title: The fractal time growth of COVID-19 pandemic: an accurate self-similar model, and urgent conclusions

text: Current available data of the worldwide impact of the COVID-19 pandemic has been analyzed using dimensional analysis and self-similarity hypotheses. We show that the time series of infected population and deaths of the most impacted and unprepared countries exhibits an asymptotic power law behavior, compatible with the propagation of a signal in a fractal network. We propose a model which predicts an asymptotically self-similar expansion of deaths in time before containment, and the final death toll under total containment measures, as a function of the delay in taking those measures after the expansion is observed. The physics of the model resembles the expansion of a flame in a homogeneous domain with a fractal dimension 3.75. After containment measures are taken, the natural fractal structure of the network is drastically altered and a secondary evolution is observed. This evolution, akin to the homogeneous combustion in a static isolated enclosure with a final quenching, has a characteristic time of 20.1 days, according to available data of the pandemic behavior in China. The proposed model is remarkably consistent with available data, which supports the simplifying hypotheses made in the model. A universal formulation for a quarantine as a function of that delay is also proposed.


title: Building Telemedicine Capacity for Trainees During the Novel Coronavirus Outbreak: a Case Study and Lessons Learned

text: INTRODUCTION: Hospital and ambulatory care systems are rapidly building their virtual care capacity in response to the novel coronavirus (COVID-19) pandemic. The use of resident trainees in telemedicine is one area of potential development and expansion. To date, however, training opportunities in this field have been limited, and residents may not be adequately prepared to provide high-quality telemedicine care. AIM: This study evaluates the impact of an adapted telemedicine Objective Structured Clinical Examination (OSCE) on telemedicine-specific training competencies of residents. SETTING: Primary Care Internal Medicine residents at a large urban academic hospital. PROGRAM DESCRIPTION: In March 2020, the New York University Grossman School of Medicine Primary Care program adapted its annual comprehensive OSCE to a telemedicine-based platform, to comply with distance learning and social distancing policies during the COVID-19 pandemic. A previously deployed in-person OSCE on the subject of a medical error was adapted to a telemedicine environment and deployed to 23 primary care residents. Both case-specific and core learning competencies were assessed, and additional observations were conducted on the impact of the telemedicine context on the encounter. PROGRAM EVALUATION: Three areas of telemedicine competency need were identified in the OSCE case: technical proficiency; virtual information gathering, including history, collateral information collection, and physical exam; and interpersonal communication skills, both verbal and nonverbal. Residents expressed enthusiasm for telemedicine training, but had concerns about their preparedness for telemedicine practice and the need for further competency and curricular development. DISCUSSION: Programs interested in building capacity among residents to perform telemedicine, particularly during the COVID-19 pandemic, can make significant impact in their trainees' comfort and preparedness by addressing key issues in technical proficiency, history and exam skills, and communication. Further research and curricular development in digital professionalism and digital empathy for trainees may also be beneficial.


Fighting the novel coronavirus: the publication of the Chinese expert consensus on the perinatal and neonatal management for the prevention and control of the 2019 novel coronavirus infection (First edition)


title: Reduced demand for oral diagnosis during COVID-19: a Brazilian center experience

text: Brazil represents the new epicenter of novel coronavirus disease 2019 (COVID-19), surpassing the mark of more than one million cases and 50,000 deaths. Despite these terrible numbers, experts estimate that the real size of the epidemic may be up to seven times higher (Hallal et al., 2020). Also, Brazilian people with mild symptoms rarely get tested. While the country and world engage in the fight against the pandemic of COVID-19, it remains vital for our health care system to continue caring for all patients.


E-Rehabilitation: One solution for patients with Parkinson's disease in COVID-19 era


title: Evidence for transmission of COVID-19 prior to symptom onset

text: We collated contact tracing data from COVID-19 clusters in Singapore and Tianjin, China and estimated the extent of pre-symptomatic transmission by estimating incubation periods and serial intervals. The mean incubation periods accounting for intermediate cases were 4.91 days (95%CI 4.35, 5.69) and 7.54 (95%CI 6.76, 8.56) days for Singapore and Tianjin, respectively. The mean serial interval was 4.17 (95%CI 2.44, 5.89) and 4.31 (95%CI 2.91, 5.72) days (Singapore, Tianjin). The serial intervals are shorter than incubation periods, suggesting that pre-symptomatic transmission may occur in a large proportion of transmission events (0.4-0.5 in Singapore and 0.6-0.8 in Tianjin, in our analysis with intermediate cases, and more without intermediates). Given the evidence for pre-symptomatic transmission it is vital that even individuals who appear healthy abide by public health measures to control COVID-19.


Profissionalismo Médico e o Contrato Social: Reflexões acerca da Pandemia de COVID-19./ [Medical Professionalism and the Social Contract: Reflections on the COVID-19 Pandemic]


title: Broad Spectrum Antiviral Agent Niclosamide and Its Therapeutic Potential

text: The recent outbreak of coronavirus disease 2019 (COVID-19) highlights an urgent need for therapeutics. Through a series of drug repurposing screening campaigns, niclosamide, an FDA-approved anthelminthic drug, was found to be effective against various viral infections with nanomolar to micromolar potency such as SARS-CoV, MERS-CoV, ZIKV, HCV, and human adenovirus, indicating its potential as an antiviral agent. In this brief review, we summarize the broad antiviral activity of niclosamide and highlight its potential clinical use in the treatment of COVID-19.


title: Incidence of venous thromboembolism in hospitalized patients with COVID-19

text: Coronavirus disease 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications. We investigated the incidence of objectively confirmed venous thromboembolism (VTE) in 198 hospitalized patients with COVID-19 in a single-center cohort study. Seventy-five patients (38%) were admitted to the intensive care unit (ICU). At time of data collection, 16 (8%) were still hospitalized and 19% had died. During a median follow-up of 7 days (IQR, 3-13), 39 patients (20%) were diagnosed with VTE of whom 25 (13%) had symptomatic VTE, despite routine thrombosis prophylaxis. The cumulative incidences of VTE at 7, 14 and 21 days were 16% (95% CI, 10-22), 33% (95% CI, 23-43) and 42% (95% CI 30-54) respectively. For symptomatic VTE, these were 10% (95% CI, 5.8-16), 21% (95% CI, 14-30) and 25% (95% CI 16-36). VTE appeared to be associated with death (adjusted HR, 2.4; 95% CI, 1.02-5.5). The cumulative incidence of VTE was higher in the ICU (26% (95% CI, 17-37), 47% (95% CI, 34-58), and 59% (95% CI, 42-72) at 7, 14 and 21 days) than on the wards (any VTE and symptomatic VTE 5.8% (95% CI, 1.4-15), 9.2% (95% CI, 2.6-21), and 9.2% (2.6-21) at 7, 14, and 21 days). The observed risk for VTE in COVID-19 is high, particularly in ICU patients, which should lead to a high level of clinical suspicion and low threshold for diagnostic imaging for DVT or PE. Future research should focus on optimal diagnostic and prophylactic strategies to prevent VTE and potentially improve survival.


title: Susceptible-Infected-Recovered (SIR) Dynamics of COVID-19 and Economic Impact

text: I estimate the Susceptible-Infected-Recovered (SIR) epidemic model for Coronavirus Disease 2019 (COVID-19). The transmission rate is heterogeneous across countries and far exceeds the recovery rate, which enables a fast spread. In the benchmark model, 28% of the population may be simultaneously infected at the peak, potentially overwhelming the healthcare system. The peak reduces to 6.2% under the optimal mitigation policy that controls the timing and intensity of social distancing. A stylized asset pricing model suggests that the stock price temporarily decreases by 50% in the benchmark case but shows a W-shaped, moderate but longer bear market under the optimal policy.


Clinical trials and Haemophilia during the COVID-19 pandemic: Madrid's experience


More information needed for patients with COVID-19 receiving spinal anaesthesia


title: Safety and immunogenicity of a candidate Middle East respiratory syndrome coronavirus viral-vectored vaccine: a dose-escalation, open-label, non-randomised, uncontrolled, phase 1 trial

text: BACKGROUND: Cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection continue to rise in the Arabian Peninsula 7 years after it was first described in Saudi Arabia. MERS-CoV poses a significant risk to public health security because of an absence of currently available effective countermeasures. We aimed to assess the safety and immunogenicity of the candidate simian adenovirus-vectored vaccine expressing the full-length spike surface glycoprotein, ChAdOx1 MERS, in humans. METHODS: This dose-escalation, open-label, non-randomised, uncontrolled, phase 1 trial was done at the Centre for Clinical Vaccinology and Tropical Medicine (Oxford, UK) and included healthy people aged 18-50 years with negative pre-vaccination tests for HIV antibodies, hepatitis B surface antigen, and hepatitis C antibodies (and a negative urinary pregnancy test for women). Participants received a single intramuscular injection of ChAdOx1 MERS at three different doses: the low-dose group received 5â×â109 viral particles, the intermediate-dose group received 2·5â×â1010 viral particles, and the high-dose group received 5â×â1010 viral particles. The primary objective was to assess safety and tolerability of ChAdOx1 MERS, measured by the occurrence of solicited, unsolicited, and serious adverse events after vaccination. The secondary objective was to assess the cellular and humoral immunogenicity of ChAdOx1 MERS, measured by interferon-Î³-linked enzyme-linked immunospot, ELISA, and virus neutralising assays after vaccination. Participants were followed up for up to 12 months. This study is registered with ClinicalTrials.gov, NCT03399578. FINDINGS: Between March 14 and Aug 15, 2018, 24 participants were enrolled: six were assigned to the low-dose group, nine to the intermediate-dose group, and nine to the high-dose group. All participants were available for follow-up at 6 months, but five (one in the low-dose group, one in the intermediate-dose group, and three in the high-dose group) were lost to follow-up at 12 months. A single dose of ChAdOx1 MERS was safe at doses up to 5â×â1010 viral particles with no vaccine-related serious adverse events reported by 12 months. One serious adverse event reported was deemed to be not related to ChAdOx1 MERS. 92 (74% [95% CI 66-81]) of 124 solicited adverse events were mild, 31 (25% [18-33]) were moderate, and all were self-limiting. Unsolicited adverse events in the 28 days following vaccination considered to be possibly, probably, or definitely related to ChAdOx1 MERS were predominantly mild in nature and resolved within the follow-up period of 12 months. The proportion of moderate and severe adverse events was significantly higher in the high-dose group than in the intermediate-dose group (relative risk 5·83 [95% CI 2·11-17·42], p<0·0001) Laboratory adverse events considered to be at least possibly related to the study intervention were self-limiting and predominantly mild in severity. A significant increase from baseline in T-cell (p<0·003) and IgG (p<0·0001) responses to the MERS-CoV spike antigen was observed at all doses. Neutralising antibodies against live MERS-CoV were observed in four (44% [95% CI 19-73]) of nine participants in the high-dose group 28 days after vaccination, and 19 (79% [58-93]) of 24 participants had antibodies capable of neutralisation in a pseudotyped virus neutralisation assay. INTERPRETATION: ChAdOx1 MERS was safe and well tolerated at all tested doses. A single dose was able to elicit both humoral and cellular responses against MERS-CoV. The results of this first-in-human clinical trial support clinical development progression into field phase 1b and 2 trials. FUNDING: UK Department of Health and Social Care, using UK Aid funding, managed by the UK National Institute for Health Research.


Quantifying the association between domestic travel and the exportation of novel coronavirus (2019-nCoV) cases from Wuhan, China in 2020: a correlational analysis


title: Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19)

text: Importance: The role of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in the setting of the coronavirus disease 2019 (COVID-19) pandemic is hotly debated. There have been recommendations to discontinue these medications, which are essential in the treatment of several chronic disease conditions, while, in the absence of clinical evidence, professional societies have advocated their continued use. Objective: To study the association between use of ACEIs/ARBs with the likelihood of testing positive for COVID-19 and to study outcome data in subsets of patients taking ACEIs/ARBs who tested positive with severity of clinical outcomes of COVID-19 (eg, hospitalization, intensive care unit admission, and requirement for mechanical ventilation). Design, Setting, and Participants: Retrospective cohort study with overlap propensity score weighting was conducted at the Cleveland Clinic Health System in Ohio and Florida. All patients tested for COVID-19 between March 8 and April 12, 2020, were included. Exposures: History of taking ACEIs or ARBs at the time of COVID-19 testing. Main Outcomes and Measures: Results of COVID-19 testing in the entire cohort, number of patients requiring hospitalizations, intensive care unit admissions, and mechanical ventilation among those who tested positive. Results: A total of 18â¯472 patients tested for COVID-19. The mean (SD) age was 49 (21) years, 7384 (40%) were male, and 12â¯725 (69%) were white. Of 18â¯472 patients who underwent COVID-19 testing, 2285 (12.4%) were taking either ACEIs or ARBs. A positive COVID-19 test result was observed in 1735 of 18â¯472 patients (9.4%). Among patients who tested positive, 421 (24.3%) were admitted to the hospital, 161 (9.3%) were admitted to an intensive care unit, and 111 (6.4%) required mechanical ventilation. Overlap propensity score weighting showed no significant association of ACEI and/or ARB use with COVID-19 test positivity (overlap propensity score-weighted odds ratio, 0.97; 95% CI, 0.81-1.15). Conclusions and Relevance: This study found no association between ACEI or ARB use and COVID-19 test positivity. These clinical data support current professional society guidelines to not discontinue ACEIs or ARBs in the setting of the COVID-19 pandemic. However, further study in larger numbers of hospitalized patients receiving ACEI and ARB therapy is needed to determine the association with clinical measures of COVID-19 severity.


Antibody tests suggest that coronavirus infections vastly exceed official counts


COVID-19 and SARS Coronavirus 2: Antibodies for the Immediate Rescue and Recovery Phase


Using Telehealth as a Tool for Rural Hospitals in the COVID-19 Pandemic Response


title: Cancellation of elective surgery and intensive care unit capacity in New York state: a retrospective cohort analysis

text: BACKGROUND: In response to the COVID-19 pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear. METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions), and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included. RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n=1,232,986/n=12,251,617) and remained stable over a 5 year period from 2011 to 2015. Among n=1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n=165,365), emergent/urgent admissions/trauma surgery (28.0%, n=345,094), and medical admissions (58.6%, n=722,527). Ventilator utilization was seen in 26.3% (n=323,789/n=1,232,986) of all ICU patients of which 6.4% (n=20,652), 32.8% (n=106,186) and 60.8% (n=196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n=2496/n=3566) in New York State. CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More work is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.


A 63-year-old man treated for coronavirus disease 2019


Preliminary estimation of the novel coronavirus disease (COVID-19) cases in Iran: A reply to Sharifi


Covid-19: virtual occupational skin health clinics for healthcare workers


COVID-19: Challenges and opportunities in the care sector


Interleukin 6 polymorphisms as an indicator of COVID-19 severity in humans


title: The Heart in COVID19: Primary Target or Secondary Bystander?

text: In the throes of the current COVID-19 pandemic, interest has burgeoned in the cardiovascular complications of this virulent viral infection. As troponin, a biomarker of cardiac injury, often rises in hospitalized patients, its interpretation and actionability require careful consideration. Fulminant myocarditis due to direct viral infection can certainly occur, but patients with increased oxygen demands due to tachycardia and fever, and reduced oxygen delivery due to hypotension and hypoxemia can cause myocardial injury indirectly. Cytokines released during the acute infection can elicit activation of cells within pre-existing atherosclerotic lesions, augmenting thrombotic risk and risk of ischemic syndromes. Moreover, microvascular activation by cytokines can cause not only myocardial injury but harm other organ systems commonly involved in COVID-19 infections including the kidneys. Dealing with the immense challenge of COVID-19 disease, confronted with severely ill patients in dire straits with virtually no rigorous evidence base to guide our therapy, we must call upon our clinical skills and judgment. These touchstones can help guide us in selecting patients who might benefit from the advanced imaging and invasive procedures that present enormous logistical challenges in the current context. Lacking a robust evidence base, pathophysiologic reasoning can help guide our choices of therapy for individual clinical scenarios. We must exercise caution and extreme humility, as often plausible interventions fail when tested rigorously. But act today we must, and understanding the multiplicity of mechanisms of myocardial injury in COVID-19 infection will help us meet our mission unsupported by the comfort of strong data.


Perianesthesia Nurses Called to Practice in Extraordinary Times


title: Reversible Encephalopathy Syndrome (PRES) in a COVID-19 patient

text: Recently WHO has declared novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Acute respiratory syndrome seems to be the most common manifestation of COVID-19. Besides pneumonia, it has been demonstrated that SARS-CoV-2 infection affects multiple organs, including brain tissues, causing different neurological manifestations, especially acute cerebrovascular disease (ischemic and hemorrhagic stroke), impaired consciousness and skeletal muscle injury. To our knowledge, among neurological disorders associated with SARS-CoV2 infection, no Posterior Reversible Encephalopathy Syndrome (PRES) has been described yet. Herein, we report a case of a 64-year old woman with COVID19 infection who developed a PRES, and we suggest that it could be explained by the disruption of the blood brain barrier induced by the cerebrovascular endothelial dysfunction caused by SARS-CoV-2.


COVID-19 and QT interval prolongation: more than just drug toxicity?


title: Dexmedetomidine and worsening hypoxemia in the setting of COVID-19: A case report

text: Emergency department management of hypoxemia in the setting of COVID-19 is riddled with uncertainty. The lack of high-quality research has translated to an absence of clarity at the bedside. With disease spread outpacing treatment consensus, provider discretion has taken on a heightened role. Here, we report a case of dexmedetomidine use in the setting of worsening hypoxemia, whereby oxygenation improved and intubation was avoided. Well known pharmacologic properties of the drug, namely the lack of respiratory depression and its anti-delirium effects, as well as other possible physiologic effects, suggest potential benefit for patients being managed with a delayed intubation approach. If dexmedetomidine can improve compliance with non-invasive oxygen support (the current recommended first-line therapy) while promoting better oxygenation, it may also decrease the need for mechanical ventilation and thus improve mortality.


title: Infection Control and Management Strategy for COVID-19 in the Radiology Department: Focusing on Experiences from China

text: Coronavirus disease 2019 (COVID-19) is a new infectious disease rapidly spreading around the world, raising global public health concerns. Radiological examinations play a crucial role in the early diagnosis and follow-up of COVID-19. Cross infection among patients and radiographers can occur in radiology departments due to the close and frequent contact of radiographers with confirmed or potentially infected patients in a relatively confined room during radiological workflow. This article outlines our experience in the emergency management procedure and infection control of the radiology department during the COVID-19 outbreak.


title: [A Case of Squamous Cell Lung Cancer in an Elderly Patient with Low PD-L1 Expression Effectively Treated with Nab-Paclitaxel(Nab-PTX)plus Carboplatin (CBDCA)plus Pembrolizumab for a Recurrence after Operation]

text: An 81-year-old man was admitted to our medical center for dyspnea. He underwent right upper lobectomy due to squamous cell lung cancer 5 years ago. Chest computed tomography(CT)revealed stenosis ofthe right main bronchus, and pathological diagnosis ofthe lesion was squamous cell carcinoma and PD-L1 expression was low(tumor proportion score [TPS]: 1%). Because his performance status(PS)was 1, he underwent 4 courses ofnab -paclitaxel(nab-PTX)plus carboplatin( CBDCA)plus pembrolizumab chemotherapy and pembrolizumab maintenance chemotherapy. The stenosis ofthe right main bronchus was clear after chemotherapy, and his dyspnea was improved. Chemotherapy using nab-PTX plus CBDCA plus pembrolizumab may become one of the therapeutic choices for the recurrence after operation of an elderly person with squamous cell lung carcinoma and low PD-L1 expression.


title: The Indian perspective of COVID-19 outbreak

text: The emerging infection of COVID-19 was initiated from Wuhan, China, have been spread to more than 210 countries around the globe including India. The clinical symptoms of COVID-19 are very similar to other respiratory viruses. The number of laboratory-confirmed cases and associated deaths are increasing regularly in various parts of the World. Seven coronaviruses (229E, NL63, OC43, HKU1, SARS, MERS and, COVID-19) can naturally infect human beings. Out of these four (229E-CoV, NL63-CoV, OC43-CoV, HKU1-CoV) are responsible for mild upper respiratory infections, while SARS-CoV, MERS-CoV, and COVID-19 are well known for their high mortality. Few mild strains of coronaviruses are circulating in India but there is no evidence of SARS and MERS outbreaks. The COVID-19 is an emerging viral infection responsible for pandemics. Fortunately, the mortality of COVID-19 is low as compared with SARS and MERS, the majority of its cases are recovered. The death toll of COVID-19 is high even after its low mortality because COVID-19 causes a pandemic while SARS-CoV and MERS-CoV cause epidemics only. COVID-19 influenced the large segments of the world population, which led to a public health emergency of international concern, putting all health organizations on high alert. COVID-19 is the first coronavirus after Spanish Flu 1918-1919, who has extremely influenced the health system, economy, and psychology of India. The present study review is on the general continent, virology, pathogenesis, global epidemiology, clinical presentation, diagnosis, treatment and control of COVID-19 with the reference to India.


title: [A Case of 11-Year Patient Survival after the Resection of a Metastatic Pancreatic Tumor of Sigmoid Colon Cancer]

text: A 44-year-old woman underwent a sigmoidectomy for sigmoid colon cancer in March 2002. At 5 years after the primary surgery, she underwent 2 hepatectomies, 2 anastomotic resections, 1 lung resection, and 1 radiofrequency ablation. Computed tomography revealed a mass in the pancreatic tail in January 2008. We performed distal pancreatectomy. The specimen showed metastases ofthe sigmoid colon cancer. Computed tomography revealed metastases to the left iliac lymph node in September 2010. She underwent chemotherapy with IRIS for the lymph node metastases. After 16 chemotherapy sessions, the lymph node metastases disappeared. The patient is alive 11 years after the pancreatectomy. Resectable pancreatic metastasis from colorectal cancer is rare. Multimodal treatment that includes radical surgery may achieve long-term survival in some cases.


title: A case of imported COVID-19 diagnosed by PCR-positive lower respiratory specimen but with PCR-negative throat swabs

text: A 35-year-old woman presented with fever and mild diarrhoea without any respiratory symptoms 9 days after travelling to Japan from Wuhan, China. Her computed tomography scan revealed pneumonia. The first polymerase chain reaction (PCR) test on throat swab for the novel corona virus upon admission was negative. Therefore, she was treated for community-acquired pneumonia, but fever persisted. On hospital day 5, PCR test on induced sputum was positive, but a second polymerase chain reaction test on throat swab remained negative. She was discharged, fully recovered, on hospital day 12. A lower respiratory tract specimen should be obtained for better diagnosis of corona virus disease 2019, even in the absence of respiratory symptoms for patients with significant travel or exposure history.


Letter to editor: CoVID-19 pandemic and sleep disorders-a web survey in Italy


SARS-CoV-2-related Hypercoagulable State Leading to Ischemic Enteritis Secondary to Superior Mesenteric Artery Thrombosis


title: Threat of COVID-19 Vaccine Hesitancy in Pakistan: The Need for Measures to Neutralize Misleading Narratives

text: Immediately after declaring COVID-19 as a pandemic, numerous wild conspiracy theories sprouted through social media. Pakistan is quite vulnerable to such conspiracy narratives and has experienced failures of polio vaccination programs because of such claims. Recently, two well-known political figures raised conspiracy theories against COVID-19 vaccines in Pakistan, stating that COVID-19 is a grand illusion and a conspiracy against Muslim countries. This theory is much discussed in the local community, supporting COVID-19 vaccine hesitancy. We urge healthcare authorities in Pakistan to take necessary measures against such claims before they penetrate to the general community. Anti-vaccine movements could undermine efforts to end the COVID-19 pandemic. We believe that ethical and responsible behavior of mass media, a careful advisory from the Pakistan Electronic Media Regulatory Authority, stern measures from healthcare authorities, effective maneuvers to increase public awareness on COVID-19, vigorous analysis of information by data or communications scientists, and publication of counter opinions from health professionals against such theories will go a long way in neutralizing such misleading claims. Because Pakistan is experiencing a large burden of disease, with a sharp rise in confirmed cases, immediate action is of paramount importance to eradicate any potential barriers to a future COVID-19 vaccination program.


Radiologie der COVID-19-Pneumonie  Bildassay und Vorschlag für die strukturierte Herangehensweise an die CT-Befundung./ Radiologie der COVID-19-Pneumonie  Bildassay und Vorschlag für die strukturierte Herangehensweise an die CT-Befundung./ Radiology of COVID-19 Pneumonia - Pictorial Essay and Structured Reporting


title: Breastfeeding during the COVID-19 pandemic: Suggestions on behalf of woman study group of AMD

text: SARS-Cov2 infection has recently spread to Italy with important consequences on pregnancy management, mother and child health and mother-child contact. Breastfeeding improves the health of mother and child and reduces risk of neonatal infection with other pathogens that are likely to cause serious illness. To date no evidence confirmed COVID-19 vertical transmission from infected pregnant mother to their fetus. However it is well known that an infected mother can transmit the COVID-19 virus through respiratory droplets during breastfeeding or intimate contact. Thus, the mothers with known or suspected COVID-19 should adhere to standard and contact precautions during breastfeeding. Woman Study Group of AMD, after reviewing current knowledge about COVID-19 vertical transmission and the compatibility of breastfeeding in COVID-19 mother, the available recommendations from Health Care Organizations and main experts opinions, issued the following suggestions on breastfeeding during the COVID-19 pandemic, addressed both to mothers with and without diabetes. It should be considered that following suggestions may change in the future when more evidence is acquired regarding SARS-Cov2 infection.


COVID-19: health literacy is an underestimated problem


Six tips for data sharing in the age of the coronavirus


Urticaria in a patient with COVID-19: Therapeutic and diagnostic difficulties


The starting line for COVID-19 vaccine development


title: Occurrence of brucellosis, leptospirosis and neosporosis in cows with retained placenta in Southwest Paraná, Brazil/ Ocorrência de brucelose, leptospirose e neosporose em vacas com retenção de placenta no Sudoeste do Paraná, Brasil

text: The aim of this study was to measure the occurrence of brucellosis, leptospirosis and neosporosis in cows from 25 family farms milk, with semi-intensive grazing system, located in the Southwest region of Paraná, Brazil. Eighty-four cows with retained placenta, between July 2013 to July 2014, diagnosed by the presence of fetal membranes in the uterus up to 12 hours after partum, decrease of appetite and of milk production, as well increase of rectal temperature were included into the study. The animals were submitted to blood collection for evaluating the seropositivity for brucellosis, leptospirosis and neosporosis. The blood was collected at 15 to 45 days postpartum, avoiding false negative results due to immune deficiency observed in the transition period. After collection, the blood was centrifuged, the serum was packed in three aliquots, identified and subsequently frozen. Serology was performed to diagnose brucellosis (technique of buffered acidified antigen), leptospirosis (through the microscopic agglutination test - MAT) and neosporosis (indirect immunofluorescence test). Animals were considered positive when presenting titer >1:100 (leptospirosis) and 1:200 (neosporosis). No animal with placenta retention presented Brucella abortus bacteria; 39% (33/84) were reactive to one or more Leptospira serovars, 15% (13/84) were positive to Neospora caninum, and 4% (4/84) had both diagnosis, being reactive for leptospirosis and neosporosis. In conclusion, data from this experiment inspires greater attention to leptospirosis and neosporosis in dairy cattle presenting placenta retention in southwest Paraná.(AU)


title: Contact surface of Cheeger sets

text: We carry on an analysis of the size of the contact surface of a Cheeger set $E$ with the boundary of its ambient space $\Omega$. We show that this size is strongly related to the regularity of $\partial \Omega$ by providing bounds on the Hausdorff dimension of $\partial E\cap \partial\Omega$. In particular we show that, if $\partial \Omega$ has $C^{1,\alpha}$ regularity then $\mathcal{H}^{d-2+\alpha}(\partial E\cap \partial\Omega)>0$. This shows that a sufficient condition to ensure that $\mathcal{H}^{d-1}(\partial E\cap \partial \Omega)>0$ is that $\partial \Omega$ has $C^{1,1}$ regularity. Since the Hausdorff bounds can be inferred in dependence of the regularity of $\partial E$ as well, we obtain that $\Omega$ convex, which yields $\partial E\in C^{1,1}$, is also a sufficient condition. Finally, we construct examples showing that such bounds are optimal in dimension $d=2$.


title: Sociodemographic, clinical and laboratory factors on admission associated with COVID-19 mortality in hospitalized patients: A retrospective observational study

text: BACKGROUND: To identify and quantify associations between baseline characteristics on hospital admission and mortality in patients with COVID-19 at a tertiary hospital in Spain. METHODS AND FINDINGS: This retrospective case series included 238 patients hospitalized for COVID-19 at Hospital Universitario Clínico San Cecilio (Granada, Spain) who were discharged or who died. Electronic medical records were reviewed to obtain information on sex, age, personal antecedents, clinical features, findings on physical examination, and laboratory results for each patient. Associations between mortality and baseline characteristics were estimated as hazard ratios (HR) calculated with Cox regression models. Series mortality was 25.6%. Among patients with dependence for basic activities of daily living, 78.7% died, and among patients residing in retirement homes, 80.8% died. The variables most clearly associated with a greater hazard of death were age (3% HR increase per 1-year increase in age; 95%CI 1-6), diabetes mellitus (HR 2.42, 95%CI 1.43-4.09), SatO2/FiO2 ratio (43% HR reduction per 1-point increase; 95%CI 23-57), SOFA score (19% HR increase per 1-point increase, 95%CI 5-34) and CURB-65 score (76% HR increase per 1-point increase, 95%CI 23-143). CONCLUSIONS: The patients residing in retirement homes showed great vulnerability. The main baseline factors that were independently associated with mortality in patients hospitalized for COVID-19 were older age, diabetes mellitus, low SatO2/FiO2 ratio, and high SOFA and CURB-65 scores.


Integrated Radiologic Algorithm for COVID-19 Pandemic


title: Potential therapeutic targets and promising drugs for combating SARS-CoV-2

text: As of April 9, 2020, a novel coronavirus (SARS-CoV-2) had caused 89,931 deaths and 1,503,900 confirmed cases worldwide, which indicates an increasingly severe and uncontrollable situation. Initially, little was known about the virus. As research continues, we now know the genome structure, epidemiological and clinical characteristics, and pathogenic mechanisms of SARS-CoV-2. Based on this knowledge, potential targets involved in the processes of virus pathogenesis need to be identified, and the discovery or development of drugs based on these potential targets is the most pressing need. Here, we have summarized the potential therapeutic targets involved in virus pathogenesis and discuss the advances, possibilities, and significance of drugs based on these targets for treating SARS-CoV-2. This review will facilitate the identification of potential targets and provide clues for drug development that can be translated into clinical applications for combating SARS-CoV-2.


title: Telemedicine During the COVID-19 Pandemic: A Pediatric Otolaryngology Perspective

text: The COVID-19 pandemic has created a situation unparalleled in our lifetime. As the medical community has attempted to navigate a sea of ever-changing information and policies, this uncertainty has instead bred creativity, community, and evolution. Necessity is the mother of invention, and one of the by-products of our rapidly changing environment is the increased reliance on telemedicine. Here, we discuss our experience with incorporating telemedicine into an urban academic pediatric otolaryngology practice, the challenges that we have encountered, and the principles unique to this population.


The higher temperature and ultraviolet, the lower COVID-19 prevalence-meta-regression of data from large US cities


title: Congenital cardiac interventions during the peak phase of COVID-19 pandemics in the country in a pandemics hospital in Istanbul

text: INTRODUCTION: In this report, we aim to present our algorithm and results of patients with congenital cardiac disorders who underwent surgical or interventional procedures during the peak phase of the pandemics in our country. PATIENTS AND METHODS: The first COVID-19 case was diagnosed in Turkey on 11 March, 2020, and the peak phase seemed to end by the end of April. All the patients whom were referred, treated, or previously operated but still at the hospital during the peak phase of COVID-19 pandemics in the country were included into this retrospective study. Patient's diagnosis, interventions, adverse events, and early post-procedural courses were studied. RESULTS: Thirty-one patients with various diagnoses of congenital cardiovascular disorders were retrospectively reviewed. Ages of the patients ranged between 2 days and 16 years. Seventeen cases were males and 14 cases were females. Elective cases were postponed. Priority was given to interventional procedures, and five cases were treated percutaneously. Palliative procedures were preferred in patients whom presumably would require long hospital stay. Corrective procedures were not hesitated in prioritised stable patients. Mortality occurred in one patient. Eight patients out of 151 ICU admissions were diagnosed with COVID-19, and they were transferred to COVID-19 ICU immediately. Three nurses whom also took care of the paediatric cases became infected with SARS-CoV-2; however, the children did not catch the disease. CONCLUSION: Mandatory and emergent congenital cardiac percutaneous and surgical procedures may be performed with similar postoperative risks as there are no pandemics with meticulous care and preventive measures.


title: Potential effective treatment for COVID-19: systematic review and meta-analysis of the severe infectious disease with convalescent plasma therapy

text: BACKGROUND: Convalescent plasma (CP) has been used successfully to treat many types of infectious diseases, and it has shown initial effects in the treatment of the emerging 2019 coronavirus disease (COVID-19). However, its curative effect and feasibility have yet to be confirmed by formal evaluation and well-designed clinical trials. To explore the effectiveness of treatment and predict the potential effect of CP for COVID-19, studies of different types of infectious diseases treated with CP were included in this systematic review and meta-analysis. METHODS: Related studies were obtained from databases and screened based on the inclusion criteria. The data quality was assessed, and the data were extracted and pooled for analysis. RESULTS: We included 40 studies on CP treatment for infectious diseases We found that CP treatment could reduce the risk of mortality with a low incidence of adverse events, promote the production of antibodies, show the decline in viral load, and shorten the disease course. A meta-analysis of 15 controlled studies showed that there was a significantly lower mortality rate in the group treated with CP (pooled OR = 0.32, 95% CI: 0.19-0.52, P < 0.001, I2 = 54%) than in the control groups. Studies were mostly of low or very low quality with a moderate or high risk of bias. The sources of clinical and methodological heterogeneity were identified. The exclusion of heterogeneity indicated that the results were stable. CONCLUSIONS: CP therapy has some curative effect and is well tolerated to treat infectious diseases. It is a potentially effective treatment for COVID-19.


title: Sex differences in the frequency of gastrointestinal symptoms and olfactory or taste disorders in 1942 nonhospitalized patients with coronavirus disease 2019 (COVID-19)

text: INTRODUCTION: The coronavirus disease 2019 (COVID 19) is a communicable disease caused by a novel coronavirus. OBJECTIVES: This study aimed to assess selfreported frequency of gastrointestinal symptoms and olfactory or taste disorders in nonhospitalized patients with COVID19 in Poland. PATIENTS AND METHODS: This crosssectional survey was conducted between April 17 and 18, 2020, in 4516 nonhospitalized patients with COVID19 in Poland. The questionnaire included 8 questions related to the health status, symptoms of COVID19, comorbidities, and smoking status. RESULTS: Completed questionnaires were obtained from 1942 patients with COVID19 with a response rate of 43%. The median age of the respondents was 50 years; 60.2% were women. Among nonhospitalized patients with COVID19, 21.3% had hypertension, 4.5% had diabetes, and 3.1% had a chronic respiratory disease. Regular tobacco use was declared by 11.2% of patients with COVID19. At least one gastrointestinal symptom was reported by 53.6% of patients. Almost half of patients (47%) with COVID19 reported lack of appetite and 24.2% reported diarrhea. Among 1942 interviewed patients, 54.2% reported at least 1 olfactory or taste disorder and 42.5% reported both alterations. Selfreported olfactory and taste disorders were 49.2% and 47.5%, respectively. Selfreported frequency of gastrointestinal symptoms and olfactory or taste disorders during COVID19 was significantly higher (P <0.001) in women than men. CONCLUSIONS: This study demonstrated that olfactory and taste disorders are frequent symptoms in patients with mildtomoderate COVID19. Moreover, our study indicated sex differences in the frequency of gastrointestinal symptoms and olfactory or taste disorders among nonhospitalized patients with COVID19.


title: Initial experiences from patients with COVID-19 on ventilatory support in Denmark

text: INTRODUCTION: The coronavirus disease 2019 (COVID-19)pandemic reached Denmark in early 2020. This paper presents initial intensive-care unit (ICU) experiences with COVID-19 patients at Roskilde Hospital, which was the primary recipient of COVID-19 patients in need of intensive care in the Zealand Region, Denmark. METHODS: An evaluation was conducted of the COVID-19 patients admitted to the ICU due to respiratory failure from 11 March 2020 to 01 April 2020. The number of ICU beds was increased from eight to 22 beds during this period. RESULTS: Sixteen patients (four women) were evaluated. The median age was 69.5 years (range: 56-84 years). All the patients were admitted to the ICU for hypoxemic respiratory failure and all needed mechanical ventilation by orotracheal intubation. By 16 April, six patients were still admitted to the ICU, four patients had been discharged from the ICU and seven had died. At present, the average length of ICU stay is 14 ± 9 days (mean ± standard deviation). One patient has remained on ventilatory support for 31 days. The evaluation revealed four key themes. COVID-19 patients 1) had greatly increased C-reactive protein levels, 2) needed a significant inspiratory O2fraction, 3) were highly positive end-expiratory pressure (PEEP) dependent on ventilatory support and 4) suffered highly fluctuating respiratory failure requiring ventilatory support for a significantly longer period of time than non-COVID-19 patients. CONCLUSIONS: COVID-19 patients have characteristic reproducible laboratory findings and present a major challenge due to their illness severity and required treatment length. FUNDING: none. TRIAL REGISTRATION: not relevant.


The old-style public health measures and the novel coronavirus outbreak


Anestesiologia pediátrica e o paradoxo da COVID-19: opinião do Comitê de Anestesia em Pediatria da Sociedade Brasileira de Anestesiologia./ [The paradox of COVID-19 and pediatric anesthesiology: opinion of the Pediatric Anesthesia Committee of the Brazilian Society of Anesthesiology]


In Response: Pediatric Airway Management in COVID-19 patients - Consensus Guidelines from the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society


title: Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society

text: The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.


Is telepsychiatry care a realistic option for community mental health services during the COVID-19 pandemic?


Strategies for patient with cancer during COVID-19 pandemic


title: The trauma and acute care surgeon in the COVID-19 pandemic era

text: The World Health Organization recognized in March 2020 the existence of a pandemic for the new coronavirus that appeared in China, in late 2019, and whose disease was named COVID-19. In this context, the SBAIT (Brazilian Society of Integrated Care for Traumatized Patients) conducted a survey with 219 trauma and emergency surgeons regarding the availability of personal protective equipment (PPE) and the role of the surgeon in this pandemic by means of an electronic survey. It was observed that surgeons have been acting under inadequate conditions, with a lack of basic supplies as well as more specific equipment such as N95 masks and facial shields for the care of potential victims who may be contaminated. The latter increases the risk of contamination of professionals, resulting in potential losses in the working teams. Immediate measures must be taken to guarantee access to safety equipment throughout the country, since all trauma victims and/or patients with emergency surgical conditions must be treated as potential carriers of COVID-19.


title: Public Health Interventions to Mitigate Early Spread of SARS-CoV-2 in Poland

text: This study aimed (1) to present public health interventions to mitigate the early spread of SARS-CoV-2 implemented in Poland between January 9 and March 29, 2020, and (2) to analyze the potential impact of these regulations on the early phase of the COVID-19 outbreak in Poland. All legal regulations published in the Journal of Laws between January 9 and March 29, 2020, were analyzed. Out of 406 legal regulations identified, 56 were related to the COVID-19 outbreak. Moreover, the official announcements published on the governmental websites dedicated to the coronavirus and health issues were analyzed. On March 4, Poland reported the first laboratory-confirmed COVID-19 case. On March 9, Poland introduced border sanitary control. Six days after the first laboratory-confirmed COVID-19 case, all mass events in Poland were banned. All schools and universities were closed 8 days after the first COVID-19 case. All gastronomic facilities and sport and entertainment services were limited starting on March 14. Eleven days after the first COVID-19 case, controls at all Polish borders were introduced, and a ban on entry into Poland by foreigners (with some exemptions) was implemented. Starting on March 15, all citizens returning from abroad had to undergo compulsory 14 days self-quarantine. On March 20, a state of epidemic was announced, which resulted in new social distancing measures starting on March 25. In Poland, compared to other European countries, far-reaching solutions were implemented relatively early to reduce the spread of infection.


title: Clinical characteristics of novel coronavirus pneumonia in organ transplant recipients and management strategy during the epidemic (1st edition)/ 器官移植

text: In December 2019, a number of cases of pneumonia with unknown causes were successively reported in multiple hospitals in Wuhan City, Hubei Province, China. The pathogen is a novel coronavirus, which can lead to novel coronavirus pneumonia (COVID-19) and even threaten the patients' lives. In the following, the COVID-19 epidemic is spreading rapidly in many provinces and cities. It is particularly important to summarize and analyze the clinical characteristics of COVID-19 in solid organ transplantation (SOT) recipients and to optimize the prevention, early diagnosis and treatment strategies. Therefore, we organized Chinese experts in the field of organ transplantation to draft this article according to the characteristics of lung infection of SOT recipients and the characteristics of current COVID-19 by referring to relevant guidelines and specifications at home and abroad, aiming to provide reference for transplant physicians in China. This management strategy will be revised at any time with the deepening understanding of the COVID-19 infection.


[Airborne spreading for patients suffering severe coronavirus disease-2019 with different oxygen therapies]


title: [Farmakoterápiás lehetoségek SARS-CoV-2-fertozés/COVID19-betegség esetén]/ Pharmacological options in treating SASR-CoV-2 infection/COVID-19

text: There is currently no proven effective therapy for COVID-19. Here we discuss the drugs most investigated for the treatment of the disease. All the listed therapies are experimental at this stage. However, due to the severe healthcare effects of the pandemic and the potentially fatal outcome of COVID-19 patients treated in the intensive care units, their off-label use should none-the-less be considered. Orv Hetil. 2020; 161(17): 685688.


title: COVID-19 impact assessment on the French radiological centers: a nationwide survey

text: PURPOSE: To determine the impact of the COVID-19 on the CT activities in French radiological centers during the epidemic peak. MATERIALS AND METHODS: A cross-sectional prospective CT scan survey was conducted between March 16 and April 12, 2020, in accordance with the local IRB. Seven hundred nine radiology centers were invited to participate in a weekly online survey. Numbers of CT examinations related to COVID-19 including at least chest (CTcovid) and whole chest CT scan activities (CTchest) were recorded each week. A sub-analysis on French departments was performed during the 4 weeks of the study. The impact of the number of RT-PCRs (reverse transcriptase polymerase chain reactions) on the CT workflow was tested using two-sample t test and Pearson's test. RESULTS: Five hundred seventy-seven structures finally registered (78%) with mean response numbers of 336 ± 18.9 (323; 351). Mean CTchest activity per radiologic structure ranged from 75.8 ± 133 (0-1444) on week 12 to 99.3 ± 138.6 (0-1147) on week 13. Mean ratio of CTcovid on CTchest varied from 0.36 to 0.59 on week 12 and week 14 respectively. There was a significant relationship between the number of RT-PCR performed and the number of CTcovid (r = 0.73, p = 3.10-16) but no link with the number of positive RT-PCR results. CONCLUSION: In case of local high density COVID-19, CT workflow is strongly modified and redirected to the management of these specific patients. KEY POINTS: â¢ Over the 4-week survey period, 117,686 chest CT (CT total ) were performed among the responding centers, including 61,784 (52%) CT performed for COVID-19 (CT covid ). â¢ Across the country, the ratio CT covid /CT total varied from 0.36 to 0.59 and depended significantly on the local epidemic density (p = 0.003). â¢ In clinical practice, in a context of growing epidemic, in France, chest CT was used as a surrogate to RT-PCR for patient triage.


COVID-19 (Coronavirus Disease 2019): Opportunities and Challenges for Digital Health and the Internet of Medical Things in China


title: Short-Term Effects of Mitigation Measures for the Containment of the COVID-19 Outbreak: An Experience From Northern Italy

text: We evaluated the short-term effects of mitigation measures imposed by the Italian government on the first 10 municipalities affected by Sars-Cov-2 spread. Our results suggest that the effects of containment measures can be appreciated in about approximately 2 wk.


Endothelial progenitor cells and mesenchymal stem cells to overcome vascular deterioration and cytokine storm in critical patients with COVID-19


title: New Normal Terminology

text: The COVID-19 pandemic has required us to recognize a new normal and other additions to our general and clinical vocabulary. Some were preexisting terms that now have been broadened or changed during these unprecedented times. Others have helped to bring to light some of the issues or difficulties that healthcare professionals faced prior to this pandemic.


title: Epidemic analysis of COVID-19 in China by dynamical modeling

text: The outbreak of novel coronavirus-caused pneumonia (COVID-19) in Wuhan has attracted worldwide attention. Here, we propose a generalized SEIR model to analyze this epidemic. Based on the public data of National Health Commission of China from Jan. 20th to Feb. 9th, 2020, we reliably estimate key epidemic parameters and make predictions on the inflection point and possible ending time for 5 different regions. According to optimistic estimation, the epidemics in Beijing and Shanghai will end soon within two weeks, while for most part of China, including the majority of cities in Hubei province, the success of anti-epidemic will be no later than the middle of March. The situation in Wuhan is still very severe, at least based on public data until Feb. 15th. We expect it will end up at the beginning of April. Moreover, by inverse inference, we find the outbreak of COVID-19 in Mainland, Hubei province and Wuhan all can be dated back to the end of December 2019, and the doubling time is around two days at the early stage.


COVID-19: A critical care perspective informed by lessons learnt from other viral epidemics


title: Successful Anesthetic Management in Cesarean Section for Pregnant Woman with COVID-19

text: BACKGROUND The current COVID-19 pandemic highlights the importance of the mindful use of financial and human resources. Preventing infections and preserving resources and manpower are crucial in healthcare. It is important to ensure the ability of surgeons and specialized interventionalists to function through the pandemic. Until now, no justified protocol has been reported for the anesthetic management in cesarean section (CS). CASE REPORT A 29-year-old pregnant woman, G2P1 at 37+4 weeks of gestation, was referred to our center on March 28, 2020, after she had tested positive for COVID-19. She was stable and the CS was planned after she reached term. Through spinal anesthesia, CS was conducted. The anesthesia team was protected with full personal protection equipment. The operation was carried out smoothly without complication. A female neonate was delivered and was tested to be negative for COVID-19. No medical staff cross-infection was reported. CONCLUSIONS Special precautions should be considered when pregnant women are undergoing CS. Spinal anesthesia is preferred over general anesthesia.


Extraordinary emergency measures set up by a Breast Unit to prevent COVID-19: Report of our experience


Check-ins not check-ups


Co-infection of SARS-CoV-2 and Influenza virus in Early Stage of the COVID-19 Epidemic in Wuhan, China


title: Sense and Sensibility: Characterizing Social Media Users Regarding the Use of Controversial Terms for COVID-19

text: With the world-wide development of 2019 novel coronavirus, although WHO has officially announced the disease as COVID-19, one controversial term -"Chinese Virus"is still being used by a great number of people. In the meantime, global online media coverage about COVID-19-related racial attacks increases steadily, most of which are anti-Chinese or anti-Asian. As this pandemic becomes increasingly severe, more people start to talk about it on social media platforms such as Twitter. When they refer to COVID-19, there are mainly two ways: using controversial terms like"Chinese Virus"or"Wuhan Virus", or using non-controversial terms like"Coronavirus". In this study, we attempt to characterize the Twitter users who use controversial terms and those who use non-controversial terms. We use the Tweepy API to retrieve 17 million related tweets and the information of their authors. We find significant differences between these two groups of Twitter users across their demographics, user-level features like the number of followers, political following status, as well as their geo-locations. Moreover, we apply classification models to predict Twitter users who are more likely to use controversial terms. To our best knowledge, this is the first large-scale social media-based study to characterize users with respect to their usage of controversial terms during a major crisis.


title: Cross-Protection Induced by Encephalitis Vaccines against COVID-19 Might be a Reason for Relatively Lower Mortality Rate in Some Countries

text: COronaVIrus Disease 2019 (COVID-19) is an on-going pandemic attributed to a novel virus named SARS-CoV-2 Comparing the statistics of incidence and death rates between nations reveals that there is discrepancy amongst countries in these regards, even between countries that share borders We herein present information from the literature indicating how cross-protection against COVID-19 conferred by the encephalitis vaccine could be the reason for lower fatality rate in the countries where immunization against encephalitis is widespread or included in national programs This may pave the way for arriving at efficient prevention strategies as well as vaccine development


title: Oncology practice during COVID-19 pandemic: a fast response is the best response

text: The first confirmed case of coronavirus disease 2019 (COVID-19) in Brasil was reported on February 25th, 2020, and by April 3rd, 8076 were confirmed in the country. As COVID-19 disease incidence escalates in Brasil, management of cancer patients requires immediate action and oncology clinics are urged to establish a contingency plan. We have installed a COVID-19 Management Committee to elaborate and implement best practices to assist cancer outpatients as well as to provide a safe environment for clinical staff and other employees at the outpatient clinics. The challenges of cancer treatment in the midst of COVID-19 global pandemic highlight the importance of a rapid response by institutions, where organizational structure, strategic planning, agility in guidelines implementation and alternative ways to protect and support clinical staff, employees and patients may be the key to mitigate pandemic effects.


title: Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China

text: BACKGROUND: A novel coronavirus disease (COVID-19) in Wuhan has caused an outbreak and become a major public health issue in China and great concern from international community. Myocarditis and myocardial injury were suspected and may even be considered as one of the leading causes for death of COVID-19 patients. Therefore, we focused on the condition of the heart, and sought to provide firsthand evidence for whether myocarditis and myocardial injury were caused by COVID-19. METHODS: We enrolled patients with confirmed diagnosis of COVID-19 retrospectively and collected heart-related clinical data, mainly including cardiac imaging findings, laboratory results and clinical outcomes. Serial tests of cardiac markers were traced for the analysis of potential myocardial injury/myocarditis. RESULTS: 112 COVID-19 patients were enrolled in our study. There was evidence of myocardial injury in COVID-19 patients and 14 (12.5%) patients had presented abnormalities similar to myocarditis. Most of patients had normal levels of troponin at admission, that in 42 (37.5%) patients increased during hospitalization, especially in those that died. Troponin levels were significantly increased in the week preceding the death. 15 (13.4%) patients have presented signs of pulmonary hypertension. Typical signs of myocarditis were absent on echocardiography and electrocardiogram. CONCLUSIONS: The clinical evidence in our study suggested that myocardial injury is more likely related to systemic consequences rather than direct damage by the 2019 novel coronavirus. The elevation in cardiac markers was probably due to secondary and systemic consequences and can be considered as the warning sign for recent adverse clinical outcomes of the patients.


Impact of COVID-19 mitigation measures on patients with spine disease in Friuli Venezia Giulia


Effects of COVID-19 lockdown on chronic drug-resistant pain patients treated using brain stimulation approaches


Sleep Health transitions during a vulnerable time


[COVID-19. The only certainty is the uncertainty]


title: Videoconferences of Infectious Diseases: An educational tool that transcends borders. A useful tool also for the current COVID-19 pandemic

text: Not available.


title: COVID-19 and ethical preparedness?

text: Mankind has to prepare for a pandemic with respect to medical and practical aspects, but also with respect to ethical issues. There are various ethical guidelines for managing infectious disease outbreaks, but they do not apply to the specific aspects of the COVID-19 pandemic, since they were formulated after the different kinds of outbreaks of avian influenza and Ebola. Today we are confronted with completely new issues endangering our fundamental human rights. As COVID-19 is spreading all over the world, we are in a desperate situation to find treatment solutions; however, despite the urgency, scientific rules have to be applied as bad science is unethical since it might be harmful for patients. Fake news and alternative facts might not be easily recognized and are also threatening scientific values. Pandemics might be leading to a meltdown of the health system if no measures are being taken constraining fundamental human rights. Tracking of persons is violating human rights as well if not accepted on a voluntary basis. A failure to have safeguards for times of crisis leads to a scarcity of medicinal products and goods resulting in a nationalistic approach and ignorance of international solidarity. And last but not least selective measures and triage in intensive care have to be taught to young physicians and nursing staff in medical schools in order to be prepared in times of an infectious disease outbreak and scarcity of resources.


title: The clinical value of two combination regimens in the Management of Patients Suffering from Covid-19 pneumonia: a single centered, retrospective, observational study

text: BACKGROUND: There is no identified pharmacological therapy for COVID-19 patients, where potential therapeutic strategies are underway to determine effective therapy under such unprecedented pandemic. Therefore, combination therapies may have the potential of alleviating the patient's outcome. This study aimed at comparing the efficacy of two different combination regimens in improving outcomes of patients infected by novel coronavirus (COVID-19). METHODS: This is a single centered, retrospective, observational study of 60 laboratory-confirmed COVID-19 positive inpatients (≥18 years old) at two wards of the Baqiyatallah Hospital, Tehran, Iran. Patient's data including clinical and laboratory parameters were recorded. According to the drug regimen, the patients were divided into two groups; group I who received regimen I consisting azithromycin, prednisolone, naproxen, and lopinavir/ritonavir and group II who received regimen II including meropenem, levofloxacin, vancomycin, hydroxychloroquine, and oseltamivir. RESULTS: The oxygen saturation (SpO2) and temperature were positively changed in patients receiving regimen I compared to regimen II (P = 0.013 and P = 0.012, respectively). The serum level of C-reactive protein (CRP) changed positively in group I (P < 0.001). Although there was a significant difference in platelets between both groups (75.44 vs 51.62, P < 0.001), their change did not clinically differ between two groups. The findings indicated a significant difference of the average length of stay in hospitals (ALOS) between two groups, where the patients under regimen I showed a shorter ALOS (6.97 vs 9.93, P = 0.001). CONCLUSION: This study revealed the beneficial effect of the short-term use of low-dose prednisolone in combination with azithromycin, naproxen and lopinavir/ritonavir (regimen I), in decreasing ALOS compared to regimen II. Since there is still lack of evidence for safety of this regimen, further investigation in our ongoing follow-up to deal with COVID-19 pneumonia is underway. Graphical abstract.


Thinking Beyond the Box: Preparing for the End of COVID-19 Outbreak in a Vascular Surgery Department


title: Genomic epidemiology, evolution, and transmission dynamics of porcine deltacoronavirus

text: The emergence of severe acute respiratory syndrome virus (SARS)-CoV-2 has shown once again that coronaviruses (CoVs) in animals are potential sources for epidemics in humans. Porcine deltacoronavirus (PDCoV) is an emerging enteropathogen of swine with a worldwide distribution. Here, we implemented and described an approach to analyze the epidemiology of PDCoV following its emergence in the pig population. We performed an integrated analysis of full genome sequence data from 21 newly-sequenced viruses, along with comprehensive epidemiological surveillance data collected globally over the last 15 years. We found four distinct phylogenetic lineages of PDCoV, which differ in their geographic circulation patterns. Interestingly, we identified more frequent intra- and inter-lineage recombination and higher virus genetic diversity in the Chinese lineages compared with the US lineage where pigs are raised in different farming systems and ecological environments. Most recombination breakpoints are located in the ORF1ab gene rather than in genes encoding structural proteins. We also identified five amino acids under positive selection in the spike protein suggesting a role for adaptive evolution. According to structural mapping, three positively selected sites are located in the N-terminal domain of the S1 subunit, which is the most likely involved in binding to a carbohydrate receptor, while the other two are located in or near the fusion peptide of the S2 subunit and thus might affect membrane fusion. Finally, our phylogeographic investigations highlighted notable South-North transmission as well as frequent long-distance dispersal events in China that could implicate human-mediated transmission. Our findings provide new insights into the evolution and dispersal of PDCoV that contribute to our understanding of the critical factors involved in coronaviruses emergence. SIGNIFICANCE: Coronaviruses (CoVs) exhibit a pronounced propensity for interspecies transmission as illustrated by important emerging viruses in humans such as severe acute respiratory syndrome virus (SARS)-CoV and Middle East respiratory syndrome virus (MERS)-CoV, as well as the recent SARS-CoV-2 that is causing a major human pandemic. A better understanding of the evolutionary process leading to viral emergence may help unravel the principles of cross-species transmission and therefore assist in preventing future introductions into new host populations. Here, we examined the evolution and spread of an emerging coronavirus that likely transmitted from birds to pigs and caused sustained epidemics in Asia and the United States. We integrated viral full genome sequence analysis and comprehensive surveillance data to examine the evolution of emerging porcine deltacoronavirus (PDCoV), and in particular the factors driving ongoing circulation and recent cases in China. We found evidence for adaptive evolution of this emerging virus in the absence of vaccine immune pressure, with important amino acids under positive selection, as well as frequent inter- and intra-lineage recombination events in the Asian lineages. Breeding patterns and ecological environment could play an important role in swine coronavirus evolution, leading to differences in recombination and population diversity. Using phylogeographic approaches, we further shed light on the dispersal history and dynamics of the China lineage of PDCoV. Our study provides a deeper understanding of the geographic dispersal of genetic lineages of PDCoV in China and suggests that southern China acted as a source of transmission. Modeling how the virus spread in China will allow the prioritization of areas for swine coronavirus surveillance in the future. These findings have important implications for preventing the emergence of coronaviruses in livestock and for controlling their spread in Asian countries.


title: Modeling of the Transmission of Coronaviruses, Measles Virus, Influenza Virus, Mycobacterium tuberculosis, and Legionella pneumophila in Dental Clinics

text: Dental health care workers are in close contact to their patients and are therefore at higher risk for contracting airborne infectious diseases. The transmission rates of airborne pathogens from patient to dental health care workers are unknown. With the outbreaks of infectious diseases, such as seasonal influenza, occasional outbreaks of measles and tuberculosis, and the current pandemic of the coronavirus disease COVID-19, it is important to estimate the risks for dental health care workers. Therefore, the transmission probability of these airborne infectious diseases was estimated via mathematical modeling. The transmission probability was modeled for Mycobacterium tuberculosis, Legionella pneumophila, measles virus, influenza virus, and coronaviruses per a modified version of the Wells-Riley equation. This equation incorporated the indoor air quality by using carbon dioxide as a proxy and added the respiratory protection rate from medical face masks and N95 respirators. Scenario-specific analyses, uncertainty analyses, and sensitivity analyses were run to produce probability rates. A high transmission probability was characterized by high patient infectiousness, the absence of respiratory protection, and poor indoor air quality. The highest transmission probabilities were estimated for measles virus (100%), coronaviruses (99.4%), influenza virus (89.4%), and M. tuberculosis (84.0%). The low-risk scenario leads to transmission probabilities of 4.5% for measles virus and 0% for the other pathogens. From the sensitivity analysis, it shows that the transmission probability is strongly driven by indoor air quality, followed by patient infectiousness, and the least by respiratory protection from medical face mask use. Airborne infection transmission of pathogens such as measles virus and coronaviruses is likely to occur in the dental practice. The risk magnitude, however, is highly dependent on specific conditions in each dental clinic. Improved indoor air quality by ventilation, which reduces carbon dioxide, is the most important factor that will either strongly increase or decrease the probability of the transmission of a pathogen.


title: Accelerated Graduation and the Deployment of New Physicians During the COVID-19 Pandemic

text: The COVID-19 pandemic has presented unprecedented challenges and opportunities for medical schools in the United States. In this Invited Commentary, the authors describe a unique collaboration between the University of Massachusetts Medical School (UMMS), the only public medical school in the state; the University of Massachusetts Memorial Medical Center (UMMMC); and the Commonwealth of Massachusetts. Through this partnership, UMMS was able to graduate fourth-year medical students 2 months early and deploy them to UMMMC to care for patients and alleviate workforce shortages during the COVID-19 surge, which peaked in Massachusetts in April 2020. The authors describe how they determined if students had fulfilled graduation requirements to graduate early, what commencement and the accompanying awards ceremony looked like this year as virtual events, the special emergency 90-day limited license these new graduates were given to practice at UMMMC during this time, and the impact these new physicians had in the hospital allowing residents and attendings to be redeployed to care for COVID-19 patients.


title: Autonomic function testing in the COVID-19 pandemic: an American Autonomic Society position statement

text: COVID-19 is a global pandemic that is wreaking havoc with the health and economy of much of human civilization. In this document from the American Autonomic Society, we identify the potential risks of exposure to patients, physicians, and allied healthcare staff. We provide guidance for conducting autonomic function testing safely in this environment.


Commentary: Restructuring residency training in ophthalmology during COVID-19 era: Challenges and opportunities


title: Anger makes fake news viral online

text: Fake news that manipulates political elections, strikes financial systems and even incites riots is more viral than real news online, resulting in unstable societies and buffeted democracy. The easier contagion of fake news online can be causally explained by the greater anger it carries. Offline questionnaires reveal that anger leads to more incentivized audiences in terms of anxiety management and information sharing and accordingly makes fake news more contagious than real news online. Our results suggest that the digital contagion of emotions, in particular anger, should be comprehensively considered in profiling the spread of online information. Cures such as tagging anger in social media could be implemented to slow or prevent the contagion of fake news at the source.


Fatal SARS-CoV-2 coinfection in course of EBV-associated lymphoproliferative disease


title: COVID-19 Pandemic and Impending Global Mental Health Implications

text: The increase in organisms transference and infectious pandemics across the globe have been accelerated by an increase in travel, international exchange and global changes in earth's climate. COVID-19, a virus caused by the novel coronavirus that was initially identified on December 2019, in Wuhan city of China is currently affecting 146 territories, states and countries raising distress, panic and increasing anxiety in individuals exposed to the (actual or supposed) peril of the virus across the globe. Fundamentally, these concerns ascend with all infections, including those of flu and other agents, and the same worldwide safeguards are compulsory and suggested for protection and the prevention of further diffusion. However, media has underlined COVID-19 as rather an exclusive threat, which has added to panic and stress in masses which can lead to several mental health issues like anxiety, obsessive compulsive disorder and post-traumatic stress disorder which should be contained immediately in its initial phases.


Commentary: The double responsibility of the thoracic surgeon at the time of the pandemic: A perspective from the North of Italy


title: Likelihood of achieving a 50%, 60%, or 70% estimated live birth rate threshold with 1 or 2 cycles of planned oocyte cryopreservation

text: PURPOSE: To characterize the likelihood of cryopreserving enough oocytes for 50%, 60%, or 70% estimated live birth rate (eLBR) with 1-2 planned oocyte cryopreservation (Pl-OC) cycles. METHODS: We performed a retrospective cohort study utilizing all patients completing ≥ 1 Pl-OC cycle from 2016 to 2018 at a large single-center OC program. Subjects were categorized by age at retrieval and number of cycles. We extrapolated age-based oocyte thresholds for 50%, 60%, or 70% eLBR from previously published data. We calculated the proportion of subjects overall, and for each age group, whose number of frozen oocytes was greater than or equal to their age-based threshold for a 50%, 60%, or 70% eLBR after 1 and 2 cycles. OR for 60% eLBR with one cycle was calculated for age and AMH cutoff values and corroborated with logistic regression. RESULTS: A total of 1241 subjects, completing 1799 Pl-OC cycles, were included. With one cycle, 66% (819/1241) achieved ≥ 50% eLBR and 51% (634/1241) achieved 70% eLBR. With two cycles, 79.6% (988/1241) attained ≥ 50% eLBR and 65.5% (813/1241) achieved 70% eLBR. Achieving 50%, 60%, or 70% eLBR with 1-2 cycles was significantly associated with both age (p < 0.001) and AMH (p < 0.001). Age < 37.5 and AMH > 1.995 were independently associated with attaining 60% eLBR with one cycle (age: OR 13.73; 95%CI 9.16-20.57, p < 0.001; AMH: OR 7.32; 95% CI 5.50-9.76, p < 0.001). CONCLUSIONS: Younger age and higher AMH were associated with achieving 50%, 60%, or 70% eLBR thresholds with Pl-OC. Nevertheless, almost all subjects were successfully able to preserve enough oocytes for ≥ 50% eLBR in 1-2 cycles.


title: Mango By-Products As Natural Source of Valuable Odor-Active Compounds

text: BACKGROUND: In order to seek natural and cheap sources of odor-active compounds, the aromatic potential of mango by-products was evaluated. A chemical characterization of volatile compounds of mango peel and seed were performed in comparison with mango pulp by HS-SPME/GC-MS. RESULTS: More than 60 volatile compounds were detected in mango by-products whose aromatic activity was estimated by means of odorant activity values (OAVs). Results pointed out mango peel as a valuable matrix on odor-active compounds which were found even in larger quantities than in edible mango fraction. 3-Carene was the predominant compound although other compounds such as decanal, 1-octen-3-one, nonanal, limonene, ß-damascenone and 2-nonenal were the most odor-active compounds in mango peel. The greatest aromatic impact with sensorial features described as fresh/herbaceous, fruity, floral and resinous was found in peel mango. CONCLUSION: The exceptional flavoring potential of mango peel by-product opens a door for its use and revalorization as natural flavoring ingredient in food and cosmetic industries. This article is protected by copyright. All rights reserved.


Together/Apart During Coronavirus Disease 2019 (COVID-19): Inclusion in the Time of Social Distancing


Together-Apart During Coronavirus Disease 2019 (COVID-19): Inclusion in the Time of Social Distancing


Digital prosthetic workflow during COVID-19 pandemic to limit infection risk in dental practice


COVID-19 research in Africa


title: Virtual screening, ADME/T, and binding free energy analysis of anti-viral, anti-protease, and anti-infectious compounds against NSP10/NSP16 methyltransferase and main protease of SARS CoV-2

text: Recently, a pathogen has been identified as a novel coronavirus (SARS-CoV-2) and found to trigger novel pneumonia (COVID-19) in human beings and some other mammals. The uncontrolled release of cytokines is seen from the primary stages of symptoms to last acute respiratory distress syndrome (ARDS). Thus, it is necessary to find out safe and effective drugs against this deadly coronavirus as soon as possible. Here, we downloaded the three-dimensional model of NSP10/NSP16 methyltransferase (PDB-ID: 6w6l) and main protease (PDB-ID: 6lu7) of COVID-19. Using these molecular models, we performed virtual screening with our anti-viral, inti-infectious, and anti-protease compounds, which are attractive therapeutics to prevent infection of the COVID-19. We found that top screened compound binds with protein molecules with good dock score with the help of hydrophobic interactions and hydrogen bonding. We observed that protease complexed with Cyclocytidine hydrochloride (anti-viral and anti-cancer), Trifluridine (anti-viral), Adonitol, and Meropenem (anti-bacterial), and Penciclovir (anti-viral) bound with a good docking score ranging from -6.8 to -5.1 (Kcal/mol). Further, NSP10/NSP16 methyltransferase complexed with Telbivudine, Oxytetracycline dihydrate (anti-viral), Methylgallate (anti-malarial), 2-deoxyglucose and Daphnetin (anti-cancer) from the docking score of -7.0 to -5.7 (Kcal/mol). In conclusion, the selected compounds may be used as a novel therapeutic agent to combat this deadly pandemic disease, SARS-CoV-2 infection, but needs further experimental research.HighlightsNSP10/NSP16 methyltransferase and main protease complex of SARS CoV-2 bind with selected drugs.NSP10/NSP16 methyltransferase and protease interacted with drugs by hydrophobic interactions.Compounds show good DG binging free energy with protein complexes.Ligands were found to follow the Lipinski rule of five.


title: Allergic respiratory disease care in the COVID-19 era: a EUFOREA statement

text: Spring and Summer 2020 are unique in that the challenges of care for those suffering from pollen allergy coincide with the COVID-19 pandemic. Several considerations are important to allow optimal care of allergic rhinitis (AR) and asthma and hence prevention of coronavirus spread through sneezing, rhinorrhoea and coughing. This compact overview of recommendations by the EUFOREA expert teams on allergic airway diseases and AIT is based on investigation of the current COVID-19 literature in association with the key words above and shared clinical experience of the experts involved. It deals with similarities and differences between AR and coronavirus infection, specific recommendations for allergic disease care in the COVID-19 era, including guidance on allergen specific immunotherapy, AIT.


title: Go viral or go broadcast? Characterizing the virality and growth of cascades

text: Quantifying the virality of cascades is an important question across disciplines such as the transmission of disease, the spread of information and the diffusion of innovations. An appropriate virality metric should be able to disambiguate between a shallow, broadcast-like diffusion process and a deep, multi-generational branching process. Although several valuable works have been dedicated to this field, most of them fail to take the position of the diffusion source into consideration, which makes them fall into the trap of graph isomorphism and would result in imprecise estimation of cascade virality inevitably under certain circumstances. In this paper, we propose a root-aware approach to quantify the virality of cascades with proper consideration of the root node in a diffusion tree. With applications on synthetic and empirical cascades, we show the property and potential utility of the proposed virality measure. Based on preferential attachment mechanism, we further introduce a model to mimic the growth of cascades. The proposed model enables the interpolation between broadcast and viral spreading during the growth of cascades. Through numerical simulations, we show the effectiveness of the proposed model in characterizing the virality of growing cascades. Our work contributes to the scientific understanding of cascade virality and growth, and could offer practical implications in a range of policy domains including viral marketing, infectious disease and information diffusion.


Covid-19 infection in therapy-naive patients with B-cell chronic lymphocytic leukemia


title: Nipah@20: Lessons Learned from Another Virus with Pandemic Potential

text: Nipah disease is listed as one of the WHO priority diseases that pose the greatest public health risk due to their epidemic potential. More than 200 experts from around the world convened in Singapore last year to mark the 20th anniversary of the first Nipah virus outbreaks in Malaysia and Singapore. Most of these experts are now involved in responding to the coronavirus disease 2019 (COVID-19) pandemic. Here, members of the Organizing Committee of the 2019 Nipah Virus International Conference review highlights from the Nipah@20 Conference and reflect on key lessons learned from Nipah that could be applied to the understanding of the COVID-19 pandemic and to preparedness against future emerging infectious diseases (EIDs) of pandemic potential.


COVID-19: switching to remote neurology outpatient consultations


Improvement of SARS-CoV-2 symptoms following Guselkumab injection in a psoriatic patient


Covid-19: Doctors should not face investigation for refusing to see patients over lack of PPE, says indemnifier


Neurosurgery at the time of COVID-19: how this pandemic infectious disease is influencing neurosurgical activities and patient management


title: The COVID-19 pandemic: growth patterns, power law scaling, and saturation

text: More and more countries show a significant slowdown in the number of new COVID-19 infections due to effective governmentally instituted lockdown and social distancing measures. We have analyzed the growth behavior of the top 25 most affected countries by means of a local slope analysis and found three distinct patterns that individual countries follow depending on the strictness of the lockdown protocols: rise and fall, power law, or logistic. For countries showing power law growth we have determined the scaling exponents. For countries that showed a strong slowdown in the rate of infections we have extrapolated the expected saturation of the total number of infections and the expected final date. Three different extrapolation methods (logistic, parabolic, and cutoff power law) were used. All methods agree on the order of magnitude of saturation and end dates. Global infection rates are analyzed with the same methods. The relevance and accuracy of these extrapolations is discussed.


text: More and more countries show a significant slowdown in the number of new COVID-19 infections due to effective governmentally instituted lockdown and social distancing measures. We have analyzed the growth behavior of the top 25 most affected countries by means of a local slope analysis and found three distinct patterns that individual countries follow depending on the strictness of the lockdown protocols: exponential rise and fall, power law, or logistic. For countries showing power law growth we have determined the scaling exponents. For countries that showed a strong slowdown in the rate of infections we have extrapolated the expected saturation of the number of infections and the expected final date. Two different extrapolation methods (logistic and parabolic) were used. Both methods agree on the order of magnitude of saturation and end dates. Global infections rates are analyzed with the same methods. The relevance and accuracy of these extrapolations is discussed.


title: Limited Early Warnings and Public Attention to Coronavirus Disease 2019 in China, January-February, 2020: A Longitudinal Cohort of Randomly Sampled Weibo Users

text: OBJECTIVE: Awareness and attentiveness have implications for the acceptance and adoption of disease prevention and control measures. Social media posts provide a record of the public's attention to an outbreak. To measure the attention of Chinese netizens to coronavirus disease 2019 (COVID-19), a pre-established nationally representative cohort of Weibo users was searched for COVID-19-related key words in their posts. METHODS: COVID-19-related posts (N = 1101) were retrieved from a longitudinal cohort of 52 268 randomly sampled Weibo accounts (December 31, 2019-February 12, 2020). RESULTS: Attention to COVID-19 was limited prior to China openly acknowledging human-to-human transmission on January 20. Following this date, attention quickly increased and has remained high over time. Particularly high levels of social media traffic appeared around when Wuhan was first placed in quarantine (January 23-24, 8-9% of the overall posts), when a scandal associated with the Red Cross Society of China occurred (February 1, 8%), and, following the death of Dr Li Wenliang (February 6-7, 11%), one of the whistleblowers who was reprimanded by the Chinese police in early January for discussing this outbreak online. CONCLUSION: Limited early warnings represent missed opportunities to engage citizens earlier in the outbreak. Governments should more proactively communicate early warnings to the public in a transparent manner.


COVID-19: Thinking about further mental and neurological disorders


The Compounding Access Problem for Surgical Care: Innovations in the Post-COVID Era


title: Treatments for COVID-19: emerging drugs against the coronavirus

text: The Coronavirus disease 19 (COVID-19) outbreak has been recognized as a global threat to public health. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and no effective therapies currently exist against this novel viral agent. Along with extensive public health measures, an unprecedented global effort in identifying effective drugs for the treatment is being implemented. Potential drug targets are emerging as the result of a fast-evolving understanding of SARS-CoV-2 virology, host response to the infection, and clinical course of the disease. This brief review focuses on the latest and most promising pharmacological treatments against COVID-19 currently under investigation and discuss their potential use based on either documented efficacy in similar viral infections, or their activity against inflammatory syndromes. Ongoing clinical trials are also emphasized.


Philosophy Problems Become Real During the COVID-19 Pandemic


title: Incidence and consequences of systemic arterial thrombotic events in COVID-19 patients

text: A high incidence of thrombotic events, particularly deep vein thrombosis and pulmonary embolism, has been clearly documented in COVID-19 patients. In addition, small series of patients with coronary, cerebrovascular and peripheral arterial thrombotic events have also been reported, but their true incidence and consequences are not well described, and constitute the objective of this study. From February 1st to April 21st, 2020, 2115 COVID-19 patients were treated at Hospital Universitario Fundación Alcorcón (Madrid, Spain), and 1419 were eventually admitted. Patient characteristics and outcomes were collected by reviewing their electronic medical records. Fourteen patients had a systemic arterial thrombotic event, which represents a 1% incidence in relation to the total number of hospitalized patients. Three patients suffered an acute coronary syndrome, two with persistent ST-segment elevation, one of whom was treated invasively, and one with transient ST-segment elevation. Eight patients had a cerebrovascular event. Six suffered an acute ischemic stroke and two a transient ischemic attack, 50% of them had a Rankin score ≥ 3 at discharge. Three additional patients had a limb thrombotic event, all of them infrapopliteal, and were managed conservatively. All three cases developed necrosis of the toes, two of them with bilateral involvement. The hospitalization death rate of patients with an arterial event was 28.6%. Although COVID-19 may favor the occurrence of thrombotic events, the destabilization and thrombosis of arterial atherosclerotic plaques do not seem to be a frequent mechanism which warrants the need for specific systematic preventive measures.


O Impacto da Pandemia COVID-19 na Saúde Mental./ [The Impact of the COVID-19 Pandemic on Mental Health]


title: ESMO Management and treatment adapted recommendations in the COVID-19 era: Breast Cancer

text: The global preparedness and response to the rapid escalation to severe acute respiratory syndrome coronavirus (SARS-CoV)-2-related disease (COVID-19) to a pandemic proportion has demanded the formulation of a reliable, useful and evidence-based mechanism for health services prioritisation, to achieve the highest quality standards of care to all patients. The prioritisation of high value cancer interventions must be embedded in the agenda for the pandemic response, ensuring that no inconsistency or discrepancy emerge in the health planning processes.The aim of this work is to organise health interventions for breast cancer management and research in a tiered framework (high, medium, low value), formulating a scheme of prioritisation per clinical cogency and intrinsic value or magnitude of benefit. The public health tools and schemes for priority setting in oncology have been used as models, aspiring to capture clinical urgency, value in healthcare, community goals and fairness, while respecting the principles of benevolence, non-maleficence, autonomy and justice.We discuss the priority health interventions across the cancer continuum, giving a perspective on the role and meaning to maintain some services (undeferrable) while temporarily abrogate some others (deferrable). Considerations for implementation and the essential link to pre-existing health services, especially primary healthcare, are addressed, outlining a framework for the development of effective and functional services, such as telemedicine.The discussion covers the theme of health systems strategising, and why oncology care, in particular breast cancer care, should be maintained in parallel to pandemic control measures, providing a pragmatic clinical model within the broader context of public healthcare schemes.


Tips from the battlefront: Psychological support of patients with a chronic illness during the COVID-19 lockdown in four steps


Head and neck cancer: high-risk population for COVID-19


Include the true value of nature when rebuilding economies after coronavirus


Hipertensión arterial pulmonar y COVID-19./ Hipertensión arterial pulmonar y COVID-19./ Pulmonary arterial hypertension and COVID-19


title: ¿Se observarán cambios en el consumo de alcohol y tabaco durante el confinamiento por COVID-19?/ ¿Se observarán cambios en el consumo de alcohol y tabaco durante el confinamiento por COVID-19?/ Will changes in alcohol and tobacco use be seen during the COVID-19 lockdown?

text: Editorial of vol. 32-2.


The COVID-19 Pandemic: A Challenge for the Cardiovascular Health


title: Finding a new balance

text: As coronavirus changes the way we live our lives, clinical psychologists Matthew Whalley and Hardeep Kaur advise on managing wellbeing.


Underestimation of co-infections in COVID-19 due to non-discriminatory use of antibiotics


title: Anesthetic Management of Patients Undergoing Aortic Dissection Repair With Suspected Severe Acute Respiratory Syndrome COVID-19 Infection

text: Severe acute respiratory syndrome coronavirus-2 is still active in Wuhan, China, and is spreading to the rest of the world. Recently, perioperative anesthetic management in patients with suspected or confirmed coronavirus-2 has been reported. However, little has been reported on the anesthetic management of patients undergoing aortic dissection repair in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. During the outbreak in Wuhan, the authors' team completed 4 cases of aortic dissection repair successfully in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. The purpose of the present report is to summarize current knowledge and experiences on anesthetic management in this patient population and to provide clinical practice guidelines on anesthetic management and infection prevention and control in these critically ill patients.