metabolic and immunological disorders suffered severe form of COVID-19 All countries and territories of the world are currently exploring available strategies to control the pandemic with the hope to significantly minimize its morbidity and mortality rate This present study critically reviewed available and latest research progress of the genetics and ecology of SARS-CoV-2, as well as the influence of climatic factors on the spread of COVID-19, and thus, discussed how these concepts could be harnessed for COVID-19 control and further scientific advancements in resolving the pandemic


Clinical Characteristics of COVID-19 in Patients With Liver Injury


Low-Intensity Monitoring After Stroke Thrombolysis During the COVID-19 Pandemic


B lines in COVID-19: "Unspecificity" is not "meaningless"


The effects of the COVID pandemic on the process of training in Occupational Medicine


A call to arms: helping family, friends and communities navigate the COVID-19 infodemic


Histopathologic Changes and SARS-CoV-2 Immunostaining in the Lung of a Patient With COVID-19


Localized mid-face miliaria as a consequence of filtering face piece respirator use during the COVID-19 pandemic


The Financial Impact of COVID-19 on Our Practice


title: The COVID-19 pandemic: Clinical practice advice for gastroenterologists, hepatologists, and liver transplant specialists

text: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a novel acute infectious disease that has rapidly reached staggering pandemic proportions. This review addresses gastroenterologists, hepatologists, liver transplant (LT) specialists, and health-care professionals working in the field of liver diseases and liver transplantation. It has been written based on a limited number of publications, recommendations of national and international liver and organ transplantation societies, and experiences of patients with COVID-19 around the world. The purpose of this review is to provide information addressing questions and concerns about COVID-19, to reveal the effects of the novel disease on patients with chronic liver disease and LT recipients, and to share information about ways in which this pandemic will affect clinical practices. We, the Turkish Association for the Study of the Liver (TASL), would like to remind you that this text is actually not a practical guide. It is imperative to act according to the standards set by health-care institutions and the Ministry of Health, Republic of Turkey.


Multiple myeloma and COVID-19


A view from the front line of the COVID-19 war


Managing the COVID-19 pandemic: international comparisons in dialysis patients


Increased importance of digital medicine and eHealth during the Covid-19 pandemic


Challenges and countermeasures for organ donation during the SARS-CoV-2 epidemic: the experience of Sichuan Provincial People's Hospital


COVID-19, severe asthma, and biologics


title: Repurposing Antiviral Protease Inhibitors Using Extracellular Vesicles for Potential Therapy of COVID-19

text: In January 2020, Chinese health agencies reported an outbreak of a novel coronavirus-2 (CoV-2) which can lead to severe acute respiratory syndrome (SARS). The virus, which belongs to the coronavirus family (SARS-CoV-2), was named coronavirus disease 2019 (COVID-19) and declared a pandemic by the World Health Organization (WHO). Full-length genome sequences of SARS-CoV-2 showed 79.6% sequence identity to SARS-CoV, with 96% identity to a bat coronavirus at the whole-genome level. COVID-19 has caused over 133,000 deaths and there are over 2 million total confirmed cases as of April 15th, 2020. Current treatment plans are still under investigation due to a lack of understanding of COVID-19. One potential mechanism to slow disease progression is the use of antiviral drugs to either block the entry of the virus or interfere with viral replication and maturation. Currently, antiviral drugs, including chloroquine/hydroxychloroquine, remdesivir, and lopinavir/ritonavir, have shown effective inhibition of SARS-CoV-2 in vitro. Due to the high dose needed and narrow therapeutic window, many patients are experiencing severe side effects with the above drugs. Hence, repurposing these drugs with a proper formulation is needed to improve the safety and efficacy for COVID-19 treatment. Extracellular vesicles (EVs) are a family of natural carriers in the human body. They play a critical role in cell-to-cell communications. EVs can be used as unique drug carriers to deliver protease inhibitors to treat COVID-19. EVs may provide targeted delivery of protease inhibitors, with fewer systemic side effects. More importantly, EVs are eligible for major aseptic processing and can be upscaled for mass production. Currently, the FDA is facilitating applications to treat COVID-19, which provides a very good chance to use EVs to contribute in this combat.


Telephone based survey in adults with congenital heart disease during COVID-19 pandemic


COVID-19 in patients with HIV


The Anesthetic Management of the First Lung Transplant for a Patient with COVID-19 Respiratory Failure


title: Current Resources for Evidence-Based Practice, July 2020

text: An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of whether it is ethical not to offer doula care to all women, and commentaries on reviews focused on folic acid and autism spectrum disorder, and timing of influenza vaccination during pregnancy.


title: Escaping an epidemic: Movement optimization via Minority Game

text: We study an optimal movement strategy, for a population during an ongoing epidemic, among the ($D$) states/regions of a country having various levels of infection spreading. If a fraction of the agents in the population have a choice of staying in any two given states, we show that the total infected population in the country could be as low as that achieved with a complete stoppage of inter-state movements for a prolonged period, provided that the agents instead follow a stochastic strategy, used in the Minority Game, for their movement decisions between their two choices. Due to the random (but fixed in time) choices of the agents, the system essentially forms a set of $D/2$ coupled Minority Games, played simultaneously. The objective for an agent is to stay in the lower infected state between their two choices. We further show that it is the agents moving once between any two states, following the stochastic strategy, who are less likely to be infected than those not having (or not opting for) such a movement choice, when the risk of getting infected during the travel is not considered. This shows the incentive for the moving agents to follow the stochastic strategy. For the non-moving agents, the strategy is still helpful, as a complete random movement of the moving group results in a significantly higher total infection.


Disturbing effect of lockdown for COVID-19 on the incidence of infective endocarditis: a word of caution


COVID-19-associated immune thrombocytopenia


title: In-silico nucleotide and protein analyses of S-gene region in selected zoonotic coronaviruses reveal conserved domains and evolutionary emergence with trajectory course of viral entry from SARS-CoV2 genomic data

text: The recent zoonotic coronavirus virus outbreak of a novel type [COVID 19] has necessitated the adequate understanding of the evolutionary pathway of zoonotic viruses which adversely affects human populations for therapeutic constructs to combat the pandemic now and in the future. We analyzed conserved domains of the severe acute respiratory coronavirus 2 [SARS-CoV2] for possible targets of viral entry inhibition in host cells, evolutionary relationship of human coronavirus [229E] and zoonotic coronaviruses with SAR-CoV2 as well as evolutionary relationship between selected SARS-CoV 2 genomic data. Conserved domains with antagonistic action on host innate antiviral cellular mechanisms in SARS-CoV 2 include nsp 11, nsp 13 etc. Also, multiple sequence alignments of the spike [S] gene protein of selected candidate zoonotic coronaviruses alongside the S gene protein of the SARs-CoV2 revealed closest evolutionary relationship [95.6%] with pangolin coronaviruses [S] gene. Clades formed between Wuhan SARS-CoV2 phylogeny data and five others suggests viral entry trajectory while revealing genomic and protein SARS CoV 2 data from Philippines as early ancestors. Therefore, phylogeny of SARS-CoV 2 genomic data suggests profiling in diverse populations with and without the outbreak alongside migration history and racial background for mutation tracking and dating of viral subtype divergence which is essential for effective management of present and future zoonotic coronavirus outbreaks.


title: Characteristics of personal protective equipment training programs in Australia and New Zealand hospitals: A survey

text: BACKGROUND: Using personal protective equipment (PPE) is one of several fundamental measures to prevent the transmission of infection and infectious diseases and is particularly pertinent in the current COVID-19 pandemic. Appropriate use of PPE by healthcare workers is, however, often suboptimal. Training and monitoring of PPE competency are essential components of an infection prevention and control program but there is a paucity of research and data on the content of such training programs across Australasia. This paper reports the results of a survey that characterised the nature of PPE training in Australian and New Zealand hospitals. METHODS: A population-based online survey was distributed to members of three major Australasian colleges representing infection prevention and control. RESULTS: Results indicate that, although training is frequently provided at orientation, many healthcare workers do not receive regular updates. Training programmes combine online and classroom sessions, but over a third do not include a practical component. The frequency of monitoring PPE competency is variable with one third of respondents indicating that no auditing occurs. PPE items used for high-level training are variable, with use of powered air purifying respirators (PAPRs) uncommon. CONCLUSION: The results of this study suggest that HCWs' confidence, competence and familiarity with PPE are a concern, which in the context of the current global COVID-19 pandemic is problematic. More research is needed into how PPE training programs could be better designed, to prepare HCWs for practice using PPE safely and confidently.


Acute aorto-iliac and mesenteric arterial thromboses as presenting features of COVID-19


title: Should we stimulate or suppress immune responses in COVID-19? Cytokine and anti-cytokine interventions

text: The coronavirus disease-19 pandemic (COVID-19), which appeared in China in December 2019 and rapidly spread throughout the world, has forced clinicians and scientists to take up extraordinary challenges. This unprecedented situation led to the inception of numerous fundamental research protocols and many clinical trials. It quickly became apparent that although COVID-19, in the vast majority of cases, was a benign disease, it could also develop a severe form with sometimes fatal outcomes. Cytokines are central to the pathophysiology of COVID-19; while some of them are beneficial (type-I interferon, interleukin-7), others appear detrimental (interleukin-1ß, -6, and TNF-α) particularly in the context of the so-called cytokine storm. Yet another characteristic of the disease has emerged: concomitant immunodeficiency, notably involving impaired type-I interferon response, and lymphopenia. This review provides an overview of current knowledge on COVID-19 immunopathology. We discuss the defective type-I IFN response, the theoretical role of IL-7 to restore lymphocyte repertoire, as well as we mention the two patterns observed in severe COVID-19 (i.e. interleukin-1ß-driven macrophage activation syndrome vs. interleukin-6-driven immune dysregulation). Next, reviewing current evidence drawn from clinical trials, we examine a number of cytokine and anti-cytokine therapies, including interleukin-1, -6, and TNF inhibitors, as well as less targeted therapies, such as corticosteroids, chloroquine, or JAK inhibitors.


title: Investigation of Turkish dentists' clinical attitudes and behaviors towards the COVID-19 pandemic: a survey study

text: Currently, the whole world is under the threat of the COVID-19 pandemic, and dentists are at high risk. The aim of this study was to investigate what kind of precautions Turkish dentists take in dental clinics during the COVID-19 pandemic. The study population consisted of dentists in Turkey. An online questionnaire (23 questions-57 items) was sent to a sample of Turkish dentists from March 16 to March 20, 2020. The questionnaire comprised a series of questions about dentists' demographic characteristics, their concerns, and the measures taken in dental clinics against COVID-19. This study included a total of 1,958 Turkish dentists. A total of 1,274 (65.1%) were general dentists, and 684 (34.9%) were specialists. Five hundred twenty-two (26.7%) dentists attended an informational meeting on COVID-19. Of these dentists, 69.8% were aware of COVID-19 according to their self-assessed knowledge scores. More than 90% of the dentists were concerned about themselves and their families. Only 12% of the dentists wore an N95 mask. Although Turkish dentists took some precautionary measures, they did not take enough precautions to protect themselves, the dental staff, and other patients from COVID-19. As the number of COVID-19 cases increased, the measures taken slightly increased in dental clinics as well. Dentists are strongly recommended to take maximum precautions in the clinical setting. The guidelines about the COVID-19 pandemic should be sent to all dentists by the regional and national dental associations.


Offline: A dangerous virus, but not the one you think


title: Scientia Potentia Est: How the Italian World of Oncology Changes in the COVID-19 Pandemic

text: PURPOSE: After coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO, a response from the Italian Health System to react to an unprecedented condition became necessary and sudden. The COVID-19 pandemic has required oncologists to redefine clinical organization and patient management. The purpose of our study was to document the difficulties emerging during the SARS-CoV-2 pandemic in Italian oncology. METHODS: We broadcasted an electronic survey to oncologic health care professionals. It consisted of 45 questions ranging from individual perception of pandemic management by hospital centers to physicians' and nurses' psychological distress and patient care. RESULTS: A total of 383 oncology health workers participated in the survey. The majority were female (71.8%) and from central Italy (46.2%). Impressively, a total of 357 (93%) participants declared the oncologic department reorganized routine clinical activity, but only 40.5% were adequately trained about the required procedures; 20% of the survey respondents think they have not received adequate and timely protective devices. CONCLUSION: Our survey demonstrated the flexibility of oncologic teams. However, the emergency response quality has been heterogeneous, and several drawbacks have emerged from the first analyses investigating how the world of oncology changes in the COVID-19 pandemic. Information, protection, testing, and training of health care professionals are key words that should be kept in mind to encourage recovery after this tragedy and to be ready to face a similar emergency in the future.


title: Clinical research protocol to evaluate the effectiveness and safety of individualized homeopathic medicine in the treatment and prevention of the COVID-19 epidemic

text: In addition to the recognized application in chronic diseases, individualized homeopathy can also act in a resolutive or complementary way in acute cases, including epidemic diseases. However, to achieve this intent, it presents a specific semiologic and therapeutic methodology that must be followed and respected, with the risk of not presenting the desired efficacy and safety. In the case of epidemic diseases, which due to the virulence of their agents causes a common symptomatological picture in most susceptible individuals, the individualized homeopathic medicine (homeopathic medicine of the epidemic genius) should present similarity with the set of characteristic symptoms and signs of the patients affected in the different stages of each epidemic outbreak. Studies show the efficacy and safety of this prophylactic and/or therapeutic practice in several epidemics of the past. Therefore, after the survey of possible homeopathic drugs individualized from the epidemic genius of each epidemic, its prophylactic and/or large-scale therapeutic application should be supported by previous clinical trials that demonstrate its efficacy and safety, in line with the ethical and bioethical aspects of research involving human beings. Fulfilling these premises of good clinical practice, we developed the current protocol with the objective of investigating, in a randomized, double-blind and placebo-controlled clinical trial, the effectiveness and safety of possible individualized homeopathic drugs of epidemic genius of COVID-19, in adjuvant and complementary treatment of patients affected by the disease. If effectiveness and safety are confirmed, and only in this condition, the medicine may be used in a generalized and collective manner in the treatment and prevention of the current epidemic. (AU)


title: Short fractionation radiotherapy for early prostate cancer in the time of COVID-19: long-term excellent outcomes from a multicenter Italian trial suggest a larger adoption in clinical practice

text: INTRODUCTION: To evaluate stereotactic body radiotherapy (SBRT) in low-risk Prostate Cancer patients as preferred treatment option in emergency health conditions. MATERIALS AND METHODS: From April 2013 to September 2015, 28 patients with low-risk prostate cancer were prospectively enrolled. The SBRT prescribed dose was 36.25 Gy in 5 fractions, twice a week. Primary endpoints were acute and late toxicity. Secondary endpoints were biochemical recurrence free survival (bRFS) and overall survival. RESULTS: Median follow-up was 65.5 months (range 52-81). No acute G3 or G4 toxicity was recorded. Acute G1 or G2 genitourinary (GU) toxicity occurred in 43% and acute G1-G2 gastrointestinal (GI) toxicity in 14%. Late G1 and G3 GU toxicity in 18% and 3.5%, respectively. The G3 toxicity was not directly attributable to radiotherapy. Late G1 GI toxicity occurred in 18%. 5yy bRFS was 96.5% (95% CI 82.3-99.4%). CONCLUSIONS: Stereotactic body radiotherapy for early prostate cancer reported safe toxicity profile and a good clinical outcome at the median follow-up of 5 years. It may be an useful option if radiotherapy is required in emergency medical conditions.


title: COVID-19 Hyperinflammation: What about Neutrophils?

text: COVID-19 is often related to hyperinflammation that drives lung or multiorgan injury. The immunopathological mechanisms that cause excessive inflammation are under investigation and constantly updated. Here, a gene network approach was used on recently published data sets to identify possible COVID-19 inflammatory mechanisms and bioactive genes. First, network analysis of putative SARS-CoV-2 cellular receptors led to the mining of a neutrophil-response signature and relevant inflammatory genes. Second, analysis of RNA-seq data sets of lung cells infected with SARS-CoV-2 revealed that infected cells expressed neutrophil-attracting chemokines. Third, analysis of RNA-seq data sets of bronchoalveolar lavage fluid cells from COVID-19 patients identified upregulation of neutrophil genes and chemokines. Different inflammatory genes mined here, including TNFR, IL-8, CXCR1, CXCR2, ADAM10, GPR84, MME, ANPEP, and LAP3, might be druggable targets in efforts to limit SARS-CoV-2 inflammation in severe clinical cases. The possible role of neutrophils in COVID-19 inflammation needs to be studied further.


COVID-19: Use of the Clinical Frailty Scale for Critical Care Decisions


Digitally aided telemedicine during the SARS-CoV-2 pandemic to screen oral medicine emergencies


Forensic medicine in the time of COVID 19: An Editorial from Milano, Italy


title: Congress pumps up NSF program to fast-track COVID-19 research

text: Roxane Silver studies the health effects of traumatic life events So it was a no-brainer for the social psychologist at the University of California, Irvine, to ask the National Science Foundation (NSF) to fund a study of how the coronavirus disease 2019 (COVID-19) pandemic would affect the well-being of Americans


title: Pulmonary Therapy 2020 Update and Podcast: Meet the Journal's Editors-in-Chief

text: The Editors-in-Chief of Pulmonary Therapy have prepared podcasts summarizing their current research, recent highlights from the field, and future predictions. Audio-only versions and the transcripts can be downloaded here: https://doi.org/10.6084/m9.figshare.11938863. Following this is a written summary of the journal's recent developments and the transcripts from the podcasts.


title: Clinical and computed tomography characteristics of COVID-19 associated acute pulmonary embolism: A different phenotype of thrombotic disease?

text: INTRODUCTION: COVID-19 infections are associated with a high prevalence of venous thromboembolism, particularly pulmonary embolism (PE). It is suggested that COVID-19 associated PE represents in situ immunothrombosis rather than venous thromboembolism, although the origin of thrombotic lesions in COVID-19 patients remains largely unknown. METHODS: In this study, we assessed the clinical and computed tomography (CT) characteristics of PE in 23 consecutive patients with COVID-19 pneumonia and compared these to those of 100 consecutive control patients diagnosed with acute PE before the COVID-19 outbreak. Specifically, RV/LV diameter ratio, pulmonary artery trunk diameter and total thrombus load (according to Qanadli score) were measured and compared. RESULTS: We observed that all thrombotic lesions in COVID-19 patients were found to be in lung parenchyma affected by COVID-19. Also, the thrombus load was lower in COVID-19 patients (Qanadli score -8%, 95% confidence interval [95%CI] -16 to -0.36%) as was the prevalence of the most proximal PE in the main/lobar pulmonary artery (17% versus 47%; -30%, 95%CI -44% to -8.2). Moreover, the mean RV/LV ratio (mean difference -0.23, 95%CI -0.39 to -0.07) and the prevalence of RV/LV ratio >1.0 (prevalence difference -23%, 95%CI -41 to -0.86%) were lower in the COVID-19 patients. CONCLUSION: Our findings therefore suggest that the phenotype of COVID-19 associated PE indeed differs from PE in patients without COVID-19, fuelling the discussion on its pathophysiology.


Reply to "Clinical Features and Chest CT Manifestations of Coronavirus Disease (COVID-19)"


From conference centre to hospital


title: Electrofluidic control of bioactive molecule delivery into soft tissue models based on gelatin methacryloyl hydrogels using threads and surgical sutures

text: The delivery of bioactive molecules (drugs) with control over spatial distribution remains a challenge. Herein, we demonstrate for the first time an electrofluidic approach to controlled delivery into soft tissue models based on gelatin methacryloyl (GelMA) hydrogels. This was achieved using a surgical suture, whereby transport of bioactive molecules, including drugs and proteins, was controlled by imposition of an electric field. Commonly employed surgical sutures or acrylic threads were integrated through the hydrogels to facilitate the directed introduction of bioactive species. The platform consisted of two reservoirs into which the ends of the thread were immersed. The anode and cathode were placed separately into each reservoir. The thread was taken from one reservoir to the other through the gel. When current was applied, biomolecules loaded onto the thread were directed into the gel. Under the same conditions, the rate of movement of the biomolecules along GelMA was dependent on the magnitude of the current. Using 5% GelMA and a current of 100 µA, 2 uL of fluorescein travelled through the hydrogel at a constant velocity of 7.17 ± 0.50 um/s and took less than 8 minutes to exit on the thread. Small molecules such as riboflavin migrated faster (5.99 ± 0.40 µm/s) than larger molecules such as dextran (2.26 ± 0.55 µm/s with 4 kDa) or BSA (0.33 ± 0.07 µm/s with 66.5 kDa). A number of commercial surgical sutures were tested and found to accommodate the controlled movement of biomolecules. Polyester, polyglactin 910, glycolide/lactide copolymer and polyglycolic acid braided sutures created adequate fluid connection between the electrodes and the hydrogel. With a view to application in skin inflammatory diseases and wound treatment, wound healing, slow and controlled delivery of dexamethasone 21-phosphate disodium salt (DSP), an anti-inflammatory prodrug, was achieved using medical surgicryl PGA absorbable suture. After 2 hours of electrical stimulation, still 81.1% of the drug loaded was encapsulated within the hydrogel.


title: Virtual screening of approved drugs as potential SARS-CoV-2 main protease inhibitors

text: The global emergency caused by COVID-19 makes the discovery of drugs capable of inhibiting SARS-CoV-2 a priority, to reduce the mortality and morbidity of this disease. Repurposing approved drugs can provide therapeutic alternatives that promise rapid and ample coverage because they have a documented safety record, as well as infrastructure for large-scale production. The main protease of SARS-CoV-2 (Mpro) is an excellent therapeutic target because it is critical for viral replication; however, Mpro has a highly flexible active site that must be considered when performing computer-assisted drug discovery. In this work, potential inhibitors of the main protease (Mpro) of SARS-Cov-2 were identified through a docking-assisted virtual screening procedure. A total of 4384 drugs, all approved for human use, were screened against three conformers of Mpro. The ligands were further studied through molecular dynamics simulations and binding free energy analysis. A total of nine currently approved molecules are proposed as potential inhibitors of SARS-CoV-2. These molecules can be further tested to speed the development of therapeutics against COVID-19.


title: End-to-End AI-Based Point-of-Care Diagnosis System for Classifying Respiratory Illnesses and Early Detection of COVID-19

text: Respiratory symptoms can be a caused by different underlying conditions, and are often caused by viral infections, such as Influenza-like illnesses or other emerging viruses like the Coronavirus. These respiratory viruses, often, have common symptoms, including coughing, high temperature, congested nose, and difficulty breathing. However, early diagnosis of the type of the virus, can be crucial, especially in cases such as the recent COVID-19 pandemic. One of the factors that contributed to the spread of the pandemic, was the late diagnosis or confusing it with regular flu-like symptoms. Science has proved that one of the possible differentiators of the underlying causes of these different respiratory diseases is coughing, which comes in different types and forms. Therefore, a reliable lab-free tool for early and more accurate diagnosis that can differentiate between different respiratory diseases is very much needed. This paper proposes an end-to-end portable system that can record data from patients with symptom, including coughs (voluntary or involuntary) and translate them into health data for diagnosis, and with the aid of machine learning, classify them into different respiratory illnesses, including COVID-19. With the ongoing efforts to stop the spread of the COVID-19 disease everywhere today, and against similar diseases in the future, our proposed low cost and user-friendly solution can play an important part in the early diagnosis.


Children of frontline coronavirus disease-2019 warriors: our observations


Children of frontline COVID-19 warriors: Our observations


title: [Prediction modeling with data fusion and prevention strategy analysis for the COVID-19 outbreak]

text: Since December 2019, the outbreak of COVID-19 in Wuhan has spread rapidly due to population movement during the Spring Festival holidays. Since January 23rd, 2020, the strategies of containment and contact tracing followed by quarantine and isolation has been implemented extensively in mainland China, and the rates of detection and confirmation have been continuously increased, which have effectively suppressed the rapid spread of the epidemic. In the early stage of the outbreak of COVID-19, it is of great practical significance to analyze the transmission risk of the epidemic and evaluate the effectiveness and timeliness of prevention and control strategies by using mathematical models and combining with a small amount of real-time updated multi-source data. On the basis of our previous research, we systematically introduce how to establish the transmission dynamic models in line with current Chinese prevention and control strategies step by step, according to the different epidemic stages and the improvement of the data. By summarized our modelling and assessing ideas, the model formulations vary from autonomous to non-autonomous dynamic systems, the risk assessment index changes from the basic regeneration number to the effective regeneration number, and the epidemic development and assessment evolve from the early SEIHR transmission model-based dynamics to the recent dynamics which are mainly associated with the variation of the isolated and suspected population sizes.


title: Prediction modeling with data fusion and prevention strategy analysis for the COVID-19 outbreak/ 中华流行病学杂志


Critical care capacity during the COVID-19 pandemic: Global availability of intensive care beds


title: The MERS-CoV Receptor DPP4 as a Candidate Binding Target of the SARS-CoV-2 Spike

text: The ongoing outbreak of the novel coronavirus pneumonia COVID-19 has caused great number of cases and deaths, but our understanding about the pathogen SARS-CoV-2 remains largely unclear. The attachment of the virus with the cell-surface receptor and a cofactor is the first step for the infection. Here, bioinformatics approaches combining human-virus protein interaction prediction and protein docking based on crystal structures have revealed the high affinity between human dipeptidylpeptidase 4 (DPP4) and the spike (S) receptor-binding domain of SARS-CoV-2. Intriguingly, the crucial binding residues of DPP4 are identical to those that are bound to the MERS-CoV-S. Moreover, E484 insertion and adjacent substitutions should be most essential for this DPP4-binding ability acquirement of SARS-CoV-2-S compared with SARS-CoV-S. This potential utilization of DPP4 as a binding target for SARS-CoV-2 may offer novel insight into the viral pathogenesis and help the surveillance and therapeutics strategy for meeting the challenge of COVID-19.


title: Two cases of COVID-19 with positive salivary and negative pharyngeal or respiratory swabs at hospital discharge: A rising concern

text: We report two cases of COVID-19 showing negative respiratory swabs but positive salivary samples at the same time. These findings rise the concern about how to manage these patients before hospital discharging, thus avoiding contagion among their family members or a second coronavirus wave once the lockdown is over.


title: Imaging features and evolution on CT in 100 COVID-19 pneumonia patients in Wuhan, China

text: OBJECTIVES: To investigate CT images of 100 confirmed COVID-19 pneumonia patients to describe the lesion distribution, CT signs, and evolution during different courses. METHODS: A retrospective study of 100 COVID-19 pneumonia patients without ARDS was performed, and CT scans were reviewed. A COVID-19 pneumonia course diagram was drawn. Mann-Whitney U test was used to compare the lesion distribution and CT scores, χ2 test was used to compare the CT findings between different stages. RESULTS: A total of 272 CT scans from 100 patients (mean age, 52.3 years ± 13.1) were investigated. Four patients with lung abnormalities on CT first showed negative RT-PCR result and turned positive afterwards. One hundred sixty-nine (62.1%) showed predominantly peripheral distribution. The CT scores of the upper zone (3.4 ± 3.6) were significantly lower than those of the middle (5.0 ± 3.9) and lower (4.8 ± 3.6) zones (p < 0.001). The CT scores of the anterior zones (4.9 ± 4.7) were significantly lower than those of the posterior zones (8.4 ± 6.2) (p < 0.001). In the early rapid progressive stage (1~7 days), ground glass opacity (GGO) plus reticular pattern (58.1%), GGO plus consolidation (43.0%), and GGO (41.9%) were all common. In the advanced stage (8~14 days), GGO plus consolidation (79.8%) and repairing CT signs (subpleural line, bronchus distortion, and fibrotic strips) showed a significant increase (p < 0.05). In the absorption stage, GGO plus consolidation (9.1%) sharply decreased (p < 0.05). CONCLUSION: CT imaging of COVID-19 pneumonia showed a predominantly peripheral, middle and lower, and posterior distribution. The early rapid progressive stage is 1~7 days from symptom onset, the advanced stage with peak levels of abnormalities on CT is 8~14 days, and the abnormalities started to improve after 14 days. KEY POINTS: â¢ The course of COVID-19 pneumonia consists of three stages: 1~7 days is the early rapid progressive stage, 8~14 days is the advanced stage, and after 14 days, the abnormalities started to decrease. â¢ In the early rapid progressive stage, GGO plus a reticular pattern, GGO plus consolidation, and GGO were all common signs; in the advanced stage, signs of progression and absorption coexisted; lung abnormalities showed an asynchronous process with parts with absorption and parts progressing. â¢ Lung abnormalities mainly showed predominantly peripheral, middle, and lower distribution.


Covid-19: Medical leaders call for rapid review to prepare for second wave


title: Estimating the relative probability of direct transmission between infectious disease patients

text: BACKGROUND: Estimating infectious disease parameters such as the serial interval (time between symptom onset in primary and secondary cases) and reproductive number (average number of secondary cases produced by a primary case) are important in understanding infectious disease dynamics. Many estimation methods require linking cases by direct transmission, a difficult task for most diseases. METHODS: Using a subset of cases with detailed genetic and/or contact investigation data to develop a training set of probable transmission events, we build a model to estimate the relative transmission probability for all case-pairs from demographic, spatial and clinical data. Our method is based on naive Bayes, a machine learning classification algorithm which uses the observed frequencies in the training dataset to estimate the probability that a pair is linked given a set of covariates. RESULTS: In simulations, we find that the probabilities estimated using genetic distance between cases to define training transmission events are able to distinguish between truly linked and unlinked pairs with high accuracy (area under the receiver operating curve value of 95%). Additionally, only a subset of the cases, 10-50% depending on sample size, need to have detailed genetic data for our method to perform well. We show how these probabilities can be used to estimate the average effective reproductive number and apply our method to a tuberculosis outbreak in Hamburg, Germany. CONCLUSIONS: Our method is a novel way to infer transmission dynamics in any dataset when only a subset of cases has rich contact investigation and/or genetic data.


title: CT image of novel coronavirus pneumonia: a case report

text: OBJECTIVE: Knowledge of CT characteristics of COVID-19 pneumonia might be helpful to the early diagnosis and treatment of patients, and to control the spread of infection. METHODS: The chest CT images of the patient were collected to describe the CT manifestations and characteristics, and they were compared with the previous studies. RESULTS: Multiple patchy ground-glass opacities (GGOs) were seen in bilateral lung, mostly in subpleural areas. They progressed within 3 days, and nodular GGOs were also seen together with subpleural patchy GGOs. CONCLUSION: Our case of COVID-19 pneumonia showed multiple subpleural GGOs in bilateral lung, rapid progression, and it also accompanied nodular GGOs on chest CT. These findings were consistent with the previous reports, and they might be useful for early detection and evaluation of severity of COVID-19 pneumonia.


title: Preventing Social Isolation: A Holistic Approach to Nursing Interventions

text: The current need for social distancing due to the COVID-19 pandemic can lead to social isolation in the older adult population. Social isolation contributes to multiple health problems for older adults residing in the community and residential care facilities. Mitigating the effects of social isolation requires a holistic approach, focusing interventions on the physical, psychological, and psychosocial needs of older adults. Nurses possess a unique expertise in developing holistic interventions and using creativity to counteract the negative health sequelae resulting from social isolation. The nursing role in holistic care serves to protect the older adult's ego integrity, improve quality of life, and maintain wellness during this time of mandated social distancing. [Journal of Psychosocial Nursing and Mental Health Services, 58(7), 11-13.].


Racial variations in COVID-19 deaths may be due to androgen receptor genetic variants associated with prostate cancer and androgenetic alopecia. Are anti-androgens a potential treatment for COVID-19?


Correction to Lancet Gastroenterol Hepatol 2020; 5: 425-27


A pilot study of the impact of facial skin protectants on qualitative fit testing of N95 masks


title: Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology

text: We report the neuropathological findings of a patient who died from complications of COVID-19. The decedent was initially hospitalized for surgical management of underlying coronary artery disease. He developed post-operative complications and was evaluated with chest imaging studies. The chest computed tomography (CT) imaging results were indicative of COVID-19 and he was subsequently tested for SARS-CoV-2, which was positive. His condition worsened and he died after more than 2 weeks of hospitalization and aggressive treatment. The autopsy revealed a range of neuropathological lesions, with features resembling both vascular and demyelinating etiologies. Hemorrhagic white matter lesions were present throughout the cerebral hemispheres with surrounding axonal injury and macrophages. The subcortical white matter had scattered clusters of macrophages, a range of associated axonal injury, and a perivascular acute disseminated encephalomyelitis (ADEM)-like appearance. Additional white matter lesions included focal microscopic areas of necrosis with central loss of white matter and marked axonal injury. Rare neocortical organizing microscopic infarcts were also identified. Imaging and clinical reports have demonstrated central nervous system complications in patients' with COVID-19, but there is a gap in our understanding of the neuropathology. The lesions described in this case provide insight into the potential parainfectious processes affecting COVID-19 patients, which may direct clinical management and ongoing research into the disease. The clinical course of the patient also illustrates that during prolonged hospitalizations neurological complications of COVID may develop, which are particularly difficult to evaluate and appreciate in the critically ill.


COVID-19 lockdown: A perfect storm for older people's mental health