title: COVID-19 in an international European liver transplant recipient cohort

text: OBJECTIVE: Knowledge on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant recipients is lacking, particularly in terms of severity of the disease. The aim of this study was to describe the demographic, baseline clinical characteristics and early outcomes of a European cohort of liver transplant recipients with SARS-CoV-2 infection. DESIGN: We conducted an international prospective study across Europe on liver transplant recipients with SARS-CoV-2 infection confirmed by microbiological assay during the first outbreak of COVID-19 pandemic. Baseline characteristics, clinical presentation, management of immunosuppressive therapy and outcomes were collected. RESULTS: 57 patients were included (70% male, median (IQR) age at diagnosis 65 (57-70) years). 21 (37%), 32 (56%) and 21 (37%) patients had one cardiovascular disease, arterial hypertension and diabetes mellitus, respectively. The most common symptoms were fever (79%), cough (55%), dyspnoea (46%), fatigue or myalgia (56%) and GI symptoms (33%). Immunosuppression was reduced in 22 recipients (37%) and discontinued in 4 (7%). With this regard, no impact on outcome was observed. Forty-one (72%) subjects were hospitalised and 11 (19%) developed acute respiratory distress syndrome. Overall, we estimated a case fatality rate of 12% (95% CI 5% to 24%), which increased to 17% (95% CI 7% to 32%) among hospitalised patients. Five out of the seven patients who died had a history of cancer. CONCLUSION: In this European multicentre prospective study of liver transplant recipients, COVID-19 was associated with an overall and in-hospital fatality rate of 12% (95% CI 5% to 24%) and 17% (95% CI 7% to 32%), respectively. A history of cancer was more frequent in patients with poorer outcome.


title: Prevention and consideration for the biosafety of laboratory testing under epidemic condition/ 中华检验医学杂志

text: Laboratory testing plays an important role in the diagnosis and treatment of patients with Novel Coronavirus pneumonia. However, the lack of understanding of the virus in the early stage led to great difficulties in biosafety protection for clinical laboratories. Based on the latest researches and findings about the virus, this paper provides some personal opinions on the biosafety prevention in clinical laboratorians under epidemic condition for the reference of laboratory workers.


title: Patients with Genetic Heart Disease and COVID-19: A Cardiac Society of Australia and New Zealand (CSANZ) Consensus Statement

text: In the context of the current global COVID-19 pandemic, this Consensus Statement provides current recommendations for patients with, or at risk of developing, genetic heart disease, and for their health care management and service provision in Australia and New Zealand. Apart from general recommendations, there are specific recommendations for the following conditions: cardiomyopathy, Brugada syndrome (including in children), long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). Other recommendations are relevant to patient self-care and primary health care.


title: Beyond the Virus: A First Look at Coronavirus-themed Mobile Malware

text: As the COVID-19 pandemic emerges in early 2020, a number of campaigns have started capitalizing the topic. Although a few media reports mentioned the existence of coronavirus-themed mobile malware, the research community lacks the understanding of the landscape of the coronavirus-themed mobile malware, and there is no publicly accessible dataset that could be utilized to boost the related research. In this paper, we present the first systematic study of coronavirus-themed mobile malware. We first make efforts to create a daily growing COVID-19 themed mobile app dataset, which contains $2,016$ COVID-19 themed apps and $277$ malware samples by the time of May 26, 2020. We then present an analysis of these apps from multiple perspectives including popularity and trends, installation methods, malicious behaviors and malicious campaigns. We observe that the growth of the number of COVID-19 themed apps is highly related to the number of confirmed cases of COVID-19 in the world. Most of them were released through distribution channels beyond app markets. A majority of the malicious apps (over 53%) are camouflaged as official apps using the same app identifiers and some of them use confusing similar app icons with the official ones to mislead users. Their main purposes are either stealing users' private information or making profit by using the tricks like phishing and extortion. Furthermore, we find that only 40\% of the COVID-19 malware creators are habitual developers who are active for a long time, while 60\% of them are new emerging ones in this pandemic and only released COVID-19 themed malware. The malicious developers are mainly located in US, mostly targeting countries including English countries, Arabic countries, Europe and China. To facilitate future research, we have publicly released all the well-labelled COVID-19 themed apps (and malware) to the research community.


title: A Multidimensional Model of Public Health Approaches Against COVID-19

text: COVID-19 is appearing as one of the most fetal disease of the world's history and has caused a global health emergency. Therefore, this study was designed with the aim to address the issue of public response against COVID-19. The literature lacks studies on social aspects of COVID-19. Therefore, the current study is an attempt to investigate its social aspects and suggest a theoretical structural equation model to examine the associations between social media exposure, awareness, and information exchange and preventive behavior and to determine the indirect as well as direct impact of social media exposure on preventive behavior from the viewpoints of awareness and information exchange. The current empirical investigation was held in Pakistan, and the collected survey data from 500 respondents through social media tools were utilized to examine the associations between studied variables as stated in the anticipated study model. The findings of the study indicate that social media exposure has no significant and direct effect on preventive behavior. Social media exposure influences preventive behavior indirectly through awareness and information exchange. In addition, awareness and information exchange have significant and direct effects on preventive behavior. Findings are valuable for health administrators, governments, policymakers, and social scientists, specifically for individuals whose situations are like those in Pakistan. This research validates how social media exposure indirectly effects preventive behavior concerning COVID-19 and explains the paths of effect through awareness or information exchange. To the best of our knowledge, there is no work at present that covers this gap, for this reason the authors propose a new model. The conceptual model offers valuable information for policymakers and practitioners to enhance preventive behavior through the adoption of appropriate awareness strategies and information exchange and social media strategies.


title: Evaluation of COVID-19 epidemic outbreak caused by temporal contact-increase in South Korea

text: OBJECTIVES: On March 15, 2020, 61.3% of the confirmed cases of COVID-19 infection in South Korea are associated with the worship service that was organized on February 9 in the Shincheonji Church of Jesus in Daegu. We aim to evaluate the effects of mass infection in South Korea and assess the preventive control intervention. METHOD: Using openly available data of daily cumulative confirmed cases and deaths, the basic and effective reproduction numbers was estimated using a modified susceptible-exposed-infected-recovered-type epidemic model. RESULTS: The basic reproduction number was estimated to be R0=1.77. The effective reproduction number increased approximately 20 times after the mass infections from the 31 st patient, which was confirmed on February 9 in the Shincheonji Church of Jesus, Daegu. However, the effective reproduction number decreased to less than unity after February 28 owing to the implementation of high-level preventive control interventions in South Korea, coupled with voluntary prevention actions by citizens. CONCLUSION: Preventive action and control intervention were successfully established in South Korea.


title: COVID-19 in two infants in China

text: INTRODUCTION: Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world and caused more than 487 000 infections and 22 000 deaths worldwide. METHODS: We report two infant cases with coronavirus disease 2019 (COVID-19) in Yichang, Hubei, China. The younger of the two is only 5-months old. We recorded their clinical manifestations, epidemiological history, laboratory examination, and treatment in detail. In addition, we provide computed tomographic images of their chest, which are the most serious imaging manifestation among the infants recorded so far. RESULTS: Although both of them eventually recovered and were discharged from the hospital, they were complicated with varying degrees of liver and myocardial injury. In addition, one of them was complicated with mycoplasma pneumoniae infection. CONCLUSIONS: Pediatricians should consider the potential risks of developing severe illness of infants infected by SARS-CoV-2 and take them seriously.


COVID-19 pandemic: the long and difficult way back to work


New York City Innocence Lost: Cardiology in the COVID-19 Pandemic


Toolkit for survival: How to run and manage ophthalmic practices during the difficult time of COVID-19 crisis


title: COVID-19: Focus on the lungs but do not forget the gastrointestinal tract

text: The coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared in the last weeks as global pandemic. Currently affecting more than 5 000 000 individuals worldwide, COVID-19 is most commonly associated with symptoms caused by the acute respiratory distress syndrome (ARDS). As the number of infected individuals increases, we are learning that not only lungs, but also other organs can be affected by the virus. The gastrointestinal symptoms, for example diarrhoea, vomiting, nausea or abdominal pain, are frequent in patients with COVID-19. Moreover, alimentary tract symptoms may precede the respiratory presentation of SARS-CoV-2 infection. This can lead to delayed diagnosis and inappropriate management of infected patients. In addition, SARS-CoV-2 nucleic acid can be detected in faeces of infected patients and rectal swabs are even reported to remain positive for a longer period of time than nasopharyngeal swabs. Here, we aim to provide an update on the gastrointestinal involvement of COVID-19 presenting the symptoms that can be encountered in infected patients. We address the role of angiotensin-converting enzyme 2 (ACE2), as a functional receptor for SARS-CoV-2, which also was found in the gastrointestinal tract. Finally, we briefly discuss faecal shedding of SARS-CoV-2 and its potential role in the pathogenesis of the disease.


Covid-19 in South Korea - Challenges of Subclinical Manifestations


Is the COVID-19 lockdown nudging people to be more active: a big data analysis


The Perioperative Services Response at a Major Children's Hospital During the Peak of the COVID-19 Pandemic in New York City


Coping with COVID-19: An Italian Perspective on Corneal Surgery and Eye Banking in the Time of a Pandemic and Beyond


Rapid assessment of COVID-19 suspected cases: A community based approach for developing countries like Pakistan


RE: RE: COVID-19 Coagulopathy: Considerations for Urologists


COVID-19, une approche polyphonique


title: COVID-19, une approche polyphonique

text: Au moment où nous avons entendu les premiers rapports sur une nouvelle épidémie en Chine, peu d’entre nous ont imaginé le scénario qui est en train de se dérouler en Europe Au début, c’était le problème d’un autre continent, de quelques épidémiologistes ou peut-être encore de l’OMS, mais pas le nôtre En très peu de temps, cette vision a été radicalement bousculée Nous sommes désormais touchés, tant au niveau privé que professionnel La pandémie nous sidère Nous, occidentaux, natifs de la seconde moitié du 20e siècle qui, à l’exception peut-être du VIH, n’avions jamais vécu de situation similaire Pourtant, les épidémies sont un fléau commun, depuis ses débuts, à toute l’humanité Le constat actuel est celui de notre vulnérabilité individuelle mais aussi nos ressources et nos forces collectives Le pays est tous les soirs à ses fenêtres pour applaudir les héros de la lutte Moins d’un an après juin 2019, force est de constater qu’il s’agit, pour beaucoup, d’héroïnes : infirmières, caissières, agentes de propreté, proches aidantes


COVID-19 pneumonia: increased choline uptake with 18F-choline PET/CT


Mental health services for children in China during the COVID-19 pandemic: results of an expert-based national survey among child and adolescent psychiatric hospitals


title: COVID-19 Outbreak in Pakistan: Model-Driven Impact Analysis and Guidelines

text: Motivated by the rapid spread of COVID-19 all across the globe, we have performed simulations of a system dynamic epidemic spread model in different possible situations. The simulation, not only captures the model dynamic of the spread of the virus, but also, takes care of population and mobility data. The model is calibrated based on epidemic data and events specifically of Pakistan, which can easily be generalized. The simulation results are quite disturbing, indicating that, even with stringent social distancing and testing strategies and for a quite long time (even beyond one year), the spread would be significant (in tens of thousands). The real alarm is when some of these measures got leaked for a short time within this duration, which may result in catastrophic situation when millions of people would be infected.


title: Therapeutic Plasma Exchange in Adults with Severe COVID-19 Infection

text: OBJECTIVES: To evaluate the therapeutic use of plasma exchange in COVID-19 patients compared to controls. METHODS: Case series of critically ill adult men and non-pregnant women, ≥18 years of age, with laboratory confirmed COVID-19, was conducted at the Royal Hospital, Oman, from April 17th to May 11th, 2020. Therapeutic plasma exchange (TPE) was performed on patients admitted to intensive care unit (ICU) with confirmed or imminent acute respiratory distress syndrome (ARDS) or severe pneumonia. Analysis was performed using univariate statistics. RESULTS: A total of 31 COVID-19 patients were included with an overall mean age of 51 ± 15 years (range: 27-76 years), 90% (n = 28) were males, and 35% (n = 11) of the patients had TPE as a mode of treatment. The TPE group was associated with higher extubation rates than the non-TPE cohort (73% versus 20%; p = 0.018). Additionally, patients on TPE had a lower 14 days (0 versus 35%; p = 0.033) and 28 days (0 versus 35%; p = 0.033) all-cause mortality compared to patients not on TPE. However, all-cause mortality was only marginally lower in the TPE group compared to the non-TPE group (9.1% versus 45%; p = 0.055; power = 66%). Laboratory and ventilatory parameters also improved with the TPE. CONCLUSIONS: The use of TPE in severe COVID-19 patients has been associated with improved outcomes, however, randomized controlled clinical trials are warranted to draw final conclusive findings.


title: Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus

text: Since December 2019, an epidemic caused by novel coronavirus (2019-nCoV) infection has occurred unexpectedly in China. As of 8 pm, 31 January 2020, more than 20 pediatric cases have been reported in China. Of these cases, ten patients were identified in Zhejiang Province, with an age of onset ranging from 112 days to 17 years. Following the latest National recommendations for diagnosis and treatment of pneumonia caused by 2019-nCoV (the 4th edition) and current status of clinical practice in Zhejiang Province, recommendations for the diagnosis and treatment of respiratory infection caused by 2019-nCoV for children were drafted by the National Clinical Research Center for Child Health, the National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine to further standardize the protocol for diagnosis and treatment of respiratory infection in children caused by 2019-nCoV.


title: Post-mortem surveillance of bovine tuberculosis in Ireland: herd-level variation in the probability of herds disclosed with lesions at routine slaughter to have skin test reactors at follow-up test

text: Post-mortem surveillance in Ireland discloses skin-test negative cattle with presumptive evidence of infection of Mycobacterium bovis (lesions at routine slaughter (LRS)), the causative agent of bovine tuberculosis (bTB). Laboratory confirmation of lesions has impacts on trade restrictions for herds, therefore if laboratory capacity was diminished, how herds are treated would require an informed risk policy. Here we report the proportion of herds with subsequent evidence of within-herd transmission, based on skin-test results. We assess how herd-size, herd-type, and bTB-history affect the probability of additional reactors at follow-up test using univariable and multivariable random-effects models. The study represents a rapid response to developing an evidential base for policy demands during an extraordinary event, the COVID-19 epidemic in Ireland. A dataset from 2005 to 2019 of breakdowns were collated. Overall, 20,116 breakdowns were initiated by LRS cases. During the index tests of these breakdowns, 3931 revealed ≥1 skin-test reactor animals (19.54%; ≥1 standard reactors: 3827; 19.02%). Increasing herd-size was associated with reactor disclosure on follow-up. For small herds (<33 animals), 11.74% of follow-up tests disclosed ≥1 reactor; 24.63% of follow-up tests from very large herds (>137) disclosed ≥1 reactors. Beef (13.87%) and "other" (13%) herd production types had lower proportion of index tests with reactors in comparison with dairy (28.27%) or suckler (20.48%) herds. Historic breakdown size during the previous 3-years was associated reactor disclosure risk on follow-up. Our results are useful for rapid tailored policy development aimed at identifying higher risk herds.


COVID-19: Pentoxifylline as a potential adjuvant treatment


title: Experiments of Federated Learning for COVID-19 Chest X-ray Images

text: AI plays an important role in COVID-19 identification. Computer vision and deep learning techniques can assist in determining COVID-19 infection with Chest X-ray Images. However, for the protection and respect of the privacy of patients, the hospital's specific medical-related data did not allow leakage and sharing without permission. Collecting such training data was a major challenge. To a certain extent, this has caused a lack of sufficient data samples when performing deep learning approaches to detect COVID-19. Federated Learning is an available way to address this issue. It can effectively address the issue of data silos and get a shared model without obtaining local data. In the work, we propose the use of federated learning for COVID-19 data training and deploy experiments to verify the effectiveness. And we also compare performances of four popular models (MobileNet, ResNet18, MoblieNet, and COVID-Net) with the federated learning framework and without the framework. This work aims to inspire more researches on federated learning about COVID-19.


title: COVID-19: Neurology residents' perspective

text: Throughout this pandemic, neurology resident education and service has, and will continue to be, affected during this unprecedented time. Balancing the safety of our residents as well as the anticipated inpatient service demands, we have, and continue to, make changes to meet the needs of our community. Education certainly has been affected but we have made great effort to maintain normalcy. We are leveraging web-based technologies to continue formal didactics. The American Academy of Neurology has provided program directors with various tools to share to provide high-yield academic education. AAN Synapse, distance learning modules, and podcasts are a few examples. Each residency training program will likely face different challenges depending on location and community structure. We have an obligation to help all of our colleagues in the hospital in providing quality and compassionate care during this time of need. Our training and education will only benefit from this experience teaching us lessons on adaptability, the importance of teamwork, and self-sacrifice.


Letter to Editor Reply: Therapeutic Strategy for Coronavirus Disease 2019 in Patients on Durable Left Ventricular Assist Device Support


Reply to Rapid on-site evaluation and the COVID-19 pandemic


COVID-19: the risks for funeral directors


title: Modifiable areal unit problem and environmental factors of COVID-19 outbreak

text: Several recent studies have explored the association between environmental factors, such as temperature, humidity, and air pollution, and the severity of the COVID-19 outbreak by analyzing the statistical association at the district level. However, we argue that the modifiable areal unit problem (MAUP) arises when aggregating disease and environmental data into districts, leading to bias in such studies. Therefore, in this study, we analyzed the association between environmental factors and the number of COVID-19 death cases under different aggregation strategies to illustrate the presence of MAUP. We used real-world COVID-19 outbreak data from the Hubei and Henan Provinces and studied their association with atmospheric NO2 levels. By fitting linear regression models with penalized splines on NO2, we found that the association between COVID-19 mortality and NO2 varies when data were aggregated (1) at the city level, (2) under two different aggregation strategies, and (3) at the provincial level, indicating the presence of MAUP. Therefore, this study reminds researchers of the presence of MAUP and the necessity to minimize this problem while exploring the environmental determinants of the COVID-19 outbreak.


Impact of the COVID-19 outbreak on cancer patient flow and management: experience from a large university hospital in Spain


Key ethical questions for research during the COVID-19 pandemic


title: Social Capital and Sleep Quality in Individuals Who Self-Isolated for 14 Days During the Coronavirus Disease 2019 (COVID-19) Outbreak in January 2020 in China

text: BACKGROUND From the end of December 2019, coronavirus disease 2019 (COVID-19) began to spread in central China. Social capital is a measure of social trust, belonging, and participation. This study aimed to investigate the effects of social capital on sleep quality and the mechanisms involved in people who self-isolated at home for 14 days in January 2020 during the COVID-19 epidemic in central China. MATERIAL AND METHODS Individuals (n=170) who self-isolated at home for 14 days in central China, completed self-reported questionnaires on the third day of isolation. Individual social capital was assessed using the Personal Social Capital Scale 16 (PSCI-16) questionnaire. Anxiety was assessed using the Self-Rating Anxiety Scale (SAS) questionnaire, stress was assessed using the Stanford Acute Stress Reaction (SASR) questionnaire, and sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Path analysis was performed to evaluate the relationships between a dependent variable (social capital) and two or more independent variables, using Pearson's correlation analysis and structural equation modeling (SEM). RESULTS Low levels of social capital were associated with increased levels of anxiety and stress, but increased levels of social capital were positively associated with increased quality of sleep. Anxiety was associated with stress and reduced sleep quality, and the combination of anxiety and stress reduced the positive effects of social capital on sleep quality. CONCLUSIONS During a period of individual self-isolation during the COVID-19 virus epidemic in central China, increased social capital improved sleep quality by reducing anxiety and stress.


Could CGRP Antagonists Be Helpful in the Fight Against COVID-19?


title: Pandemic responses: Planning to neutralize SARS-CoV-2 and prepare for future outbreaks

text: The PLOS Medicine Editors discuss the current SARS-CoV-2 outbreak and implications for global health.


Mental Health Outcomes Among Frontline and Second-Line Health Care Workers During the Coronavirus Disease 2019 (COVID-19) Pandemic in Italy


A clinical dilemma amid COVID-19 pandemic: missed or encountered diagnosis of cancer?


title: The outbreak of coronavirus disease in China: Risk perceptions, knowledge, and information sources among prenatal and postnatal women

text: BACKGROUND: The COVID-19 pandemic has created anxiety among members of the public, including all women over the childbirth continuum, who are considered to be at a greater risk of contracting most infectious diseases. Understanding the perspectives of health care consumers on COVID-19 will play a crucial role in the development of effective risk communication strategies. This study aimed to examine COVID-19-related risk perceptions, knowledge, and information sources among prenatal and postnatal Chinese women during the initial phase of the COVID-19 pandemic. METHODS: A cross-sectional survey design was adopted, and a four-section online questionnaire was used to collect data. Using a social media platform, the online survey was administered to 161 participants during the outbreak of COVID-19 in Nanjing, China, in February 2020. RESULTS: The participants perceived their risk of contracting and dying from COVID-19 to be lower than their risk of contracting influenza, however many of them were worried that they might contract COVID-19. The participants demonstrated adequate knowledge about COVID-19. The three major sources from which they obtained information about COVID-19 were doctors, nurses/midwives, and the television, and they placed a high level of confidence in these sources. There was no significant relationship between the perceived risk of contracting COVID-19 and knowledge about this disease. CONCLUSION: The present findings offer valuable insights to healthcare professionals, including midwives, who serve on the frontline and provide care to pregnant women. Although the participants were adequately knowledgeable about COVID-19, they had misunderstood some of the recommendations of the World Health Organisation.


Impact of COVID-19 on family planning services in India


title: A Hidden Key to COVID-19 Management in Korea: Public Health Doctors

text: Public health doctors of Korea contributed significantly to massive coronavirus disease 2019 (COVID-19) testing. They were immediately dispatched to epicenters of the COVID-19 pandemic, and have run tests at screening centers, airport quarantines and hospitals. However, their expertise from in-field experience has been often neglected. It is time to reorganize public health doctor system to better prepare for future epidemics. Transforming and strengthening their roles as public health experts through systematic training is crucial.


Immune status could determine efficacy of COVID-19 therapies


COVID-19 suspicion and diagnosis: Are we still chasing epidemiological criteria?


Preliminary recommendations for lung surgery during COVID-19 epidemic period


Co-infection with an atypical pathogen of COVID-19 in a young


title: Care of immunocompromised patients with head and neck cancer during the COVID-19 pandemic: Two challenging and informative clinical cases

text: BACKGROUND AND METHODS: There is an added level of complexity in the management of head and neck cancer patients with underlying immunosuppressive disorders during the COVID-19 pandemic. Head and neck oncologists are tasked with balancing the dual risks of cancer progression in the setting of impaired tumor immunity and increased susceptibility to life-threatening complications from exposure to viral infection for patients and providers. Through two cases of immunocompromised patients with newly diagnosed head and neck malignancies, we aim to provide guidance to clinicians struggling with how to best counsel and manage this unique subset of patients under these difficult circumstances. RESULTS: After careful consideration of the options, we took different approaches in the care of these two patients. CONCLUSIONS: Ultimately, there is no uniform set of rules to apply to this heterogeneous group of immunocompromised patients. We provide some general principles to help guide patient management during the current pandemic.


Indications regarding the management of interventional clinical trials with drugs during the current COVID-19 emergency in Italy


title: Estudios de imagen cardiaca en la pandemia COVID-19./ Cardiac imaging studies in the COVID-19 pandemic

text: COVID-19 is an acute respiratory syndrome caused by coronavirus-2 (SARS COV2). The different cardiac imaging methods have issued specific recommendations for the different imaging methods in this pandemic, so it is essential to emphasize the recommendations for carrying out these studies.


title: Estudios de imagen cardiaca en la pandemia COVID-19

text: COVID-19 is an acute respiratory syndrome caused by coronavirus-2 (SARS COV2) The different cardiac imaging methods have issued specific recommendations for the different imaging methods in this pandemic, so it is essential to emphasize the recommendations for carrying out these studies


title: COVID-19 and US Health Financing: Perils and Possibilities

text: While the COVID-19 pandemic presents every nation with challenges, the United States' underfunded public health infrastructure, fragmented medical care system, and inadequate social protections impose particular impediments to mitigating and managing the outbreak. Years of inadequate funding of the nation's federal, state, and local public health agencies, together with mismanagement by the Trump administration, hampered the early response to the epidemic. Meanwhile, barriers to care faced by uninsured and underinsured individuals in the United States could deter COVID-19 care and hamper containment efforts, and lead to adverse medical and financial outcomes for infected individuals and their families, particularly those from disadvantaged groups. While the United States has a relatively generous supply of Intensive Care Unit beds and most other health care infrastructure, such medical resources are often unevenly distributed or deployed, leaving some areas ill-prepared for a severe respiratory epidemic. These deficiencies and shortfalls have stimulated a debate about policy solutions. Recent legislation, for instance, expanded coverage for testing for COVID-19 for the uninsured and underinsured, and additional reforms have been proposed. However comprehensive health care reform - for example, via national health insurance - is needed to provide full protection to American families during the COVID-19 outbreak and in its aftermath.


COVID-19 and 'lockdown' in organ transplantation in the UK


title: The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities

text: This paper collates the pathological findings from initial published autopsy reports on 23 patients with coronavirus disease 2019 (COVID-19) from 5 centers in the United States of America, including 3 cases from Houston, Texas. Findings confirm that COVID-19 is a systemic disease with major involvement of the lungs and heart. Acute COVID-19 pneumonia has features of a distinctive acute interstitial pneumonia with a diffuse alveolar damage component, coupled with microvascular involvement with intra- and extravascular fibrin deposition and intravascular trapping of neutrophils, and, frequently, with formation of microthombi in arterioles. Major pulmonary thromboemboli with pulmonary infarcts and/or hemorrhage occurred in 5 of the 23 patients. Two of the Houston cases had interstitial pneumonia with diffuse alveolar damage pattern. One of the Houston cases had multiple bilateral segmental pulmonary thromboemboli with infarcts and hemorrhages coupled with, in nonhemorrhagic areas, a distinctive interstitial lymphocytic pneumonitis with intra-alveolar fibrin deposits and no hyaline membranes, possibly representing a transition form to acute fibrinous and organizing pneumonia. Multifocal acute injury of cardiac myocytes was frequently observed. Lymphocytic myocarditis was reported in 1 case. In addition to major pulmonary pathology, the 3 Houston cases had evidence of lymphocytic pericarditis, multifocal acute injury of cardiomyocytes without inflammatory cellular infiltrates, depletion of splenic white pulp, focal hepatocellular degeneration and rare glomerular capillary thrombosis. Each had evidence of chronic cardiac disease: hypertensive left ventricular hypertrophy (420 g heart), dilated cardiomyopathy (1070 g heart), and hypertrophic cardiomyopathy (670 g heart). All 3 subjects were obese (BMIs of 33.8, 51.65, and 35.2 Kg/m2). Overall, the autopsy findings support the concept that the pathogenesis of severe COVID-19 disease involves direct viral-induced injury of multiple organs, including heart and lungs, coupled with the consequences of a procoagulant state with coagulopathy.


Highlights from the 2019 San Antonio Breast Cancer Symposium


Do Black Lives Matter to Consultation-Liaison Psychiatry?


Considerations for cancer immunotherapy biomarker research during COVID-19


Third time's the charm: COVID-19 testing issues


Segmental Pulmonary Vascular Changes in COVID-19 Pneumonia


title: Alterações pulmonares causadas pelo novo Coronavírus (COVID-19) e o uso da ventilação mecânica invasiva

text: Introdução: o novo coronavírus é semelhante a outras pneumonias coronavirais e também pode levar à síndrome do desconforto respiratório agudo Métodos: comunicação breve sobre as repercussões pulmonares causadas pela doença e uso da ventilação mecânica invasiva Resultados: a ventilção mecânica invasiva é a forma de tratamento adequada para pacientes com saturação abaixo de 92%, pressão arterial de O2 abaixo de 65 mm/Hg com ou sem hipercapnia, frequência respiratória >30 ipm e piora clínica Conclusão: o uso da ventilação não invasiva ou de oxigenoterapia nasal de alto fluxo não é recomendado na rotina (AU) Introduction: the novel coronavirus is similar to other coronaviral pneumonias, and can also lead to acute respiratory distress syndrome Methods: brief communication about the pulmonary repercussions caused by the disease and the use of invasive mechanical ventilation Results: Invasive mechanical ventilation is the appropriate form of treatment for patients with saturation below 92%, oxygen arterial pressure below 65 mm /hg with or without hypercapnia, respiratory rate>30 ipm and clinical worsening Conclusion: the use of non-invasive ventilation or high-flow nasal oxygen therapy is not recommended in routine


Covid-19: "Huge rise" in deaths at home is not fully explained by virus, say experts


The clinical characteristics of myocardial injury in severe and very severe patients with 2019 novel coronavirus disease


Comment on "Tracheotomy in Ventilated Patients with COVID-19"


title: Hypomethylating Agent Azacitidine Is Effective in Treating Brain Metastasis Triple-Negative Breast Cancer Through Regulation of DNA Methylation of Keratin 18 Gene

text: Breast cancer patients presenting with symptomatic brain metastases have poor prognosis, and current chemotherapeutic agents are largely ineffective. In this study, we evaluated the hypomethylating agent azacitidine (AZA) for its potential as a novel therapeutic in preclinical models of brain metastasis of breast cancer. We used the parental triple-negative breast cancer MDA-MB-231 (231) cells and their brain colonizing counterpart (231Br) to ascertain phenotypic differences in response to AZA. We observed that 231Br cells have higher metastatic potential compared to 231 cells. With regard to therapeutic value, the AZA IC50 value in 231Br cells is significantly lower than that in parental cells (Pâ¯<â¯.01). AZA treatment increased apoptosis and inhibited the Wnt signaling transduction pathway, angiogenesis, and cell metastatic capacity to a significantly higher extent in the 231Br line. AZA treatment in mice with experimental brain metastases significantly reduced tumor burden (Pâ¯=â¯.0112) and increased survival (Pâ¯=â¯.0026) compared to vehicle. Lastly, we observed a decreased expression of keratin 18 (an epithelial maker) in 231Br cells due to hypermethylation, elucidating a potential mechanism of action of AZA in treating brain metastases from breast cancer.


Delayed benign surgery during the COVID-19 pandemic: the other side of the coin


title: Remarks on a data-driven model for predicting the course of COVID-19 epidemic

text: Norden E. Huang, Fangli Qiao and Ka Kit Tung presented a data-driven model for the COVID-19 epidemic in which the relevant functions depend on a set of seven parameters obtained from a statistical analysis of the available data. These parameters are not independent, they are linked through a set of relations the authors call Main Results which are validated by a statistical analysis of the data. The parameters in questions and the relations between them are not always explicitated by the authors. By given them here their (simple) mathematical formulations all the relevant functions describing the dynamic can be explicitely written down. All the explicit formulas follow from the fact that the log of the number of infected, is a quadratic function of time. The formulas presented here are not themselves approximations - but the parameters they involve are of course statistical quantities derived from the data. These formulas could maybe be of some use either to validate the data, the model itself, to update the model or to find approximations to the relevant quantities.


title: Good deeds and cheap marketing-The food industry in the times of COVID-19

text: The consumption of ultra-processed foods is one of the main drivers of the global obesity and non-communicable disease (NCDs) epidemic1 . It is well known that obesity is associated with a low intensity chronic inflammatory state that creates a suboptimal immune response,2 which negatively affects the prognosis of COVID-193 . The epidemic of obesity and COVID-19 can be viewed as a syndemic as they negatively interact with one another to exacerbate the course of disease, leading to greater complications and severe illness. Together, they create a simultaneous and significant burden on the health system4 . Thus, an in-depth analysis on the food industry's role in this pandemic and in our society is necessary.


title: Nitrous oxide inhalant abuse and massive pulmonary embolism in COVID-19

text: A patient presented to the emergency department with altered mental status and lower extremity weakness in the setting of nitrous oxide inhalant abuse and Coronavirus Disease-2019 (COVID-19) infection. He subsequently developed hypotension and severe hypoxia, found to have a saddle pulmonary embolus (PE) with right heart strain requiring alteplase (tPA).


title: Accuracy of a new intraocular lens power calculation method based on artificial intelligence

text: PURPOSE: The purpose of this study is to develop and assess the accuracy of a new intraocular lens (IOL) power calculation method based on machine learning techniques. METHODS: The following data were retrieved for 260 eyes of 260 patients undergoing cataract surgery: preoperative simulated keratometry, mean keratometry of posterior surface, axial length, anterior chamber depth, lens thickness, and white-to-white diameter; model and power of implanted IOL; and subjective refraction at 3 months post surgery. These data were used to train different machine learning models (k-Nearest Neighbor, Artificial Neural Networks, Support Vector Machine, Random Forest, etc). Implanted lens characteristics and biometric data were used as input to predict IOL power and refractive outcomes. For external validation, a dataset of 52 eyes was used. The accuracy of the trained models was compared with that of the power formulas Holladay 2, Haigis, Barrett Universal II, and Hill-RBF v2.0. RESULTS: The SD of the prediction error in order of lowest to highest was the new method (designated Karmona) (0.30), Haigis (0.36), Holladay 2 (0.38), Barrett Universal II (0.38), and Hill-RBF v2.0 (0.40). Using the Karmona method, 90.38% and 100% of eyes were within ±0.50 and ±1.00 D respectively. CONCLUSIONS: The method proposed emerged as the most accurate to predict IOL power.


Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in Israel


Corrigendum to: "Letter: Neurosurgery and Coronavirus (COVID-19) Epidemic: Doing our Part" by Pesce et al. Neurosurgery, nyaa115, https://doi.org/10.1093/neuros/nyaa115


title: Towards Contactless Patient Positioning

text: The ongoing COVID-19 pandemic, caused by the highly contagious SARS-CoV-2 virus, has overwhelmed healthcare systems worldwide, putting medical professionals at a high risk of getting infected themselves due to a global shortage of personal protective equipment. This has in-turn led to understaffed hospitals unable to handle new patient influx. To help alleviate these problems, we design and develop a contactless patient positioning system that can enable scanning patients in a completely remote and contactless fashion. Our key design objective is to reduce the physical contact time with a patient as much as possible, which we achieve with our contactless workflow. Our system comprises automated calibration, positioning, and multi-view synthesis components that enable patient scan without physical proximity. Our calibration routine ensures system calibration at all times and can be executed without any manual intervention. Our patient positioning routine comprises a novel robust dynamic fusion (RDF) algorithm for accurate 3D patient body modeling. With its multi-modal inference capability, RDF can be trained once and used across different applications (without re-training) having various sensor choices, a key feature to enable system deployment at scale. Our multi-view synthesizer ensures multi-view positioning visualization for the technician to verify positioning accuracy prior to initiating the patient scan. We conduct extensive experiments with publicly available and proprietary datasets to demonstrate efficacy. Our system has already been used, and had a positive impact on, hospitals and technicians on the front lines of the COVID-19 pandemic, and we expect to see its use increase substantially globally.


title: Quantifying the role of social distancing, personal protection and case detection in mitigating COVID-19 outbreak in Ontario, Canada

text: Public health interventions have been implemented to mitigate the spread of coronavirus disease 2019 (COVID-19) in Ontario, Canada; however, the quantification of their effectiveness remains to be done and is important to determine if some of the social distancing measures can be relaxed without resulting in a second wave. We aim to equip local public health decision- and policy-makers with mathematical model-based quantification of implemented public health measures and estimation of the trend of COVID-19 in Ontario to inform future actions in terms of outbreak control and de-escalation of social distancing. Our estimates confirm that (1) social distancing measures have helped mitigate transmission by reducing daily infection contact rate, but the disease transmission probability per contact remains as high as 0.145 and case detection rate was so low that the effective reproduction number remained higher than the threshold for disease control until the closure of non-essential business in the Province; (2) improvement in case detection rate and closure of non-essential business had resulted in further reduction of the effective control number to under the threshold. We predict the number of confirmed cases according to different control efficacies including a combination of reducing further contact rates and transmission probability per contact. We show that improved case detection rate plays a decisive role to reduce the effective reproduction number, and there is still much room in terms of improving personal protection measures to compensate for the strict social distancing measures.


Letter: The Risk of COVID-19 Infection During Neurosurgical Procedures: A Review of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) Modes of Transmission and Proposed Neurosurgery-Specific Measures for Mitigation


Novel Wuhan (2019-nCoV) Coronavirus


title: Pro-Russian Biases in Anti-Chinese Tweets about the Novel Coronavirus

text: The recent COVID-19 pandemic, which was first detected in Wuhan, China, has been linked to increased anti-Chinese sentiment in the United States. Recently, Broniatowski et al. found that foreign powers, and especially Russia, were implicated in information operations using public health crises to promote discord -- including racial conflict -- in American society (Broniatowski, 2018). This brief considers the problem of automatically detecting changes in overall attitudes, that may be associated with emerging information operations, via artificial intelligence. Accurate analysis of these emerging topics usually requires laborious, manual analysis by experts to annotate millions of tweets to identify biases in new topics. We introduce extensions of the Word Embedding Association Test from Caliskan et. al to a new domain (Caliskan, 2017). This practical and unsupervised method is applied to quantify biases being promoted in information operations. Analyzing historical information operations from Russia's interference in the 2016 U.S. presidential elections, we quantify biased attitudes for presidential candidates, and sentiment toward Muslim groups. We next apply this method to a corpus of tweets containing anti-Chinese hashtags. We find that roughly 1% of tweets in our corpus reference Russian-funded news sources and use anti-Chinese hashtags and, beyond the expected anti-Chinese attitudes, we find that this corpus as a whole contains pro-Russian attitudes, which are not present in a control Twitter corpus containing general tweets. Additionally, 4% of the users in this corpus were suspended within a week. These findings may indicate the presence of abusive account activity associated with rapid changes in attitudes around the COVID-19 public health crisis, suggesting potential information operations.


title: Role and Management of a Head and Neck Department during the COVID-19 Outbreak in Lombardy

text: The recent Italian outbreak of coronavirus disease 2019 led to an unprecedented burden on our health care system. Despite head and neck-otolaryngology not being a front-line specialty in dealing with this disease, our department had to face several specific issues. Despite a massive reallocation of resources in the hospital, we managed to keep the service active, improving safety measures for our personnel, specifically during common otolaryngologic maneuvers known to produce aerosols. Furthermore, we strived to maintain our teaching role, giving residents an inclusive role in managing the response to the emergency state, and we progressively integrated our inactive specialists into other service rotations to relieve front-line colleagues' burden. Specific issues and management decisions are discussed in detail in the article.


title: Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient during COVID-19 Pandemic: Expert Review and Recommendation

text: Critically ill COVID-19 patients are generally admitted to the ICU for respiratory insufficiency which can evolve into a multiple-organ dysfunction syndrome requiring extracorporeal organ support. Ongoing advances in technology and science and progress in information technology support the development of integrated multi-organ support platforms for personalized treatment according to the changing needs of the patient. Based on pathophysiological derangements observed in COVID-19 patients, a rationale emerges for sequential extracorporeal therapies designed to remove inflammatory mediators and support different organ systems. In the absence of vaccines or direct therapy for COVID-19, extracorporeal therapies could represent an option to prevent organ failure and improve survival. The enormous demand in care for COVID-19 patients requires an immediate response from the scientific community. Thus, a detailed review of the available technology is provided by experts followed by a series of recommendation based on current experience and opinions, while waiting for generation of robust evidence from trials.


title: The Science Underlying COVID-19: Implications for the Cardiovascular System

text: The coronavirus disease 2019 (COVID-19) pandemic has affected health and economy worldwide on an unprecedented scale. Patients have diverse clinical outcomes, but those with preexisting cardiovascular disease, hypertension, and related conditions incur disproportionately worse outcome. The high infectivity of severe acute respiratory syndrome coronavirus 2 is in part related to new mutations in the receptor binding domain, and acquisition of a furin cleavage site in the S-spike protein. The continued viral shedding in the asymptomatic and presymptomatic individuals enhances its community transmission. The virus uses the angiotensin converting enzyme 2 receptor for internalization, aided by transmembrane protease serine 2 protease. The tissue localization of the receptors correlates with COVID-19 presenting symptoms and organ dysfunction. Virus-induced angiotensin converting enzyme 2 downregulation may attenuate its function, diminish its anti-inflammatory role, and heighten angiotensin II effects in the predisposed patients. Lymphopenia occurs early and is prognostic, potentially associated with reduction of the CD4+ and some CD8+ T cells. This leads to imbalance of the innate/acquired immune response, delayed viral clearance, and hyperstimulated macrophages and neutrophils. Appropriate type I interferon pathway activation is critical for virus attenuation and balanced immune response. Persistent immune activation in predisposed patients, such as elderly adults and those with cardiovascular risk, can lead to hemophagocytosis-like syndrome, with uncontrolled amplification of cytokine production, leading to multiorgan failure and death. In addition to the airways and lungs, the cardiovascular system is often involved in COVID-19 early, reflected in the release of highly sensitive troponin and natriuretic peptides, which are all extremely prognostic, in particular, in those showing continued rise, along with cytokines such as interleukin-6. Inflammation in the vascular system can result in diffuse microangiopathy with thrombosis. Inflammation in the myocardium can result in myocarditis, heart failure, cardiac arrhythmias, acute coronary syndrome, rapid deterioration, and sudden death. Aggressive support based on early prognostic indicators with expectant management can potentially improve recovery. Appropriate treatment for heart failure, arrhythmias, acute coronary syndrome, and thrombosis remain important. Specific evidence-based treatment strategies for COVID-19 will emerge with ongoing global collaboration on multiple approaches being evaluated. To protect the wider population, antibody testing and effective vaccine will be needed to make COVID-19 history.


Covid-19: Én verden, én helse./ Covid-19: Én verden, én helse./ COVID-19: One world, one health


Tracking online heroisation and blame in epidemics


The five 'W' of cognitive telerehabilitation in the Covid-19 era


title: Can China's 'standard of care' for COVID-19 be replicated in Europe?

text: The Director-General of the WHO has suggested that China's approach to the COVID-19 crisis could be the standard of care for global epidemics. However, as remarkable as the Chinese strategy might be, it cannot be replicated in other countries and certainly not in Europe. In Europe, there is a distribution of power between the European Union and its member states. In contrast, China's political power is concentrated in the central government. This enables it to take immediate measures that affect the entire country, such as massive quarantines or closing borders. Moreover, the Chinese legal framework includes restrictions on privacy and other human rights that are unknown in Europe. In addition, China has the technological power to easily impose such restrictions. In most European countries, that would be science fiction. These conditions have enabled China to combat epidemics like no other country can. However, the WHO might have been overoptimistic. The Chinese standard of care for treating COVID-19 also raises problematic issues for human rights, and the real consequences of these actions remain to be seen.


Diabetiker auch in Zeiten von Corona gut versorgen : Editorial


Telecardiología en tiempos de la pandemia COVID-19./ [Telecardiology in times of the COVID-19 pandemic]


title: A simulation approach to measure critical safety behaviors when evaluating training methods for respirator education in healthcare workers

text: BACKGROUND: The N95 respirator is the most common safety tool used in hospitals to protect health care workers (HCW) from inhaling airborne particles. Focusing on HCW behavior related to respirator use is an effective route to improve HCW safety and respiratory health. METHODS: Participants were asked to perform the donning and doffing of an N95 respirator to camera. Then they were randomized to a video alone or a reflective practice intervention. After the intervention they repeated the donning and doffing to camera. A critical safety behavior scoring tool (CSBST) was developed to compare the performance of the participants over time at pretest, post-test and 1 month later for follow-up. RESULTS: The reflective practice intervention group was found to have significantly higher scores on the CSBST at post-test and follow-up than the video alone group. In the reflective practice intervention group, the participants perceived they were better at performing the N95 donning and doffing than the experts scored them. CONCLUSIONS: The CSBST is a tool to measure the performance of HCWs on a specific targeted safety behaviors. The addition of a reflective practice intervention may result in a measurable and sustained improvement in the safety behaviors demonstrated when using the N95 respirator.


Rapid COVID-19-related Clinical Adaptations and Unanticipated Risks


Partha Kar: To tackle racism, the NHS needs policies with teeth


Laryngeal oedema associated with COVID-19 complicating airway management


Resources during covid-19


What led to the UK's COVID-19 death toll? - An insight into the mistakes made and the current situation


title: Preventing Facial Pressure Injury for Health Care Providers Adhering to COVID-19 Personal Protective Equipment Requirements

text: OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath a N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask's seal. METHODS: Since February 21, 2020, staff in high risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when doing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital's Pressure Injury Prevention Committee explored and created a stepwise process to protect the skin under these masks. This procedure was developed over time and tested to make sure that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes who became part of this evidence generation project. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. An added advantage was increased comfort with less friction as self-reported by the staff. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method by which staff could apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.


title: Back to school: Safe for children with underlying medical conditions

text: As schools reopen as a result of low community transmission rates of COVID-19, parents and teachers will have understandable concerns about the risks to students and staff.


Travel rush during Chinese Spring Festival and the 2019-nCoV


title: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): An overview of viral structure and host response

text: BACKGROUND AND AIM: As a result of its rapid spread in various countries around the world, on March 11, 2020, WHO issued an announcement of the change in coronavirus disease 2019 status from epidemic to pandemic disease. The virus that causes this disease is indicated originating from animals traded in a live animal market in Wuhan, China. Severe Acute Respiratory Syndrome Coronavirus 2 can attack lung cells because there are many conserved receptor entries, namely Angiotensin Converting Enzyme-2. The presence of this virus in host cells will initiate various protective responses leading to pneumonia and Acute Respiratory Distress Syndrome. This review aimed to provide an overview related to this virus and examine the body's responses and possible therapies. METHOD: We searched PubMed databases for Severe Acute Respiratory Syndrome Coronavirus-2, Middle East respiratory syndrome-related coronavirus and Severe Acute Respiratory Syndrome Coronavirus. Full texts were retrieved, analyzed and developed into an easy-to-understand review. RESULTS: We provide a complete review related to structure, origin, and how the body responds to this virus infection and explain the possibility of an immune system over-reaction or cytokine storm. We also include an explanation of how this virus creates modes of avoidance to evade immune system attacks. We further explain the therapeutic approaches that can be taken in the treatment and prevention of this viral infection. CONCLUSION: In summary, based on the structural and immune-evasion system of coronavirus, we suggest several approaches to treat the disease.


title: A Review of SARS-CoV-2 and the Ongoing Clinical Trials

text: The sudden outbreak of 2019 novel coronavirus (2019-nCoV, later named SARS-CoV-2) in Wuhan, China, which rapidly grew into a global pandemic, marked the third introduction of a virulent coronavirus into the human society, affecting not only the healthcare system, but also the global economy. Although our understanding of coronaviruses has undergone a huge leap after two precedents, the effective approaches to treatment and epidemiological control are still lacking. In this article, we present a succinct overview of the epidemiology, clinical features, and molecular characteristics of SARS-CoV-2. We summarize the current epidemiological and clinical data from the initial Wuhan studies, and emphasize several features of SARS-CoV-2, which differentiate it from SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), such as high variability of disease presentation. We systematize the current clinical trials that have been rapidly initiated after the outbreak of COVID-19 pandemic. Whereas the trials on SARS-CoV-2 genome-based specific vaccines and therapeutic antibodies are currently being tested, this solution is more long-term, as they require thorough testing of their safety. On the other hand, the repurposing of the existing therapeutic agents previously designed for other virus infections and pathologies happens to be the only practical approach as a rapid response measure to the emergent pandemic, as most of these agents have already been tested for their safety. These agents can be divided into two broad categories, those that can directly target the virus replication cycle, and those based on immunotherapy approaches either aimed to boost innate antiviral immune responses or alleviate damage induced by dysregulated inflammatory responses. The initial clinical studies revealed the promising therapeutic potential of several of such drugs, including favipiravir, a broad-spectrum antiviral drug that interferes with the viral replication, and hydroxychloroquine, the repurposed antimalarial drug that interferes with the virus endosomal entry pathway. We speculate that the current pandemic emergency will be a trigger for more systematic drug repurposing design approaches based on big data analysis.


What could be the better choice between ACE inhibitors and AT1R antagonists in coronavirus disease 2019 (COVID-19) patients?


title: Transforming ophthalmic education into virtual learning during COVID-19 pandemic: a global perspective

text: OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has imposed measures of social distancing and barriers in delivery of "in person" education. Institutions, involved in training the next generation of ophthalmologists, are using alternative teaching methods to maintain the standard of education. METHODS: We conducted a worldwide survey among physicians, who are actively involved in Ophthalmology-related education, between 3 and 14 April 2020. The expert survey, developed on the basis of literature search and focus group discussions, comprised 23 questions addressing the use of e-learning in Ophthalmology during the COVID-19 pandemic. RESULTS: A total of 321 participants from both academic and non-academic institutions worldwide, with variable practice experience and expertise, completed the survey. Before the pandemic, the majority of participants used traditional training modalities, including lectures, grand rounds and journal clubs, and 48% did not use any e-learning. There was a statistically significant increase in the use of all e-learning alternatives during the pandemic (p < 0.001), associated mainly with the availability of e-learning facilities (p < 0.001) and the academic character of institutions (p < 0.001). Zoom® was recognized as the mostly used platform for virtual teaching. Although theoretical teaching may take place, the surgical training of residents/fellows was dramatically reduced. The latter was significantly associated with participants' perspectives about teaching practices (p < 0.001). CONCLUSION: COVID-19 pandemic imposed great challenges in the educational field of Ophthalmology. The experience related to virtual training in Ophthalmology, gained during the pandemic, may change the traditional teaching practices in the world and provide new educational opportunities.


title: Case series of six kidney transplanted patients with COVID-19 pneumonia treated with tocilizumab

text: Few reports described the outcome of kidney transplanted patients (KTs) affected by COVID-19 treated with interleukin-6 receptor inhibitor tocilizumab (TCZ). We report our case series of 6 KTs with COVID-19 pneumonia who received TCZ: All were of male gender, with a mean age of 55.5 ± 8.4 years, a median time from transplantation of 3611 days (1465-5757); 5/6 had cardiovascular comorbidities, 1/6 had diabetes, and 3/6 have one or more previous KTs. Four out of six patients died, at an average time of 9.75 ± 2.4 days after tocilizumab administration, 3/6 due to a coexistent septic shock. Two patients improved after TCZ and were discharged at 20 and 21 days, respectively; in both patient, a significant increase of total lymphocyte count was observed. In conclusion, KTs, where the role of peculiar factors such as chronic immunosuppression is still undetermined, represent a high-risk group with significant COVID-19-associated mortality. The evaluation of the TCZ effect in COVID-19 pneumonia requires controlled studies (ideally RCTs) in this specific population.


text: Few reports described the outcome of kidney transplanted patients (KTs) affected by COVID-19 treated with interleukin-6 receptor inhibitor Tocilizumab (TCZ). We report our case series of 6 KTs with COVID-19 pneumonia who received TCZ: all were of male gender, with a mean age of 55.5±8.4 years, a median time from transplantation of 3611 days (1465-5757); 5/6 had cardiovascular comorbidities, 1/6 had diabetes and 3/6 have one or more previous KTs. Four out of six patients died, at an average time of 9.75±2.4 days after tocilizumab administration, 3/6 due to a coexistent septic shock. Two patients improved after TCZ and were discharged at 20 and 21 days respectively; in both patient a significant increase of total lymphocyte count was observed. In conclusion KTs, where the role of peculiar factors such as chronic immunosuppression is still undetermined, represent a high-risk group with significant COVID-19 associated mortality. The evaluation of the TCZ effect in COVID-19 pneumonia requires controlled studies (ideally RCTs) in this specific population.


SARS-CoV, Mers-CoV and COVID-19: what differences from a dermatological viewpoint?


title: A Second Pandemic? Perspective on Information Overload in the COVID-19 Era

text: The outbreak of COVID-19 has affected the globe in previously unimaginable ways, with far-reaching economic and social implications. It has also led to an outpouring of daily, ever-changing information. To assess the amount of data that were emerging, a PubMed search related to COVID-19 was performed. Nearly 8000 articles have been published since the virus was defined 4 months ago. This number has grown exponentially every month, potentially hindering our ability to discern what is scientifically important. Unlike previous global pandemics, we exist in a world of instantaneous access. Information, accurate or otherwise, is flowing from one side of the world to the other via word of mouth, social media, news, and medical journals. Changes in practice guidelines should be based on high-quality, well-powered research. Our job as health care providers is to mitigate misinformation and provide reassurance to prevent a second pandemic of misinformation.


title: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19

text: BACKGROUND: Coronavirus disease 2019 (Covid-19) may disproportionately affect people with cardiovascular disease. Concern has been aroused regarding a potential harmful effect of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in this clinical context. METHODS: Using an observational database from 169 hospitals in Asia, Europe, and North America, we evaluated the relationship of cardiovascular disease and drug therapy with in-hospital death among hospitalized patients with Covid-19 who were admitted between December 20, 2019, and March 15, 2020, and were recorded in the Surgical Outcomes Collaborative registry as having either died in the hospital or survived to discharge as of March 28, 2020. RESULTS: Of the 8910 patients with Covid-19 for whom discharge status was available at the time of the analysis, a total of 515 died in the hospital (5.8%) and 8395 survived to discharge. The factors we found to be independently associated with an increased risk of in-hospital death were an age greater than 65 years (mortality of 10.0%, vs. 4.9% among those ≤65 years of age; odds ratio, 1.93; 95% confidence interval [CI], 1.60 to 2.41), coronary artery disease (10.2%, vs. 5.2% among those without disease; odds ratio, 2.70; 95% CI, 2.08 to 3.51), heart failure (15.3%, vs. 5.6% among those without heart failure; odds ratio, 2.48; 95% CI, 1.62 to 3.79), cardiac arrhythmia (11.5%, vs. 5.6% among those without arrhythmia; odds ratio, 1.95; 95% CI, 1.33 to 2.86), chronic obstructive pulmonary disease (14.2%, vs. 5.6% among those without disease; odds ratio, 2.96; 95% CI, 2.00 to 4.40), and current smoking (9.4%, vs. 5.6% among former smokers or nonsmokers; odds ratio, 1.79; 95% CI, 1.29 to 2.47). No increased risk of in-hospital death was found to be associated with the use of ACE inhibitors (2.1% vs. 6.1%; odds ratio, 0.33; 95% CI, 0.20 to 0.54) or the use of ARBs (6.8% vs. 5.7%; odds ratio, 1.23; 95% CI, 0.87 to 1.74). CONCLUSIONS: Our study confirmed previous observations suggesting that underlying cardiovascular disease is associated with an increased risk of in-hospital death among patients hospitalized with Covid-19. Our results did not confirm previous concerns regarding a potential harmful association of ACE inhibitors or ARBs with in-hospital death in this clinical context. (Funded by the William Harvey Distinguished Chair in Advanced Cardiovascular Medicine at Brigham and Women's Hospital.).


title: Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study

text: BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is leading to social (physical) distancing policies worldwide, including in the USA. Some of the first actions taken by governments are the closing of schools. The evidence that mandatory school closures reduce the number of cases and, ultimately, mortality comes from experience with influenza or from models that do not include the effect of school closure on the health-care labour force. The potential benefits from school closures need to be weighed against costs of health-care worker absenteeism associated with additional child-care obligations. In this study, we aimed to measure child-care obligations for US health-care workers arising from school closures when these are used as a social distancing measure. We then assessed how important the contribution of health-care workers would have to be in reducing mortality for their absenteeism due to child-care obligations to undo the benefits of school closures in reducing the number of cases. METHODS: For this modelling analysis, we used data from the monthly releases of the US Current Population Survey to characterise the family structure and probable within-household child-care options of US health-care workers. We accounted for the occupation within the health-care sector, state, and household structure to identify the segments of the health-care workforce that are most exposed to child-care obligations from school closures. We used these estimates to identify the critical level at which the importance of health-care labour supply in increasing the survival probability of a patient with COVID-19 would undo the benefits of school closures and ultimately increase cumulative mortality. FINDINGS: Between January, 2018, and January, 2020, the US Current Population Survey included information on more than 3·1 million individuals across 1·3 million households. We found that the US health-care sector has some of the highest child-care obligations in the USA, with 28·8% (95% CI 28·5-29·1) of the health-care workforce needing to provide care for children aged 3-12 years. Assuming non-working adults or a sibling aged 13 years or older can provide child care, 15·0% (14·8-15·2) of the health-care workforce would still be in need of child care during a school closure. We observed substantial variation within the health-care system. We estimated that, combined with reasonable parameters for COVID-19 such as a 15·0% case reduction from school closings and 2·0% baseline mortality rate, a 15·0% decrease in the health-care labour force would need to decrease the survival probability per percent health-care worker lost by 17·6% for a school closure to increase cumulative mortality. Our model estimates that if the infection mortality rate of COVID-19 increases from 2·00% to 2·35% when the health-care workforce declines by 15·0%, school closures could lead to a greater number of deaths than they prevent. INTERPRETATION: School closures come with many trade-offs, and can create unintended child-care obligations. Our results suggest that the potential contagion prevention from school closures needs to be carefully weighted with the potential loss of health-care workers from the standpoint of reducing cumulative mortality due to COVID-19, in the absence of mitigating measures. FUNDING: None.


COVID-19 Pandemic Disrupts HIV Continuum of Care and Prevention: Implications for Research and Practice Concerning Community-Based Organizations and Frontline Providers


COVID-19: Timing is Important


What the World Can Learn from China's Experience With Coronavirus : Lessons from a Pandemics 'Ground Zero


Response to: Sore throat in COVID-19: comment on "Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: A single arm meta-analysis"


Severe COVID-19 in the young and healthy: monogenic inborn errors of immunity?


Population Trends in Rates of Percutaneous Coronary Revascularization for Acute Coronary Syndromes Associated With the COVID-19 Outbreak


title: Factors affecting the chemical composition of precipitation in Syria

text: Concentrations of the major ions (Ca2+, Mg2+, Na+, K+, NH4+, Cl-, HCO3-, SO42- and NO3-), pH and electrical conductivity (EC) values in the rainwater (RW) samples at 16 stations in Syria were determined for characterizing the principal factors affecting the chemical composition of precipitation (P) in this country. Collection of the RW samples was made on a monthly basis during the period (1989-2006). The volume-weighted mean (VWM) values calculated for the different parameters at all stations show VWM values of 6.84 and 96 µS/cm for pH and EC, respectively. The ionic trend of the VWM concentrations (µeq/L) in the RW samples of entire dataset follows the descending order: Ca2+ ≥ HCO3- > SO42- > Mg2+ > Cl- > Na+ > NO3- > K+ > NH4+. The lowest pH and EC values were found for the southern mountainous stations, while the highest were reported for the interior inland stations, depending on the amount of carbonate dust present in the atmosphere. The major part of the RW salinity (> 70%) was due to Ca2+, HCO3- and SO42- concentrations. The highest concentrations of Na+ and Cl- were found for the Tartous coastal station, where the Na+/Cl- ratio (0.84 ± 0.16) was remarkably very close to that of the Mediterranean Sea (MS) value (0.86), implying thus the sea spray effect. The highest NO3- concentrations (≈ 8-9 mg/L), with relatively high SO42-/NO3- ratios (> 2 ± 1), were found for the major cities (Damascus, Homs and Aleppo), implying hence the influence of intensive traffics and urban pollutions. The pH parameter was moderately linked with Ca2+ and HCO3- (R2 ≈ 0.36), while EC was correlated with all ions, except NH4+. This later ion was weakly correlated with NO3- (R2 ≈ 0.23). Strong correlations were found between Ca2+ and SO42- (R2 ≈ 0.80) and between Cl- and Na+ (R2 ≈ 0.95). Ca2+ and Mg2+ ions were the most responsible for neutralizing the RW acidity. The role of K+ and NH4+ as acidity neutralizers was small. By using the principal component analysis (PCA), five major factors, explaining ≈ 87% of the total variance, were suggested for the possible sources affecting the chemical composition of RW in this country. The factors are (1) crustal natural materials, (2) sea salts, (3) fossil fuel combustion, (4) rural activity, and (5) biomass burning.


When Life is Put on Hold, How Do We Hold on to Life? Challenges and Opportunities in Developmental and Behavioral Pediatrics During COVID-19


title: Urology surgical activity and COVID-19: Risk assessment at the epidemic peak the parisian multicenter experience

text: OBJECTIVES: To evaluate the risk of contracting severe COVID-19, defined as COVID-19 specific intensive care unit (ICU) admission or death, for patients undergoing urological surgery during the epidemic. To define consequences of receiving surgery for COVID-19 patients. PATIENTS AND METHODS: This is a multicenter observational cohort study. Every patient receiving a urological procedure in Paris academic urological centers during the 4 initial weeks of surgical restrictions were included. Their status was updated minimum 3 weeks after the procedure. The main outcomes were the COVID-19 specific ICU admission and death. Statistics were mostly descriptive. The Post-operative COVID-19 confirmed group was compared with non-COVID patients using Chi-square tests for categorical and Wilcoxon test tests for continuous variables. RESULTS: During the 4-week period, 552 patients received surgery within 8 centers. At follow-up, 57 (10%) patients were lost. Among the 11 preoperative COVID-19 cases, one remained in ICU, no new admission, and no death. For the non-COVID patients, 57 (12%) developed COVID-related symptoms; only one case (0.2%) required COVID-19 specific ICU and 3 (0.6%) patients died of COVID-19 after surgery. CONCLUSIONS: Performing urological surgery during the COVID-19 epidemic peak has a limited impact on ICU admissions but presents a real (0.6%) risk of specific mortality. Surgical activities should be maintained according to this risk.


title: A snapshot of the ongoing clinical research on COVID-19

text: The pandemic of coronavirus disease 2019 (COVID-19) presents an unprecedented challenge to rapidly develop new diagnostic, preventive and therapeutic strategies. Currently, thousands of new COVID-19 patients are quickly enrolled in clinical studies. We aimed to investigate the characteristics of the COVID-19 studies registered in ClinicalTrials.gov and report the extent to which they have incorporated features that are desirable for generating high-quality evidence. On April 28, 2020, a total of 945 studies on COVID-19 have been registered in ClinicalTrials.gov; 586 studies are interventional (62.0%), the most frequent allocation scheme is the parallel group assignment (437; 74.6%), they are open-label and the most common primary purpose is the research on treatment. Too many of the ongoing interventional studies have a small expected sample size and may not generate credible evidence at completion. This might lead to a delayed recognition of effective therapies that are urgently needed, and a waste of time and resources. In the COVID-19 pandemic era, it is crucial that the adoption of new diagnostic, preventive and therapeutic strategies is based upon evidence coming from well-designed, adequately powered and carefully conducted clinical trials.


Extraordinary diseases require extraordinary solutions


Predictors of refractory Coronavirus disease (COVID-19) pneumonia


title: Potential Novel Role of COVID-19 in Alzheimer's Disease and Preventative Mitigation Strategies

text: There are a number of potential implications for the field of Alzheimer's disease (AD) stemming from the global spread of SARS-CoV-2. Neuroinflammation is known to be a prominent feature of neurodegeneration and plays a major role in AD pathology. Immune response and excessive inflammation in COVID-19 may also accelerate the progression of brain inflammatory neurodegeneration, and elderly individuals are more susceptible to severe outcomes after SARS-CoV-2 infection. Individuals with type 2 diabetes (T2D) are at an increased risk for AD as well as severe outcomes after SARS-CoV-2 infection. Genetic and socioeconomic factors influencing the rates of T2D, AD, and COVID-19 severity may create an exceptionally high-risk profile for certain demographics such as African Americans and Hispanic Americans. Type I interferon response plays an important role in both host response to viral infection, as well as AD pathology and may be a sensible therapeutic target in both AD and COVID-19.


COVID-19 and endoscopy: implications for healthcare and digestive cancer screening


title: PriLok: Citizen-protecting distributed epidemic tracing

text: Contact tracing is an important instrument for national health services to fight epidemics. As part of the COVID-19 situation, many proposals have been made for scaling up contract tracing capacities with the help of smartphone applications, an important but highly critical endeavor due to the privacy risks involved in such solutions. Extending our previously expressed concern, we clearly articulate in this article, the functional and non-functional requirements that any solution has to meet, when striving to serve, not mere collections of individuals, but the whole of a nation, as required in face of such potentially dangerous epidemics. We present a critical information infrastructure, PriLock, a fully-open preliminary architecture proposal and design draft for privacy preserving contact tracing, which we believe can be constructed in a way to fulfill the former requirements. Our architecture leverages the existing regulated mobile communication infrastructure and builds upon the concept of"checks and balances", requiring a majority of independent players to agree to effect any operation on it, thus preventing abuse of the highly sensitive information that must be collected and processed for efficient contact tracing. This is enforced with a largely decentralised layout and highly resilient state-of-the-art technology, which we explain in the paper, finishing by giving a security, dependability and resilience analysis, showing how it meets the defined requirements, even while the infrastructure is under attack.


title: Immune response in children with COVID-19 is characterized by lower levels of T cell activation than infected adults

text: XX XXX This article is protected by copyright. All rights reserved.


COVID-19 pandemic: Ophthalmic practice and precautions in a tertiary eye hospital in Iran


Tracking COVID-19 responsibly


title: The Society for Immunotherapy of Cancer perspective on regulation of interleukin-6 signaling in COVID-19-related systemic inflammatory response

text: The pandemic caused by the novel coronavirus SARS-CoV-2 has placed an unprecedented burden on healthcare systems around the world. In patients who experience severe disease, acute respiratory distress is often accompanied by a pathological immune reaction, sometimes referred to as 'cytokine storm'. One hallmark feature of the profound inflammatory state seen in patients with COVID-19 who succumb to pneumonia and hypoxia is marked elevation of serum cytokines, especially interferon gamma, tumor necrosis factor alpha, interleukin 17 (IL-17), interleukin 8 (IL-8) and interleukin 6 (IL-6). Initial experience from the outbreaks in Italy, China and the USA has anecdotally demonstrated improved outcomes for critically ill patients with COVID-19 with the administration of cytokine-modulatory therapies, especially anti-IL-6 agents. Although ongoing trials are investigating anti-IL-6 therapies, access to these therapies is a concern, especially as the numbers of cases worldwide continue to climb. An immunology-informed approach may help identify alternative agents to modulate the pathological inflammation seen in patients with COVID-19. Drawing on extensive experience administering these and other immune-modulating therapies, the Society for Immunotherapy of Cancer offers this perspective on potential alternatives to anti-IL-6 that may also warrant consideration for management of the systemic inflammatory response and pulmonary compromise that can be seen in patients with severe COVID-19.


title: Operational Strategies to Prevent Coronavirus Disease 2019 (COVID-19) Spread in Radiology: Experience From a Singapore Radiology Department After Severe Acute Respiratory Syndrome

text: As coronavirus disease 2019 (COVID-19) infection spreads globally, the demand for chest imaging will inevitably rise with an accompanying increase in risk of disease transmission to frontline radiology staff. Radiology departments should implement strict infection control measures and robust operational plans to minimize disease transmission and mitigate potential impact of possible staff infection. In this article, the authors share several operational guidelines and strategies implemented in our practice to reduce spread of COVID-19 and maintain clinical and educational needs of a teaching hospital.


title: A cutting-edge immunoinformatics approach for design of multi-epitope oral vaccine against dreadful human malaria

text: Human malaria is a pathogenic disease mainly caused by Plasmodium falciparum, which was responsible for about 405,000 deaths globally in the year 2018. To date, several vaccine candidates have been evaluated for prevention, which failed to produce optimal output at various preclinical/clinical stages. This study is based on designing of polypeptide vaccines (PVs) against human malaria that cover almost all stages of life-cycle of Plasmodium and for the same 5 genome derived predicted antigenic proteins (GDPAP) have been used. For the development of a multi-immune inducer, 15 PVs were initially designed using T-cell epitope ensemble, which covered >99% human population as well as linear B-cell epitopes with or without adjuvants. The immune simulation of PVs showed higher levels of T-cell and B-cell activities compared to positive and negative vaccine controls. Furthermore, in silico cloning of PVs and codon optimization followed by enhanced expression within Lactococcus lactis host system was also explored. Although, the study has sound theoretical and in silico findings, the in vitro/in vivo evaluation seems imperative to warrant the immunogenicity and safety of PVs towards management of P. falciparum infection in the future.


Food frights: COVID-19 and the specter of hunger


Atypical Presentation of Covid-19 in an Older Adult With Severe Alzheimer Disease


title: RE: ISTH interim guidance to recognition and management of coagulopathy in COVID-19

text: The unrelenting acceleration of COVID-19 infections due to SARS-CoV-2 is unquestionably the greatest medical challenge of our professional careers. The Scientific and Standardisation Committee (SSC) on disseminated intravascular coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH) is to be commended for the rapid publication of guidance for clinicians worldwide to assist in management of the coagulopathy widely reported to be associated with severe COVID-19 infection. However, we would like to offer constructive feedback as to how the SSC's interim guidance1 might be improved.


title: Characterisation of COVID-19 Pandemic in Paediatric Age Group: A Systematic Review and Meta-Analysis

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) is a pandemic first originated in Wuhan the capital of Hubei province, China in December 2019 and then spread globally. It is caused by SARS-CoV-2. Until 1st April 2020, the number of cases worldwide was recorded to be 823,626 with 40,598 deaths. Most of the reported cases were adults with few cases described in children and neonates. OBJECTIVES: We performed a systematic review and meta-analysis to analyse the disease characterisation in paediatric age group including the possibility of vertical transmission to the neonates. METHODS: Articles published up to 2nd April 2020 in PubMed and google Scholar were considered for this study. FINDINGS: The most frequently reported symptoms were cough 49% (95% CI: 42 - 55%) and fever 47% (95% CI: 41- 53%). Lymphopenia and increased Procalcitonin were recorded in (21%, 95% CI: 12 - 30%) and (28%, 95% CI: 18 - 37%) respectively. No sex difference for COVID-19 was found in paediatric age group (pâ¯=â¯0.7). Case fatality rate was 0%. Four out of 58 neonates (6.8%) born to COVID-19 confirmed mothers tested positive for the disease. CONCLUSION: The disease trajectory in Paediatric patients has good prognosis compared to adults. Intensive care unit and death are rare. Vertical transmission and virus shedding in breast milk are yet to be established.


title: Preventing transmission among operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other personal protective equipment

text: The COVID-19 pandemic is highly challenging for the operating room staff and healthcare workers in emergency departments. SARS-CoV-2 is a positive-sense single-stranded RNA beta-coronavirus that primarily targets the human respiratory system, with fever, cough, myalgia, and pneumonia as the most common manifestations. However, since SARS-CoV-2 RNA was detected in stool specimens much more attention has been paid to gastrointestinal symptoms such as loss of appetite, nausea, and diarrhea. Furthermore, the expression of ACE-2 receptors in absorptive enterocytes from ileum and colon suggests that these organs should also be considered as a potential high risk for SARS-CoV-2 infection. During aerosol-generating medical procedures (AGMP; e.g. intubating and extubating patients or any surgical procedures), the production of both airborne particles and droplets may increase the risk of infection. In this situation, the surgical staff is strongly recommended to wear personal protective equipment (PPE). A transparent plastic cube, the so-called "Aerosol Box" (AB), has been recently designed to lend further protection against droplets and aerosol exposure during the AGMP.


title: A search for medications to treat COVID-19 via in silico molecular docking models of the SARS-CoV-2 spike glycoprotein and 3CL protease

text: BACKGROUND: The COVID-19 has now been declared a global pandemic by the World Health Organization. There is an emergent need to search for possible medications. METHOD: Utilization of the available sequence information, homology modeling, and in slico docking a number of available medications might prove to be effective in inhibiting the SARS-CoV-2 two main drug targets, the spike glycoprotein, and the 3CL protease. RESULTS: Several compounds were determined from the in silico docking models that might prove to be effective inhibitors for SARS-CoV-2. Several antiviral medications: Zanamivir, Indinavir, Saquinavir, and Remdesivir show potential as and 3CLPRO main proteinase inhibitors and as a treatment for COVID-19. CONCLUSION: Zanamivir, Indinavir, Saquinavir, and Remdesivir are among the exciting hits on the 3CLPRO main proteinase. It is also exciting to uncover that Flavin Adenine Dinucleotide (FAD) Adeflavin, B2 deficiency medicine, and Coenzyme A, a coenzyme, may also be potentially used for the treatment of SARS-CoV-2 infections. The use of these off-label medications may be beneficial in the treatment of the COVID-19.


Covid-19./ Covid-19


title: Improving Hand Hygiene Adherence in Healthcare Workers Before Patient Contact: A Multimodal Intervention in Four Tertiary Care Hospitals in Japan

text: BACKGROUND: Hand hygiene is key to preventing healthcare-associated infection and the spread of respiratory viruses like the novel coronavirus that causes COVID-19. Unfortunately, hand hygiene adherence of healthcare workers (HCWs) in Japan is suboptimal according to previous studies. OBJECTIVES: Our objectives were to evaluate hand hygiene adherence among physicians and nurses before touching hospitalized patients and to evaluate changes in hand hygiene adherence after a multimodal intervention was implemented. DESIGN, SETTING, AND PARTICIPANTS: We conducted a pre- and postintervention study with HCWs at four tertiary hospitals in Niigata, Japan. Hand hygiene observations were conducted from June to August 2018 (preintervention) and February to March 2019 (postintervention). INTERVENTION: The multimodal hand hygiene intervention recommended by the World Health Organization was tailored to each hospital and implemented from September 2018 to February 2019. MAIN OUTCOMES AND MEASURES: We observed hand hygiene adherence before touching patients in each hospital and compared rates before and after intervention. Intervention components were also evaluated. RESULTS: There were 2,018 patient observations preintervention and 1,630 postintervention. Overall, hand hygiene adherence improved from 453 of 2,018 preintervention observations (22.4%) to 548 of 1,630 postintervention observations (33.6%; P < .001). Rates improved more among nurses (13.9 percentage points) than among doctors (5.7 percentage points). Improvement varied among the hospitals: Hospital B (18.4 percentage points) was highest, followed by Hospitals D (11.4 percentage points), C (11.3 percentage points), and Hospital A (6.5 percentage points). CONCLUSIONS: A multimodal intervention improved hand hygiene adherence rates in physicians and nurses in Niigata, Japan; however, further improvement is necessary. Given the current suboptimal hand hygiene adherence rates in Japanese hospitals, the spread of COVID-19 within the hospital setting is a concern.


title: Guidance for Healthcare Providers Managing COVID-19 in Rural and Underserved Areas

text: Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has ravaged many urban and high-density areas in the USA. However, rural areas (despite their low population density) may be especially vulnerable to poor outcomes from COVID-19, owing to limited healthcare infrastructure, long distances to advanced health care, and population characteristics (e.g., high tobacco use, hypertension, obesity, older age). A panel of experts who are actively engaged in treating and managing COVID-19 at a rural academic center was convened to address this topic. In this commentary, we provide readers with some specific issues faced by rural healthcare providers and offer guidance in overcoming these challenges. This guidance includes alternative ventilator strategies, personal protective equipment (PPE), and common therapeutic options.


Amendment to the law to curb violence against doctors during the coronavirus disease 2019 crisis in India


Histologic features of long-lasting chilblain-like lesions in a paediatric COVID-19 patient


Strategies to control COVID-19 and future pandemics in Africa and around the globe


Response to: Management of Traumatic Spinal Fracture in the Coronavirus Disease 2019 Situation


title: Feasibility of Tocilizumab in ICU patients with COVID-19

text: Severe COVID-19 causes cytokine release syndrome and is associated with high mortality. In this retrospective case series, all patients diagnosed with COVID-19 by semi quantitative RT-PCR and hyperinflammatory markers were treated with tocilizumab. The use of tocilizumab was associated with rapid apyrexia, improvement of respiratory, biological parameters and short length of hospitalization (11 days). Moreover, no adverse effect attributed to the treatment was noticed. Tocilizumab seems to be a promising and safe therapy in severe patients. This article is protected by copyright. All rights reserved.


Covid-19: Children with conditions managed in primary care may not need to shield


Prothrombotic phenotype in COVID-19 severe patients


title: COVID-19: Uncharted waters

text: 'Uncharted waters' is perhaps an understatement of where we are headed at this time. The situation is fluid, with government regulations for our society changing rapidly.


COVID-19 pandemic: an opportunity to assess the utility of telemedicine in patients with rheumatic diseases


title: Potential inhibitors of coronavirus 3-chymotrypsin-like protease (3CLpro): an in silico screening of alkaloids and terpenoids from African medicinal plants

text: The novel coronavirus disease 2019 (COVID-19) caused by SARS-COV-2 has raised myriad of global concerns. There is currently no FDA approved antiviral strategy to alleviate the disease burden. The conserved 3-chymotrypsin-like protease (3CLpro), which controls coronavirus replication is a promising drug target for combating the coronavirus infection. This study screens some African plants derived alkaloids and terpenoids as potential inhibitors of coronavirus 3CLpro using in silico approach. Bioactive alkaloids (62) and terpenoids (100) of plants native to Africa were docked to the 3CLpro of the novel SARS-CoV-2. The top twenty alkaloids and terpenoids with high binding affinities to the SARS-CoV-2 3CLpro were further docked to the 3CLpro of SARS-CoV and MERS-CoV. The docking scores were compared with 3CLpro-referenced inhibitors (Lopinavir and Ritonavir). The top docked compounds were further subjected to ADEM/Tox and Lipinski filtering analyses for drug-likeness prediction analysis. This ligand-protein interaction study revealed that more than half of the top twenty alkaloids and terpenoids interacted favourably with the coronaviruses 3CLpro, and had binding affinities that surpassed that of lopinavir and ritonavir. Also, a highly defined hit-list of seven compounds (10-Hydroxyusambarensine, Cryptoquindoline, 6-Oxoisoiguesterin, 22-Hydroxyhopan-3-one, Cryptospirolepine, Isoiguesterin and 20-Epibryonolic acid) were identified. Furthermore, four non-toxic, druggable plant derived alkaloids (10-Hydroxyusambarensine, and Cryptoquindoline) and terpenoids (6-Oxoisoiguesterin and 22-Hydroxyhopan-3-one), that bind to the receptor-binding site and catalytic dyad of SARS-CoV-2 3CLpro were identified from the predictive ADME/tox and Lipinski filter analysis. However, further experimental analyses are required for developing these possible leads into natural anti-COVID-19 therapeutic agents for combating the pandemic.Communicated by Ramaswamy H. Sarma.


SARS-CoV-2 and enhancing antibodies


title: Recommendations for the Care of Pediatric Orthopaedic Patients During the COVID-19 Pandemic

text: The COVID-19 pandemic has necessitated modifications to pediatric orthopaedic practice to protect patients, families, and healthcare workers and to minimize viral transmission. It is critical to balance the benefits of alterations to current practice to reduce the chances of COVID-19 infection, with the potential long-term impact on patients. Early experiences of the pandemic from orthopaedic surgeons in China, Singapore, and Italy have provided the opportunity to take proactive and preventive measures to protect all involved in pediatric orthopaedic care. These guidelines, based on expert opinion and best available evidence, provide a framework for the management of pediatric orthopaedic patients during the COVID-19 pandemic. General principles include limiting procedures to urgent cases such as traumatic injuries and deferring outpatient visits during the acute phase of the pandemic. Nonsurgical methods should be considered where possible. For patients with developmental or chronic orthopaedic conditions, it may be possible to delay treatment for 2 to 4 months without substantial detrimental long-term impact.