title: Morbid Obesity as an Independent Risk Factor for COVID-19 Mortality in Hospitalized Patients Younger than 50

text: OBJECTIVE: COVID-19 continues to spread and younger patients are also being critically affected. This study analyzed obesity as an independent risk factor for mortality in hospitalized patients younger than fifty. METHODS: We retrospectively analyzed data of COVID-19 patients hospitalized to a large academic hospital system in New York City between March 1st and May 17th, 2020. Data included demographics, comorbidities, BMI and smoking status. Obesity groups included: BMI 30-40 kg/m2 and BMI ≥ 40 kg/m2 . Multivariable logistic regression models identified variables independently associated with mortality in patients younger and older than 50. RESULTS: Overall, 3,406 patients were included. 572 (17.0%) of the patients were younger than 50. In the younger age group, 60 (10.5%) patients died. In the older age group, 1,076 (38.0%) patients died. For the younger population, BMI above 40 kg/m2 was independently associated with mortality (aOR 5.1, 95% CI 2.3-11.1). For the older population, BMI above 40 kg/m2 was also independently associated with mortality to a lesser extent (aOR 1.6, 95% CI 1.2 - 2.3). CONCLUSION: Our study demonstrates that hospitalized patients younger than 50 with morbid obesity are more likely to die from COVID-19. This is particularly relevant in the western world where obesity rates are high.


title: Bi-Level Graph Neural Networks for Drug-Drug Interaction Prediction

text: We introduce Bi-GNN for modeling biological link prediction tasks such as drug-drug interaction (DDI) and protein-protein interaction (PPI). Taking drug-drug interaction as an example, existing methods using machine learning either only utilize the link structure between drugs without using the graph representation of each drug molecule, or only leverage the individual drug compound structures without using graph structure for the higher-level DDI graph. The key idea of our method is to fundamentally view the data as a bi-level graph, where the highest level graph represents the interaction between biological entities (interaction graph), and each biological entity itself is further expanded to its intrinsic graph representation (representation graphs), where the graph is either flat like a drug compound or hierarchical like a protein with amino acid level graph, secondary structure, tertiary structure, etc. Our model not only allows the usage of information from both the high-level interaction graph and the low-level representation graphs, but also offers a baseline for future research opportunities to address the bi-level nature of the data.


title: Detection of Covid-19 From Chest X-ray Images Using Artificial Intelligence: An Early Review

text: In 2019, the entire world is facing a situation of health emergency due to a newly emerged coronavirus (COVID-19). Almost 196 countries are affected by covid-19, while USA, Italy, China, Spain, Iran, and France have the maximum active cases of COVID-19. The issues, medical and healthcare departments are facing in delay of detecting the COVID-19. Several artificial intelligence based system are designed for the automatic detection of COVID-19 using chest x-rays. In this article we will discuss the different approaches used for the detection of COVID-19 and the challenges we are facing. It is mandatory to develop an automatic detection system to prevent the transfer of the virus through contact. Several deep learning architecture are deployed for the detection of COVID-19 such as ResNet, Inception, Googlenet etc. All these approaches are detecting the subjects suffering with pneumonia while its hard to decide whether the pneumonia is caused by COVID-19 or due to any other bacterial or fungal attack.


title: A study on the psychological needs of nurses caring for patients with coronavirus disease 2019 from the perspective of the existence, relatedness, and growth theory

text: Objective: This study aimed to explore the psychological needs of nurses caring for patients with coronavirus disease 2019(COVID-19) and to propose corresponding interventions. Methods: In-depth interviews were conducted with 10 nurses who cared for patients with COVID-19. Interview data were analyzed by category analysis from the perspective of the existence, relatedness, and growth theory (ERG). Results: The existence needs were mainly reflected in health and security needs, whereas the relatedness needs consisted mainly of interpersonal needs, humanistic concern needs, and family needs; further, the growth needs were mainly reflected as a strong need for knowledge. Existence needs were the main needs during the epidemic, with health and security needs influencing each other. Humanistic concern needs were the most important of the relatedness needs; interpersonal and family needs were also growing. Conclusion: It is found that the existence, relatedness, and growth needs coexist in clinical nurses. It is helpful to take effective interventions to meet their needs if the needs of nurses caring for COVID-19 patients could be perceived well.


title: Psychological Impact and Coping Strategies of Frontline Medical Staff in Hunan Between January and March 2020 During the Outbreak of Coronavirus Disease 2019 (COVID19) in Hubei, China

text: BACKGROUND Throughout China, during the recent epidemic in Hubei province, frontline medical staff have been responsible for tracing contacts of patients infected with coronavirus disease 2019 (COVID19). This study aimed to investigate the psychological impact and coping strategies of frontline medical staff in Hunan province, adjacent to Hubei province, during the COVID19 outbreak between January and March 2020. MATERIAL AND METHODS A cross-sectional observational study included doctors, nurses, and other hospital staff throughout Hunan province between January and March 2020. The study questionnaire included five sections and 67 questions (scores, 0-3). The chi-squared χ² test was used to compare the responses between professional groups, age-groups, and gender. RESULTS Study questionnaires were completed by 534 frontline medical staff. The responses showed that they believed they had a social and professional obligation to continue working long hours. Medical staff were anxious regarding their safety and the safety of their families and reported psychological effects from reports of mortality from COVID19 infection. The availability of strict infection control guidelines, specialized equipment, recognition of their efforts by hospital management and the government, and reduction in reported cases of COVID19 provided psychological benefit. CONCLUSIONS The COVID19 outbreak in Hubei resulted in increased stress for medical staff in adjacent Hunan province. Continued acknowledgment of the medical staff by hospital management and the government, provision of infection control guidelines, specialized equipment and facilities for the management of COVID19 infection should be recognized as factors that may encourage medical staff to work during future epidemics.


Targeting the inflammatory cascade with anakinra in moderate to severe COVID-19 pneumonia: case series


Dermatologic findings in two patients with COVID-19


Vascular surgery in the COVID-19 pandemic


title: Caspase1/11 signaling affects muscle regeneration and recovery following ischemia, and can be modulated by chloroquine

text: BACKGROUND: We previously showed that the autophagy inhibitor chloroquine (CQ) increases inflammatory cleaved caspase-1 activity in myocytes, and that caspase-1/11 is protective in sterile liver injury. However, the role of caspase-1/11 in the recovery of muscle from ischemia caused by peripheral arterial disease is unknown. We hypothesized that caspase-1/11 mediates recovery in muscle via effects on autophagy and this is modulated by CQ. METHODS: C57Bl/6 J (WT) and caspase-1/11 double-knockout (KO) mice underwent femoral artery ligation (a model of hind-limb ischemia) with or without CQ (50 mg/kg IP every 2nd day). CQ effects on autophagosome formation, microtubule associated protein 1A/1B-light chain 3 (LC3), and caspase-1 expression was measured using electron microscopy and immunofluorescence. Laser Doppler perfusion imaging documented perfusion every 7 days. After 21 days, in situ physiologic testing in tibialis anterior muscle assessed peak force contraction, and myocyte size and fibrosis was also measured. Muscle satellite cell (MuSC) oxygen consumption rate (OCR) and extracellular acidification rate was measured. Caspase-1 and glycolytic enzyme expression was detected by Western blot. RESULTS: CQ increased autophagosomes, LC3 consolidation, total caspase-1 expression and cleaved caspase-1 in muscle. Perfusion, fibrosis, myofiber regeneration, muscle contraction, MuSC fusion, OCR, ECAR and glycolytic enzyme expression was variably affected by CQ depending on presence of caspase-1/11. CQ decreased perfusion recovery, fibrosis and myofiber size in WT but not caspase-1/11KO mice. CQ diminished peak force in whole muscle, and myocyte fusion in MuSC and these effects were exacerbated in caspase-1/11KO mice. CQ reductions in maximal respiration and ATP production were reduced in caspase-1/11KO mice. Caspase-1/11KO MuSC had significant increases in protein kinase isoforms and aldolase with decreased ECAR. CONCLUSION: Caspase-1/11 signaling affects the response to ischemia in muscle and effects are variably modulated by CQ. This may be critically important for disease treated with CQ and its derivatives, including novel viral diseases (e.g. COVID-19) that are expected to affect patients with comorbidities like cardiovascular disease.


title: Distinct phenotypes require distinct respiratory management strategies in severe COVID-19

text: Coronavirus disease 2019 (COVID-19) can cause severe respiratory failure requiring mechanical ventilation. The abnormalities observed on chest computed tomography (CT) and the clinical presentation of COVID-19 patients are not always like those of typical acute respiratory distress syndrome (ARDS) and can change over time. This manuscript aimed to provide brief guidance for respiratory management of COVID-19 patients before, during, and after mechanical ventilation, based on the recent literature and on our direct experience with this population. We identify that chest CT patterns in COVID-19 may be divided into three main phenotypes: 1) multiple, focal, possibly overperfused ground-glass opacities; 2) inhomogeneously distributed atelectasis; and 3) a patchy, ARDS-like pattern. Each phenotype can benefit from different treatments and ventilator settings. Also, peripheral macro- and microemboli are common, and attention should be paid to the risk of pulmonary embolism. We suggest use of personalized mechanical ventilation strategies based on respiratory mechanics and chest CT patterns. Further research is warranted to confirm our hypothesis.


title: Virtual Ophthalmology: Telemedicine in a COVID-19 Era

text: PURPOSE: To discuss the effects of the severe acute respiratory syndrome coronavirus 2 betacoronavirus on ambulatory ophthalmology practices, the value proposition of telemedicine, teleophthalmology implementation methodologies, and the accelerated future of telemedicine. DESIGN: Review of the current telehealth landscape including usage, policies, and techniques for ambulatory practice integration. METHODS: We provide author-initiated review of recent trends in telehealth, governmental recommendations for health care delivery during the COVID-19 pandemic, and a PubMed Central query for telemedicine in ophthalmology or teleophthalmology. In addition, the authors' comprehensive experience in telemedicine design and implementation is provided. RESULTS: We provide a summary describing the present state of telehealth, teleophthalmology modeling, care delivery, and the proposed impact of telehealth surges on the future of ophthalmology practice. CONCLUSION: Recent patient and provider interest in telemedicine, the relaxation of regulatory restrictions, increased remote care reimbursement, and ongoing social distancing practices compel many ophthalmologists to consider virtualizing services.


Concern over a COVID-19-related BCG shortage


title: Exploring pharmacological approaches for managing cytokine storm associated with pneumonia and acute respiratory distress syndrome in COVID-19 patients

text: Sars-CoV-2 complications include pneumonia and acute respiratory distress syndrome (ARDS), which require intensive care unit admission. These conditions have rapidly overwhelmed healthcare systems, with detrimental effects on the quality of care and increased mortality. Social isolation strategies have been implemented worldwide with the aim of reducing hospital pressure. Among therapeutic strategies, the use of immunomodulating drugs, to improve prognosis, seems promising. Particularly, since pneumonia and ARDS are associated with a cytokine storm, drugs belonging to therapeutic classes as anti-IL-6, anti-TNF, and JAK inhibitors are currently studied. In this article, we discuss the potential advantages of the most promising pharmacological approaches.


Is one- or two-meters social distancing enough for COVID-19? Evidence for reassessing


title: Severe Pediatric COVID-19 Presenting With Respiratory Failure and Severe Thrombocytopenia

text: The novel severe acute respiratory syndrome coronavirus 2 is a worldwide pandemic. The severe morbidity and mortality associated with coronavirus disease 2019 has mostly affected the elderly or those with underlying medical conditions. We present a case of a 12-year-old girl with no past medical history who presented with fever, cough, and vomiting. Laboratory evaluation revealed severe thrombocytopenia and elevated markers of inflammation. The patient progressed to respiratory failure, and testing results for the severe acute respiratory syndrome coronavirus 2 returned positive. Because of the severity of her thrombocytopenia, she was treated with intravenous immunoglobulin and steroids with prompt improvement in platelets. The patient's severe acute respiratory distress syndrome was managed with mechanical ventilation, inhaled nitric oxide, and then airway pressure release ventilation. After azithromycin and hydroxychloroquine were given without improvement, our patient received tocilizumab, an anti-interleukin-6 receptor antibody, and remdesivir, a broad antiviral agent, with significant clinical benefit soon afterward. Given that severe pediatric coronavirus disease 2019 is rare, we hope to inform pediatric providers on the clinical course and management considerations as this pandemic continues to spread.


title: An encoder-decoder-based method for COVID-19 lung infection segmentation

text: The novelty of the COVID-19 disease and the speed of spread has created a colossal chaos, impulse among researchers worldwide to exploit all the resources and capabilities to understand and analyze characteristics of the coronavirus in term of the ways it spreads and virus incubation time. For that, the existing medical features like CT and X-ray images are used. For example, CT-scan images can be used for the detection of lung infection. But the challenges of these features such as the quality of the image and infection characteristics limitate the effectiveness of these features. Using artificial intelligence (AI) tools and computer vision algorithms, the accuracy of detection can be more accurate and can help to overcome these issues. This paper proposes a multi-task deep-learning-based method for lung infection segmentation using CT-scan images. Our proposed method starts by segmenting the lung regions that can be infected. Then, segmenting the infections in these regions. Also, to perform a multi-class segmentation the proposed model is trained using the two-stream inputs. The multi-task learning used in this paper allows us to overcome shortage of labeled data. Also, the multi-input stream allows the model to do the learning on many features that can improve the results. To evaluate the proposed method, many features have been used. Also, from the experiments, the proposed method can segment lung infections with a high degree performance even with shortage of data and labeled images. In addition, comparing with the state-of-the-art method our method achieves good performance results.


Seroconversion and indolent course of COVID-19 in patients with multiple sclerosis treated with fingolimod and teriflunomide


Coronavirus pandemic: compassionate communities and information technology


title: Unfolding SARS-CoV-2 viral genome to understand its gene expression regulation

text: SARS-CoV-2 is a new virus responsible for an outbreak of respiratory illness known as COVID-19, which has spread to several countries around the world and a global effort is being undertaken to characterize the molecular features and evolutionary origins of this virus. In silico analysis of the transcription start sites, promoter regions, transcription factors and their binding sites, gene ontology, CpG islands for SARS-CoV-2 viral genome are a first step to understand the regulation mechanisms of gene expression and its association with genetic variations in the genomes. For this purpose, we first computationally surveyed all SARS-CoV-2 virus genes with the open reading frames from NCBI database and found eleven sequences to accomplish the mentioned features by using bioinformatics tools. Our analysis revealed that all (100%) of the SARS-CoV-2 virus genes have more than one TSS. By taking all TSSs with the highest predictive score we determined promoter regions and identified five common candidate motifs (MVI, MVII, MVIII, MVIV and MVV) of which MVI was found to be shared by all promoter regions of SARS-CoV-2 virus genes with the least E-value (3.8e-056, statistically highly significant). In our further analysis of MVI we showed MVI serve as binding sites for a single transcription factor (TF) family, EXPREG, involved in the regulatory mode of these genes. From EXPREG family four TFs that belongs to Cyclic AMP (cAMP) receptor protein (CRP) and Catabolite control protein A (CcpA) group mostly serve as transcriptional activator whereas two TFs that belong to LexA group always serve as transcriptional repressor in different kinds of cellular processes and molecular functions. Therefore, we unfolded SARS-CoV-2 viral genome to shed light on its gene expression regulation that could help to design and evaluate diagnostic tests, to track and trace the ongoing outbreak and to identify potential intervention options.


title: Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

text: OBJECTIVE: Diabetes is common in COVID-19 patients and associated with unfavorable outcomes. We aimed to describe the characteristics and outcomes and to analyze the risk factors for in-hospital mortality of COVID-19 patients with diabetes. RESEARCH DESIGN AND METHODS: This two-center retrospective study was performed at two tertiary hospitals in Wuhan, China. Confirmed COVID-19 patients with diabetes (N = 153) who were discharged or died from 1 January 2020 to 8 March 2020 were identified. One sex- and age-matched COVID-19 patient without diabetes was randomly selected for each patient with diabetes. Demographic, clinical, and laboratory data were abstracted. Cox proportional hazards regression analyses were performed to identify the risk factors associated with the mortality in these patients. RESULTS: Of 1,561 COVID-19 patients, 153 (9.8%) had diabetes, with a median age of 64.0 (interquartile range 56.0-72.0) years. A higher proportion of intensive care unit admission (17.6% vs. 7.8%, P = 0.01) and more fatal cases (20.3% vs. 10.5%, P = 0.017) were identified in COVID-19 patients with diabetes than in the matched patients. Multivariable Cox regression analyses of these 306 patients showed that hypertension (hazard ratio [HR] 2.50, 95% CI 1.30-4.78), cardiovascular disease (HR 2.24, 95% CI 1.19-4.23), and chronic pulmonary disease (HR 2.51, 95% CI 1.07-5.90) were independently associated with in-hospital death. Diabetes (HR 1.58, 95% CI 0.84-2.99) was not statistically significantly associated with in-hospital death after adjustment. Among patients with diabetes, nonsurvivors were older (76.0 vs. 63.0 years), most were male (71.0% vs. 29.0%), and they were more likely to have underlying hypertension (83.9% vs. 50.0%) and cardiovascular disease (45.2% vs. 14.8%) (all P values <0.05). Age ≥70 years (HR 2.39, 95% CI 1.03-5.56) and hypertension (HR 3.10, 95% CI 1.14-8.44) were independent risk factors for in-hospital death of patients with diabetes. CONCLUSIONS: COVID-19 patients with diabetes had worse outcomes compared with the sex- and age-matched patients without diabetes. Older age and comorbid hypertension independently contributed to in-hospital death of patients with diabetes.


title: AhR and IDO1 in pathogenesis of Covid-19 and the "Systemic AhR Activation Syndrome:" Translational review and therapeutic perspectives

text: Covid-19 is the acute illness caused by SARS-CoV-2 with initial clinical symptoms such as cough, fever, malaise, headache, and anosmia. After entry into cells, corona viruses (CoV) activate aryl hydrocarbon receptors (AhRs) by an indoleamine 2,3-dioxygenase (IDO1)-independent mechanism, bypassing the IDO1-kynurenine-AhR pathway. The IDO1-kynurenine-AhR signaling pathway is used by multiple viral, microbial and parasitic pathogens to activate AhRs and to establish infections. AhRs enhance their own activity through an IDO1-AhR-IDO1 positive feedback loop prolonging activation induced by pathogens. Direct activation of AhRs by CoV induces immediate and simultaneous up-regulation of diverse AhR-dependent downstream effectors, and this, in turn, results in a "Systemic AhR Activation Syndrome" (SAAS) consisting of inflammation, thromboembolism, and fibrosis, culminating in multiple organ injuries, and death. Activation of AhRs by CoV may lead to diverse sets of phenotypic disease pictures depending on time after infection, overall state of health, hormonal balance, age, gender, comorbidities, but also diet and environmental factors modulating AhRs. We hypothesize that elimination of factors known to up-regulate AhRs, or implementation of measures known to down-regulate AhRs, should decrease severity of infection. Although therapies selectively down-regulating both AhR and IDO1 are currently lacking, medications in clinical use such as dexamethasone may down-regulate both AhR and IDO1 genes, as calcitriol/vitamin D3 may down-regulate the AhR gene, and tocopherol/vitamin E may down-regulate the IDO1 gene. Supplementation of calcitriol should therefore be subjected to epidemiological studies and tested in prospective trials for prevention of CoV infections, as should tocopherol, whereas dexamethasone could be tried in interventional trials. Because lack of physical exercise activates AhRs via the IDO1-kynurenine-AhR signaling pathway increasing risk of infection, physical exercise should be encouraged during quarantines and stay-at-home orders during pandemic outbreaks. Understanding which factors affect gene expression of both AhR and IDO1 may help in designing therapies to prevent and treat humans suffering from Covid-19.


Going viral: Doctors must combat fake news in the fight against covid-19


Low-dose corticosteroid therapy does not delay viral clearance in patients with COVID-19


title: Sustainable practice of ophthalmology during COVID-19: challenges and solutions

text: PURPOSE: The Coronavirus (COVID-19) outbreak is rapidly emerging as a global health threat. With no proven vaccination or treatment, infection control measures are paramount. In this article, we aim to describe the impact of COVID-19 on our practice and share our strategies and guidelines to maintain a sustainable ophthalmology practice. METHODS: Tan Tock Seng Hospital (TTSH) Eye Centre is the only ophthalmology department supporting the National Centre for Infectious Diseases (NCID), which is the national screening center and the main center for management of COVID-19 patients in Singapore. Our guidelines during this outbreak are discussed. RESULTS: Challenges in different care settings in our ophthalmology practice have been identified and analyzed with practical solutions and guidelines implemented in anticipation of these challenges. First, to minimize cross-infection of COVID-19, stringent infection control measures were set up. These include personal protective equipment (PPE) for healthcare workers and routine cleaning of "high-touch" surfaces. Second, for outpatient care, a stringent dual screening and triaging process were carried out to identify high-risk patients, with proper isolation for such patients. Administrative measures to lower patient attendance and reschedule appointments were carried out. Third, inpatient and outpatient care were separated to minimize interactions. Last but not least, logistics and manpower plans were drawn up in anticipation of resource demands and measures to improve the mental well-being of staff were implemented. CONCLUSION: We hope our measures during this COVID-19 pandemic can help ophthalmologists globally and serve to guide and maintain safe access in ophthalmology clinics when faced with similar disease outbreaks.


title: Use of Anakinra to Prevent Mechanical Ventilation in Severe COVID-19: A Case Series

text: OBJECTIVE: To report the clinical experience with anakinra for preventing mechanical ventilation (MV) in patients with COVID-19, features of cytokine storm syndrome (CSS), and acute hypoxic respiratory failure (AHRF). METHODS: In this retrospective case series, patients must have had SARS-CoV-2, fever, ferritin >1,000 ng/mL with one additional laboratory marker of hyperinflammation, and AHRF. AHRF was defined as requiring 15L of supplemental oxygen via non-rebreather mask combined with 6L nasal cannula or use of ≥95% oxygen by high flow nasal cannula. We excluded patients with suspicion for bacterial infection or on immunosuppressants. Subcutaneous anakinra was initiated at 100 mg q6 hours and gradually tapered off completely. Primary outcome was prevention of MV. RESULTS: Eleven of 14 patients meeting criteria received anakinra for a maximum of 19 days. Seven of those who initiated anakinra ≤36 hours after onset of AHRF did not require MV, and all were discharged home. Four patients who started anakinra ≥4 days after onset of AHRF required MV. Of those, 3 patients were extubated (2 discharged home, 1 remains hospitalized) and 1 died. All 3 patients who met criteria but did not receive anakinra required MV. Two were extubated (1 discharged and 1 remains hospitalized) and 1 remains on MV. CONCLUSIONS: Our data suggest that anakinra could be beneficial in COVID-19 patients with evidence of CSS when initiated early after onset of AHRF. Our patient selection and treatment approach should be considered for investigation in a clinical trial to determine the safety and efficacy of anakinra in patients with COVID-19 and features of CSS.


Fear in the age of COVID-19


Collateral damage of COVID-19-lockdown in Germany: decline of NSTE-ACS admissions


Solidarity and transparency against the COVID-19 pandemic


Update on possible animal sources for COVID-19 in humans


title: The perplexing question of trained immunity versus adaptive memory in COVID-19

text: The wide spectrum of symptoms observed in COVID-19 appears to defy explanation. Apart from geographic limitation to people with prior exposure to other coronaviruses and air pollutants, inflammatory comordidities and older ages are also among the main factors of susceptibility to severe illness. The unusual epidemiological data pointed out in children and African territories have revealed new insights in host-pathogen interplay with more focus on epigenetic regulation of cognitive compartments belonging to innate immunity. Should trained immunity be proven to be involved in timely immune responsiveness against SARS-CoV-2 and that adaptive memory could be detrimental, both treatment regimens and vaccine design will tremendously change accordingly with more focus on upper respiratory tissue innate immunity to subdue this threat underway. This article is protected by copyright. All rights reserved.


Radiation Therapy in King County, Washington During the COVID-19 Pandemic: Balancing Patient Care, Transmission Mitigation, and Resident Training


Association of the Coronavirus Disease 2019 (COVID-19) Outbreak With Enrollment in Cancer Clinical Trials


title: Characteristics and diagnosis rate of 5630 subjects receiving SARS-CoV-2 nucleic acid tests from Wuhan, China

text: BACKGROUNDThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a novel viral pneumonia (COVID-19), which is rapidly spreading throughout the world. The positive result of nucleic acid test is a golden criterion to confirm SARS-CoV-2 infection, but the detection features remain unclear.METHODSWe performed a retrospective analysis in 5630 high-risk individuals receiving SARS-CoV-2 nucleic acid tests in Wuhan, China, and investigated their characteristics and diagnosis rates.RESULTSThe overall diagnosis rate was 34.7% (1952/5630). Male (P = 0.025) and older populations (P = 2.525 × 10-39) were at significantly higher risk of SARS-CoV-2 infection. People were generally susceptible, and most cases concentrated in people of 30-79 years. Furthermore, we investigated the association between diagnosis rate and the amount of testing in 501 subjects. Results revealed a 1.27-fold improvement (from 27.9% to 35.5%) of diagnosis rate from testing once to twice (P = 5.847 × 10-9) and a 1.43-fold improvement (from 27.9% to 39.9%) from testing once to 3 times (P = 7.797 × 10-14). More than 3 testing administrations was not helpful for further improvement. However, this improvement was not observed in subjects with pneumonia (P = 0.097).CONCLUSIONAll populations are susceptible to SARS-CoV-2 infection, and male and older-aged populations are at significantly higher risk. Increasing the amount of testing could significantly improve diagnosis rates, except for subjects with pneumonia. It is recommended to test twice in those high-risk individuals whose results are negative the first time, and performing 3 tests is better, if possible.FUNDINGThis work was supported by National Mega Project on Major Infectious Disease Prevention (no. 2017ZX10103005-007) and National Key Research and Development Program of China (no. 2018YFE0204500).


Proteinuria in Covid-19 pregnant women: Preeclampsia or severe infection?


Dramatic improvement after tocilizumab of severe COVID-19 in a child with sickle cell disease and acute chest syndrome


Can computed tomography be a primary tool for COVID-19 detection? Evidence appraisal through meta-analysis


title: Exploratory Analysis of a Social Media Network in Sri Lanka during the COVID-19 Virus Outbreak

text: During the COVID-19 pandemic, multiple aspects of human life were subjected to unprecedented changes, globally. In Sri Lanka, a developing country located in South Asia, it was possible to observe a range of events that arose due to the influence of the COVID-19 virus outbreak. Thus, the people of Sri Lanka used Social Media to voice their opinions regarding such events and those involved in them, enabling the ideal avenue to explore the social perception. However, the outcome of such actions was at certain times detrimental. This study was conducted as an attempt to identify the reasons for such instances as well as to identify the behaviours of the Sri Lankan populace during such a crisis event. To support this study, observations, as well as data of related posts from a sample of 50 sources, were manually collected from the most popular social media platform in Sri Lanka, Facebook. The posts considered spanned until approximately a month after the initial major virus outbreak in the country and contained content that even vaguely related to the virus. Utilising such data, various forms of analyses such as topic significance and topic co-occurrences were conducted. The findings highlight, while there can be social detrimental ideas shared, the majority of the posts point constructive and positive thoughts suggesting the successful influence from the cultural and social values Sri Lanka society promotes throughout.


title: Vets would not manage Covid-19 this way

text: There needs to be a more effective and sustainable strategy to manage Covid-19 than the current economically ruinous policy, argue vets Dick Sibley and Joe Brownlie.


COVID-19 in Nursing Homes: The Problematic Management of Residents Without Positive COVID-19 RT-PCR


title: [Epidemiological characteristics of infection in COVID-19 close contacts in Ningbo city]

text: Objective: To estimate the infection rate of close contacts of COVID-19 cases, and to evaluate the risk of COVID-19 under different exposure conditions. Methods: A prospective study was used to conduct continuous quarantine medical observations of close contacts of people infected with COVID-19, collect epidemiological, clinical manifestations, and laboratory test data to estimate the infection rate of close contacts under different exposures. Results: The epidemiological curve of COVID-19 in Ningbo showed persistent human-to-human characteristics. A total of 2 147 close contacts were tracked and investigated. The total infection rate was 6.15%. The infection rates of confirmed cases and positive contacts were 6.30% and 4.11%, respectively. The difference was not statistically significant (P>0.05). Among close contacts of different relationships, friends/pilgrims (22.31%), family members (18.01%), and relatives (4.73%) have a higher infection rate, and close contacts of medical staff were not infected. Differences in infection rates among the close contacts were statistically significant (P<0.005). Living with the case (13.26%), taking the same transportation (11.91%), and dining together (7.18%) are high risk factors for infection. Cross-infection in the hospital should not be ignored (1.94%). The median of incubation period is 5 days. Conclusion: The infection rate of close contacts of COVID-19 cases is high, and isolation medical observation measures should be implemented in strict accordance with the close contact management plan.


Radiological approach to COVID-19 pneumonia: Attention should be paid to pulmonary embolism and radiation exposure


Li Wenliang, a face to the frontline healthcare worker. The first doctor to notify the emergence of the SARS-CoV-2, (COVID-19), outbreak


title: The Covid-19 pandemic seen from the frontline

text: COVID-19 disease caused by infection with the SARS-CoV-2 virus produces respiratory symptoms, predominantly of the upper airways, which can progress to pneumonia after 7 days with persistent fever, cough and dyspnea, and even develop a syndrome of acute respiratory distress (ARDS), multi-organ failure and death. Since COVID-19 disease was declared by the WHO there has been a redistribution of the healthcare system for these types of patients, especially in the front line, which is, in primary care, emergencies and in intensive care units (ICU). In primary care, the fundamental role is the diagnosis of the suspected patients, follow-up mainly by telemedicine (specially telephone calls) to detect warning signs in case of worsening and subsequent referral to the emergency department; as well as explaining home isolation measures. In the emergency department, it is included the management of suspicious cases and, if it any risk factor is found, complementary tests are carried out for precise diagnosis and admission assessment; In case of oxygen saturation <95% and poor general condition, valuation is requested for admission to the ICU. Depending on the severity of the patient, he/she would be or not a candidate for invasive mechanical ventilation, which must be performed by trained personnel to prevent the spread of the infection minimizing the risk of contagion. ARDS's treatment strategies include pulmonary protection ventilation, prone position, recruitment maneuvers and, less frequently, oxygenation by extracorporeal membrane. Among the specific treatments for COVID-19 stand out mainly drugs to reduce viral load, although sometimes specific drugs will be needed to treat hyperinflammation, hypercoagulability and concomitant infections. One of the goals to be achieved is for patients to recover and be able to successfully return to work; for this purpose, an adequate physical and psychological rehabilitation program is essential, as about 50% have symptoms of anxiety and depression.


COVID-19 and elective cosmetic procedures: Asymptomatic transmission in epidemic area and subsequent burdens


title: An Exploratory Study of COVID-19 Misinformation on Twitter

text: Although a lot of correct and useful information is shared through channels such as Twitter, it has also become a home ground for misinformation on COVID-19. To tackle this still ongoing infodemic, scientific oversight as well as a better understanding by practitioners in crisis management is needed. We have conducted an exploratory study into the propagation, authors and content of misinformation on Twitter around the topic of COVID-19 in order to gain early insights into the COVID-19 infodemic. Our results enable us to not only give first indications but also to suggest gaps in the current scientific coverage of the topic. Moreover, we propose actions for authorities to counter misinformation and hints for social media users on how to help stop the spread of misinformation.


title: Clinical Profile of Cases of COVID-19 in Far Western Province of Nepal

text: The novel coronavirus (COVID-19) cause various symptoms such as pneumonia, fever, breathing difficult and lung infection. Till now, total 9 cases are reported in Nepal and 4 cases from this province. This case series is to describe the initial clinical features of COVID-19 among the patients admitted in isolation ward of Seti Provincial Hospital. Oropharyngeal swab was taken from all four patients and sample was transfer to national reference laboratory. Three patients were coming from infected country and one is local transmission. Age of patients was range from 20 to 40 years of age with male preponderance. The patient coming from United Arab Emirate was presented with mild symptoms and others were asymptomatic. More tests, contact tracing and keeping them in quarantine are the necessitated action need to be taken by government of Nepal. Keywords: COVID-19; local transmission; oropharyngeal swab.


Use of Gerontechnology to Assist Older Adults to Cope with the COVID-19 Pandemic


title: Umifenovir treatment is not associated with improved outcomes in patients with coronavirus disease 2019: a retrospective study

text: OBJECTIVES: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Umifenovir (Arbidol®) is an antiviral drug being used to treat influenza in Russia and China. This study aimed to investigate the effectiveness and safety of umifenovir for COVID-19. METHODS: A retrospective study was performed in a non-intensive care unit (ICU) ward in Jinyintan Hospital from 2 February 2020 to 20 March 2020. COVID-19 was confirmed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of pharyngeal swab specimens. The confirmed patients were divided into the umifenovir group and the control group according to the use of umifenovir. The main outcomes were the rate of negative pharyngeal swab tests for SARS-CoV-2 within 1 week after admission and the time for the virus to turn negative. The negativity time of SARS-CoV-2 was defined as the first day of a negative test if the nucleic acid of SARS-CoV-2 was negative for two consecutive tests. RESULTS: A total of 81 COVID-19 patients were included, with 45 in the umifenovir group and 36 in the control group. Baseline clinical and laboratory characteristics were comparable between the two groups. Thirty-three out of 45 (73%) patients in the umifenovir group tested negative for SARS-CoV-2 within 7 days after admission, the number was 28/36 (78%) in the control group (p 0.19). The median time from onset of symptoms to SARS-CoV-2 turning negative was 18 days (interquartile range (IQR) 12-21) in the umifenovir group and 16 days (IQR 11-21) in the control group (p 0.42). Patients in the umifenovir group had a longer hospital stay than patients in the control group (13 days (IQR 9-17) vs 11 days (IQR 9-14), p 0.04). No deaths or severe adverse reactions were found in both groups. DISCUSSION: Umifenovir might not improve the prognosis or accelerate SARS-CoV-2 clearance in non-ICU patients. A randomized control clinical trial is needed to assess the efficacy of umifenovir.


Challenges and countermeasures in the prevention of nosocomial infections of SARS-CoV-2 before resumption of work: implications for the dermatology department


View From the COVID Palliative Care Unit


COVID-19: How to select patients for endoscopy and how to reschedule the procedures?


Tracking, tracing, trust: contemplating mitigating the impact of COVID-19 through technological interventions


The Italian Endo-COVID-19. Our response to the emergency


title: A Global Digital Citizen Science Policy to Tackle Pandemics Like COVID-19

text: The coronavirus disease (COVID-19) pandemic is an extremely complex existential threat that requires cohesive societal effort to address health system inefficiencies. When our society has faced existential crises in the past, we have banded together by using the technology at hand to overcome them. The COVID-19 pandemic is one such threat that requires not only a cohesive effort, but also enormous trust to follow public health guidelines, maintain social distance, and share necessities. However, are democratic societies with civil liberties capable of doing this? Mobile technology has immense potential for addressing pandemics like COVID-19, as it gives us access to big data in terms of volume, velocity, veracity, and variety. These data are particularly relevant to understand and mitigate the spread of pandemics such as COVID-19. In order for such intensive and potentially intrusive data collection measures to succeed, we need a cohesive societal effort with full buy-in from citizens and their representatives. This article outlines an evidence-based global digital citizen science policy that provides the theoretical and methodological foundation for ethically sourcing big data from citizens to tackle pandemics such as COVID-19.


Duration of quarantine in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a question needing an answer


title: Speech-Language Pathology Guidance for Tracheostomy During the COVID-19 Pandemic: An International Multidisciplinary Perspective

text: Purpose As the COVID-19 pandemic has unfolded, there has been growing recognition of risks to frontline health care workers. When caring for patients with tracheostomy, speech-language pathologists have significant exposure to mucosal surfaces, secretions, and aerosols that may harbor the SARS-CoV-2 virus. This tutorial provides guidance on practices for safely performing patient evaluation and procedures, thereby reducing risk of infection. Method Data were collated through review of literature, guidelines, and consensus statements relating to COVID-19 and similar high-consequent infections, with a focus on mitigating risk of transmission to health care workers. Particular emphasis was placed on speech-language pathologists, nurses, and other allied health professionals. A multinational interdisciplinary team then analyzed findings, arriving at recommendations through consensus via electronic communications and video conference. Results Reports of transmission of infection to health care workers in the current COVID-19 pandemic and previous outbreaks substantiate the need for safe practices. Many procedures routinely performed by speech-language pathologists have a significant risk of infection due to aerosol generation. COVID-19 testing can inform level of protective equipment, and meticulous hygiene can stem spread of nosocomial infection. Modifications to standard clinical practice in tracheostomy are often required. Personal protective equipment, including either powered air-purifying respirator or N95 mask, gloves, goggles, and gown, are needed when performing aerosol-generating procedures in patients with known or suspected COVID-19 infection. Conclusions Speech-language pathologists are often called on to assist in the care of patients with tracheostomy and known or suspected COVID-19 infection. Appropriate care of these patients is predicated on maintaining the health and safety of the health care team. Careful adherence to best practices can significantly reduce risk of infectious transmission.


title: Nursing human resource management of infectious disease hospitals under novel coronavirus pneumonia threats/ 中华医院管理杂志

text: With the outbreak of novel coronavirus pneumonia, Beijing You'an Hospital has become one of the three infectious disease specialist hospitals designated to treat patients of such pneumonia. Under the premise of comprehensively implementing various emergency treatment tasks and ensuring the normal operation of other wards, the Nursing Department has put in place emergency plans and deployed due manpower for rapid response, timely personnel deployment, and reasonable reserve echelon structure. These measures have been taken as required by the patients’ numbers, critical conditions, disease diagnosis, and the guidelines of treatment and protection. While ensuring the completion of treatment work, we manage to leverage nursing human resources in a scientific, standardized and maximized efficiency manner, to ensure the quality of nursing, and the physical and mental health of nursing staff.


Three Cases of COVID-19 Disease With Colonic Manifestations


COVID-19 makes a stronger research focus on home drinking more important than ever


COVID and consent


COVID-19 pandemic and limited palliative care response: "Lack of comfort care"


title: Consideration of the respiratory support strategy of severe acute respiratory failure caused by SARS-CoV-2 infection in children

text: The recent ongoing outbreak of severe pneumonia associated with a novel coronavirus (SARS-CoV-2), currently of unknown origin, creates a world emergency that has put global public health institutions on high alert. At present there is limited clinical information of the SARS-CoV-2 and there is no specific treatment recommended, although technical guidances and suggestions have been developed and will continue to be updated as additional information becomes available. Preventive treatment has an important role to control and avoid the spread of severe respiratory disease, but often is difficult to obtain and sometimes cannot be effective to reduce the risk of deterioration of the underlining lung pathology. In order to define an effective and safe treatment for SARS-CoV-2-associated disease, we provide considerations on the actual treatments, on how to avoid complications and the undesirable side effects related to them and to select and apply earlier the most appropriate treatment. Approaching to treat severe respiratory disease in infants and children, the risks related to the development of atelectasis starting invasive or non-invasive ventilation support and the risk of oxygen toxicity must be taken into serious consideration. For an appropriate and effective approach to treat severe pediatric respiratory diseases, two main different strategies can be proposed according to the stage and severity of the patient conditions: patient in the initial phase and with non-severe lung pathology and patient with severe initial respiratory impairment and/or with delay in arrival to observation. The final outcome is strictly connected with the ability to apply an appropriate treatment early and to reduce all the complications that can arise during the intensive care admission.


title: Simulation of the Final Size of the Evolution Curve of Coronavirus Epidemic in Morocco using the SIR Model

text: Since the epidemic of COVID-19 was declared in Wuhan, Hubei Province of China, and other parts of the world, several studies have been carried out over several regions to observe the development of the epidemic, to predict its duration, and to estimate its final size, using complex models such as the SEIR model or the simpler ones such as the SIR model. These studies showed that the SIR model is much more efficient than the SEIR model; therefore, we are applying this model in the Kingdom of Morocco since the appearance of the first case on 2 March 2020, with the objective of predicting the final size of the epidemic.


title: Double-bright (CD56bright/CD16bright) NK cell adoptive immunotherapy for SARS-CoV-2

text: SARS-CoV-2, affecting predominantly elderlies, was recognized as a global pandemic in March 11th , 2020; clinical signs and laboratory alterations are similar to previous coronavirus epidemics with lymphocytopenia and neutrophilia observed in severe cases.


title: Extracting Possibly Representative COVID-19 Biomarkers from X-ray Images with Deep Learning Approach and Image Data Related to Pulmonary Diseases

text: Purpose: While the spread of COVID-19 is increased, new, automatic, and reliable methods for accurate detection are essential to reduce the exposure of the medical experts to the outbreak. X-ray imaging, although limited to specific visualizations, may be helpful for the diagnosis. In this study, the problem of automatic classification of pulmonary diseases, including the recently emerged COVID-19, from X-ray images, is considered. Methods: Deep Learning has proven to be a remarkable method to extract massive high-dimensional features from medical images. Specifically, in this paper, the state-of-the-art Convolutional Neural Network called Mobile Net is employed and trained from scratch to investigate the importance of the extracted features for the classification task. A large-scale dataset of 3905 X-ray images, corresponding to 6 diseases, is utilized for training MobileNet v2, which has been proven to achieve excellent results in related tasks. Results: Training the CNNs from scratch outperforms the other transfer learning techniques, both in distinguishing the X-rays between the seven classes and between Covid-19 and non-Covid-19. A classification accuracy between the seven classes of 87.66% is achieved. Besides, this method achieves 99.18% accuracy, 97.36% Sensitivity, and 99.42% Specificity in the detection of COVID-19. Conclusion: The results suggest that training CNNs from scratch may reveal vital biomarkers related but not limited to the COVID-19 disease, while the top classification accuracy suggests further examination of the X-ray imaging potential.


title: Coronavirus-Pandemie  Erinnerungen an die Grippe-Epidemie von 1918 aus gynäkologisch-geburtshilflicher Sicht./ [Coronavirus pandemic-Memories of the flu epidemic from 1918 from a gynecological and obstetric perspective]

text: From the medical reports on the flu epidemic in 1918, there is accordance with the present-day corona pandemic. The symptoms, course and outcome all seem to show parallels. Pregnant women in the last trimester are to be classified as being particularly vulnerable. Physicians in several disciplines, e.g. gynecology, general medicine and internal medicine are equally called upon to be particularly vigilant.


Severe exacerbation of immune thrombocytopenia and COVID-19: the favorable response to corticosteroid-based therapy-a case report


title: Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study

text: Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring self-isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18-48 [0-116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID-19 transmission.


Cardiac drugs and outcome in COVID-19


COVID-19 and heart injury: Appropriate methodology is crucial for assessing the emerging evidence


Workflow updates to maintain clinical services and reduce utilisation of personal protective equipment during the COVID-19 outbreak


title: Effects of SARS-CoV-2 infection on pregnant women and their infants: A retrospective study in Wuhan, China

text: Context: The pandemic of a novel coronavirus, termed SARS-CoV-2, has created an unprecedented global health burden. Objective: To investigate the effect of the SARS-CoV-2 infection on maternal, fetal, and neonatal morbidity and other poor obstetrical outcomes. Design: All suspected cases of pregnant women with Coronavirus Disease 2019 (COVID-19) admitted into one center of Wuhan from Jan 20, 2020 to March 19, 2020 were included. Detailed clinical data of those pregnancies with COVID-19 were retrospectively collected and analyzed. Results: Twenty-seven laboratory or clinically confirmed SARS-CoV-2 infection pregnant women (4 early pregnancies included) and 24 neonates born to the 23 late pregnant mothers were analyzed. On admission, 46.2% (13/27) of the patients had symptoms, including fever (11/27), cough (9/27) and vomiting (1/27). Decreased total lymphocytes count was observed in 81.6% (22/27) patients. Twenty-six patients showed typical viral pneumonia by chest computed tomography (CT) scan, while one patient confirmed with COVID-19 infection showed no abnormality on chest CT. One mother developed severe pneumonia three days after her delivery. No maternal and perinatal death occurred. Moreover, one early preterm newborn, born to a mother with complication of premature rupture of fetal membranes, highly suspected with SARS-CoV-2 infection, was SARS-CoV-2 negative after repeated real-time reverse transcriptase polymerase chain reaction testing. Statistical difference was observed between the groups of early pregnant and late pregnant women with COVID-19 in the occurrence of lymphopenia and thrombocytopenia. Conclusions: No major complication were reported among the studied cohort, though one serious case and one perinatal infection were observed. Much effort should be done to reduce the pathogenic effect of COVID-19 infection in pregnancies.


title: A Genomic Perspective on the Origin and Emergence of SARS-CoV-2

text: The ongoing pandemic of a new human coronavirus, SARS-CoV-2, has generated enormous global concern. We and others in China were involved in the initial genome sequencing of the virus. Herein, we describe what genomic data reveal about the emergence SARS-CoV-2 and discuss the gaps in our understanding of its origins.


Changes in the work mode of cardiologists during the COVID-19 epidemic in Wuhan


title: Statistical and network analysis of 1212 COVID-19 patients in Henan, China

text: BACKGROUND: COVID-19 is spreading quickly all over the world. Publicly released data for 1212 COVID-19 patients in Henan of China were analyzed in this paper. METHODS: Various statistical and network analysis methods were employed. RESULTS: We found that COVID-19 patients show gender (55% vs 45%) and age (81% aged between 21 and 60) preferences; possible causes were explored. The estimated average, mode and median incubation periods are 7.4, 4 and 7 days. Incubation periods of 92% of patients were no more than 14 days. The epidemic in Henan has undergone three stages and has shown high correlations with the numbers of patients recently returned from Wuhan. Network analysis revealed that 208 cases were clustering infected, and various People's Hospitals are the main force in treating COVID-19. CONCLUSIONS: The incubation period was statistically estimated, and the proposed state transition diagram can explore the epidemic stages of emerging infectious disease. We suggest that although the quarantine measures are gradually working, strong measures still might be needed for a period of time, since â¼7.45% of patients may have very long incubation periods. Migrant workers or college students are at high risk. State transition diagrams can help us to recognize the time-phased nature of the epidemic. Our investigations have implications for the prevention and control of COVID-19 in other regions of the world.


COVID-19 Carrier or Pneumonia: Positive Real-Time Reverse-Transcriptase Polymerase Chain Reaction but Negative or Positive Chest CT Results


title: [Anosmia and COVID-19]

text: Anosmia associated or not with dysgeusia seems to be a frequent symptom in cases of infection with SARS-CoV-2 responsible for COVID-19 It can be the initial symptom of the disease or remain isolated in pauci-symptomatic patients Waiting for scientific confirmation and in the context of the current pandemic, it seems essential to consider any patient with a new anosmia as being infected with SARS-CoV-2 until proven otherwise These patients should therefore isolate themselves and remain alert to the occurrence of other symptoms suggestive of the infection and/or be tested Topical and systemic corticosteroids and nose washes are contraindicated The natural course of anosmia seems to be favorable in most cases


Care homes after covid-19: the government needs a plan


title: Neurosurgery and Neurology Practices during the Novel COVID-19 Pandemic: A Consensus Statement from India

text: Background: The COVID-19 infection outbreak has aroused increasing attention and affected thousands of people nationwide. The long incubation period, high infectious rate, varied manifestation, and absence of effective treatment make it difficult to manage the disease transmission. Objective: The intended goals are to encourage efficient management of neurological and neurosurgical patients, resource utilization, and protecting the healthcare provider during the COVID-19 epidemic. Herein, we present a consensus statement from various centers in India. Methodology: In addition to the literature review, recommendations were included from neurologists and neurosurgeons from various centers in India. Results: Every patient presenting for treatment should be treated as a potential asymptomatic infected case. Patients should be categorized based upon the priority as acute (require immediate treatment/surgery within 24 h), sub-acute (requiring treatment within a maximum of 7-10 days), or chronic (requiring treatment within a month). Non-essential elective surgeries and outpatient clinics should be avoided after informing the patient(s). There is a high risk of aerosol dispersion during intubation and certain neurosurgical procedures particularly those involving drills and endoscopes. These procedures should be performed wearing full personal protective equipment. The workflow of the operating rooms should also be modified significantly. Minor modifications in personal and professional lifestyles and routine training to use the PPE will ensure efficient management of resources. Conclusion: These recommendations could be used to mitigate the risks and reduce exposure to other patients, public, and healthcare staff.


title: Automated Detection of TMJ Osteoarthritis Based on Artificial Intelligence

text: The purpose of this study was to develop a diagnostic tool to automatically detect temporomandibular joint osteoarthritis (TMJOA) from cone beam computed tomography (CBCT) images with artificial intelligence. CBCT images of patients diagnosed with temporomandibular disorder were included for image preparation. Single-shot detection, an object detection model, was trained with 3,514 sagittal CBCT images of the temporomandibular joint that showed signs of osseous changes in the mandibular condyle. The region of interest (condylar head) was defined and classified into 2 categories-indeterminate for TMJOA and TMJOA-according to image analysis criteria for the diagnosis of temporomandibular disorder. The model was tested with 2 sets of 300 images in total. The average accuracy, precision, recall, and F1 score over the 2 test sets were 0.86, 0.85, 0.84, and 0.84, respectively. Automated detection of TMJOA from sagittal CBCT images is possible by using a deep neural networks model. It may be used to support clinicians with diagnosis and decision making for treatments of TMJOA.


The Impact of the COVID-19 Pandemic on Cardiovascular Fellows-in-Training: A National Survey


title: Neuro-oncology Management During the COVID-19 Pandemic With a Focus on WHO Grade III and IV Gliomas

text: BACKGROUND: Because of the increased risk in cancer patients of developing complications caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), physicians have to balance the competing risks of the negative impact of the pandemic and the primary tumor. In this consensus statement, an international group of experts present mitigation strategies and treatment guidance for patients suffering from high grade gliomas (HGG) during the coronavirus disease 2019 (COVID-19) pandemic. METHOD / RESULTS: 16 international experts in the treatment of HGG contributed to this consensus-based practice recommendation including neuro-oncologists, neurosurgeons, radiation -oncologists and a medical physicist. Generally, treatment of neuro-oncological patients cannot be significantly delayed and initiating therapy should not be outweighed by COVID-19. We present detailed interdisciplinary treatment strategies for molecular subgroups in two pandemic scenarios, a scale-up phase and a crisis phase. CONCLUSION: This practice recommendation presents a pragmatic framework and consensus-based mitigation strategies for the treatment of HGG patients during the SARS-CoV-2 pandemic.


title: The outbreak of COVID-19 coronavirus and its impact on global mental health

text: BACKGROUND: The current outbreak of COVID-19 coronavirus infection among humans in Wuhan (China) and its spreading around the globe is heavily impacting on the global health and mental health. Despite all resources employed to counteract the spreading of the virus, additional global strategies are needed to handle the related mental health issues. METHODS: Published articles concerning mental health related to the COVID-19 outbreak and other previous global infections have been considered and reviewed. COMMENTS: This outbreak is leading to additional health problems such as stress, anxiety, depressive symptoms, insomnia, denial, anger and fear globally. Collective concerns influence daily behaviors, economy, prevention strategies and decision-making from policy makers, health organizations and medical centers, which can weaken strategies of COVID-19 control and lead to more morbidity and mental health needs at global level.


Management strategy of emergency surgery combined with 2019 novel coronavirus (SARS-CoV-2) infection in cardiovascular surgery


Editorial: Aerosol reduction urgency in post-COVID-19 dental practice


Fast Screening Systems for COVID-19


title: Sentiment Analysis: Detecting Valence, Emotions, and Other Affectual States from Text

text: Recent advances in machine learning have led to computer systems that are human-like in behaviour. Sentiment analysis, the automatic determination of emotions in text, is allowing us to capitalize on substantial previously unattainable opportunities in commerce, public health, government policy, social sciences, and art. Further, analysis of emotions in text, from news to social media posts, is improving our understanding of not just how people convey emotions through language but also how emotions shape our behaviour. This article presents a sweeping overview of sentiment analysis research that includes: the origins of the field, the rich landscape of tasks, challenges, a survey of the methods and resources used, and applications. We also discuss discuss how, without careful fore-thought, sentiment analysis has the potential for harmful outcomes. We outline the latest lines of research in pursuit of fairness in sentiment analysis.


title: COVID-19 and coagulative axis: review of emerging aspects in a novel disease

text: Latest evidences from literature suggest that SARS-CoV-2 disease 2019 (COVID-19) is commonly complicated with coagulopathy and that disseminated intravascular coagulation is present in the majority of deceased patients. Particularly, conventional coagulation parameters appear to be significantly altered in patients with poor prognosis. A wide-ranging cross- talk between coagulative haemostasis and inflammation, as well as the activation of coagulation cascade during viral infections, are well established. Another important evidence which may explain coagulation disorders in COVID-19 is the increase of thrombus formation under conditions of hypoxia. Despite the exact pathophysiological mechanism of coronavirus-induced thromboembolism needs to be further investigated, this finding suggests that it is good practice to assess the risk of thrombosis in COVID-19 patients to improvethe clinical management in terms of anticoagulation therapy. Anticoagulants, mainly low-molecular-weight heparin (LMWH), should be tailored in patients meeting sepsis induced coagulopathy (SIC) criteria or with markedly elevated D-dimer. In this context, further studies are needed to optimise the decision making in therapeutic approach.


title: Laboratory-confirmed COVID-19 in children and youth in Canada, January 15-April 27, 2020

text: Understanding the epidemiology of COVID-19 among children and youth in Canada will help to inform public health measures in settings where children gather. As of April 27, 2020, provinces and territories provided the Public Health Agency of Canada with detailed information on 24,079 cases, of which 3.9% (n=938) were younger than 20 years of age. The detection rate per 100,000 population was lower in this age group (11.9 per 100,000), compared with those aged 20-59 years (72.4 per 100,000) and 60 and older (113.6 per 100,000). The median age among those younger than 20 years of age was 13 years, and cases were distributed equally across male and female genders. Among provinces and territories with more than 100 cases, 1.6% to 9.8% of cases were younger than 20 years of age. Cases in this age group were more likely to be asymptomatic: 10.7% compared with 2.4% in those aged 20-59 years and 4.1% in those aged 60 and older. Children and youth experienced severe outcomes less often, but 2.2% (n=15/672) of cases within this age group were severe enough to require hospitalization. Based on available exposure information, 11.3% (n=59/520) of cases aged younger than 20 years had no known contact with a case. Canadian findings align with those of other countries.


SARS-CoV-2-associated cold agglutinin disease: a report of two cases


title: [Airway management of COVID-19 patients with severe pneumonia]

text: Patients with severe and critical COVID-19 will develop into acute respiratory distress syndrome in a short time. Noninvasive or invasive positive pressure ventilation will be important means for those patients, which will help to improve the clinical cure rate and reduce the mortality. Effective airway management has a great significance to improve respiratory support, reduce complications, and promote rehabilitation.


title: Did lockdowns serve their purpose?

text: We show that the dynamics of the number of deaths due to Covid in different countries is to a large extent universal once the origin of time is chosen to be the start of the lockdown, and the number of death is rescaled by the total number of deaths after the lockdown, itself a proxy of the number of infections at the start of the lockdown. Such a curve collapse is much less convincing when normalizing by the total population. Sweden, with its no-lockdown, light-touch approach, is the only outlier that deviates considerably from the average behavior. We argue that these model-free findings provide strong support for the effectiveness of the lockdowns in mitigating the lethality of the virus.


Health measures to travellers and cruise ships in response to COVID-19


Patients with sickle cell disease and suspected COVID-19 in a paediatric intensive care unit


title: Hyperacute multi-organ thromboembolic storm in COVID-19: a case report

text: Acute viral pneumonia, hypoxemic respiratory failure and severe inflammatory response are hallmarks of severe coronavirus disease 2019 (COVID-19). The COVID-19-associated inflammatory state may further lead to symptomatic thromboembolic complications despite prophylaxis. We report a 66-year-old female patient with post-mortem diagnosis of COVID-19 who presented progressive livedo racemosa, acute renal failure and myocardial injury, as well as an absence of respiratory symptoms. Transthoracic echocardiography showed severe spontaneous echo contrast in the right cardiac chambers and right-sided cardiac overload presumed to result from pulmonary microvascular thrombosis or embolism. D-dimer levels were increased. The patient developed an acute ischemic stroke and died 2 days following presentation despite therapeutic anticoagulation. Her predominantly thromboembolic presentation supports the concept of coronavirus infection of endothelial cells and hypercoagulability, or COVID-19 endotheliitis. The case we report highlights that COVID-19-associated hyperacute multi-organ thromboembolic storm may precede or present disproportionately to respiratory involvement.


title: Excessive lysosomal ion-trapping of hydroxychloroquine and azithromycin

text: A recent report identified significant reductions or disappearance of viral load in COVID-19 patients given a combination of hydroxychloroquine and azithromycin. The present communication discusses some common pharmacokinetic properties of these two drugs that may be linked to a potential underlying mechanism of action for these antiviral effects. The physicochemical properties of both hydroxychloroquine and azithromycin are consistent with particularly high affinity for the intracellular lysosomal space, which has been implicated as a target site for antiviral activity. The properties of both drugs predict dramatic accumulation in lysosomes, with calculated lysosomal drug concentrations that exceed cytosolic and extracellular concentrations by more than 50 000-fold. These predictions are consistent with previously reported experimentally measured cellular and extracellular concentrations of azithromycin. This is also reflected in the very large volumes of distribution of these drugs, which are among the highest of all drugs currently in use. The combination of hydroxychloroquine and azithromycin produces very high local concentrations in lysosomes. The clinical significance of this observation is unclear; however, the magnitude of this mechanism of drug accumulation via ion-trapping in lysosomes could be an important factor for the pharmacodynamic effects of this drug combination.


The perils of COVID-19 in Nepal: Implications for population health and nutritional status


Corticosteroids and the hyper-inflammatory phase of the COVID-19 disease


Infection of severe acute respiratory syndrome coronavirus 2 in a patient with acquired immunodeficiency syndrome


Supporting Social Distancing for COVID-19 Mitigation Through Community-Based Volunteer Networks


Knowledge regarding COVID-19 pandemic in patients with multiple sclerosis (MS): A report from Iran


Novel corona virus disease (COVID-19) and ophthalmic manifestations: Clinical evidences


title: A COVID-19 Transmission within a family cluster by presymptomatic infectors in China

text: We report a COVID-19 family cluster caused by a presymptomatic case. There were 9 family members, including 8 laboratory-confirmed with COVID-19, and a 6-year-old child had no evidence of infection. Amongst the 8 patients, one adult and one 13-month-old infant were asymptomatic, one adult was diagnosed as having severe pneumonia.


Rapid response to COVID-19 outbreak in Northern Italy: how to convert a classic infectious disease ward into a COVID-19 response centre


"Sex in the Time of COVID": Clinical Guidelines for Sexually Transmitted Disease Management in an Era of Social Distancing


Covid-19: doctors' leaders warn that staff could quit and may die over lack of protective equipment


title: Short-term skin reactions following use of N95 respirators and medical masks

text: BACKGROUND: In the context of the COVID-19 pandemic, cases of adverse skin reactions related to the wearing of masks have been observed. OBJECTIVES: To analyze the short-term effects of N95 respirators and medical masks, respectively, on skin physiological properties and to report adverse skin reactions caused by the protective equipment. METHODS: This study used a randomized crossover design with repeated measurements. Twenty healthy Chinese volunteers were recruited. Skin parameters were measured on areas covered by the respective masks and on uncovered skin 2 and 4 hours after donning, and 0.5 and 1 hour after removing the masks, including skin hydration, transepidermal water loss (TEWL), erythema, pH, and sebum secretion. Adverse reactions were clinically assessed, and perceived discomfort and non-compliance measured. RESULTS: Skin hydration, TEWL, and pH increased significantly with wearing the protective equipment. Erythema values increased from baseline. Sebum secretion increased both on the covered and uncovered skin with equipment-wearing. There was no significant difference in physiological values between the two types of equipment. More adverse reactions were reported following a N95 mask use than the use of a medical mask, with a higher score of discomfort and non-compliance. CONCLUSIONS: This study demonstrates that skin biophysical characters change as a result of wearing a mask or respirator. N95 respirators were associated with more skin reactions than medical masks.


title: Therapeutic pulmonary telerehabilitation protocol for patients affected by COVID-19, confined to their homes: study protocol for a randomized controlled trial

text: BACKGROUND: In December 2019, 27 cases of pneumonia, of unknown cause, were identified in the province of Hubei (China). The WHO declared the situation as a Public Health Emergency of International Concern, and it was finally declared a global pandemic on March 11, 2020. The Spanish Government obliges the entire population to remain confined to their homes, with the exception of essential basic services, to stop the spread of COVID-19. Home isolation implies a notable physical deconditioning. Telerehabilitation methods have reported positive experiences, and we propose to study in affected patients of COVID-19, due to the general house confinement of the entire Spanish population. METHODS: Patients will be recruited in the regions of Andalusia, Murcia, and Valencia (Spain). Patients will remain confined to their homes, and there, they will carry out their assigned exercise program, which will be controlled telematically. Evaluators will attend to carry out all measurements at the beginning, during, and end of the study, telematically controlled. The patients will be randomly divided into three groups, two of them will perform a home exercise program (breathing exercises or non-specific exercises for muscle toning) and the third group will perform sedentary activities, using mental activation techniques, and will act as a sham group. We will evaluate respiratory variables and other variables of the physical state through physical tests, effort, and perceived fatigue. The data will be statistically analyzed, and the hypotheses will be tested between the groups, using the SPSS software, v.24, considering a 95% confidence interval. DISCUSSION: We will analyze the results, in terms of the level of fatigue and perceived exertion, physical health, and maintenance of respiratory activity of two types of exercise programs, toning and respiratory, applied in patients affected by COVID-19 during the period of home confinement. We intend to investigate a field not previously studied, such as the repercussion of carrying out a toning and respiratory exercise program in these patients, in historical circumstances that no one had previously observed in Spain, since the general population has never been forced to remain confined in their homes, due to a pandemic infection, by a coronavirus (COVID-19). Observing the effects that these two home exercise programs could produce in patients infected with COVID-19, we will try to better analyze and understand the mechanisms that are associated with the worsening of breathing in this type of patient. TRIAL REGISTRATION: Brazilian Clinical Trial Registry RBR-6m69fc . Registered on March 31, 2020.


title: Immunophenotyping of COVID-19 and influenza highlights the role of type I interferons in development of severe COVID-19

text: Although most SARS-CoV-2-infected individuals experience mild coronavirus disease 2019 (COVID-19), some patients suffer from severe COVID-19, which is accompanied by acute respiratory distress syndrome and systemic inflammation. To identify factors driving severe progression of COVID-19, we performed single-cell RNA-seq using peripheral blood mononuclear cells (PBMCs) obtained from healthy donors, patients with mild or severe COVID-19, and patients with severe influenza. Patients with COVID-19 exhibited hyper-inflammatory signatures across all types of cells among PBMCs, particularly up-regulation of the TNF/IL-1ß-driven inflammatory response as compared to severe influenza. In classical monocytes from patients with severe COVID-19, type I IFN response co-existed with the TNF/IL-1ß-driven inflammation, and this was not seen in patients with milder COVID-19. Interestingly, we documented type I IFN-driven inflammatory features in patients with severe influenza as well. Based on this, we propose that the type I IFN response plays a pivotal role in exacerbating inflammation in severe COVID-19.


title: Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID-19 outbreak: a cross-sectional study

text: OBJECTIVES: To investigate the mental status of pregnant women and to determine their obstetric decisions during the COVID-19 outbreak. DESIGN: Cross-sectional study. SETTING: Two cities in China, Wuhan (epicentre) and Chongqing (a less affected city). POPULATION: 1947 pregnant women. METHODS: We collected demographic, pregnancy, and epidemic information from our pregnant subjects, along with their attitudes towards COVID-19 (using a self-constructed five-point scale). The Self-Rating Anxiety Scale (SAS) was used to assess anxiety status. Obstetric decision-making was also evaluated. The differences between cities in all of the above factors were compared, and the factors that influenced anxiety levels were identified by multivariable analysis. MAIN OUTCOME MEASURES: Anxiety status and its influencing factors. Obstetric decision-making. RESULTS: Differences were observed between cities in some background characteristics and women's attitudes towards COVID-19 in Wuhan were more extreme. More women in Wuhan felt anxious (24.5% vs 10.4%). Factors that influenced anxiety also included household income, subjective symptoms, and attitudes. Overall, obstetric decisions also revealed city-based differences; these decisions mainly concerned hospital preference, time of prenatal care or delivery, mode of delivery and infant feeding. CONCLUSIONS: The outbreak aggravated prenatal anxiety, and the associated factors could be targets for psychological care. In parallel, key obstetric decision-making changed, emphasising the need for pertinent professional advice. Special support is essential for pregnant mothers during epidemics.


title: The COVID-19 pandemic: a new challenge for syndromic surveillance

text: The COVID-19 pandemic is exerting major pressures on society, health and social care services and science. Understanding the progression and current impact of the pandemic is fundamental to planning, management and mitigation of future impact on the population. Surveillance is the core function of any public health system, and a multi-component surveillance system for COVID-19 is essential to understand the burden across the different strata of any health system and the population. Many countries and public health bodies utilise 'syndromic surveillance' (using real-time, often non-specific symptom/preliminary diagnosis information collected during routine healthcare provision) to supplement public health surveillance programmes. The current COVID-19 pandemic has revealed a series of unprecedented challenges to syndromic surveillance including: the impact of media reporting during early stages of the pandemic; changes in healthcare-seeking behaviour resulting from government guidance on social distancing and accessing healthcare services; and changes in clinical coding and patient management systems. These have impacted on the presentation of syndromic outputs, with changes in denominators creating challenges for the interpretation of surveillance data. Monitoring changes in healthcare utilisation is key to interpreting COVID-19 surveillance data, which can then be used to better understand the impact of the pandemic on the population. Syndromic surveillance systems have had to adapt to encompass these changes, whilst also innovating by taking opportunities to work with data providers to establish new data feeds and develop new COVID-19 indicators. These developments are supporting the current public health response to COVID-19, and will also be instrumental in the continued and future fight against the disease.


title: Preventing SARS-CoV-2 transmission in rehabilitation pools and therapeutic water environments

text: SARS-CoV-2 is mainly transmitted by respiratory droplets and contact with contaminated surfaces. It can be retrieved in faeces but there is no evidence of faecal-oral transmission, which is the main route of contamination in recreational waters. Standard cleaning and disinfecting procedure, microbiologic control and health rules aim to prevent infectious risk regardless of the microorganisms. In the context of progressive lockdown exit and hospital activities recovery, we assessed the risk of SARS-CoV-2 transmission in rehabilitation pools and therapeutic water environments in order to provide specific recommendations to control the spread of SARS-CoV-2 while ensuring essential rehabilitation cares for patients.


Comment on: "Do We Have Enough Ophthalmologists to Manage Vision-Threatening Diabetic Retinopathy? A Global Perspective"


title: Joint Guidance from SGEI, ISG and INASL for Gastroenterologists and Gastrointestinal Endoscopists on the Prevention, Care, and Management of Patients With COVID-19

text: Coronavirus disease 2019 (COVID-19), which started in December 2019 in China, has resulted in a pandemic leading to significant morbidity and mortality across the globe. Although it mainly causes respiratory symptoms, respiratory failure and death due to multiorgan failure, there is evolving evidence to suggest gastrointestinal (GI) and liver involvement by this virus. Owing to this, health-care professionals taking care of GI and liver diseases are also at an increased risk of getting exposed. Hence, there is a need for protocols to be prepared to guide the handling of COVID-19 patients by the GI and liver specialists, as well as to manage the pre-existing GI and liver diseases during the ongoing pandemic. We present here the guidelines prepared jointly by the three Indian professional bodies in the field of GI diseases, namely the Society of Gastrointestinal Endoscopy of India, Indian Society of Gastroenterology, and Indian National Association for the Study of the Liver.


Association between Angiotensin Blockade and Incidence of Influenza in the United Kingdom


title: Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies

text: BACKGROUND: International experience with coronavirus 2019 (COVID-19) suggests it poses a significant risk of infectious transmission to skull base surgeons, due to high nasal viral titers and the unknown potential for aerosol generation during endonasal instrumentation. The purpose of this study was to simulate aerosolization events over a range of endoscopic procedures to obtain an evidence-based aerosol risk assessment. METHODS: Aerosolization was simulated in a cadaver using fluorescein solution (0.2 mg per 10 mL) and quantified using a blue-light filter and digital image processing. Outpatient sneezing during endoscopy was simulated using an intranasal atomizer in the presence or absence of intact and modified surgical mask barriers. Surgical aerosolization was simulated during nonpowered instrumentation, suction microdebrider, and high-speed drilling after nasal fluorescein application. RESULTS: Among the outpatient conditions, a simulated sneeze event generated maximal aerosol distribution at 30 cm, extending to 66 cm. Both an intact surgical mask and a modified VENT mask (which enables endoscopy) eliminated all detectable aerosol spread. Among the surgical conditions, cold instrumentation and microdebrider use did not generate detectable aerosols. Conversely, use of a high-speed drill produced significant aerosol contamination in all conditions tested. CONCLUSION: We confirm that aerosolization presents a risk to the endonasal skull base surgeon. In the outpatient setting, use of a barrier significantly reduces aerosol spread. Cold surgical instrumentation and microdebrider use pose significantly less aerosolization risk than a high-speed drill. Procedures requiring drill use should carry a special designation as an "aerosol-generating surgery" to convey this unique risk, and this supports the need for protective personal protective equipment.


The value of chest CT as a COVID-19 screening tool in children


title: On rare core collapse supernovae inside planetary nebulae

text: We conduct simulations of white dwarf (WD) - neutron star (NS) reverse evolution, and conclude that a core collapse supernova (CCSN) explosion might occur inside a planetary nebula (PN) only if a third star forms the PN. In the WD-NS reverse evolution the primary star evolves and transfers mass to the secondary star, forms a PN, and leaves a WD remnant. If the mass transfer brings the secondary star to have a mass of>8Mo before it develops a helium core, it explodes as a CCSN and leaves a NS remnant. Using the Modules for Experiments in Stellar Astrophysics (MESA) we find that in the reverse evolution the time period from the formation of the PN by the primary star to the explosion of the secondary star is longer than a million years. By that time the PN has long dispersed into the interstellar medium. If we start with two stars that are too close in mass to each other, then the mass transfer takes place after the secondary star has developed a helium core and it ends forming a PN and a WD. The formation of a CCSN inside a PN (so called CCSNIP) requires the presence of a third star, either as a tertiary star in the system or as a nearby member in an open cluster. The third star should be less massive than the secondary star but by no more than few 0.01Mo. We estimate that the rate of CCSNIP is about 0.0001 times the rate of all CCSNe.


title: Infection Control in Dental Practice During the COVID-19 Pandemic

text: COVID-19 is the disease supported by SARS-CoV-2 infection, which causes a severe form of pneumonia. Due to the pathophysiological characteristics of the COVID-19 syndrome, the particular transmissibility of SARS-CoV-2, and the high globalization of our era, the epidemic emergency from China has spread rapidly all over the world. Human-to-human transmission seems to occur mainly through close contact with symptomatic people affected by COVID-19, and the main way of contagion is via the inhalation of respiratory droplets, for example when patients talk, sneeze or cough. The ability of the virus to survive outside living organisms, in aerosol or on fomites has also been recognized. The dental practitioners are particularly exposed to a high risk of SARS-CoV-2 infection because they cannot always respect the interpersonal distance of more than a meter and are exposed to saliva, blood, and other body fluids during surgical procedures. Moreover, many dental surgeries can generate aerosol, and the risk of airborne infection is to be considered higher. The aim of this paper is to provide practical advice for dentists based on the recent literature, which may be useful in reducing the risk of spreading COVID-19 during clinical practice.


title: A model for the spread of an epidemic from local to global: A case study of COVID-19 in India

text: In this paper we propose an epidemiological model for the spread of COVID-19. The dynamics of the spread is based on four fundamental categories of people in a population: Tested and infected, Non-Tested but infected, Tested but not infected, and non-Tested and not infected. The model is based on two levels of dynamics of spread in the population: at local level and at the global level. The local level growth is described with data and parameters which include testing statistics for COVID-19, preventive measures such as nationwide lockdown, and the migration of people across neighboring locations. In the context of India, the local locations are considered as districts and migration or traffic flow across districts are defined by normalized edge weight of the metapopulation network of districts which are infected with COVID-19. Based on this local growth, state level predictions for number of people tested with COVID-19 positive are made. Further, considering the local locations as states, prediction is made for the country level. The values of the model parameters are determined using grid search and minimizing an error function while training the model with real data. The predictions are made based on the present statistics of testing, and certain linear and log-linear growth of testing at state and country level. Finally, it is shown that the spread can be contained if number of testing can be increased linearly or log-linearly by certain factors along with the preventive measures in near future. This is also necessary to prevent the sharp growth in the count of infected and to get rid of the second wave of pandemic.


title: COVID-19 Guide for the Rehabilitation Clinician: A Review of Non-Pulmonary Manifestations and Complications

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - also known as COVID-19 - is primarily known for respiratory illness. While it is clear that patients with moderate to severe cases of COVID-19 will require pulmonary rehabilitation, physiatrists will need to consider effective management plans for COVID-19 survivors with extra-pulmonary involvement. This report will summarize key non-pulmonary considerations to guide rehabilitation clinicians who may be involved in the care of COVID-19 survivors with the best available early evidence.


Remote Rehabilitation Conferences in the Age of SARS-CoV-2


We aimed to assess the Chinese mental health burden during the COVID-19 pandemic. Data were collected from 7,236 participants assessed with anxiety disorders, depressive symptoms, and poor sleep . The overall prevalence of anxiety disorders, depressive symptoms, sleep quality were 35.1%, 20.1%, 18.2%, respectively. Younger people reported a higher prevalence of anxiety disorders and depressive symptoms than older people (P < 0.001). Compared with other occupation, healthcare workers have the highest rate of poor sleep quality (P < 0.001). We identified a major mental health burden of the public during the COVID-19 pandemic outbreak in China. Younger people and healthcare workers were at high risk for mental illness.


Reply to correspondence: Vaginal delivery in a woman infected with SARS-CoV-2 - The first case reported in Portugal


Successful treatment of severe COVID-19 with subcutaneous anakinra as a sole treatment


Diagnostic performance of a SARS-CoV-2 IgG/IgM lateral flow immunochromatography assay in symptomatic patients presenting to the emergency department


title: Digital Contact Tracing, Privacy, and Public Health

text: Digital contact tracing, in combination with widespread testing, has been a focal point for many plans to "reopen" economies while containing the spread of Covid-19. Most digital contact tracing projects in the United States and Europe have prioritized privacy protections in the form of local storage of data on smartphones and the deidentification of information. However, in the prioritization of privacy in this narrow form, there is not sufficient attention given to weighing ethical trade-offs within the context of a public health pandemic or to the need to evaluate safety and effectiveness of software-based technology applied to public health.


Re: Ventilation-Perfusion Scans During the Coronavirus Disease 2019 (COVID-19) Outbreak


title: A human neutralizing antibody targets the receptor-binding site of SARS-CoV-2

text: An outbreak of coronavirus disease 2019 (COVID-19)1-3, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)4, has spread globally. Countermeasures are needed to treat and prevent further dissemination of the virus. Here we report the isolation of two specific human monoclonal antibodies (termed CA1 and CB6) from a patient convalescing from COVID-19. CA1 and CB6 demonstrated potent SARS-CoV-2-specific neutralization activity in vitro. In addition, CB6 inhibited infection with SARS-CoV-2 in rhesus monkeys in both prophylactic and treatment settings. We also performed structural studies, which revealed that CB6 recognizes an epitope that overlaps with angiotensin-converting enzyme 2 (ACE2)-binding sites in the SARS-CoV-2 receptor-binding domain, and thereby interferes with virus-receptor interactions by both steric hindrance and direct competition for interface residues. Our results suggest that CB6 deserves further study as a candidate for translation to the clinic.


title: Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography

text: OBJECTIVE: To raise awareness for possible benefits of examining known COVID-19 patients presenting sudden clinical worsening with CT pulmonary angiography instead of standard non-contrast chest CT.


COVID-19: opportunity arises from a world health crisis


title: Implications of the virus-encoded miRNA and host miRNA in the pathogenicity of SARS-CoV-2

text: The outbreak of COVID-19 caused by SARS-CoV-2 has rapidly spread worldwide and has caused over 1,400,000 infections and 80,000 deaths. There are currently no drugs or vaccines with proven efficacy for its prevention and little knowledge was known about the pathogenicity mechanism of SARS-CoV-2 infection. Previous studies showed both virus and host-derived MicroRNAs (miRNAs) played crucial roles in the pathology of virus infection. In this study, we use computational approaches to scan the SARS-CoV-2 genome for putative miRNAs and predict the virus miRNA targets on virus and human genome as well as the host miRNAs targets on virus genome. Furthermore, we explore miRNAs involved dysregulation caused by the virus infection. Our results implicated that the immune response and cytoskeleton organization are two of the most notable biological processes regulated by the infection-modulated miRNAs. Impressively, we found hsa-miR-4661-3p was predicted to target the S gene of SARS-CoV-2, and a virus-encoded miRNA MR147-3p could enhance the expression of TMPRSS2 with the function of strengthening SARS-CoV-2 infection in the gut. The study may provide important clues for the mechisms of pathogenesis of SARS-CoV-2.


title: Severe and fatal forms of COVID-19 in children

text: OBJECTIVES: The aim of this study was to describe severe forms of novel coronavirus disease 2019 in children, including patient characteristics, clinical, laboratory, and imaging findings, as well as the disease management and outcomes. METHODS: This was a retrospective, single-center, observational study conducted in a pediatric intensive and high-dependency care unit (PICU, HDU) in an urban hospital in Paris. All patients, aged from 1 month to 18 years, admitted for confirmed or highly suspected SARS-CoV-2 were included. RESULTS: We analyzed the data of 27 children. Comorbidities (n=19, 70%) were mainly neurological (n=7), respiratory, (n=4), or sickle cell disease (n=4). SARS-CoV-2 PCR results were positive in 24 children (nasopharyngeal swabs). The three remaining children had a chest CT scan consistent with COVID-19. Respiratory involvement was observed in 24 patients (89%). Supportive treatments were invasive mechanical ventilation (n=9), catecholamine (n=4), erythropheresis (n=4), renal replacement therapy (n=1), and extracorporeal membrane oxygenation (n=1). Five children died, of whom three were without past medical history. CONCLUSION: This study highlighted the large spectrum of clinical presentation and time course of disease progression as well as the non-negligible occurrence of pediatric life-threatening and fatal cases of COVID-19 mostly in patients with comorbidities. Additional laboratory investigations are needed to further analyze the mechanism underlying the variability of SARS-Cov-2 pathogenicity in children.


A snapshot of urgent upper gastrointestinal endoscopy care during the COVID-19 outbreak in Italy


Fair Allocation of Scarce Medical Resources in the Time of Covid-19