Influence of delayed separation of plasma from whole blood and centrifugation protocol on Zn plasma concentration


Practical Implications of Novel Coronavirus COVID-19 on Hospital Operations, Board Certification, and Medical Education in Surgery in the USA


title: Exercising in Times of Lockdown: An Analysis of the Impact of COVID-19 on Levels and Patterns of Exercise among Adults in Belgium

text: Countries all over the world implemented lockdowns to counteract COVID-19. These lockdowns heavily limited people's exercise possibilities. At the same time, experts advocated to remain physically active to prevent future health problems. Based on an online survey, this study examines adults' exercise levels and patterns during the COVID-19 lockdown in Belgium. Ordinal logistic regression analyses of 13,515 valid and population-weighted responses indicate a general increase in exercise frequencies, as well as in sedentary behavior. Except for people aged 55+, previously low active adults self-reported to exercise more during the lockdown. Among the people who were already high active before COVID-19, those above 55 years old, those with low education, those used to exercise with friends or in a sport club, and those who were not using online tools to exercise, self-reported to exercise less during the lockdown. Having less time, sitting more, and missing the familiar way and competitive element of exercising were the main reasons for a self-reported exercise reduction. Given the health risks associated with physical inactivity, results imply that governments should consider how those who were not reached can be encouraged to exercise during a lockdown. After all, additional COVID-19 lockdowns might be implemented in the future.


title: How to Surge to Face the SARS-CoV-2 Outbreak: Lessons Learned From Lombardy, Italy

text: Italy is fighting against one of the worst medical emergency since the 1918 Spanish Flu. Pressure on the hospitals is tremendous. As for official data on March 14th: 8372 admitted in hospitals, 1518 in intensive care units, 1441 deaths (175 more than the day before). Unfortunately, hospitals are not prepared: even where a plan for massive influx of patients is present, it usually focuses on sudden onset disaster trauma victims (the most probable case scenario), and it has not been tested, validated, or propagated to the staff. Despite this, the All Hazards Approach for management of major incidents and disasters is still valid and the "4S" theory (staff, stuff, structure, systems) for surge capacity can be guidance to respond to this disaster.


title: A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic

text: The pandemic of COVID-19 has presented new challenges to hospital personnel providing care for infected patients with diabetes who represent more than 20% of critically ill patients in intensive care units. Appropriate glycemic management contributes to a reduction in adverse clinical outcomes in acute illness but also requires intensive patient interactions for bedside glucose monitoring, intravenous and subcutaneous insulin administration, as well as rapid intervention for hypoglycemia events. These tasks are required at a time when minimizing patient interactions is recommended as a way of avoiding prolonged exposure to COVID-19 by health care personnel who often practice in settings with limited supplies of personal protective equipment. The purpose of this manuscript is to provide guidance for clinicians for reconciling recommended standards of care for infected hospitalized patients with diabetes while also addressing the daily realities of an overwhelmed health care system in many areas of the country. The use of modified protocols for insulin administration, bedside glucose monitoring, and medications such as glucocorticoids and hydroxychloroquine that may affect glycemic control are discussed. Continuous glucose monitoring systems have been proposed as an option for reducing time spent with patients, but there are important issues that need to be addressed if these are used in hospitalized patients. On site and remote glucose management teams have potential to provide guidance in areas where there are shortages of personnel who have expertise in inpatient glycemic management.


SARS-CoV, MERS-CoV and now the 2019-novel CoV: Have we investigated enough about coronaviruses? - A bibliometric analysis


Species distribution models are inappropriate for COVID-19


title: Facing a disruptive threat: how can a nuclear medicine service be prepared for the coronavirus outbreak 2020?

text: PURPOSE: The aim of this short communication is to outline our experience in policies and processes of a nuclear medicine service during the COVID-19 outbreak in Singapore. METHODS: We describe the key considerations of policies and processes that have been implemented in our nuclear medicine service since the first case of COVID-19 was confirmed in Singapore General Hospital on 23 January 2020, up to the present time. RESULTS: Infection control, screening of patients and visitors, segregation of risk groups, segregation of staff and service continuity plans, communication and staff welfare, using electronic platforms for multi-disciplinary meetings and tele-reporting are discussed. CONCLUSION: Since our hospital received the first patient with COVID-19 in Singapore, our centre has managed 16 COVID-19 cases to date. There has not been any healthcare worker in our institution who has contracted COVID-19 through patient contact. We have highlighted for discussion some of the policies and processes to prepare a nuclear medicine service for the COVID-19 threat.


title: Pharmacological agents under investigation in the treatment of coronavirus disease 2019 and the importance of melatonin

text: Coronavirus disease 2019 (COVID-19) is a life-threatening infectious respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 pandemic causing morbidities and even deaths worldwide revealed that there is urgent need to find pharmacological agents or vaccines. Although there are a lot of agents under investigation, there is no approved agent for the prevention or treatment of the COVID-19 yet. Treatment of patients remains mainly supportive as well as compassionate use of the agents under investigation. It is well established that excessive inflammatory and immune response as well as oxidative injury play a critical role in the pathogenesis of COVID-19. In this review, we aimed to update knowledge about pathogenesis, clinical features and pharmacological treatment of COVID-19 and review the potential beneficial effects of ancient antioxidant, anti-inflammatory and immunomodulatory molecule melatonin for prevention and treatment of COVID-19.


title: Competing during a pandemic? Retailers' ups and downs during the COVID-19 outbreak

text: The COVID-19 pandemic (that started in early 2020) is causing several disruptions in the short- and mid-term, to which businesses have to adapt. Some retailers have reacted to the emergency immediately, displaying a plethora of different intervention types. The authors aim to synthesize the challenges that retailers are facing during the COVID-19 emergency. We do this from the perspective of both consumers and managers, with the goal of providing guidelines on and examples of how retailers can handle this unprecedented situation.


title: Nitazoxanide/azithromycin combination for COVID-19: A suggested new protocol for early management

text: Azithromycin has been shown to have a clinical efficacy against severe acute respiratory syndrome coronavirus 2; ivermectin has also demonstrated a remarkable experimental efficacy with a potential to be used for Coronavirus disease 2019. Further, BCG vaccination is being considered for clinical trials aiming to test its potential for lowering COVID-19 morbidity and mortality. This article illustrates some structural and functional relationships that may gather these drugs and the author, basing on a combined pathophysiological and pharmacological approach, recommends the FDA-approved antidiarrhea drug; nitazoxanide, which has been previously suggested but unfortunately widely ignored, to be tested in combination with azithromycin for their potential activity against SARS CoV-2, soonest. The author also recommends testing their combined administration as early during the clinical course of COVID-19 as possible. Further, basing on the same represented concept, the author suggests more trials for interferons to be tested against SARS CoV-2, especially in severe and critical COVID-19 cases.


title: Kaplan-Meier type survival curves for COVID-19: a health data based decision-making tool

text: Countries are recording health information on the global spread of COVID-19 using different methods, sometimes changing the rules after a few days. They are all publishing the number of new individuals infected, cured and dead, along with some supplementary data. These figures are often recorded in a non-uniform manner and do not match the standard definitions of these variables. However, in this paper we show that the Kaplan-Meier curves calculated with them could provide useful information about the dynamics of the disease in different countries. Our aim is to present a robust and simple model to show certain characteristics of the evolution of the dynamic process, showing that the differences of evolution among the countries is reflected in the corresponding Kaplan-Meier-type curves. We compare the curves obtained for the most affected countries so far, proposing possible interpretations of the properties that distinguish them.


title: A simple computational approach to the Susceptible-Infected-Recovered (SIR) epidemic model via the Laplace-Adomian Decomposition Method

text: The Susceptible-Infected-Recovered (SIR) epidemic model is extensively used for the study of the spread of infectious diseases. Even that the exact solution of the model can be obtained in an exact parametric form, in order to perform the comparison with the epidemiological data a simple but highly accurate representation of the time evolution of the SIR compartments would be very useful. In the present paper we obtain a series representation of the solution of the SIR model by using the Laplace-Adomian Decomposition Method to solve the basic evolution equation of the model. The solutions are expressed in the form of infinite series. The series representations of the time evolution of the SIR compartments are compared with the exact numerical solutions of the model. We find that there is a good agreement between the Laplace-Adomian semianalytical solutions containing only three terms, and the numerical results.


title: Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)

text: Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.


The impact of social distancing on pediatric neurosurgical emergency referrals during the COVID-19 pandemic: a prospective observational cohort study


title: Binding site analysis of potential protease inhibitors of COVID-19 using AutoDock

text: Recent outbreak of COVID-19 caused by SARS-CoV-2 in December 2019 raised global health concerns. Re-purposing the available protease inhibitor drugs for immediate use in treatment in SARS-CoV-2 infections could improve the currently available clinical management. The current study, aims to predict theoretical structure for protease of COVID-19 and to explore further whether this protein can serve as a target for protease inhibitor drugs such as remdesivir, nelfinavir, lopinavir, ritonavir and α-ketoamide. While the 3D structure of protease was predicted using SWISS MODEL server, molecular interaction studies between protein and ligands were performed using AutoDock software. The predicted protease model was reasonably good based on reports generated by different validation servers. The study further revealed that all the protease inhibitor drugs got docked with negative dock energy onto the target protein. Molecular interaction studies showed that protease structure had multiple active site residues for remdesivir, while for remaining ligands the structure had only one active site residue each. From the output of multiple sequence alignment, it is evident that ligand binding sites were conserved. The current in silico study thus, provides structural insights about the protease of COVID-19 and also its molecular interactions with some of the known protease inhibitors.


title: Battling COVID-19: critical care and peri-operative healthcare resource management strategies in a tertiary academic medical centre in Singapore

text: In December 2019, a cluster of atypical pneumonia cases were reported in Wuhan, China, and a novel coronavirus elucidated as the aetiologic agent. Although most initial cases occurred in China, the disease, termed coronavirus disease 2019, has become a pandemic and continues to spread rapidly with human-to-human transmission in many countries. This is the third novel coronavirus outbreak in the last two decades and presents an ensuing healthcare resource burden that threatens to overwhelm available healthcare resources. A study of the initial Chinese response has shown that there is a significant positive association between coronavirus disease 2019 mortality and healthcare resource burden. Based on the Chinese experience, some 19% of coronavirus disease 2019 cases develop severe or critical disease. This results in a need for adequate preparation and mobilisation of critical care resources to anticipate and adapt to a surge in coronavirus disease 2019 case-load in order to mitigate morbidity and mortality. In this article, we discuss some of the peri-operative and critical care resource planning considerations and management strategies employed in a tertiary academic medical centre in Singapore in response to the coronavirus disease 2019 outbreak.


title: School and pre-school children with type 1 diabetes during covid-19 quarantine: the synergic effect of parental care and technology

text: INTRODUCTION: Management of Type 1 Diabetes (T1D) poses numerous challenges, especially for young children and their families. Parental care positively influencesthe outcomesofchildren with T1D, while there are often criticisms in school environment. The COVID-19 pandemic has forced children and parents to spend many hours at home and diabetes care has returned mainly in the hands of parents. AIM OF THE STUDY: To evaluate the effectiveness of exclusive return to parental care in pre-school and school children with T1D treated with Tandem Basal IQ system during the COVID-19 pandemic. PATIENTS AND METHODS: 22 children (M:F = 14:8) with T1D have been evaluated. We compared insulin and CGM data (TIR, TBR and TAR) of two periods: PRE-COV and IN-COV, in which children have transitioned from normal school attendance to the exclusive care of their parents. RESULTS: During the IN-COV period a significantly (p < 0.001) higher median value of TIR (66,41%) was observed as compared to PRE-COV period (61,45%). Patients also showed a statistically significant difference (p < 0.002) between the IN-COV period and the PRE-COV period as concerning the TAR metric: respectively 29,86 ± 10,6 % vs 34,73 ± 12,8 %. The difference between the bolus insulin doses was statistically significant (PRE-COV 5,3 IU/day, IN-COV 7,9 IU/day - p<0.05). CONCLUSION: Our observational real-life study confirms the positive effect of parental care in T1D very young children and demonstrates that during the COVID-19 pandemic it was possible to obtain a good glycometabolic compensation despite the significant change in lifestyle.


title: The mechanism and treatment of gastrointestinal symptoms in patients with COVID-19

text: In addition to the typical respiratory response, new coronavirus pneumonia (COVID-19) is also associated with very common gastrointestinal symptoms. Cases with gastrointestinal symptoms are more likely to be complicated by liver injury and acute respiratory distress syndrome (ARDS), and diarrhea can also lead to electrolyte disturbances, causing nausea and vomiting, headache, fatigue, etc. If not treated in time, coma and circulatory failure may ensue. As SARS-CoV-2 infects the human body through the combination of ACE2 in the gastrointestinal tract, the mechanism underlying the gastrointestinal symptoms may involve damage to the intestinal mucosal barrier and promotion of the production of inflammatory factors, causing cytokine storms. Indeed, after cells in the lungs become infected by SARS-CoV-2, effector CD4+ T cells reach the small intestine through the gut-lung axis, causing intestinal immune damage and diarrhea; early extensive use of antibacterial and antiviral drugs can also lead to diarrhea in patients. Thus, treatment options for COVID-19 patients should be promptly adjusted when they have gastrointestinal symptoms. Additionally, when drug-induced diarrhea occurs, drugs should be withdrawn or reduced, and microecological regulators should be applied to maintain the intestinal microecological balance and prevent secondary bacterial infections. To guarantee effective treatment, attention should be paid to the patient's enteral nutrition and digestive tract function. As SARS-CoV-2 has been detected in the feces of COVID-19 patients, future prevention and control efforts must consider the possibility of fecal-oral transmission of the virus.


COVID-19 and liver disease


How to safeguard children's mental health during emergencies


title: Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series

text: OBJECTIVE: To study the clinical characteristics of patients in Zhejiang province, China, infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) responsible for coronavirus disease 2019 (covid-2019) , DESIGN: Retrospective case series , SETTING: Seven hospitals in Zhejiang province, China , PARTICIPANTS: 62 patients admitted to hospital with laboratory confirmed SARS-Cov-2 infection Data were collected from 10 January 2020 to 26 January 2020 , MAIN OUTCOME MEASURES: Clinical data, collected using a standardised case report form, such as temperature, history of exposure, incubation period If information was not clear, the working group in Hangzhou contacted the doctor responsible for treating the patient for clarification , RESULTS: Of the 62 patients studied (median age 41 years), only one was admitted to an intensive care unit, and no patients died during the study According to research, none of the infected patients in Zhejiang province were ever exposed to the Huanan seafood market, the original source of the virus;all studied cases were infected by human to human transmission The most common symptoms at onset of illness were fever in 48 (77%) patients, cough in 50 (81%), expectoration in 35 (56%), headache in 21 (34%), myalgia or fatigue in 32 (52%), diarrhoea in 3 (8%), and haemoptysis in 2 (3%) Only two patients (3%) developed shortness of breath on admission The median time from exposure to onset of illness was 4 days (interquartile range 3-5 days), and from onset of symptoms to first hospital admission was 2 (1-4) days , CONCLUSION: As of early February 2020, compared with patients initially infected with SARS-Cov-2 in Wuhan, the symptoms of patients in Zhejiang province are relatively mild , (C) 2020 BMJ Publishing Group Ltd


text: OBJECTIVE: To study the clinical characteristics of patients in Zhejiang province, China, infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) responsible for coronavirus disease 2019 (covid-2019). DESIGN: Retrospective case series. SETTING: Seven hospitals in Zhejiang province, China. PARTICIPANTS: 62 patients admitted to hospital with laboratory confirmed SARS-Cov-2 infection. Data were collected from 10 January 2020 to 26 January 2020. MAIN OUTCOME MEASURES: Clinical data, collected using a standardised case report form, such as temperature, history of exposure, incubation period. If information was not clear, the working group in Hangzhou contacted the doctor responsible for treating the patient for clarification. RESULTS: Of the 62 patients studied (median age 41 years), only one was admitted to an intensive care unit, and no patients died during the study. According to research, none of the infected patients in Zhejiang province were ever exposed to the Huanan seafood market, the original source of the virus; all studied cases were infected by human to human transmission. The most common symptoms at onset of illness were fever in 48 (77%) patients, cough in 50 (81%), expectoration in 35 (56%), headache in 21 (34%), myalgia or fatigue in 32 (52%), diarrhoea in 3 (8%), and haemoptysis in 2 (3%). Only two patients (3%) developed shortness of breath on admission. The median time from exposure to onset of illness was 4 days (interquartile range 3-5 days), and from onset of symptoms to first hospital admission was 2 (1-4) days. CONCLUSION: As of early February 2020, compared with patients initially infected with SARS-Cov-2 in Wuhan, the symptoms of patients in Zhejiang province are relatively mild.


title: The SARS-CoV-2 Coronavirus and the COVID-19 Outbreak

text: The SARS-CoV-2, a newly identified ß-coronavirus, is the causative agent of the third large-scale pandemic from the last two decades. The outbreak started in December 2019 in Wuhan City, Hubei province in China. The patients presented clinical symptoms of dry cough, fever, dyspnea, and bilateral lung infiltrates on imaging. By February 2020, The World Health Organization (WHO) named the disease as Coronavirus Disease 2019 (COVID-19). The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses (ICTV) recognized and designated this virus as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 uses the same host receptor, angiotensin-converting enzyme 2 (ACE2), used by SARS-CoV to infect humans. One hypothesis of SARSCoV-2 origin indicates that it is likely that bats serve as reservoir hosts for SARSCoV-2, being the intermediate host not yet determined. The predominant route of transmission of SARS-CoV-2 is from human to human. As of May 10th 2020, the number of worldwide confirmed COVID-19 cases is over 4 million, while the number of global deaths is around 279.000 people. The United States of America (USA) has the highest number of COVID-19 cases with over 1.3 million cases followed by Spain, Italy, United Kingdom, Russia, France and Germany with over 223.000, 218.000, 215.000, 209.000, 176.000, and 171.000 cases, respectively.


Epidemiology of Covid-19


title: How relevant is the decision of containment measures against COVID-19 applied ahead of time?

text: The cumulative number of confirmed infected individuals by the new coronavirus outbreak until April 30th, 2020, is presented for the countries: Belgium, Brazil, United Kingdom (UK), and United States of America (USA). After an initial period with a low incidence of newly infected people, a power-law growth of the number of confirmed cases is observed. For each country, a distinct growth exponent is obtained. For Belgium, UK, and USA, countries with a large number of infected people, after the power-law growth a distinct behavior is obtained when approaching saturation. Brazil is still in the power-law regime. Such updates of the data and projections corroborate recent results regarding the power-law growth of the virus and their strong Distance Correlation between some countries around the world. Furthermore, we show that act in time is one of the most relevant non-pharmacological weapons that the health organizations have in the battle against the COVID-19, infectious disease caused by the most recently discovered coronavirus. We study how changing the social distance and the number of daily tests to identify infected asymptomatic individuals can interfere in the number of confirmed cases of COVID-19 when applied in three distinct days, namely April 16th (early), April 30th (current), and May 14th (late). Results show that containment actions are necessary to flatten the curves and should be applied as soon as possible.


The COVID-19 pandemic: major risks to healthcare and other workers on the front line


title: [Intervention mechanism of Qingwen Baidu Yin on cytokine storm based on network pharmacology]

text: The aim of this paper was to explore the intervention mechanism of Qingwen Baidu Yin in cytokine storm based on network pharmacology. TCMSP and TCMIP V2.0 server were used to predict all chemical components and action targets of Qingwen Baidu Yin. Diseases that could be treated by Qingwen Baidu Yin were predicted through Enrichr database. A compound target interaction(PPI) network diagram was constructed using STRING 11.0. OmicShare was used to analyzed the gene ontology(GO) enrichment and enrichment of the Kyoto encyclopedia of genes and genomes(KEGG) pathway of core targets. Component-target-path network diagram was constructed with Cytoscape 3.6.0 software. After analysis of the database, 267 compounds were screened for Qingwen Baidu Yin, involving 1 450 targets, and a protein interaction network was constructed. Total 219 core target proteins were predicted, such as NFKB1, STAT1, RAF1, IL2, JAK1, IL6, TNF, BCL2 and other important targets, and 221 core target pathways were enriched, including cancer pathway, Kaposi's sarcoma-associated herpes virus infection, chemokine signal pathway, PI3 K-AKT signal pathway, EB virus infection, virus carcinogenesis and T cell receptor signaling pathways, a collection of which were highly related to cytokine storms. GO annotation analysis suggested that Qingwen Baidu Yin Decoction may exert therapeutic effects by regulating protein phosphorylation, cell response to cytokine stimulation, cell proliferation, inflammatory response, transmembrane receptor protein tyrosine kinase signaling pathway, and cytokine-mediated signaling pathways. This study revealed potential active components of Qingwen Baidu Yin in defending against cytokine storm and its possible mechanism of action, and provided theoretical basis and technical support for further clinical application of this prescription.


title: Clinical and Immune Features of Hospitalized Pediatric Patients With Coronavirus Disease 2019 (COVID-19) in Wuhan, China

text: Importance: The epidemiologic and clinical characteristics of pediatric patients with coronavirus disease 2019 (COVID-19) have been reported, but information on immune features associated with disease severity is scarce. Objective: To delineate and compare the immunologic features of mild and moderate COVID-19 in pediatric patients. Design, Setting, and Participants: This single-center case series included 157 pediatric patients admitted to Wuhan Children's Hospital with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data were collected from January 25 to April 18, 2020. Exposures: Documented SARS-CoV-2 infection. Main Outcomes and Measures: Clinical and immunologic characteristics were collected and analyzed. Outcomes were observed until April 18, 2020. Results: Of the 157 pediatric patients with COVID-19, 60 (38.2%) had mild clinical type with pneumonia, 88 (56.1%) had moderate cases, 6 (3.8%) had severe cases, and 3 (1.9%) were critically ill. The 148 children with mild or moderate disease had a median (interquartile range [IQR]) age of 84 (18-123) months, and 88 (59.5%) were girls. The most common laboratory abnormalities were increased levels of alanine aminotransferase (ALT) (median [IQR], 16.0 [12.0-26.0] U/L), aspartate aminotransferase (AST) (median [IQR], 30.0 [23.0-41.8] U/L), creatine kinase MB (CK-MB) activity (median [IQR], 24.0 [18.0-34.0] U/L), and lactate dehydrogenase (LDH) (median [IQR], 243.0 [203.0-297.0] U/L), which are associated with liver and myocardial injury. Compared with mild cases, levels of inflammatory cytokines including interleukin 6, tumor necrosis factor α, and interferon Î³ were unchanged, whereas the level of immune suppressive interleukin 10 was markedly increased in moderate cases compared with mild cases (median [IQR], 3.96 [3.34-5.29] pg/mL vs 3.58 [3.10-4.36] pg/mL; P = .048). There was no statistically significant difference in absolute number of lymphocytes (including T cells and B cells) between mild and moderate cases, but moderate cases were associated with a decrease in neutrophil levels compared with mild cases (median [IQR], 2310/µL [1680/µL-3510/µL] vs 3120/µL [2040/µL-4170/µL]; P = .01). Immunoglobin G and the neutrophil to lymphocyte ratio were negatively associated with biochemical indices related to liver and myocardial injury (immunoglobulin G, ALT: r, -0.3579; AST: r, -0.5280; CK-MB activity: r, -0.4786; LDH: r, -0.4984; and neutrophil to lymphocyte ratio, ALT: r, -0.1893; AST: r, -0.3912; CK-MB activity: r, -0.3428; LDH: r, -0.3234), while counts of lymphocytes, CD4+ T cells, and interleukin 10 showed positive associations (lymphocytes, ALT: r, 0.2055; AST: r, 0.3615; CK-MB activity: r, 0.338; LDH: r, 0.3309; CD4+ T cells, AST: r, 0.4701; CK-MB activity: r, 0.4151; LDH: r, 0.4418; interleukin 10, ALT: r, 0.2595; AST: r, 0.3386; CK-MB activity: r, 0.3948; LDH: r, 0.3794). Conclusions and Relevance: In this case series, systemic inflammation rarely occurred in pediatric patients with COVID-19, in contrast with the lymphopenia and aggravated inflammatory responses frequently observed in adults with COVID-19. Gaining a deeper understanding of the role of neutrophils, CD4+ T cells, and B cells in the pathogenesis of SARS-CoV-2 infection could be important for the clinical management of COVID-19.


title: Waiting for COVID-19

text: I wrote this as a narrative piece for school, but it is a very honest description of how I'm feeling at this time. I just wanted to reassure people that I am ok. For anyone else who is feeling the same as I am, it's ok. I think it is good for us to be honest about how we are feeling, and it is perfectly reasonable for us to feel confusion during this time. I also think it is good for us to not let any anxiety overwhelm us. So let it out. Talk to someone. Write it down. And breathe. For me, watching the sunrise this morning was a good way to focus on something other than the chaos, other than my feelings.


title: Boosting test-efficiency by pooled testing strategies for SARS-CoV-2

text: In the current COVID19 crisis many national healthcare systems are confronted with an acute shortage of tests for confirming SARS-CoV-2 infections. For low overall infection levels in the population, pooling of samples can drastically amplify the testing efficiency. Here we present a formula to estimate the optimal pooling size, the efficiency gain (tested persons per test), and the expected upper bound of missed infections in the pooled testing, all as a function of the populationwide infection levels and the false negative/positive rates of the currently used PCR tests. Assuming an infection level of 0.1 % and a false negative rate of 2 %, the optimal pool size is about 32, the efficiency gain is about 15 tested persons per test. For an infection level of 1 % the optimal pool size is 11, the efficiency gain is 5.1 tested persons per test. For an infection level of 10 % the optimal pool size reduces to about 4, the efficiency gain is about 1.7 tested persons per test. For infection levels of 30 % and higher there is no more benefit from pooling. To see to what extent replicates of the pooled tests improve the estimate of the maximal number of missed infections, we present all results for 1, 3, and 5 replicates.


title: Emerging manufacturers engagements in the COVID -19 vaccine research, development and supply

text: The World Health Organization declared the COVID-19 disease as a pandemic requiring a rapid response. Through online search, direct communication with network members and an internal survey, engagements of developing countries' vaccine manufacturers' network members in the research and development of COVID-19 vaccines and their capacities in the manufacturing, fill-finish and distribution of vaccines were assessed. Currently, 19 network members engaged in research and development of COVID-19 vaccines, using six principal technology platforms. In addition, an internal survey showed that the number of vaccines supplied collectively by 37 members, in 2018-19, was about 3.5 billion doses annually. Almost a third of network members having vaccines prequalified by the World Health Organization comply with international regulations and mechanisms to distribute vaccines across borders. The use of existing manufacturing, fill-finish and distribution capabilities can support an efficient roll-out of vaccines against COVID-19, while maintaining supply security of existing vaccines for on-going immunization programmes.


COVID-19 Epidemic and Enhancing China's National Biosecurity System


title: Ketogenic diet therapy provision in the COVID-19 pandemic: Dual-center experience and recommendations

text: The current coronavirus-19 pandemic has changed dramatically how neurologists care for children and adults with epilepsy. Stay-at-home orders and resistance to hospitalizations by patients have led epileptologists to engage in telemedicine and reevaluate how to provide elective services. Ketogenic diet therapy is often started in the hospital, with families educated in hospital-based classes, but this is difficult to do in this current pandemic. At our two academic centers, both our pediatric and adult epilepsy diet centers have had to quickly consider alternative methods to both start and maintain ketogenic diet therapy. This paper provides several examples of how ketogenic diet therapy can be provided to patients in unique ways, along with recommendations from other experts and patients, learned over the past few months.


title: An AI approach to COVID-19 infection risk assessment in virtual visits: a case report

text: OBJECTIVE: In an effort to improve the efficiency of computer algorithms applied to screening for COVID-19 testing, we used natural language processing (NLP) and artificial intelligence (AI)-based methods with unstructured patient data collected through telehealth visits. METHODS: After segmenting and parsing documents, we conducted analysis of overrepresented words in patient symptoms. We then developed a word embedding-based convolutional neural network for predicting COVID-19 test results based on patients' self-reported symptoms. RESULTS: Text analytics revealed that concepts such as "smell" and "taste" were more prevalent than expected in patients testing positive. As a result, screening algorithms were adapted to include these symptoms. The deep learning model yielded an AUC of 0.729 for predicting positive results and was subsequently applied to prioritize testing appointment scheduling. DISCUSSION: Informatics tools such as NLP and AI methods can have significant clinical impacts when applied to data streams early in the development of clinical systems for outbreak response.


title: COVID-19 et maladies cardiovasculaires./ [COVID-19 andcardiovascular diseases]

text: COVID-2019 disease mainly affects the respiratory tract and can progress in severe cases to pneumonia, acute respiratory distress syndrome and multi-organ failure. Patients with prior cardiovascular disease are at higher risk of developing an infection and progressing to a severe form of the disease. Also, due to the growing number of infected cases, it is clear that, in addition to the typical respiratory symptoms caused by the infection, some patients suffer from cardiovascular damage. This condition can, in fact, cause significant myocardial damage, which worsens the disease and affects the prognosis. Based on the results of currently published research, it seems important to discuss the manifestations and characteristics of myocardial damage induced by COVID-19 and its impact on patient prognosis.


title: Biological sex impacts COVID-19 outcomes

text: The current novel coronavirus disease 2019 (COVID-19) pandemic is revealing profound differences between men and women in disease outcomes worldwide. In the United States, there has been inconsistent reporting and analyses of male-female differences in COVID-19 cases, hospitalizations, and deaths. We seek to raise awareness about the male-biased severe outcomes from COVID-19, highlighting the mechanistic differences including in the expression and activity of angiotensin-converting enzyme 2 (ACE2) as well as in antiviral immunity. We also highlight how sex differences in comorbidities, which can be associated with both age and race, impact male-biased outcomes from COVID-19.


title: Lessons Learned from COVID-19 Pandemic in Italy

text: Since the COVID-19 outbreak, Italy has been one of the most affected countries in Europe and the second for number of deaths. In this commentary, we discuss some lessons that we learned as healthcare providers working in a large public hospital during the pandemic, with a special focus on the importance of infection containment and early diagnosis, the role of swab, serological tests, home isolation and individual protection devices, and the available therapies and management indications to better face a possible new outbreak in the near future. These comments should stimulate a more diffused, efficient and efficacious management of COVID-19 patients, also reducing the number of accesses to hospital emergency departments and the related spread of the infection.


Mitigating Risk of COVID-19 in Dialysis Facilities


title: Emergency Restructuring of a General Surgery Residency Program During the Coronavirus Disease 2019 Pandemic: The University of Washington Experience

text: Seattle, Washington, is an epicenter of the coronavirus disease 2019 epidemic in the United States. In response, the Division of General Surgery at the University of Washington Department of Surgery in Seattle has designed and implemented an emergency restructuring of the facility's general surgery resident care teams in an attempt to optimize workforce well-being, comply with physical distancing requirements, and continue excellent patient care. This article introduces a unique approach to general surgery resident allocation by dividing patient care into separate inpatient care, operating care, and clinic care teams. Separate teams made up of all resident levels will work in each setting for a 1-week period. By creating this emergency structure, we have limited the number of surgery residents with direct patient contact and have created teams working in isolation from one another to optimize physical distancing while still performing required work. This also provides a resident reserve without exposure to the virus, theoretically flattening the curve among our general surgery resident cohort. Surgical resident team restructuring is critical during a pandemic to optimize patient care and ensure the well-being and vitality of the resident workforce while ensuring the entire workforce is not compromised.


New intrigant possibility for prevention of coronavirus pneumonitis: natural purified polyphenols


title: COVID-19: a retrospective cohort study with focus on the over-80s and hospital-onset disease

text: BACKGROUND: Data from the UK COVID-19 outbreak are emerging, and there are ongoing concerns about a disproportionate effect on ethnic minorities. There is very limited information on COVID-19 in the over-80s, and the rates of hospital-onset infections are unknown. METHODS: This was a retrospective cohort study from electronic case records of the first 450 patients admitted to our hospital with PCR-confirmed COVID-19, 77% of the total inpatient caseload to date. Demographic, clinical and biochemical data were extracted. The primary endpoint was death during the index hospital admission. The characteristics of all patients, those over 80 years of age and those with hospital-onset COVID-19 were examined. RESULTS: The median (IQR) age was 72 (56, 83), with 150 (33%) over 80 years old and 60% male. Presenting clinical and biochemical features were consistent with those reported elsewhere. The ethnic breakdown of patients admitted was similar to that of our underlying local population. Inpatient mortality was high at 38%. Patients over 80 presented earlier in their disease course and were significantly less likely to present with the typical features of cough, breathlessness and fever. Cardiac co-morbidity and markers of cardiac dysfunction were more common, but not those of bacterial infection. Mortality was significantly higher in this group (60% vs 28%, p < 0.001). Thirty-one (7%) patients acquired COVID-19 having continuously been in hospital for a median of 20 (14, 36) days. The peak of hospital-onset infections occurred at the same time as the overall peak of admitted infections. Despite being older and more frail than those with community-onset infection, their outcomes were no worse. CONCLUSIONS: Inpatient mortality was high, especially among the over-80s, who are more likely to present atypically. The ethnic composition of our caseload was similar to the underlying population. While a significant number of patients acquired COVID-19 while already in hospital, their outcomes were no worse.


Commentary: Obesity: The "Achilles heel" for COVID-19?


title: Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis

text: OBJECTIVE: Previous meta-analyses concluded that there was insufficient evidence to determine the effect of N95 respirators. We aimed to assess the effectiveness of N95 respirators versus surgical masks for prevention of influenza by collecting randomized controlled trials (RCTs). METHODS: We searched PubMed, EMbase and The Cochrane Library from the inception to January 27, 2020 to identify relevant systematic reviews. The RCTs included in systematic reviews were identified. Then we searched the latest published RCTs from the above three databases and searched ClinicalTrials.gov for unpublished RCTs. Two reviewers independently extracted the data and assessed risk of bias. Meta-analyses were conducted to calculate pooled estimates by using RevMan 5.3 software. RESULTS: A total of six RCTs involving 9 171 participants were included. There were no statistically significant differences in preventing laboratory-confirmed influenza (RR = 1.09, 95% CI 0.92-1.28, P > .05), laboratory-confirmed respiratory viral infections (RR = 0.89, 95% CI 0.70-1.11), laboratory-confirmed respiratory infection (RR = 0.74, 95% CI 0.42-1.29) and influenzalike illness (RR = 0.61, 95% CI 0.33-1.14) using N95 respirators and surgical masks. Meta-analysis indicated a protective effect of N95 respirators against laboratory-confirmed bacterial colonization (RR = 0.58, 95% CI 0.43-0.78). CONCLUSION: The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza. It suggests that N95 respirators should not be recommended for general public and nonhigh-risk medical staff those are not in close contact with influenza patients or suspected patients.


title: Early SNS-based monitoring system for the COVID-19 outbreak in Japan: a population-level observational study

text: BackgroundThe World Health Organization declared the novel coronavirus outbreak (COVID-19) to be a pandemic on March 11, 2020. Large-scale monitoring for capturing the current epidemiological situation of COVID-19 in Japan would improve preparation for and prevention of a massive outbreak.MethodsA chatbot-based healthcare system named COOPERA (COvid-19: Operation for Personalized Empowerment to Render smart prevention And care seeking) was developed using the LINE app to evaluate the current Japanese epidemiological situation. LINE users could participate in the system either though a QR code page in the prefecture's website, or a banner at the top of the LINE app screen. COOPERA asked participants questions regarding personal information, preventive actions, and non-specific symptoms related to COVID-19 and their duration. We calculated daily cross correlation functions between the reported number of infected cases confirmed by PCR and the symptom-positive group captured by COOPERA.ResultsWe analyzed 206,218 participants from three prefectures reported between March 5 and 30, 2020. The mean (standard deviation) age of participants was 44.2 (13.2). No symptoms were reported by 96.93% of participants, but there was a significantly positive correlation between the reported number of COVID-19 cases and self-reported fevers, suggesting that massive monitoring of fever might help to estimate the scale of the COVID-19 epidemic in real time.ConclusionsCOOPERA is the first real-time system being used to monitor trends in COVID-19 in Japan, and provides useful insights to assist political decisions to tackle the epidemic.


COVID-19 Exposes Need for Progressive Criminal Justice Reform


title: Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China

text: We report co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A virus in a patient with pneumonia in China. The case highlights possible co-detection of known respiratory viruses. We noted low sensitivity of upper respiratory specimens for SARS-CoV-2, which could further complicate recognition of the full extent of disease.


Virtually supported home peanut introduction during COVID-19 for at-risk infants


COVID-19 in jails and prisons: A neglected infection in a marginalized population


3D printed circuit splitter and flow restriction devices for multiple patient lung ventilation using one anaesthesia workstation or ventilator


title: An Environmental and Health Perspective for COVID-19 Outbreak: Meteorology and Air Quality Influence, Sewage Epidemiology Indicator, Hospitals Disinfection, Drug Therapies and Recommendations

text: This Opinion Paper wishes to provide a summary of recent findings and solutions for a better understanding of the environmental and health problems associated with COVID-19. The list of topics covered is large: meteorology and air quality factors with correlation number of infections, sewage waters as a way to reveal the scale of COVID-19 outbreak, current hospital disinfection procedures and new eco-friendly technologies and list of drug therapies recommend waiting for the desired vaccine to come. During the last two months we did notice an increase in the scientific literature regarding COVID-19 with a partial vision of this problem. The current Opinion Paper is one of the first attempts, to my understanding, to summarize and integrate environmental and human health aspects related to the monitoring, fate and treatment solutions for COVID-19. That being said I believe that this Opinion Paper can serve as multipurpose document, not only for scientists of different disciplines but for social media and citizens in general.


title: Proteasome Inhibitors as a Possible Therapy for SARS-CoV-2

text: The COVID-19 global pandemic is caused by SARS-CoV-2, and represents an urgent medical and social issue. Unfortunately, there is still not a single proven effective drug available, and therefore, current therapeutic guidelines recommend supportive care including oxygen administration and treatment with antibiotics. Recently, patients have been also treated with off-label therapies which comprise antiretrovirals, anti-inflammatory compounds, antiparasitic agents and plasma from convalescent patients, all with controversial results. The ubiquitin-proteasome system (UPS) is important for the maintenance of cellular homeostasis, and plays a pivotal role in viral replication processes. In this review, we discuss several aspects of the UPS and the effects of its inhibition with particular regard to the life cycle of the coronaviruses (CoVs). In fact, proteasome inhibition by various chemical compounds, such as MG132, epoxomycin and bortezomib, may reduce the virus entry into the eucariotic cell, the synthesis of RNA, and the subsequent protein expression necessary for CoVs. Importantly, since UPS inhibitors reduce the cytokine storm associated with various inflammatory conditions, it is reasonable to assume that they might be repurposed for SARS-CoV-2, thus providing an additional tool to counteract both virus replication as well as its most deleterious consequences triggered by abnormal immunological response.


title: Pandemic Populism: Facebook Pages of Alternative News Media and the Corona Crisis -- A Computational Content Analysis

text: The COVID-19 pandemic has not only had severe political, economic, and societal effects, it has also affected media and communication systems in unprecedented ways. While traditional journalistic media has tried to adapt to the rapidly evolving situation, alternative news media on the Internet have given the events their own ideological spin. Such voices have been criticized for furthering societal confusion and spreading potentially dangerous"fake news"or conspiracy theories via social media and other online channels. The current study analyzes the factual basis of such fears in an initial computational content analysis of alternative news media's output on Facebook during the early Corona crisis, based on a large German data set from January to the second half of March 2020. Using computational content analysis, methods, reach, interactions, actors, and topics of the messages were examined, as well as the use of fabricated news and conspiracy theories. The analysis revealed that the alternative news media stay true to message patterns and ideological foundations identified in prior research. While they do not spread obvious lies, they are predominantly sharing overly critical, even anti-systemic messages, opposing the view of the mainstream news media and the political establishment. With this pandemic populism, they contribute to a contradictory, menacing, and distrusting worldview, as portrayed in detail in this analysis.


title: Minimizing SARS-CoV-2 exposure when performing surgical interventions during the COVID-19 pandemic

text: BACKGROUND: Infection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences. METHODS: We assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment. RESULTS: Patients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas. CONCLUSION: Based on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.


Del empirismo a la evidencia científica en el tratamiento con antivíricos en los casos graves de infección por coronavirus en tiempos de epidemia./ Del empirismo a la evidencia científica en el tratamiento con antivíricos en los casos graves de infección por coronavirus en tiempos de epidemia./ From empiricism to scientific evidence in antiviral treatment in severe cases of coronavirus infection in times of epidemic


Illuminating COVID-19 lung disease through autopsy studies


A smartphone based e-Consult in addiction medicine: An initiative in COVID lockdown


title: Clinical and Demographic Characteristics of Cluster Cases and Sporadic Cases of Coronavirus Disease 2019 (COVID-19) in 141 Patients in the Main District of Chongqing, China, Between January and February 2020

text: BACKGROUND In December 2019, an outbreak of coronavirus disease 2019 (COVID-19), due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurred in Wuhan, China. Patients with COVID-19 were also identified in Chongqing. This study aimed to investigate the clinical and demographic characteristics of cluster cases and sporadic cases of COVID-19 in 141 patients in the main district of Chongqing during one month, between January and February 2020. MATERIAL AND METHODS A retrospective study included 141 patients with a diagnosis of COVID-19. The diagnosis was confirmed using real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2. The patients were divided into cluster cases (n=90) and sporadic cases (n=51). Demographic and clinical characteristics were compared between the two study groups and included the presence of comorbidities, the presenting symptoms, chest computed tomography (CT) imaging findings, and laboratory findings. RESULTS The mean age of the 141 patients diagnosed with COVID-19 was 47.3 years, and the most common presenting symptom was a persistent cough (48.9%). The 90 cluster cases (63.8%) were older than the sporadic cases, and cross-infection from family gathering occurred in 82.2%, and cough was more common than fever, and there was an increased prevalence of asymptomatic, mild, and moderate cases. Cluster cases showed fewer typical manifestations of COVID-19 on chest CT. However, the laboratory findings between the cluster and sporadic cases showed no significant differences. CONCLUSIONS There were demographic and clinical differences between cluster cases and sporadic cases of COVID-19 in the main district of Chongqing during the month between January to February 2020.


Temperature-dependent surface stability of SARS-CoV-2


title: Application Prospects of Virtual Autopsy in Forensic Pathological Investigations on COVID-19

text: Abstract: Autopsy of patients who died of infectious diseases is of significance for public health management. Few forensic autopsies have been performed since the outbreak of the corona virus disease 2019 ï¼COVID-19ï¼ due to some limitations, thus forensic pathological examination failed to contribute to the prevention and treatment of infectious diseases. Virtual autopsy has unique advantages in the forensic examination of patients who died of infectious diseases. Accumulated virtual autopsy image data are of great value to the study of the pathological mechanism and diagnosis of COVID-19. This article reviews the relationship between imaging changes and pathology of the COVID-19 as well as the application of virtual autopsy in autopsy of patients who died of infectious diseases, in order to provide reference for performing virtual autopsy in the outbreak of COVID-19.


Epidémie au nouveau coronavirus (SARS-CoV-2) et prescription de la clozapine: quelles mesures? Pourquoi?/ [Clozapine prescription in the wake of the coronavirus (SARS CoV-2) outbreak: What measures? Why?]


title: Coronavirus 2019 and health systems affected by protracted conflict: The case of Syria

text: INTRODUCTION: Two thirds of countries globally are unprepared to respond to a health emergency as per the International Health Regulations (2005), with conflict-affected countries like Syria being particularly vulnerable. Political influences on outbreak preparedness, response and reporting may also adversely affect control of SARS-CoV-2 in Syria. Syria reported its first case on 22 March 2020; however, concerns were raised that this was delayed and that underreporting continues. DISCUSSION: Syria's conflict has displaced more than half of its pre-war population, leaving 6.7 million people internally displaced. The consequent overcrowding - with insufficient water, sanitation and healthcare (including laboratory capacity) - could lead to conditions that are ideal for spread of SARS-CoV-2 in Syria. Political changes have led to the formation of at least three health systems within Syria's borders, each with its own governance, capacity and planning. This fragmentation, with little interaction between them, could lead to poor resource allocation and adversely affect control. As such, COVID-19 could overwhelm the health systems (particularly intensive care capacity), leading to high deaths across the population, particularly for the most vulnerable such as detainees. CONCLUSIONS: Locally implementable interventions that rapidly build WASH and health system capacity are required across Syria to ensure early detection and management of COVID-19 cases.


title: Not all interventions are equal for the height of the second peak

text: In this paper we conduct a simulation study of the spread of an epidemic like COVID-19 with temporary immunity on finite spatial and non-spatial network models. In particular, we assume that an epidemic spreads stochastically on a scale-free network and that each infected individual in the network gains a temporary immunity after its infectious period is over. After the temporary immunity period is over, the individual becomes susceptible to the virus again. When the underlying contact network is embedded in Euclidean geometry, we model three different intervention strategies that aim to control the spread of the epidemic: social distancing, restrictions on travel, and restrictions on maximal number of social contacts per node. Our first finding is that on a finite network, a long enough average immunity period leads to extinction of the pandemic after the first peak, analogous to the concept of"herd immunity". For each model, there is a critical average immunity length $L_c$ above which this happens. Our second finding is that all three interventions manage to flatten the first peak (the travel restrictions most efficiently), as well as decrease the critical immunity length $L_c$, but elongate the epidemic. However, when the average immunity length $L$ is shorter than $L_c$, the price for the flattened first peak is often a high second peak: for limiting the maximal number of contacts, the second peak can be as high as 1/3 of the first peak, and twice as high as it would be without intervention. Thirdly, interventions introduce oscillations into the system and the time to reach equilibrium is, for almost all scenarios, much longer. We conclude that network-based epidemic models can show a variety of behaviors that are not captured by the continuous compartmental models.


Indian response to COVID-19: Expertise and transparency


Covid-19: Government cannot say whether NHS will run out of protective gowns this weekend


title: Identification of lysine acetylation sites on MERS-CoV replicase pp1ab

text: MERS is a life-threatening disease and MERS-CoV has the potential to cause the next pandemic. Protein acetylation is known to play a crucial role in host response to viral infection. Acetylation of viral proteins encoded by other RNA viruses have been reported to affect viral replication. It is therefore of interest to see whether MERS-CoV proteins are also acetylated. Viral proteins obtained from infected cells were trypsin-digested into peptides. Acetylated peptides were enriched by immunoprecipitation and subject to nano-LC-Orbitrap analysis. Bioinformatic analysis was performed to assess the conservation level of identified acetylation sites and to predict the upstream regulatory factors. A total of 12 acetylation sites were identified from 7 peptides, which all belong to the replicase polyprotein pp1ab. All identified acetylation sites were found to be highly conserved across MERS-CoV sequences in NCBI database. Upstream factors, including deacetylases of the SIRT1 and HDAC families as well as acetyltransferases of the TIP60 family, were predicted to be responsible for regulating the acetylation events identified. Western blot confirms that acetylation events indeed occur on pp1ab protein by expressing NSP4 in HEK293 cells. Acetylation events on MERS-CoV viral protein pp1ab were identified for the first time, which indicate that MERS-CoV might use the host acetylation machinery to regulate its enzyme activity and to achieve optimal replication. Upstream factors were predicted, which might facilitate further analysis of the regulatory mechanism of MERS-CoV replication.


Containing COVID-19 in a specialised neurology centre: the risks of presymptomatic transmission


title: Departmental Experience and Lessons Learned With Accelerated Introduction of Telemedicine During the COVID-19 Crisis

text: Despite the use of digital technology in healthcare, telemedicine has not been readily adopted. During the COVID-19 pandemic, healthcare systems have begun crisis management planning. To appropriately allocate resources and prevent virus exposure while maintaining effective patient care, our orthopaedic surgery department rapidly introduced a robust telemedicine program during a 5-day period. Implementation requires attention to patient triage, technological resources, credentialing, education of providers and patients, scheduling, and regulatory considerations. This article provides practical instruction based on our experience for physicians who wish to implement telemedicine during the COVID-19 pandemic. Between telemedicine encounters and necessary in-person visits, providers may be able to achieve 50% of their typical clinic volume within 2 weeks. When handling the massive disruption to the routine patient care workflow, it is critical to understand the key factors associated with an accelerated introduction of telemedicine for the safe and effective continuation of orthopaedic care during this pandemic. LEVEL OF EVIDENCE:: V.


title: The Balanced Opioid Initiative: protocol for a clustered, sequential, multiple-assignment randomized trial to construct an adaptive implementation strategy to improve guideline-concordant opioid prescribing in primary care

text: BACKGROUND: Rates of opioid prescribing tripled in the USA between 1999 and 2015 and were associated with significant increases in opioid misuse and overdose death. Roughly half of all opioids are prescribed in primary care. Although clinical guidelines describe recommended opioid prescribing practices, implementing these guidelines in a way that balances safety and effectiveness vs. risk remains a challenge. The literature offers little help about which implementation strategies work best in different clinical settings or how strategies could be tailored to optimize their effectiveness in different contexts. Systems consultation consists of (1) educational/engagement meetings with audit and feedback reports, (2) practice facilitation, and (3) prescriber peer consulting. The study is designed to discover the most cost-effective sequence and combination of strategies for improving opioid prescribing practices in diverse primary care clinics. METHODS/DESIGN: The study is a hybrid type 3 clustered, sequential, multiple-assignment randomized trial (SMART) that randomizes clinics from two health systems at two points, months 3 and 9, of a 21-month intervention. Clinics are provided one of four sequences of implementation strategies: a condition consisting of educational/engagement meetings and audit and feedback alone (EM/AF), EM/AF plus practice facilitation (PF), EM/AF + prescriber peer consulting (PPC), and EM/AF + PF + PPC. The study's primary outcome is morphine-milligram equivalent (MME) dose by prescribing clinicians within clinics. The study's primary aim is the comparison of EM/AF + PF + PPC versus EM/AF alone on change in MME from month 3 to month 21. The secondary aim is to derive cost estimates for each of the four sequences and compare them. The exploratory aim is to examine four tailoring variables that can be used to construct an adaptive implementation strategy to meet the needs of different primary care clinics. DISCUSSION: Systems consultation is a practical blend of implementation strategies used in this case to improve opioid prescribing practices in primary care. The blend offers a range of strategies in sequences from minimally to substantially intensive. The results of this study promise to help us understand how to cost effectively improve the implementation of evidence-based practices. TRIAL REGISTRATION: NCT04044521 (ClinicalTrials.gov). Registered 05 August 2019.


Impact of COVID-19 pandemic on Subarachnoid Hemorrhage


The Effects of Pregnancy on Women with COVID-19: Maternal and Infant Outcomes


A Low-cost, Safe, and Effective Method for Smoke Evacuation in Laparoscopic Surgery for Suspected Coronavirus Patients


Developing antibody tests for SARS-CoV-2


title: A 21st century view of infection control in everyday settings: Moving from the Germ Theory of Disease to the Microbial Theory of Health

text: BACKGROUND: The growing understanding of the importance of a healthy microbiome is challenging traditional thinking that resulted in the general acceptance of the Germ Theory of Disease. We propose a more encompassing Microbial Theory of Health that will have implications for the way that we address our relationship with microbes, including hygiene policy and community-based infection control practices. METHODS: This paper considers theories over the last 30 years that have impacted hygiene policy and consumer practice, from the Germ Theory of Disease and the Hygiene Hypothesis, to the Microbial Theory of Health, including the concept of Bidirectional Hygiene. Here we present a high-level review of the literature on pathogen transmission and the cycle of infection in the home and everyday settings. RESULTS: Targeted hygiene is an evidence-based hygiene policy that is employed to prevent transmission of pathogens and the transmission of infectious diseases through targeting only sites, surfaces, and practices that are considered high risk for pathogen transmission. Targeted hygiene also discourages the indiscriminate use of broad-spectrum microbicides for lower-risk activities and surfaces. CONCLUSIONS: The Microbial Theory of Health, including age-appropriate and health-appropriate hygiene practices for home and everyday life, should usher in a new era in which pathogen reduction can be accomplished without indiscriminate elimination of potentially beneficial microbes from the human and environmental microbiomes.


COVID-19 - Looking beyond the immediate concerns


title: Changing the Landscape of Medical Oncology Training at the National University Hospital in the Philippines during the Coronavirus Disease 2019 (COVID-19) Pandemic

text: Serving as one of the few training institutions of medical oncology in the Philippines, the University of the Philippines-Philippine General Hospital was faced with challenges brought by the coronavirus 2019 disease (COVID-19) pandemic. With the dismantling of routines and practices in the hospital, training activities such as daily rounds, conferences, and examinations were temporarily put on hold. Recognizing that the strength of any clinical training program is its wealth of patients, the immediate resumption of patient services, albeit limited at first, had been instrumental in ensuring the continuation of training in our institution. Opportunistic teaching-learning strategies between the faculty and fellows were devised. Innovative approaches to learning such as the use of online meeting platforms for division conferences, webinars, examinations, and other learning activities were initiated. Emphasis was given on the important considerations in the management of cancer patients during the COVID-19 pandemic. The emotional and psychological well-being of the faculty and fellows during this crisis were considered and a mental health assessment was conducted prior to the resumption of training activities.


title: Impact of 3D printed medical equipment on the management of the Covid19 pandemic

text: Very high mortality rates of coronavirus pandemic (COVID-19) are observed around the world due to lack of medical equipment. The increased need for medical devices and personal protective equipment (PPE) has kept several healthcare professionals at risk. Fortunately, 3D printing technology allows to overcome the lack of medical supplies. This study highlights the impact of 3D printing on the combat against COVID19, and its importance in the medical product supply chain. Indeed, the existing medical equipment fabricated by 3D printing technology and its role in the management of Covid19 pandemic is presented. Moreover, the last works are examined to know whether the models of the medical equipment are free of use and whether useful informations are presented (eg, available design data and setup guidelines).


COVID-19: one threat, one world, one response (magical thinking)


title: Trapped in a Double Bind: Chinese Overseas Student Anxiety during the COVID-19 Pandemic

text: The severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), the COVID-19 disease cases stemming from it, and the resulting pandemic have imposed severe, distressing, physical, and psychological challenges on communities worldwide. The stressful situation faced by Chinese overseas students (COSs) has been particularly acute. With this population as the focus, the current study evaluated the psychological state of COSs abroad during the initial phases of the pandemic. Participants (N = 182) were recruited to complete an online survey (during April 7-14, 2020) assessing their physical and social circumstances, and sense of wellbeing. Results showed COSs experienced high levels of anxiety primarily stemming from discrimination from the media, fear of COVID-19, and mixed messages from their social connections. Feeling entrapped in a double bind (DbB) situation with their close relations significantly increased anxiety. Perceived social support negatively correlated with anxiety, and those experiencing a DbB felt the greatest stress, particularly those unable to effectively differentiate the opposing messages. Findings of the study, limitations, and implications are discussed.


title: The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis

text: The coronavirus disease 2019 (COVID-19) pandemic has caused enormous psychological impact worldwide. We conducted a systematic review and meta-analysis on the psychological and mental impact of COVID-19 among healthcare workers, the general population, and patients with higher COVID-19 risk published between 1 Nov 2019 to 25 May 2020. We conducted literature research using Embase, PubMed, Google scholar and WHO COVID-19 databases. Among the initial search of 9207 studies, 62 studies with 162,639 participants from 17 countries were included in the review. The pooled prevalence of anxiety and depression was 33% (95% confidence interval: 28%-38%) and 28% (23%-32%), respectively. The prevalence of anxiety and depression was the highest among patients with pre-existing conditions and COVID-19 infection (56% [39%-73%] and 55% [48%-62%]), and it was similar between healthcare workers and the general public. Studies from China, Italy, Turkey, Spain and Iran reported higher-than-pooled prevalence among healthcare workers and the general public. Common risk factors included being women, being nurses, having lower socioeconomic status, having high risks of contracting COVID-19, and social isolation. Protective factors included having sufficient medical resources, up-to-date and accurate information, and taking precautionary measures. In conclusion, psychological interventions targeting high-risk populations with heavy psychological distress are in urgent need.


Identification of potential cross-protective epitope between a new type of coronavirus (2019-nCoV) and severe acute respiratory syndrome virus


title: Sodium status and kidney involvement during COVID-19 infection

text: The angiotensin-converting enzyme 2 receptor (ACE2) is expressed in epithelial cells of many tissues including the kidney, and has been identified to interact with human pathogenic coronaviruses, including SARS-CoV-2. Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19 infection, two recent studies demonstrate that kidney impairment in hospitalized COVID-19 patients is common, and that kidney involvement is associated with high risk of in-hospital death. Interestingly, studies in rats have demonstrated that high dietary sodium intake results in down-regulation of the ACE2 expression in kidney tissue. We hypothesize that low sodium status makes kidney involvement during the course of COVID-19 infection more likely due to upregulation of membrane bound ACE2 in the kidneys. We propose that sodium intake and status should be monitored carefully during severe COVID-19 infections, and that low sodium intake be corrected early in its course, despite a potential conflict regarding common dietary recommendations to restrict dietary sodium intake in patients with hypertension, diabetes, and kidney disease.


title: Why is influenza vaccine uptake so low among Aboriginal adults?

text: OBJECTIVES: Determine major barriers to, and facilitators of, influenza vaccination of Aboriginal adults, in order to improve coverage from the current level of 30%. METHODS: i) A focus group with 13 Aboriginal Immunisation Healthcare Workers; and ii) a cross-sectional survey of Aboriginal people aged ≥18 years at the 2017 New South Wales Koori Knockout (29 September-2 October). RESULTS: The focus group nominated poor identification of Aboriginality in general practice. Of 273 survey respondents, a substantial minority (30%) were unaware of their eligibility for free influenza vaccination. More than half (52%) believed the vaccine could cause influenza, 40% reported there were better ways than vaccination for avoiding infection and 30% said they would not have the vaccine if it was offered to them. Regarding health service access, few reported experiencing difficulty (17%), feeling uncomfortable (15%) or being discriminated against (8%), but 53% reported not receiving a reminder from a health professional. CONCLUSIONS: Misconceptions about influenza disease and vaccine among Aboriginal people and inadequate identification of Aboriginality in general practice appear to be the greatest barriers to vaccination, rather than health service access in general. Implications for public health: More active communication to and targeting of Aboriginal adults is required; this is even more urgent following the arrival of COVID-19.


Anosmia, hyposmia, and dysgeusia as indicators for positive SARS-CoV-2 infection


Covid-19 face masks: A potential source of microplastic fibers in the environment


Introducing the Video call to facilitate the communication between health care providers and families of patients in the intensive care unit during COVID-19 pandemia


title: A mathematical epidemic model using genetic fitting algorithm with cross-validation and application to early dynamics of COVID-19 in Algeria

text: A compartmental epidemic model based on genetic fitting algorithm and using cross-validation method to overcome the overfitting problem is proposed. This generic enhanced SEIR model allows to estimate approximate nowcast and forecast of epidemic evolution including key epidemic parameters and non-measurable asymptomatic infected portion of the susceptible population. The model is used to study COVID-19 outbreak dynamics in Algeria between February 25th and May 24th. Basic reproduction number on Feb. 25th is estimated to 3.78 (95% CI 3.033-4.53) and effective reproduction number on May 24th after three months of the outbreak is estimated to 0.651 (95% CI 0.539-0.761). Infection peak time is predicted to the end of April while active cases peak time is predicted to the end of May 2020. The disease incidence, CFR and IFR are calculated. Information provided by this study could help establish a realistic assessment of the situation in Algeria for the time being, inform predictions about potential future evolution, and guide the design of appropriate public health measures.


Where are the hernias? A paradoxical decrease in emergency hernia surgery during COVID-19 pandemic


title: What Could "Fair Allocation" during the Covid-19 Crisis Possibly Mean in Sub-Saharan Africa?

text: The Covid-19 pandemic has sparked rapid and voluminous production of bioethics commentary in popular media and academic publications. Many of the discussions are new twists on an old theme: how to fairly allocate scarce medical resources, such as ventilators and intensive care unit beds. In this essay, we do not add another allocation scheme to the growing pile, partly out of appreciation that such schemes should be products of inclusive and transparent community engagement and partly out of recognition of their limited utility for physicians working in the field. Instead, we make the more modest claim that context matters when making such decisions and, more specifically, that recommendations from high-income countries about fair allocation during Covid-19 should not be cut and pasted into low-income settings. We offer a few examples of why seemingly universal, well-intentioned ethical recommendations could have adverse consequences if unreflectively applied in sub-Saharan Africa.


Pearls and Pitfalls in Multimodality Imaging of Colonic Volvulus


title: Hyperbaric oxygen as a treatment for COVID-19 infection?

text: Recently the internet has been abuzz with new ideas to treat COVID-19, including hyperbaric oxygen (HBO2) therapy, undoubtedly driven by the fact that until recently there have been few therapeutic options for this highly contagious and often lethal infection Refractory hypoxemia is certainly treatable with hyperbaric oxygen due to the obvious effect of increasing inspired oxygen partial pressure (PO2), the major reason for using HBO2 for its established indications However, the length of time during which patients can safely be administered HBO2 inside a chamber is limited, due to practical issues of confinement and isolation from other necessary medical interventions, but also because of oxygen toxicity


SARS-CoV-2 infection in a psoriatic patient treated with IL-23 inhibitor


title: Mexico: Lessons learned from the 2009 pandemic that help us fight COVID-19

text: In April 2009, Mexican, American, and Canadian authorities announced a novel influenza that became the first pandemic of the century. We report on lessons learned in Mexico. The Mexican Pandemic Influenza Preparedness and Response Plan, developed and implemented since 2005, was a decisive element for the early response. Major lessons-learned were the need for flexible plans that consider different scenarios; the need to continuously strengthen routine surveillance programs and laboratory capacity and strengthen coordination between epidemiological departments, clinicians, and laboratories; maintain strategic stockpiles; establish a fund for public health emergencies; and collaboration among neighboring countries. Mexico responded with immediate reporting and transparency, implemented aggressive control measures and generous sharing of data and samples. Lessons learned induced changes leading to a better response to public health critical events.


title: Global Hidradenitis Suppurativa COVID-19 Registry: A Registry to Inform Data-Driven Management Practices

text: The management of hidradenitis suppurativa (HS), a chronic inflammatory skin disease, deserves special consideration in the context of the Coronavirus 2019 (COVID-19) pandemic. A new Global Hidradenitis Suppurativa COVID-19 Registry has been developed to capture data on risks, clinical course, and outcomes of COVID-19 in HS patients. Caused by the virus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2), COVID-19 is an easily transmissible disease which, in its most severe form, is characterized by respiratory failure and multiple organ dysfunction triggered by a cytokine storm response that predominates in older adults and those with significant comorbidities.


Keeping our eyecare providers and patients safe during the COVID-19 pandemic


Response to: 'Concerns and needs of patients with systemic lupus erythematosus regarding hydroxychloroquine supplies during the COVID-19 pandemic: results from a patient-centred survey' by Plüß et al


Audio Interview: New Research on Possible Treatments for Covid-19


title: Immunomodulation by anticancer cell cycle inhibitors

text: Cell cycle proteins that are often dysregulated in malignant cells, such as cyclin-dependent kinase 4 (CDK4) and CDK6, have attracted considerable interest as potential targets for cancer therapy. In this context, multiple inhibitors of CDK4 and CDK6 have been developed, including three small molecules (palbociclib, abemaciclib and ribociclib) that are currently approved for the treatment of patients with breast cancer and are being extensively tested in individuals with other solid and haematological malignancies. Accumulating preclinical and clinical evidence indicates that the anticancer activity of CDK4/CDK6 inhibitors results not only from their ability to block the cell cycle in malignant cells but also from a range of immunostimulatory effects. In this Review, we discuss the ability of anticancer cell cycle inhibitors to modulate various immune functions in support of effective antitumour immunity.


title: How to Influence Rural Tourism Intention by Risk Knowledge during COVID-19 Containment in China: Mediating Role of Risk Perception and Attitude

text: With both cost and safety taken into account in the context of the life-threatening COVID-19 pandemic globally, rural tourism is expected to be the top choice for Chinese residents for relaxation and enhancing parent-child relationships. In this paper, a structural equation (SEM) model was proposed to compare risk knowledge, risk perception, risk aversion attitudes and behavioral intentions towards rural tourism. According to the empirical results, there was a large proportion of tourists showing preference for rural tourism recently. Potential participants in rural tourism paid most attention to the performance realization and time cost of scenic spots, while the psycho-social risk posed by COVID-19 had little impact. The inherent risk nature of risk aversion attitudes made knowledge of the pneumonia risk less effective in reducing tourists' intentions, while knowledge of the pneumonia risk was more effective in alleviating the risk perception that potential tourists have towards rural tourism. With regard to travel intention and recommendation intention of rural tourism, the negative impacts of risk aversion attitude were more considerable compared to risk perception. Meanwhile, the parallel mediating effect of risk perception and risk aversion attitude in rural tourism needed to be taken into consideration together.


Interleukin-6 as a potential biomarker of COVID-19 progression


Significant demands on healthcare resources during the COVID crisis


Hospital Medicine Management in the Time of COVID-19: Preparing for a Sprint and a Marathon


Cardiac arrest during emergency intubation in an elderly patient with confirmed coronavirus disease 2019


title: Efficacy and tolerability of tapentadol for the treatment of chronic low back pain in elderly patients

text: BACKGROUND: Chronic low back pain (CLBP) is a highly prevalent and disabling condition in the elderly, and yet it is undertreated and understudied in this patient population. Tapentadol is a central analgesic with an improved tolerability profile that may be particularly beneficial to the elderly CLBP. METHODS: We performed an observational retrospective study to comparatively assess the efficacy and tolerability of tapentadol in young and elderly patients with severe CLBP. Sixtyfive young patients (< 65 years) and 87 elderly patients (≥ 65 years) were titrated on tapentadol extended release to their optimal dose (25-250 mg bid) over 1 month and, then, maintained at that dose for 3 months. The primary endpoint were changes from baseline in 24-h pain intensity on a 0-10 Numerical Rating Scale (NRS) at month-4 of treatment (titration plus maintenance periods). Patients were assessed for several efficacy and tolerability outcomes using a battery of scales and tests for neuropathic pain intensity, quality of life and sleep, and cognitive and gastrointestinal functions. RESULTS: At pretreatment, young and elderly patients had similar pain intensities with younger patients presenting with more intense depressive and neuropathic pain symptoms, and lesser comorbidities and durations of pain (P < 0.05). Thirty-eight patients discontinued treatment because of adverse events occurring mostly during titration. Treatment with tapentadol was associated with comparable and clinically meaningful pain reductions in 24-h NRS from baseline to treatment month-4 both in young and elderly patients (- 5.3 ± 1.4 and - 4.8 ± 2.1; P < 0.01); a 50% pain relief was achieved in 66% and 58% of young and elderly patients. The percentage of patients with a neuropathic component decreased similarly in young and elderly patients (from 38 to 0% and from 19 to 3%; P < 0.01). Quality of life and sleep improved. The performances in global cognition and sustained attention tasks remained stable or improved across all age group. CONCLUSIONS: These findings indicate that tapentadol extended release maintains efficacy and good tolerability in CLBP patients with advancing age.


title: A time series method to analyze incidence pattern and estimate reproduction number of COVID-19

text: The ongoing pandemic of Coronavirus disease (COVID-19) emerged in Wuhan, China in the end of 2019. It has already affected more than 300,000 people, with the number of deaths nearing 13000 across the world. As it has been posing a huge threat to global public health, it is of utmost importance to identify the rate at which the disease is spreading. In this study, we propose a time series model to analyze the trend pattern of the incidence of COVID-19 outbreak. We also incorporate information on total or partial lockdown, wherever available, into the model. The model is concise in structure, and using appropriate diagnostic measures, we showed that a time-dependent quadratic trend successfully captures the incidence pattern of the disease. We also estimate the basic reproduction number across different countries, and find that it is consistent except for the United States of America. The above statistical analysis is able to shed light on understanding the trends of the outbreak, and gives insight on what epidemiological stage a region is in. This has the potential to help in prompting policies to address COVID-19 pandemic in different countries.


title: Differentially Private Health Tokens for Estimating COVID-19 Risk

text: In the fight against Covid-19, many governments and businesses are in the process of evaluating, trialling and even implementing so-called immunity passports. Also known as antibody or health certificates, there is a clear demand for any technology that could allow people to return to work and other crowded places without placing others at risk. One of the major criticisms of such systems is that they could be misused to unfairly discriminate against those without immunity, allowing the formation of an `immuno-privileged' class of people. In this work we are motivated to explore an alternative technical solution that is non-discriminatory by design. In particular we propose health tokens -- randomised health certificates which, using methods from differential privacy, allow individual test results to be randomised whilst still allowing useful aggregate risk estimates to be calculated. We show that health tokens could mitigate immunity-based discrimination whilst still presenting a viable mechanism for estimating the collective transmission risk posed by small groups of users. We evaluate the viability of our approach in the context of identity-free and identity-binding use cases and then consider a number of possible attacks. Our experimental results show that for groups of size 500 or more, the error associated with our method can be as low as 0.03 on average and thus the aggregated results can be useful in a number of identity-free contexts. Finally, we present the results of our open-source prototype which demonstrates the practicality of our solution.


When Pandemics Call: Community-Based Research Considerations for HIV Scholars


Battle with COVID-19 in Iran: What lessons can be learned from the implementation of response strategies so far?


Questions remain following first COVID-19 vaccine results


title: Obesity accompanying COVID-19: the role of epicardial fat

text: With interest we read the study by Simonnet A et al. (1) in which important novel evidence is addressed that obesity is highly frequent among critically ill patients with severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) infection. Although clinically very relevant, it remains difficult to elucidate the mechanisms by which SARS-Cov-2 severity is increased in the context of obesity. As reported by Katz JN et al. (2), 28% of hospitalised patients with coronavirus disease 2019 (COVID-19) presented cardiac complications including myocarditis, arrhythmias, heart failure (HF) and sudden death. Considering that myocardial response in COVID-19 is closely associated with in-hospital mortality, local biological effects on myocardial tissue from epicardial adipose tissue (EAT) is warrant further discussion.


Editors' Comments Regarding Special Feature Articles on COVID-19 in 2020


Avoidable Waste of Research on Coronavirus Disease 2019 (COVID-19)


title: SARS-CoV-2 may be related to conjunctivitis but not necessarily spread through the conjunctiva SARS-CoV-2 and conjunctiva

text: We appreciate the comments of Liu et al.1 and Peng et al.2 in relation to our previous study. Currently, the controversy on the relationship among SARS-CoV-2 infection, the ocular surface and conjunctivitis are reflected in two aspects as follows: (i) can SARS-CoV-2 infection cause conjunctivitis? (ii) can SARS-CoV-2 be transmitted through the ocular surface? This article is protected by copyright. All rights reserved.


title: Media's effect on shaping knowledge, awareness risk perceptions and communication practices of pandemic COVID-19 among pharmacists

text: BACKGROUND: Coronavirus disease (COVID-19), an infection of the zoonotic coronavirus, is presenting a healthcare challenge around the globe. This study aims to assess the levels of disease knowledge and risk perception among pharmacists. We also recognize predictors of risk perception and perceived media roles. Methods This is a questionnaire-base cross-sectional study. The questionnaire was developed on a web-based platform and invitations were sent to pharmacists nationwide to participate in the study using social media applications. Results A total of 486 pharmacists participated in this study, where females were dominant (78.6%, n = 382). Most (40.4%, n = 198) pharmacists scored 4 out of 5 in basic disease knowledge, and more than half were able to recognize common methods of spread. Risk was highly perceived among participants, and was predicted by gender, living area, and having children (p < 0,05). Frequency of watching the media and sources of information also influenced both risk perception and perceived media roles. Conclusion Disease awareness among pharmacists, as well as risk perception must be considered for effective risk communication planning. The role of media in shaping perceptions should also be carefully studied to encourage compliance with government containment measures and engagement in preventive behaviors.


Missing during COVID-19 lockdown: Children with onset of type 1 diabetes


title: SARS-CoV-2 infection among patients with systemic autoimmune diseases

text: OBJECTIVES: This study aimed to evaluate the prevalence of clinically overt SARS-CoV-2 infection (COVID-19) among patients with systemic autoimmune diseases residing in Tuscany, and to compare it with that observed in the general Tuscan population. METHODS: In this cross-sectional study, Tuscan outpatients with systemic autoimmune diseases followed at a tertiary referral centre were telephonically interviewed between April 1st-14th 2020 to collect demographic and clinical data, information on ongoing immunomodulating/immunosuppressive treatments, and on the presence of symptoms suspected of SARS-CoV-2 or of a confirmed infection. RESULTS: 458 patients were interviewed [74% female, median age 56 years (IQR 43-68)]; 56% of them were receiving corticosteroids, 44% traditional disease-modifying anti-rheumatic drugs (DMARDs), of whom 23% hydroxychloroquine, 5% colchicine, while 41% were on biologic DMARDs (of whom 9% on tocilizumab). Thirteen patients reported symptoms suggesting SARS-CoV-2 infection. Of them, 7 had undergone nasopharyngeal swab and only one was positive and developed severe SARS-CoV-2 complications. Within our cohort, the prevalence of SARS-CoV-2 infection was therefore 0.22% (0.01-1.21%), comparable to that observed in the general population of Tuscany [0.20% (0.20-0.21%), p = .597]. CONCLUSIONS: Patients with systemic autoimmune diseases do not seem to carry an increased risk of SARS- CoV-2 infection as compared to the general population.


Skin reactions to non-glove personal protective equipment: an emerging issue in the COVID-19 pandemic


title: Outcomes of a Rapid Adolescent Telehealth Scale-Up During the COVID-19 Pandemic

text: PURPOSE: To describe the first 30 days of rapid adolescent telehealth scale-up in response to the coronavirus (COVID-19) pandemic at a single academic medical center and assess for disparities in visit completion rates by patient characteristics. METHODS: Visit outcome and patient demographic data were obtained via electronic health record (EHR) reports. Telehealth visit completion rates were compared by patient characteristics using the chi-square test and t-test. We used zip code data to generate latitude- and longitude-based maps of the range and density of service delivery. Patient cases highlighting challenges and opportunities for adolescent telehealth were summarized. RESULTS: Between March 16 and April 15, 2020, 392 telehealth visits were scheduled in 331 unique patients, with an 82% appointment completion rate. Video visits were conducted for eating disorders (39%), contraception/menstrual disorders (22%), gender-affirming care (17%), general adolescent medicine (15%), HIV treatment (6%), and substance abuse (1%). The majority of telehealth patients were female Caucasian minors with private insurance. There were no significant differences in telehealth visit completion rates by age, sex, gender, or insurance. Patients coded as non-white (African-American, Asian, or other) in the EHR had lower visit completion rates than white patients (p = .003). Telehealth patients were distributed across five states, with the highest concentration in the zip codes nearest to the clinic. CONCLUSIONS: Rapid scale-up of telehealth for Adolescent Medicine was achieved at this large academic medical center. Future implementation research is needed to assure telehealth reaches adolescents without widening health disparities.


Noradrenergic and serotonergic drugs may have opposing effects on COVID-19 cytokine storm and associated psychological effects


Medical Education Adaptations: Really Good Stuff for educational transition during a pandemic


Provision of cancer care during the COVID-19 pandemic


Uso do decúbito ventral para o manejo de pacientes com COVID19 hospitalizados em enfermaria./ [Prone positioning in management of COVID-19 hospitalized patients]