title: Epidemiological and clinical characteristics of 46 newly-admitted coronavirus disease 2019 cases in Beijing/ 中华传染病杂志

text: Objective@#To investigate and analyze the epidemiological and clinical characteristics of some cases of coronavirus disease 2019 (COVID-19) in Beijing.@*Methods@#A retrospective study was conducted to analyze the data of 46 patients with COVID-19 in Beijing from 20th January 2020 to 8th February 2020 at the Fifth Medical Center of the PLA General Hospital. Features of clinical symptoms, laboratory inspections and imaging inspections were analyzed. Statistical analysis used Fisher exact test. If P<0.05, post-hoc test was used for pairwise comparison, and the statistics were corrected by Bonferroni test.@*Results@#Among the 46 patients included in this study, 27 were male and 19 were female. The age range was between 3 - 79 years old, and the mean age was (41.8 ± 16.3) years old. The average incubation period was (4.85 ± 3.00) days. A total of 26 cases (56.5%) were clustered patients, and 12 (26.1%), 23 (50.0%) and 11 patients (23.9%)were assigned to the mild group, common group, and sever group, respectively. Fever (39.8%), cough (27.6%), and fatigue (25.3%) was the main clinical symptom for these patients. The decrease in white blood cell counts occurred in 12 patients, four had the decrease in T lymphocyte counts, 17 had the decrease in CD4 + T lymphocyte counts, seven had the decrease in CD8 + T lymphocyte counts, 21 had the increase level of C-reactive protein (45.7%), and IL-6 level increased in 32 cases (69.6%), erythrocyte sedimentation rate increased in 20 cases(50.0%), serum ferritin level increased in 26 cases (56.5%), and blood lactate level increased in nine cases. There was a statistically significant difference in the number of cases in which the absolute value of T lymphocytes and of CD8 + T lymphocytes decreased among the mild, common and severe groups (all P<0.05). Comparing the number of cases in the three groups with elevated C-reactive protein, interleukin-6, erythrocyte sedimentation rate, serum ferritin and blood lactate levels, the differences were statistically significant (all P<0.05). The number of cases with elevated C-reactive protein levels was higher in severe group than that in mild and common group. The number of cases with elevated interleukin-6, erythrocyte sedimentation rate, and serum ferritin levels were higher in severe group than in mild group. The number of cases with elevated blood lactic acid levels was higher in severe group than in mild group. The differences between the above groups were statistically significant (both adjusted P<0.017). Analysis of chest X-rays showed that 34 patients (73.9%) had inflammation in the lungs.@*Conclusions@#The epidemiological characteristics of cases with COVID-19 in Beijing are mainly imported cases and clustered cases. The clinical manifestations are mainly fever , fatigue and cough. C-reactive protein, interleukin-6, red blood cell sedimentation rate, serum ferritin and blood lactate levels are higher in severe patients.


title: [Guide for the prevention and treatment of coronavirus disease 2019]

text: In December 2019, a novel coronavirus was identified in Wuhan City, Hubei Province, China and later the disease was named coronavirus disease 2019 (COVID-19) . On March 11, 2020, the World Health Organization (WHO) officially announced that COVID-19 had reached global pandemic status. This article summarized the understanding of the etiology, pathogenesis, epidemiology, clinical characteristics, diagnosis, treatment, rehabilitation, and prevention and control measures of COVID-19 based on the available data and anti-epidemic experience in China.


COVID-19 With Limb Ischemic Necrosis


COVID-19, Urologists and Hospitals


title: Prevention and treatment of COVID-19 disease by controlled modulation of innate immunity

text: The recent outbreak of coronavirus disease 2019 (COVID-19), triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses an enormous threat to global public health and economies. Human coronaviruses normally cause no or mild respiratory disease but in the past two decades, potentially fatal coronavirus infections have emerged, causing respiratory tract illnesses such as pneumonia and bronchitis. These include severe acute respiratory syndrome coronavirus (SARS-CoV), followed by the Middle East respiratory syndrome coronavirus (MERS-CoV), and recently the SARS-CoV-2 coronavirus outbreak that emerged in Wuhan, China, in December 2019. Currently, most COVID-19 patients receive traditional supportive care including breathing assistance. To halt the ongoing spread of the pandemic SARS-CoV-2 coronavirus and rescue individual patients, established drugs and new therapies are under evaluation. Since it will be some time until a safe and effective vaccine will be available, the immediate priority is to harness innate immunity to accelerate early antiviral immune responses. Second, since excessive inflammation is a major cause of pathology, targeted anti-inflammatory responses are being evaluated to reduce inflammation-induced damage to the respiratory tract and cytokine storms. Here, we highlight prominent immunotherapies at various stages of development that aim for augmented anti-coronavirus immunity and reduction of pathological inflammation.


Chloroquine as a prophylactic agent against COVID-19?


Patients with lupus are not protected from COVID-19


Hydroxychloroquine, Coronavirus Disease 2019, and QT Prolongation


title: Management of a patient presenting with anterior STEMI with concomitant COVID-19 infection early in the course of the U.S. pandemic

text: The coronavirus disease-2019 (COVID-19) is a viral illness with heterogenous clinical manifestations, ranging from mild symptoms to severe acute respiratory distress syndrome and shock caused by the severe acute respiratory syndrome coronavirus-2. The global healthcare community is rapidly learning more about the effects of COVID-19 on the cardiovascular system, as well as the strategies for management of infected patients with cardiovascular disease. There is minimal literature available surrounding the relationship between COVID-19 infection and acute coronary syndrome. We describe the case of a woman who presented with an acute anterior ST-elevation myocardial infarction managed by primary percutaneous coronary intervention, who subsequently developed severe COVID-19 infection and ultimately succumbed to multisystem organ failure.


title: Specific coagulation markers may provide more therapeutic targets in COVID-19 patients receiving prophylactic anticoagulant

text: I read with interest the recent published article from Professor Robert L. Medcalf, entitled "Fibrinolysis and COVID-19: a plasmin paradox" [1]. As an indirect marker of thrombin and plasmin activation, D-dimer has been suggested to guide anticoagulant treat in COVID-19 patients [2, 3]. However, D-dimer may not be able to reflect accurate fibrinolysis status of COVID-19 patients, and therefore can't guide the possible antifibrinolysis or thrombolytic therapy in different stages of COVID-19, as Professor Robert L. Medcalf discussed. Hence, we speculated that measuring direct markers of thrombin, plasmin and so on, may provide more therapeutic targets in COVID-19 patients with coagulopathy.


title: Treatments Administered to the First 9152 Reported Cases of COVID-19: A Systematic Review

text: The emergence of SARS-CoV-2/2019 novel coronavirus (COVID-19) has created a global pandemic with no approved treatments or vaccines. Many treatments have already been administered to COVID-19 patients but have not been systematically evaluated. We performed a systematic literature review to identify all treatments reported to be administered to COVID-19 patients and to assess time to clinically meaningful response for treatments with sufficient data. We searched PubMed, BioRxiv, MedRxiv, and ChinaXiv for articles reporting treatments for COVID-19 patients published between 1 December 2019 and 27 March 2020. Data were analyzed descriptively. Of the 2706 articles identified, 155 studies met the inclusion criteria, comprising 9152 patients. The cohort was 45.4% female and 98.3% hospitalized, and mean (SD) age was 44.4 years (SD 21.0). The most frequently administered drug classes were antivirals, antibiotics, and corticosteroids, and of the 115 reported drugs, the most frequently administered was combination lopinavir/ritonavir, which was associated with a time to clinically meaningful response (complete symptom resolution or hospital discharge) of 11.7 (1.09) days. There were insufficient data to compare across treatments. Many treatments have been administered to the first 9152 reported cases of COVID-19. These data serve as the basis for an open-source registry of all reported treatments given to COVID-19 patients at www.CDCN.org/CORONA. Further work is needed to prioritize drugs for investigation in well-controlled clinical trials and treatment protocols.


title: Building Mean Field State Transition Models Using The Generalized Linear Chain Trick and Continuous Time Markov Chain Theory

text: The well-known Linear Chain Trick (LCT) allows modelers to derive mean field ODEs that assume gamma (Erlang) distributed passage times, by transitioning individuals sequentially through a chain of sub-states. The time spent in these states is the sum of $k$ exponentially distributed random variables, and is thus gamma (Erlang) distributed. The Generalized Linear Chain Trick (GLCT) extends this technique to the much broader phase-type family of distributions, which includes exponential, Erlang, hypoexponential, and Coxian distributions. Intuitively, phase-type distributions are the absorption time distributions for continuous time Markov chains (CTMCs). Here we review CTMCs and phase-type distributions, then illustrate how to use the GLCT to efficiently build mean field ODE models from underlying stochastic model assumptions. We generalize the Rosenzweig-MacArthur and SEIR models and show the benefits of using the GLCT to compute numerical solutions. These results highlight some practical benefits, and the intuitive nature, of using the GLCT to derive ODE models from first principles.


title: [Clinical outcomes of COVID-19 cases and influencing factors in Guangdong province]

text: Objective: To analyze the clinical courses and outcomes of COVID-19 cases and the influencing factors in Guangdong province and provide basis for the formulation or adjustment of medical care and epidemic control strategy for COVID-19. Methods: We collected demographic data, medical histories, clinical courses and outcomes of 1 350 COVID-19 patients reported in Guangdong as of 4 March 2020 via epidemiological investigation and process tracking. Disease severity and clinical course characteristics of the patients and influencing factors of severe illness were analyzed in our study. Results: Among 1 350 cases of COVID-19 cases in Guangdong, 72 (5.3%) and 1049 (77.7%) were mild and ordinary cases, 164 (12.1%) were severe cases, 58 (4.3%) were critical cases and 7 (0.5%) were fatal. The median duration of illness were 23 days (P(25)-P(75): 18-31 days) and the median length of hospitalization were 20 days (P(25)-P(75): 15-27 days). For severe cases, the median time of showing severe manifestations was on the 12th day after onset (P(25)-P(75): 9th to 15th days), and the median time of severe manifestation lasted for 8 days P(25)-P(75): 4-14 days). Among 1 066 discharged/fetal cases, 36.4% (36/99) and 1.0% (1/99) of the mild cases developed to ordinary cases and severe cases respectively after admission; and 5.2% (50/968) and 0.6% (6/968) of the ordinary cases developed to severe cases, and critical cases respectively after admission. In severe cases, 11.4% developed to critical cases (10/88). The influencing factors for severe illness or worse included male (aHR=1.87, 95%CI: 1.43-2.46), older age (aHR=1.67, 95%CI: 1.51-1.85), seeking medical care on day 2-3 after onset (aHR=1.73, 95%CI: 1.20-2.50) pre-existing diabetes (aHR=1.75, 95%CI: 1.12-2.73) and hypertension (aHR=1.49, 95%CI: 1.06-2.09). Conclusions: The course of illness and length of hospitalization of COVID-19 cases were generally long and associated with severity of disease clinical outcomes. The severe cases were mainly occurred in populations at high risk. In the epidemic period, classified management of COVID-19 cases should be promoted according to needs for control and prevention of isolation and treatment for the purpose of rational allocation of medical resources.


Role of serology in the COVID-19 pandemic


COVID-19 and Working Conditions in Health Care


Retraction-Chinese medical staff request international medical assistance in fighting against COVID-19


title: Universal Testing for COVID-19 in Essential Orthopaedic Surgery Reveals a High Percentage of Asymptomatic Infections

text: BACKGROUND: The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health-care institutions. The identification of infected individuals is vital to prevent the spread of illness to staff and other patients as well as to identify those who may be at risk for disease-related complications. This is particularly relevant with the resumption of elective orthopaedic surgery around the world. We report the results of a universal testing protocol for COVID-19 in patients undergoing orthopaedic surgery during the coronavirus pandemic and to describe the postoperative course of asymptomatic patients who were positive for COVID-19. METHODS: A retrospective review of adult operative cases between March 25, 2020, and April 24, 2020, at an orthopaedic specialty hospital in New York City was performed. Initially, a screening questionnaire consisting of relevant signs and symptoms (e.g., fever, cough, shortness of breath) or exposure dictated the need for nasopharyngeal swab real-time quantitative polymerase chain reaction (RT-PCR) testing for all admitted patients. An institutional policy change occurred on April 5, 2020, that indicated nasopharyngeal swab RT-PCR testing for all orthopaedic admissions. Screening and testing data for COVID-19 as well as relevant imaging, laboratory values, and postoperative complications were reviewed for all patients. RESULTS: From April 5, 2020, to April 24, 2020, 99 patients underwent routine nasopharyngeal swab testing for COVID-19 prior to their planned orthopaedic surgical procedure. Of the 12.1% of patients who tested positive for COVID-19, 58.3% were asymptomatic. Three asymptomatic patients developed postoperative hypoxia, with 2 requiring intubation. The negative predictive value of using the signs and symptoms of disease to predict a negative test result was 91.4% (95% confidence interval [CI], 81.0% to 97.1%). Including a positive chest radiographic finding as a screening criterion did not improve the negative predictive value of screening (92.5% [95% CI, 81.8% to 97.9%]). CONCLUSIONS: A protocol for universal testing of all orthopaedic surgery admissions at 1 hospital in New York City during a 3-week period revealed a high rate of COVID-19 infections. Importantly, the majority of these patients were asymptomatic. Using chest radiography did not significantly improve the negative predictive value of screening. These results have important implications as hospitals anticipate the resumption of elective surgical procedures. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


title: COVID-19 highlights risks of healthcare and social care workers attending work while ill

text: As COVID-19 affects healthcare and social care systems around the world, reports of infection among healthcare and social care workers continue to accumulate.


The virus crisis affects Orthopaedic surgery and scientific activities worldwide


title: Changes in testing rates could mask the novel coronavirus disease (COVID-19) growth rate

text: Since the novel coronavirus disease (COVID-19) emerged in December 2019 in China, it has rapidly spread around the world, leading to one of the most significant pandemic events of recent history. Deriving reliable estimates of the COVID-19 epidemic growth rate is quite important to guide the timing and intensity of intervention strategies. Indeed, many studies have quantified the epidemic growth rate using time-series of reported cases during the early phase of the outbreak to estimate the basic reproduction number, R0. Using daily time series of COVID-19 incidence, we illustrate how epidemic curves of reported cases may not always reflect the true epidemic growth rate due to changes in testing rates, which could be influenced by limited diagnostic testing capacity during the early epidemic phase.


title: When to Operate, Hesitate and Reintegrate: Society of Gynecologic Oncology Surgical Considerations during the COVID-19 Pandemic

text: The COVID-19 pandemic has challenged our ability to provide timely surgical care for our patients. In response, the U.S. Surgeon General, the American College of Srugeons, and other surgical professional societies recommended postponing elective surgical procedures and proceeding cautiously with cancer procedures that may require significant hospital resources and expose vulnerable patients to the virus. These challenges have particularly distressing for women with a gynecologic cancer diagnosis and their providers. Currently, circumstances vary greatly by region and by hospital, depending on COVID-19 prevalence, case mix, hospital type, and available resources. Therefore, COVID-19-related modifications to surgical practice guidelines must be individualized. Special consideration is necessary to evaluate the appropriateness of procedural interventions, recognizing the significant resources and personnel they require. Additionally, the pandemic may occur in waves, with patient demand for surgery ebbing and flowing accordingly. Hospitals, cancer centers and providers must prepare themselves to meet this demand. The purpose of this white paper is to highlight all phases of gynecologic cancer surgical care during the COVID-19 pandemic and to illustrate when it is best to operate, to hestitate, and reintegrate surgery. Triage and prioritization of surgical cases, preoperative COVID-19 testing, peri-operative safety principles, and preparations for the post-COVID-19 peak and surgical reintegration are reviewed.


title: The association between international and domestic air traffic and the coronavirus (COVID-19) outbreak

text: BACKGROUND: The World Health Organization (WHO) has declared the current outbreak of the novel coronavirus (COVID-19) a global pandemic. Many countries are facing increasing numbers of COVID-19 cases, which are, in their origin mostly attributed to regular international flight connections with China. This study aims to investigate this relation by analyzing available data on air traffic volume and the spread of COVID-19 cases. METHODS: and findings: We analyzed available data on current domestic and international passenger volume and flight routes and compared these to the distribution of domestic and international COVID-19 cases. RESULTS: Our data indicate a strong linear correlation between domestic COVID-19 cases and passenger volume for regions within China (r2 = 0.92, p = 0.19) and a significant correlation between international COVID-19 cases and passenger volume (r2 = 0.98, p < 0.01). CONCLUSIONS: The number of flight routes as well as total passenger volume are highly relevant risk factors for the spread of current COVID-19. Multiple regions within Asia, as well as some in North America and Europe are at serious risk of constant exposure to COVID-19 from China and other highly infected countries. Risk for COVID-19 exposure remains relatively low in South America and Africa. If adequate measures are taken, including on-site disease detection and temporary passenger quarantine, limited but not terminated air traffic can be a feasible option to prevent a long-term crisis. Reasonable risk calculations and case evaluations per passenger volume are crucial aspects which must be considered when reducing international flights.


title: COVID-19 infection during pregnancy: fetus as a patient deserves more attention

text: The novel coronavirus disease 2019 (COVID-19) pandemic is causing concern also for the management and outcome of COVID-19-positive pregnant women and their offspring, as reported cases are rare. Current evidence suggests the association of COVID-19 infection in pregnancy with both severe maternal morbidity requiring intensive care and perinatal complications (preterm birth with consequent neonatal morbidity and even perinatal death). Most of the reported cases focused specifically on the maternal outcomes and possible vertical transmission, but less attention has been paid to fetus as a patient in such pregnancies. The use of antenatal steroids and fetal neuroprotection with magnesium sulfate is clearly underreported. Several recently issued guidelines suggest lowering the upper gestational age for antenatal steroid administration and also advocate extreme caution or even restraining from the use of magnesium sulfate. Also, the rate of cesarean deliveries among COVID-19 women is unacceptably high. Here we provide arguments for NOT changing the existing guidelines and caution against cesarean delivery that was the prevalent delivery mode in the reported cases and case series.


title: Future of COVID-19 in Italy: A mathematical perspective

text: We have proposed an SEIR compartmental mathematical model. The prime objective of this study is to analyze and forecast the pandemic in Italy for the upcoming months. The basic reproduction number has been calculated. Based on the current situation in Italy, in this paper, we will estimate the possible time for the end of the pandemic in the country. The impact of lockdown and rapid isolation on the spread of the pandemic are also discussed. Further, we have studied four of the most pandemic affected regions in Italy. Using the proposed model, a prediction has been made about the duration of pandemic in these regions. The variation in the basic reproduction number corresponding to the sensitive parameters of the model is also examined.


Meeting the challenge of the 2019 novel coronavirus disease in patients with cancer


title: Saliva is a non-negligible factor in the spread of COVID-19

text: SARS-CoV-2, a novel emerging coronavirus, has caused severe disease (COVID-19), and rapidly spread worldwide since the beginning of 2020. SARS-CoV-2 mainly spreads by coughing, sneezing, droplet inhalation, and contact. SARS-CoV-2 has been detected in saliva samples, making saliva a potential transmission route for COVID-19. The participants in dental practice confront a particular risk of SARS-CoV-2 infection due to close contact with the patients and potential exposure to saliva-contaminated droplets and aerosols generated during dental procedures. In addition, saliva-contaminated surfaces could lead to potential cross-infection. Hence, the control of saliva-related transmission in the dental clinic is critical, particularly in the epidemic period of COVID-19. Based on our experience of the COVID-19 epidemic, some protective measures that can help reduce the risk of saliva-related transmission are suggested, in order to avoid the potential spread of SARS-CoV-2 among patients, visitors, and dental practitioners.


Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic: From the ACC's Interventional Council and SCAI


SARS-CoV-2 pandemics: The lack of critical reflection addressing short- and long-term challenges


Remdesivir in Patients with Acute or Chronic Kidney Disease and COVID-19


title: The impact of nutrition on COVID-19 susceptibility and long-term consequences

text: While all groups are affected by the COVID-19 pandemic, the elderly, underrepresented minorities, and those with underlying medical conditions are at the greatest risk. The high rate of consumption of diets high in saturated fats, sugars, and refined carbohydrates (collectively called Western diet, WD) worldwide, contribute to the prevalence of obesity and type 2 diabetes, and could place these populations at an increased risk for severe COVID-19 pathology and mortality. WD consumption activates the innate immune system and impairs adaptive immunity, leading to chronic inflammation and impaired host defense against viruses. Furthermore, peripheral inflammation caused by COVID-19 may have long-term consequences in those that recover, leading to chronic medical conditions such as dementia and neurodegenerative disease, likely through neuroinflammatory mechanisms that can be compounded by an unhealthy diet. Thus, now more than ever, wider access to healthy foods should be a top priority and individuals should be mindful of healthy eating habits to reduce susceptibility to and long-term complications from COVID-19.


There is a Relationship Between Obesity and Coronavirus Disease 2019 but More Information is Needed


title: Taking care of systemic sclerosis patients during COVID-19 pandemic: rethink the clinical activity

text: COVID-19 outbreak has quickly spread worldwide, causing a high pressure on the health-care system. In Italy, from March 8, 2020, all the deferrable clinical activities have been suspended to increase the health care offer for COVID-19 patients. The hospital organization has been modified also in order to assure non-COVID-19 patients assistance. The Scleroderma Unit of ASST Pini-CTO Hospital, in Milan, in the region mostly hit by SARS-CoV-2 in Italy, follows more than 600 patients affected by systemic sclerosis (SSc). Patients with SSc need a close follow-up with a regular screening of organ involvement and frequent intravenous treatments. All SSc patients have been educated about ministerial directives to limit COVID-19 spread. The organization of our Scleroderma Unit has been quickly rethought to assure SSc patients assistance in safety for them and for health-care workers during urgent visits or infusion therapies. Using electronic way of communication with frequent virtual contact and guarantying home deliveries of some therapies, we allowed a continuity of care also outside the Hospital.


title: Promising inhibitors of main protease of novel corona virus to prevent the spread of COVID-19 using docking and molecular dynamics simulation

text: Coronavirus disease-2019 (COVID-19) is a global health emergency and the matter of serious concern, which has been declared a pandemic by WHO. Till date, no potential medicine/ drug is available to cure the infected persons from SARS-CoV-2. This deadly virus is named as novel 2019-nCoV coronavirus and caused coronavirus disease, that is, COVID-19. The first case of SARS-CoV-2 infection in human was confirmed in the Wuhan city of the China. COVID-19 is an infectious disease and spread from man to man as well as surface to man . In the present work, in silico approach was followed to find potential molecule to control this infection. Authors have screened more than one million molecules available in the ZINC database and taken the best two compounds based on binding energy score. These lead molecules were further studied through docking against the main protease of SARS-CoV-2. Then, molecular dynamics simulations of the main protease with and without screened compounds were performed at room temperature to determine the thermodynamic parameters to understand the inhibition. Further, molecular dynamics simulations at different temperatures were performed to understand the efficiency of the inhibition of the main protease in the presence of the screened compounds. Change in energy for the formation of the complexes between the main protease of novel coronavirus and ZINC20601870 as well ZINC00793735 at room temperature was determined on applying MM-GBSA calculations. Docking and molecular dynamics simulations showed their antiviral potential and may inhibit viral replication experimentally. Communicated by Ramaswamy H. Sarma.


Changes in Gastroenterology and Endoscopy Practices in Response to the Coronavirus Disease 2019 Pandemic: Results From a North American Survey


title: Adjusting to the new reality: Evaluation of early practice pattern adaptations to the COVID-19 pandemic

text: OBJECTIVE: We aim to define national practice patterns to assess current clinical practice, anticipated delays and areas of concern that potentially could lead to deviations from the normal standard of care. METHODS: Anonymous surveys were emailed to members of the Society of Gynecologic Oncology (SGO). The spread of COVID-19 and its impact on gynecologic oncology care in terms of alterations to normal treatment patterns and anticipated challenges were assessed. The Wilcoxon rank sum test was performed to determine risk factors for COVID-19 infection. RESULTS: We analyzed the responses of 331 gynecologic oncology providers. COVID-19 is present in 99.1% of surveyed communities with 99.7% reporting mitigation efforts in effect. The infection rate differs significantly between regions (pâª0.001) with the Northeast reporting the highest number of COVID-19 cases. Practice volume has dropped by 61.6% since the start of the pandemic with most cancellations being provider initiated. A majority of responders (52.8%) believed that ovarian cancer will be the most affected cancer by COVID-19. >94% of responders are proceeding with gynecologic cancer surgeries with exception of grade 1, endometrioid endometrial adenocarcinoma (36.3%). Surgical backlog (58.6%), delayed cancer diagnosis (43.2%) and re-establishing normal care with delayed patient (37.8%) were identified as the top 3 challenges after COVID-19 has abated. CONCLUSIONS: COVID-19 is widespread and has radically altered normal practice patterns. Despite COVID-19 related concerns, most gynecologic oncology care is proceeding. However, the steep decline in clinical volume shows there is a large group of patients who are not being diagnosed or are deferring care.


title: Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19)

text: Coronavirus has emerged as a global health threat due to its accelerated geographic spread over the last two decades. This article reviews the current state of knowledge concerning the origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19). Historically, it has caused two pandemics: severe acute respiratory syndrome and Middle East respiratory syndrome followed by the present COVID-19 that emerged from China. The virus is believed to be acquired from zoonotic source and spreads through direct and contact transmission. The symptomatic phase manifests with fever, cough and myalgia to severe respiratory failure. The diagnosis is confirmed using reverse transcriptase PCR. Management of COVID-19 is mainly by supportive therapy along with mechanical ventilation in severe cases. Preventive strategies form the major role in reducing the public spread of virus along with successful disease isolation and community containment. Development of a vaccine to eliminate the virus from the host still remains an ongoing challenge.


title: Medical waste management practice during the 2019-2020 novel coronavirus pandemic: Experience in a general hospital

text: It is currently a critical period for the prevention and control of the COVID-19 pandemic. Since the medical waste disposal could be an important way to control the source of infection, standardization, and strict implementation of the management of COVID-19 related medical waste should be with careful consideration to reduce the risk of epidemic within hospitals. This study illustrates the practice of medical waste disposal responding to the 2019-2020 novel coronavirus pandemic.


title: Identification of a druggable binding pocket in the spike protein reveals a key site for existing drugs potentially capable of combating Covid-19 infectivity

text: BACKGROUND: Following the recent outbreak of the new coronavirus pandemic (Covid-19), the rapid determination of the structure of the homo-trimeric spike glycoprotein has prompted the study reported here. The aims were to identify potential "druggable" binding pockets in the protein and, if located, to virtual screen pharmaceutical agents currently in use for predicted affinity to these pockets which might be useful to restrict, reduce, or inhibit the infectivity of the virion. RESULTS: Our analyses of this structure have revealed a key potentially druggable pocket where it might be viable to bind pharmaceutical agents to inhibit its ability to infect human cells. This pocket is found at the inter-chain interface that exists between two domains prior to the virion binding to human Angiotensin Converting Enzyme 2 (ACE2) protein. One of these domains is the highly mobile receptor binding domain, which must move into position to interact with ACE2, which is an essential feature for viral entry to the host cell. Virtual screening with a library of purchasable drug molecules has identified pharmaceuticals currently in use as prescription and over the counter medications that, in silico, readily bind into this pocket. CONCLUSIONS: This study highlights possible drugs already in use as pharmaceuticals that may act as agents to interfere with the movements of the domains within this protein essential for the infectivity processes and hence might slow, or even halt, the infection of host cells by this new coronavirus. As these are existing pharmaceuticals already approved for use in humans, this knowledge could accelerate their roll-out, through repurposing, for affected individuals and help guide the efforts of other researchers in finding effective treatments for the disease.


title: From Hard Spheres and Cubes to Nonequilibrium Maps with Thirty-Some Years of Thermostatted Molecular Dynamics

text: This is our current research perspective on models providing insight into statistical mechanics. It is necessarily personal, emphasizing our own interest in simulation as it developed from the National Laboratories' work to the worldwide explosion of computation of today. We contrast the past and present in atomistic simulations, emphasizing those simple models which best achieve reproducibility and promote understanding. Few-body models with pair forces have led to today's"realistic"simulations with billions of atoms and molecules. Rapid advances in computer technology have led to change. Theoretical formalisms have largely been replaced by simulations incorporating ingenious algorithm development. We choose to study particularly simple, yet relevant, models directed toward understanding general principles. Simplicity remains a worthy goal, as does relevance. We discuss hard-particle virial series, melting, thermostatted oscillators with and without heat conduction, chaotic dynamics, fractals, the connection of Lyapunov spectra to thermodynamics, and finally simple linear maps. Along the way we mention directions in which additional modelling could provide more clarity and yet more interesting developments in the future.


title: Onkológiai beteg tervezett PET/CT vizsgálata során véletlenszeruen felfedezett COVID-19-betegség/ Oncologic patient with COVID-19 discovered incidentally by PET/CT examination: (A COVID19-pandémia orvosszakmai kérdései)

text: The scientific literature of coronavirus-disease 2019 (COVID-19) is rapidly expanding. There is a growing evidence on the discrepancy between clinical symptoms and radiologic findings in many patients. This case report gives details about a patient with only mild symptoms but relatively severe radiological findings. The 75-year-old patient suffering from oncologic disease had a planned a F18-fluoro-deoxy-glucose positron-emission tomography/computer tomography scan with a routine oncological indication where incidental radiomorphologic findings of pneumonia suspect for COVID-19 were detected. After immediate isolation, the patient was transferred to the corresponding medical department, where further investigations verified the diagnosis of COVID-19. With this case, our aim is to raise the awareness for the importance of the instant evaluation of chest computer tomography series when performing planned imaging examination, especially in frail patients. With this practice, potential radiomorphologic findings of pneumonia suspect for COVID-19 could be identified in time, which fundamentally determines further patient management steps. Orv Hetil. 2020; 161(23): 971-976.


title: Análise da tendência de casos e óbitos por Coronavirus Disease-2019 (COVID-19) nos principais países afetados e no Brasil: uma análise dos primeiros 50 dias da pandemia

text: Objetivo: analisar a tendência de casos e óbitos pelo COVID-19 Métodos: foram analisados os óbitos e os casos confirmados até o dia 15 de março de 2020, informados pela Organização Mundial da Saúde, utilizando-se Regressão Joinpoint Resultados: a partir de 6 de fevereiro, os casos globais de COVID-19 apresentaram aumento de 8,2% e relacionavam-se com os casos registrados na Europa, e o incremento no número de óbitos, a partir de 20 de fevereiro, coincidiu com o aumento dos registros na Itália e Irã Conclusão: na China, houve tendência de redução de casos e óbitos, enquanto a Europa apresentou transmissão sustentada (AU)Objective: to analyze the trend of cases and deaths by COVID-19 Methods: the deaths and confirmed cases until March 15th, 2020 were analyzed, reported by the World Health Organization, using Joinpoint Regression Results: From February 6th, the global cases of COVID-19 presented an increase of 8 2% and were related to cases recorded in Europe, and the increase in the number of deaths, from February 20th, coincided with the increase of registrations in Italy and Iran Conclusion: in China, there was a tendency of reduction of cases and deaths, while Europe showed sustained transmission (AU)


title: Could nutritional and functional status serve as prognostic factors for COVID-19 in the elderly?

text: Geriatric patients seem to be the most vulnerable group in COVID-19. These patients are usually characterized by impaired mobilization and malnutrition. In addition, obesity has been correlated with increased mortality rates after COVID-19 infection, highlighting the role of nutrition in prognosis of COVID-19 as well. In the past, several indices of nutritional status (GNRI) and functional status (ECOG performance status, Barthel Index, Handgrip Strength) have demonstrated a prognostic ability for hospitalized patients with influenza-like respiratory infections from coronavirus, metapneumovirus, parainfluenza and rhinovirus. Our hypothesis suggests that the previously mentioned nutritional and functional status indices, combined with the pneumonia severity index (CRB-65), could be useful in prognosis of morbidity and mortality of the elderly after the novel COVID-19 infection. Our hypothesis, is the first in the literature, which suggests a prognostic association between nutritional status of patients and COVID-19 infection, offering a quick and low-cost prognostic tool for COVID-19 in the elderly.


title: Distribution and growth rate of COVID-19 outbreak in Tamil Nadu: A log-linear regression approach

text: Background: Most of the countries are affected with the pandemic outbreak of the coronavirus infection. Understanding the severity and distribution in various regions will help in planning the controlling measures. Objectives: The objective was to assess the distribution and growth rate of COVID-19 infection in Tamil Nadu, India. Methods: The data on the number of infections of COVID-19 have been obtained from the media reports released by the Government of Tamil Nadu. The data contain information on the incidence of the disease for the first 41 days of the outbreak started on March 7, 2020. Log-linear model has been used to estimate the progression of the COVID-19 infection in Tamil Nadu. Separate models were employed to model the growth rate and decay rate of the disease. Spatial Poisson regression was used to identify the high-risk areas in the state. Results: : The models estimated the doubling time for the number of cases in growth phase as 3.96 (95% confidence interval [CI]: 2.70, 9.42) days and halving time in the decay phase as 12.08 (95% CI: 6.79, 54.78) days. The estimated median reproduction numbers were 1.88 (min = 1.09, max = 2.51) and 0.76 (min = 0.56, max = 0.99) in the growth and decay phases, respectively. The spatial Poisson regression identified 11 districts as high risk. Conclusion: The results indicate that the outbreak is showing decay in the number of infections of the disease which highlights the effectiveness of controlling measures.


title: Biosafety measures for preventing infection from COVID-19 in clinical laboratories: IFCC Taskforce Recommendations

text: Coronavirus disease 2019 (COVID-19) is the third coronavirus outbreak that has emerged in the past 20 years, after severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). One important aspect, highlighted by many global health organizations, is that this novel coronavirus outbreak may be especially hazardous to healthcare personnel, including laboratory professionals. Therefore, the aim of this document, prepared by the COVID-19 taskforce of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), is to provide a set of recommendations, adapted from official documents of international and national health agencies, on biosafety measures for routine clinical chemistry laboratories that operate at biosafety levels 1 (BSL-1; work with agents posing minimal threat to laboratory workers) and 2 (BSL-2; work with agents associated with human disease which pose moderate hazard). We believe that the interim measures proposed in this document for best practice will help minimazing the risk of developing COVID-19 while working in clinical laboratories.


COVID umbrella trials multiply


The Impact of COVID-19 on Radiation Oncology Clinics and Cancer Patients in the U.S


title: The synthetic LPS binding peptide 19-2.5 interferes with clotting and prevents degradation of high molecular weight kininogen in plasma

text: Sepsis and septic shock are life-threatening conditions and remain an important medical problem, emphasizing the need to identify novel therapeutic approaches. Coagulation dysfunction, hypotension, disturbed microcirculation and multiorgan failure occur frequently. These severe conditions result from an overwhelming inflammatory response, induced by pathogen and damage associated molecular patterns (PAMPs and DAMPs) released into the bloodstream. In the present study, we demonstrated that the synthetic Lipopolysaccharid (LPS)-binding peptide 19-2.5 interferes with the activation of the coagulation and contact system. Moreover, binding of LPS to high molecular weight kininogen (HK), one of the major LPS carrier in blood, could be prevented by the peptide. Thus, peptide 19-2.5 might represent a promising target in the treatment of endotoxemia and sepsis, not only by its anti-inflammatory potential, but also by the anticoagulant effect, together with its ability to prevent degradation of HK.


title: A Global Effort to Define the Human Genetics of Protective Immunity to SARS-CoV-2 Infection

text: SARS-CoV-2 infection displays immense inter-individual clinical variability, ranging from silent infection to lethal disease. The role of human genetics in determining clinical response to the virus remains unclear. Studies of outliers-individuals remaining uninfected despite viral exposure and healthy young patients with life-threatening disease-present a unique opportunity to reveal human genetic determinants of infection and disease.


Comment on "Is the type of diabetes treatment relevant to outcome of COVID-19?"


Pérdida del sentido del olfato durante la pandemia COVID-19./ Pérdida del sentido del olfato durante la pandemia COVID-19./ Olfactory dysfunction during COVID-19 pandemic


title: The implication of ocular manifestation of COVID-19 for medical staff and patients - systematic review

text: INTRODUCTION: SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) is a coronavirus that causes COVID-19 (coronavirus disease 2019) with mild to severe respiratory illness. It is a highly contagious disease transmitted through direct or indirect contact with infected people or contaminated surfaces, mainly through respiratory droplets, but other routes are being investigated. OBJECTIVE: It is known that coronaviruses (CoVs) can cause a variety of ocular pathologies in animals, including conjunctivitis, anterior uveitis, retinitis, and optic neuritis, many of which are severe. However, there is no evidence of the SARS-CoV-2 presence in the eye tissue of asymptomatic patients, even if the symptomatic incidence is low. This systematic review presents updated literature on this issue. ABBREVIATED DESCRIPTION OF THE STATE OF KNOWLEDGE: COVID-19 has now spread throughout the continents and poses a global threat to public health. The risk of rapidly overloading health care systems and causing substantial mortality worldwide is real. On 11 March 2020, the World Health Organization (WHO) announced coronavirus as a global pandemic. Several studies described a few cases with initial ocular symptoms followed by systemic symptoms of the disease. SUMMARY: Although the frequency of transmission of SARS-CoV-2 infection through the eye is low, ocular symptoms are not uncommon in COVID-19. In some cases, eye symptoms may be the first signs of illness. This implies the need for hygienic recommendations and use of personal protective equipment (PPE) for medical staff and other services to minimize COVID-19 infection of both health-care workers and patients. A triage for ophthalmic outpatient clinic is mandatory.


Coronavirus Disease 2019 or Lung Cancer: A Differential Diagnostic Experience and Management Model From Wuhan


Thoughts on the scientific evidences in the Covid-19 era


title: Is anosmia the price to pay in an immune-induced scorched-earth policy against COVID-19?

text: Since the outbreak of Coronavirus Disease 2019 (COVID-19), loss of smell has increasingly been reported as a frequent clinical sign. Understanding the underlying mechanism and the prognostic value of this symptom will help better manage patients. SARS-CoV-2, as SARS-CoV-1, may likely spread to the central nervous system (CNS) via the olfactory nerve, a known gateway for respiratory neurotropic viruses. We hypothesise that sudden loss of smell due to COVID-19 is the consequence of a protective host defence mechanism involving apoptosis of olfactory receptor neurons. Sacrificing smelling over neuroprotection is a logical strategy, even more so as olfaction is the only sense with the ability to regenerate in adults. Induced apoptosis of olfactory neurons has been shown in mice, successfully preventing neuroinvasion. On the other hand, adult olfactory neurogenesis has been shown to be regulated in part by the immune system, allowing to restore olfactory function. Understanding anosmia as part of a defence mechanism would support the concept of sudden anosmia as being a positive prognostic factor in the short term. Also, it may orient research to investigate the risk of future neurodegenerative disease linked to persisting coronavirus in neurons.


COVID-19 infection in cancer patients: early observations and unanswered questions


title: Knowledge, attitudes, and practices of Sudanese residents towards COVID-19

text: Background: Coronavirus disease 2019 (COVID-19) is a severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sufficient knowledge, positive attitudes, and correct practices are crucial for the prevention of COVID-19. Aims: This study aimed at assessing the knowledge, attitudes and practices of a sample of Sudanese residents towards COVID-19. Methods: A cross-sectional community-based survey was conducted on 812 participants, including both sexes and aged 18 years and above, with the exclusion of health care workers. Considerable care was taken to include people with different education levels. Results: Among the survey respondents (n=812), 45.8% were women, 40.4% held a bachelor's degree, 5.7% were uneducated, and 51.1% were aged 18-25 years. The overall correct rate of the knowledge questionnaire was 78.2%; 66.9% agreed that religious gatherings and events should be cancelled to prevent the spread of COVID-19; 34.1% of respondents wore medical masks; and 57.9% avoided shaking hands in recent days. Conclusion: This study showed that sampled Sudanese residents have incomplete knowledge and poor practices towards COVID-19. However, we found that women and people aged 18-25 years were more knowledgeable and had more positive attitudes towards COVID-19. We hope that concerned authorities will establish awareness programmes to improve the ability to combat this disease.


Cardiopulmonary resuscitation after hospital admission with covid-19


title: Ensuring safety and sustainability of radiotherapy services during the COVID-19 pandemic in resources constrain country: An Indonesian experience

text: The global COVID-19 pandemic has placed a significant burden on the healthcare sector, overwhelming health services in affected countries worldwide. As healthcare facilities reorganize their services to adapt to this challenging problem, it is important that the sustainability of essential oncology services, including radiotherapy, is maintained. This article describes the Indonesian experience in ensuring sustainability of radiotherapy services during the pandemic, highlighting various important adjustments which were made to allow radiotherapy centers nationwide to continue operating while protecting staff and patients from the risk of disease transmission. As the backlog of patients waiting to start treatment will inevitably grow, some insight on how to proactively manage this issue will also be described.


COVID-19, a pandemic that affects more than just physical health: Two case reports


Summary of recommendations regarding COVID-19 in children with diabetes: Keep Calm and Mind your Diabetes Care and Public Health Advice


Lessons Learned: Achieving Critical Mass in Masking Among Youth in Congregate Living


SARS-CoV-2 infection complicated by inflammatory syndrome. Could high-dose human immunoglobulin for intravenous use (IVIG) be beneficial?


title: A 55-Day-Old Female Infant Infected With 2019 Novel Coronavirus Disease: Presenting With Pneumonia, Liver Injury, and Heart Damage

text: BACKGROUND: Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were mainly based on information from adult populations. Limited data are available for children with COVID-19, especially for infected infants. METHODS: We report a 55-day-old case with COVID-19 confirmed in China and describe the identification, diagnosis, clinical course, and treatment of the patient, including the disease progression from day 7 to day 11 of illness. RESULTS: This case highlights that children with COVID-19 can also present with multiple organ damage and rapid disease changes. CONCLUSIONS: When managing such infant patients with COVID-19, frequent and careful clinical monitoring is essential.


Prevalence of venous thromboembolism in critically ill patients with COVID-19


title: Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic

text: OBJECTIVE: The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. We characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic. METHODS: This was a cross-sectional web survey of physicians, advanced practice providers, residents/fellows, and nurses, conducted during a peak of inpatient admissions for COVID-19 in NYC (April 9th-April 24th 2020) at a large medical center in NYC (n = 657). RESULTS: Positive screens for psychological symptoms were common; 57% for acute stress, 48% for depressive, and 33% for anxiety symptoms. For each, a higher percent of nurses/advanced practice providers screened positive vs. attending physicians, though housestaff's rates for acute stress and depression did not differ from either. Sixty-one percent of participants reported increased sense of meaning/purpose since the COVID-19 outbreak. Physical activity/exercise was the most common coping behavior (59%), and access to an individual therapist with online self-guided counseling (33%) garnered the most interest. CONCLUSIONS: NYC HCWs, especially nurses and advanced practice providers, are experiencing COVID-19-related psychological distress. Participants reported using empirically-supported coping behaviors, and endorsed indicators of resilience, but they also reported interest in additional wellness resources. Programs developed to mitigate stress among HCWs during the COVID-19 pandemic should integrate HCW preferences.


title: Fibrinolytic abnormalities in acute respiratory distress syndrome (ARDS) and versatility of thrombolytic drugs to treat COVID-19

text: The global pandemic of coronavirus disease 2019 (COVID-19) is associated with the development of acute respiratory distress syndrome (ARDS), which requires ventilation in critically ill patients. The pathophysiology of ARDS results from acute inflammation within the alveolar space and prevention of normal gas exchange. The increase in proinflammatory cytokines within the lung leads to recruitment of leukocytes, further propagating the local inflammatory response. A consistent finding in ARDS is the deposition of fibrin in the air spaces and lung parenchyma. COVID-19 patients show elevated D-dimers and fibrinogen. Fibrin deposits are found in the lungs of patients due to the dysregulation of the coagulation and fibrinolytic systems. Tissue factor (TF) is exposed on damaged alveolar endothelial cells and on the surface of leukocytes promoting fibrin deposition, while significantly elevated levels of plasminogen activator inhibitor 1 (PAI-1) from lung epithelium and endothelial cells create a hypofibrinolytic state. Prophylaxis treatment of COVID-19 patients with low molecular weight heparin (LMWH) is important to limit coagulopathy. However, to degrade pre-existing fibrin in the lung it is essential to promote local fibrinolysis. In this review, we discuss the repurposing of fibrinolytic drugs, namely tissue-type plasminogen activator (tPA), to treat COVID-19 associated ARDS. tPA is an approved intravenous thrombolytic treatment, and the nebulizer form has been shown to be effective in plastic bronchitis and is currently in Phase II clinical trial. Nebulizer plasminogen activators may provide a targeted approach in COVID-19 patients to degrade fibrin and improving oxygenation in critically ill patients.


title: COVID-19 rise in Younger adults with Obesity: Visceral Adiposity can predict the Risk

text: A concerning rise in coronavirus disease 2019 (COVID-19) cases has been recently reported, particularly in the USA. The causes of this increase are likely multifactorial and the object of an ongoing health and socio-economic debate. However, preliminary data indicate that the new COVID-19 cases are increasing among younger and obese adults. Considering this recent spike, the timing of the paper by Deng et al is of particular importance (1). Deng et al not only confirmed that obesity is a major and independent risk factor for COVID-19 complications in young adults (2), they pointed out ectopic and visceral fat depots as new markers of that risk. The authors found that computed tomography (CT) imaging of fatty liver and epicardial adipose tissue (EAT) were significantly higher in severely and critically ill COVID-19 patients under 40 years old as compared to those with milder disease.


title: Examining the Specificity of Forms and Functions of Aggressive Behavior in Boys With Fragile X Syndrome

text: Limited information is available concerning the specificity of the forms and functions of aggressive behavior exhibited by boys with fragile X syndrome (FXS). To investigate these relationships, we conducted indirect functional assessments of aggressive behavior exhibited by 41 adolescent boys with FXS and 59 age and symptom-matched controls with intellectual and developmental disability (IDD) and compared the data between groups. Results showed that boys with FXS were more likely to exhibit specific forms of aggressive behavior (i.e., scratching others and biting others) compared to controls, but the sources of reinforcement identified for aggression were similar across groups. Boys with FXS who were prescribed psychotropic medications were more likely to be older and to exhibit more forms of aggression. The implications for the treatment of aggressive behavior during this critical developmental period in FXS are discussed.


title: Impact of Home Quarantine on Physical Activity Among Older Adults Living at Home During the COVID-19 Pandemic: Qualitative Interview Study

text: BACKGROUND: Older adults and those with pre-existing medical conditions are at risk of death from severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). In this period of quarantine, one of the reasons for going out is physical activity. This issue is important, as the impact of a sedentary lifestyle might be lower for children and young adults, but is far more severe for older adults. Although older adults need to stay at home because they have a higher risk of coronavirus disease (COVID-19), they need to avoid a sedentary lifestyle. Physical activity is important for older adults, especially to maintain their level of independence, mental health, and well-being. Maintaining mobility in old age is necessary, as it may predict loss of independence in older adults. OBJECTIVE: Our first objective was to evaluate the impact of this quarantine period on physical activity programs and on the physical and mental health of older adults. Our second objective was to discuss alternatives to physical activity programs that could be suggested for this population to avoid a sedentary lifestyle. METHODS: We conducted a qualitative survey using semistructured interviews with professionals (managers in charge of physical activity programs for older adults and sports trainers who run these physical activity programs) from the French Federation of Physical Education and Voluntary Gymnastics (FFPEVG) and older adults participating in a physical activity program of the FFPEVG. We followed a common interview guide. For analysis, we carried out a thematic analysis of the interviews. RESULTS: This study suggests that the COVID-19 epidemic has affected, before quarantine measures, the number of seniors attending group physical activity programs in the two study territories. In addition, despite the decline in their participation in group physical activities before the quarantine, older adults expressed the need to perform physical activity at home. There is a need to help older adults integrate simple and safe ways to stay physically active in a limited space. A national policy to support older adults for physical activity at home appears essential in this context. CONCLUSIONS: Given the results of our study, it seems necessary to globally communicate how important it is for older adults to maintain physical activity at home. We are concerned about the level of independence and mental health state of older adults after the end of quarantine if there is no appropriate campaign to promote physical activity among them at home.


title: Search query interest for gastrointestinal symptoms associated with COVID-19 diagnosis: an infodemiology study

text: BACKGROUND: The coronavirus disease 2019 (COVID-19) is a novel viral illness that has rapidly spread worldwide. While the disease primarily presents as a respiratory illness, gastrointestinal symptoms such as diarrhea have been reported in up to a third of confirmed cases, and patients may have mild symptoms that do not prompt medical attention. Internet-based infodemiology approaches offer an approach to studying symptoms at a population level, even in patients who do not seek medical care. OBJECTIVE: This study aimed to determine if a correlation exists between internet searches for gastrointestinal symptoms and confirmed case count of COVID-19 in the United States. METHODS: The search terms chosen for analysis in this study include common gastrointestinal symptoms such as diarrhea, nausea, vomiting, and abdominal pain. Furthermore, fever and cough were used as positive controls and constipation as a negative control. Daily query shares for the selected symptoms were obtained from Google Trends between October 1, 2019 and June 15, 2020 for all U.S. states. These shares were divided into two time periods: pre-COVID-19 (prior to March 1) and post-COVID-19 (March 1-June 15). Confirmed COVID-19 case number was obtained from the Johns Hopkins University Center for Systems Science and Engineering data repository. Moving averages of the daily query shares (normalized to baseline pre-COVID-19) were then analyzed against the confirmed disease case count and daily new cases to establish a temporal relationship. RESULTS: While the relative search query share of many symptoms including nausea, vomiting, abdominal pain, and constipation remained near or below baseline throughout the time period studied, there was a notable increase in searches for the positive controls, fever and cough, as well as for diarrhea. This increase in daily search queries for fever, cough, and diarrhea preceded the rapid rise in case number by about 10-14 days. Search volume for these terms began declining after mid-March despite continued rise in cumulative cases and daily new case count. CONCLUSIONS: Google searches for symptoms may precede the actual rise in cases and hospitalizations during pandemics. During the current COVID-19 pandemic, this study demonstrates that internet search queries for fever, cough, and diarrhea increase prior to confirmed case count by available testing during the early weeks of the pandemic in the U.S. While search volume eventually decreased significantly as cases continued to rise, internet query search data may still be a useful tool at a population level to identify areas of active disease transmission at the cusp of new outbreaks.


title: Compressing Piecewise Smooth Images with the Mumford-Shah Cartoon Model

text: Compressing piecewise smooth images is important for many data types such as depth maps in 3D videos or optic flow fields for motion compensation. Specialised codecs that rely on explicitly stored segmentations excel in this task since they preserve discontinuities between smooth regions. However, current approaches rely on ad hoc segmentations that lack a clean interpretation in terms of energy minimisation. As a remedy, we derive a generic region merging algorithm from the Mumford-Shah cartoon model. It adapts the segmentation to arbitrary reconstruction operators for the segment content. In spite of its conceptual simplicity, our framework can outperform previous segment-based compression methods as well as BPG by up to 3 dB.


Audio Interview: Acute Lung Injury in Covid-19


title: Measuring multimorbidity beyond counting diseases: systematic review of community and population studies and guide to index choice

text: OBJECTIVES: To identify and summarise existing indices for measuring multimorbidity beyond disease counts, to establish which indices include mental health comorbidities or outcomes, and to develop recommendations based on applicability, performance, and usage. DESIGN: Systematic review. DATA SOURCES: Seven medical research databases (Medline, Web of Science Core Collection, Cochrane Library, Embase, PsycINFO, Scopus, and CINAHL Plus) from inception to October 2018 and bibliographies and citations of relevant papers. Searches were limited to English language publications. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Original articles describing a new multimorbidity index including more information than disease counts and not focusing on comorbidity associated with one specific disease. Studies were of adults based in the community or at population level. RESULTS: Among 7128 search results, 5560 unique titles were identified. After screening against eligibility criteria the review finally included 35 papers. As index components, 25 indices used conditions (weighted or in combination with other parameters), five used diagnostic categories, four used drug use, and one used physiological measures. Predicted outcomes included mortality (18 indices), healthcare use or costs (13), hospital admission (13), and health related quality of life (7). 29 indices considered some aspect of mental health, with most including it as a comorbidity. 12 indices are recommended for use. CONCLUSIONS: 35 multimorbidity indices are available, with differing components and outcomes. Researchers and clinicians should examine existing indices for suitability before creating new ones. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017074211.


title: What we know so far about Coronavirus Disease 2019 in children: A meta-analysis of 551 laboratory-confirmed cases

text: AIM: To summarize what we know so far about coronavirus disease (COVID-19) in children. METHOD: We searched PubMed, Scientific Electronic Library Online, and Latin American and Caribbean Center on Health Sciences Information from 1 January 2020 to 4 May 2020. We selected randomized trials, observational studies, case series or case reports, and research letters of children ages birth to 18 years with laboratory-confirmed COVID-19. We conducted random-effects meta-analyses to calculate the weighted mean prevalence and 95% confidence interval (CI) or the weighted average means and 95% CI. RESULT: Forty-six articles reporting 551 cases of COVID-19 in children (aged 1 day-17.5 years) were included. Eighty-seven percent (95% CI: 77%-95%) of patients had household exposure to COVID-19. The most common symptoms and signs were fever (53%, 95% CI: 45%-61%), cough (39%, 95% CI: 30%-47%), and sore throat/pharyngeal erythema (14%, 95% CI: 4%-28%); however, 18% (95% CI: 11%-27%) of cases were asymptomatic. The most common radiographic and computed tomography (CT) findings were patchy consolidations (33%, 95% CI: 23%-43%) and ground glass opacities (28%, 95% CI: 18%-39%), but 36% (95% CI: 28%-45%) of patients had normal CT images. Antiviral agents were given to 74% of patients (95% CI: 52%-92%). Six patients, all with major underlying medical conditions, needed invasive mechanical ventilation, and one of them died. CONCLUSION: Previously healthy children with COVID-19 have mild symptoms. The diagnosis is generally suspected from history of household exposure to COVID-19 case. Children with COVID-19 and major underlying condition are more likely to have severe/critical disease and poor prognosis, even death.


title: The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system

text: In 2019-2020 a new coronavirus named SARS-CoV-2 was identified as the causative agent of a several acute respiratory infection named COVID-19, which is causing a worldwide pandemic. There are still many unresolved questions regarding the pathogenesis of this disease and especially the reasons underlying the extremely different clinical course, ranging from asymptomatic forms to severe manifestations, including the Acute Respiratory Distress Syndrome (ARDS). SARS-CoV-2 showed phylogenetic similarities to both SARS-CoV and MERS-CoV viruses, and some of the clinical features are shared between COVID-19 and previously identified beta-coronavirus infections. Available evidence indicate that the so called "cytokine storm" an uncontrolled over-production of soluble markers of inflammation which, in turn, sustain an aberrant systemic inflammatory response, is a major responsible for the occurrence of ARDS. Chemokines are low molecular weight proteins with powerful chemoattractant activity which play a role in the immune cell recruitment during inflammation. This review will be aimed at providing an overview of the current knowledge on the involvement of the chemokine/chemokine-receptor system in the cytokine storm related to SARS-CoV-2 infection. Basic and clinical evidences obtained from previous SARS and MERS epidemics and available data from COVID-19 will be taken into account.


A case of cytokine hemofiltration and extracorporeal life support as treatment of coronavirus disease 2019 (COVID-19) respiratory failure


title: Dispatches from the frontlines: A critical care nurse's response to COVID19

text: The emergency alert that appeared on my phone read "Serious Communicable Diseases Unit (SCDU) Activation," indicating Emory University Hospital's SCDU had just been pulled into the battle against COVID-19. As part of this unit, I've donned personal protective equipment (PPE) and participated in countless training exercises, and prepared other clinicians to safely care for people with highly pathogenic infectious diseases. What followed the activation alert, however, was a dynamic interplay between deliberate biosafety methodologies and rapid, reflexive critical care interventions as my teammates and I navigated a novel, burgeoning health threat that called for a whole-system response. As this pandemic continues to exact a grave toll on healthcare workers, our families and our communities, politicians have asked, "How could we have seen this coming?" As a pandemic preparedness researcher, my question to them is, "How could you not have seen this coming?" This perspective piece argues that despite the many missed opportunities to prepare for this crisis, the greatest opportunities lie ahead of us if we choose today to invest in pandemic preparedness for tomorrow.


Mortality and the use of Antithrombotic Therapies among Nursing Home Residents with COVID-19


title: Proactive Prophylaxis With Azithromycin and HydroxyChloroquine in Hospitalised Patients With COVID-19 (ProPAC-COVID): A structured summary of a study protocol for a randomised controlled trial

text: OBJECTIVES: The aim of this randomised GCP-controlled trial is to clarify whether combination therapy with the antibiotic azithromycin and hydroxychloroquine via anti-inflammation/immune modulation, antiviral efficacy and pre-emptive treatment of supra-infections can shorten hospitalisation duration for patients with COVID-19 (measured as "days alive and out of hospital" as the primary outcome), reduce the risk of non- invasive ventilation, treatment in the intensive care unit and death. TRIAL DESIGN: This is a multi-centre, randomised, Placebo-controlled, 2-arm ratio 1:1, parallel group double-blind study. PARTICIPANTS: 226 participants are recruited at the trial sites/hospitals, where the study will take place in Denmark: Aalborg, Bispebjerg, Gentofte, Herlev, Hillerød, Hvidovre, Odense and Slagelse hospitals. INCLUSION CRITERIA: â¢ Patient admitted to Danish emergency departments, respiratory medicine departments or internal medicine departments â¢ Age≥ 18 years â¢ Hospitalized ≤48 hours â¢ Positive COVID-19 test / diagnosis during the hospitalization (confirmed). â¢ Men or non-fertile women. Fertile women* must not be pregnant, i.e. negative pregnancy test must be available at inclusion â¢ Informed consent signed by the patient *Defined as after menarche and until postmenopausal (no menstruation for 12 months) Exclusion criteria: â¢ At the time of recruitment, the patient uses >5 LO2/min (equivalent to 40% FiO2 if measured) â¢ Known intolerance/allergy to azithromycin or hydroxychloroquine or hypersensitivity to quinine or 4-aminoquinoline derivatives â¢ Neurogenic hearing loss â¢ Psoriasis â¢ Retinopathy â¢ Maculopathy â¢ Visual field changes â¢ Breastfeeding â¢ Severe liver diseases other than amoebiasis (INR> 1.5 spontaneously) â¢ Severe gastrointestinal, neurological and hematological disorders (investigator-assessed) â¢ eGFR <45 ml/min/1.73 m2 â¢ Clinically significant cardiac conduction disorders/arrhythmias or prolonged QTc interval (QTc (f) of> 480/470 ms). â¢ Myasthenia gravis â¢ Treatment with digoxin* â¢ Glucose-6-phosphate dehydrogenase deficiency â¢ Porphyria â¢ Hypoglycaemia (Blood glucose at any time since hospitalization of <3.0 mmol/L) â¢ Severe mental illness which significantly impedes cooperation â¢ Severe linguistic problems that significantly hinder cooperation â¢ Treatment with ergot alkaloids *The patient must not be treated with digoxin for the duration of the intervention. For atrial fibrillation/flutter, select according to the Cardiovascular National Treatment Guide (NBV): Calcium antagonist, Beta blocker, direct current (DC) conversion or amiodarone. In case of urgent need for digoxin treatment (contraindication for the aforementioned equal alternatives), the test drug should be paused, and ECG should be taken daily. INTERVENTION AND COMPARATOR: Control group: The control group will receive the standard treatment + placebo for both types of intervention medication at all times. If part or all the intervention therapy being investigated becomes standard treatment during the study, this may also be offered to the control group. Intervention group: The patients in the intervention group will also receive standard care. Immediately after randomisation to the intervention group, the patient will begin treatment with: Azithromycin: Day 1-3: 500 mg x 1 Day 4-15: 250 mg x 1 If the patient is unable to take the medication orally by themselves, the medication will, if possible, be administered by either stomach-feeding tube, or alternatively, temporary be changed to clarithromycin 500 mg x 2 (this only in agreement with either study coordinator Pradeesh Sivapalan or principal investigator Jens-Ulrik Stæhr Jensen). This will also be done in the control group if necessary. The patient will switch back to azithromycin when possible. Hydroxychloroquine: Furthermore, the patient will be treated with hydroxychloroquine as follows: Day 1-15: 200 mg x 2 MAIN OUTCOMES: â¢ Number of days alive and discharged from hospital within 14 days (summarises both whether the patient is alive and discharged from hospital) ("Days alive and out of hospital") RANDOMISATION: The sponsor (Chronic Obstructive Pulmonary Disease Trial Network, COP:TRIN) generates a randomisation sequence. Randomisation will be in blocks of unknown size and the final allocation will be via an encrypted website (REDCap). There will be stratification for age (>70 years vs. <=70 years), site of recruitment and whether the patient has any of the following chronic lung diseases: COPD, asthma, bronchiectasis, interstitial lung disease (Yes vs. No). BLINDING (MASKING): Participants and study personnel will both be blinded, i.e. neither will know which group the participant is allocated to. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): This study requires 226 patients randomised 1:1 with 113 in each group. TRIAL STATUS: Protocol version 1.8, from April 16, 2020. Recruitment is ongoing (first patient recruited April 6, 2020; final patient expected to be recruited October 31, 2020). TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04322396 (registered March 26, 2020) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Reconnecting for our future: The Lancet One Health Commission


title: The future of sleep-disordered breathing: A public health crisis

text: Find the whole series here https://onlinelibrary.wiley.com/doi/toc/10.1111/(ISSN)1440-1843.new-frontiers-in-sleep-disordered-breathing See cover image.


title: On the impact of treewidth in the computational complexity of freezing dynamics

text: An automata network is a network of entities, each holding a state from a finite set and evolving according to a local update rule which depends only on its neighbors in the network's graph. It is freezing if there is an order on states such that the state evolution of any node is non-decreasing in any orbit. They are commonly used to model epidemic propagation, diffusion phenomena like bootstrap percolation or cristal growth. In this paper we establish how treewidth and maximum degree of the underlying graph are key parameters which influence the overall computational complexity of finite freezing automata networks. First, we define a general model checking formalism that captures many classical decision problems: prediction, nilpotency, predecessor, asynchronous reachability. Then, on one hand, we present an efficient parallel algorithm that solves the general model checking problem in NC for any graph with bounded degree and bounded treewidth. On the other hand, we show that these problems are hard in their respective classes when restricted to families of graph with polynomially growing treewidth. For prediction, predecessor and asynchronous reachability, we establish the hardness result with a fixed set-defiend update rule that is universally hard on any input graph of such families.


Covid-19 brings the world economy to its knees


title: Endovascular Treatment of a Ruptured Pararenal Abdominal Aortic Aneurysm in a Patient With Coronavirus Disease-2019: Suggestions and Case Report

text: The aim of this report is to discuss emergent repair for complex aortic diseases in patients affected by novel coronavirus pneumonia (coronavirus disease-2019 [COVID-19]), describing a case of ruptured pararenal aortic aneurysm. An eighty-year-old man with COVID-19 was admitted for ruptured aneurysm of the pararenal aorta and hemorrhagic shock. Endovascular repair was chosen, and a proximal extension of the previous abdominal endograft was performed with parallel stents in the right renal artery and the superior mesenteric artery. Endovascular treatment and early anticoagulation are the key for success for vascular emergencies in patients with COVID-19, despite the risk of late endoleak.


Authoritarianism and the threat of infectious diseases


title: Pediatric Modification of the Medically Necessary, Time-Sensitive Scoring System for Operating Room Procedure Prioritization During the COVID-19 Pandemic

text: BACKGROUND: The COVID-19 pandemic forced surgeons to reconsider concepts of "elective" operations. Perceptions about the time sensitivity and medical necessity of a procedure have taken on greater significance during the pandemic. The evolving ethical and clinical environment requires reappraisal of perioperative factors, such as personal protective equipment conservation; limiting the risk of exposure to COVID-19 for patients, families, and healthcare workers; preservation of hospital beds and ICU resources; and minimizing COVID-19-related perioperative risk to patients. STUDY DESIGN: A scaffold for the complex decision-making required for prioritization of medically necessary, time-sensitive (MeNTS) operations was developed for adult patients by colleagues at the University of Chicago. Although adult MeNTS scoring can be applied across adult surgical specialties, some variables were irrelevant in a pediatric population. Pediatric manifestations of chronic diseases and congenital anomalies were not accounted for. To account for the unique challenges children face, we modified the adult MeNTS system for use across pediatric subspecialties. RESULTS: This pediatric MeNTS scoring system was applied to 101 cases both performed and deferred between March 23 and April 19, 2020 at the University of Chicago Comer Children's Hospital. The pediatric MeNTS scores provide a safe, equitable, transparent, and ethical strategy to prioritize children's surgical procedures. CONCLUSIONS: This process is adaptable to individual institutions and we project it will be useful during the acute phase of the pandemic (maximal limitations), as well as the anticipated recovery phase.


title: Coronavirus Covid-19 spreading in Italy: optimizing an epidemiological model with dynamic social distancing through Differential Evolution

text: The aim of this paper consists in the application of a recent epidemiological model, namely SEIR with Social Distancing (SEIR--SD), extended here through the definition of a social distancing function varying over time, to assess the situation related to the spreading of the coronavirus Covid--19 in Italy and in two of its most important regions, i.e., Lombardy and Campania. To profitably use this model, the most suitable values of its parameters must be found. The estimation of the SEIR--SD model parameters takes place here through the use of Differential Evolution, a heuristic optimization technique. In this way, we are able to evaluate for each of the three above-mentioned scenarios the daily number of infectious cases from today until the end of virus spreading, the day(s) in which this number will be at its highest peak, and the day in which the infected cases will become very close to zero.


Craniofacial Surgeons in Different Settings Facing the COVID-19 Pandemic


title: Psychological Functioning of Slovene Adults during the COVID-19 Pandemic: Does Resilience Matter?

text: As a public health emergency, a pandemic increases susceptibility to unfavourable psychological outcomes. The aim of the present study was to investigate the buffering role of personal resilience in two aspects of psychological functioning, mental health and stress, among Slovene adults at the beginning of the COVID-19 outbreak. Within five days after Slovenia declared epidemics, 2722 participants (75% female) completed an on-line survey measuring mental health and perceived stress as outcome variables and demographics, health-related variables, and personal resilience as predictor variables. Hierarchical logistic regression analyses demonstrated that women, younger, and less educated participants had higher odds for less favourable psychological functioning during the COVID-19 outbreak. In addition, poorer health indicators and COVID-19 infection concerns predicted diminished psychological functioning. The crucial factor promoting good psychological functioning during the COVID-19 pandemics was resilience, additionally buffering against detrimental effects of demographic and health-related variables on mental health and perceived stress. While previous research suggests that mental health problems increase during pandemics, one way to prevent these problems and bolster psychological functioning is to build individuals' resilience. The interventions should be targeted particularly at younger adults, women, less educated people, and individuals who subjectively perceive their health to be rather poor.


Impact of COVID-19 pandemic on emergency department services acuity and possible collateral damage


title: COVID-19 and Paediatric Dentistry after the lockdown

text: Coronaviruses are a large family of respiratory RNA viruses that can cause severe infections of the airways, as we have seen in the past, difficult months. We know that the route of transmission of the disease is through saliva droplets produced by speaking, coughing and sneezing. The virus is highly infectious, and each infected individual infects 2.5 people on average. The average incubation period is about 5 days, with an estimated range from 2 to 14 days; the incubation period in children is similar, however some have exhibited a longer incubation. The virus binds to the cellular receptor ACE2, which in children has a structural and functional immaturity thus offering lower affinity to the pathogen; this could explain the lower incidence of infection from SARS-CoV-2 in this segment of the population.The common clinical observation is that COVID-19 is less severe in children, and in this group the disease is often asymptomatic. Pending further clinical studies able to clarify the infection and transmission dynamics, it is therefore important to apply also in children all preventive and hygiene measures recommended by the health authorities during dental treatment. We should avoid procedures that generate aerosols as much as possible, minimising the use of the air syringe. When possible, it is recommended to employ minimally invasive procedures and ART (Atraumatic Restorative Treatment). The latter is a technique that can also be employed in very young and uncooperative patients with widespread carious lesions, in order to avoid more invasive and complex procedures. Ozone therapy could be of great help in the control of the progression of the asymptomatic carious lesions, especially during the Phase 2 of reopening, when we should to minimise the use of rotating instruments producing aerosols. The above introduces a new concept of "no aerosol" that will possibly guide our therapeutic choices not only in the immediate future but also in the long term, opening scenarios of prevention and cure that are more efficient, safe, and sustainable. During procedures that generate aerosols, the use of proper PPE is crucial to minimise the risk of transmission. It is also strongly recommended to work with an assistant, and to use double suction and a rubber dam. We will have to rethink and review the schedule of daily activities, in terms of timing and mode of delivery of care, on the basis of an agenda which can be divided into "no aerosol" and "aerosol" procedures, and "virtual visits" (including management of true emergencies), creating a virtuous optimisation of care for the safety of operators and office staff, as discussed in an article published on this very EJPD issue. In the coming months we will perhaps deliver more "patient-oriented" than "tooth-oriented" treatments, and this is true not only for young patients!


title: Quantification of Tomographic Patterns associated with COVID-19 from Chest CT

text: Purpose: To present a method that automatically segments and quantifies abnormal CT patterns commonly present in coronavirus disease 2019 (COVID-19), namely ground glass opacities and consolidations. Materials and Methods: In this retrospective study, the proposed method takes as input a non-contrasted chest CT and segments the lesions, lungs, and lobes in three dimensions, based on a dataset of 9749 chest CT volumes. The method outputs two combined measures of the severity of lung and lobe involvement, quantifying both the extent of COVID-19 abnormalities and presence of high opacities, based on deep learning and deep reinforcement learning. The first measure of (PO, PHO) is global, while the second of (LSS, LHOS) is lobewise. Evaluation of the algorithm is reported on CTs of 200 participants (100 COVID-19 confirmed patients and 100 healthy controls) from institutions from Canada, Europe and the United States collected between 2002-Present (April, 2020). Ground truth is established by manual annotations of lesions, lungs, and lobes. Correlation and regression analyses were performed to compare the prediction to the ground truth. Results: Pearson correlation coefficient between method prediction and ground truth for COVID-19 cases was calculated as 0.92 for PO (P<.001), 0.97 for PHO(P<.001), 0.91 for LSS (P<.001), 0.90 for LHOS (P<.001). 98 of 100 healthy controls had a predicted PO of less than 1%, 2 had between 1-2%. Automated processing time to compute the severity scores was 10 seconds per case compared to 30 minutes required for manual annotations. Conclusion: A new method segments regions of CT abnormalities associated with COVID-19 and computes (PO, PHO), as well as (LSS, LHOS) severity scores.


title: [Strategy of pharmaceutical care services for clinical Chinese pharmacists in coronavirus disease 2019 (COVID-19)]

text: The outbreak of coronavirus disease 2019(COVID-19) seriously endangers people's health. Traditional Chinese medicine(TCM) has been recommended for the treatment of COVID-19 in Novel Coronavirus Pneumonia Prevention and Control Strategy, which have made outstanding contributions to the prevention and control of the epidemic. The wide application of Chinese medicine asked the pharmacists and doctors, nurses, and medical technicians in Wuhan and around the country to stand on the front line of COVID-19 treatment, and provide pharmaceutical care services, which has effectively guaranteed the safety and rational use of Chinese medicine. This article will introduce the TCM cognition of the COVID-19, analyze the clinical application of Chinese medicine and the entry point of pharmaceutical care, and clarify that clinical Chinese pharmacists can participate in making medication therapy plan, medication reconciliation, and prescription review, promoting rational drug use, pharmaceutical monitoring, and drug risk management. The participation of clinical Chinese pharmacists in the prevention and treatment of COVID-19 is conducive to improving the level of rational use of TCM, by ensuring the effectiveness, and safety.


title: COVID-19 treatment: Combining anti-inflammatory and antiviral therapeutics using a network-based approach

text: To date, there are no effective antiviral medications for COVID-19. Drug repurposing, a strategy that uses existing drugs, offers potential prevention and treatment options for COVID-19. We discuss one treatment strategy that combines anti-inflammatory (melatonin) and antiviral (toremifene) agents for patients infected with SARS-CoV-2 from network medicine-based findings. We also describe the pathobiology and immunologic characteristics of COVID-19 and highlight the rationale of combination drug treatment to rescue the pulmonary and cardiovascular conditions resulting from COVID-19. A preliminary analysis reveals a high potential for the synergistic effects of melatonin and toremifene to reduce viral infection and replication, and the aberrant host inflammatory responses, offering strong biologic plausibility as an effective therapy for COVID-19.


title: COVID-19 and spinal cord injury and disease: results of an international survey

text: STUDY DESIGN: An online survey. OBJECTIVES: To query the international spinal cord medicine community's engagement with and response to the novel coronavirus (COVID-19) pandemic and to assess pandemic-specific information needs and patient concerns. SETTING: An international collaboration of authors and participants. METHODS: Two near-identical surveys (one English and one Spanish language) were distributed via the internet. Responses from those questions shared between the surveys were pooled then analyzed; four questions' responses (those not shared) were analyzed separately. RESULTS: A total of 783 responses were submitted from six continents. Few participants (5.8%) had tested their outpatients with SCI/D for COVID-19; only 4.4% reported having a patient with SCI/D with the virus. Of respondents who worked at an inpatient facility, 53.3% reported that only individuals with symptoms were being screened and 29.9% said that no screening was occurring. Participants relayed several concerns offered by their patients with SCI/D, including vulnerability to infection (76.9%) and fragility of caretaker supply (42%), and those living in countries with guaranteed health care were more likely to report widespread availability of COVID-19 testing than were those living in countries without universal care, χ2 (3, N = 625) = 46.259, p < 0.001. CONCLUSION: There is substantial variability in the rehabilitation medicine community in COVID-19 screening practices and availability of screening kits. People living with SCI/D are expressing legitimate and real concerns about their vulnerability to COVID-19. More and rapid work is needed to address these concerns and to standardize best-practice protocols throughout the rehabilitation community.


Adaptation of the 'Assembly Line' and 'Brick System' techniques for hospital resource management of personal protective equipment, as preparedness for mitigating the impact of the COVID-19 pandemic in a large public hospital in India


Heightened Central Line-associated Blood Stream Infection Risk During a Pandemic


Fasting during Ramadan and the COVID-19 pandemic


title: SARS-CoV-2 Receptor ACE2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues

text: There is pressing urgency to understand the pathogenesis of the severe acute respiratory syndrome coronavirus clade 2 (SARS-CoV-2), which causes the disease COVID-19. SARS-CoV-2 spike (S) protein binds angiotensin-converting enzyme 2 (ACE2), and in concert with host proteases, principally transmembrane serine protease 2 (TMPRSS2), promotes cellular entry. The cell subsets targeted by SARS-CoV-2 in host tissues and the factors that regulate ACE2 expression remain unknown. Here, we leverage human, non-human primate, and mouse single-cell RNA-sequencing (scRNA-seq) datasets across health and disease to uncover putative targets of SARS-CoV-2 among tissue-resident cell subsets. We identify ACE2 and TMPRSS2 co-expressing cells within lung type II pneumocytes, ileal absorptive enterocytes, and nasal goblet secretory cells. Strikingly, we discovered that ACE2 is a human interferon-stimulated gene (ISG) in vitro using airway epithelial cells and extend our findings to in vivo viral infections. Our data suggest that SARS-CoV-2 could exploit species-specific interferon-driven upregulation of ACE2, a tissue-protective mediator during lung injury, to enhance infection.


How sexual medicine is facing the outbreak of COVID-19: experience of Italian urological community and future perspectives


title: Early neurological manifestations of hospitalized COVID-19 patients

text: INTRODUCTION: Neurological manifestations can occur during coronavirus disease 19 (COVID-19). Several pathogenic mechanisms have been hypothesized, without conclusive results. In this study, we evaluated the most frequent neurological symptoms in a cohort of hospitalized COVID-19 patients, and also investigated the possible relationship between plasmatic inflammatory indices and olfactory disorders (ODs) and between muscle pain and creatine kinase (CK). METHODS: We consecutively enrolled hospitalized COVID-19 patients. A structured questionnaire concerning typical and neurological symptoms, focusing on headache, dizziness, ODs, taste disorders (TDs), and muscle pain, was administrated by telephone interviews. RESULTS: Common neurological symptoms were reported in the early phase of the disease, with a median onset ranging from 1 to 3 days. Headache showed tension-type features and was more frequently associated with a history of headache. Patients with ODs less frequently needed oxygen therapy. Inflammatory indices did not significantly differ between patients with and without ODs. Muscle pain did not show any association with CK level but was more frequently associated with arthralgia and headache. CONCLUSION: In our cohort, ODs were an early symptom of COVID-19, more frequently reported by patients with milder forms of disease. Headache in association with arthralgia and muscle pain seems to reflect the common symptoms of the flu-like syndrome, and not COVID-19 infection-specific.


title: Health-protective behaviour, social media usage and conspiracy belief during the COVID-19 public health emergency

text: BACKGROUND: Social media platforms have long been recognised as major disseminators of health misinformation. Many previous studies have found a negative association between health-protective behaviours and belief in the specific form of misinformation popularly known as 'conspiracy theory'. Concerns have arisen regarding the spread of COVID-19 conspiracy theories on social media. METHODS: Three questionnaire surveys of social media use, conspiracy beliefs and health-protective behaviours with regard to COVID-19 among UK residents were carried out online, one using a self-selecting sample (N = 949) and two using stratified random samples from a recruited panel (N = 2250, N = 2254). RESULTS: All three studies found a negative relationship between COVID-19 conspiracy beliefs and COVID-19 health-protective behaviours, and a positive relationship between COVID-19 conspiracy beliefs and use of social media as a source of information about COVID-19. Studies 2 and 3 also found a negative relationship between COVID-19 health-protective behaviours and use of social media as a source of information, and Study 3 found a positive relationship between health-protective behaviours and use of broadcast media as a source of information. CONCLUSIONS: When used as an information source, unregulated social media may present a health risk that is partly but not wholly reducible to their role as disseminators of health-related conspiracy beliefs.


title: 'Distancers' and 'non-distancers'? The potential social psychological impact of moralizing COVID-19 mitigating practices on sustained behaviour change

text: COVID-19 mitigating practices such as 'hand-washing', 'social distancing', or 'social isolating' are constructed as 'moral imperatives', required to avert harm to oneself and others. Adherence to COVID-19 mitigating practices is presently high among the general public, and stringent lockdown measures supported by legal and policy intervention have facilitated this. In the coming months, however, as rules are being relaxed and individuals become less strict, and thus, the ambiguity in policy increases, the maintenance of recommended social distancing norms will rely on more informal social interactional processes. We argue that the moralization of these practices, twinned with relaxations of policy, may likely cause interactional tension between those individuals who do vs. those who do not uphold social distancing in the coming months: that is, derogation of those who adhere strictly to COVID-19 mitigating practices and group polarization between 'distancers' and 'non-distancers'. In this paper, we explore how and why these processes might come to pass, their impact on an overall societal response to COVID-19, and the need to factor such processes into decisions regarding how to lift restrictions.