title: Clinical characteristics of 182 pediatric COVID-19 patients with different severities and allergic status

text: BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has made widespread impact recently. We aim to investigate the clinical characteristics of COVID-19 children with different severities and allergic status. METHODS: Data extracted from the electronical medical records, including demographics, clinical manifestations, comorbidities, laboratory and immunological results and radiological images of 182 hospitalized COVID-19 children were summarized and analyzed. RESULTS: The median age was 6 years old, ranging from 3 days to 15 years, and there were more boys (male-female ratio about 2:1) within the studied 182 patients. Most of the children were infected by family members. Fever (43.4%) and dry cough (44.5%) were common symptoms, and gastrointestinal manifestations accounted for 11.0%, including diarrhea, abdominal discomfort and vomiting. 71.4% had abnormal chest computed tomography (CT) scan images, and typical signs of pneumonia were ground-glass opacity and local patchy shadowing on admission. Laboratory results were mostly within normal ranges, and only a small ratio of lymphopenia (3.9%) and eosinopenia (29.5%) were observed. The majority (97.8%) of infected children were not severe, and 24 (13.2%) of them had asymptomatic infections. Compared to children without pneumonia(manifested as asymptomatic and acute upper respiratory infection), children with pneumonia were associated with higher percentages of the comorbidity history, symptoms of fever and cough, and increased levels of serum procalcitonin, alkaline phosphatase and serum interleukins (IL)-2, IL-4, IL-6, IL-10 and TNF-α.There were no differences of treatments, duration of hospitalization, time from first positive to first negative nucleic acid testing and outcomes between children with mild pneumonia and without pneumonia. All the hospitalized COVID-19 children had recovered except one death due to intussusception and sepsis. In 43 allergic children with COVID-19, allergic rhinitis (83.7%) was the major disease, followed by drug allergy, atopic dermatitis, food allergy and asthma. Demographics and clinical features were not significantly different between allergic and non-allergic groups. Allergic patients showed less increase in acute phase reactants, procalcitonin, D-dimer and aspartate aminotransferase levels compared to all patients. Immunological profiles including circulating T, B and NK lymphocyte subsets, total immunoglobulin and complement levels and serum cytokines did not show any difference in allergic and pneumonia groups. Neither eosinophil counts nor serum total immunoglobulin E (IgE) levels showed a significant correlation with other immunological measures, such as other immunoglobulins, complements, lymphocyte subsets numbers and serum cytokine levels. CONCLUSION: Pediatric COVID-19 patients tended to have a mild clinical course. Patients with pneumonia had higher proportion of fever and cough and increased inflammatory biomarkers than those without pneumonia. There was no difference between allergic and non-allergic COVID-19 children in disease incidence, clinical features, laboratory and immunological findings. Allergy was not a risk factor for developing and severity of SARS-CoV-2 infection and hardly influenced the disease course of COVID-19 in children.


title: [Logistic regression analysis of death risk factors of patients with severe and critical coronavirus disease 2019 and their predictive value]

text: OBJECTIVE: To analyze the risk factors of death in patients with severe and critical coronavirus disease 2019 (COVID-19) and their predictive value. METHODS: Using the clinical and epidemiological database of Yangtze River Shipping General Hospital in Wuhan, the clinical and epidemiological data of 105 patients with severe and critical COVID-19 from January to March in 2020 were collected. Multivariate unconditional Logistic regression method was used to analyze the death risk factors of patients during hospitalization. The receiver operating characteristic (ROC) curve was drawn according to the multivariate analysis results to construct a death prediction model; the prediction value of the model was analyzed. RESULTS: The 105 patients with severe and critical COVID-19 were enrolled with 66 males (62.9%) and 39 females (37.1%). The age was (58.2±14.4) years old. Forty-two patients died in hospital and 63 survived. Among the dead patients, 69.0% (29/42) were male, and 78.6% (33/42) were over 60 years old. Compared with survival patients, the non-survival patients were older (years old: 59.2±12.5 vs. 51.2±11.4), and had more comorbidities, including coronary heart disease, hypertension, myocardial damage and thrombocytopenia (coronary heart disease: 33.3% vs. 11.1%, hypertension: 28.6% vs. 9.5%, myocardial damage: 73.8% vs. 11.1%, thrombocytopenia: 61.9% vs. 14.3%), and received more mechanical ventilation (92.9% vs. 44.4%), with significant differences (all P < 0.01). The variables of gender, age, basic diseases, mechanical ventilation and complications were included in the unconditional Logistic regression analysis, which showed that gender [odds ratio (OR) = 2.852, 95% confidence interval (95%CI) was 0.122-66.694], age (OR = 3.257, 95%CI was 0.466-18.584), coronary heart disease (OR = 7.337, 95%CI was 0.227-87.021), hypertension (OR = 5.517, 95%CI was 0.258-65.024) and concurrent myocardial damage (OR = 7.322, 95%CI was 0.278-95.020) and thrombocytopenia (OR = 3.968, 95%CI was 0.325-35.549) were independent risk factors for death in patients with severe and critical COVID-19 during hospitalization. According to the risk factors, the death prediction model was constructed and ROC curve was analyzed, which showed that the area under ROC curve (AUC) of death prediction model for predicting the mortality of patients with severe and critical COVID-19 during hospitalization was 0.804, the sensitivity was 83.8%, and the specificity was 82.3%. CONCLUSIONS: Various risk factors are associated with the death of severe or critical COVID-19 patients, such as gender, age, basic diseases and complications. The death prediction model is constructed by gender, age, basic diseases with coronary heart disease and hypertension, concurrent myocardial damage and thrombocytopenia, which has certain predictive value for the death of patients with severe or critical COVID-19.


Health policy and technology challenges in responding to the COVID-19 pandemic


Hyperbaric oxygen treatment of novel coronavirus (COVID-19) respiratory failure


title: A Deep Learning Pipeline for Patient Diagnosis Prediction Using Electronic Health Records

text: Augmentation of disease diagnosis and decision-making in healthcare with machine learning algorithms is gaining much impetus in recent years. In particular, in the current epidemiological situation caused by COVID-19 pandemic, swift and accurate prediction of disease diagnosis with machine learning algorithms could facilitate identification and care of vulnerable clusters of population, such as those having multi-morbidity conditions. In order to build a useful disease diagnosis prediction system, advancement in both data representation and development of machine learning architectures are imperative. First, with respect to data collection and representation, we face severe problems due to multitude of formats and lack of coherency prevalent in Electronic Health Records (EHRs). This causes hindrance in extraction of valuable information contained in EHRs. Currently, no universal global data standard has been established. As a useful solution, we develop and publish a Python package to transform public health dataset into an easy to access universal format. This data transformation to an international health data format facilitates researchers to easily combine EHR datasets with clinical datasets of diverse formats. Second, machine learning algorithms that predict multiple disease diagnosis categories simultaneously remain underdeveloped. We propose two novel model architectures in this regard. First, DeepObserver, which uses structured numerical data to predict the diagnosis categories and second, ClinicalBERT_Multi, that incorporates rich information available in clinical notes via natural language processing methods and also provides interpretable visualizations to medical practitioners. We show that both models can predict multiple diagnoses simultaneously with high accuracy.


title: Distribution of Patients at Risk for Complications Related to COVID-19 in the United States: Model Development Study

text: BACKGROUND: Coronavirus disease (COVID-19) has spread exponentially across the United States. Older adults with underlying health conditions are at an especially high risk of developing life-threatening complications if infected. Most intensive care unit (ICU) admissions and non-ICU hospitalizations have been among patients with at least one underlying health condition. OBJECTIVE: The aim of this study was to develop a model to estimate the risk status of the patients of a nationwide pharmacy chain in the United States, and to identify the geographic distribution of patients who have the highest risk of severe COVID-19 complications. METHODS: A risk model was developed using a training test split approach to identify patients who are at high risk of developing serious complications from COVID-19. Adult patients (aged ≥18 years) were identified from the Walgreens pharmacy electronic data warehouse. Patients were considered eligible to contribute data to the model if they had at least one prescription filled at a Walgreens location between October 27, 2019, and March 25, 2020. Risk parameters included age, whether the patient is being treated for a serious or chronic condition, and urban density classification. Parameters were differentially weighted based on their association with severe complications, as reported in earlier cases. An at-risk rate per 1000 people was calculated at the county level, and ArcMap was used to depict the rate of patients at high risk for severe complications from COVID-19. Real-time COVID-19 cases captured by the Johns Hopkins University Center for Systems Science and Engineering (CSSE) were layered in the risk map to show where cases exist relative to the high-risk populations. RESULTS: Of the 30,100,826 adults included in this study, the average age is 50 years, 15% have at least one specialty medication, and the average patient has 2 to 3 comorbidities. Nearly 28% of patients have the greatest risk score, and an additional 34.64% of patients are considered high-risk, with scores ranging from 8 to 10. Age accounts for 53% of a patient's total risk, followed by the number of comorbidities (29%); inferred chronic obstructive pulmonary disease, hypertension, or diabetes (15%); and urban density classification (5%). CONCLUSIONS: This risk model utilizes data from approximately 10% of the US population. Currently, this is the most comprehensive US model to estimate and depict the county-level prognosis of COVID-19 infection. This study shows that there are counties across the United States whose residents are at high risk of developing severe complications from COVID-19. Our county-level risk estimates may be used alongside other data sets to improve the accuracy of anticipated health care resource needs. The interactive map can also aid in proactive planning and preparations among employers that are deemed critical, such as pharmacies and grocery stores, to prevent the spread of COVID-19 within their facilities.


title: Impact of COVID-19 epidemic on maxillofacial surgery in Italy

text: Maxillofacial departments in 23 surgical units in Italy have been increasingly involved in facing the COVID-19 emergency. Elective surgeries have been progressively postponed to free up beds and offer human and material resources to those infected. We compiled an inventory of 32 questions to evaluate the impact of the SARS-COV2 epidemic on maxillofacial surgery in 23 selected Italian maxillofacial departments. The questionnaire focused on three different aspects: the variation of the workload, showing both a reduction of the number of team members (-16% among specialists, -11% among residents) due to reallocation or contamination and a consistent reduction of elective activities (the number of outpatient visits cancelled during the first month of the COVID-19 epidemic was about 10 000 all over Italy), while only tumour surgery and trauma surgery has been widely guaranteed; the screening procedures on patients and physicians (22% of maxillofacial units found infected surgeons, which is 4% of all maxillofacial surgeons); and the availability of Personal Protective Equipment, is only considered to be partial in 48% of Maxillofacial departments. This emergency has forced those of us in the Italian health system to change the way we work, but only time will prove if these changes have been effective.


title: Caring for Critically Ill Adults With Coronavirus Disease 2019 in a PICU: Recommendations by Dual Trained Intensivists

text: OBJECTIVE: In the midst of the severe acute respiratory syndrome coronavirus 2 pandemic, which causes coronavirus disease 2019, there is a recognized need to expand critical care services and beds beyond the traditional boundaries. There is considerable concern that widespread infection will result in a surge of critically ill patients that will overwhelm our present adult ICU capacity. In this setting, one proposal to add "surge capacity" has been the use of PICU beds and physicians to care for these critically ill adults. DESIGN: Narrative review/perspective. SETTING: Not applicable. PATIENTS: Not applicable. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The virus's high infectivity and prolonged asymptomatic shedding have resulted in an exponential growth in the number of cases in the United States within the past weeks with many (up to 6%) developing acute respiratory distress syndrome mandating critical care services. Coronavirus disease 2019 critical illness appears to be primarily occurring in adults. Although pediatric intensivists are well versed in the care of acute respiratory distress syndrome from viral pneumonia, the care of differing aged adult populations presents some unique challenges. In this statement, a team of adult and pediatric-trained critical care physicians provides guidance on common "adult" issues that may be encountered in the care of these patients and how they can best be managed in a PICU. CONCLUSIONS: This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise.


COVID-19: collaboration will keep us ahead of the curve


title: Anti-malarial drug, artemisinin and its derivatives for the treatment of respiratory diseases

text: Artemisinins are sesquiterpene lactones with a peroxide moiety that are isolated from the herb Artemisia annua. It has been used for centuries for the treatment of fever and chills, and has been recently approved for the treatment of malaria due to its endoperoxidase properties. Progressively, research has found that artemisinins displayed multiple pharmacological actions against inflammation, viral infections, and cell and tumour proliferation, making it effective against diseases. Moreover, it has displayed a relatively safe toxicity profile. The use of artemisinins against different respiratory diseases has been investigated in lung cancer models and inflammatory-driven respiratory disorders. These studies revealed the ability of artemisinins in attenuating proliferation, inflammation, invasion, and metastasis, and in inducing apoptosis. Artemisinins can regulate the expression of pro-inflammatory cytokines, nuclear factor-kappa B (NF-κB), matrix metalloproteinases (MMPs), vascular endothelial growth factor (VEGF), promote cell cycle arrest, drive reactive oxygen species (ROS) production and induce Bak or Bax-dependent or independent apoptosis. In this review, we aim to provide a comprehensive update of the current knowledge of the effects of artemisinins in relation to respiratory diseases to identify gaps that need to be filled in the course of repurposing artemisinins for the treatment of respiratory diseases. In addition, we postulate whether artemisinins can also be repurposed for the treatment of COVID-19 given its anti-viral and anti-inflammatory properties.


¿Es la hiporrespuesta inmune de la uremia un factor de protección contra la neumonía grave por COVID-19?/ ¿Es la hiporrespuesta inmune de la uremia un factor de protección contra la neumonía grave por COVID-19?/ Is the immune hyporesponsiveness of uremic patients a protective factor for severe COVID-19 pneumonia?


title: COVID-19 and ECMO: the interplay between coagulation and inflammation-a narrative review

text: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has presently become a rapidly spreading and devastating global pandemic. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) may serve as life-saving rescue therapy for refractory respiratory failure in the setting of acute respiratory compromise such as that induced by SARS-CoV-2. While still little is known on the true efficacy of ECMO in this setting, the natural resemblance of seasonal influenza's characteristics with respect to acute onset, initial symptoms, and some complications prompt to ECMO implantation in most severe, pulmonary decompensated patients. The present review summarizes the evidence on ECMO management of severe ARDS in light of recent COVID-19 pandemic, at the same time focusing on differences and similarities between SARS-CoV-2 and ECMO in terms of hematological and inflammatory interplay when these two settings merge.


title: Small changes in PDMMLA structure influence the adsorption behavior of ECM proteins and syndecan-4 on PDMMLA derivative surfaces: Experimental validation by tensiometric surface force measurements

text: Cardiovascular diseases are the leading cause of death around the world according to the World Health Organization. In-stent restenosis is an inflammatory response of the immune system to endovascular stent implantation in atherosclerotic patients. Biocompatible and biodegradable polymers are of great interest in this field in order to limit the side effects of stent treatments. Poly([R,S]-3,3-dimethylmalic acid) (PDMMLA) is a new biodegradable statistical polyester which presents promising properties as a stent coating. In this work, we studied by dynamic tensiometry, the adhesion of extracellular matrix proteins (bovine serum albumin, fibronectin, fibrinogen, and vitronectin) and plasma membrane proteoglycan (syndecan-4) on three PDMMLA derivatives with different hydrophilicity levels. The results show that proteins have different adhesion profiles and affinity on these surfaces. They show similar behavior on the most hydrophilic surface, making hydrophilic, ionic and hydrogen type bonds. Then we compared each protein's individual profile to that of a mixture of all studied proteins. The comparison shows that vitronectin and syndecan-4 are the quantitatively dominating proteins adsorbed by specific interactions. Based on the results from previous studies, this work allowed us to identify the most important PDMMLA surface as a promising biomaterial for bioactive stent-coating.


COVID pandemic: Lessons for Pakistan


Markers of liver injury and clinical outcomes in COVID-19 patients: A systematic review and meta-analysis


title: Nano-based anti-tubercular drug delivery: an emerging paradigm for improved therapeutic intervention

text: Tuberculosis (TB) classified as one of the most fatal contagious diseases is of prime concern globally. Mycobacterium tuberculosis is the causative agent that ingresses within the host cells. The approved conventional regimen, though the only viable option available, is unfavorably impacting the quality of life of the affected individual. Despite newer antibiotics gaining light, there is an unending demand for more therapeutic alternatives. Therefore, substantial continuous endeavors are been undertaken to come up with novel strategies to curb the disease, the stepping stone being nanotechnology. This approach is instrumental in overcoming the anomalies associated with conventional therapy owing to their intriguing attributes and leads to optimization of the therapeutic effect to a certain extent. This review focusses on the different types of nanocarrier systems that are being currently explored by the researchers for the delivery of anti-tubercular drugs, the outcomes achieved by them, and their prospects. Graphical abstract.


The healthcare professionals amidst COVID-19 pandemic: A perspective of resilience and posttraumatic growth


title: High mortality rate in cancer patients with symptoms of COVID-19 with or without detectable SARS-COV-2 on RT-PCR

text: BACKGROUND: Cancer patients presenting with COVID-19 have a high risk of death. In this work, predictive factors for survival in cancer patients with suspected SARS-COV-2 infection were investigated. METHODS: PRE-COVID-19 is a retrospective study of all 302 cancer patients presenting to this institute with a suspicion of COVID-19 from March 1st to April 25th 2020. Data were collected using a web-based tool within electronic patient record approved by the Institutional Review Board. Patient characteristics symptoms and survival were collected and compared in SARS-COV-2 real-time or reverse-transcriptase PCR (RT-PCR)-positive and RT-PCR-negative patients. RESULTS: Fifty-five of the 302 (18.2%) patients with suspected COVID-19 had detectable SARS-COV-2 with RT-PCR in nasopharyngeal samples. RT-PCR-positive patients were older, had more frequently haematological malignancies, respiratory symptoms and suspected COVID-19 pneumonia of computed tomography (CT) scan. However, respectively, 38% and 20% of SARS-COV-2 RT-PCR-negative patients presented similar respiratory symptoms and CT scan images. Thirty of the 302 (9.9%) patients died during the observation period, including 24 (80%) with advanced disease. At the median follow-up of 25 days after the first symptoms, the death rate in RT-PCR-positive and RT-PCR-negative patients were 21% and 10%, respectively. In both groups, independent risk factors for death were male gender, Karnofsky performance status <60, cancer in relapse and respiratory symptoms. Detection of SARS-COV-2 on RT-PCR was not associated with an increased death rate (p = 0.10). None of the treatment given in the previous month (including cytotoxics, PD1 Ab, anti-CD20, VEGFR2 ) correlated with survival. The survival of RT-PCR-positive and -negative patients with respiratory symptoms and/or COVID-19 type pneumonia on CT scan was similar with a 18.4% and 19.7% death rate at day 25. Most (22/30, 73%) cancer patients dying during this period were RT-PCR negative. CONCLUSION: The 30-day death rate of cancer patients with or without documented SARS-COV-2 infection is poor, but the majority of deaths occur in RT-PCR-negative patients.


Novel Coronavirus Mimicking Kawasaki Disease in an Infant


Supporting Young Adults to Rise to the Challenge of COVID-19


title: The role of imaging in 2019 novel coronavirus pneumonia (COVID-19)

text: Almost the entire world, not only China, is currently experiencing the outbreak of a novel coronavirus that causes respiratory disease, severe pneumonia, and even death. The outbreak began in Wuhan, China, in December of 2019 and is currently still ongoing. This novel coronavirus is highly contagious and has resulted in a continuously increasing number of infections and deaths that have already surpassed the SARS-CoV outbreak that occurred in China between 2002 and 2003. It is now officially a pandemic, announced by WHO on the 11th of March. Currently, the 2019 novel coronavirus (SARS-CoV-2) can be identified by virus isolation or viral nucleic acid detection; however, false negatives associated with the nucleic acid detection provide a clinical challenge and thus make the imaging examination crucial. Imaging exams have been a main clinical diagnostic criteria for the 2019 novel coronavirus disease (COVID-19) in China. Imaging features of multiple patchy areas of ground glass opacity and consolidation predominately in the periphery of the lungs are characteristic manifestations on chest CT and extremely helpful in the early detection and diagnosis of this disease, which aids prompt diagnosis and the eventual control of this emerging global health emergency. Key Points â¢ In December 2019, China, an outbreak of pneumonia caused by a novel, highly contagious coronavirus raised grave concerns and posed a huge threat to global public health. â¢ Among the infected patients, characteristic findings on CT imaging include multiple, patchy, ground-glass opacity, crazy-paving pattern, and consolidation shadows, mainly distributed in the peripheral and subpleural areas of both lungs, which are very helpful for the frontline clinicians. â¢ Imaging examination has become the indispensable means not only in the early detection and diagnosis but also in monitoring the clinical course, evaluating the disease severity, and may be presented as an important warning signal preceding the negative RT-PCR test results.


title: 22G Acquire vs. 20G Procore needle for endoscopic ultrasound-guided biopsy of pancreatic masses: a randomized study comparing histologic sample quantity and diagnostic accuracy

text: BACKGROUND : Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has been suggested for obtaining high quality tissue samples from pancreatic tumors. We performed a multicenter randomized crossover trial comparing EUS-FNB with a 20G Procore needle vs. a 22G Acquire needle. The aims were to compare the quantity of targeted tissue (pancreas) and diagnostic accuracy for the two needles. METHODS : 60 patients admitted for EUS-FNB in three endoscopy units were included. One pass was performed consecutively with each needle, in a randomized order. Histologic material was studied in a blinded manner with respect to the needle. The primary end point was mean cumulative length of tissue core biopsies per needle pass. RESULTS : Final diagnosis was adenocarcinoma (nâ=â46; 77â%), neuroendocrine neoplasm (nâ=â11; 18â%), autoimmune pancreatitis (nâ=â2), and mass-forming chronic pancreatitis (nâ=â1). The mean cumulative length of tissue core biopsies per needle pass was significantly higher with the 22G Acquire needle at 11.4âmm (95â% confidence interval [CI] 9.0â-â13.8] vs. 5.4âmm (95â%CI 3.8â-â7.0) for the 20G Procore needle (Pâ<â0.001), as was the mean surface area (3.5âmm2 [95â%CI 2.7â-â4.3] vs. 1.8âmm2 [95â%CI 1.2â-â2.3]; Pâ<â0.001). Diagnostic adequacy and accuracy were 100â% and 87â% with the 22G Acquire needle, and 82â% and 67â% with the 20G Procore needle (Pâ=â0.001 and Pâ=â0.02, respectively). CONCLUSIONS : EUS-guided biopsy of pancreatic masses with the 22G Acquire needle provided more tissue for histologic evaluation and better diagnostic accuracy than the 20G Procore needle.


title: Immunosuppressive and immunomodulator therapy for rare or uncommon skin disorders in pandemic days

text: Immunosuppressive and immunomodulatory therapies are important in dermatology, but indications are influenced by SARS-CoV-2. We will focus on skin disorders such as autoimmune connective tissue disorders, neutrophilic dermatoses, and vasculitis. Immunomodulators such as colchicine and antimalarials can easily be preferred taking their beneficial effects on COVID-19 into consideration and also given their wide spectrum of action. Among the conventional therapies, methotrexate, azathioprine, and mycophenolate mofetil increase the risk of infection, and thus their use is recommended only when necessary and at low doses. On the other hand, use of cyclosporine is also not recommended as it increases the risk of hypertension, which is susceptible to COVID-19. Anti-TNF agents from among the biological therapies appear to be slightly risky in terms of susceptibility to infection. However, there are ongoing studies which suggest that some biological treatments may reduce cytokine storm impeding the COVID-19 progression as a result, in spite of their susceptibilities to COVID-19. Patients, who will be started on immunosuppressive therapy, should be tested for COVID-19 prior to the therapy, and in the event that COVID-19 is suspected, the therapy should be discontinued.


title: SARS-CoV-2 infection risk assessment in the endometrium: viral infection-related gene expression across the menstrual cycle

text: OBJECTIVE: To determine the susceptibility of the endometrium to infection by-and thereby potential damage from-SARS-CoV-2. DESIGN: Analysis of SARS-Cov-2 infection-related gene expression from endometrial transcriptomic data sets. SETTING: Infertility research department affiliated with a public hospital. PATIENT(S): Gene expression data from five studies in 112 patients with normal endometrium collected throughout the menstrual cycle. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Gene expression and correlation between viral infectivity genes and age throughout the menstrual cycle. RESULT(S): Gene expression was high for TMPRSS4, CTSL, CTSB, FURIN, MX1, and BSG; medium for TMPRSS2; and low for ACE2. ACE2, TMPRSS4, CTSB, CTSL, and MX1 expression increased toward the window of implantation. TMPRSS4 expression was positively correlated with ACE2, CTSB, CTSL, MX1, and FURIN during several cycle phases; TMPRSS2 was not statistically significantly altered across the cycle. ACE2, TMPRSS4, CTSB, CTSL, BSG, and MX1 expression increased with age, especially in early phases of the cycle. CONCLUSION(S): Endometrial tissue is likely safe from SARS-CoV-2 cell entry based on ACE2 and TMPRSS2 expression, but susceptibility increases with age. Further, TMPRSS4, along with BSG-mediated viral entry into cells, could imply a susceptible environment for SARS-CoV-2 entry via different mechanisms. Additional studies are warranted to determine the true risk of endometrial infection by SARS-CoV-2 and implications for fertility treatments.


title: The importance of consistent advice during a pandemic: An analysis of Australian advice regarding personal protective equipment in healthcare settings during COVID-19

text: BACKGROUND: Lessons from previous pandemics emphasise the importance of consistent information and advice for healthcare workers (HCWs), particularly in relation to their use of personal protective equipment (PPE). OBJECTIVE: The aim of this article is to review the consistency of advice regarding HCW use of PPE among Australian states and territories and 10 key Australian professional and advocacy organisations, against the Australian Government's national guidelines. DISCUSSION: While some recommendations expand on the national guidelines, the Australian Government's efforts to work in concert with states, territories and peak professional and advocacy organisations are evident in the broadly consistent recommendations for the use of PPE by HCWs and other people working in healthcare settings across the country. The overall consistency of recommendations for the use of PPE shows a nationwide attempt to support and protect the healthcare workforce and the Australian community during the COVID-19 pandemic.


Low-flow Nasal Cannula and Potential Nosocomial Spread of COVID-19


title: COVID-19 identification in chest X-ray images on flat and hierarchical classification scenarios

text: BACKGROUND AND OBJECTIVE: The COVID-19 can cause severe pneumonia and is estimated to have a high impact on the healthcare system. Early diagnosis is crucial for correct treatment in order to possibly reduce the stress in the healthcare system. The standard image diagnosis tests for pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. Although CT scan is the gold standard, CXR are still useful because it is cheaper, faster and more widespread. This study aims to identify pneumonia caused by COVID-19 from other types and also healthy lungs using only CXR images. METHODS: In order to achieve the objectives, we have proposed a classification schema considering the following perspectives: i) a multi-class classification; ii) hierarchical classification, since pneumonia can be structured as a hierarchy. Given the natural data imbalance in this domain, we also proposed the use of resampling algorithms in the schema in order to re-balance the classes distribution. We observed that, texture is one of the main visual attributes of CXR images, our classification schema extract features using some well-known texture descriptors and also using a pre-trained CNN model. We also explored early and late fusion techniques in the schema in order to leverage the strength of multiple texture descriptors and base classifiers at once. To evaluate the approach, we composed a database, named RYDLS-20, containing CXR images of pneumonia caused by different pathogens as well as CXR images of healthy lungs. The classes distribution follows a real-world scenario in which some pathogens are more common than others. RESULTS: The proposed approach tested in RYDLS-20 achieved a macro-avg F1-Score of 0.65 using a multi-class approach and a F1-Score of 0.89 for the COVID-19 identification in the hierarchical classification scenario. CONCLUSIONS: As far as we know, the top identification rate obtained in this paper is the best nominal rate obtained for COVID-19 identification in an unbalanced environment with more than three classes. We must also highlight the novel proposed hierarchical classification approach for this task, which considers the types of pneumonia caused by the different pathogens and lead us to the best COVID-19 recognition rate obtained here.


COVID-19 Follow up Testing


Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: Value of Diagnostic Testing for SARS-CoV-2/COVID-19


title: SARS oubreaks in Ontario, Hong Kong and Singapore: the role of diagnosis and isolation as a control mechanism

text: In this article we use global and regional data from the SARS epidemic in conjunction with a model of susceptible, exposed, infective, diagnosed, and recovered classes of people (``SEIJR'') to extract average properties and rate constants for those populations. The model is fitted to data from the Ontario (Toronto) in Canada, Hong Kong in China and Singapore outbreaks and predictions are made based on various assumptions and observations, including the current effect of isolating individuals diagnosed with SARS. The epidemic dynamics for Hong Kong and Singapore appear to be different from the dynamics in Toronto, Ontario. Toronto shows a very rapid increase in the number of cases between March 31st and April 6th, followed by a {\it significant} slowing in the number of new cases. We explain this as the result of an increase in the diagnostic rate and in the effectiveness of patient isolation after March 26th. Our best estimates are consistent with SARS eventually being contained in Toronto, although the time of containment is sensitive to the parameters in our model. It is shown that despite the empirically modeled heterogeneity in transmission, SARS' average reproductive number is 1.2, a value quite similar to that computed for some strains of influenza \cite{CC2}. Although it would not be surprising to see levels of SARS infection higher than ten per cent in some regions of the world (if unchecked), lack of data and the observed heterogeneity and sensitivity of parameters prevent us from predicting the long-term impact of SARS.


title: [Prognostic value of myocardial injury in patients with COVID-19]

text: Objective: To analyze the prognostic value of myocardial injury in patients with COVID-19. Method: Confirmed cases of COVID-19 patients admitted from January 31st to February 5th at isolation ward of Renmin Hospital of Wuhan University were divided into non-survival group and survival group according to the clinical outcomes 5 weeks after admission. Data including demographics, comorbidities, vital signs, laboratory results were obtained. Cardiac injury was defined as serum concentration of high sensitivity cardiac troponin I (hs-cTnI) above 0.04 µg/L. Univariate and multivariate Cox regression were used to analyze the prognostic value of myocardial injury in patients with COVID-19. Kaplan-Meier analysis was used to plotted survival curve and analyze the impact of myocardial injury on the survival outcome of COVID-19 patients. Results: A total of 202 patients were included, the age was 63 (51, 70) years old, 88 (43.6%) of them were male, 85 (42.1%) of them had comorbidities, 125 (61.9%) of them were severely to critically ill. Till March 11, 33 patients died, all of them were critically ill patients. The age, proportion of males, comorbidities, respire rate, serum levels of hs-cTnI and incidence of heart failure in the non-survival group were significantly higher than those in the survival group (all P<0.05). The hospitalization time of non-survival group was significantly shorter than that of survival group (6(4, 9) vs. 32(23, 36), P<0.001). Myocardial injury was an important prognostic factor of COVID-19 (HR=5.382, 95%CI 2.404-12.05, P<0.001). Kaplan-Meier survival analysis showed that the presence of myocardial injury was significantly associated with the reduced survival rate among COVID-19 patients (P<0.001). Conclusion: Myocardial injury is an important prognostic factor of COVID-19, COVID-19 patients with myocardial injury face a significantly higher risk of death.


title: Baloxavir for the treatment of Influenza in allogeneic hematopoietic stem cell transplant recipients previously treated with oseltamivir

text: BACKGROUND: Seasonal influenza causes significant morbidity and mortality in allogeneic stem cell transplant (SCT) recipients. In this population, influenza virus can replicate for prolonged periods, despite neuraminidase inhibitor treatment, leading to resistance and treatment failure. Baloxavir targets the influenza polymerase and may be an effective treatment option in these patients. METHODS: We used baloxavir to treat five allogeneic SCT recipients that were still symptomatic and shedding influenza virus after completing one or more treatment courses of oseltamivir and characterized the viral isolates before and during treatment. RESULTS: Two patients were infected with influenza A/H1pdm09 carrying a neuraminidase variant (H275Y) linked to oseltamivir resistance. Both these two patients were successfully treated with baloxavir. Of the three patients infected with wild-type influenza virus, two cleared the virus after baloxavir treatment, while the third patient developed the polymerase I38T variant linked to baloxavir resistance. CONCLUSIONS: Our data suggest that baloxavir treatment can be effective in treating neuraminidase inhibitor-resistant influenza in profoundly immunocompromised patients. Randomized clinical trials are needed to define the role of baloxavir alone and combined with oseltamivir for the treatment of influenza in SCT recipients and other immunocompromised populations.


Is There a Guarantee That the Crisis of COVID-19 Will not Be Repeated?


Coronavirus epidemic and geriatric mental healthcare in China: how a coordinated response by professional organizations helped older adults during an unprecedented crisis


To relax restrictions: Are communities ready to deal with repeated epidemic waves of COVID-19?


title: A random walk Monte Carlo simulation study of COVID-19-like infection spread

text: Recent analysis of COVID-19 data from China showed that the number of confirmed cases followed a subexponential power-law increase, with a growth exponent of around 2.2. The power-law behavior was attributed to a combination of effective containment and mitigation measures employed as well as behavioral changes by the population. In this work, we report a random walk Monte Carlo simulation study of proximity-based infection spread. Social distancing is incorporated in the simulations through a single parameter, the size of each step in the random walk process. The step size $l$ is taken to be a multiple of $\langle r \rangle$, which is the average separation between individuals. Three temporal growth regimes (quadratic, intermediate power-law and exponential) are shown to emerge naturally from our simulations. For $l = \langle r \rangle$, we get intermediate power-law growth exponents that are in general agreement with available data from China. On the other hand, we obtain a quadratic growth for smaller step sizes $l \lesssim \langle r \rangle/2 $, while for large $l$ the growth is found to be exponential. Together with available data, these results suggest that the early containment of the disease within China was close to optimal. We further performed a comparative case study of data from three other countries, India, Brazil and South Africa. We show that reasonable agreement with these data can be obtained by incorporating small-world-like connections in our simulations.


title: The newly emerged COVID-19 disease: a systemic review

text: Coronaviruses are large family-RNA viruses that belong to the order Nidovirales, family Coronaviridae, subfamily Coronavirinae. The novel COVID-19 infection, caused by a beta coronavirus called SARS-CoV-2, is a new outbreak that has been emerged in Wuhan, China in December 2019. The most common symptoms of COVID-19 are fever, cough, and dyspnea. As per the March 12, 2020, WHO report, more than 125,048 confirmed COVID-19 cases and over 4613 deaths have been identified in more than 117 countries. It is now regarded as a pandemic that seriously spread and attack the world. The primary means of transmission is person to person through droplets that occurred during coughing or sneezing, through personal contact (shaking hands), or by touching contaminated objects. So far, there is no effective therapy and vaccine available against this novel virus and therefore, only supportive care is used as the mainstay of management of patients with COVID-19. The mortality rate of COVID-19 is considerable. This work aimed to provide insight on the newly emerged COVID-19, in the hope to gain a better understanding on the general overview, epidemiology, transmission, clinical features, diagnosis, treatment, and clinical outcomes as well as the prevention and control of COVID-19.


A COVID-19 pneumonia case report of autoimmune polyendocrine syndrome type 1 in Lombardy, Italy: letter to the editor


title: Hydroxychloroquine as antiviral prophylaxis for exposed caregivers to Covid-19: An urgent appraisal is needed

text: BACKGROUND: Since the onset of the new coronavirus pandemic, the world is facing a public health emergency. Repositioning hydroxychloroquine (HQ) seems to be a promising option. Many emerging evidences have converged on the effectiveness of HQ in the treatment of Covid-19 infection. In a recent paper, Gautret et al. suggested that further works are needed to determine if HQ antiviral prophylaxis is useful, especially for healthcare workers. METHODS: The purpose of this paper is to assess the Covid-19 exposure and risks level among caregivers. For this, we performed research on internet and PubMed by crossing the following keywords: healthcare givers, healthcare workers, doctors, nurses, coronavirus, Covid-19, mortality, infection rate, chloroquine, hydroxychloroquine. RESULTS: Data on healthcare worker's infection and mortality by Covid-19 are partial and are not systematically published. However, it seems that the infection rate varies between 3.8% and 9% depending on the country. Moreover, the mean age of this population is relatively old, especially in the OECD area. CONCLUSIONS: Anti-Covid-19 HQ prophylaxis should be urgently accessed, especially for healthcare workers. It is to be hoped that HQ prophylaxis reduces the morbidity and mortality from Covid-19 infection among this population which is particularly exposed and relatively old.


Women join Italy's all-male coronavirus task force


Chloroquine and the potential adverse outcome in undiagnosed G6PD-deficient cases infected with COVID-19


title: Emergence from the COVID-19 Pandemic and the Care of Chronic Pain: Guidance for the Interventionalist

text: INTRODUCTION: The current coronavirus disease (COVID-19) pandemic led to a significant disruption in the care of pain from chronic and subacute conditions. The impact of this cessation of pain treatment may have unintended consequences of increased pain, reduced function, increased reliance on opioid medications and potential increased morbidity, due to the systemic impact of untreated disease burden. This may include decreased mobility, reduction in overall health status and increase of opioid use with the associated risks. METHODS: The article is the work of the American Society of Pain and Neuroscience (ASPN) COVID-19 Task Force to evaluate the policies set forth by federal, state, and local agencies to reduce or eliminate elective procedures for those patients with pain from spine, nerve and joint disease. The impact of these decisions, which were needed to reduce the spread of the pandemic, led to a delay in care for many patients. We hence review an emergence plan to reinitiate this pain-related care. The goal is to outline a path to work with federal, state, and local authorities to combat the spread of the pandemic and minimize the deleterious impact of pain and suffering on our chronic pain patients. RESULT: The paper sets forth a strategy for the interventional pain centers to reemerge from the current pandemic and to set a course for future events.


Endoscopy Units and the Coronavirus Disease 2019 Outbreak: A Multicenter Experience From Italy


title: COVID-19 knowledge prevents biologics discontinuation: Data from an Italian multicenter survey during RED-ZONE declaration

text: SARS-CoV-2 become pandemics and there is still a dearth of data about its the potentially among dermatological patients under biologics. We aimed to assess health literacy, disease knowledge, treatment dissatisfaction and biologics attitudes toward COVID-19. We performed a cross-sectional, questionnaire-based survey on 98/105 consecutive dermatological patients treated with biologics-51 suffering from plaque psoriasis, 22 from atopic dermatitis, and 25 from hidradenitis suppurativa. An ad hoc, validated questionnaire has 44 items investigating the following domains: knowledge of COVID-19 related to (a) epidemiology, (b) pathogenesis, (c) clinical symptoms, (d) preventive measures, and (e) attitudes. Patients data and questionnaires were collected. Despite only 8.1% thought that biologics may increase the risk of COVID-19, 18.4% and 21.4% of the patients were evaluating the possibility to discontinue or modify the dosage of the current biologic therapy, respectively. Globally, male patients (P = .001) with higher scholarity level (P = .005) displayed higher knowledge of COVID-19. Patients with lower DLQI (P = .006), longer disease duration (P = .051) and lower scholarity (P = .007) have thought to discontinue/modify autonomously their biologic therapy. At the multivariate logistic regression, only the knowledge of epidemiology and preventive measures resulted independent predictors of continuation vs discontinuation and modification vs no modification, respectively. Dermatologists should promote COVID-19 knowledge to prevent biologics disruption.


title: Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan

text: Coronavirus disease is reported to affect the cardiovascular system. We showed that relative bradycardia was a common characteristic for 54 patients with PCR-confirmed mild-to-moderate coronavirus disease in Japan. This clinical sign could help clinicians to diagnose this disease.


title: Surgeries of the Gieseking hyperbolic ideal simplex manifold

text: In our Novi Sad conference paper (1999) we described Dehn type surgeries of the famous Gieseking (1912) hyperbolic ideal simplex manifold $\mathcal{S}$, leading to compact fundamental domain $\mathcal{S}(k)$, $k = 2, 3, \dots$ with singularity geodesics of rotation order $k$, but as later turned out with cone angle $2(k-1)/k$. We computed also the volume of $S(k)$, tending to zero if $k$ goes to infinity. That time we naively thought that we obtained orbifolds with the above surprising property. As the reviewer of Math. Rev., Kevin P. Scannell (MR1770996 (2001g:57030)) rightly remarked,"this is in conflict with the well-known theorem of D. A. Kazhdan and G. A. Margulis (1968) and with the work of Thurston, describing the geometric convergence of orbifolds under large Dehn fillings". In this paper we refresh our previous publication. Correctly, we obtained cone manifolds (for $k>2$), as A. D. Mednykh and V. S. Petrov (2006) kindly pointed out. We complete our discussion and derive the above cone manifold series (Gies.1 and Gies.2) in two geometrically equivalent form, by the half turn symmetry of any ideal simplex. Moreover we obtain a second orbifold series (Gies.3 and 4), tending to the regular ideal simplex as the original Gieseking manifold.


How coronavirus lockdowns stopped flu in its tracks


Commentary: Testosterone, a key hormone in the context of COVID-19 pandemic


Covid-19: Footballers mark silent respect for victims


title: Spatial and space-time clustering and demographic characteristics of human nontyphoidal Salmonella infections with major serotypes in Toronto, Canada

text: Nontyphoidal Salmonella enterica (NTS) causes a substantial health burden to human populations in Canada and worldwide. Exposure sources and demographic factors vary by location and can therefore have a major impact on salmonellosis clustering. We evaluated major NTS serotypes: S. Enteritidis (n = 620), S. Typhimurium (n = 150), S. Thompson (n = 138), and S. Heidelberg (n = 136) reported in the city of Toronto, Canada, between January 1, 2015, and December 31, 2017. Cases were analyzed at the forward sortation area (FSA)-level (an area indicated by the first three characters of the postal code). Serotype-specific global and local clustering of infections were evaluated using the Moran's I method. Spatial and space-time clusters were investigated using Poisson and multinomial scan statistic models. Case-case analyses using a multinomial logistic regression model was conducted to compare seasonal and demographic factors among the different serotypes. High infection rate FSAs clustered in the central region of Toronto for S. Enteritidis, in the south-central region for S. Typhimurium, in north-west region for S. Thompson, and in the south-east region for S. Heidelberg. The relative risk ratio of S. Enteritidis infections was significantly higher in cases who reported travel outside of Ontario. The relative risk ratio of infections was significantly higher in summer for S. Typhimurium, and in fall for S. Thompson. The relative risk ratio of infection was highest for the 0-9 age group for S. Typhimurium, and the 20-39 age group for S. Heidelberg. Our study will aid public health stakeholders in designing serotype-specific geographically targeted disease prevention programs.


title: Science, Religion, Government, and SARS-CoV-2: A Time for Synergy

text: Religion, science and government have been institutions throughout the ages that have helped us deal with fears and threats like SARS-CoV-2. However, reliance on any one of these institutions exclusively has limitations and therefore are sources of disappointments. The SARS-CoV-2 is a reminder that we can and need to blend these seemingly divergent views of science, religion and government. Each of these institutions provides ways to cope with this worldwide pandemic but they can exercise a much greater impact if they operate in unison for the common good and well-being of all.


title: Disinfection of N95 masks artificially contaminated with SARS-CoV-2 and ESKAPE bacteria using hydrogen peroxide plasma: impact on the reutilization of disposable devices

text: INTRODUCTION: One of the serious consequences of the SARS-CoV-2 pandemic is the shortage of protective equipment for health personnel. N95 masks are considered one of the essential protective equipment in the management of patients with COVID-19. The shortage of N95 masks implies potential health risks for health personnel and significant economic losses for the health institution. The objective of this work was to investigate the disinfection of N95 masks artificially contaminated with SARS-CoV-2 and ESKAPE bacteria by using hydrogen peroxide plasma. MATERIAL AND METHODS: We examined the disinfection capacity of hydrogen peroxide plasma against the SARS-CoV-2 and two members of the ESKAPE bacteria (Acinetobacter baumannii and Staphylococcus aureus) through a study of artificial contamination in situ of N95 masks. Amplification of specific genes by RT-PCR of SARS-CoV-2 and microbiological culture of ESKAPE bacteria was performed before and after the disinfection process. RESULTS: SARS-CoV-2 was not detected in all assays using five different concentrations of the virus, and A. baumannii and S. aureus were not cultivable with inoculums of 102 to 106 CFU after disinfection tests of N95 masks with hydrogen peroxide plasma. CONCLUSION: Disinfection of N95 masks by using the hydrogen peroxide plasma technology can be an alternative for their reuse in a shortage situation. Implications for the use of disinfection technologies of N95 masks and the safety of health personnel are discussed.


title: Challenges for the dental radiology clinic in times of the COVID-19 pandemic

text: This letter addresses the challenges for the dental radiology clinic in times of the COVID-19 pandemic. It highlights the use of teleradiography and mobile devices, as well as the proper care in disinfecting these equipments. As there are still no specific therapies for COVID-19, biosafety measures that promote containment and prevent the spread of the virus are crucial to stop the outbreak and control a possible new infectious peak.


title: Rapid asymptomatic transmission of COVID-19 during the incubation period demonstrating strong infectivity in a cluster of youngsters aged 16-23 years outside Wuhan and characteristics of young patients with COVID-19: A prospective contact-tracing study

text: BACKGROUND: The outbreak of coronavirus-disease-2019 (COVID-19) has rapidly spread to many places outside Wuhan. Previous studies on COVID-19 mostly included older hospitalized-adults. Little information on infectivity among and characteristics of youngsters with COVID-19 is available. METHODS: A cluster of 22 close-contacts of a 22-year-old male (Patient-Index) including youngsters with laboratory-confirmed COVID-19 and hospitalized close-contacts testing negative for severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) in Anhui Province, China was prospectively-traced. RESULTS: Since January 23, 2020, we enrolled a cluster of eight youngsters with COVID-19 (median age [range], 22 [16-23] years; six males) originating from Patient-Index returning from Wuhan to Hefei on January 19. Patient-Index visited his 16-year-old female cousin in the evening on his return, and met 15 previous classmates in a get-together on January 21. He reported being totally asymptomatic and were described by all his contacts as healthy on January 19-21. His very first symptoms were itchy eyes and fever developed at noon and in the afternoon on January 22, respectively. Seven youngsters (his cousin and six classmates) became infected with COVID-19 after a-few-hour-contact with Patient-Index. None of the patients and contacts had visited Wuhan (except Patient-Index), or had any exposure to wet-markets, wild-animals, or medical-institutes within three months. For affected youngsters, the median incubation-period was 2 days (range, 1-4). The median serial-interval was 1 day (range, 0-4). Half or more of the eight COVID-19-infected youngsters had fever, cough, sputum production, nasal congestion, and fatigue on admission. All patients had mild conditions. Six patients developed pneumonia (all mild; one bilateral) on admission. As of February 20, four patients were discharged. CONCLUSIONS: SARS-CoV-2-infection presented strong infectivity during the incubation-period with rapid transmission in this cluster of youngsters outside Wuhan. COVID-19 developed in these youngsters had fast onset and various nonspecific atypical manifestations, and were much milder than in older patients as previously reported.


How to make an alternative plastic gown during the personal protective equipment shortage due to the COVID-19 pandemic


The COVID-19 challenge


title: Hydroxychloroquine effects on psoriasis: A systematic review and a cautionary note for COVID-19 treatment

text: BACKGROUND: While evidence suggests that hydroxychloroquine (HCQ) may decrease the viral load in patients with a COVID-19 infection, a number of case reports indicate adverse dermatologic effects of this potential treatment. OBJECTIVE: To conduct a systematic review of previously reported cases of psoriasis onset, exacerbation, or relapse after HCQ treatment. METHODS: Embase and MEDLINE were comprehensively searched for original studies examining adverse effects of HCQ treatment related to psoriasis. Participant demographics and details of HCQ administration and psoriasis diagnosis were extracted from 15 articles representing 18 patients. RESULTS: Women accounted for a significantly larger number of cases of psoriasis compared with men and unreported sex (14 [77.8%] vs 2 [11.1%] vs 2 [11.1%], respectively). In addition, 50% (n = 9) of the patients did not have a history of psoriasis before taking HCQ. Of the 18 patients, 9 (50.0%) experienced de novo psoriasis, 5 (27.8%) experienced exacerbation of psoriatic symptoms, and 4 (22.2%) had a relapse of psoriasis after HCQ administration. CONCLUSION: HCQ treatment may result in induction, exacerbation, or relapse of psoriasis. Monitoring for adverse effects of HCQ treatment is necessary, and clinical trials are essential in characterizing the safety profile of HCQ use in patients with a COVID-19 infection.


title: Socially distanced school-based nutrition program feeding under COVID 19 in the rural Niger Delta

text: The Niger Delta region of Nigeria is widely recognized as a complex and contentious space for oil exploration and production. Over the past few decades, the Niger Delta has witnessed large-scale mass peaceful mobilizations and rebellion-like conditions from violent militia groups. Oil companies have been implicated in violence perpetrated by Nigerian security forces. Local host communities have suffered greatly from corruption, political instability, violence and the environmental devastation of their farmlands and fishing grounds. Oil companies have increasingly turned to corporate social responsibility (CSR) initiatives to attempt to build or repair relations with oil-producing communities. There are also governmental and non-governmental humanitarian actors supporting various initiatives in the oil-producing areas. This article highlights the challenges that one long running micro-scale development project has faced due to the COVID 19 disease outbreak and the closure of all schools in Rivers State, Nigeria in March 2020. The school closures have halted some initiatives, but our weekly nutritional program feedings have continued in new, socially distanced forms.


title: Targeting hub genes and pathways of innate immune response in COVID-19: A network biology perspective

text: The current pandemic of 2019 novel coronavirus disease (COVID-19) caused by a novel virus strain, 2019-nCoV/SARS-CoV-2 have posed a serious threat to global public health and economy. It is largely unknown how the human immune system responds to this infection. A better understanding of the immune response to SARS-CoV-2 will be important to develop therapeutics against COVID-19. Here, we have used transcriptomic profile of human alveolar adenocarcinoma cells (A549) infected with SARS-CoV-2 and employed a network biology approach to generate human-virus interactome. Network topological analysis discovers 15 SARS-CoV-2 targets, which belongs to a subset of interferon (IFN) stimulated genes (ISGs). These ISGs (IFIT1, IFITM1, IRF7, ISG15, MX1, and OAS2) can be considered as potential candidates for drug targets in the treatments of COVID-19. We have identified significant interaction between ISGs and TLR3 agonists, like poly I: C, and imiquimod, and suggests that TLR3 agonists can be considered as a potential drug for drug repurposing in COVID-19. Our network centric analysis suggests that moderating the innate immune response is a valuable approach to target COVID-19.


title: D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19

text: BACKGROUND: The outbreak of the coronavirus disease 2019 (Covid-19) has shown a global spreading trend. Early and effective predictors of clinical outcomes are urgently needed to improve management of Covid-19 patients. OBJECTIVE: The aim of the present study was to evaluate whether elevated D-dimer levels could predict mortality in patients with Covid-19. METHODS: Patients with laboratory confirmed Covid-19 were retrospective enrolled in Wuhan Asia General Hospital from January 12, 2020, to March 15, 2020. D-dimer levels on admission and death events were collected to calculate the optimum cutoff using receiver operating characteristic curves. According to the cutoff, the subjects were divided into two groups. Then the in-hospital mortality between two groups were compared to assess the predictive value of D-dimer level. RESULTS: A total of 343 eligible patients were enrolled in the study. The optimum cutoff value of D-dimer to predict in-hospital mortality was 2.0 µg/mL with a sensitivity of 92.3% and a specificity of 83.3%. There were 67 patients with D-dimer ≥2.0 µg/mL, and 267 patients with D-dimer <2.0 µg/mL on admission. 13 deaths occurred during hospitalization. Patients with D-dimer levels ≥2.0 µg/mL had a higher incidence of mortality when comparing with those who with D-dimer levels <2.0 µg/mL (12/67 vs 1/267, P < .001; hazard ratio, 51.5; 95% confidence interval, 12.9-206.7). CONCLUSIONS: D-dimer on admission greater than 2.0 µg/mL (fourfold increase) could effectively predict in-hospital mortality in patients with Covid-19, which indicated D-dimer could be an early and helpful marker to improve management of Covid-19 patients. (Chinese Clinical Trial Registry: ChiCTR2000031428).


The timing of labor epidurals in COVID-19 parturients: a balance of risk and benefit


Cost-effectiveness of rivaroxaban plus aspirin (dual pathway inhibition) for prevention of ischaemic events in patients with cardiovascular disease: on top optimisation of secondary prevention medication in the context of COVID-19 pandemia


African Resources and the Promise of Resilience against COVID-19.


Randomized Clinical Trials and COVID-19: Managing Expectations


As labs move to reopen, safety worries abound


Reverse Batwing sign in COVID-19 Pneumonia


title: [the Psychological Impact of Covid-19 on Mental Health - Literature Review]

text: INTRODUCTION: The spread of epidemics resulting in many deaths has been known since the dawn of civilization, for example, the typhus and smallpox epidemics and the plague. Early in the previous century there was an outbreak of the Spanish Flue and towards the end of the 60's, the AIDS epidemic (HIV). Since the start of the current century, several epidemics broke out and spread to various places around the world, for instance, SARS (Severe Acute Respiratory Syndrome), the Avian Influenza and the Swine Influenza. In 2014 there was an outbreak of Ebola (Ebola virus disease) and in 2015 the Zika virus emerged and there were more. Epidemics cause havoc and impact all areas of life. Each epidemic takes an unfathomable price in lives. It is estimated, for example, that the AIDS epidemic took the lives of some 30 million people. The Corona virus (Covid-19) broke out in China, towards the end of 2019 and spread to most parts of the world. The implications of the outbreak are similar in many countries, among others, due to the uncertainty regarding the way the virus spreads, the appropriate treatment, the lack of vaccination and the high rate of deaths. Naturally, at such times physical protection is a top priority. However, coping with the implications to people's mental health is no less important and these may result in long-term negative impacts.


COVID-19 and orthodontics-A call for action


title: Could anti-CD20 therapy jeopardise the efficacy of a SARS-CoV-2 vaccine?

text: A vaccine against SARS-CoV-2 might represent the most promising approach to halt durably the current COVID-19 pandemic. We believe that anti-CD20 therapy may jeopardise the efficacy of such a vaccine. This is regrettable because patients receiving anti-CD20 therapy (i.e. those with haematologic malignancies or autoimmune disorders) are particularly at risk of severe COVID-19 and, as such, are the most in need of a vaccine. Here, we review the reasons why anti-CD20 therapy may abrogate or diminish the efficacy of a vaccine against SARS-CoV-2 and we draw physicians' attention towards this potential risk so that it can be considered when evaluating the risk/benefit ratio of anti-CD20 therapy during the current pandemic.


title: Postendodontic pain following occlusal reduction in mandibular posterior teeth with symptomatic irreversible pulpitis and sensitivity to percussion: a single-centre randomized controlled trial

text: AIM: This randomized, prospective, controlled trial assessed the effect of occlusal reduction on postendodontic pain and medication intake following root canal treatment of mandibular posterior teeth with symptomatic irreversible pulpitis with sensitivity to percussion treated in two visits. METHODOLOGY: Three hundred and eight patients were randomly assigned into two equal groups according to whether occlusal reduction was done or not (n=154). For all patients, root canal treatment was carried out in two visits without intracanal medication. Patients assessed their pain using the 0-10 numerical rating scale (NRS) 6h, 12h 24h, 48h after the first visit (Postinstrumentation) and 6h and 12h following root canal filling (Postobturation). Patients, also, recorded their medication intake (Sham or analgesic) postinstrumentation and postobturation; patients initially received a sham capsule, but, if pain persisted, an analgesic was prescribed. Data were analysed using Mann-Whitney U-test, Friedman's test, Wilcoxon's rank test and Chi2 (χ2 ) test. The Relative Risk (RR) and its 95% confidence interval (CI) were calculated for binary data. RESULTS: Occlusal reduction was associated with less pain intensity than no occlusal reduction at 12h and 24h postinstrumentation (p<0.05). Pain intensity significantly and gradually decreased with both groups at all postinstrumentation and postobturation timepoints compared to preoperative pain (p<0.05). The RR of moderate-to-severe pain was 0.61 (95% CI: 0.41, 0.91) 12h postinstrumentation and the RR of pain incidence, regardless of its level, was 0.75 (95% CI: 0.61, 0.92) 24h postinstrumentation. There was no significant difference in medication intake (sham or analgesic) between groups (p>0.05). CONCLUSIONS: Occlusal reduction was effective in reducing the intensity of postoperative pain 12h and 24h after root canal instrumentation in the first visit in patients with symptomatic irreversible pulpitis with sensitivity to percussion. Occlusal reduction lowered the risk of moderate-to-severe pain by about 40% 12h postinstrumentation and the overall risk of pain by 25% 24h postinstrumentation; yet, it did not affect medication intake.


Peptic Ulcer Disease as a Common Cause of Bleeding in Patients with Coronavirus Disease 2019


title: Economics of COVID-19: challenges and the way forward for health policy during and after the pandemic

text: The emergence of novel coronavirus disease 2019 (COVID-19) pandemic provides unique challenges for health system. While on the one hand, the government has to struggle with the strategies for control of COVID-19, on the other hand, other routine health services also need to be managed. Second, the infrastructure needs to be augmented to meet the potential epidemic surge of cases. Third, economic welfare and household income need to be guaranteed. All of these have complicated the routine ways in which the governments have dealt with various trade-offs to determine the health and public policies. In this paper, we outline key economic principles for the government to consider for policymaking, during, and after the COVID-19 pandemic. The pandemic rightfully places long due attention of policymakers for investing in health sector. The policy entrepreneurs and public health community should not miss this once-in-a-lifetime "policy window" to raise the level of advocacy for appropriate investment in health sector.


title: Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis

text: OBJECTIVE: To better inform efforts to treat and control the current outbreak with a comprehensive characterization of COVID-19. METHODS: We searched PubMed, EMBASE, Web of Science, and CNKI (Chinese Database) for studies published as of March 2, 2020, and we searched references of identified articles. Studies were reviewed for methodological quality. A random-effects model was used to pool results. Heterogeneity was assessed using I2. Publication bias was assessed using Egger's test. RESULTS: 43 studies involving 3600 patients were included. Among COVID-19 patients, fever (83.3% [95% CI 78.4-87.7]), cough (60.3% [54.2-66.3]), and fatigue (38.0% [29.8-46.5]) were the most common clinical symptoms. The most common laboratory abnormalities were elevated C-reactive protein (68.6% [58.2-78.2]), decreased lymphocyte count (57.4% [44.8-69.5]) and increased lactate dehydrogenase (51.6% [31.4-71.6]). Ground-glass opacities (80.0% [67.3-90.4]) and bilateral pneumonia (73.2% [63.4-82.1]) were the most frequently reported findings on computed tomography. The overall estimated proportion of severe cases and case-fatality rate (CFR) was 25.6% (17.4-34.9) and 3.6% (1.1-7.2), respectively. CFR and laboratory abnormalities were higher in severe cases, patients from Wuhan, and older patients, but CFR did not differ by gender. CONCLUSIONS: The majority of COVID-19 cases are symptomatic with a moderate CFR. Patients living in Wuhan, older patients, and those with medical comorbidities tend to have more severe clinical symptoms and higher CFR.


APSDE-COVID statements: recommendations should be modified according to the prevalence of COVID infection rates


Pre-existing immunity to SARS-CoV-2: the knowns and unknowns


title: Fear of COVID-19 scale: Psychometric characteristics, reliability and validity in the Israeli population

text: Mental health clinicians worldwide have been expressing concerns regarding the broad psychological effects of the COVID-19 pandemic. Nonetheless, only a few studies have thus far evaluated the degree of fear of COVID-19, partially due to the lack of validated measures. In this study we evaluated the psychometric properties of the Hebrew version of the Fear of COVID-19 scale (FCV-19S), recently developed to assess different aspects of the fear of the pandemic, in a normative population of participants in Israel. Participants (n = 639) were asked to complete the FCV-19S scale, as well as to report anxiety, depression, and stress levels using validated scales. The results a unidimensional factor structure of the FCV-19S which explained 53.71% of the variance. When forcing a two-factor structure model, the analysis revealed two factors pertaining to emotional fear reactions and symptomatic expressions of fear. Gender, sociodemographic status, chronic illness, being in an at-risk group, and having a family member dying of COVID-19 were positively associated with fear of COVID-19. The measure was associated with anxiety, stress and depression. These results suggest that the FCV-19S has good psychometric properties, and can be utilized in studies assessing the effects of the pandemic on the population's mental health.


title: Kansans in the Middle of the Pandemic: Risk Perception, Knowledge, Compliance with Preventive Measures, and Primary Sources of Information about COVID-19

text: INTRODUCTION: As we conduct this study, the world is in the grasp of a deadly pandemic In less than six months since its first diagnosis in Wuhan, China, the COVID-19 infectious disease due to the novel coronavirus has infected over 5,000,000 people and claimed over 350,000 lives In the United States, most of the cases are in large urban settings along the coasts, but the disease is slowly progressing through the mainland Kansas, with its particular location in the midwest United States, has seen a relatively small number of cases, but these are increasing The Kansas government took radical measures to prevent the spread of the disease According to the Health Beliefs Model, an individual's perception of risk will dictate engagement with preventive behaviors Knowledge about the disease and preventive measures drive the risk assessment Knowledge is dependant on the sources of information used This study explored these metrics in a sample of Kansans living in the times of the COVID-19 pandemic METHODS: A combination of snowball samples and random distribution through social media was used to recruit participants to an online survey The risk and knowledge instrument was developed and validated by WHO Europe Data collection lasted 96 hours RESULTS: The attitudes and behaviors of Kansans concerning COVID-19 were consistent with its location in an area of the country with a relatively lower incidence of the disease Participants had good knowledge about the disease and preventive measures and were willing to comply with recommendations from local authorities CONCLUSION: Localized information sources that cater to the community are often primary, while social media is not a valuable source for information pertinent to COVID-19


COVID-19: searching for clues among other respiratory viruses


Reduced rate of hospital admissions for liver-related morbidities during the initial COVID-19 outbreak


title: Decreased T cell populations contribute to the increased severity of COVID-19

text: BACKGROUND: We observe changes of the main lymphocyte subsets (CD16+CD56ãCD19ãCD3ãCD4ãand CD8) in COVID-19-infected patients and explore whether the changes are associated with disease severity. METHODS: One-hundred and fifty-four cases of COVID-19-infected patients were selected and divided into 3 groups (moderate group, severe group and critical group). The flow cytometry assay was performed to examine the numbers of lymphocyte subsets. RESULTS: CD3+, CD4+ and CD8 + T lymphocyte subsets were decreased in COVID-19-infected patients. Compared with the moderate group and the sever group, CD3+, CD4+ and CD8+ T cells in the critical group decreased greatly (P < 0.001, P = 0.005 or P = 0.001). CONCLUSIONS: Reduced CD3+, CD4+, CD8+ T lymphocyte counts may reflect the severity of the COVID-19. Monitoring T cell changes has important implications for the diagnosis and treatment of severe patients who may become critically ill.


The Role of Psychotherapy During the COVID-19 Pandemic


Offline: COVID-19-a reckoning


title: Industry 4.0 technologies and their applications in fighting COVID-19 pandemic

text: BACKGROUND AND AIMS: COVID 19 (Coronavirus) pandemic has created surge demand for essential healthcare equipment, medicines along with the requirement for advance information technologies applications. Industry 4.0 is known as the fourth industrial revolution, which has the potential to fulfil customised requirement during COVID-19 crisis. This revolution has started with the applications of advance manufacturing and digital information technologies. METHODS: A detailed review of the literature is done on the technologies of Industry 4.0 and their applications in the COVID-19 pandemic, using appropriate search words on the databases of PubMed, SCOPUS, Google Scholar and Research Gate. RESULTS: We found several useful technologies of Industry 4.0 which help for proper control and management of COVID-19 pandemic and these have been discussed in this paper. The available technologies of Industry 4.0 could also help the detection and diagnosis of COVID-19 and other related problems and symptoms. CONCLUSIONS: Industry 4.0 can fulfil the requirements of customised face masks, gloves, and collect information for healthcare systems for proper controlling and treating of COVID-19 patients. We have discussed ten major technologies of Industry 4.0 which help to solve the problems of this virus. It is useful to provide day to day update of an infected patient, area-wise, age-wise and state-wise with proper surveillance systems. We also believe that the proper implementation of these technologies would help to enhance education and communication regarding public health. These Industry 4.0 technologies could provide a lot of innovative ideas and solution for fighting local and global medical emergencies.


title: Convalescent plasma transfusion for the treatment of COVID-19: Systematic review

text: The recent emergence of coronavirus disease 2019 (COVID-19) pandemic has reassessed the usefulness of historic convalescent plasma transfusion (CPT). This review was conducted to evaluate the effectiveness of CPT therapy in COVID-19 patients based on the publications reported till date. To our knowledge, this is the first systematic review on convalescent plasma on clinically relevant outcomes in individuals with COVID-19. PubMed, EMBASE, and Medline databases were searched upto 19 April 2020. All records were screened as per the protocol eligibility criteria. We included five studies reporting CPT to COVID-19 patients. The main findings from available data are as follows: (a) Convalescent plasma may reduce mortality in critically ill patients, (b) Increase in neutralizing antibody titers and disappearance of SARS-CoV-2 RNA was observed in almost all the patients after CPT therapy, and (c) Beneficial effect on clinical symptoms after administration of convalescent plasma. Based on the limited scientific data, CPT therapy in COVID-19 patients appears safe, clinically effective, and reduces mortality. Well-designed large multicenter clinical trial studies should be conducted urgently to establish the efficacy of CPT to COVID-19 patients.


title: Central nervous system manifestations of COVID-19: A systematic review

text: OBJECTIVE: In this systematic review, we will discuss the evidence on the occurrence of central nervous system (CNS) involvement and neurological manifestations in patients with COVID-19. METHODS: MEDLINE (accessed from PubMed) and Scopus from December 01, 2019 to March 26, 2020 were systematically searched for related published articles. In both electronic databases, the following search strategy was implemented and these key words (in the title/abstract) were used: "COVID 19" OR "coronavirus" AND "brain" OR "CNS" OR "neurologic". RESULTS: Through the search strategy, we could identify two articles about neurological involvement by COVID-19. One of these publications was a narrative review and the other one was a viewpoint. However, the authors scanned the reference lists of the included studies and could identify multiple references. One study, specifically investigated the neurological manifestations of COVID-19 and could document CNS manifestations in 25% of the patients. Most of the studies investigated the manifestations of COVID-19 in general. CONCLUSION: While neurological manifestations of COVID-19 have not been studied appropriately, it is highly likely that some of these patients, particularly those who suffer from a severe illness, have CNS involvement and neurological manifestations. Precise and targeted documentation of neurological symptoms, detailed clinical, neurological, and electrophysiological investigations of the patients, attempts to isolate SARS-CoV-2 from cerebrospinal fluid, and autopsies of the COVID-19 victims may clarify the role played by this virus in causing neurological manifestations.


title: Topical preparations to reduce SARS-CoV-2 aerosolization in head and neck mucosal surgery

text: AIM: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has put health care workers at risk when exposed to aerosolized viral particles during upper airway mucosal surgery. The objective of this review was to discuss topical preparations that could be utilized preoperatively to help to decrease viral load and potentially reduce the risks of viral transmission. METHODS: A PubMed/MEDLINE database review of articles was performed querying topical preparations with virucidal activity against coronaviruses. RESULTS: Povidone-iodine (PVP-I) solutions ranging from 0.23% to 7% have been found to demonstrate highly effective virucidal activity against a broad range of viruses including several coronaviruses responsible for recent epidemics including SARS-CoV-1 and MERS-CoV. CONCLUSIONS: While specific evidence regarding SARS-CoV-2 is lacking, PVP-I-based preparations have been successfully demonstrated to reduce viral loads of coronaviruses. They are relatively safe to use in the upper airway and may reduce risk of SARS-CoV-2 aerosolization during upper airway mucosal surgery.


Coronavirus disease (COVID-19) outbreak provides a unique platform to review behavioral changes in Iran


title: Aligning Time Series on Incomparable Spaces

text: Dynamic time warping (DTW) is a useful method for aligning, comparing and combining time series, but it requires them to live in comparable spaces. In this work, we consider a setting in which time series live on different spaces without a sensible ground metric, causing DTW to become ill-defined. To alleviate this, we propose Gromov dynamic time warping (GDTW), a distance between time series on potentially incomparable spaces that avoids the comparability requirement by instead considering intra-relational geometry. We derive a Frank-Wolfe algorithm for computing it and demonstrate its effectiveness at aligning, combining and comparing time series living on incomparable spaces. We further propose a smoothed version of GDTW as a differentiable loss and assess its properties in a variety of settings, including barycentric averaging, generative modeling and imitation learning.


Delivery for respiratory compromise among pregnant women with coronavirus disease 2019


title: Effects of methylprednisolone use on viral genomic nucleic acid negative conversion and CT imaging lesion absorption in COVID-19 patients under 50 years old

text: The use of corticosteroids has been controversial in viral pneumonia. In most cases, application of methylprednisolone in severe and critical viral pneumonia patients can quickly alleviate the symptoms of dyspnea and prevent disease progression. However, some scholars have confirmed that corticosteroids delayed the body's clearance of the virus. In our retrospective non-randomised study, 34 patients under 50 years old and diagnosed with coronavirus disease 2019 (COVID-19) were included, according to given methylprednisolone treatment (n = 18) or not (n = 16), they were separated into 2 groups. By comparing the clinical data we concluded that corticosteroids therapy can effectively release COVID-19 symptoms such as persistent fever and difficult breathing, improve oxygenation and prevent disease progression. However, it can prolong the negative conversion of nucleic acids. This article is protected by copyright. All rights reserved.


Is Sexual Route a Matter of Concern for the SARS-CoV-2/COVID-19?


title: [A képalkotó diagnosztika jelentosége a COVID19-fertozött betegek ellátásában]/ Importance of the imaging techniques in the management of COVID-19-infected patients

text: Critical-care physicians are facing a challenging process in healthcare due to the overwhelming case number of hypoxic respiratory failure patients. Pneumonia has an utmost importance in the primary pathomechanism of the development of critical illness in the COVID-19 patients. Thus, imaging techniques are situated in the frontline to aim the diagnostic decision-making, to follow up the progress and to evaluate the possible complications. Reviewing the available literature, so far the common chest CT, chest X-ray and chest wall ultrasound features are presented, and recommendations are pronounced for the indications of the different modalities. At the initial phase, the atypical presentations of the virus infection are multiplex, peripheral ground glass opacities situated in the right lower lobe of the lung evolving rapidly into a bilateral involvement of the middle and basal zones. Along with the progression, the ratio of the consolidation is increasing subsequently deteriorating into fibrosis with reticular pattern. Chest ultrasound performed at the bedside has a paramount importance to reduce the possible number of health-care worker contacts in consequence of the strict and special infection control orders established on account of the SARS-CoV-2 pandemia. Orv Hetil. 2020; 161(17): 672677.


title: Mortality risk in post-operative head and neck cancer patients during the SARS-Cov2 pandemic: early experiences

text: PURPOSE: The objective of this report is to outline our early experience with head and neck cancer patients in a tertiary referral center, during the SARS-Cov2 pandemic, and to describe the poor outcomes of patients who acquired the infection. METHODS: In this case series from a single-center, national tertiary referral center for head and neck cancer we describe three consecutive head and neck cancer patients who contracted SARS-Cov2 during their inpatient stay. RESULTS: Of the three patients described in our case series that contracted SARS-Cov2, two patients died from SARS-Cov2 related illness. CONCLUSION: We have demonstrated the significant implications that SARS-Cov2 has on head and neck cancer patients, with 3 patients acquiring SARS-Cov2 in hospital, and 2 deaths in our that cohort. We propose a complete separation in the location of where these patients are being managed, and also dedicated non-SARS-Cov2 staff for their peri-operative management. LEVEL OF EVIDENCE: IV.


title: The spread of COVID-19 in six western metropolitan regions: a false myth on the excess of mortality in Lombardy and the defense of the city of Milan

text: We analyzed the spread of the COVID-19 epidemic in 6 metropolitan regions with similar demographic characteristics, daytime commuting population and business activities: the New York metropolitan area, the Île-de-France region, the Greater London county, Bruxelles-Capital, the Community of Madrid and the Lombardy region. The highest mortality rates 30-days after the onset of the epidemic were recorded in New York (81.2 x 100,000) and Madrid (77.1 x 100,000). Lombardy mortality rate is below average (41.4 per 100,000), and it is the only situation in which the capital of the region (Milan) has not been heavily impacted by the epidemic wave. Our study analyzed the role played by containment measures and the positive contribution offered by the hospital care system. (www.actabiomedica.it).


title: Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic

text: The impact of COVID-19 across health services, including treatment services for people who use drugs, is emerging but likely to have a high impact. Treatment services for people who use drugs provide essential treatment services including opiate agonist treatment and needle syringe programmes alongside other important treatment programmes across all substance types including withdrawal and counselling services. Drug and alcohol hospital consultation-liaison clinicians support emergency departments and other services provided in hospital settings in efficiently managing patients who use drugs and present with other health problems.COVID-19 will impact on staff availability for work due to illness. Patients may require home isolation and quarantine periods. Ensuring ongoing supply of opiate treatment during these periods will require significant changes to how treatment is provided. The use of monthly depot buprenorphine as well as moving from a framework of supervised dosing will be required for patients on sublingual buprenorphine and methadone. Ensuring ready access to take-home naloxone for patients is crucial to reduce overdose risks. Delivery of methadone and buprenorphine to the homes of people with confirmed COVID-19 infections is likely to need to occur to support home isolation.People who use drugs are likely to be more vulnerable during the COVID-19 epidemic, due to poorer health literacy and stigma and discrimination towards this group. People who use drugs may prioritise drug use above other health concerns. Adequate supply of clean injecting equipment is important to prevent outbreaks of blood-borne viruses. Opiate users may misinterpret SARS-CoV2 symptoms as opiate withdrawal and manage this by using opioids. Ensuring people who use drugs have access to drug treatment as well as access to screening and testing for SARS-CoV2 where this is indicated is important.


title: Reply to "Coronaviruses and immunosuppressed patients. The facts during the third epidemic"

text: We read with interest the letter by D'Antiga evaluating the early experience with Coronavirus-19 disease (COVID-19) in liver transplant (LT) recipients in Bergamo and suggesting the absence of correlation between immunosuppression and severity of disease. We report two cases of early liver transplant recipients infected by SARS-CoV-2 with only mild clinical manifestations. On the contrary, long-term recipients with comorbities showed a more aggressive course and worse prognosis. Considering the emerging evidence of the contribution of immune activation in the severity of the COVID-19, immunosuppression may in part prevent a more aggressive course of the disease.


title: Neutralization of SARS-CoV-2 by Destruction of the Prefusion Spike

text: There are as yet no licensed therapeutics for the COVID-19 pandemic. The causal coronavirus (SARS-CoV-2) binds host cells via a trimeric spike whose receptor binding domain (RBD) recognizes angiotensin-converting enzyme 2, initiating conformational changes that drive membrane fusion. We find that the monoclonal antibody CR3022 binds the RBD tightly, neutralizing SARS-CoV-2, and report the crystal structure at 2.4 Å of the Fab/RBD complex. Some crystals are suitable for screening for entry-blocking inhibitors. The highly conserved, structure-stabilizing CR3022 epitope is inaccessible in the prefusion spike, suggesting that CR3022 binding facilitates conversion to the fusion-incompetent post-fusion state. Cryogenic electron microscopy (cryo-EM) analysis confirms that incubation of spike with CR3022 Fab leads to destruction of the prefusion trimer. Presentation of this cryptic epitope in an RBD-based vaccine might advantageously focus immune responses. Binders at this epitope could be useful therapeutically, possibly in synergy with an antibody that blocks receptor attachment.


Author response to Letter to the Editor: Potential implications of COVID-19 in non-alcoholic fatty liver disease


text: We are grateful to Grietje h. Prins and his colleagues for their interest in our recent article regarding the characteristics and mechanisms of liver damage caused by three highly pathogenic coronavirus infections and for their valuable insights on the liver injury among COVID-19.


The coronavirus czar


COVID-19: Patient Safety and Quality Improvement Skills to Deploy during the Surge


title: Decrease in acute coronary syndrome presentations during the COVID-19 pandemic in upstate New York

text: The COVID-19 virus is a devastating pandemic that has impacted the US healthcare system significantly. More than one study reported a significant decrease in acute coronary syndrome admissions during that pandemic which is still due to unknown reasons. METHODS: This is a retrospective non-controlled multi-centered study of 180 patients (117 males and 63 females) with acute coronary syndrome (STEMI and NSTEMI) admitted during March/April of 2019 and March/April 2020 in Upstate New York. RESULTS: A total of 113 patients (61.9% males, 38.1% females) with a mean age of 72.3â¯±â¯14.2 presented during March/April 2019 with ACS (STEMI + NSTEMI) while only 67 (70.1% males, 29.9% females) COVID-19 negative patients with a mean age of 65.1â¯±â¯14.5 presented during the same period (March/April) in 2020. This is a drop by 40.7% (Pâ¯<â¯.05) of total ACS cases during the COVID-19 pandemic. In NSTEMI patients, 36.4% presented late (>24 hours of symptoms) during the COVID-19 pandemic in comparison with 2019 (27.1%, Pâ¯=â¯.033). CONCLUSION: The COVID-19 pandemic led to a substantial drop by 40.7% (Pâ¯<â¯.05) of total ACS admissions in our area. This decrease in hospital admissions and late presentations can be a worrisome sign for an increase in future complications of myocardial infarctions.


Air Medical Physician Association Position Statement on COVID-19


2019-nCoV epidemic: address mental health care to empower society


A novel treatment approach to the novel coronavirus: an argument for the use of therapeutic plasma exchange for fulminant COVID-19


title: Herramientas de salud digital para superar la brecha de atención en epilepsia antes, durante y después de la pandemia de COVID-19./ [E-health tools to overcome the gap in epilepsy care before, during and after COVID-19 pandemics]

text: INTRODUCTION: Epilepsy is a common chronic neurological disorder that affects around 50 million worldwide and there is an abundance of literature on the health care gap for this sector of the population. This gap will increase with the current pandemic due to COVID-19. AIM: To evaluate the current availability of digital health tools for the care of people with epilepsy according to the world medical literature and their use during said pandemic. DEVELOPMENT: We reviewed the publications in scientific journals in the last decade that had as their main topic the use of digital health tools or telemedicine focused on the care of patients with epilepsy, including 4 months after the national quarantines due to the appearance of the virus SARS-CoV-2. Seventeen publications were found on the use of telemedicine focused on epilepsy. The most widely used tools internationally are online platforms, followed by mobile applications, videoconferences, epileptic seizure capture systems, checklists, algorithms for understanding medical data, phone calls, tele-encephalography and text messages. None was published during the COVID-19 current pandemic. CONCLUSIONS: Although there is little literature on the use of digital health tools focused on epilepsy, there are several that can be used to fight the attention gap, especially in this global pandemic by COVID-19 that forces quarantines of people and communities for long periods. It is necessary to remove barriers and facilitate patient access to these new information technologies.


title: Convergence of two-stage iterative scheme for $K$-weak regular splittings of type II with application to Covid-19 pandemic model

text: Monotone matrices play a key role in the convergence theory of regular splittings and different types of weak regular splittings. If monotonicity fails, then it is difficult to guarantee the convergence of the above-mentioned classes of matrices. In such a case, $K$-monotonicity is sufficient for the convergence of $K$-regular and $K$-weak regular splittings, where $K$ is a proper cone in $\mathbb{R}^n$. However, the convergence theory of a two-stage iteration scheme in general proper cone setting is a gap in the literature. Especially, the same study for weak regular splittings of type II (even if in standard proper cone setting, i.e., $K=\mathbb{R}^n_+$), is open. To this end, we propose convergence theory of two-stage iterative scheme for $K$-weak regular splittings of both types in the proper cone setting. We provide some sufficient conditions which guarantee that the induced splitting from a two-stage iterative scheme is a $K$-regular splitting and then establish some comparison theorems. We also study $K$-monotone convergence theory of the stationary two-stage iterative method in case of a $K$-weak regular splitting of type II. The most interesting and important part of this work is on $M$-matrices appearing in the Covid-19 pandemic model. Finally, numerical computations are performed using the proposed technique to compute the next generation matrix involved in the pandemic model.


title: TEMPORARY REMOVAL: An effective protective equipment to use in the vaginal delivery of the pregnant women with suspected/diagnosed COVID-19: Delivery Table Shield

text: The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at: https://www.elsevier.com/about/our-business/policies/article-withdrawal.


Protective equipment to use in the vaginal delivery of the pregnant women with suspected/diagnosed COVID-19:Delivery Table Shield


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