title: A clinical pathway for pre-operative screening of COVID-19 and its influence on clinical outcome in patients with traumatic fractures

text: PURPOSE: Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. The toughest issue traumatic orthopaedic surgeons are faced with is how to maintain a balance between adequate COVID-19 screening and timely surgery. In this study, we described our experience with pre-operative COVID-19 screening in patients with traumatic fractures. Furthermore, we analysed the clinical results of fracture patients undergoing confined or emergency surgery during the COVID-19 outbreak. METHODS: This was a case series study. Patients with traumatic fractures who were admitted to our hospital for surgery were enrolled in this study during the COVID-19 outbreak from March to April 2020. All patients were enrolled and managed using the standardized clinical pathway we designed for preoperative COVID-19 screening. Clinical, laboratory and outcome data were analysed. RESULTS: The average surgery waiting time from injury to surgery was 8.7 ± 3.4 days. The average waiting time from admission to surgery was 5.3 ± 2.8 days. These average waiting times were increased by 4.1 days and 2.0 days, respectively, compared with 2019 data. Cardiovascular complications, venous thromboembolism and pneumonia occurred in one, two and one patient, respectively. Three and two patients developed pre-operative and postoperative fevers, respectively. CONCLUSIONS: We introduced a novel clinical pathway for pre-operatively screening of COVID-19 in traumatic orthopaedic patients. The delay in surgery caused by COVID-19 screening was minimized to a point at which reasonable and acceptable clinical outcomes were achieved. Doctors should pay more attention to perioperative complications, such as cardiovascular complications, venous thromboembolism, pneumonia and fever.


China adopts non-contact free consultation to help the public cope with the psychological pressure caused by new coronavirus pneumonia


title: Relatedness of the Incidence Decay with Exponential Adjustment (IDEA) Model,"Farr's Law"and Compartmental Difference Equation SIR Models

text: Mathematical models are often regarded as recent innovations in the description and analysis of infectious disease outbreaks and epidemics, but simple models have been in use for projection of epidemic trajectories for more than a century. We recently described a single equation model (the incidence decay with exponential adjustment, or IDEA, model) that can be used for short term forecasting. In the mid-19th century, Dr. William Farr developed a single equation approach (Farr's law) for epidemic forecasting. We show here that the two models are in fact identical, and can be expressed in terms of one another, and also in terms of a susceptible-infectious-removed (SIR) compartmental model with improving control. This demonstrates that the concept of the reproduction number, R0, is implicit to Farr's (pre-microbial era) work, and also suggests that control of epidemics, whether via behavior change or intervention, is as integral to the natural history of epidemics as is the dynamics of disease transmission.


title: Atención farmacéutica especializada en centros sociosanitarios en tiempos de COVID-19./ Specialized pharmaceutical care in social health centers in the times of COVID-19

text: The COVID-19 pandemic is having a devastating effect on the nursing homes for dependent older people. The difficulty of management of this crisis is aggravated by the frailty of the people served and by the specific characteristics of the care area, mainly the fact of not being integrated into the health system. The objective of this work is to describe the pharmaceutical care developed by a hospital pharmacy service established in a nursing home and, from a more global perspective, analyze the strengths and weaknesses found from the various experiences of hospital pharmacy in all spanish autonomous communities to deal with this pandemic. Specialized pharmaceutical care has provided rigor in the validation and treatments review processes from a comprehensive perspective, maximizing safety and collaborating in the establishment of the therapeutic intensity degree most appropriate to the individual situation, has ensured the availability of all necessary medications, has collaborated in the acquisition and management of personal protective equipment, has been able to adapt the dispensation processes to the internal nursing homes sectorization and has facilitated the coordination between the nursing home and the health system. It is clear that the crisis casued by COVID- 19 has put relevance of the need to integrate the social-health level into the health system. And also, the contribution of specialized pharmaceutical care in improving healthcare coverage and coordination with health services has highlighted the urgency of developing the current legislation, prioritizing the establishment of pharmacy services able to provid specialized and specific care for this area, so that it meets healthcare needs and is integrated into the health system.


Smart cities for emergency management


Covid-19: MPs reject calls to routinely test health and care workers


Novel coronavirus: how things are in Wuhan


Caring for the Vaccine Hesitant Family: Evidence-Based Alternatives to Dismissal


title: Aerosol containment box to the rescue: extra protection for the front line

text: As the COVID-19 pandemic has created shortages of vital personal protective equipment that threatens healthcare workers' risk of exposure, a need for innovative new ways to protect healthcare workers has emerged. An aerosol containment box that covers the patient's head and neck in bed provides a solution to protect clinicians during aerosol-generating procedures such as intubation. We collaborated with original designer HYL and modified the size to adapt to larger patients and operator mobility. We expand its applicability by allowing the use of different instruments. The container is outfitted with an ultra-low particulate air-equipped filtration vacuum device to create negative pressure within the chamber and actively remove floating droplet nuclei generated during a procedure. This barrier method will be a valuable and economical option to protect healthcare workers on the front line globally during this pandemic and beyond.


Adapting a TB contact investigation strategy for COVID-19


title: A review of potential treatments to date in COVID-19 patients according to the stage of the disease

text: INTRODUCTION AND MOTIVATION: Since the end of 2019, the COVID-19 pandemic has affected millions of people worldwide. With the rapid spread of this virus, an immense burden has fallen upon both healthcare and economic systems. As a consequence, there is an unprecedented urgency for researchers and scientific committees from all over the world to find an effective treatment and vaccine. REVIEW STRUCTURE: Many potential therapies are currently under investigation, with some, like Hydroxychloroquine, being authorized for emergency use in some countries. The crucial issue is now clearly to find the suitable treatment strategy for patients given comorbidities and the timeline of the illness. Vaccines are also under development and phase 1 clinical trials are rolling. Despite all efforts, no single drug or vaccine has yet been approved. In this review, we aim at presenting the proposed pathophysiological mechanisms of SARS-CoV-2 and to provide clinicians with a brief and solid overview of the current potential treatments classified according to their use at the three different currently proposed disease stages. In light of pathogenesis and proposed clinical classification, this review's purpose is to summarize and simplify the most important updates on the management and the potential treatment of this emergent disease.


The treatment and outcome of a pulmonary sarcomatoid carcinoma patient infected with SARS-CoV-2


[Prone ventilation for novel coronavirus pneumonia: no time to delay]


title: Practical laboratory considerations amidst the COVID-19 outbreak: early experience from Singapore

text: The coronavirus disease 2019 (COVID-19) is a zoonotic viral infection originating from Wuhan, China in December 2019. The World Health Organization has classified this pandemic as a global health emergency due to its virulent nature of transmission, which may lead to acute respiratory distress syndrome. Singapore's health ministry has responded with enhanced surveillance of COVID-19 for all suspected pneumonia cases, further increasing the volume of testing via real-time reverse transcription PCR, as well as samples necessitating stringent infectious control. Collectively, this has implications on the total testing process, laboratory operations and its personnel due to biosafety concerns. Turnaround time for routine testing may also be affected. The aim of this article is to present our tertiary institution's early experience with managing this emerging crisis and offer practical considerations for the preanalytical, analytical and postanalytical phases of laboratory testing in this cohort of patients.


A Pandemic Forces United States to Leap Forward


Covid-19: Two thirds of healthcare workers who have died were from ethnic minorities


title: Is serological response to SARS-CoV-2 preserved in MS patients on ocrelizumab treatment? A case report

text: The emergency represented by the COVID-19 pandemic represents a new challenge for clinicians who deal with autoimmune diseases because of patients undergoing immunosuppressive therapy. Few cases of Multiple Sclerosis (MS) patients receiving ocrelizumab who contracted COVID-19 with a benign course have recently been published. We present the case of a MS patient with mild COVID-19 who developed SARS-CoV-2 specific IgA without IgG ten weeks after infection. Patients on B-cell depleting drugs have a reduced antibody immune response to viral neoantigens. A relative sparing of mucosal-associated lymphoid tissues (MALT) could be responsible for IgA response in our patient.


Venezuelan migrants "struggling to survive" amid COVID-19


Use of low-molecular-weight heparin in COVID-19 patients


Positive externalities of an epidemic: The case of the coronavirus (COVID-19) in China


title: Practicing Corona - Towards a research agenda of health policies

text: As Corona virus is putting a huge stress on healthcare systems around the world, analysts of health policy will have to respond with starting up research on the consequences of current policies. In this paper, we propose an agenda for research of health policy from a governance perspective, focussing on the consequences of decision-making structures and practices, the mediatisation of the pandemic, the organisation of healthcare systems and the role of expertise.


title: Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy

text: OBJECTIVE: To report clinical and laboratory characteristics, as well as treatment and clinical outcomes of patients admitted for neurologic diseases with and without COVID-19. METHODS: In this retrospective, single center cohort study, we included all adult inpatients with confirmed COVID-19, admitted to a Neuro-COVID Unit from February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (FDR-corrected) to those of neurologic patients without COVID-19 admitted in the same period. RESULTS: One hundred seventy-three patients were included in this study, of whom 56 were positive for COVID-19 while 117 were negative for COVID-19. Patients with COVID-19 were older (77.0, IQR 67.0-83.8 vs 70.1, IQR 52.9-78.6, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.5, IQR 0.4-0.6 vs 0.9, IQR 0.7-1.1, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. COVID-19 and non-COVID patients with stroke had similar baseline characteristics but patients with COVID-19 had higher modified Rankin scale scores at discharge (5.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (OR 4.47, 95% CI 1.21-16.5; p = 0.025), lower platelet count (0.98, 0.97-0.99; p = 0.005) and higher lactate dehydrogenase (1.01, 1.00-1.03; p = 0.009) on admission. CONCLUSIONS: COVID-19 patients admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality, incident delirium and higher disability than patients without COVID-19.


Global health concerns stirred by emerging viral infections


title: Diabetes and metabolic syndrome as risk factors for COVID-19

text: BACKGROUND AND AIMS: Clinical evidence exists that patients with diabetes are at higher risk for Coronavirus disease 2019 (COVID-19). We investigated the physiological origins of this clinical observation linking diabetes with severity and adverse outcome of COVID-19. METHODS: Publication mining was applied to reveal common physiological contexts in which diabetes and COVID-19 have been investigated simultaneously. Overall, we have acquired 1,121,078 publications from PubMed in the time span between 01-01-2000 and 17-04-2020, and extracted knowledge graphs interconnecting the topics related to diabetes and COVID-19. RESULTS: The Data Mining revealed three pathophysiological pathways linking diabetes and COVID-19. The first pathway indicates a higher risk for COVID-19 because of a dysregulation of Angiotensin-converting enzyme 2. The other two important physiological links between diabetes and COVID-19 are liver dysfunction and chronic systemic inflammation. A deep network analysis has suggested clinical biomarkers predicting the higher risk: Hypertension, elevated serum Alanine aminotransferase, high Interleukin-6, and low Lymphocytes count. CONCLUSIONS: The revealed biomarkers can be applied directly in clinical practice. For newly infected patients, the medical history needs to be checked for evidence of a long-term, chronic dysregulation of these biomarkers. In particular, patients with diabetes, but also those with prediabetic state, deserve special attention.


Covid-19: increasing demand for dialysis sparks fears of supply shortage


title: A New Application of Social Impact in Social Media for Overcoming Fake News in Health

text: One of the challenges today is to face fake news (false information) in health due to its potential impact on people's lives. This article contributes to a new application of social impact in social media (SISM) methodology. This study focuses on the social impact of the research to identify what type of health information is false and what type of information is evidence of the social impact shared in social media. The analysis of social media includes Reddit, Facebook, and Twitter. This analysis contributes to identifying how interactions in these forms of social media depend on the type of information shared. The results indicate that messages focused on fake health information are mostly aggressive, those based on evidence of social impact are respectful and transformative, and finally, deliberation contexts promoted in social media overcome false information about health. These results contribute to advancing knowledge in overcoming fake health-related news shared in social media.


Jean-Marie Michel : Nous ne sommes pas encore au stade post-COVID


title: New onset neurologic events in people with COVID-19 infection in three regions in China

text: OBJECTIVE: To investigate new-onset neurologic impairments associated with coronavirus disease 2019 (COVID-19). METHODS: A retrospective multicenter cohort study conducted between 18 January and 20 March 2020 including people with confirmed COVID-19 from 56 hospitals officially designated in three Chinese regions; data were extracted from medical records. New-onset neurologic events as assessed by neurology consultants based on manifestations, clinical examination and investigations, in which critical events included disorders of consciousness, stroke, CNS infection, seizures and status epilepticus. RESULTS: We enrolled 917 people with average age 48.7 years and 55% were male. The frequency of new onset critical neurologic events was 3.5% (32/917) overall and 9.4% (30/319) among those with severe or critical COVID-19. These were impaired consciousness (n=25) or/and stroke (n=10). The risk of critical neurologic events was highly associated with age above 60 years and previous history of neurological conditions. Non-critical events were seen in less than 1% (7/917), including muscle cramp, unexplained headache, occipital neuralgia, tic and tremor. Brain CT in 28 people led to new findings in nine. Findings from lumbar puncture in three with suspected CNS infection, unexplained headache or severe occipital neuralgia were unremarkable. CONCLUSIONS: People with COVID-19 aged over 60 and neurologic comorbidities were at higher risk of developing critical neurologic impairment, mainly impaired consciousness and cerebrovascular accidents. Brain CT should be considered when new-onset brain injury is suspected, especially in people under sedation or showing an unexplained decline in consciousness. Evidence of direct acute insult of SARS-COV-2 to the CNS is still lacking.


title: FACT als onderdeel van wijkgerichte zorg in het (zorg)netwerk./ [Flexible assertive community treatment (FACT) as part of a community (health) network]

text:
BACKGROUND: Community-based care for people with severe mental illness increasingly requires far-reaching cooperation between different domains. This cooperation must always be unique and local, and at the same time provide an answer to generic and nationally set goals.
 AIM: Offering new insights on collaboration within and between domains.
 METHOD: Reflection on developments in the social domain and specialist mental healthcare using relevant literature and recent (inter)national experiences.
 RESULTS: It seems possible to provide better integral care by allowing FACT-teams to network together with Social Support partners (e.g. by sharing financial and/or human resources). In this process, networks of care for people with serious mental illness (SMI), develop over various phases and realize new partnerships. The model fidelity scale for FACT-teams was adjusted to facilitate that process. CONCLUSIONS The new FACT model fidelity scale is ready to allow FACT-teams to explore flexible local solutions for partnerships to realize the much-needed multi-domain integrated community care for people with SMI.


Impact of the COVID-19 pandemic on the symptomatic diagnosis of cancer: the view from primary care


title: Interferon-Induced Transmembrane Protein 3 Genetic Variant rs12252-C Associated With Disease Severity in Coronavirus Disease 2019

text: A major unanswered question in the current global coronavirus disease 2019 (COVID-19) outbreak is why severe disease develops in a small minority of infected individuals. In the current article, we report that homozygosity for the C allele of rs12252 in the interferon-induced transmembrane protein 3 (IFITM3) gene is associated with more severe disease in an age-dependent manner. This supports a role for IFITM3 in disease pathogenesis and the opportunity for early targeted intervention in at-risk individuals.


Perú un escenario posible para coinfección entre COVID-19 y dengue


title: COVID-19: Nasal and oropharyngeal swab

text: Performing a proper nasal and oropharyngeal swab procedure is essential in the screening of COVID-19 infection. The video illustration of nasal and oropharyngeal swab is presented (Video S1). To correctly perform the nasopharyngeal swab, the patient must be seated comfortably with the back of their head against the headrest. The swab is inserted in the nose horizontally, along an imaginary line between the nostril and the ear. Oropharyngeal sampling is easier to perform. The swab is directed toward the rear wall of the oropharynx and it is rotated a few times before removal. After taking the sample, it is necessary to insert both swabs in the same tube, breaking the rod with one swift and controlled movement. Finally, carefully reset the cap. It appears to be extremely important to properly collect nasopharyngeal and oropharyngeal swabs in order to minimize the false negative rate among COVID-19 positive patients.


Treat COVID-19 as Though It Is Airborne: It May Be


title: Dying during Covid-19

text: I had been on the phone with Madeleine's mother for fifteen minutes, and she had sobbed throughout. She pleaded with me, "You won't even let our family visit her together. If you really want to help my daughter, you will let us stay with her." Madeleine, who was twenty-four years old, was dying of end-stage acute myeloid leukemia and was intubated in one of our intensive care units. Her intensivist had requested a clinical ethics consultation for potentially inappropriate medical treatment-in my world of clinical ethics consultation, routine stuff. Except that, in March 2020, nothing was routine anymore. The Covid-19 pandemic calls for creative thinking about ad hoc and post hoc bereavement efforts, and it may result in efforts to revise existing accounts of what constitutes a good death in order to accommodate patients' and families' experiences at the end of life during a pandemic.


title: Innovation in Response to the COVID-19 Pandemic Crisis

text: The COVID-19 pandemic has disrupted all aspects of academic medical center missions. The number and rapidity of innovative responses to the crisis are extraordinary. When the pandemic has subsided, the world of academic medicine will have changed. The author of this Invited Commentary anticipates that at least some of these innovations will become part of academic medicine's everyday clinical and educational operations. Here he considers the implications of exemplary innovations-virtual care, hospital at home, advances in diagnosis and therapy, virtual learning, and virtual clinical learning-for regulators, academic medical centers, faculty, and students.


title: Achieve Research Continuity During Social Distancing by Rapidly Implementing Individual and Group Videoconferencing with Participants: Key Considerations, Best Practices, and Protocols

text: The novel coronavirus has upended many traditional research procedures as universities and other research entities have closed to activate social distancing. Some social and behavioral research activities (e.g. data analysis, manuscript preparation) can be continued from other environments with appropriate security protocols in place. For studies involving in-person interactions, continuity may be more difficult. Phone-based interactions provide a low-tech solution that may suffice in some cases. Yet, videoconferencing platforms can nearly replicate in-person interactions, activating both auditory and visual senses and potentially resulting in more substantial engagement. Staff can meet with participants individually or in groups, each seeing and hearing one another in real time. This paper provides guidance for researchers transitioning in-person assessments and interventions to a synchronous videoconferencing platform. Best practices, key considerations, examples from the field, and sample protocols are presented to ease transition for ongoing studies and maximize the potential of videoconferencing-and social distancing.


title: Comparison of the Indicators of Psychological Stress in the Population of Hubei Province and Non-Endemic Provinces in China During Two Weeks During the Coronavirus Disease 2019 (COVID-19) Outbreak in February 2020

text: BACKGROUND During February 2020, the coronavirus disease 2019 (COVID-19) epidemic in Hubei Province, China, was at its height, requiring isolation of the population. This study aimed to compare the emotional state, somatic responses, sleep quality, and behavior of people in Hubei Province with non-endemic provinces in China during two weeks in February 2020. MATERIAL AND METHODS Questionnaires were completed by 939 individuals (357 men; 582 women), including 33 from Hubei and 906 from non-endemic provinces. The Stress Response Questionnaire (SRQ) determined the emotional state, somatic responses, and behavior. The Pittsburgh Sleep Quality Index (PSQI) was used to measure the duration of sleep and sleep quality. RESULTS There were 939 study participants, aged 18-24 years (35.89%) and 25-39 years (35.57%); 65.92% were university students. During a two week period in February 2020, the emotional state and behavior of participants in Hubei improved, but the quality of sleep did not. Health workers and business people became increasingly anxious, but other professionals became less anxious. The data showed that most people in Hubei Province developed a more positive attitude regarding their risk of infection and the chances of surviving the COVID-19 epidemic. CONCLUSIONS During a two-week period, front-line health workers and people in Hubei Province became less anxious about the COVID-19 epidemic, but sleep quality did not improve. Despite public awareness, levels of anxiety exist that affect the quality of life during epidemics, including periods of population quarantine. Therefore, health education should be combined with psychological counseling for vulnerable individuals.


title: [Pathological changes of the spleen in ten patients with coronavirus disease 2019(COVID-19) by postmortem needle autopsy]

text: Objective: To study the pathological changes of the spleen in patients with COVID-19 and to analyze the relationship between the weakened immune system and splenic lesions. Methods: Postmortem needle autopsies from the spleen were carried out on 10 patients who died from COVID-19 in Wuhan. Routine hematoxylin and eosin (HE) staining was used to observe the pathological changes. The changes of lymphocytes were studied further with immunohistochemistry.RT-PCR was used to detect 2019-nCoV RNA in the spleen. In addition,the Epstein-Barr virus (EBV) was detected by in situ hybridization, and coronavirus particles were detected by transmission electron microscopy in 2 cases. Results: There were 7 males and 3 females, with an average age of 68.3 years.Of the 10 cases, 4 had cancer history and another 4 had other underlying diseases respectively.Cough, fever, malaise and dyspnea were the main clinical symptoms.The time from onset to death was 15-45 days.Ten cases patients had normal or slight increase in peripheral blood leukocyte count in the early stage of the disease, 6 cases had significant increase before death. Five patients' peripheral blood lymphocyte count decreased in the early stage of the disease, and 10 patients' peripheral blood lymphocyte count decreased significantly before the disease progressed or died. Seven cases were treated with corticosteroid (methylprednisolone ≤40 mg/d, not more than 5 days). Histopathological examination showed that the cell composition of the spleen decreased, white pulp atrophied at different levels, meanwhile lymphoid follicles decreased or absent;in addition, the ratio of red pulp to white pulp increased with varying degrees. In 7 cases, more neutrophil infiltration was found, and in 5 cases, scattered plasma cell infiltration was found. Macrophage proliferation and hemophagocytic phenomena in a few cells were found in a case. Meanwhile, necrosis and lymphocyte apoptosis were detected in 2 cases, small artery thrombosis and spleen infarction in 1 case, and fungal infection in 1 case. The results of immunohistochemistry showed that the T and B lymphocyte components of the spleen in all cases decreased in varying degrees. CD20(+) B cells were found to accumulate in the lymphoid sheath around the splenic artery in 8 cases. However, CD20 and CD21 immunostaining in 2 cases showed that the number of white pulp was almost normal, and splenic nodules were atrophic. CD3(+), CD4(+) and CD8(+)T cells were decreased. In 9 cases,CD68(+) macrophages were no significant changes in the distribution and quantity. While more CD68(+) cells were found in the medullary sinuses of 1 case (related to fungal infection). Few CD56(+) cells were found. EBV was negative by in situ hybridization. RT-PCR was used to detect the nucleic acid of 2019-nCoV. One of 10 cases was positive, 39 years old,who was the youngest patient in this group, and the other 9 cases were negative. Coronavirus particles were found in the cytoplasm of macrophage under electron microscope in 2 cases. Conclusions: The death of COVID-19 occurs mainly in the elderly, and some cases have no underlying diseases. Spleen may be one of the organs directly attacked by the virus in some patients who died from COVID-19. T and B lymphocyte in the spleen decrease in varying degrees, lymphoid follicles are atrophied, decreased or absent, and the number of NK cells do not change significantly. And the pathological changes of the spleen are not related to the use of low dose corticosteroid, which may be related to the direct attack of virus and the attack of immune system on its own tissues.


title: Challenges for Liver Transplantation During Recovery From the COVID-19 Pandemic: Insights and Recommendations

text: The coronavirus disease 2019 (COVID-19) pandemic is placing an increasing burden on liver transplant (LT) services worldwide. At the peak of the pandemic, many LT services worldwide reduced or halted their activities. With the gradual easing of lockdowns, LT teams face new challenges when restarting activities. The numbers of LTs are likely to drop in the immediate post-COVID era. Prolonged and intermittent lockdowns are likely to lead to a shortage of supplies, especially in poor resource settings. Special attention is needed to avoid nosocomial COVID-19 infection among cirrhotic patients awaiting transplant, post-transplant patients, and members of transplant teams. LT programs may have to revise existing strategies in selecting donors and recipients for transplants. Redesigning service provision, restructuring outpatient care, carefully screening and selecting donors and recipients, and performing LT with limited resources will have to be initiated in the post-COVID era if long-term recovery of LT services is to be expected. Costs involved with LT are likely to increase, considering the change in protocols of testing, quarantining, and interstate traveling. This paper discusses the different elements affecting and the widespread impact of the COVID-19 pandemic on LT and strategies to minimize the impact of these factors and to adapt so LT services can meet the health care needs during this pandemic and beyond.


title: Drug Repurposing to find Inhibitors of SARS-CoV-2 Main Protease

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the strain of coronavirus that causes coronavirus disease 2019 (COVID-19), the respiratory illness responsible for the COVID-19 pandemic. Currently there is no known vaccine or specific antiviral treatment for COVID-19 and so, there is an urgent need for expedite discovery of new therapeutics to combat the disease until a vaccine will be available worldwide. Drug repurposing is a strategy for identifying new uses for approved drugs that has the advantage (over conventional approaches that attempt to develop a drug from scratch) that time frame of the overall process can be significantly reduced because of the few number of clinical trial required. In this work, a virtual screening of FDA-approved drugs was performed for repositioning as potential inhibitors of the main protease Mpro of SARS-CoV-2. As a result of this study, 12 drugs are proposed as candidates for inhibitors of the Mpro enzyme. Some of the selected compounds are antiviral drugs that are already being tested in COVID-19 clinical trials (i.e. ribavirin) or are used to alleviate symptoms of the disease (i.e. codeine). Surprisingly, the most promising candidate is the naturally occurring broad spectrum antibiotic oxytetracycline. This compound has largely outperformed the remaining selected candidates along all filtering steps of our virtual screening protocol. If the activity of any of these drugs is experimentally corroborated, they could be used directly in clinical trials without the need for pre-clinical testing or safety evaluation since they are already used as drugs for other diseases.


Two cases report of epidemic stress disorder to novel coronavirus pneumonia


COVID-19 lockdown allows researchers to quantify the effects of human activity on wildlife


title: Multiparameter tests of general relativity using multiband gravitational-wave observations

text: In this Letter we show that multiband observations of stellar-mass binary black holes by the next generation of ground-based observatories (3G) and the space-based Laser Interferometer Space Antenna (LISA) would facilitate a comprehensive test of general relativity by simultaneously measuring all the post-Newtonian (PN) coefficients. Multiband observations would measure most of the known PN phasing coefficients to an accuracy below a few percent---two orders-of-magnitude better than the best bounds achievable from even `golden' binaries in the 3G or LISA bands. Such multiparameter bounds would play a pivotal role in constraining the parameter space of modified theories of gravity beyond general relativity.


title: COVID-19 and androgen targeted therapy for prostate cancer patients

text: The current pandemic (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global health challenge with active development of antiviral drugs and vaccines seeking to reduce its significant disease burden. Early reports have confirmed that transmembrane serine protease 2 (TMPRSS2) and angiotensin converting enzyme 2 (ACE2) are critical targets of SARS-CoV-2 that facilitate viral entry into host cells. TMPRSS2 and ACE2 are expressed in multiple human tissues beyond the lung including the testes where predisposition to SARS-CoV-2 infection may exist. TMPRSS2 is an androgen responsive gene and its fusion represents one of the most frequent alterations in prostate cancer. Androgen suppression by androgen deprivation therapy and androgen receptor signaling inhibitors form the foundation of prostate cancer treatment. In this review, we highlight the growing evidence in support of androgen regulation of TMPRSS2 and ACE2 and the potential clinical implications of using androgen suppression to downregulate TMPRSS2 to target SARS-CoV-2. We also discuss the future directions and controversies that need to be addressed in order to establish the viability of targeting TMPRSS2 and/or ACE2 through androgen signaling regulation for COVID-19 treatment, particularly its relevance in the context of prostate cancer management.


title: Estimating Uncertainty and Interpretability in Deep Learning for Coronavirus (COVID-19) Detection

text: Deep Learning has achieved state of the art performance in medical imaging. However, these methods for disease detection focus exclusively on improving the accuracy of classification or predictions without quantifying uncertainty in a decision. Knowing how much confidence there is in a computer-based medical diagnosis is essential for gaining clinicians trust in the technology and therefore improve treatment. Today, the 2019 Coronavirus (SARS-CoV-2) infections are a major healthcare challenge around the world. Detecting COVID-19 in X-ray images is crucial for diagnosis, assessment and treatment. However, diagnostic uncertainty in the report is a challenging and yet inevitable task for radiologist. In this paper, we investigate how drop-weights based Bayesian Convolutional Neural Networks (BCNN) can estimate uncertainty in Deep Learning solution to improve the diagnostic performance of the human-machine team using publicly available COVID-19 chest X-ray dataset and show that the uncertainty in prediction is highly correlates with accuracy of prediction. We believe that the availability of uncertainty-aware deep learning solution will enable a wider adoption of Artificial Intelligence (AI) in a clinical setting.


title: Medical students at the bedside of COVID-19 patients : motivations and challenges/ Etudiant·e·s en medecine engage·e·s au chevet des patient·e·s hospitalise·e·s pour COVID-19 - Motivations et enjeux

text: The SARS-CoV-2 pandemic is putting our healthcare system under exceptional pressure, given the number of affected patients In a context of limited human healthcare resources, senior medical students represent a valuable workforce that can quickly be mobilized for patient care This is the approach followed in Switzerland and other countries, in several outpatient structures or inpatient services, including the Department of Internal Medicine, of the Lausanne University Hospital (CHUV) In this article, we first give the floor to students who responded to our call We conclude with important considerations in terms of students' clinical supervision It is reminded that the involvement of students in the care of COVID-19 patients should only occur on a vo luntary basis La pandemie de COVID-19 met notre systeme de sante sous une pression exceptionnelle, au vu du nombre de patient·e·s atteint·e·s Dans un contexte de ressources humaines medico-soignantes limitees, les etudiant·e·s en medecine avance·e·s dans leur cursus representent un renfort tres precieux, rapidement mobilisable aupres des patient·e·s Cest la demarche suivie en Suisse et ailleurs dans le monde par diverses structures ambulatoires ou services hospitaliers, dont le Service de medecine interne du Centre hospitalier universitaire vaudois (CHUV) Dans cet article, nous donnons tout dabord la parole aux etudiant·e·s qui ont repondu a notre appel Nous terminons par des considerations importantes quant a laccueil et laccompagnement de ces etudiant·e·s Il est rappele que lengagement detudiant·e·s aupres de patient·e·s souffrant de COVID-19 devrait se faire sur une base volontaire uniquement


title: [Medical students at the bedside of COVID-19 patients : motivations and challenges]

text: The SARS-CoV-2 pandemic is putting our healthcare system under exceptional pressure, given the number of affected patients In a context of limited human healthcare resources, senior medical students represent a valuable workforce that can quickly be mobilized for patient care This is the approach followed in Switzerland and other countries, in several outpatient structures or inpatient services, including the Department of Internal Medicine, of the Lausanne University Hospital (CHUV) In this article, we first give the floor to students who responded to our call We conclude with important considerations in terms of students' clinical supervision It is reminded that the involvement of students in the care of COVID-19 patients should only occur on a vo luntary basis


title: Estimating the number of SARS-CoV-2 infections and the impact of social distancing in the United States

text: Understanding the number of individuals who have been infected with the novel coronavirus SARS-CoV-2, and the extent to which social distancing policies have been effective at limiting its spread, are critical for effective policy going forward. Here we present estimates of the extent to which confirmed cases in the United States undercount the true number of infections, and analyze how effective social distancing measures have been at mitigating or suppressing the virus. Our analysis uses a Bayesian model of COVID-19 fatalities with a likelihood based on an underlying differential equation model of the epidemic. We provide analysis for four states with significant epidemics: California, Florida, New York, and Washington. Our short-term forecasts suggest that these states may be following somewhat different trajectories for growth of the number of cases and fatalities.


title: Asymptotic profile in selection-mutation equations: Gauss versus Cauchy distributions

text: In this paper, we study the asymptotic (large time) behavior of a selection-mutation-competition model for a population structured with respect to a phenotypic trait, when the rate of mutation is very small. We assume that the reproduction is asexual, and that the mutations can be described by a linear integral operator. We are interested in the interplay between the time variable $t$ and the rate $\varepsilon$ of mutations. We show that depending on $\alpha>0$, the limit $\varepsilon \to 0$ with $t = \varepsilon^{-\alpha}$ can lead to population number densities which are either Gaussian-like (when $\alpha$ is small) or Cauchy-like (when $\alpha$ is large).


Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit


title: Returning to Clinics Amidst COVID-19: A Student Response to Compton et al

text: As U.K based medical students, we read with great interest the article by Compton et al 1 exploring the various factors influencing students' motivation to return to clinical practice amidst the ongoing COVID-19 pandemic. Despite the study exploring several convincing factors in explaining the hesitance of medical students in returning to clinical placement, social vulnerability is often overlooked when explaining this reluctance. Many black and minority ethnic (BME) groups, who experience higher rates of mortality and live in multi-generational households, may risk the health of their own family members by returning to placement prematurely, or without adequate protection.


Safe patient transport for COVID-19


Full Spectrum of Cancer Patients in SARS-CoV-2 Infection Still Being Described


Impact of SARS-CoV-2 pandemic on mental health in the elderly: perspective from a psychogeriatric clinic at a tertiary hospital in São Paulo, Brazil


COVID-19: The end of a story through the eyes of an emergency Practitioner


title: Analyses of electronic health records utilization in a large community hospital

text: INTRODUCTION: The Electronic Health Record (EHR) has become an integral component of healthcare delivery. Survey based studies have estimated that physicians spend 4-6 hours of their workday devoted to EHR. Our study was designed to use computer software to objectively obtain time spent on EHR. METHODS: We recorded EHR time for 248 physiciansover 2 time intervals. EHR active use was defined as more than 15 keystrokes, or 3 mouse clicks, or 1700 "mouse miles" per minute. We recorded total time and % of work hours spent on EHR, and differences in those based on seniority. Physicians reported duty hours using a standardized toolkit. RESULTS: Physicians spent 3.8 (±2) hours on EHR daily, which accounted for 37% (±17%), 41% (±14%), and 45% (±12%) of their day for all clinicians, residents, and interns, respectively. With the progression of training, there was a reduction in EHR time (all p values <0.01). During the first academic quarter, clinicians spent 38% (± 8%) of time on chart review, 17% (± 7%) on orders, 28% (±11%) on documentation (i.e. writing notes) and 17% (±7%) on other activities (i.e. physician hand-off and medication reconciliation). This pattern remained unchanged during the fourth quarter. CONCLUSIONS: Physicians spend close to 40% of their work day on EHR, with interns spending the most time. There is a significant reduction in time spent on EHR with training and greater experience, although the overall amount of time spent on EHR remained high.


Expert recommendations for the management of autoimmune bullous diseases during the COVID-19 pandemic


title: Chimeric Antigen Receptor T Cell Therapy During the COVID-19 Pandemic

text: The SARS-CoV-2 coronavirus (COVID-19) pandemic has significantly impacted the delivery of cellular therapeutics, including chimeric antigen receptor (CAR) T cells. This impact has extended beyond patient care to include logistics, administration, and distribution of increasingly limited health care resources. Based on the collective experience of the CAR T-cell Consortium investigators, we review and address several questions and concerns regarding cellular therapy administration in the setting of COVID-19 and make general recommendations to address these issues. Specifically, we address (1) necessary resources for safe administration of cell therapies; (2) determinants of cell therapy utilization; (3) selection among patients with B cell non-Hodgkin lymphomas and B cell acute lymphoblastic leukemia; (4) supportive measures during cell therapy administration; (5) use and prioritization of tocilizumab; and (6) collaborative care with referring physicians. These recommendations were carefully formulated with the understanding that resource allocation is of the utmost importance, and that the decision to proceed with CAR T cell therapy will require extensive discussion of potential risks and benefits. Although these recommendations are fluid, at this time it is our opinion that the COVID-19 pandemic should not serve as reason to defer CAR T cell therapy for patients truly in need of a potentially curative therapy.


COVID-19 studies registration worldwide for prospective studies with a specific focus on the fast-tracking of French ethic procedures


Response to 'Pulmonary thrombosis in 2019-nCoV pneumonia?'


The role of lower respiratory tract samples in the diagnosis of COVID-19


title: Effect of COVID-19 on liver transplantation in Korea

text: COVID-19 is now a pandemic with increasing numbers of cases and deaths. In addition to the economic and social damage caused by COVID-19 outbreak prolongation, damage caused by delayed treatment of other diseases such as severe cirrhosis is also serious. We aimed to describe the effect of COVID-19 on the number of liver transplants (LT) in South Korea. The number of LT performed in Korea during the Middle East Respiratory Syndrome (MERS) outbreak, and the COVID-19 pandemic was compared with the average number of LT performed in the past 5 years. There were 108.5 cases of LT performed per month during the MERS outbreak. It was 11% lower than the average of 122.8 cases per month for the last 5 years. LDLT and DDLT decreased by 13% to 75.3 cases and by 7.5% to 33.2 cases per month during the MERS epidemic, respectively. From January to March 2020 (COVID-19 outbreak), the number of LT did not decrease significantly. The lockdown caused by COVID-19 did not affect the number of liver transplants in Korea. Establishing a safe process and procedure of liver transplantation within safe boundaries can be beneficial in reducing the side effects of lockdown and saving patients' lives.


title: “Keep it short and sweet” Improving risk communication to family physicians during public health crises

text: Objective To identify recommendations from family physicians in Canada on how public health agencies and professional organizations might improve future crisis and emergency risk communications Design Qualitative content analysis Setting Canada Participants Sixteen family physicians who have experienced a public health crisis Methods Semistructured interviews were conducted with 16 family physicians practising in various regions across Canada who had experienced what they defined as a public health crisis These events included environmental crises, like forest fires and hurricanes, and infectious disease crises, like the SARS (severe acute respiratory syndrome) and H1N1 outbreaks Interview transcripts were coded using an inductive qualitative content analysis method, specifically focusing on recommendations from participants on how to improve risk communication to family physicians in the event of a future public health crisis Main findings Based on their personal experiences, participants had many explicit recommendations on how to improve risk communication strategies in the event of a future public health crisis These included having a single trusted source of information;having timely and succinct communication;having consideration for learners;ensuring access to information for all physicians;improving public health and family medicine collaboration;having crisis information for patients;and creating communication infrastructure before a crisis occurs Conclusion This research provides thoughtful and varied considerations and advice from practising family physicians on how to improve risk communication from public health agencies and professional organizations to this group in the event of a public health crisis With improved communications between these bodies and family physicians, practitioners will be better informed and prepared to provide the best possible care to their patient populations during such events


title: IJED support for eating disorders research in the time of COVID-19

text: This editorial reports on an anonymous survey question posed to eating disorders researchers about changes the International Journal of Eating Disorders (IJED) should implement to support the eating disorders research community affected by COVID-19. The editorial accompanies an IJED article that details responses to the larger survey focusing more broadly on COVID-19-related research disruptions. Survey invitations were sent to editorial board members of eating disorders journals, members of eating disorder scientific organizations (e.g., Eating Disorders Research Society), and individuals who provided at least three IJED reviews in the prior 12 months. We reviewed the responses of 187 participants and identified three categories of changes that: (a) had already been implemented by the journal, (b) cannot be implemented because they fall outside the scope of IJED, or (c) will be implemented in coming weeks or months. The latter category includes publishing topical COVID-19 papers, making some COVID-19-related content available open access, revising statistical guidelines, and issuing author guidance on reporting protocol changes caused by COVID-19-related disruptions. IJED recognizes the disruptive impacts that COVID-19 has on all activities in our field, including clinical work, teaching, and advocacy, and is committed to supporting authors during this difficult time while striving to publish high-quality research.


title: Expert consensus from the Italian Society for Colposcopy and Cervico-Vaginal Pathology (SICPCV) for colposcopy and outpatient surgery of the lower genital tract during the COVID-19 pandemic

text: In the context of the COVID-19 pandemic, patients need to be evaluated within 2-4 weeks in the following cases: cytology result of "squamous cell carcinoma," "atypical glandular cells, favor neoplastic," "endocervical adenocarcinoma in situ," or "adenocarcinoma"; histopathological diagnosis of suspected invasion from cervical/vaginal biopsy, or invasive disease after a cervical excision procedure, vaginal excision, or vulvar biopsy/excision; sudden onset of strongly suggestive symptoms for malignancy. Digital imaging technologies represent an important opportunity during the COVID-19 pandemic to share colposcopic images with reference centers, with the aim of avoiding any concentration of patients. All patients must undergo screening for COVID-19 exposure and should wear a surgical mask. A high-efficiency filter smoke evacuation system is mandatory to remove surgical smoke. Electrosurgical instruments should be set at the lowest possible power and not be used for long continuous periods to reduce the amount of surgical smoke. The following personal protective equipment should be used: sterile fluid-repellant surgical gloves, an underlying pair of gloves, eye protection, FFP3 mask, surgical cap, and gown. The colposcope should be protected by a disposable transparent cover. A protective lens that must be disinfected after each use should be applied. The use of a video colposcope should be preferred.


title: The nonlinear initiation of side-branching by activator-inhibitor (Turing) morphogenesis

text: An understanding of the underlying mechanism of side-branching is paramount to control and/or potentially form mammalian organs, such as lungs, kidneys, and glands. Motivated by an activator-inhibitor approach that is believed to dominate the initiation of side-branching, I show that the mechanism stems from the nonlinear (subcritical) Turing bifurcation to periodic and spatially localized solutions that are essential for excitation at the differentiation-front propagation. The results demonstrate a distinct robust mechanism of side-branching through numerical analysis of model equations that have been employed to study branching in the lungs.


Prise en charge adaptée au COVID-19./ [Healthcare in the context of Covid-19]


title: Multi-Center Evaluation of the Cepheid Xpert Xpress SARS-CoV-2 Assay for the Detection of SARS-CoV-2 in Oropharyngeal Swab Specimens

text: The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a global health concern that has spread worldwide since December 2019 (1-4). .


Pression-induced facial ulcers by prone position for COVID-19 mechanical ventilation


Addressing the Experience of Children and Adolescents During the COVID-19 Pandemic


title: COVID-19 comorbidities, associated pro-coagulant extracellular vesicles and venous thromboembolisms: a possible link with ethnicity?

text: Several comorbidities predict mortality in patients with COVID-19, some of which are more prevalent in Black Asian and Minority Ethnic (BAME) groups. Extracellular vesicles (EVs) released from cells are nano-sized membrane-bound vesicles that carry nucleic acids and proteins and mediate intercellular communication. In COVID-19 associated comorbidities including diabetes, CVD and risk factors such as hypertension, elevated angiotensin II and obesity, levels of circulating EVs are raised and their cargo modified. Importantly, EVs released from damaged endothelial cells are known to be procoagulant. EVs in Black and White populations differentially express phosphorylated insulin signalling proteins, associated with impaired insulin signalling, insulin resistance and an increased risk of venous thromboembolism; these EV proteins are also associated with clinical mortality risk markers. If plasma EV levels are raised, and cargo modified in comorbidities associated with COVID-19 such as diabetes, and account for excess deaths in BAME patients, this raises the possibility for important roles of EVs, also relating to ethnicity. This places EVs as hitherto understudied key factors, filling the current knowledge gap in COVID-19, amongst BAME patients.


Implementing Physical Distancing in the Hospital: A Key Strategy to Prevent Nosocomial Transmission of COVID-19


title: A review of cardiac manifestations and predictors of outcome in patients with COVID - 19

text: Coronavirus disease (COVID-19) pandemic has so far involved 184 countries and more than 2.79 million patients worldwide. Over the past three months, it has attributed to more than 196,000 deaths, with more than 50,000 deaths in the United States alone. Pulmonary manifestations are predominant and have been well identified. Cardiac involvement is also common. Acute cardiac injury, the most common cardiac manifestation of this disease can be seen in patients even without prior cardiac comorbidities. Established cardiovascular risk factors such as diabetes mellitus, hypertension, and coronary artery disease predispose to cardiac injury, the severity of illness and mortality. Non-ischemic myocardial injury secondary to cytokine storm is thought to be the predominant mechanism of acute cardiac injury associated with COVID-19. Multiple mechanisms and processes contribute to cardiac injury resulting in a poor outcome. Some of these are not clearly understood. Clinical and diagnostic details of cardiovascular involvement in these patients are mostly limited to biochemical markers. Multiple therapeutic agents have been tried with questionable efficacy and without clinical evidence. Interactions of comorbidities, cardiovascular drugs, the cardiac effect of therapeutic agents on the illness continue to be under investigation. With an increasing number of patients, newer promising therapies, and ongoing clinical trials, the exact mechanisms and extent to which these risk factors contribute to outcomes will be clearer in the future.


Correction to Lancet Respir Med 2020; 8: 420-22


title: Clinical features, isolation, and complete genome sequence of severe acute respiratory syndrome coronavirus 2 from the first two patients in Vietnam

text: In January 2020, we identified two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients in a familial cluster with one person coming from Wuhan, China. The complete genome sequences of two SARS-CoV-2 strains isolated from these patients were identical and 99.98% similar to strains isolated in Wuhan. This is genetically suggestive of human-to-human transmission of SARS-CoV-2 and indicates Wuhan as the most plausible origin of the early outbreak in Vietnam. The younger patient had a mild upper respiratory illness and a brief viral shedding, whereas the elderly with multi-morbidity had pneumonia, prolonged viral shedding, and residual lung damage. The evidence of nonsynonymous substitutions in the ORF1ab region of the viral sequence warrants further studies.


Comment on "Managing COVID-19 in Surgical Systems": An Opportunity for Global Surgery to Advance Global Health


Giving birth under lockdown during the COVID-19 epidemic


Rapidly Progressive COVID-19 Pneumonia: What Radiologists Should Do


title: A framework for identifying and mitigating the equity harms of COVID-19 policy interventions

text: INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a global pandemic. Governments have implemented combinations of 'lockdown' measures of various stringencies, including school and workplace closures, cancellations of public events, and restrictions on internal and external movements. These policy interventions are an attempt to shield high risk individuals and to prevent overwhelming countries' healthcare systems, or, colloquially, 'flatten the curve'. However, these policy interventions may come with physical and psychological health harms, group and social harms, and opportunity costs. These policies may particularly affect vulnerable populations and not only exacerbate pre-existing inequities, but also generate new ones. METHODS: We developed a conceptual framework to identify and categorise adverse effects of COVID-19 lockdown measures. We based our framework on Lorenc and Oliver's framework for the adverse effects of public health interventions and the PROGRESS-Plus equity framework. To test its application we purposively sampled COVID-19 policy examples from around the world and evaluated them for the potential physical, psychological, and social harms, as well as opportunity costs, in each of the PROGRESS-Plus equity domains: Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, and disability). RESULTS: We found examples of inequitably distributed adverse effects for each COVID-19 lockdown policy example, stratified by LMIC and HIC, in every PROGRESS-Plus equity domain. We identified known policy interventions intended to mitigate some of these adverse effects. The same harms (anxiety; depression; food insecurity; loneliness; stigma; violence) appear to be repeated across many groups, and are exacerbated by several COVID-19 policy interventions. CONCLUSION: Our conceptual framework highlights the fact that COVID-19 policy interventions can generate or exacerbate interactive and multiplicative equity harms. Applying this framework can help in three ways: (1) identifying areas where a policy intervention may generate inequitable adverse effects; (2) mitigating policy and practice interventions by facilitating the systematic examination of relevant evidence; and (3) planning for lifting COVID-19 lockdowns and policy interventions around the world.


title: Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors

text: OBJECTIVE: To evaluate the prevalence of and factors associated with SARS-CoV-2 infection in general practitioners and nurses from primary care centers and nursing homes in the Healthcare Area of León (Spain). MATERIALS AND METHODS: Cross-sectional study in a convenience sample of professionals from 30 health centers and 30 nursing homes from the primary care management division of the Healthcare Area of Leon. The work center, type of profession, COVID-19 infection, level of exposure, compliance with preventive measures, isolation (if required) and diagnostic tests carried out were collected. The determination of infection was made by differentiated rapid diagnostic test (dRDT), using a finger-stick whole-blood sample. The association of variables with infection was assessed by multivariable non-conditional logistic regression. The true prevalence of SARS-CoV-2 infection was calculated according to two scenarios for RDT (Sensitivity=0.6 and Specificity=0.985; Sensitivity=0.8 and Specificity=1). RESULTS: The true prevalence of SARS-CoV-2 infection was between 4.9% and 11.0%. The observed prevalence was 5.9% and was higher in nursing homes than in primary care centers (9.5% vs. 5.5%). No statistically significant differences were observed by sex, type of professional, level of exposure or compliance with preventive measures. CONCLUSIONS: The prevalence of SARS-CoV-2 infection in this group is low. A high number of professionals remain susceptible to SARS-CoV-2 infection and therefore protective measures should be taken, especially for professionals working in nursing homes.


Global imperative to combat stigma associated with the coronavirus disease 2019 pandemic


title: Clinical characteristics and risk factors of mild-to-moderate COVID-19 patients with false-negative SARS-CoV-2 nucleic acid

text: This study investigates the clinical and imaging characteristics of coronavirus disease 2019 (COVID-19) patients with false-negative nucleic acids. Mild-to-moderate COVID-19 patients, including 19 cases of nucleic acid false-negative patients and 31 cases of nucleic acid positive patients, were enrolled. Their epidemiological, clinical, and laboratory examination data and imaging characteristics were analyzed. Risk factors for false negatives were discussed. Compared with the nucleic acid positive group, the false-negative group had less epidemiological exposure (52.6% vs 83.9%; P = .025), less chest discomfort (5.3% vs 32.3%; P = .035), and faster recovery (10 [8, 13] vs 15 [11, 18.5] days; P = .005). The number of involved lung lobes was (2 [1, 2.5] vs 3 [2, 4] days; P = .004), and the lung damage severity score was (3 [2.5, 4.5] vs 5 [4, 9] days; P = .007), which was lighter in the nucleic acid false-negative group. Thus, the absence of epidemiological exposure may be a potential risk factor for false-negative nucleic acids. The false-negative cases of COVID-19 are worth noting because they have a risk of viral transmission without positive test results, lighter clinical manifestations, and less history of epidemiological exposure.


The association between domestic train transportation and novel coronavirus (2019-nCoV) outbreak in China from 2019 to 2020: A data-driven correlational report


title: The challenges of lockdown for early-career researchers

text: Thousands of UK doctoral students and early-career researchers shared the repercussions of lockdown on their work and wellbeing.


Case 19-2020: A 74-Year-Old Man with Acute Respiratory Failure and Unclear Goals of Care


title: Learning hidden influences in large-scale dynamical social networks: A data-driven sparsity-based approach

text: Interpersonal influence estimation from empirical data is a central challenge in the study of social structures and dynamics. Opinion dynamics theory is a young interdisciplinary science that studies opinion formation in social networks and has a huge potential in applications, such as marketing, advertisement and recommendations. The term social influence refers to the behavioral change of individuals due to the interactions with others in a social system, e.g. organization, community, or society in general. The advent of the Internet has made a huge volume of data easily available that can be used to measure social influence over large populations. Here, we aim at qualitatively and quantitatively infer social influence from data using a systems and control viewpoint. First, we introduce some definitions and models of opinions dynamics and review some structural constraints of online social networks, based on the notion of sparsity. Then, we review the main approaches to infer the network's structure from a set of observed data. Finally, we present some algorithms that exploit the introduced models and structural constraints, focusing on the sample complexity and computational requirements.


Covid-19 - Navigating the Uncharted


Can iron chelation as an adjunct treatment of COVID-19 improve the clinical outcome?


title: Patients with Coronavirus 2019 (COVID-19) and Surgery: Guidelines and Checklist Proposal

text: The management of patients with novel coronavirus 2019 (COVID-19) represents a new challenge for medical and surgical teams. Each operating room in the world should be prepared thoughtfully, and the development of a protocol and patient route seems mandatory. An adequate degree of protection must be used. We propose recommendations to help different professionals in the establishment of protocols for the management of patients with COVID-19. We also offer a checklist that could be used in the operating room.


"Does having diabetes increase chances of contracting COVID-19 infection?"


title: The United States badly bungled coronavirus testing—but things may soon improve ;Science ;AAAS

text: Speed is critical in the response to COVID-19 So why has the United States been so slow in its attempt to develop reliable diagnostic tests and use them widely? The World Health Organization (WHO) has shipped testing kits to 57 countries China had five commercial tests on the market 1 month ago and can now do up to 1 6 million tests a week;South Korea has tested 65,000 people so far The U S Centers for Disease Control and Prevention (CDC), in contrast, has done only 459 tests since the epidemic began The rollout of a CDC-designed test kit to state and local labs has become a fiasco because it contained a faulty reagent Labs around the country eager to test more suspected cases—and test them faster—have been unable to do so No commercial or state labs have the approval to use their own tests In what is already an infamous snafu, CDC initially refused a request to test a patient in Northern California who turned out to be the first probable COVID19 case without known links to an infected person


Why people failed to adhere to COVID-19 preventive behaviors? Perspectives from an integrated behavior change model


COVID-19 pandemic & head and neck cancer patients management: The role of virtual multidisciplinary team meetings


title: Is Alcohol in Hand Sanitizers Absorbed Through the Skin or Lungs? Implications for Disulfiram Treatment

text: AIM: In view of the increase in the use of ethanol-containing hand sanitizers throughout the world due to the current COVID-19 pandemic, we wished to review the possible risks to patients treated with disulfiram, following a case report in which an apparent DER (disulfiram-ethanol reaction) was attributed to the cutaneous absorption of alcohol from hand sanitizers as well as by inhalation of vapour. METHOD: Simple experiments to assess the levels of absorption by each route separately. RESULTS: Our results strongly suggest that while amounts of alcohol sufficient to cause a DER may be inhaled when hand sanitizers are used in confined spaces, absorption can be avoided by dispersal of the fumes, and absorption from the skin alone does not occur in pharmacologically significant quantities. CONCLUSION: Warnings about absorption of alcohol through the skin from hand sanitizers and products such as perfumes, deodorants and after-shave (whose use is often warned against when disulfiram is prescribed) should be modified accordingly.


Conferences After COVID and Academics in Adversity: Physical Globalization is Fragile, But so Too is Internet Neutrality


title: Bariatric surgery and the COVID-19 pandemic: SICOB recommendations on how to perform surgery during the outbreak and when to resume the activities in phase 2 of lockdown

text: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its related disease, coronavirus disease 2019 (COVID-19), has been rapidly spreading all over the world and is responsible for the current pandemic. The current pandemic has found the Italian national health system unprepared to provide an appropriate and prompt response, heavily affecting surgical activities. Based on the limited data available in the literature and personal experiences, the Società Italiana di Chirurgia dell'OBesità e Malattie Metaboliche (SICOB) provides recommendations regarding the triage of bariatric surgical procedures during the COVID-19 pandemic defining a dedicated path for surgery in morbidly obese patients with known or suspected COVID-19 who may require emergency operations. Finally, the current paper delineates a strategy to resume outpatient visits and elective bariatric surgery once the acute phase of the pandemic is over. Models developed during the COVID-19 crisis should be integrated into hospital practices for future use in similar scenarios. Surgeons are presented with a golden opportunity to embrace systemic change and to drive their professional future.


Lifestyle changes in patients with morbid obesity and type 2 diabetes mellitus during the COVID-19 pandemic


title: COVID-19 Neurologic Complication with CNS Vasculitis-Like Pattern

text: Coronavirus disease 2019 (COVID-19) is a viral infection caused by the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), which spreads rapidly from person to person and manifests in most symptomatic patients as a respiratory illness, similar to prior SARS viruses. Neurologic manifestations of COVID-19 are uncommon; those so far reported include encephalopathy, stroke from large-vessel occlusion, and polyneuropathy. We report a unique neurologic complication of COVID-19 in a patient who had extensive cerebral small-vessel ischemic lesions resembling cerebral vasculitis in a characteristic combined imaging pattern of ischemia, hemorrhage, and punctuate postcontrast enhancement. Also, a characteristic lower extremity skin rash was present in our patient. Our observation lends support to the increasingly suspected mechanism of "endotheliitis" associated with this novel coronavirus.


The elderly and COVID-19: cocooning or culling-the choice is ours


The Elderly & COVID-19: Cocooning or Culling: - the choice is ours


Senegal faces the coronavirus disease -19 challenge


title: Comparison of two commercial molecular tests and a laboratory-developed modification of the CDC 2019-nCoV RT-PCR assay for the detection of SARS-CoV-2

text: We compared the ability of 2 commercial molecular amplification assays [RealTime SARS-CoV-2 on the m2000 (Abbott) (abbreviated ACOV) and ID NOW™ COVID-19 (Abbott) (abbreviated IDNOW)] and a laboratory-developed test [modified CDC 2019-nCoV RT-PCR assay with RNA extraction by eMag® (bioMérieux) and amplification on QuantStudio™ 6 or ABI 7500 Real-Time PCR System (Life Technologies) (abbreviated CDC COV)] to detect SARS-CoV-2 RNA in upper respiratory tract specimens. Discrepant results were adjudicated by medical record review. 200 nasopharyngeal swab specimens in viral transport medium (VTM) were collected from symptomatic patients between March 27 and April 9, 2020. Results were concordant for 167 specimens (83.5% overall agreement), including 94 positive and 73 negative specimens. The ACOV assay yielded 33 additional positive results, 25 of which were also positive by the CDC COV assay but not by the IDNOW assay. In a follow-up evaluation, 97 patients for whom a dry nasal swab specimen yielded negative results by IDNOW had a paired nasopharyngeal swab specimen collected in VTM and tested by the ACOV assay; SARS-CoV-2 RNA was detected in 13 (13.4%) of these specimens. Medical record review deemed all discrepant results to be true positives. The IDNOW test was the easiest to perform and provided a result in the shortest time, but detected fewer cases of COVID-19. The ACOV assay detected more cases of COVID-19 than CDC COV or IDNOW assays.


Elective surgery after the pandemic: waves beyond the horizon


Response to: 'Glucocorticoid-induced relapse of COVID-19 in a patient with sarcoidosis' by Györfi et al


Second Future of Nursing Report to Incorporate Pandemic Response


title: Cross-neutralization of SARS-CoV-2 by a human monoclonal SARS-CoV antibody

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly emerged coronavirus that is responsible for the current pandemic of coronavirus disease 2019 (COVID-19), which has resulted in more than 3.7 million infections and 260,000 deaths as of 6 May 20201,2. Vaccine and therapeutic discovery efforts are paramount to curb the pandemic spread of this zoonotic virus. The SARS-CoV-2 spike (S) glycoprotein promotes entry into host cells and is the main target of neutralizing antibodies. Here we describe several monoclonal antibodies that target the S glycoprotein of SARS-CoV-2, which we identified from memory B cells of an individual who was infected with severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003. One antibody (named S309) potently neutralizes SARS-CoV-2 and SARS-CoV pseudoviruses as well as authentic SARS-CoV-2, by engaging the receptor-binding domain of the S glycoprotein. Using cryo-electron microscopy and binding assays, we show that S309 recognizes an epitope containing a glycan that is conserved within the Sarbecovirus subgenus, without competing with receptor attachment. Antibody cocktails that include S309 in combination with other antibodies that we identified further enhanced SARS-CoV-2 neutralization, and may limit the emergence of neutralization-escape mutants. These results pave the way for using S309 and antibody cocktails containing S309 for prophylaxis in individuals at a high risk of exposure or as a post-exposure therapy to limit or treat severe disease.


title: CoViD-19 e dispositivi di protezione individuale: qualcuno di noi morirà per la loro carenza./ [CoViD-19 and PPE: some of us will die because of the shortage.]

text: The shortage of personal protective equipment exposes doctors and nurses to the risk of being infected by CoViD-19. Hospital managers and administrators ask healthcare professionals not to talk about the problem. In this way, however, the problem is enormously underestimated. It is unthinkable, explains the author, that your profession as a health worker can risk taking your life.


title: Quantifying Projected Impact of Social Distancing Policies on COVID-19 Outcomes in the US

text: Current social distancing measures to impede COVID-19 (such as shelter-in-place) are economically unsustainable in the long term. Models are needed to understand the implications of possible relaxation options for these measures. We report such models, together with corresponding parameter estimation techniques and prediction outcomes, borrowing insights from another domain; namely, information cascades. Our models assume that the containment of the virus into isolated locales is no longer possible. Instead, we explore options that reduce the rate of spread. We predict COVID-19 contagion trends in different geographic regions under a"what if"scenario to understand the effects of potential policy decisions on regional trends. Our model allows experimentation with other policies that, we hope, can contribute to socially viable outcomes both in terms of health system capacity and economic impact. We apply our model to over 30 highly impacted states in the US and publish the results at https://covid19predictions.csl.illinois.edu/


title: Status and strategies for the management of head and neck cancer during COVID-19 pandemic: Indian scenario

text: In India, oral cancer is the most common head and neck cancer (HNC) in men, mainly caused by the consumption of smoked and smokeless tobacco. During the current pandemic, delaying surgery for even 1 or 2 months may lead to more extensive surgery or inoperability, where only supportive care can be provided. Being semi-emergent in nature, treatment for these patients is currently on hold or delayed in most centers across the country. This study was conducted to assess the impact of COVID-19 pandemic and inability of the health system to treat HNC in a timely fashion and how surgeons are coping to this emergent situation. This article highlights the situation in India, a country burdened with one of the highest incidence rates of HNC.


title: Cardiovascular Collapse in COVID-19 Infection: The Role of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO)

text: COVID-19 has been associated with cardiovascular complications including acute cardiac injury, heart failure and cardiogenic shock. The role of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the event of COVID-19-associated cardiovascular collapse has not yet been established. We reviewed existing literature surrounding the role of VA-ECMO in the treatment of coronavirus-related cardiovascular collapse. COVID-19 is associated with higher incidence of cardiovascular complications compared to previous coronavirus outbreaks (SARS-CoV, MERS-CoV). We found only one case report from China where COVID-19-associated fulminant myocarditis and cardiogenic shock (CS) was successfully rescued using VA-ECMO as a bridge to recovery (BTR). We identified potential clinical scenarios (cardiac injury, myocardial infarction with and without obstructive coronary artery disease, viral myocarditis, and decompensated heart failure) leading to CS and risk factors for poor/uncertain benefit (age, sepsis, mixed/predominantly vasodilatory shock, prothrombotic state and/or coagulopathy, severe acute respiratory distress syndrome, multi-organ failure or high-risk prognostic scores) specific to using VA-ECMO as BTR in COVID-19 infection. Additional considerations and proposed recommendations specific to the COVID-19 pandemic were formulated with guidance from published data and expert consensus. A small subset of patients with cardiovascular complications from COVID-19 infection may progress to refractory CS. Accepting that resource scarcity may be the overwhelming concern for healthcare systems during this pandemic, VA-ECMO can be considered in highly selected cases of refractory CS and echocardiographic evidence of biventricular failure. The decision to initiate this therapy should take into consideration availability of resources, perceived benefit as well as risks of transmitting disease.


Makeshift face shield for healthcare professionals during the COVID-19 pandemic


Right Ventricular Dilation in Hospitalized Patients with COVID-19 Infection


Hearing Humanity Through the Noise of a Pandemic


title: Variables Influencing Radiology Volume Recovery During the Next Phase of the Coronavirus Disease 2019 (COVID-19) Pandemic

text: The coronavirus disease 2019 (COVID-19) pandemic has reduced radiology volumes across the country as providers have decreased elective care to minimize the spread of infection and free up health care delivery system capacity. After the stay-at-home order was issued in our county, imaging volumes at our institution decreased to approximately 46% of baseline volumes, similar to the experience of other radiology practices. Given the substantial differences in severity and timing of the disease in different geographic regions, estimating resumption of radiology volumes will be one of the next major challenges for radiology practices. We hypothesize that there are six major variables that will likely predict radiology volumes: (1) severity of disease in the local region, including potential subsequent "waves" of infection; (2) lifting of government social distancing restrictions; (3) patient concern regarding risk of leaving home and entering imaging facilities; (4) management of pent-up demand for imaging delayed during the acute phase of the pandemic, including institutional capacity; (5) impact of the economic downturn on health insurance and ability to pay for imaging; and (6) radiology practice profile reflecting amount of elective imaging performed, including type of patients seen by the radiology practice such as emergency, inpatient, outpatient mix and subspecialty types. We encourage radiology practice leaders to use these and other relevant variables to plan for the coming weeks and to work collaboratively with local health system and governmental leaders to help ensure that needed patient care is restored as quickly as the environment will safely permit.


title: Posterior oropharyngeal saliva for the detection of SARS-CoV-2

text: BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has put tremendous pressure on the healthcare system worldwide. Diagnostic testing remained one of the limiting factors for early identification and isolation of infected patients. This study aimed to evaluate posterior oropharyngeal saliva (POPS) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection among patients with confirmed or suspected COVID-19. METHODS: The laboratory information system was searched retrospectively for all respiratory specimens and POPS requested for SARS-CoV-2 RNA detection between Feb 1, 2020 and Apr 15, 2020. The agreement and diagnostic performance of POPS against NPsp were evaluated. RESULTS: A total of 13772 specimens were identified during the study period, including 2130 POPS and 8438 NPsp. Two hundred and twenty-nine same-day POPS-NPsp paired were identified with POPS and NPsp positivity of 61.5% (95% CI [55.1-67.6%]) and 53.3% (95% CI [46.8-59.6%]). The overall, negative and positive percent agreement were 76.0% (95% CI [70.2-80.9%]), 65.4% (95% CI [55.5-74.2%]), 85.2% (95% CI [77.4-90.8%]). Better positive percent agreement was observed in POPS-NPsp obtained within seven days (96.6%, 95% CI [87.3-99.4%]) compared with after seven days of symptom onset (75.0%, 95% CI [61.4-85.2%)). Among the 104 positive pairs, the mean difference in Cp value was 0.26 (range: 12.63 to -14.74), with an overall higher Cp value in NPsp (Pearson coefficient 0.579). No significant temporal variation was noted between the two specimen types. CONCLUSIONS: POPS is an acceptable alternative specimen to nasopharyngeal specimen for the detection of SARS-CoV-2.


Covid-19: UK government is urged to publish daily care home deaths as it promises more testing


Covid-19: 90% of cases will hit NHS over nine week period, chief medical officer warns


title: Salvage radiotherapy in patients affected by oligorecurrent pelvic nodal prostate cancer

text: PURPOSE: Metastasis-directed therapy (MDT) is an investigational treatment option in patients with oligorecurrent prostate cancer (PCa). The aim of this retrospective study is to report oncologic outcome and toxicity of elective nodal radiotherapy (ENRT) in PCa patients affected by pelvic nodal oligorecurrence. METHODS: 41 consecutive patients were treated with salvage radiotherapy. At biochemical recurrence after primary treatment, oligorecurrent disease was detected by positron emission tomography (PET) in 94% of the patients. Image-guided intensity modulated radiation therapy (IMRT) was delivered using tomotherapy. 83% of the patients received androgen deprivation therapy (ADT) in combination with ENRT. Survival analysis was performed with Kaplan-Meier method, log-rank test was used to analyze associations between survival end-points and clinical parameters. Multivariate analysis was performed using Cox proportional hazards regression models. Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. RESULTS: The median at follow-up was 33.6 months. At 3 years, overall survival (OS), cancer-specific survival (CSS), and biochemical progression-free survival (b-PFS) were 89%, 92%, and 53%, respectively. At univariate analysis, all survival end-points were correlated with the number of positive pelvic lymph nodes at oligorecurrence (≤ 3 vs > 3). Biochemical-PFS was correlated with PSA (p = 0.034) and PSA doubling time (p = 0.004) at oligorecurrence. At multivariate analysis, no independent variable was statistically significant. No patient experienced grade ≥ 2 late toxicity after radiotherapy. CONCLUSIONS: The number of metastatic lymph nodes and PSA doubling time seems to be important prognostic factors in the pelvic oligorecurrent setting. Salvage radiotherapy combined with short-course ADT might be a valid treatment strategy.


Awake prone positioning in COVID-19


title: The COVID-19 outbreak in Italy: perspectives from an orthopaedic hospital

text: PURPOSE: Italy is one of the more severely affected countries in the world by the recent COVID-19 outbreak. The aim of this report is to describe how COVID-19 affected the life and organization of one of the main orthopaedic hospitals of the country, and which measures were implemented to face the outbreak. METHODS: A personal interview has been conducted with four doctors involved in the management of COVID-19 outbreak in one of the main orthopaedic hospitals of Italy. RESULTS: Hospital was re-organized, elective surgeries were cancelled, and only trauma surgeries were allowed, together with oncologic and urgent cases. Since the number of cases among patients and healthcare workers increased, the hospital management responded not only with a massive testing campaign aimed at detecting contact histories but also with an additional testing campaign for asymptomatic healthcare workers. CONCLUSION: The main lection is that any actions should be quick and decisive, for 1 week during the COVID-19 epidemic could make the difference.


Ethics in the Time of Coronavirus: Recommendations in the COVID-19 Pandemic


title: Infectability of human BrainSphere neurons suggests neurotropism of SARS-CoV-2

text: Reports from Wuhan suggest that 36% of COVID-19 patients show neurological symptoms, and cases of viral encephalitis have been reported, suggesting that the virus is neurotropic under unknown circumstances. This is well established for other coronaviruses. In order to understand why some patients develop such symptoms and others do not, we address herein the infectability of the central nervous system (CNS). Reports that the ACE2 receptor - critical for virus entry into lung cells - is found in different neurons supports this expectation. We employ a human induced pluripotent stem cell (iPSC)-derived BrainSphere model, which we used earlier for Zika, Dengue, HIV and John Cunningham virus infection studies. We detected the expression of the ACE2 receptor but not TMPRSS2 in the model. Incubating the BrainSpheres for 6 hours with SARS-CoV-2 at multiplicity of infection (MOI) of 0.1 led to the infection of a fraction of neural cells with replication of the virus evident 72 hours later. Virus particles were found in the neuronal cell body extending into apparent neurite structures. PCR measurements corroborated the replication of the virus, suggesting at least a tenfold increase in virus copies per total RNA. Leveraging state-of-the-art 3D organotypic cell culture, which has been shown to allow both virus infection and (developmental) neurotoxicity but is at the same time simple enough to be transferred and used in a BSL-3 environment, we demonstrate, for the first time, the potential critically important neurotropism of SARS-CoV-2.


title: Clinical Analysis of 25 Novel Coronavirus Infections in Children

text: BACKGROUND: To describe the characteristics of clinical manifestations of children with 2019 novel coronavirus (2019-nCoV) infection in Chongqing. METHODS: All 25 children with laboratory-confirmed 2019-nCoV infection by real-time reverse transcription-PCR (RNA-PCR) were admitted from the 4 designated treatment hospitals of 2019-nCoV in Chongqing from January 19 to March 12, 2020. Clinical data and epidemiological history of these patients were retrospectively collected and analyzed. RESULTS: The diagnosis was confirmed through RNA-PCR testing. Among the 25 cases, 14 were males and 11 were females. The median age was 11.0 (6.3-14.5) years (range 0.6-17.0 years). All children were related to a family cluster outbreak, and 7 children (28%) with a travel or residence history in Hubei Province. These patients could be categorized into different clinical types, including 8 (32%) asymptomatic, 4 (16%) very mild cases and 13 (52%) common cases. No severe or critical cases were identified. The most common symptoms were cough (13 cases, 52%) and fever (6 cases, 24%). The duration time of clinical symptoms was 13.0 (8.0-25.0) days. In the 25 cases, on admission, 21 cases (84%) had normal white blood cell counts, while only 2 cases (8%) more than 10 × 10/L and 2 cases (8%) less than 4 × 10/L, respectively; 22 cases(88%) had normal CD4+ T lymphocyte counts, while in the remaining 3 cases(8%) this increased mildly; 23 cases had normal CD8+ T lymphocyte counts, while in the remaining 2 cases (8%) CD8+ T lymphocyte counts were mildly increased as well. All Lymphocyte counts were normal. There were no statistical differences of lab results between the groups of asymptomatic cases, mild cases and common cases. There were only 13 cases with abnormal CT imaging, most of which were located in the subpleural area of the bottom of the lung. All patients were treated with interferon, 6 cases combined with Ribavirin, and 12 cases combined with lopinavir or ritonavir. The days from onset to RNA turning negative was 15.20 ± 6.54 days. There was no significant difference of RNA turning negative between the groups of interferon, interferon plus ribavirin and interferon plus lopinavir or ritonavir treatment. All the cases recovered and were discharged from hospital. CONCLUSIONS: The morbidity of 2019-nCoV infection in children is lower than in adults and the clinical manifestations and inflammatory biomarkers in children are nonspecific and milder than that in adults. RNA-PCR test is still the most reliable diagnostic method, especially for asymptomatic patients.


title: Clinical Analysis of 25 COVID-19 Infections in Children

text: BACKGROUND: To describe the characteristics of clinical manifestations of children with 2019 novel coronavirus (2019-nCoV) infection in Chongqing. METHODS: All 25 children with laboratory-confirmed 2019-nCoV infection by real-time reverse transcription-PCR (RNA-PCR) were admitted from the 4 designated treatment hospitals of 2019-nCoV in Chongqing from January 19 to March 12, 2020. Clinical data and epidemiologic history of these patients were retrospectively collected and analyzed. RESULTS: The diagnosis was confirmed through RNA-PCR testing. Among the 25 cases, 14 were males and 11 were females. The median age was 11.0 (6.3-14.5) years (range 0.6-17.0 years). All children were related to a family cluster outbreak, and 7 children (28%) with a travel or residence history in Hubei Province. These patients could be categorized into different clinical types, including 8 (32%) asymptomatic, 4 (16%) very mild cases and 13 (52%) common cases. No severe or critical cases were identified. The most common symptoms were cough (13 cases, 52%) and fever (6 cases, 24%). The duration time of clinical symptoms was 13.0 (8.0-25.0) days. In the 25 cases, on admission, 21 cases (84%) had normal white blood cell counts, while only 2 cases (8%) more than 10 × 10/L and 2 cases (8%) less than 4 × 10/L, respectively; 22 cases(88%) had normal CD4+ T lymphocyte counts, while in the remaining 3 cases(8%) this increased mildly; 23 cases had normal CD8+ T lymphocyte counts, while in the remaining 2 cases (8%) CD8+ T lymphocyte counts were mildly increased as well. All Lymphocyte counts were normal. There were no statistical differences of lab results between the groups of asymptomatic cases, mild cases and common cases. There were only 13 cases with abnormal CT imaging, most of which were located in the subpleural area of the bottom of the lung. All patients were treated with interferon, 6 cases combined with Ribavirin, and 12 cases combined with lopinavir or ritonavir. The days from onset to RNA turning negative was 15.20 ± 6.54 days. There was no significant difference of RNA turning negative between the groups of interferon, interferon plus ribavirin and interferon plus lopinavir or ritonavir treatment. All the cases recovered and were discharged from hospital. CONCLUSIONS: The morbidity of 2019-nCoV infection in children is lower than in adults and the clinical manifestations and inflammatory biomarkers in children are nonspecific and milder than that in adults. RNA-PCR test is still the most reliable diagnostic method, especially for asymptomatic patients.


Systemic isotretinoin therapy in the era of COVID-19


title: Pure-tone audiometry without bone-conduction thresholds: using the digits-in-noise test to detect conductive hearing loss

text: Objective: COVID-19 has been prohibitive to traditional audiological services. No- or low-touch audiological assessment outside a sound-booth precludes test batteries including bone conduction audiometry. This study investigated whether conductive hearing loss (CHL) can be differentiated from sensorineural hearing loss (SNHL) using pure-tone air conduction audiometry and a digits-in-noise (DIN) test.Design: A retrospective sample was analysed using binomial logistic regressions, which determined the effects of pure tone thresholds or averages, speech recognition threshold (SRT), and age on the likelihood that participants had CHL or bilateral SNHL.Study sample: Data of 158 adults with bilateral SNHL (n = 122; PTA0.5-4 kHz > 25 dB HL bilaterally) or CHL (n = 36; air conduction PTA0.5-4 kHz > 25 dB HL and ≥20 dB air bone gap in the affected ears) were included.Results: The model which best discriminated between CHL and bilateral SNHL used low-frequency pure-tone average (PTA), diotic DIN SRT, and age with an area under the ROC curve of 0.98 and sensitivity and specificity of 97.2 and 93.4%, respectively.Conclusion: CHL can be accurately distinguished from SNHL using pure-tone air conduction audiometry and a diotic DIN. Restrictions on traditional audiological assessment due to COVID-19 require lower touch audiological care which reduces infection risk.


title: COVID-19 and cancer research

text: The COVID-19 pandemic has had a devastating effect on human lives and society. The accompanying editorial summarises some of the major effects on cancer patients and impacts on cancer research. These may be mitigated by appropriate responses from governments, research funders, charities, universities, industry and the public. It is already clear that different approaches to management have drastically different outcomes.


Meet the engineer behind China's first robot-run coronavirus ward


title: Follow-up for pregnant women during the COVID-19 pandemic: French national authority for health recommendations

text: INTRODUCTION: In the context of the stage 3 SARS-Cov-2 epidemic situation, it is necessary to put forward a method of rapid response for an HAS position statement in order to answer to the requests from the French Ministry of Solidarity and Health, healthcare professionals and/or health system users' associations concerning follow-up of pregnant women during the COVID-19 outbreak. METHODS: A simplified 7-step process that favours HAS collaboration with experts (healthcare professionals, health system users' associations, scientific societies etc.), the restrictive selection of available evidence and the use of digital means of communication. A short and specific dissemination format, which can be quickly updated in view of the changes in available data has been chosen.


title: The impact of MicroRNAs (miRNAs) on the genotype of coronaviruses

text: Summar y. The beginning of 2020 has seen the emergence of COVID-19, an outbreak caused by a novel coronavirus, SARS-CoV-2, an important pathogen for humans. SARS-CoV-2 is an RNA virus containing 29891 nucleotides encoding 9889 amino acids. The genome is arranged as 5p-replicase (orf1/ab)-structural proteins [Spike (S) -Envelope (E) - Membrane (M) -Nucleocapsid (N)] -3. Viruses are obligate intracellular infectious agents that use the host cellular machinery to ensure their own fitness and survival. MicroRNAs (miRNA9) systems are potent post-transcriptional gene expression regulators that are important modulators of viral infections, and could play an important role in the treatment of viral infections. This review focuses to the genomic structure of coronaviruses, the functions of genomic proteins, the effects of micro RNA (miRNA) on virus replication and its pathogenesis.


title: COVID-19, Negligence and Occupational Health and Safety: Ethical and Legal Issues for Hospitals and Health Centres

text: The international incidence of health workers being infected with COVID-19 is deeply troubling. Until a vaccine is developed, they are the community's bulwark against the pandemic. It is vital that they be protected to the maximum extent possible. This entails the need for implementation of effective and compassionate protocols to keep their workplace as safe as possible for them, their colleagues and their patients in a context of much as yet not being known about the virus and awareness that some persons infected by it are for a time at least asymptomatic and that others test negative for it when they are prodromal or even already displaying some symptomatology. This has repercussions both for the liability of hospitals and multi-practitioner centres for negligence and also under occupational health and safety legislation. With the commencement of the roll out of biosecurity and disaster/emergency measures by government and escalating levels of anxiety in the general population, it is important to reflect upon the measures that most effectively can be adopted practically and ethically to protect the health and safety of those whose task it is to care for us if we become infected by COVID-19.


COVID-19 as triggering co-factor for cortical cerebral venous thrombosis?