title: Risk Factors Associated with Clinical Outcomes in 323 COVID-19 Hospitalized Patients in Wuhan, China

text: BACKGROUND: With evidence of sustained transmission in more than 190 countries, coronavirus disease 2019 (COVID-19) has been declared a global pandemic. Data are urgently needed about risk factors associated with clinical outcomes. METHODS: A retrospective review of 323 hospitalized patients with COVID-19 in Wuhan was conducted. Patients were classified into three disease severity groups (non-severe, severe, and critical), based on initial clinical presentation. Clinical outcomes were designated as favorable and unfavorable, based on disease progression and response to treatments. Logistic regression models were performed to identify risk factors associated with clinical outcomes, and log-rank test was conducted for the association with clinical progression. RESULTS: Current standard treatments did not show significant improvement in patient outcomes. By univariate logistic regression analysis, 27 risk factors were significantly associated with clinical outcomes. Multivariate regression indicated age over 65 years (p<0.001), smoking (p=0.001), critical disease status (p=0.002), diabetes (p=0.025), high hypersensitive troponin I (>0.04 pg/mL, p=0.02), leukocytosis (>10 x 109/L, p<0.001) and neutrophilia (>75 x 109/L, p<0.001) predicted unfavorable clinical outcomes. By contrast, the administration of hypnotics was significantly associated with favorable outcomes (p<0.001), which was confirmed by survival analysis. CONCLUSIONS: Hypnotics may be an effective ancillary treatment for COVID-19. We also found novel risk factors, such as higher hypersensitive troponin I, predicted poor clinical outcomes. Overall, our study provides useful data to guide early clinical decision making to reduce mortality and improve clinical outcomes of COVID-19.


title: Low serum 25-hydroxyvitamin D (25[OH]D) levels in patients hospitalised with COVID-19 are associated with greater disease severity

text: OBJECTIVES: Vitamin D deficiency (VDD) has been proposed to play a role in Coronavirus Disease 2019 (COVID-19) pathophysiology. We aim to evaluate our implementation of a local protocol for treatment of VDD among patients hospitalized for COVID-19; to assess the prevalence of VDD among COVID-19 inpatients, and examine potential associations with disease severity and fatality. DESIGN AND PARTICIPANTS: We conducted a retrospective interim audit of a local clinical care pathway for 134 inpatients with COVID-19. Prevalence of VDD, compliance with local treatment protocol and relationship of baseline serum 25(OH)D with markers of COVID-19 severity and fatality were analysed. RESULTS: 55.8% of eligible patients received Colecalciferol replacement, albeit not all according to the suggested protocol. Patients admitted to ITU were younger than those managed on medical wards (61.1 years ± 11.8 vs. 76.4 years ± 14.9, respectively, p<0.001), with greater prevalence of hypertension, higher baseline respiratory rate, National Early Warning Score-2 and C-Reactive protein level. While mean serum 25(OH)D levels were comparable (p=0.3), only 19% of ITU patients had 25(OH)D levels greater than 50 nmol/L vs. 39.1% of non-ITU patients (p=0.02). However, there was no association with fatality, potentially due to small sample size and prompt diagnosis and treatment of VDD. CONCLUSIONS: Higher prevalence of VDD was observed in patients requiring ITU admission compared to patients managed on medical wards. Larger prospective studies and/or clinical trials are needed to validate and extend our observations.


title: Effect of non-pharmaceutical interventions to contain COVID-19 in China

text: On 11 March 2020, the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic1. The strategies based on non-pharmaceutical interventions that were used to contain the outbreak in China appear to be effective2, but quantitative research is still needed to assess the efficacy of non-pharmaceutical interventions and their timings3. Here, using epidemiological data on COVID-19 and anonymized data on human movement4,5, we develop a modelling framework that uses daily travel networks to simulate different outbreak and intervention scenarios across China. We estimate that there were a total of 114,325 cases of COVID-19 (interquartile range 76,776-164,576) in mainland China as of 29 February 2020. Without non-pharmaceutical interventions, we predict that the number of cases would have been 67-fold higher (interquartile range 44-94-fold) by 29 February 2020, and we find that the effectiveness of different interventions varied. We estimate that early detection and isolation of cases prevented more infections than did travel restrictions and contact reductions, but that a combination of non-pharmaceutical interventions achieved the strongest and most rapid effect. According to our model, the lifting of travel restrictions from 17 February 2020 does not lead to an increase in cases across China if social distancing interventions can be maintained, even at a limited level of an on average 25% reduction in contact between individuals that continues until late April. These findings improve our understanding of the effects of non-pharmaceutical interventions on COVID-19, and will inform response efforts across the world.


Prone positioning in management of COVID-19 hospitalized patients


The COVID-19 Pandemic: Challenges for the Neurosurgeons and Neurologists


Clinical and demographic characteristics of patients dying from COVID-19 in Italy vs China


title: Epidemiological data from the COVID-19 outbreak, real-time case information

text: Cases of a novel coronavirus were first reported in Wuhan, Hubei province, China, in December 2019 and have since spread across the world. Epidemiological studies have indicated human-to-human transmission in China and elsewhere. To aid the analysis and tracking of the COVID-19 epidemic we collected and curated individual-level data from national, provincial, and municipal health reports, as well as additional information from online reports. All data are geo-coded and, where available, include symptoms, key dates (date of onset, admission, and confirmation), and travel history. The generation of detailed, real-time, and robust data for emerging disease outbreaks is important and can help to generate robust evidence that will support and inform public health decision making.


Investigation on cognition of covid-19 and safety during the pandemic among hospital pharmacy staff


Coronavirus Disease 2019 (COVID-19): Protecting Hospitals From the Invisible


title: COVID-19 and neurosurgical training and education: an Italian perspective

text: BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has an impact also on neurosurgical training and education, especially in most affected countries. We surveyed Italian neurosurgical residents, asking them to provide a brief description and analyze the situation they are experiencing and how the educational system reacted to the pandemic in one of the most affected countries all over the world. METHODS: An 18-question, web-based survey was administered to Italian neurosurgical residents from May 3 to May 11, 2020, by web-link or e-mail invitation. Closed-ended, multiple choice questions were focused on the experience of neurosurgical residents in the last 2 months (from March to May 2020) concerning both clinical and educational aspects. RESULTS: Among 331 Italian neurosurgical residents invited to participate, 192 responded to the survey (58%). According to the participants' responses, in the whole country, only 29.7% of residents were directly involved in the clinical management of COVID-19 patients. Time spent in the clinic and surgical activity was significantly reduced in most of the cases. Educational activities as well as scientific activity and time spent for studying, on the other hand, were reported to be significantly increased by the majority of respondents. CONCLUSIONS: Most Italian neurosurgical residents reported significant changes on both training and education, highlighting a prompt reaction of the educational system in the whole country, regardless the local and regional diffusion of the pandemic.


title: Impact of the COVID-19 Pandemic on Neurosurgical Practice in India: Results of an Anonymized National Survey

text: Background: The COVID-19 pandemic has created an unprecedented challenge for medical professionals throughout the world to tackle the rapidly changing scenario. The objective of this survey was to analyze the change in neurosurgical practice in India following the COVID-19 outbreak and assess its impact on practising neurosurgeons. Materials and Methods: Between May 7th and 23rd, 2020, a validated questionnaire was circulated amongst practising neurosurgeons across the country by social media and e-mails, regarding changes in the patterns of patients seen, adaptations made in their practice, effect on surgeries performed, financial burden, and impact on their personal lives. The responses were kept anonymous and were analyzed for correlations between the changes observed and independent factors such as hospital affiliations, teaching professions, and neurosurgical experience. Results: Our survey showed a drastic fall in the number of neurosurgical patients seen in the outpatient department (OPD) as well as the number of surgeries performed. A drop of 76.25% was seen in OPD patients (P = 0.000) and that of 70.59% in surgeries performed (P = 0.000). There was no uniformity among the neurosurgeons in the number of COVID-19 tests being done before elective/emergency surgery and in the use of protective gear while examining patients. Private practitioners were more affected financially as compared to those in the government sector. The pandemic has affected the research work of 53.23% of all respondents, with those in the teaching profession (70.96%) more affected than those in the non-teaching profession (24.67%). Conclusions: Evidence-based policies, screening COVID-19 tests with better sensitivity, and better-quality personal protective equipment kits in adequate numbers are required to protect our medical professionals from COVID-19. Mental health issues among neurosurgeons may also be an issue, this being a high risk speciality and should be closely watched for.


Temperature and the difference in impact of SARS CoV-2 infection (COVID-19) between tropical and non-tropical regions in Taiwan


Preventing COVID-19 and Its Sequela: "There Is No Magic Bullet... It's Just Behaviors"


Away-from-home food during coronavirus pandemic


Private Equity-Backed Hospital Investments and the Impact of the Coronavirus Disease 2019 (COVID-19) Epidemic


title: Cause-and-effect of linear mechanisms sustaining wall turbulence

text: Despite the nonlinear nature of turbulence, there is evidence that the energy-injection mechanisms sustaining wall turbulence can be ascribed to linear processes. Different scenarios stem from linear stability theory and comprise exponential instabilities of the mean flow, neutral modes, transient growth from non-normal operators, and parametric instabilities from temporal mean-flow variations, among others. These mechanisms, each potentially capable of leading to the observed turbulence structure, are rooted in simplified theories and conceptual arguments. Whether the flow follows any or a combination of them remains unclear. Here, we devise a collection of numerical experiments in which the Navier-Stokes equations are sensibly modified to quantify the role of the different linear mechanisms at low Reynolds number ($Re_\tau\approx180$). We do this by DNS of turbulent channel flows, in which the energy transfer from the streamwise-averaged mean-flow ($\boldsymbol{U}$) to the fluctuating velocities ($\boldsymbol{u}'$) is constrained to preclude a targeted linear mechanism. In contrast to other studies, our approach allows for direct evaluation of cause-and-effect links between the linear energy injection from $\boldsymbol{U}$ to $\boldsymbol{u}'$ in a fully nonlinear setup. We show that turbulence persists when exponential instabilities of the mean flow are suppressed. Removing all exponential instabilities only reduces the turbulent fluctuations by 10%. We also show that the energy transfer from $\boldsymbol{U}$ to $\boldsymbol{u}'$ via transient growth alone, without exponential or parametric instabilities, suffices to sustain turbulence. Finally, we demonstrate that a collection of simulations with frozen-in-time $\boldsymbol{U}$ that only support transient growth provides a faithful representation of the actual time-varying energy transfer from $\boldsymbol{U}$ to $\boldsymbol{u}'$.


African-American COVID-19 Mortality: A Sentinel Event


A modified barrier enclosure to prevent viral aerosol transmission during endotracheal intubation and extubation of patients with coronavirus disease


title: Sex Differences in Severity and Mortality Among Patients With COVID-19: Evidence from Pooled Literature Analysis and Insights from Integrated Bioinformatic Analysis

text: Objective: To conduct a meta-analysis of current studies that examined sex differences in severity and mortality in patients with COVID-19, and identify potential mechanisms underpinning these differences. Methods: We performed a systematic review to collate data from observational studies examining associations of sex differences with clinical outcomes of COVID-19. PubMed, Web of Science and four preprint servers were searched for relevant studies. Data were extracted and analyzed using meta-analysis where possible, with summary data presented otherwise. Publicly available bulk RNA sequencing (RNA-seq), single-cell RNA sequencing (scRNA-seq), and chromatin immunoprecipitation sequencing (ChIP-seq) data were analyzed to explore the potential mechanisms underlying the observed association. Results: 39 studies met inclusion criteria, representing 77932 patients, of which 41510 (53.3%) were males. Men were at a markedly increased risk of developing severe cases compared with women. Furthermore, the pooled odds ratio (OR) of mortality for male group compared with the female group indicated significant higher mortality rate for male. Data from scRNA-seq suggest that men have a higher amount of ACE2-expressing pulmonary alveolar type II cells than women. Sex-based immunological differences exist. The expression of androgen receptor (AR) is positively correlated with ACE2, and there is evidence that AR may directly regulate the expression of ACE2. Conclusions: This meta-analysis detected an increased severity and mortality rate in the male populations with COVID-19, which might be attributable to the sex-based differences in cellular compositions and immunological microenvironments of the lung. The host cell receptor ACE2 is likely regulated by AR signaling pathway, which is identified as a potential target for prevention and treatment of SARS-Cov-2 infections in men.


title: Document Classification for COVID-19 Literature

text: The global pandemic has made it more important than ever to quickly and accurately retrieve relevant scientific literature for effective consumption by researchers in a wide range of fields. We provide an analysis of several multi-label document classification models on the LitCovid dataset, a growing collection of 8,000 research papers regarding the novel 2019 coronavirus. We find that pre-trained language models fine-tuned on this dataset outperform all other baselines and that the BioBERT and novel Longformer models surpass all others with almost equivalent micro-F1 and accuracy scores of around 81% and 69% on the test set. We evaluate the data efficiency and generalizability of these models as essential features of any system prepared to deal with an urgent situation like the current health crisis. Finally, we explore 50 errors made by the best performing models on LitCovid documents and find that they often (1) correlate certain labels too closely together and (2) fail to focus on discriminative sections of the articles; both of which are important issues to address in future work. Both data and code are available on GitHub.


title: AYUSH, modern medicine and the Covid-19 pandemic

text: The COVID-19 pandemic has posed several challenges to the Indian healthcare system. Here, we examine the situation in India considering the moral and ethical imperatives of decision making for public health. Currently, in the absence of proven therapies, empirical evidence is being used for treatment of Covid-19 disease. We find a dual standard of practice. Currently, only modern medicine therapies are used on an empirical basis, however, the same principle is not considered for the use of AYUSH systems. Appropriate use of evidence is required. In the ethics context and in the interest of the larger public good, we suggest the inclusion of simple and safe measures from AYUSH systems in the integrative protocols for prophylaxis and treatment of Covid-19. Keywords: AYUSH systems, Covid-19, pandemic, prophylaxis, evidence, empirical evidence, priority setting, public health decision making, global health emergencies,complementary medicine, integrative healthcare.


title: Phenomenological analysis of the 2020 COVID-19 outbreak dynamics

text: In the wake of the COVID-19 virus outbreak, a brief phenomenological (descriptive, comparative) analysis of the dynamics of the disease spread among different countries is presented. Results indicate that the infection spread dynamics is currently the most pronounced in the USA (confirmed cases are currently doubling every 2.16 days, with a decreasing doubling time tendency), while other countries with the most confirmed cases show different values, and tendencies. The reported number of deaths is currently doubled every 2.28 days in Germany, 2.56 days in France, 2.57 days in Switzerland, 2.59 days in France, and 2.62 days in USA, while only France and USA are currently exhibiting further acceleration (diminishing doubling time).


title: Radiologist-Level COVID-19 Detection Using CT Scans with Detail-Oriented Capsule Networks

text: Radiographic images offer an alternative method for the rapid screening and monitoring of Coronavirus Disease 2019 (COVID-19) patients. This approach is limited by the shortage of radiology experts who can provide a timely interpretation of these images. Motivated by this challenge, our paper proposes a novel learning architecture, called Detail-Oriented Capsule Networks (DECAPS), for the automatic diagnosis of COVID-19 from Computed Tomography (CT) scans. Our network combines the strength of Capsule Networks with several architecture improvements meant to boost classification accuracies. First, DECAPS uses an Inverted Dynamic Routing mechanism which increases model stability by preventing the passage of information from non-descriptive regions. Second, DECAPS employs a Peekaboo training procedure which uses a two-stage patch crop and drop strategy to encourage the network to generate activation maps for every target concept. The network then uses the activation maps to focus on regions of interest and combines both coarse and fine-grained representations of the data. Finally, we use a data augmentation method based on conditional generative adversarial networks to deal with the issue of data scarcity. Our model achieves 84.3% precision, 91.5% recall, and 96.1% area under the ROC curve, significantly outperforming state-of-the-art methods. We compare the performance of the DECAPS model with three experienced, well-trained thoracic radiologists and show that the architecture significantly outperforms them. While further studies on larger datasets are required to confirm this finding, our results imply that architectures like DECAPS can be used to assist radiologists in the CT scan mediated diagnosis of COVID-19.


The 2019 Novel Coronavirus (2019-nCoV): Novel Virus, Old Challenges


title: Optimizing your telemedicine visit during the COVID-19 pandemic: Practice guidelines for patients with head and neck cancer

text: The COVID-19 epidemic has resulted in many hospitals and practices to cancel in-person outpatient clinic visits, where head and neck patients receive their critical longitudinal care. Out of necessity, most practices have been encouraged to use telemedicine as a method to maintain a continuum of care with their patients. As a result, the prevalence of telemedicine has grown rapidly during this pandemic, without allowing the physicians and patients to be adequately educated on how best to utilize the services. There is a steep learning curve as we have learned, and our goal is to provide guidelines for both patients and physicians, as well as a valuable patient handout in preparation for their visit.


title: Viral and host factors related to the clinical outcome of COVID-19

text: In December 2019, coronavirus disease 2019 (COVID-19), which is caused by the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in Wuhan (Hubei province, China)1; it soon spread across the world. In this ongoing pandemic, public health concerns and the urgent need for effective therapeutic measures require a deep understanding of the epidemiology, transmissibility and pathogenesis of COVID-19. Here we analysed clinical, molecular and immunological data from 326 patients with confirmed SARS-CoV-2 infection in Shanghai. The genomic sequences of SARS-CoV-2, assembled from 112 high-quality samples together with sequences in the Global Initiative on Sharing All Influenza Data (GISAID) dataset, showed a stable evolution and suggested that there were two major lineages with differential exposure history during the early phase of the outbreak in Wuhan. Nevertheless, they exhibited similar virulence and clinical outcomes. Lymphocytopenia, especially reduced CD4+ and CD8+ T cell counts upon hospital admission, was predictive of disease progression. High levels of interleukin (IL)-6 and IL-8 during treatment were observed in patients with severe or critical disease and correlated with decreased lymphocyte count. The determinants of disease severity seemed to stem mostly from host factors such as age and lymphocytopenia (and its associated cytokine storm), whereas viral genetic variation did not significantly affect outcomes.


The American Academy of Dermatology COVID-19 registry: Crowdsourcing dermatology in the age of COVID-19


title: Ribavirin, Remdesivir, Sofosbuvir, Galidesivir, and Tenofovir against SARS-CoV-2 RNA dependent RNA polymerase (RdRp): A molecular docking study

text: AIMS: A new human coronavirus (HCoV), which has been designated SARS-CoV-2, began spreading in December 2019 in Wuhan City, China causing pneumonia called COVID-19. The spread of SARS-CoV-2 has been faster than any other coronaviruses that have succeeded in crossing the animal-human barrier. There is concern that this new virus will spread around the world as did the previous two HCoVs-Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS)-each of which caused approximately 800 deaths in the years 2002 and 2012, respectively. Thus far, 11,268 deaths have been reported from the 258,842 confirmed infections in 168 countries. MAIN METHODS: In this study, the RNA-dependent RNA polymerase (RdRp) of the newly emerged coronavirus is modeled, validated, and then targeted using different anti-polymerase drugs currently on the market that have been approved for use against various viruses. KEY FINDINGS: The results suggest the effectiveness of Ribavirin, Remdesivir, Sofosbuvir, Galidesivir, and Tenofovir as potent drugs against SARS-CoV-2 since they tightly bind to its RdRp. In addition, the results suggest guanosine derivative (IDX-184), Setrobuvir, and YAK as top seeds for antiviral treatments with high potential to fight the SARS-CoV-2 strain specifically. SIGNIFICANCE: The availability of FDA-approved anti-RdRp drugs can help treat patients and reduce the danger of the mysterious new viral infection COVID-19. The drugs mentioned above can tightly bind to the RdRp of the SARS-CoV-2 strain and thus may be used to treat the disease. No toxicity measurements are required for these drugs since they were previously tested prior to their approval by the FDA.


title: Comprehensive pollution monitoring of the Egyptian Red Sea coast by using the environmental indicators

text: The environmental pollution indicators and multivariate statistical analysis were used to evaluate the potential ecological risk and the contamination of Fe, Mn, Zn, Ni, Pb, Cu, Cd, and Co in surface sediments of the Egyptian Red Sea coast. The results revealed that the studied area suffers from high contamination of certain metals such as the Hurghada area (Pb, Cd, Zn, Ni, and Cu), Quseir City area (Cd, Co, Pb, and Ni), and Safaga and Marsa Alam areas (Cd and Pb). Enrichment factor and principal components analysis reported that the pollution sources of Fe, Mn, and Co are related to natural weathering process while Cu, Zn, Ni, and Pb are related to anthropogenic sources as landfill, plastic rubbish, fishing boats, phosphate operations, and tourist activities. Moreover, Co and Cd metals can come from both of natural and anthropogenic sources. The average concentrations of Cd, Cu, Zn, Pb, Ni, and Co in sediments of the Egyptian Red Sea coast are higher than those in the coasts of the Red Sea (Saudi Arabia), Mediterranean Sea (Egypt and Libya), Bengal bay (India), and the Caspian Sea (Russia). However, the studied metal content is lower than the sediment quality guideline values except for Cd.


title: Epidemiological and clinical characteristics analysis of COVID-19 in the surrounding areas of Wuhan, Hubei Province in 2020

text: AIM: Since December 2019, new COVID-19 outbreaks have occurred and spread around the world. However, the clinical characteristics of patients in other areas around Wuhan, Hubei Province are still unclear. In this study, we performed epidemiological and clinical characteristics analysis on these regional cases. METHODS: We retrospectively investigated COVID-19 patients positively confirmed by nucleic acid Q-PCR at Taihe Hospital from January 16 to February 4, 2020. Their epidemiological, clinical manifestations, and imaging characteristics were analysed. RESULTS: Among the 73 patients studied, 12.3 % developed symptoms after returning to Shiyan from Wuhan, and 71.2 % had a history of close contact with Wuhan personnel or confirmed cases. Among these patients, 9 cases were associated with family clustering. The first main symptoms presented by these patients were fever (84.9 %) and cough (21.9 %). The longest incubation period was 26 days, and the median interval from the first symptoms to admission was 5 days. Of the patients, 67.1 % were originally healthy people with no underlying diseases, others mostly had common comorbidities including hypertension (12.3 %) and diabetes (5.5 %), 10.9 % were current smokers, 30.1 % had low white blood cell counts and 45.2 % showed decreased lymphocytes at the first time of diagnosis. CT scans showed that multiple patchy ground glass shadows outside of the patient lungs were commonly observed, and a single sub-pleural sheet of ground glass shadow with enhanced vascular bundles was also found located under the pleura. Patient follow-up to February 14 presented 38.4 % severe cases and 2.7 % critical cases. After follow-up, the parameter of lymphocyte counts below 0.8 × 109/L cannot be used to predict severe and critical groups from the ordinary group, and a lower proportion of smokers and higher proportion of diabetes patients occur in the poor outcome group. Other co-morbidities are observed but did not lead to poor outcomes. CONCLUSION: The epidemiological characteristics of patients in the area around Wuhan, such as Shiyan, at first diagnosis are described as follows: Patients had histories of Wuhan residences in the early stage and family clustering in the later period. The incubation period was relatively long, and the incidence was relatively hidden, but the virulence was relatively low. The initial diagnosis of the patients was mostly ordinary, and the percentage of critical patients who evolved into the ICU during follow-up is 2.7 %, which is lower than the 26.1 % reported by Wuhan city. According to the Shiyan experience, early diagnosis with multiple swaps of the Q-PCR test and timely treatment can reduce the death rate. Diabetes could be one of the risk factors for progression to severe/critical outcomes. No evidence exists that smoking protects COVID-19 patients from developing to severe/critical cases, and the absolute number of lymphocytes at initial diagnosis could not predict the progression risk from severe to critical condition. Multivariate regression analysis should be used to further guide the allocation of clinical resources.


ESPEN expert statements and practical guidance on clinical nutrition in COVID-19 patients


Reorganization of a large academic hospital to face COVID-19 outbreak: The model of Parma, Emilia-Romagna region, Italy


title: If COVID-19 Becomes Endemic will the Current Dental Guidelines Still Remain Valid?

text: In a recent paper, the authors Jamal et al reviewed various guidelines published by dental societies of the world for the prevention of transmission of COVID-19 virus in the dental care setting during the current pandemic(Jamal et al., 2020). While this review is very interesting, I have a genuine apprehension that these guidelines may not be valid for a long time and very soon new guidelines will be required in the unfortunate event of COVID-19 becoming endemic.


If COVID-19 becomes endemic will the current dental guidelines still remain valid?


title: A Survey of Labor and Delivery Practices in New York City during the COVID-19 Pandemic

text: Recently, a novel coronavirus, precisely severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), that causes the disease novel coronavirus disease 2019 (COVID-19) has been declared a worldwide pandemic. Over a million cases have been confirmed in the United States. As of May 5, 2020, New York State has had over 300,000 cases and 24,000 deaths with more than half of the cases and deaths occurring in New York City (NYC). Little is known, however, of how this virus impacts pregnancy. Given this lack of data and the risk for severe disease in this relatively immunocompromised population, further understanding of the obstetrical management of COVID-19, as well as hospital level preparation for its control, is crucial. Guidance has come from expert opinion, professional societies and public health agencies, but to date, there is no report on how obstetrical practices have adapted these recommendations to their local situations. We therefore developed an internet-based survey to elucidate the practices put into place to guide the care of obstetrical patients during the COVID-19 pandemic. We surveyed obstetrical leaders in four academic medical centers in NYC who were implementing and testing protocols at the height of the pandemic. We found that all sites made changes to their practices, and that there appeared to be agreement with screening and testing for COVID-19, as well as labor and delivery protocols, for SARS-CoV-2-positive patients. We found less consensus with respect to inpatient antepartum fetal surveillance. We hope that this experience is useful to other centers as they formulate their plans to face this pandemic. KEY POINTS: · Practices changed to accommodate public health needs.. · Most practices are screened for novel coronavirus disease 2019 (COVID-19) on admission.. · Fetal testing in COVID-19 patients varied..


title: Laboratory readiness and response for novel coronavirus (2019-nCoV) in expert laboratories in 30 EU/EEA countries, January 2020

text: Timely detection of novel coronavirus (2019-nCoV) infection cases is crucial to interrupt the spread of this virus. We assessed the required expertise and capacity for molecular detection of 2019-nCoV in specialised laboratories in 30 European Union/European Economic Area (EU/EEA) countries. Thirty-eight laboratories in 24 EU/EEA countries had diagnostic tests available by 29 January 2020. A coverage of all EU/EEA countries was expected by mid-February. Availability of primers/probes, positive controls and personnel were main implementation barriers.


title: Association of diabetes mellitus with disease severity and prognosis in COVID-19: A retrospective cohort study

text: AIMS: The 2019 novel coronavirus disease (COVID-19) emerged in Wuhan, China, and was characterized as a pandemic by the World Health Organization. Diabetes is an established risk associated with poor clinical outcomes, but the association of diabetes with COVID-19 has not been reported yet. METHODS: In this cohort study, we retrospectively reviewed 258 consecutive hospitalized COVID-19 patients with or without diabetes at the West Court of Union Hospital in Wuhan, China, recruited from January 29 to February 12, 2020. The clinical features, treatment strategies and prognosis data were collected and analyzed. Prognosis was followed up until March 12, 2020. RESULTS: Of the 258 hospitalized patients (63 with diabetes) with COVID-19, the median age was 64 years (range 23-91), and 138 (53.5%) were male. Common symptoms included fever (82.2%), dry cough (67.1%), polypnea (48.1%), and fatigue (38%). Patients with diabetes had significantly higher leucocyte and neutrophil counts, and higher levels of fasting blood glucose, serum creatinine, urea nitrogen and creatine kinase isoenzyme MB at admission compared with those without diabetes. COVID-19 patients with diabetes were more likely to develop severe or critical disease conditions with more complications, and had higher incidence rates of antibiotic therapy, non-invasive and invasive mechanical ventilation, and death (11.1% vs. 4.1%). Cox proportional hazard model showed that diabetes (adjusted hazard ratio [aHR] = 3.64; 95% confidence interval [CI]: 1.09, 12.21) and fasting blood glucose (aHR = 1.19; 95% CI: 1.08, 1.31) were associated with the fatality due to COVID-19, adjusting for potential confounders. CONCLUSIONS: Diabetes mellitus is associated with increased disease severity and a higher risk of mortality in patients with COVID-19.


Re: SARS-CoV-2 testing and outcomes in the first 30 days after the first case of COVID-19 at an Australian children's hospital


Implications for Telehealth in a Postpandemic Future: Regulatory and Privacy Issues


From the editors: The COVID-19 crisis and its implications for pediatric surgeons


title: RadioGraphics Update: Medical 3D Printing for the Radiologist

text: Editor's Note.-Articles in the RadioGraphics Update section provide current knowledge to supplement or update information found in full-length articles previously published in RadioGraphics. Authors of the previously published article provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes. Articles in this section are published solely online and are linked to the original article.


title: COVID-19 pandemic perception in adults with celiac disease: an impulse to implement the use of telemedicine: COVID-19 and CeD

text: Background: Coronavirus Disease 2019 (COVID-19) causes severe complications and deaths all over the world. COVID-19 also has indirect effects from the lockdown and the possible lack of food. We aimed to evaluate the perception of this in Celiac Disease (CeD) patients who require a lifelong gluten-free diet as a therapy. Methods: We invited by e-mail CeD adult patients from the University of Salerno (Campania, South Italy) and the University of Padua (Veneto, North Italy) to answer an ad hoc COVID-19 survey. Results: We sent the web survey to 651 email addresses and we received 276 answers (42,4%). CeD patients did not feel more vulnerable because they had CeD (not at all 56.6%)and they did not worry much about the possible shortness of gluten-free food during the epidemic(not at all 48.5%)The most worried were the elderly patients, patients with other comorbidities and females. Finally, CeD patients were happy with remote consultations and explicitly asked to have them. Discussion: The COVID-19 pandemic has impacted a proportion of patients with CeD; in particular, women, elderly patients, patients with other comorbidities. COVID-19, although a challenging experience from the medical and the psychological point of view, has offered an opportunity to practice, on a large-scale, a remote consultation approach for CeD healthcare.


title: COVID-19 pandemic perception in adults with celiac disease: an impulse to implement the use of telemedicine

text: BACKGROUND: Coronavirus Disease 2019 (COVID-19) causes severe complications and deaths all over the world. COVID-19 also has indirect effects from the lockdown and the possible lack of food. We aimed to evaluate the perception of this in Celiac Disease (CeD) patients who require a lifelong gluten-free diet as a therapy. METHODS: We invited by e-mail CeD adult patients from the University of Salerno (Campania, South Italy) and the University of Padua (Veneto, North Italy) to answer an ad hoc COVID-19 survey. RESULTS: We sent the web survey to 651 email addresses and we received 276 answers (42,4%). CeD patients did not feel more vulnerable because they had CeD (not at all 56.6%) and they did not worry much about the possible shortness of gluten-free food during the epidemic (not at all 48.5%). The most worried were the elderly patients, patients with other comorbidities and females. Finally, CeD patients were happy with remote consultations and explicitly asked to have them. DISCUSSION: The COVID-19 pandemic has impacted a proportion of patients with CeD; in particular, women, elderly patients, patients with other comorbidities. COVID-19, although a challenging experience from the medical and the psychological point of view, has offered an opportunity to practice, on a large-scale, a remote consultation approach for CeD healthcare.


Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19)


Impact of COVID-19 on Traditional Healthcare Associated Infection Prevention Efforts - CORRIGENDUM


title: Molecular docking, simulation and MM-PBSA studies of nigella sativa compounds: a computational quest to identify potential natural antiviral for COVID-19 treatment

text: Nigella sativa or black seed is used as a medicinal plant around the globe. Oil and seeds have a long tradition of folklore use in various medicinal and food systems. The conventional therapeutic use of Nigella sativa, in different ways, has been reported in several studies to treat different diseases including influenza, headache, hypertension, diabetes, inflammation, eczema, fever, cough, asthma, bronchitis, and fever. Based on previously reported potential therapeutic uses of N. sativa compounds, and keeping in mind the dire need of time for the development of potent antiviral, a combined docking, ADMET properties calculation, molecular dynamics, and MM-PBSA approaches were applied in the current study to check the therapeutic potentials of N. sativa chief constituents against COVID-19. Among the studied compounds, we found that dithymoquinone (DTQ), with binding affinity of -8.6 kcal/mol compared to a positive control (chloroquine, -7.2 kcal/mol) , has the high potential of binding at SARS-CoV-2:ACE2 interface and thus could be predicted as a plausible inhibitor to disrupt viral-host interactions. Molecular dynamics simulation of 100 ns well complemented binding affinity of the compound and revealed strong stability of DTQ at the docked site. Additionally, MM-PBSA also affirms the docking results. Compound DTQ of the present study, if validated in wet lab experiments, could be used to treat COVID-19 and could serve as a lead in the future for development of more effective natural antivirals against COVID-19. Communicated by Ramaswamy H. Sarma.


title: Early postmortem brain MRI findings in COVID-19 non-survivors

text: OBJECTIVES: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuro-invasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). This study investigates the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework. METHODS: In this prospective, monocentric, case series study, consecutive patients who fulfilled the following inclusion criteria benefited from an early postmortem structural brain MRI: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest computerized tomographic (CT) scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility. RESULTS: Among the 62 patients who died from COVID-19 from 31/03/2020 to 24/04/2020 at our institution, 19 decedents fulfilled the inclusion criteria. Parenchymal brain abnormalities were observed in 4 decedents: subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent). Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality was observed. CONCLUSIONS: Postmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. Brainstem MRI findings do not support a brain-related contribution to respiratory distress in COVID-19.


title: Biological and Epidemiological Trends in the Prevalence and Mortality due to Outbreaks of Novel Coronavirus COVID-19 Medical education during pandemics: a UK perspective

text: The novel coronavirus (Covid-19) infection outbreak has posed a major threat to international health system and economy This study is aimed at investigating the biological and epidemiological trends in the prevalence and mortality due to outbreaks of novel coronavirus (COVID-19) infections The data on the global outbreak of COVID-19, were obtained from World Health Organization (WHO), Worldometer, Centers for Disease Control and Prevention (CDC), and research institutes The information was also recorded from research documents published in global scientific journals indexed in Pub Med and Institute of Scientific Information (ISI) Web of Science on the trends in the prevalence and mortality due to COVID-19 infection outbreaks The results show rising trends in the transmission, prevalence and mortality rate due to coronavirus COVID-19 During the period of December 29, 2019 through March 31, 2020, it has infected 750890 people worldwide, resulting in 36405 deaths with a mortality rate of 4 84% The infections were more frequent among male gender with above 60 years of age The mean growth rate index for total number of cases from January 23 to March 31, 2020 was 1 20 and growth rate index for mortality rate was 1 12 There was a positive association between the prevalence and mortality rate (R2=0 996) The novel coronavirus COVID-19 is highly contagious and has affected a large number of people worldwide It is still spreading with mutable prevalence and mortality outbreak trends The global health officials have taken priority measures to prevent the further outbreaks of this emerging pathogen across the globe However, the rising number of cases and mortality risk estimates are demonstrating that enhanced public health mediations, good hygienic conditions, social distancing and movement limitations may control the COVID-19 epidemics


title: Biological and Epidemiological Trends in the Prevalence and Mortality due to Outbreaks of Novel Coronavirus COVID-19

text: The novel coronavirus (Covid-19) infection outbreak has posed a major threat to international health system and economy. This study is aimed at investigating the biological and epidemiological trends in the prevalence and mortality due to outbreaks of novel coronavirus (COVID-19) infections. The data on the global outbreak of COVID-19, were obtained from World Health Organization (WHO), Worldometer, Centers for Disease Control and Prevention (CDC), and research institutes. The information was also recorded from research documents published in global scientific journals indexed in Pub Med and Institute of Scientific Information (ISI) Web of Science on the trends in the prevalence and mortality due to COVID-19 infection outbreaks. The results show rising trends in the transmission, prevalence and mortality rate due to coronavirus COVID-19. During the period of December 29, 2019 through March 31, 2020, it has infected 750890 people worldwide, resulting in 36405 deaths with a mortality rate of 4.84%. The infections were more frequent among male gender with above 60 years of age. The mean growth rate index for total number of cases from January 23 to March 31, 2020 was 1.20 and growth rate index for mortality rate was 1.12. There was a positive association between the prevalence and mortality rate (R2=0.996). The novel coronavirus COVID-19 is highly contagious and has affected a large number of people worldwide. It is still spreading with mutable prevalence and mortality outbreak trends. The global health officials have taken priority measures to prevent the further outbreaks of this emerging pathogen across the globe. However, the rising number of cases and mortality risk estimates are demonstrating that enhanced public health mediations, good hygienic conditions, social distancing and movement limitations may control the COVID-19 epidemics.


title: Pulmonary embolism in acute medicine: a case-based review incorporating latest guidelines in the COVID-19 era

text: Pulmonary embolism remains an important cause of morbidity and mortality in the UK, particularly following the outbreak of the novel coronavirus 2019 (COVID-19), where those infected have an increased prevalence of venous thromboembolic events. The pathophysiology in COVID-19 patients is thought to relate to a thromboinflammatory state within the pulmonary vasculature, triggered by the infection, but other risk factors such as reduced mobility, prolonged immobilisation and dehydration are likely to contribute. Several societies have released comprehensive guidelines emphasising the importance of risk stratification in patients with acute pulmonary embolism. They advocate the use of clinically validated risk scores in conjunction with biochemical and imaging results. Patients with mild disease can now be managed in the outpatient setting and with newly developed therapies, such as catheter-directed thrombolysis, becoming available in more centres, treatment options for those with more severe disease are also expanding. This article presents four theoretical but realistic cases, each diagnosed with acute pulmonary embolism, but differing in levels of severity. These demonstrate how the guidelines can be applied in a clinical setting, with particular focus on risk stratification and management.


title: Effects of the COVID-19 Pandemic on Population Mobility under Mild Policies: Causal Evidence from Sweden

text: Sweden has adopted far less restrictive social distancing policies than most countries following the COVID-19 pandemic. This paper uses data on all mobile phone users, from one major Swedish mobile phone network, to examine the impact of the Coronavirus outbreak under the Swedish mild recommendations and restrictions regime on individual mobility and if changes in geographical mobility vary over different socio-economic strata. Having access to data for January-March in both 2019 and 2020 enables the estimation of causal effects of the COVID-19 outbreak by adopting a Difference-in-Differences research design. The paper reaches four main conclusions: (i) The daytime population in residential areas increased significantly (64 percent average increase); (ii) The daytime presence in industrial and commercial areas decreased significantly (33 percent average decrease); (iii) The distance individuals move from their homes during a day was substantially reduced (38 percent decrease in the maximum distance moved and 36 percent increase in share of individuals who move less than one kilometer from home); (iv) Similar reductions in mobility were found for residents in areas with different socioeconomic and demographic characteristics. These results show that mild government policies can compel people to adopt social distancing behavior.


title: All India Ophthalmological Society - Eye Bank Association of India consensus statement on guidelines for cornea and eyebanking during COVID-19 era

text: The COVID-19 pandemic has brought with it the huge burden of mortality and morbidity across the world and the added effects of the mandatory lockdown measures to try and control the spread. A number of aspects of healthcare including eye donation and eye collection require adequate safety precautions in place to keep both the involved healthcare workers and patients safe. This paper highlights the consensus-based guidelines by an expert panel on how to restart eye banking and eye collection services and carry out emergency corneal surgeries during this COVID-19 time. These guidelines will be applicable to all eye banks across the country and should help ophthalmologists and eye banking staff to restart eye banking while safeguarding themselves and their patients.


Community engagement in times of COVID-19: Lessons from neo-Vaishnavite practices


title: MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS OUTBREAK ;ORTA DOĞU SOLUNUM SENDROMU CORONAVÍRÜSÜ SALGINLARI / MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS OUTBREAK

text: The aim of this review is to learn about MERS (Middle EastRespiratory Syndrome) and track its increasing occurence since its firstidentification in 2012 The outbreaks of MERS-CoV have a higher fatality rate(34 4%) than the SARS virus(11%) which is also under the Coronavirus family,has become a global threat with 2494 cases and 858 deaths across 27 countriessince it was first diagnosed The virus can be easily transmitted by closecontact and cause hospital based outbreaks, spreading from human to human ;Derlemenin amacı 2012 yılında yeni tanımlanmış MERS (OrtaDoğu Solunum Sendromu) hastalığı etkeni olan MERS-CoV (Orta Doğu SolunumSendromu Coronavirüs) virüsünü tanımak ve günümüze kadar neden olduğu olguartışlarını ortaya koymaktır Aynı Coronavirüs ailesinde yer alan salgın etkeniSARS’dan () daha yüksek fatalite hızına ( 4) sahip MERS-CoV salgınları,ilk tanımlandığından bu yana 27 ülkede, 858 ölüm dahil toplam 2494 olgu ileküresel bir halk sağlığı tehdidi haline gelmiştir Özellikle yakın temas ilebulaşmakta olan MERS-CoV virüsü hastane kaynaklı salgınlara neden olarakinsandan insana yayılabilmektedir


title: Public Goods From Private Data -- An Efficacy and Justification Paradox for Digital Contact Tracing

text: Debate about the adoption of digital contact tracing (DCT) apps to control the spread of COVID-19 has focussed on risks to individual privacy (Sharma&Bashir 2020, Tang 2020). This emphasis reveals significant challenges to ethical deployment of DCT, but generates constraints which undermine justification to implement DCT. It would be a mistake to view this result solely as the successful operation of ethical foresight analysis (Floridi&Strait 2020), preventing deployment of potentially harmful technology. Privacy-centric analysis treats data as private property, frames the relationship between individuals and governments as adversarial, entrenches technology platforms as gatekeepers, and supports a conception of emergency public health authority as limited by individual consent and considerable corporate influence that is in some tension with the more communitarian values that typically inform public health ethics. To overcome the barriers to ethical and effective DCT, and develop infrastructure and policy that supports the realization of potential public benefits of digital technology, a public resource conception of aggregate data should be developed.


title: Forecasting the Future of Urology Practice: A Comprehensive Review of the Recommendations by International and European Associations on Priority Procedures During the COVID-19 Pandemic

text: CONTEXT: The unprecedented health care scenario caused by the coronavirus disease 2019 (COVID-19) pandemic has revolutionized urology practice worldwide. OBJECTIVE: To review the recommendations by the international and European national urological associations/societies (UASs) on prioritization strategies for both oncological and nononcological procedures released during the current emergency scenario. EVIDENCE ACQUISITION: Each UAS official website was searched between April 8 and 18, 2020, to retrieve any document, publication, or position paper on prioritization strategies regarding both diagnostic and therapeutic urological procedures, and any recommendations on the use of telemedicine and minimally invasive surgery. We collected detailed information on all urological procedures, stratified by disease, priority (higher vs lower), and patient setting (outpatient vs inpatient). Then, we critically discussed the implications of such recommendations for urology practice in both the forthcoming "adaptive" and the future "chronic" phase of the COVID-19 pandemic. EVIDENCE SYNTHESIS: Overall, we analyzed the recommendations from 13 UASs, of which four were international (American Urological Association, Confederation Americana de Urologia, European Association of Urology, and Urological Society of Australia and New Zealand) and nine national (from Belgium, France, Germany, Italy, Poland, Portugal, The Netherlands, and the UK). In the outpatient setting, the procedures that are likely to impact the future burden of urologists' workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia. Finally, some UASs recommended special precautions to perform minimally invasive surgery, while others outlined the potential role of telemedicine to optimize resources in the current and future scenarios. CONCLUSIONS: The expected changes will put significant strain on urological units worldwide regarding the overall workload of urologists, internal logistics, inflow of surgical patients, and waiting lists. In light of these predictions, urologists should strive to leverage this emergency period to reshape their role in the future. PATIENT SUMMARY: Overall, there was a large consensus among different urological associations/societies regarding the prioritization of most urological procedures, including those in the outpatient setting, urological emergencies, and many inpatient surgeries for both oncological and nononcological conditions. On the contrary, some differences were found regarding specific cancer surgeries (ie, radical cystectomy for higher-risk bladder cancer and nephrectomy for larger organ-confined renal masses), potentially due to different prioritization criteria and/or health care contexts. In the future, the outpatient procedures that are likely to impact the burden of urologists' workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia.


Proctology in the COVID-19 era: handle with care


title: Benchmarking Differentially Private Residual Networks for Medical Imagery

text: Hospitals and other medical institutions often have vast amounts of medical data which can provide significant value when utilized to advance research. However, this data is often sensitive in nature and as such is not readily available for use in a research setting, often due to privacy concerns. In this paper, we measure the performance of a deep neural network on differentially private image datasets pertaining to Pneumonia. We analyze the trade-off between the model's accuracy and the scale of perturbation among the images. Knowing how the model's accuracy varies among different perturbation levels in differentially private medical images can be quite a useful measure for hospitals to know. Furthermore, we also seek to measure the usefulness of local differential privacy for such medical imagery tasks and see if there's room for improvement.


title: Analysis of false-negative results for 2019 novel coronavirus nucleic acid test and related countermeasures/ 中华检验医学杂志

text: In December 2019, a cluster of patients with pneumonia of unknown cause were linked to a seafood wholesale market in Wuhan, China. Some studies found that the virus was a new kind of virus which had never been found in the human body. Then, the virus was named 2019 Novel Coronavirus (2019-nCoV) by the World Health Organization (WHO). 2019-nCoV nucleic acid detection is one of the essential indicators of NCP (Novel Coronavirus Pneumonia). Recently, some false-negative cases in China-Japan Friendship Hospital and Hangzhou Hospital led the clinical doctors to question the value of the nucleic acid detection. In this paper, more than 3 000 results of 2019-nCoV detection in Zhongnan Hospital, Wuhan University were analyzed. Attention should be paid to the root cause of false-negative results and the related countermeasures should be taken.


Crisis sanitaria COVID-19: el papel de un cirujano./ Crisis sanitaria COVID-19: el papel de un cirujano./ The COVID-19 health crisis: The surgeon role


title: Empfehlungen der AG Thoraxdiagnostik der Deutschen Röntgengesellschaft zur klinischen Anwendung der Thoraxbildgebung und strukturierten CT-Befundung bei COVID-19-Pandemie./ Empfehlungen der AG Thoraxdiagnostik der Deutschen Röntgengesellschaft zur klinischen Anwendung der Thoraxbildgebung und strukturierten CT-Befundung bei COVID-19-Pandemie./ Recommendations of the Thoracic Imaging Section of the German Radiological Society for clinical application of chest imaging and structured CT reporting in the COVID-19 pandemic

text: This information provided by the Thoracic Imaging Section of the German Radiological Society is intended to give physicians recommendations on the use of thoracic imaging procedures in the context of the current COVID-19 pandemic. It represents the consensus of the authors based on the previous scientific knowledge and is intended to provide guidance for unified, structured CT reporting if COVID-19 pneumonia is suspected. The recommendations presented correspond to state of knowledge at the time of print and will be updated according to the results of ongoing and future scientific studies. KEY POINTS:: · COVID-19. · chest imaging. · German Radiological Society. CITATION FORMAT: · Vogel-Claussen J, Ley-Zaporozhan J, Agarwal P etâal. Recommendations of the Thoracic Imaging Section of the German Radiological Society for clinical application of chest imaging and structured CT reporting in the COVID-19 pandemic. Fortschr Röntgenstr 2020; DOI: 10.1055/a-1174-8378.


title: Development of a manual for dealing with novel coronavirus patients at the surgery center using a multi-professional simulation at our center

text: Introduction On March 11, 2020, the World Health Organization (WHO) announced that the number of people infected with the novel coronavirus infection (COVID-19), which broke out from Wuhan, China in December 2019, has been increasing rapidly The novel coronavirus infection is designated as a designated infectious disease under Article 6(8) of the Infectious Diseases Act from February 1, 2020 As a general rule, it is mandatory to treat the disease at a designated medical institution for type 1 or type 2 infectious diseases Our center is the only designated medical institution for Type 1 infectious diseases in Wakayama Prefecture and the only designated medical institution for Type 2 infectious diseases in Wakayama City Therefore, patients with novel coronavirus infection or those with a history of infection may be examined and operated on In the absence of clinically specific measures and manuals for the surgery of novel coronavirus-positive patients, our center has decided to operate on patients with a positive viral history (negative at the time of the decision to operate) Prior to surgery, a multi-disciplinary simulation was conducted with a physician from the Department of Infectious Diseases, a certified nurse for infection control, an anesthesiologist, an operating physician, and a certified surgical nurse (presented as a reference at the end of this paper), and a manual for the surgery center was created In addition, the content was updated after patient surgery to reflect on the issues Although this manual has not been proven to be the most reasonable method of dealing with novel coronavirus patients during surgery, many facilities are currently working on the creation of a similar manual based on clinical practice as a matter of urgency, so we have decided to introduce this manual prepared by our center as a resource We would be grateful if you could give us your comments on this manual


title: Managing ACS during COVID-19 infection: Do not follow the traditional route

text: COVID-19 pandemic is creating havoc in the world. It is also spreading in India creating a massive healthcare problem. Few major hospitals were closed down because of the spread among healthcare personnel. Management of several commonly occurring diseases needed modifications to a lesser or greater extent because of this pandemic. Management of acute coronary syndrome (ACS) also requires certain modifications. In this opinion paper an attempt has been made to give an outline of ACS management in this changed scenario.


title: First chromosome data on Steindachneridion doceanum (Siluriformes: Pimelodidae): a critically endangered catfish endemic of the Doce River basin, Brazil

text: The present report represents the first cytogenetic description of Steindachneridion doceanum, great catfish which is currently at high extinction risk and it is listed as threatened on the red list of the Brazilian Ministry of the Environment, also are suggested karyotype relationships with other species of the same genus endemic from other river basins. The results revealed a diploid number of 2n = 56 and the karyotype composed of 18 metacentric, 20 submetacentric, 10 subtelocentric and 8 acrocentric chromosomes (NF = 104). The AgNORs and CMA3 signals were coincident in location occupying the short arm of an acrocentric chromosome pair (25th), in a secondary constriction. The 5S rDNA genes were localized on the short arms of one subtelocentric pair. C-banding revealed terminal blocks on the short arms on many chromosomes as well as terminal positive bands at the both ends of a submetacentric pair. C banding also revealed a large heterochromatic block in the secondary constriction (25th) region that was coincident with the AgNORs sites and CMA3+ bright bands. In spite S. doceanum represent an endemic taxon, in spite their geographic isolation their cytogenetic characteristics show similarities with other species of the genus.(AU)


title: Temporal data series of COVID-19 epidemics in the USA, Asia and Europe suggests a selective sweep of SARS-CoV-2 Spike D614G variant

text: The COVID-19 pandemic started in Wuhan, China, and caused the worldwide spread of the RNA virus SARS-CoV-2, the causative agent of COVID-19. Because of its mutational rate, wide geographical distribution, and host response variance this coronavirus is currently evolving into an array of strains with increasing genetic diversity. Most variants apparently have neutral effects for disease spread and symptoms severity. However, in the viral Spike protein, which is responsible for host cell attachment and invasion, an emergent variant, containing the amino acid substitution D to G in position 614 (D614G), was suggested to increase viral infection capability. To test whether this variant has epidemiological impact, the temporal distributions of the SARS-CoV-2 samples bearing D or G at position 614 were compared in the USA, Asia and Europe. The epidemiological curves were compared at early and late epidemic stages. At early stages, where containment measures were still not fully implemented, the viral variants are supposed to be unconstrained and its growth curves might approximate the free viral dynamics. Our analysis shows that the D614G prevalence and the growth rates of COVID-19 epidemic curves are correlated in the USA, Asia and Europe. Our results suggest a selective sweep that can be explained, at least in part, by a propagation advantage of this variant, in other words, that the molecular level effects of D614G have sufficient impact on population transmission dynamics as to be detected by differences in rate coefficients of epidemic growth curves.


A perspective from a NYC chief oral and maxillofacial surgery resident during the COVID-19 pandemic


Shining a light on the evidence for hydroxychloroquine in SARS-CoV-2


Initial ELSO Guidance Document: ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure


title: [Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19]

text: Objective: To evaluate the cardiovascular damage of patients with COVID-19, and determine the correlation of serum N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin-I (cTnI) with the severity of COVID-19, and the impact of concomitant cardiovascular disease on severity of COVID-19 was also evaluated. Methods: A cross-sectional study was designed on 150 consecutive patients with COVID-19 in the fever clinic of Tongji Hospital in Wuhan from January to February in 2020, including 126 mild cases and 24 cases in critical care. Both univariate and multivariate logistic regression were used to analyze the correlation of past medical history including hypertension, diabetes and coronary heart disease (CHD) , as well as the levels of serum NT-proBNP and cTnI to the disease severity of COVID-19 patients. Results: Age, hypersensitive C-reactive protein(hs-CRP) and serum creatinine levels of the patients were higher in critical care cases than in mild cases(all P<0.05). Prevalence of male, elevated NT-proBNP and cTnI, hypertension and coronary heart disease were significantly higher in critical cases care patients than in the mild cases(all P<0.05). Univariate logistic regression analysis showed that age, male, elevated NT-proBNP, elevated cTnI, elevated hs-CRP, elevated serum creatinine, hypertension, and CHD were significantly correlated with critical disease status(all P<0.05). Multivariate logistic regression analysis showed that elevated cTnI(OR=26.909, 95%CI 4.086-177.226, P=0.001) and CHD (OR=16.609, 95%CI 2.288-120.577, P=0.005) were the independent risk factors of critical disease status. Conclusions: COVID-19 can significantly affect the heart function and lead to myocardial injury. The past medical history of CHD and increased level of cTnI are two independent determinants of clinical disease status in patients with COVID-19.


The challenge of COVID-19 has accelerated the use of new data-sharing technologies


Novel and economical apparatus to decrease direct droplet exposure during endoscopy in the ongoing COVID-19 pandemic: A hypothesis-generating innovation


title: Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection

text: In December 2019, a series of patients with severe pneumonia were identified in Wuhan, Hubei province, China, who progressed to severe acute respiratory syndrome and acute respiratory distress syndrome. Subsequently, COVID-19 was attributed to a new betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approximately 20% of patients diagnosed as COVID-19 develop severe forms of the disease, including acute hypoxemic respiratory failure, severe acute respiratory syndrome, acute respiratory distress syndrome and acute renal failure and require intensive care. There is no randomized controlled clinical trial addressing potential therapies for patients with confirmed COVID-19 infection at the time of publishing these treatment recommendations. Therefore, these recommendations are based predominantly on the opinion of experts (level C of recommendation).


May we deliver neuro-oncology in difficult times (e.g. COVID-19)?


Should international medical electives to resource-poor countries continue during COVID-19?


Resident Response During Pandemic: This Is Our Time


title: Codon Usage and Phenotypic Divergences of SARS-CoV-2 Genes

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first occurred in Wuhan (China) in December of 2019, causes a severe acute respiratory illness with a high mortality rate, and has spread around the world. To gain an understanding of the evolution of the newly emerging SARS-CoV-2, we herein analyzed the codon usage pattern of SARS-CoV-2. For this purpose, we compared the codon usage of SARS-CoV-2 with that of other viruses belonging to the subfamily of Orthocoronavirinae. We found that SARS-CoV-2 has a high AU content that strongly influences its codon usage, which appears to be better adapted to the human host. We also studied the evolutionary pressures that influence the codon usage of five conserved coronavirus genes encoding the viral replicase, spike, envelope, membrane and nucleocapsid proteins. We found different patterns of both mutational bias and natural selection that affect the codon usage of these genes. Moreover, we show here that the two integral membrane proteins (matrix and envelope) tend to evolve slowly by accumulating nucleotide mutations on their corresponding genes. Conversely, genes encoding nucleocapsid (N), viral replicase and spike proteins (S), although they are regarded as are important targets for the development of vaccines and antiviral drugs, tend to evolve faster in comparison to the two genes mentioned above. Overall, our results suggest that the higher divergence observed for the latter three genes could represent a significant barrier in the development of antiviral therapeutics against SARS-CoV-2.


title: Preparing for the aftermath of COVID-19: Shifting risk and downstream health consequences

text: Due to the COVID-19 pandemic, the public is currently living through a collective continuous traumatic stressor. Objective risk levels shift with each new piece of data regarding the coronavirus. These data points are communicated through public health officials and the media, easily accessible through modern advanced technology including online news and push notifications. When objective risk changes, individuals must reappraise their subject risk levels. Updating subjective risk levels several times per week is linked to ambiguity of the situation and uncertainty in daily life. The uncertainty and potential feelings of uncontrollability is linked to heightened anxiety. The continuous stress, anxiety, and uncertainty may have several negative downstream mental and physical health effects nationwide. The health care sector must begin preparing for the long-term consequences of the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assessing the skillset of surgeons facing the COVID-19 pandemic


title: Successful treatment for the first confirmed noval coronavirus-infected pneumonia in Guizhou Province/ 中华危重病急救医学

text: Noval coronavirus-infected pneumonia is an acute respiratory infectious diease caused by an noval coronavirus, and it is highly contagious. The first confirmed coronavirus-infected pneumonia in Guizhou was admitted to the department of Critical Care Medicine, Affiliated Hospital of Guizhou Medical University. After has been given isolation, anti-viral therapy, oxygen therapy, maintaining internal environment stability, organ functions protection and psychological comfort for 8 days, the patient successfully recovered from the disease. It is suggested that early recognition, early isolation, timely antiviral treatment, organ function protection and psychological intervention are effective methods for patient with noval coronavirus-infected pneumonia.


title: How do Funeral Practices impact Bereaved Relatives' Mental Health, Grief and Bereavement? A Mixed Methods Review with Implications for COVID-19

text: Those who are bereaved during the current COVID-19 pandemic are subject to restrictions on funeral sizes and practices. We conducted a rapid review synthesising the quantitative and qualitative evidence regarding the effect of funeral practices on bereaved relatives' mental health and bereavement outcomes. Searches of MEDLINE, PsycINFO, KSR Evidence, and COVID-related resources were conducted. 805 records were screened; 17 studies of variable quality were included. Current evidence regarding the effect of funeral practices on bereaved relatives' mental health and bereavement outcomes is inconclusive. Five observational studies found benefits from funeral participation while six did not. However, qualitative research provides additional insight: the benefit of after-death rituals including funerals depends on the ability of the bereaved to shape those rituals and say goodbye in a way which is meaningful for them. Findings highlight the important role of funeral officiants during the pandemic. Research is needed to better understand the experiences and sequalae of grief and bereavement during COVID-19.


COVID-19 from veterinary medicine and one health perspectives: What animal coronaviruses have taught us


COVID-19 and the CRISPR Community Response


How research funders are tackling coronavirus disruption


title: Endogenous Deficiency of Glutathione as the Most Likely Cause of Serious Manifestations and Death in COVID-19 Patients

text: Higher rates of serious illness and death from coronavirus SARS-CoV-2 (COVID-19) infection among older people and those who have comorbidities suggest that age- and disease-related biological processes make such individuals more sensitive to environmental stress factors including infectious agents like coronavirus SARS-CoV-2. Specifically, impaired redox homeostasis and associated oxidative stress appear to be important biological processes that may account for increased individual susceptibility to diverse environmental insults. The aim of this Viewpoint is to justify (1) the crucial roles of glutathione in determining individual responsiveness to COVID-19 infection and disease pathogenesis and (2) the feasibility of using glutathione as a means for the treatment and prevention of COVID-19 illness. The hypothesis that glutathione deficiency is the most plausible explanation for serious manifestation and death in COVID-19 patients was proposed on the basis of an exhaustive literature analysis and observations. The hypothesis unravels the mysteries of epidemiological data on the risk factors determining serious manifestations of COVID-19 infection and the high risk of death and opens real opportunities for effective treatment and prevention of the disease.


SARS-CoV-2 and Legionella co-infection in a person returning from a Nile cruise


Hand eczema pandemic caused by severe acute respiratory syndrome coronavirus 2 hygiene measures: the set-up of a hand eczema helpline for hospital personnel


COVID-19: Increased Risk to the Mental Health and Safety of Women Living with HIV in South Africa


title: An alarming retraction rate for scientific publications on Coronavirus Disease 2019 (COVID-19)

text: The ongoing Coronavirus Disease 2019 (COVID-19) global pandemic has triggered a flurry of associated research publications, numbering to ~137 papers a day since February 2020. This rate of publication appears to be exceptionally high, when compared to research papers published on other similar topics. Searches of COVID-19-associated publications on PubMed and Retraction Watch Database indicate that the retraction record appearance rate for COVID-19-related research is also exceptionally high compared to other related research topics in viral epidemics/pandemics and surpasses the basal level of about 4 in 10,000 papers. This finding serves as a reminder and caution against any lapses in the standard of work, peer review, and publication of COVID-19-related research.


title: Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

text: BACKGROUND: Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection. METHODS: Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation. FINDINGS: All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 109 cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8-9 and a 5-min Apgar score of 9-10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus. INTERPRETATION: The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy. FUNDING: Hubei Science and Technology Plan, Wuhan University Medical Development Plan.


title: Formación continuada a través de plataformas./ Continuous learning through platforms

text: The health crisis situation we have experienced caused by the SARSCoV-2 virus has changed our daily life in numerous aspects, including those related to training (undergraduate, postgraduate, and continuing education, etc). Training activities, conferences, lectures, face-to-face workshops were suspended until the Health Situation was over. Alternatives to face-to-face training were needed to guarantee the continuity of these activities. Online training, teaching and evaluation emerged as a relatively fast, simple, operational and flexible solution. Universities and faculties promoted online teaching through virtual classes. The Spanish Society of Hospital Pharmacy supported this initiative by signing an agreement with the Board of Deans and Chancellors of Pharmacy to make it possible for undergraduate students to continue their studies and supervised practices in hospital pharmacy departments. Specialized training was affected. Pharmacy residency programs were significantly modified by hospital pharmacies to be able to provide the new clinical and research activities required, everyday, by the pandemic situation. Postgraduate and residency training were also negatively affected. Again, online activities made up for restrictions to face-to-face teaching and training. The Spanish Society of Hospital Pharmacy promoted continuing education and provided updated information on the SARS-CoV-2 virus through its website. Thus, numerous virtual sessions, lectures and webinars have been held, and high-quality material was offered to provide up-todate knowledge, on the pharmacological management of patients with COVID-19. Online teaching and education has demonstrated to be an invaluable tool for hard times. During the lockdown, technology has kept us closer and has emerged as an ally. Many of us have found a new means of communication, information, and training. The Spanish Society of Hospital Pharmacy has substantially contributed to make it possible.


title: Effect of Limb Position on Measurements of the Quadriceps Muscle Length/Femoral Length Ratio in Normal Beagle Dogs

text: OBJECTIVES: Dogs with patella alta reportedly have a shorter extensor mechanism than normal dogs. The present study aimed to measure the length of the extensor mechanism and to assess the effect of limb position on the quadriceps muscle length (QML)/femoral bone length (FL) ratio. STUDY DESIGN: Three-dimensional computed tomography images were taken of 12 Beagle dogs. Each dog underwent computed tomographic imaging 24 times with different limb positions. The QML/FL was measured on each image, along with the hip flexion-extension, hip abduction-adduction and stifle flexion-extension angles. Multiple regression analysis was used to determine the effect of these angles on the QML/FL. RESULTS: The QML/FL was increased with the hip extended (standardized partial regression coefficient 0.855 with linear plotting, 0.829 with log plotting) and with the stifle flexed (standardized partial regression coefficient 0.814 with linear plotting, 0.800 with log plotting). The partial regression coefficient of the hip abduction-adduction angle was small, indicating a small impact on the QML/FL. The 95% confidence range of the QML/FL with the hip extended and stifle flexed was 0.87 to 1.00 (mean ± standard deviation: 0.93 ± 0.03). CONCLUSION: The QML/FL was more influenced by joint angles when the hip was flexed or the stifle was extended. Hence, these positions should be avoided when evaluating the QML/FL so that the QML is less altered by slight positioning disparities.


title: Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) causes severe community and nosocomial outbreaks. Comprehensive data for serial respiratory viral load and serum antibody responses from patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are not yet available. Nasopharyngeal and throat swabs are usually obtained for serial viral load monitoring of respiratory infections but gathering these specimens can cause discomfort for patients and put health-care workers at risk. We aimed to ascertain the serial respiratory viral load of SARS-CoV-2 in posterior oropharyngeal (deep throat) saliva samples from patients with COVID-19, and serum antibody responses. METHODS: We did a cohort study at two hospitals in Hong Kong. We included patients with laboratory-confirmed COVID-19. We obtained samples of blood, urine, posterior oropharyngeal saliva, and rectal swabs. Serial viral load was ascertained by reverse transcriptase quantitative PCR (RT-qPCR). Antibody levels against the SARS-CoV-2 internal nucleoprotein (NP) and surface spike protein receptor binding domain (RBD) were measured using EIA. Whole-genome sequencing was done to identify possible mutations arising during infection. FINDINGS: Between Jan 22, 2020, and Feb 12, 2020, 30 patients were screened for inclusion, of whom 23 were included (median age 62 years [range 37-75]). The median viral load in posterior oropharyngeal saliva or other respiratory specimens at presentation was 5·2 log10 copies per mL (IQR 4·1-7·0). Salivary viral load was highest during the first week after symptom onset and subsequently declined with time (slope -0·15, 95% CI -0·19 to -0·11; R2=0·71). In one patient, viral RNA was detected 25 days after symptom onset. Older age was correlated with higher viral load (Spearman's ρ=0·48, 95% CI 0·074-0·75; p=0·020). For 16 patients with serum samples available 14 days or longer after symptom onset, rates of seropositivity were 94% for anti-NP IgG (n=15), 88% for anti-NP IgM (n=14), 100% for anti-RBD IgG (n=16), and 94% for anti-RBD IgM (n=15). Anti-SARS-CoV-2-NP or anti-SARS-CoV-2-RBD IgG levels correlated with virus neutralisation titre (R2>0·9). No genome mutations were detected on serial samples. INTERPRETATION: Posterior oropharyngeal saliva samples are a non-invasive specimen more acceptable to patients and health-care workers. Unlike severe acute respiratory syndrome, patients with COVID-19 had the highest viral load near presentation, which could account for the fast-spreading nature of this epidemic. This finding emphasises the importance of stringent infection control and early use of potent antiviral agents, alone or in combination, for high-risk individuals. Serological assay can complement RT-qPCR for diagnosis. FUNDING: Richard and Carol Yu, May Tam Mak Mei Yin, The Shaw Foundation Hong Kong, Michael Tong, Marina Lee, Government Consultancy Service, and Sanming Project of Medicine.


title: Early forecasting of the potential risk zones of COVID-19 in China's megacities

text: Recently, the coronavirus disease 2019 (COVID-19) has become a worldwide public health threat. Early and quick identification of the potential risk zones of COVID-19 infection is increasingly vital for the megacities implementing targeted infection prevention and control measures. In this study, the communities with confirmed cases during January 21-February 27 were collected and considered as the specific epidemic data for Beijing, Guangzhou, and Shenzhen. We evaluated the spatiotemporal variations of the epidemics before utilizing the ecological niche models (ENM) to assemble the epidemic data and nine socioeconomic variables for identifying the potential risk zones of this infection in these megacities. Three megacities were differentiated by the spatial patterns and quantities of infected communities, average cases per community, the percentages of imported cases, as well as the potential risks, although their COVID-19 infection situations have been preliminarily contained to date. With higher risks that were predominated by various influencing factors in each megacity, the potential risk zones coverd about 75% to 100% of currently infected communities. Our results demonstrate that the ENM method was capable of being employed as an early forecasting tool for identifying the potential COVID-19 infection risk zones on a fine scale. We suggest that local hygienic authorities should keep their eyes on the epidemic in each megacity for sufficiently implementing and adjusting their interventions in the zones with more residents or probably crowded places. This study would provide useful clues for relevant hygienic departments making quick responses to increasingly severe epidemics in similar megacities in the world.


title: Liu Shen capsule shows antiviral and anti-inflammatory abilities against novel coronavirus SARS-CoV-2 via suppression of NF-κB signaling pathway

text: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread worldwide through person-to-person contact, causing a public health emergency of international concern. At present, there is no specific antiviral treatment recommended for SARS-CoV-2 infection. Liu Shen capsule (LS), a traditional Chinese medicine, has been proven to have a wide spectrum of pharmacological properties, such as anti-inflammatory, antiviral and immunomodulatory activities. However, little is known about the antiviral effect of LS against SARS-CoV-2. Herein, the study was designed to investigate the antiviral activity of SARS-CoV-2 and its potential effect in regulating the host's immune response. The inhibitory effect of LS against SARS-CoV-2 replication in Vero E6 cells was evaluated by using the cytopathic effect (CPE) and plaque reduction assay. The number of virions of SARS-CoV-2 was observed under transmission electron microscope after treatment with LS. Proinflammatory cytokine expression levels upon SARS-CoV-2 infection in Huh-7 cells were measured by real-time quantitative PCR assays. The results showed that LS could significantly inhibit SARS-CoV-2 replication in Vero E6 cells, and reduce the number of virus particles and it could markedly reduce pro-inflammatory cytokines (TNF-α, IL-6, IL-1ß, IL-8, CCL-2/MCP-1 and CXCL-10/IP-10) production at the mRNA levels. Moreover, the expression of the key proteins in the NF-κB/MAPK signaling pathway was detected by western blot and it was found that LS could inhibit the expression of p-NF-κB p65, p-IκBα and p-p38 MAPK, while increasing the expression of IκBα. These findings indicate that LS could inhibit SARS-CoV-2 virus infection via downregulating the expression of inflammatory cytokines induced virus and regulating the activity of NF-κB/MAPK signaling pathway in vitro, making its promising candidate treatment for controlling COVID-19 disease.


Clinical Management of Nonrespiratory Diseases in the COVID-19 Pandemic: What Have We Done and What Needs to Be Done? (Re: Telemed J E Health [Epub ahead of print]; DOI: 10.1089/tmj.2020.0106)


title: Pulmonary Embolism and Increased Levels of d-Dimer in Patients with Coronavirus Disease

text: We report 3 patients with coronavirus disease who had a decline in respiratory status during their hospital course that responded well to intravenous steroids and interleukin-6 receptor antagonist therapy. These patients later showed development of persistent hypoxia with increased levels of d-dimer levels and were given a diagnosis of pulmonary embolisms.


title: Characterization of doxycycline-mediated inhibition of Marfan syndrome-associated aortic dilation by multiphoton microscopy

text: Marfan syndrome (MFS) is a connective tissue disorder that results in aortic root widening and aneurysm if unmanaged. We have previously reported doxycycline, a nonselective matrix metalloproteinases (MMPs) inhibitor, to attenuate aortic root widening and improve aortic contractility and elasticity in MFS mice. We were also first to use multiphoton microscopy, a non-invasive and label-free imaging technique, to quantify and link the aortic ultrastructure to possible changes in the skin dermis. Here, we aimed to assess the effects of long-term doxycycline treatment on the aortic ultrastructure and skin dermis of MFS mice through immunohistochemical evaluation and quantification of elastic and collagen content and morphology using multiphoton microscopy. Our results demonstrate a rescue of aortic elastic fiber fragmentation and disorganization accompanied by a decrease in MMP-2 and MMP-9 expression within the aortic wall in doxycycline-treated MFS mice. At 12 months of age, reduced skin dermal thickness was observed in both MFS and control mice, but only dermal thinning in MFS mice was rescued by doxycycline treatment. MMP-2 and MMP-9 expression was reduced in the skin of doxycycline-treated MFS mice. A decrease in dermal thickness was found to be positively associated with increased aortic root elastin disorganization and wall thickness. Our findings confirm the beneficial effects of doxycycline on ultrastructural properties of aortic root as well as on skin elasticity and structural integrity in MFS mice.


title: Using Reports of Own and Others' Symptoms and Diagnosis on Social Media to Predict COVID-19 Case Counts: Observational Infoveillance Study in Mainland China

text: Can public social media data be harnessed to predict COVID-19 case counts? We analyzed approximately 15 million COVID-19 related posts on Weibo, a popular Twitter-like social media platform in China, from November 1, 2019 to March 31, 2020. We developed a machine learning classifier to identify"sick posts,"which are reports of one's own and other people's symptoms and diagnosis related to COVID-19. We then modeled the predictive power of sick posts and other COVID-19 posts on daily case counts. We found that reports of symptoms and diagnosis of COVID-19 significantly predicted daily case counts, up to 14 days ahead of official statistics. But other COVID-19 posts did not have similar predictive power. For a subset of geotagged posts (3.10% of all retrieved posts), we found that the predictive pattern held true for both Hubei province and the rest of mainland China, regardless of unequal distribution of healthcare resources and outbreak timeline. Researchers and disease control agencies should pay close attention to the social media infosphere regarding COVID-19. On top of monitoring overall search and posting activities, it is crucial to sift through the contents and efficiently identify true signals from noise.


Applying to Pain Fellowships in the Time of COVID-19


On a knife's edge of a COVID-19 pandemic: is containment still possible?


COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020


title: Retrospective analysis of the possibility of predicting the COVID-19 outbreak from Internet searches and social media data, China, 2020

text: The peak of Internet searches and social media data about the coronavirus disease 2019 (COVID-19) outbreak occurred 10-14 days earlier than the peak of daily incidences in China. Internet searches and social media data had high correlation with daily incidences, with the maximum r > 0.89 in all correlations. The lag correlations also showed a maximum correlation at 8-12 days for laboratory-confirmed cases and 6-8 days for suspected cases.


Letter to the Editor "Changes to Neurosurgery Resident Education Since Onset of the COVID-19 Pandemic"


title: RNA to the rescue: RNA is one of the most promising targets for drug development given its wide variety of uses

text: The race for a vaccine against SARS-CoV-2 has accelerated research on RNA-based therapeutics. Beyond vaccines, RNA also shows great potential for cancer therapies.


Facepiece filtering respirators with exhalation valve should not be used in the community to limit SARS-CoV-2 diffusion


Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy


Suggestions for Combatting COVID-19 by Natural Means in the Absence of Standard Medical Regimens


title: In-House Three-Dimensional Printing Workflow for Face Shield During COVID-19 Pandemic

text: From the beginning of the year 2020, the world was affected by a coronavirus disease (COVID-19) pandemic, caused by SARS-CoV-2, leading to a shortage of personal protective equipment (PPE) at a global level, and thus generating exposure of health professionals to this extremely contagious virus. Within this context, the present work seeks to present an alternative for the production of face shields "face shields," in which it recommends its production "in house" through 3D printing, in principle initiated by Prusa Research, where we download your project of support of facial protectors, proceeding with printing through the 3D printer Gtmax3D Core H5. The authors produced a face shield in ABS, in a total time of 3 hours and 44 minutes. Thus, the model presented proved to be feasible, at a low cost, adding to the list of possibilities to produce inputs necessary to maintain the fight against this epidemic.


Effect of the COVID-19 Pandemic on Cancer Clinician Decision Making: Known Knowns and Known Unknowns


Soluble urokinase plasminogen activator receptor (suPAR) as an early predictor of severe respiratory failure in patients with COVID-19 pneumonia


title: Management of COVID-19: the risks associated with treatment are clear, but the benefits remain uncertain

text: Even though the early reports from China provided advance warning of what was to come, the COVID-19 pandemic has spread throughout the world with devastating consequences. Emergency measures are being implemented to reduce the magnitude of the public health crisis, prevent healthcare facilities from becoming overwhelmed and reduce the death toll of the disease. Containment strategies to mitigate viral transmission and emergency measures to increase the capacity of each country to provide intensive care are at the forefront of the public health management of the epidemic, even though the detrimental social and psychological effects of quarantine are evident on a global scale. Optimal management of critically ill patients with COVID-19 is also unclear, and the initial suggestion for early intubation as in typical ARDS may have caused significant harm. The management of mild cases of confirmed infection is another point of controversy, as drugs which may be repurposed for COVID-19 treatment have significant, potentially irreversible toxic effects and their use in mild cases of a viral illness which is typically self-limited may be harmful.


Take proactive measures for the pandemic COVID-19 infection in the dialysis facilities


Recapitulation of SARS-CoV-2 infection and cholangiocyte damage with human liver ductal organoids