title: Critical care management of adults with community-acquired severe respiratory viral infection

text: With the expanding use of molecular assays, viral pathogens are increasingly recognized among critically ill adult patients with community-acquired severe respiratory illness; studies have detected respiratory viral infections (RVIs) in 17-53% of such patients. In addition, novel pathogens including zoonotic coronaviruses like the agents causing Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the 2019 novel coronavirus (2019 nCoV) are still being identified. Patients with severe RVIs requiring ICU care present typically with hypoxemic respiratory failure. Oseltamivir is the most widely used neuraminidase inhibitor for treatment of influenza; data suggest that early use is associated with reduced mortality in critically ill patients with influenza. At present, there are no antiviral therapies of proven efficacy for other severe RVIs. Several adjunctive pharmacologic interventions have been studied for their immunomodulatory effects, including macrolides, corticosteroids, cyclooxygenase-2 inhibitors, sirolimus, statins, anti-influenza immune plasma, and vitamin C, but none is recommended at present in severe RVIs. Evidence-based supportive care is the mainstay for management of severe respiratory viral infection. Non-invasive ventilation in patients with severe RVI causing acute hypoxemic respiratory failure and pneumonia is associated with a high likelihood of transition to invasive ventilation. Limited existing knowledge highlights the need for data regarding supportive care and adjunctive pharmacologic therapy that is specific for critically ill patients with severe RVI. There is a need for more pragmatic and efficient designs to test different therapeutics both individually and in combination.


2020 Year of the nurse and the midwife


COVID-19 et greffe de cellules souches hématopoïétiques : recommandations et situation au Maroc./ [COVID-19 and hematopoietic stem cell transplantation: Recommendations]


title: [Management and prevention of common skin problems during epidemic prevention and control of COVID-19]

text: In the ongoing fight against the epidemic of COVID-19, the medical staff has been under tremendous pressure. Wearing the protective equipment (masks, goggles, and protective screens) with a poor breathability for a long time causes various skin problems, such as allergies, excessive skin hydration, local mechanical injuries, and even secondary infections. In addition, in a closed environment, compression and friction aggravate skin reactions, which may compromise duty performance of the medical staff. It is therefore essential to provide timely treatment opinions and prevention methods for common skin problems. We also give suggestions concerning the preparation of medical kit for skin protection in the epidemic area.


COVID-19 and the RAAS


title: Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial

text: Importance: Convalescent plasma is a potential therapeutic option for patients with coronavirus disease 2019 (COVID-19), but further data from randomized clinical trials are needed. Objective: To evaluate the efficacy and adverse effects of convalescent plasma therapy for patients with COVID-19. Design, Setting, and Participants: Open-label, multicenter, randomized clinical trial performed in 7 medical centers in Wuhan, China, from February 14, 2020, to April 1, 2020, with final follow-up April 28, 2020. The trial included 103 participants with laboratory-confirmed COVID-19 that was severe (respiratory distress and/or hypoxemia) or life-threatening (shock, organ failure, or requiring mechanical ventilation). The trial was terminated early after 103 of a planned 200 patients were enrolled. Intervention: Convalescent plasma in addition to standard treatment (n = 52) vs standard treatment alone (control) (n = 51), stratified by disease severity. Main Outcomes and Measures: Primary outcome was time to clinical improvement within 28 days, defined as patient discharged alive or reduction of 2 points on a 6-point disease severity scale (ranging from 1 [discharge] to 6 [death]). Secondary outcomes included 28-day mortality, time to discharge, and the rate of viral polymerase chain reaction (PCR) results turned from positive at baseline to negative at up to 72 hours. Results: Of 103 patients who were randomized (median age, 70 years; 60 [58.3%] male), 101 (98.1%) completed the trial. Clinical improvement occurred within 28 days in 51.9% (27/52) of the convalescent plasma group vs 43.1% (22/51) in the control group (difference, 8.8% [95% CI, -10.4% to 28.0%]; hazard ratio [HR], 1.40 [95% CI, 0.79-2.49]; P = .26). Among those with severe disease, the primary outcome occurred in 91.3% (21/23) of the convalescent plasma group vs 68.2% (15/22) of the control group (HR, 2.15 [95% CI, 1.07-4.32]; P = .03); among those with life-threatening disease the primary outcome occurred in 20.7% (6/29) of the convalescent plasma group vs 24.1% (7/29) of the control group (HR, 0.88 [95% CI, 0.30-2.63]; P = .83) (P for interaction = .17). There was no significant difference in 28-day mortality (15.7% vs 24.0%; OR, 0.65 [95% CI, 0.29-1.46]; P = .30) or time from randomization to discharge (51.0% vs 36.0% discharged by day 28; HR, 1.61 [95% CI, 0.88-2.93]; P = .12). Convalescent plasma treatment was associated with a negative conversion rate of viral PCR at 72 hours in 87.2% of the convalescent plasma group vs 37.5% of the control group (OR, 11.39 [95% CI, 3.91-33.18]; P < .001). Two patients in the convalescent plasma group experienced adverse events within hours after transfusion that improved with supportive care. Conclusion and Relevance: Among patients with severe or life-threatening COVID-19, convalescent plasma therapy added to standard treatment, compared with standard treatment alone, did not result in a statistically significant improvement in time to clinical improvement within 28 days. Interpretation is limited by early termination of the trial, which may have been underpowered to detect a clinically important difference. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000029757.


COVID-19, A and Hypersensitivity Pneumonitis


Sexual Health in the SARS-CoV-2 Era


title: Analytical performances of a chemiluminescence immunoassay for SARS-CoV-2 IgM/IgG and antibody kinetics

text: Background Coronavirus disease 2019, abbreviated to COVID-19, represents an emerging health threat worldwide as, after initial reports in China, it has continued to spread rapidly. The clinical spectrum of the disease varies from mild to severe acute respiratory distress syndrome (ARDS). Moreover, many patients can be asymptomatic, thus increasing the uncertainty of the diagnostic work-up. Laboratory tests play a pivotal role in the diagnosis and management of COVID-19, the current gold standard being real-time reverse transcription polymerase chain reaction (rRT-PCR) on respiratory tract specimens. However, the diagnostic accuracy of rRT-PCR depends on many pre-analytical and analytical variables. The measurement of specific COVID-19 antibodies (both IgG and IgM) should serve as an additional, non-invasive tool for disease detection and management. Methods The imprecision of the MAGLUMI™ 2000 Plus 2019-nCov IgM and IgG assays (Snibe, Shenzhen, China) was assessed by adopting the Clinical and Laboratory Standards Institute (CLSI) EP15-A3 protocol. Linearity of dilution and recovery was evaluated by means of mixes of high-level pools and low-level pools of serum samples. Immunoglobulin time kinetics were evaluated using a series of serum samples, repeatedly collected from COVID-19-positive patients at different times, from <5 days up to 26-30 days. Results Findings at the analytical validation of the assay carried out according to the CLSI EP15-A3 guideline demonstrated that imprecision and repeatability were acceptable (repeatability was <4% and <6% for IgM and IgG, respectively, whilst intermediate imprecision was <6%). In addition, results of dilution and recovery studies were satisfactory. The kinetics of COVID-19 antibodies confirmed previously reported findings, showing a rapid increase of both IgM and IgG after 6-7 days from the symptom onset. IgG had 100% sensitivity on day 12, whilst 88% was the higher positive rate achieved for IgM after the same time interval. Conclusions The findings of this study demonstrate the validity of the MAGLUMI 2000 Plus CLIA assay for the measurement of specific IgM and IgG in sera of COVID-19 patients, and for obtaining valuable data on the kinetics of both (IgM and IgG) COVID-19 antibodies. These data represent a pre-requisite for the appropriate utilization of specific antibodies for the diagnosis and management of COVID-19 patients.


title: [Digital surveillance tools for contact tracking of infected persons by SARS-CoV-2.]

text: BACKGROUND: In times of pandemic, case management and tracking people with contact can be differential elements for controlling the spread The objective of this review was to evaluate the digital tools used to track contacts of people infected with SARS-CoV-2 METHODS: A systematic exploratory review was conducted in the electronic databases Pubmed, Scopus and Web of Science on May 29, 2020 through the descriptors: coronavirus, digital surveillance and contact tracing A total of 11 studies were finally selected RESULTS: The results showed that some countries are implementing digital tools for contact tracking through mobile apps that allow user data to be shared via the device's GPS and/or Bluetooth The terms on the privacy and confidentiality of the population data are, in some cases, questionable CONCLUSIONS: The use of digital surveillance tools to track contacts of people infected with an infectious disease, such as SARS-CoV-2, can be key to reducing the number of people infected and reducing the spread of the virus


title: Digital surveillance tools for contact tracking of infected persons by SARS-CoV-2./ Herramientas de vigilancia digital para el rastreo de contactos de personas contagiadas de SARS-CoV-2

text: BACKGROUND: In times of pandemic, case management and tracking people with contact can be differential elements for controlling the spread The objective of this review was to evaluate the digital tools used to track contacts of people infected with SARS-CoV-2 METHODS: A systematic exploratory review was conducted in the electronic databases Pubmed, Scopus and Web of Science on May 29, 2020 through the descriptors: coronavirus, digital surveillance and contact tracing A total of 11 studies were finally selected RESULTS: The results showed that some countries are implementing digital tools for contact tracking through mobile apps that allow user data to be shared via the device's GPS and/or Bluetooth The terms on the privacy and confidentiality of the population data are, in some cases, questionable CONCLUSIONS: The use of digital surveillance tools to track contacts of people infected with an infectious disease, such as SARS-CoV-2, can be key to reducing the number of people infected and reducing the spread of the virus OBJETIVO: En tiempos de pandemia, la gestion de casos y el rastreo de contactos pueden ser elementos diferenciales para el control de la propagacion de la misma El objetivo de esta revision fue evaluar las herramientas digitales empleadas para el rastreo de contactos de personas contagiadas de SARS-CoV-2 METODOS: Se realizo una revision sistematica exploratoria en las bases de datos electronicas Pubmed, Scopus y Web of Science el dia 29 de mayo de 2020 a traves de los descriptores: coronavirus, digital surveillance y contact tracing Se seleccionaron finalmente un total de 11 estudios RESULTADOS: Los resultados mostraron como algunos paises estan implantando herramientas digitales para el rastreo de contactos a traves de aplicaciones para moviles, las cuales permiten compartir datos de los usuarios a traves del GPS y/o Bluetooth del dispositivo Los terminos sobre la privacidad y confidencialidad de los datos de la poblacion estan, en algunos casos, en entredicho CONCLUSIONES: El uso de herramientas de vigilancia digital para el rastreo de contactos de personas contagiadas de una enfermedad infecciosa, como la provocada por el SARS-CoV-2, puede ser capital para reducir el numero de personas infectadas y reducir la propagacion del virus


Cost-Related Antihypertensive Medication Nonadherence:Action in the Time of COVID-19 and Beyond


title: What Can We Learn From Almost a Decade of Food Tweets

text: We present the Latvian Twitter Eater Corpus - a set of tweets in the narrow domain related to food, drinks, eating and drinking. The corpus has been collected over time-span of over 8 years and includes over 2 million tweets entailed with additional useful data. We also separate two sub-corpora of question and answer tweets and sentiment annotated tweets. We analyse contents of the corpus and demonstrate use-cases for the sub-corpora by training domain-specific question-answering and sentiment-analysis models using data from the corpus.


The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2


COVID-19 shot protects monkeys


title: Epidemiology of 2019 novel coronavirus in Jiangsu Province, China after wartime control measures: A population-level retrospective study

text: BACKGROUND: A novel coronavirus emerged in China in December 2019, and human-to-human transmission was previously identified. This study aimed to compare the epidemiological characteristics in Jiangsu Province and assess whether so-called wartime control measures changed the trend of coronavirus disease 2019 (COVID-19) in the province. METHODS: Epidemiological data were obtained from the websites of China's Bureau of Health and the People's Government of Jiangsu Province and informal online sources from January 22 to February 20, 2020. RESULTS: The cumulative number of patients in Jiangsu Province (over 79 million people) was 613. The number of daily confirmed new cases reached the inflection point on January 31 with the maximum of 39 cases. The temporal number of patients peaked from January 29 to February 9. The proportion of confirmed cases who were residents or travelers to Hubei Province was 100.0%-58.8% before January 31 and then gradually declined. The proportion of close contacts increased gradually from January 27 to February 17. The geographical distribution of COVID-2019 cases showed that all 13 cites reported confirmed new cases after only five days of the first confirmed new case in Suzhou. The cases were concentrated in Nanjing, Suzhou, and Xuzhou with a high population density (over eight million people). The epidemiological features of COVID-2019 cases in Wuxi, Jiangsu showed that seven confirmed cases were tourists from others areas beyond Hubei Province. The longest incubation period of COVID-2019 was 19 days based on the onset of laboratory-confirmed cases. CONCLUSION: The number of daily confirmed new cases in Jiangsu Province peaked around January 31 and then declined. This result emphasized that wartime control measures, such as putting cities on lockdown to limit population mobility in Jiangsu Province, resulted in dramatic reductions in COVID-19 cases.


title: Oligodendrocytes that survive acute coronavirus infection induce prolonged inflammatory responses in the CNS

text: Neurotropic strains of mouse hepatitis virus (MHV), a coronavirus, cause acute and chronic demyelinating encephalomyelitis with similarities to the human disease multiple sclerosis. Here, using a lineage-tracking system, we show that some cells, primarily oligodendrocytes (OLs) and oligodendrocyte precursor cells (OPCs), survive the acute MHV infection, are associated with regions of demyelination, and persist in the central nervous system (CNS) for at least 150 d. These surviving OLs express major histocompatibility complex (MHC) class I and other genes associated with an inflammatory response. Notably, the extent of inflammatory cell infiltration was variable, dependent on anatomic location within the CNS, and without obvious correlation with numbers of surviving cells. We detected more demyelination in regions with larger numbers of T cells and microglia/macrophages compared to those with fewer infiltrating cells. Conversely, in regions with less inflammation, these previously infected OLs more rapidly extended processes, consistent with normal myelinating function. Together, these results show that OLs are inducers as well as targets of the host immune response and demonstrate how a CNS infection, even after resolution, can induce prolonged inflammatory changes with CNS region-dependent impairment in remyelination.


title: Counting Coronavirus Disease 2019 (COVID-19) Cases: Case Definitions, Screened Populations and Testing Techniques Matter

text: While counting cases of disease appears straightforward, there are issues to consider when enumerating disease counts during an epidemic. For example, for Coronavirus Disease-2019 (COVID-19), how is a case defined? Hubei province in China changed its case definition twice in a fortnight-from laboratory-confirmed cases to clinically-confirmed cases without laboratory tests, and back to laboratory-confirmed cases. This caused confusion in the reported number of cases. If a confirmed case requires laboratory testing, what is the population who are laboratory-tested? Due to limited laboratory testing capacity in the early phase of an emerging epidemic, only "suspected cases" are laboratory-tested in most countries. This will result in underdiagnosis of confirmed cases and also raises the question: how is a "suspect case" defined? With the passage of time and increased capability to perform laboratory tests, more people can be screened and the number of confirmed cases will increase. What are the technical considerations of laboratory testing? This includes specimen collection (variable collection methods), samples collected (upper or lower respiratory tract biospecimens), time of collection in relation to course of disease, different laboratory test methods and kits (not all of which may be standardised or approved by authorities such as the Food and Drug Administration). Are approved laboratory facilities and trained manpower available, and how are test results interpreted and false-negatives excluded? These issues will affect the accuracy of disease counts, which in turn will have implications on how we mount an appropriate response to the outbreak.


title: Pattern of liver injury in adult patients with COVID-19: a retrospective analysis of 105 patients

text: BACKGROUND: Recent studies reported that patients with coronavirus disease-2019 (COVID-19) might have liver injury. However, few data on the combined analysis and change patterns of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) have been shown. METHODS: This is a single-center retrospective study. A total of 105 adult patients hospitalized for confirmed COVID-19 in Beijing Ditan Hospital between January 12, and March 17, 2020 were included, and divided into mild group (n = 79) and severe group(n = 26). We compared liver functional test results between the two groups. Category of ALT change during the disease course was also examined. RESULTS: 56.2% (59/105) of the patients had unnormal ALT, AST, or total TBil throughout the course of the disease, but in 91.4% (96/105) cases the level of ALT, AST or TBil ≤3 fold of the upper limit of normal reference range (ULN). The overall distribution of ALT, AST, and TBil were all significantly difference between mild and severe group (P < 0.05). The percentage of the patients with elevated both ALT and AST was 12.7% (10/79) in mild cases vs. 46.2% (12/26) in severe cases (P = 0.001). 34.6% (9/26) severe group patients started to have abnormal ALT after admission, and 73.3% (77/105) of all patients had normal ALT before discharge. CONCLUSIONS: Elevated liver function index is very common in patients with COVID-19 infection, and the level were less than 3 × ULN, but most are reversible. The abnormality of 2 or more indexes is low in the patients with COVID-19, but it is more likely to occur in the severe group.


title: Early antiviral therapy of abidor combined with lopinavir/ritonavir and re-combinant interferonα-2b in patients with novel coronavirus pneumonia in Zhejiang: A multicenter and prospective study/ 中华临床感染病杂志

text: Objective@#Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province.@*Methods@#A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data.@*Results@#The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05).@*Conclusions@#The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.


Why is SARS-CoV-2 infection milder among children?


COVID-19 and the need to prioritize health equity and social determinants of health


SARS-CoV-2 self-isolation: recommendations for people with a vision impairment


Pulmonary telerehabilitation: An international call for action


title: Learning New Ways of Teaching and Assessment - The Impact of Covid-19 on Undergraduate Dermatology Education

text: Covid-19 has resulted in unprecedented global disruption. As this global pandemic persists with no end in sight, we must not ignore its impact on undergraduate medical education. Dermatology undergraduate exposure is variable, limited and often suboptimal. It has been shown that medical students and qualified doctors are not adequately confident in their ability to assess and manage skin conditions, and many feel that their undergraduate dermatology teaching was not satisfactory.


title: Liver transplantation in the era of COVID-19

text: Liver transplantation is considered the ultimate solution for patients with end-stage chronic liver disease or acute liver failure. Patients with liver transplant need special care starting from preoperative preparation, surgical intervention ending with postoperative care. Transplanted patients have to receive immunosuppressive therapy to prevent rejection. Such a state of immune suppression could predispose to different types of infections in liver transplant recipients. Currently, the world is suffering a pandemic caused by a new strain of the coronavirus family called COVID-19. Certain infection control precautions are needed to protect immunocompromised and vulnerable patients, including liver transplant candidates and recipients from acquiring COVID-19 infection. Restricting non-transplant elective surgical procedures, managing transplant patients in separate outpatient clinics, and in-patient wards can prevent transmission of infection both to patients and healthcare workers. Telemedicine can help in the triage of patients to screen for symptoms of COVID-19 before their regular appointment. Management of immunosuppressive therapy and drug-drug interactions in liver transplant recipients infected with COVID-19 should be cautiously practiced to prevent rejection and effectively treat the underlying infection. In this report, we are trying to summarize available evidence about different aspects of the management of liver transplant candidates and recipients in the era of COVID-19.


COVID-19 in pediatric patients: What the prehospital teams need to know


Letter: Collateral Pandemic in Face of the Present COVID-19 Pandemic: A Neurosurgical Perspective


Clinical trials for COVID-19 should include sex as a variable


COVID-19 and lung pathology


What matters most: Why the COVID-19 pandemic should prompt us to revisit the dermatology resident selection process


SARS-CoV-2 impact in a community-based hematological ward in an Italian Red Zone


title: COVID-19 patients presenting with afebrile acute abdominal pain

text: IMPORTANCE: With the surge in COVID-19 cases worldwide, the medical community should be aware of atypical clinical presentations to help with correct diagnosis, to take the proper measures to place the patient in isolation and to avoid healthcare professionals being infected by coronavirus (SARS-CoV-2). OBJECTIVE: To report that patients who subsequently test positive for COVID-19 may present with acute abdominal pain and no pulmonary symptoms, although they already have typical lung lesions on computed tomography (CT) scan. DESIGN, SETTING AND PARTICIPANTS: This case series is about three patients who presented to the emergency department of a community hospital in Montpellier, France, with acute abdominal pain. RESULTS: The three patients had an elevated C-reactive protein level. CT scans demonstrated no abdominal anomaly, but bilateral lung lesions at the lung bases, typical of COVID-19 lesions, were observed. COVID-19 RT-PCR tests were positive for the three patients.The patients were transferred to the COVID-19 centre for disease control at Montpellier University Hospital. As of 29 March 2020, two of those patients are still intubated in the intensive care unit (ICU) and the third was discharged home. CONCLUSION AND RELEVANCE: COVID-19 infections may present as an acute abdominal pain. In our case series, CT scan findings helped us to suspect the correct diagnosis, which was subsequently confirmed with COVID-19 RT-PCR tests.


title: Distress propagation on production networks: Coarse-graining and modularity of linkages

text: Distress propagation occurs in connected networks, its rate and extent being dependent on network topology. To study this, we choose economic production networks as a paradigm. An economic network can be examined at many levels: linkages among individual agents (microscopic), among firms/sectors (mesoscopic) or among countries (macroscopic). New emergent dynamical properties appear at every level, so the granularity matters. For viral epidemics, even an individual node may act as an epicenter of distress and potentially affect the entire network. Economic networks, however, are known to be immune at the micro-levels and more prone to failure in the meso/macro-levels. We propose a dynamical interaction model to characterize the mechanism of distress propagation, across different modules of a network, initiated at different epicenters. Vulnerable modules often lead to large degrees of destabilization. We demonstrate our methodology using a unique empirical data-set of input-output linkages across 0.14 million firms in one administrative state of India, a developing economy. The network has multiple hub-and-spoke structures that exhibits moderate disassortativity, which varies with the level of coarse-graining. The novelty lies in characterizing the production network at different levels of granularity or modularity, and finding `too-big-to-fail' modules supersede `too-central-to-fail' modules in distress propagation.


title: COVID-19 patients benefit from early antiviral treatment: a comparative, retrospective study

text: BACKGROUND: The outbreak of COVID-19, caused by SARS-CoV-2, started in December 2019, Wuhan, China. We aimed to figure out the time-point and duration of using antiviral drugs for receiving the maximal effects in patients with COVID-19. METHODS: In this study, we enrolled 129 confirmed COVID-19 mild to moderate patients who had been treated with antiviral drugs during their hospitalization in Wuhan Union Hospital China. The patients were divided into early antiviral treatment group and late antiviral treatment group. The demographic data, laboratory tests, the virus clearance time, chest computed tomography (CT) scans, etc. were extracted, calculated and compared between two groups. RESULTS: Our data showed that the median time from illness onset to initiation of antiviral treatment was 6 days in all patients. The group with early antiviral treatment demonstrated 7 days shorter in the virus clearance time when compared to the group with late antiviral treatment. After virus clearance, the group with early antiviral treatment showed milder illness than the group with late antiviral treatment. CONCLUSIONS: Early antiviral treatment could effectively shorten the virus clearance time, and prevent the rapid progression of COVID-19. Therefore, the COVID-19 patients should receive combined therapies with antiviral treatment at early stage. This article is protected by copyright. All rights reserved.


Tele-Neuro-Ophthalmology During the Age of COVID-19


title: Mathematical Modeling of Epidemic Diseases; A Case Study of the COVID-19 Coronavirus

text: The outbreak of the Coronavirus COVID-19 has taken the lives of several thousands worldwide and locked-out many countries and regions, with yet unpredictable global consequences. In this research we study the epidemic patterns of this virus, from a mathematical modeling perspective. The study is based on an extensions of the well-known susceptible-infected-recovered (SIR) family of compartmental models. It is shown how social measures such as distancing, regional lockdowns, quarantine and global public health vigilance, influence the model parameters, which can eventually change the mortality rates and active contaminated cases over time, in the real world. As with all mathematical models, the predictive ability of the model is limited by the accuracy of the available data and to the so-called level of abstraction used for modeling the problem. In order to provide the broader audience of researchers a better understanding of spreading patterns of epidemic diseases, a short introduction on biological systems modeling is also presented and the Matlab source codes for the simulations are provided online.


title: Clinical Prognosis of Right-Sided Infective Endocarditis not Associated with Cardiac Devices or Intravenous Drug use: a Cohort Study and Meta-Analysis

text: Right-sided infective endocarditis (RSIE), classically associated with intravenous drug use or intracardiac devices, is considered a good-prognosis infective endocarditis (IE) form. However, predisposing factors and prognosis for "NODID" RSIE (NOt associated with cardiac Devices or Intravenous Drug use) remain unclear. The aim of this study was to evaluate predisposing factors and prognosis of NODID RSIE compared to other RSIE forms. A retrospective cohort study (January 2008-January 2019) was conducted in a reference center on 300 patients diagnosed with IE. Endocarditis-related events were defined as related to IE in mortality or open-heart surgery during follow-up. A review and meta-analysis of associated literature (January 2008-January 2019) were also performed. Fifty-seven patients presented RSIE (19%), 22 of which were NODID RSIE (39%). Use of intravascular catheters (23% vs 3%; p = 0.027) and congenital heart diseases (18% vs 0%; p = 0.019) were associated with NODID RSIE. This group had a higher in-hospital mortality (23% vs 3%; p = 0.027) and endocarditis-related event rates (41% vs 6%; p = 0.001) than non-NODID RSIE. Furthermore, NODID RSIE was independently associated with in-hospital endocarditis-related events (OR = 19.29; 95%CI:2.23-167.16; p = 0.007). Our meta-analysis evaluated four studies and identified 96 cases (30%) of NODID RSIE from 320 total RSIE cases. NODID RSIE patients demonstrated higher in-hospital mortality (RR = 2.81; 95%CI:1.61-4.90; p < 0.001; I2 = 0.0%) and necessity of open-heart surgery (RR = 13.89; 95%CI:4.14-46.60; p < 0.001; I2 = 0.0%) than non-NODID RSIE cases. Our study suggests that NODID RSIE has the highest endocarditis-related event rate and in-hospital mortality among RSIE cases and therefore should not be considered a good-prognosis IE.


Caring for Patients with Advanced Stage Cancer at the Time of COVID-19


title: The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times

text: The impact of the COVID-19 pandemic on otolaryngology practice is nowhere more evident than in acute airway management. Considerations of preventing SARS-CoV-2 transmission, conserving personal protective equipment, and prioritizing care delivery based on acuity have dictated clinical decision making in the acute phase of the pandemic. With transition to a more chronic state of pandemic, heightened vigilance is necessary to recognize how deferral of care in patients with tenuous airways and COVID-19 infection may lead to acute airway compromise. Furthermore, it is critical to respect the continuing importance of flexible laryngoscopy in diagnosis. Safely managing airways during the pandemic requires thoughtful multidisciplinary planning. Teams should consider trade-offs among aerosol-generating procedures involving direct laryngoscopy, supraglottic airway use, fiberoptic intubation, and tracheostomy. We share clinical cases that illustrate enduring principles of acute airway management. As algorithms evolve, time-honored approaches for diagnosis and management of acute airway pathology remain essential in ensuring patient safety.


COVID-19 era: A chance to learn something new about monitoring psoriatic patients in biological therapy


Kicking on while it's still kicking off - getting surgery and anaesthesia restarted after COVID-19


title: COVID-19 and ENT surgery: a brief review of essential precautions and triage

text: PURPOSE: This study is a brief review of the existing knowledge on the ENT surgeon's approach towards management of patients during the COVID-19 pandemic. While it is being recommended to carry out only the emergent procedures and to postpone the non-urgent ones to a later date, this article is meant to provide an insight into triage of the ENT procedures and the various precautions to be taken into account by the ENT surgeons while carrying out a procedure during the COVID-19 pandemic. METHODS: The ENT Cochrane, Pubmed and Web of Science databases were searched without a time limit using the terms 'COVID-19 and SARS-CoV-2 in conjunction with ENT surgery. RESULTS: Elective and non urgent cases are best avoided during this time. Only absolutely essential and emergent procedures need to be carried out with the use of Personal protective equipment comprising of safety gown, N95 mask, safety goggles, disposable gloves and caps. There is a possibility of transmission of the SARS- CoV-2 through asymptomatic patients and hence all patients, even with an unknown COVID-19 status, need to undergo a preoperative screening. As all procedures under general anesthesia are aerosol generating, the use of Personal protective equipment (PPE) is recommended for all the health care workers present in the operation theater. CONCLUSION: A proper knowledge of triage would be of immense help to the ENT surgeon in minimizing the exposure to health care workers and patients during this pandemic. All patients with an unknown COVID-19 status should be considered suspects and essential precautions for their management be taken accordingly.


A perspective on modern advances for COVID-19 (SARS-CoV-2) therapeutics


title: An assessment of real-time RT-PCR kits for SARS-CoV-2 detection

text: The COVID-19 outbreak caused by SARS-CoV-2 in Wuhan (China) in December 2019 is currently spreading rapidly and globally. We recently reported a laboratory diagnostic protocol for SARS-CoV-2 based on real-time RT-PCR assays using two primer sets, N and N2. On 30-31 January 2020, the protocol and reagents for these assays were distributed to local public health institutes and quarantine depots in Japan, and nationwide, SARS-CoV-2 diagnostic testing was started. For further validation, the assays were compared with the commercially available kits using SARS CoV-2 viral RNA and the clinical specimens obtained from COVID19-suspected individuals. The LightMix Modular SARS and Wuhan CoV E-gene (LN S&W-E) assay was highly sensitive for SARS-CoV-2, as was the N2 set, and both assays had perfectly consistent results with the clinical specimens. While the LM S&W-E set targets the highly conserved region of the E gene in SARS-CoV and SARS-CoV-2, the N2 set was designed to target the unique region in the SARS-CoV-2 N gene. Thus, the N2 set has high specificity and sensitivity for SARS-CoV-2 detection. These indicate that the protocol using the N and N2 sets is comparable to commercially available kits and is reliable for the laboratory diagnosis of COVID-19.


Publishing in the Time of the Coronavirus Pandemic


title: A non-parametric Hawkes process model of primary and secondary accidents on a UK smart motorway

text: A self-exciting spatio-temporal point process is fitted to incident data from the UK National Traffic Information Service to model the rates of primary and secondary accidents on the M25 motorway in a 12-month period during 2017-18. This process uses a background component to represent primary accidents, and a self-exciting component to represent secondary accidents. The background consists of periodic daily and weekly components, a spatial component and a long-term trend. The self-exciting components are decaying, unidirectional functions of space and time. These components are determined via kernel smoothing and likelihood estimation. Temporally, the background is stable across seasons with a daily double peak structure reflecting commuting patterns. Spatially, there are two peaks in intensity, one of which becomes more pronounced during the study period. Self-excitation accounts for 6-7% of the data with associated time and length scales around 100 minutes and 1 kilometre respectively. In-sample and out-of-sample validation are performed to assess the model fit. When we restrict the data to incidents that resulted in large speed drops on the network, the results remain coherent.


title: Web Exclusive. Annals Graphic Medicine - COVID Cataclysms: Coronavirus Through a Medical Student's Microscope

text: [Figure: see text].


title: COVID 19 therapies and anti-cancer drugs: A systematic review of recent literature

text: BACKGROUND: It is reasonable to think that cancer patients undergoing chemotherapy, targeted therapy or immunotherapy could have a more aggressive course if positive for Coronavirus disease CoV-2 (COVID- 19). METHODS: We conducted a literature review on https://www.ncbi.nlm.nih.gov/pubmed/, https://scholar.google.com, www.arxiv.org, www.biorxiv.org, of all articles published using the keywords COVID-19 therapy or treatment and cancer until May 2, 2020. A total of 205 articles were identified and 53 were included in this review. RESULTS: We describe the ongoing COVID-19 therapies that should be known by oncologists and highlight the potential interactions with antineoplastic drugs, commonly used in clinical practice. The main drug interactions were found with tocilizumab, ruxolitinib and colchicine. CONCLUSIONS: The literature provides an inconclusive picture on potential preferred treatments for COVID-19 and their interactions with antineoplastic agents. Future clinical trials are needed to better understand the interactions between different drugs in the context of COVID-19 pandemic.


Endo tracheal tube exchange in a COVID positive patient


Rapid review of COVID-19


Lessons from the USA Delayed Response to the COVID-19 Pandemic


title: The Janus kinase 1/2 inhibitor ruxolitinib in COVID-19 with severe systemic hyperinflammation

text: A subgroup of patients with severe COVID-19 suffers from progression to acute respiratory distress syndrome and multiorgan failure. These patients present with progressive hyperinflammation governed by proinflammatory cytokines. An interdisciplinary COVID-19 work flow was established to detect patients with imminent or full blown hyperinflammation. Using a newly developed COVID-19 Inflammation Score (CIS), patients were prospectively stratified for targeted inhibition of cytokine signalling by the Janus Kinase 1/2 inhibitor ruxolitinib (Rux). Patients were treated with efficacy/toxicity guided step up dosing up to 14 days. Retrospective analysis of CIS reduction and clinical outcome was performed. Out of 105 patients treated between March 30th and April 15th, 2020, 14 patients with a CIS ≥ 10 out of 16 points received Rux over a median of 9 days with a median cumulative dose of 135 mg. A total of 12/14 patients achieved significant reduction of CIS by ≥25% on day 7 with sustained clinical improvement in 11/14 patients without short term red flag warnings of Rux-induced toxicity. Rux treatment for COVID-19 in patients with hyperinflammation is shown to be safe with signals of efficacy in this pilot case series for CRS-intervention to prevent or overcome multiorgan failure. A multicenter phase-II clinical trial has been initiated (NCT04338958).


Delivering psychotherapy by video conference in the time of COVID-19: Some considerations


Pulmonary embolism in COVID-19. When nothing is what it seems


PET imaging of COVID-19: the target and the number


title: On the incorporation of iron into hexagonal barium titanate: II. Magnetic moment, electron paramagnetic resonance (EPR) and optical transmission

text: Systematic measurements of the magnetic moment in dependence on temperature and magnetic field of hexagonal 6H-BaTiO3+ 0.04 BaO + x/2 Fe2O3(0.005 ≤ x ≤ 0.05) ceramics were performed to study the influence of Fe ions on the magnetic properties. While the samples show Curie-Weiss paramagnetism for Fe concentrations ≤ 1.0 mol%, antiferromagnetic interactions become manifest for 2.0 and 5.0 mol% iron. With increasing Fe content the antiferromagnetic interaction, which is assumed to be caused by a superexchange mechanism Fe3+Ti(1)- O2-O(2)- Fe3+Ti(2), becomes stronger. At external magnetic fields smaller than 1 T a further, ferromagnetic interaction between Fe3+ions is detected below 200 K. The interactions between Fe3+ions in the samples with 2.0 and 5.0 mol% iron are also manifest in the EPR spectra by numerous lines with low intensity. Q-band EPR investigations of 5.0 mol% Fe doped single crystals confirm the existence of only one type of Fe3+- VOassociates in the samples.


title: The SARS-CoV-2 receptor, ACE-2, is expressed on many different cell types: implications for ACE-inhibitor- and angiotensin II receptor blocker-based cardiovascular therapies

text: SARS-CoV-2 is characterized by a spike protein allowing viral binding to the angiotensin-converting enzyme (ACE)-2, which acts as a viral receptor and is expressed on the surface of several pulmonary and extra-pulmonary cell types, including cardiac, renal, intestinal and endothelial cells. There is evidence that also endothelial cells are infected by SARS-COV-2, with subsequent occurrence of systemic vasculitis, thromboembolism and disseminated intravascular coagulation. Those effects, together with the "cytokine storm" are involved in a worse prognosis. In clinical practice, angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) are extensively used for the treatment of hypertension and other cardiovascular diseases. In in vivo studies, ACE-Is and ARBs seem to paradoxically increase ACE-2 expression, which could favour SARS-CoV-2 infection of host's cells and tissues. By contrast, in patients treated with ACE-Is and ARBs, ACE-2 shows a downregulation at the mRNA and protein levels in kidney and cardiac tissues. Yet, it has been claimed that both ARBs and ACE-Is could result potentially useful in the clinical course of SARS-CoV-2-infected patients. As detected in China and as the Italian epidemiological situation confirms, the most prevalent comorbidities in deceased patients with COVID-19 are hypertension, diabetes and cardiovascular diseases. Older COVID-19-affected patients with cardiovascular comorbidities exhibit a more severe clinical course and a worse prognosis, with many of them being also treated with ARBs or ACE-Is. Another confounding factor is cigarette smoking, which has been reported to increase ACE-2 expression in both experimental models and humans. Sex also plays a role, with chromosome X harbouring the gene coding for ACE-2, which is one of the possible explanations of why mortality in female patients is lower. Viral entry also depends on TMPRSS2 protease activity, an androgen dependent enzyme. Despite the relevance of experimental animal studies, to comprehensively address the question of the potential hazards or benefits of ACE-Is and ARBs on the clinical course of COVID-19-affected patients treated by these anti-hypertensive drugs, we will need randomized human studies. We claim the need of adequately powered, prospective studies aimed at answering the following questions of paramount importance for cardiovascular, internal and emergency medicine: Do ACE-Is and ARBs exert similar or different effects on infection or disease course? Are such effects dangerous, neutral or even useful in older, COVID-19-affected patients? Do they act on multiple cell types? Since ACE-Is and ARBs have different molecular targets, the clinical course of SARS-CoV-2 infection could be also different in patients treated by one or the other of these two drug classes. At present, insufficient detailed data from trials have been made available.


title: Insights into redox mediators-resource harvest/application with power production from waste activated sludge through freezing/thawing-assisted anaerobic acidogenesis coupling microbial fuel cells

text: This first-attempted study demonstrated endogenous redox-mediators harvest/application from waste activated sludge (WAS) through freezing/thawing (F/T) pretreatment-enhanced anaerobic acidogenesis coupled with microbial fuel cells (MFCs). A total of 2.57 kWh electricity was produced from per kg soluble chemical oxygen demand (SCOD) via MFCs just in 2 d with about 90% organics removal, which contained 1.152 kWh/kg COD from F/T liquid together with 1.418 kWh/kg COD from fermentation liquid. The fermentation liquor-MFCs fostered higher anodic biodiversity and more power output as compared with the F/T liquid-MFCs. Essentially, the completely endogenous redox mediators-like substances with relatively high redox activities could be retained after MFC electrogenesis from F/T liquid and played electron shuttle-roles sufficiently in enlarging bio-energy production of MFCs, which seemed to be an effective option for harvesting endogenous redox mediators from sludge. This study might inspire progressive thinking toward aims of high-efficiency of resource recycle/bioenergy production from WAS.


title: Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective

text: In response to the estimated potential impact of coronavirus disease (COVID-19) on New York City hospitals, our institution prepared for an influx of critically ill patients. Multiple areas of surge planning progressed, simultaneously focused on infection control, clinical operational challenges, ICU surge capacity, staffing, ethics, and maintenance of staff wellness. The protocols developed focused on clinical decisions regarding intubation, the use of high-flow oxygen, engagement with infectious disease consultants, and cardiac arrest. Mechanisms to increase bed capacity and increase efficiency in ICUs by outsourcing procedures were implemented. Novel uses of technology to minimize staff exposure to COVID-19 as well as to facilitate family engagement and end-of-life discussions were encouraged. Education and communication remained key in our attempts to standardize care, stay apprised on emerging data, and review seminal literature on respiratory failure. Challenges were encountered and overcome through interdisciplinary collaboration and iterative surge planning as ICU admissions rose. Support was provided for both clinical and nonclinical staff affected by the profound impact COVID-19 had on our city. We describe in granular detail the procedures and processes that were developed during a 1-month period while surge planning was ongoing and the need for ICU capacity rose exponentially. The approaches described here provide a potential roadmap for centers that must rapidly adapt to the tremendous challenge posed by this and potential future pandemics.


Pulmonary Embolism in COVID-19 Patients: Awareness of an Increased Prevalence


COVID-19 and Health Equity-A New Kind of "Herd Immunity"


A Good Death : A Pandemic Lesson


Mortality from COVID-19: A cross-country comparison of containment versus mitigation strategy


Early signs that COVID-19 is being contained in Australia


The Meaning of Care and Ethics to Mitigate the Harshness of Triage in Second-Wave Scenario Planning During the COVID-19 Pandemic


title: Secondary HLH is uncommon in severe COVID-19

text: Severe cases of COVID-19, caused by novel coronavirus SARS-CoV-2, have been associated with a hyperinflammatory state.(Huang, Wang et al. 2020) This has been described as a form of secondary haemophagocytic lymphohistiocytosis (sHLH)(Bergsten, Horne et al. 2017) that may contribute to increased mortality.(Ramos-Casals, Brito-Zeron et al. 2014) Screening with the HScore(Fardet, Galicier et al. 2014) to identify cases has been recommended to guide immunosuppressive therapy(Mehta, McAuley et al. 2020).


title: Home monitoring for COVID-19

text: Cleveland Clinic recognized the importance of mitigating community transmission of COVID-19 by keeping people at home. Patient-care activities quickly pivoted to remote touches, preserving continuity through a variety of digital and telephonic modalities. As the number of confirmed cases grew, standardizing home-based care became critical to managing high-risk patients, moderating the risk of exposure for healthcare workers, and reducing the amount of community spread through appropriate education on home-based care for exposed or infected individuals. This novel, team-based approach to caring for patients with COVID-19 incorporates a self-monitoring app for patient engagement, monitors symptoms for early intervention, and promotes a holistic view of care.


title: Italian suggestions for pulmonary rehabilitation in COVID-19 patients recovering from acute respiratory failure: results of a Delphi process

text: There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts' opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision making within the context of the individual patient. Further studies will evaluate the clinical usefulness of these suggestions.


COVID-19 and gastrointestinal endoscopy: Importance of reducing SARS-CoV-2 infection risks of medical workers and preserving personal protective equipment resources


title: Changes in head and neck oncologic practice during the COVID-19 pandemic

text: INTRODUCTION: The COVID-19 pandemic has raised controversies regarding safe and effective care of patients with head and neck cancer. It is unknown how much the pandemic has changed surgeon practice. METHODS: A questionnaire was distributed to head and neck surgeons assessing opinions related to treatment and concerns for the safety of patients, self, family, and staff. RESULTS: A total of 88 head and neck surgeons responded during the study period. Surgeons continued to recommend primary surgical treatment for oral cavity cancers. Respondents were more likely to consider nonsurgical therapy for patients with early glottic cancers and HPV-mediated oropharynx cancer. Surgeons were least likely to be concerned for their own health and safety and had the greatest concern for their resident trainees. CONCLUSIONS: This study highlights differences in the willingness of head and neck surgeons to delay surgery or alter plans during times when hospital resources are scarce and risk is high.


Clinical diagnostic value of CT imaging in COVID-19 with multiple negative RT-PCR testing


title: Pandemic March: 2019 Coronavirus Disease's First Wave Circumnavigates the Globe

text: OBJECTIVE: March 2020 was a pivotal month for the worldwide geographic and numeric expansion of the first wave of Coronavirus Disease 2019 (COVID-19). We examined the major storylines that depicted this explosive spread of COVID-19 around the globe. METHODS: A detailed review of World Health Organization (WHO) situation reports, surveillance summaries, and online resources allowed us to quantify the increases in cases and deaths by region and by country throughout the month of March 2020. RESULTS: During March, COVID-19 was officially declared by the WHO to be a pandemic. COVID-19 emerged from a focalized outbreak in the Western Pacific Region and rapidly proliferated across all continents worldwide. Globally, cumulative numbers of confirmed cases increased by a factor of nine throughout the month. During the entire month, cases rose exponentially throughout Europe. Starting in mid-March, confirmed cases accelerated coast-to-coast throughout the United States and, on March 26, the United States surpassed all other nations to rank first in numbers of cases. COVID-19 mortality lagged several weeks behind but by month's end, death tolls were also rising exponentially. CONCLUSION: March 2020 was a consequential month when the COVID-19 pandemic wrapped completely around the planet, with outbreaks erupting in most nations worldwide.


Response to Letter to the Editor on "Digital Orthopedics. A Glimpse Into the Future in the Midst of a Pandemic"


Enfermedad por coronavirus2019(COVID-19): laimportancia de estar alerta ante las zoonosis/ Coronavirus disease2019(COVID-19): the importance of being aware of zoonose


The COVID-19 Curriculum


title: Clinical evaluation of AusDiagnostics SARS-CoV-2 multiplex tandem PCR assay

text: BACKGROUND: In the context of the pandemic, the rapid emergency use authorisation of diagnostic assays for SARS-CoV-2 has meant there are few peer-reviewed published studies of clinical performance of commercial assays. AIMS: To evaluate the clinical performance of AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2. METHODS: We reviewed the results following implementation of AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2, and compared with an in-house RT-PCR assay at our State Reference Laboratory. RESULTS: Initial validation using AusDiagnostics coronavirus multiplex tandem PCR assay including SARS-CoV-2 demonstrated good concordance with the State Reference Laboratory. After implementing the AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2, we tested 7839 samples. 127 samples in which SARS-CoV-2 was detected using the AusDiagnostics assay were referred for testing at the State Reference Laboratory, with concordant results in 118/127 (92.9%) of samples. After resolution of discrepancies, 125/127 (98.4%) of AusDiagnostics results were determined to be true positive results. Out of 7839 samples tested for SARS-CoV-2 during this period, only 2 tests (0.02%) were indeterminate results. CONCLUSION: The AusDiagnostics respiratory MT-PCR assay is a reliable assay for detection of SARS-CoV-2.


Successful sequencing of the first SARS-CoV-2 genomes from Croatian patients


title: [Analysis of Symptoms Relieved in Addition to Pain after Administration of Oxycodone or Morphine to Patients with Advanced Cancer Living at Home]

text: Cancer pain was observed in 131 of 160 patients with advanced cancer living at home. Oxycodone or morphine was administered to patients suffering from cancer pain or fentanyl transdermal patch was switched to morphine. Subsequently, 70 patients were found to have alleviation of symptoms such as nausea/vomiting, dyspnea, abdominal fullness, general fatigue, cough, and urinary urgency in addition to pain. Pain was defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage by the International Association for the Study of Pain. This definition of pain is cited in a lot of books. However, the author was unable to intervene with detailed reports of unpleasant sensations associated with tissue damage. Therefore, here the author reports about an unpleasant sensation caused by tissue damage of cancer that was alleviated by oxycodone or morphine.


title: The invisible victims - Impact of the pandemic on patients without COVID-19

text: The coronavirus disease (COVID-19) pandemic has shocked the world to a standstill. Routine healthcare has been severely disrupted. Healthcare service is a finite resource and in the current pandemic situation the risks of providing care to individual patients, whether they be confirmed, probable or suspected cases, should be balanced against the ability to provide safe routine long-term care to others. But how far can the healthcare system protect itself and fear the unknown, before it starts causing harm by omission? Herein we provide a review of cases that were misdiagnosed, left stranded in the system or had to face unnecessary delays due to the lack of an organised pathway.


title: Improving the care of older patients during the COVID-19 pandemic

text: The SARS-CoV-2 pandemic has led to a dramatic crisis of Health Care Systems worldwide, and older people have been among the most disadvantaged. Specific recommendations and reports have been released both at International and National level, regarding the diagnosis and management of COVID-19 in the elderly. However, little has been proposed for an appropriate response to older, frail and multimorbid patients in different settings of care (acute care units, long term care facilities, nursing homes and primary care) and for the management of geriatric syndromes (i.e. delirium, sarcopenia, falls). We presume that the current pandemic of will leads to substantial changes in health care systems, and we suggest some key guide principles that could inspire the provision of healthcare services to older people and their families. These principles are primarily directed to physicians and nurses working in the geriatric field but could also be useful for other specialists.


Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing, China


title: Repurposing Quaternary Ammonium Compounds as Potential Treatments for COVID-19

text: The COVID-19 pandemic has highlighted an important role for drug repurposing. Quaternary ammonium compounds such as ammonium chloride, cetylpyridinium and miramistin represent widely accessible antiseptic molecules with well-known broad-spectrum antiviral activities and represent a repurposing opportunity as therapeutics against SARS-CoV-2.


Potential for global spread of a novel coronavirus from China


Procedures to minimize viral diffusion in the intensive care unit during the COVID-19 pandemic


title: Restructuring Structural Heart Disease Practice During the COVID-19 Pandemic: JACC Review Topic of the Week

text: Patients with structural heart disease are at increased risk of adverse outcomes from the coronavirus disease-2019 (COVID-19) due to advanced age and comorbidity. In the midst of a global pandemic of a novel infectious disease, reality-based considerations comprise an important starting point for formulating clinical management pathways. The aims of these "crisis-driven" recommendations are: 1) to ensure appropriate and timely treatment of structural heart disease patients; 2) to minimize the risk of COVID-19 exposure to patients and health care workers; and 3) to limit resource utilization under conditions of constraint. Although the degree of disruption to usual practice will vary across the United States and elsewhere, we hope that early experiences from a heart team operating in the current global epicenter of COVID-19 may prove useful for others adapting their practice in advance of local surges of COVID-19.


title: In-store epidemic behavior: scale development and validation

text: Epidemics of infectious diseases have accompanied humans for a long time and, depending on the scale, cause various undesirable social and economic consequences. During the ongoing COVID-19 pandemic, governments of many countries impose restrictions to inhibit spreading of infection. Isolation and limiting interpersonal contacts are particularly recommended actions. Adhering to the rule of isolation may involve restrictions in freedom during daily activities, such as shopping. The aim of the study was to develop a scale of in-store pandemic behavior. The whole process involved 3 stages: qualitative inquiry, scale purification and scale validation, which were based on 3 studies: 1 qualitative (20 in-depth interviews) 2 two quantitative (373 and 584 respondents, respectively), and allowed to identify 8 factors. Following, a theoretical model was created to investigate the impact of in-store infection threat on identified variables. All identified factors significantly correlated with the in-store infection threat which reiterates the importance of providing information revealing the true scale of the pandemic and not leaving space for individuals to create subjective probability judgments. The developed scale can help counteract disinformation and assess consumer behavior compliance and understanding of the official recommendations imposed by governments, enabling more efficient educational efforts.


Editorial: increasing IBD prevalence and its complications in the context of the COVID-19 pandemic. Authors' reply


title: Why African Americans Are a Potential Target for COVID-19 Infection in the United States

text: Since the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic, significant changes have occurred in the United States as the infection spread reached and passed its exponential phase. A stringent analysis of COVID-19 epidemiologic data requires time and would generally be expected to happen with significant delay after the exponential phase of the disease is over and when the focus of the health care system is diverted away from crisis management. Although much has been said about high-risk groups and the vulnerability of the elderly and patients with underlying comorbidities, the impact of race on the susceptibility of ethnic minorities living in indigent communities has not been discussed in detail worldwide and specifically in the United States. There are currently some data on disparities between African American and Caucasian populations for COVID-19 infection and mortality. While health care authorities are reorganizing resources and infrastructure to provide care for symptomatic COVID-19 patients, they should not shy away from protecting the general public as a whole and specifically the most vulnerable members of society, such as the elderly, ethnic minorities, and people with underlying comorbidities.


title: Any unique image biomarkers associated with COVID-19?

text: OBJECTIVE: To define the uniqueness of chest CT infiltrative features associated with COVID-19 image characteristics as potential diagnostic biomarkers. METHODS: We retrospectively collected chest CT exams including n = 498 on 151 unique patients RT-PCR positive for COVID-19 and n = 497 unique patients with community-acquired pneumonia (CAP). Both COVID-19 and CAP image sets were partitioned into three groups for training, validation, and testing respectively. In an attempt to discriminate COVID-19 from CAP, we developed several classifiers based on three-dimensional (3D) convolutional neural networks (CNNs). We also asked two experienced radiologists to visually interpret the testing set and discriminate COVID-19 from CAP. The classification performance of the computer algorithms and the radiologists was assessed using the receiver operating characteristic (ROC) analysis, and the nonparametric approaches with multiplicity adjustments when necessary. RESULTS: One of the considered models showed non-trivial, but moderate diagnostic ability overall (AUC of 0.70 with 99% CI 0.56-0.85). This model allowed for the identification of 8-50% of CAP patients with only 2% of COVID-19 patients. CONCLUSIONS: Professional or automated interpretation of CT exams has a moderately low ability to distinguish between COVID-19 and CAP cases. However, the automated image analysis is promising for targeted decision-making due to being able to accurately identify a sizable subsect of non-COVID-19 cases. KEY POINTS: â¢ Both human experts and artificial intelligent models were used to classify the CT scans. â¢ ROC analysis and the nonparametric approaches were used to analyze the performance of the radiologists and computer algorithms. â¢ Unique image features or patterns may not exist for reliably distinguishing all COVID-19 from CAP; however, there may be imaging markers that can identify a sizable subset of non-COVID-19 cases.


Understanding COVID-19 new diagnostic guidelines - a message of reassurance from an internal medicine doctor in Shanghai


title: Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

text: BACKGROUND: An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. METHODS: In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. FINDINGS: Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3-11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. INTERPRETATION: The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1-2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. FUNDING: None.


Altered taste in patients with COVID-19: The potential role of salivary glands


title: The Microbiology of Coronaviruses

text: The end of 2019 marked the start of coronavirus disease (COVID-19) pandemic from China, which went on to envelope more than 190 countries and territories across the globe. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from a group of betacoronaviruses, is responsible for COVID-19. The virulent factors include the presence of envelope and spike proteins having receptor bonding domains (RBD). Clinical manifestations can range from mild respiratory infections to fatal outcomes. The viability of virus ranges from 3 to 72 hours. Polymerase chain reaction (PCR) is the diagnostic test of choice in this pandemic situation. Due to the absence of specific antivirals and vaccine, adoption of preventive option can help to combat the specific life-threatening outcomes.


COVID-19 in Canada and the use of Personal Protective Equipment


title: How we should respond to the Coronavirus SARS-CoV-2 outbreak: A German perspective

text: BACKGROUND: In the early phase of the COVID-19 pandemic Germany missed to set up efficient containment measures. Consequently, the number of cases increased exponentially until a lockdown was implemented to suppress the spread of SARS-CoV-2. Fortunately, Germany has a high capability for coronavirus lab testing and more than 30,000 ICU beds. These capabilities and the lockdown turned out to be an advantage to combat the pandemic and to prevent a health-system overload. AIM: The aim was to predict the plateau day of SARS-CoV-2 infections or deaths. RESULTS: The effect on the viral spread of the German measures taken and the impact on the peak of new infection cases is shown. By normalizing daily case numbers, the plateau day of the current outbreak in Germany could be calculated to be reached at April 12, 2020 (day 103 of 2020). CONCLUSION: Normalized case number curves are helpful to predict the time point at which no further new infections will occur if the epidemic situation remains stable. Upon reaching the plateau day during a lockdown phase, a residual time-period of about 2-3 weeks can be utilized to prepare a safe unlocking period. As can be learned from Asian countries such as South Korea and Taiwan there must be strict rules to keep the risk of infection low. Those include social distancing, face mask wearing in combination with digital contact tracing and serosurveillance studies. Following those rules, a safe dance around the infection curve allows to keep the population at a reduced infection rate.


title: COVID-19 in recent kidney transplant recipients

text: As the coronavirus disease 2019 (COVID-19) pandemic spread across the globe, transplant programs suffered a setback. We report the first experience of COVID-19 infection within 1 month of living donor kidney transplant (LDKT). We describe 2 LDKT recipients who were detected positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at day 19 and day 7 posttransplant. They had minimal symptoms at diagnosis and did not develop any respiratory complications or allograft dysfunction. Immunosuppression was de-escalated; however, nasopharyngeal swab real-time reverse transcription polymerase chain reaction (rRT-PCR) remained positive for SARS-CoV-2 for a prolonged time. Younger age, absence of other comorbidities, and lower dose of anti-thymocyte globulin (ATG) used as induction possibly contributed to good outcome in our recent LDKT recipients compared with earlier published cases of recent deceased donor kidney transplant recipients with COVID-19.


Lack of type 1 diabetes involvement in SARS-COV-2 population: Only a particular coincidence?


title: Reconfiguring the scope and practice of regional anesthesia in a pandemic: the COVID-19 perspective

text: The COVID-19 outbreak is on the world. While many countries have imposed general lockdown, emergency services are continuing. Healthcare professionals have been infected with the virulent severe acute respiratory syndrome coronavirus-2 (SARS), which spreads by close contact and aerosols. The anesthesiologist is particularly vulnerable to aerosols while performing intubation and other airway related procedures. Regional anesthesia (RA) minimizes the need for airway manipulation and the risks of cross infection to other patients, and the healthcare personnel. In this context, for prioritizing RA over general anesthesia, wherever possible, a structured algorithmic approach is outlined. The role of percentage saturation of hemoglobin with oxygen (oxygen saturation), blood pressure and early use of point-of-care ultrasound in differential diagnosis and specific management is detailed. The perioperative anesthetic implications of multisystem manifestations of COVID-19, anesthetic management options, the scope of RA and considerations for its safe conduct in operating rooms is described. An outline for safe and rapid training of healthcare personnel, with an Entrustable Professional Activity framework for ascertaining the practice readiness among trained residents for RA in COVID-19, is suggested. These are the authors' experiences gained from the current pandemic and similar SARS, Middle East Respiratory Syndrome and influenza outbreaks in recent past faced by our authors in Singapore, India, Hong Kong and Canada.


title: Public Health Communication in Time of Crisis: Readability of On-Line COVID-19 Information

text: OBJECTIVE: The purpose of this study was to assess the readability of information on the Internet posted about coronavirus disease 2019 (COVID-19) to determine how closely these materials are written to the recommended reading levels. METHODS: Using the search term "coronavirus," information posted on the first 100 English language websites was identified. Using an online readability calculator, multiple readability tests were conducted to ensure a comprehensive representation would result. RESULTS: The mean readability scores ranged between grade levels 6.2 and 17.8 (graduate school level). Four of the 5 measures (GFI, CLI, SMOG, FRE) found that readability exceeded the 10th grade reading level indicating that the text of these websites would be difficult for the average American to read. The mean reading level for nearly all noncommercial and commercial websites was at or above the 10th grade reading level. CONCLUSIONS: Messages about COVID-19 must be readable at an "easy" level, and must contain clear guidelines for behavior. The degree to which individuals seek information in response to risk messages is positively related to the expectation that the information will resolve uncertainty. However, if the information is too complex to interpret and it fails to lead to disambiguation, this can contribute to feelings of panic.


COVID-19 cytokine storm and novel truth


title: Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic

text: INTRODUCTION: Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols. OBJECTIVE: To demonstrate the utility of a modified anesthesia protocol for ECT utilizing preoxygenation by facemask and withholding the use of BMV for only those patients who desaturate during the apneic period. METHODS: This chart review study analyzes patients who were treated with ECT using both the traditional and modified anesthesia protocols. RESULTS: A total of 106 patients were analyzed, of whom 51 (48.1%) required BMV using the new protocol. Of clinical factors, only patient BMI was significantly associated with the requirement for BMV. Mean seizure duration reduced from 52.0 ± 22.4 to 46.6 ± 17.1 s, but seizure duration was adequate in all cases. No acute physical, respiratory, or psychiatric complications occurred during treatment. CONCLUSIONS: A modified anesthesia protocol reduces the use of BMV by more than 50%, while retaining adequate seizure duration.


title: Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China

text: BACKGROUND: On January 20, 2020, a new coronavirus epidemic with human-to-human transmission was officially declared by the Chinese government, which caused significant public panic in China. In light of the coronavirus disease 2019 outbreak, pregnant women may be particularly vulnerable and in special need for preventive mental health strategies. Thus far, no reports exist to investigate the mental health response of pregnant women to the coronavirus disease 2019 outbreak. OBJECTIVE: This study aimed to examine the impact of coronavirus disease 2019 outbreak on the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women across China. STUDY DESIGN: A multicenter, cross-sectional study was initiated in early December 2019 to identify mental health concerns in pregnancy using the Edinburgh Postnatal Depression Scale. This study provided a unique opportunity to compare the mental status of pregnant women before and after the declaration of the coronavirus disease 2019 epidemic. A total of 4124 pregnant women during their third trimester from 25 hospitals in 10 provinces across China were examined in this cross-sectional study from January 1, 2020, to February 9, 2020. Of these women, 1285 were assessed after January 20, 2020, when the coronavirus epidemic was publicly declared and 2839 were assessed before this pivotal time point. The internationally recommended Edinburgh Postnatal Depression Scale was used to assess maternal depression and anxiety symptoms. Prevalence rates and risk factors were compared between the pre- and poststudy groups. RESULTS: Pregnant women assessed after the declaration of coronavirus disease 2019 epidemic had significantly higher rates of depressive symptoms (26.0% vs 29.6%, P=.02) than women assessed before the epidemic declaration. These women were also more likely to have thoughts of self-harm (P=.005). The depressive rates were positively associated with the number of newly confirmed cases of coronavirus disease 2019 (P=.003), suspected infections (P=.004), and deaths per day (P=.001). Pregnant women who were underweight before pregnancy, primiparous, younger than 35 years, employed full time, in middle income category, and had appropriate living space were at increased risk for developing depressive and anxiety symptoms during the outbreak. CONCLUSION: Major life-threatening public health events such as the coronavirus disease 2019 outbreak may increase the risk for mental illness among pregnant women, including thoughts of self-harm. Strategies targeting maternal stress and isolation such as effective risk communication and the provision of psychological first aid may be particularly useful to prevent negative outcomes for women and their fetuses.


title: Perinatal depressive and anxiety symptoms of pregnant women along with COVID-19 outbreak in China

text: BACKGROUND: On January 20, 2020, a new coronavirus epidemic with "human-to-human" transmission was officially announced by the Chinese government, which caused significant public panic in China. Pregnant women may be particularly vulnerable and in special need for preventative mental health strategies. Thus far, no reports exist to investigate the mental health response of pregnant women to the COVID-19 outbreak. OBJECTIVE: The aim of the present study is to examine the impact of COVID-19 outbreak on the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women across China. STUDY DESIGN: A multi-center cross-sectional study was initiated in early December 2019 to identify mental health concerns in pregnancy using the Edinburgh Postnatal Depression Scale (EPDS). This study provided a unique opportunity to compare the mental status of pregnant women before and after the announcement of the COVID-19 epidemic. A total of 4124 pregnant women during their third trimester from 25 hospitals in 10 provinces across China were examined in this cross-sectional study from January 1 to February 9, 2020. Of these women, 1285 were assessed after January 20, 2020 when the coronavirus epidemic was publically announced and 2839 were assessed before this pivotal time point. The internationally recommended EPDS was used to assess maternal depression and anxiety symptoms. Prevalence rates and risk factors were compared between the pre and post study groups. RESULTS: Pregnant women assessed after the declaration of COVID-19 epidemic had significantly higher rates of depressive symptoms (26.0% vs 29.6%, P=0.02) than women assess pre-epidemic announcement. These women were also more likely to endorse thoughts of self-harm (P=0.005). The depressive rates were positively associated with the number of newly-confirmed COVID-19 cases (P=0.003), suspected infections (P=0.004), and death cases per day (P=0.001). Pregnant women who were underweight pre-pregnancy, primiparous, < 35 years old, employed full-time, middle income, and had appropriate living space were at increased risk to develop depressive and anxiety symptoms during the outbreak. CONCLUSION: Major life-threatening public health events such as the COVID-19 outbreak may increase the risk for mental illness among pregnant women including thoughts of self-harm. Strategies targeting maternal stress and isolation such as effective risk communication and the provision of psychological first aid may be particularly useful to prevent negative outcomes for women and their fetuses.


COVID-19: a danger and an opportunity for the future of general practice


Lung Ultrasound in COVID-19 Patients - More Shadows Than Information - Letter to the Editor on the Article "W. LU et al. Ultraschall in Med. 2020 Apr 15"


title: WiFiTrace: Network-based Contact Tracing for Infectious Diseases Using Passive WiFi Sensing

text: Contact tracing is a well-established and effective approach for containment of spread of infectious diseases. While bluetooth-based contact tracing method using phones have become popular recently, these approaches suffer from the need for a critical mass of adoption in order to be effective. In this paper, we present WifiTrace, a network-centric approach for contact tracing that relies on passive WiFi sensing with no client-side involvement. Our approach exploits WiFi network logs gathered by enterprise networks for performance and security monitoring and utilizes it for reconstructing device trajectories for contact tracing. Our approach is specifically designed to enhance the efficacy of traditional methods, rather than to supplant it with a new technology. We design an efficient graph algorithm to scale our approach to large networks with tens of thousands of users. We have implemented a full prototype of our system and deployed it on two large university campuses. We validate our approach and demonstrate its efficacy using case studies and detailed experiments using real-world WiFi datasets.


Second-Trimester Miscarriage in a Pregnant Woman With SARS-CoV-2 Infection


title: NCI's Work to Advance Cancer Research while Responding to the COVID-19 Pandemic

text: During the COVID-19 pandemic, the National Cancer Institute (NCI) is bringing to bear its considerable expertise and capabilities to understand, treat, and prevent the disease. While responding to the pandemic, NCI's priority remains the advancement of cancer research. NCI has implemented many flexibilities for grantees and trainees.


COVID-19 and Perinatal Psychiatry


title: Serology characteristics of SARS-CoV-2 infection since exposure and post symptom onset

text: BACKGROUND: Timely diagnosis of SARS-CoV-2 infection is a prerequisite for treatment and prevention. The serology characteristics and complement diagnosis value of the antibody test to RNA test need to be demonstrated. METHOD: Serial sera of 80 patients with PCR-confirmed COVID-19 were collected at the First Affiliated Hospital of Zhejiang University, China. Total antibody (Ab), IgM and IgG antibodies against SARS-CoV-2 were detected, and the antibody dynamics during the infection were described. RESULTS: The seroconversion rates for Ab, IgM and IgG were 98.8%, 93.8% and 93.8%, respectively. The first detectible serology marker was Ab, followed by IgM and IgG, with a median seroconversion time of 15, 18 and 20â days post exposure (d.p.e) or 9, 10 and 12â days post onset (d.p.o), respectively. The antibody levels increased rapidly beginning at 6â d.p.o. and were accompanied by a decline in viral load. For patients in the early stage of illness (0-7â d.p.o), Ab showed the highest sensitivity (64.1%) compared to IgM and IgG (33.3% for both, p<0.001). The sensitivities of Ab, IgM and IgG increased to 100%, 96.7% and 93.3% 2â weeks later, respectively. When the same antibody type was detected, no significant difference was observed between enzyme-linked immunosorbent assays and other forms of immunoassays. CONCLUSIONS: A typical acute antibody response is induced during SARS-CoV-2 infection. Serology testing provides an important complement to RNA testing in the later stages of illness for pathogenic specific diagnosis and helpful information to evaluate the adapted immunity status of patients.


Reumataxi: una experiencia solidaria en tiempos de COVID-19./ Reumataxi: una experiencia solidaria en tiempos de COVID-19./ Reumataxi: An experience of solidarity in times of COVID-19


title: [Psychological status and sleep quality of nursing interns during the outbreak of COVID-19]

text: OBJECTIVE: To investigate the psychological status and sleep quality of nursing interns in collective isolation during the outbreak of coronavirus disease 2019 (COVID-19) and provide evidence for adequate interventions. METHODS: We surveyed a total of 95 nursing interns who were isolated collectively in a general teaching hospital in Guangzhou using a self-designed questionnaire, which consisted of a basic information form, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Pittsburgh Sleep Quality Index (PSQI). Descriptive analysis, single factor analysis and correlation analysis were used to analyze the current status of the interns' psychology and sleep quality, the potential factors affecting their psychology and sleep quality, and the correlation between their psychological status and sleep quality. RESULTS: The surveyed interns had SAS, SDS and PSQI score of 37.79±6.59, 43.98±9.74 and 5.20±3.14, respectively, which were significant higher than the national norms in China (P < 0.05). Correlation analysis indicated that both anxiety and depression were positively correlated with the sleep quality score (r=0.508 and 0.546, respectively). Univariate analysis showed that the major factors affecting the psychological status and sleep quality of the interns during collective isolation included recent contact with persons from the affected area before isolation and the onset of fever during the isolation. CONCLUSIONS: These interns showed relatively high levels of anxiety and depression during the collective isolation to affect their sleep quality, and interventions should be timely administered to improve their mental health and sleep quality.


Going viral with kindness


title: SARS-CoV-2-specific antibody detection in healthcare workers in Germany with direct contact to COVID-19 patients

text: BACKGROUND: The novel coronavirus SARS-CoV-2 is associated with a severe respiratory manifestation, COVID-19, and presents a challenge for healthcare systems worldwide. Healthcare workers are a vulnerable cohort for SARS-CoV-2 infection due to frequent and close contact to patients with COVID-19. STUDY DESIGN: Serum samples from 316 healthcare workers of the University Hospital Essen, Germany were tested for SARS-CoV-2-IgG antibodies. A questionnaire was used to collect demographic and clinical data. Healthcare workers were grouped depending on the frequency of contact to COVID-19 patients in high-risk-group (n = 244) with daily contact to known or suspected SARS-CoV-2 positive patients, intermediated-risk-group (n = 37) with daily contact to patients without known or suspected SARS-CoV-2 infection at admission and low-risk-group (n = 35) without patient contact. RESULTS: In 5 of 316 (1.6 %) healthcare workers SARS-CoV-2-IgG antibodies could be detected. The seroprevalence was higher in the intermediate-risk-group vs. high-risk-group (2/37 (5.4 %) vs. 3/244 (1.2 %), p = 0.13). Four of the five subject were tested negative for SARS-CoV-2 via PCR. One (20 %) subject was not tested via PCR since he was asymptomatic. CONCLUSION: The overall seroprevalence of SARS-CoV-2 in healthcare workers of a tertiary hospital in Germany is low (1.6 %). The data indicate that the local hygiene standard might be effective.


Treating neovascular age-related macular degeneration in the era of COVID-19


China coronavirus: cases surge as official admits human to human transmission


Maintaining quality newborn care in Ghana amid the COVID-19 pandemic


Severe acute respiratory syndrome coronavirus 19 and human pregnancy


title: Redesign of a GI endoscopy unit during the COVID-19 emergency: A practical model

text: The pandemic diffusion of the SARS-CoV-2 infection throughout the world required measures to prevent and strategies to control the infection, as well as the reallocation of the hospital structures in order to take care of an increased number of infected patients. Endoscopy Units should be able to perform endoscopic procedures on COVID-19 infected as well as on noninfected patients. The aim of this manuscript is to propose a model for a fast reorganization of the endoscopy department environment in order to safely perform endoscopic procedures in this Pandemic COVID-19 scenario, according to the current advices given by the Scientific Societies.


title: M3d-CAM: A PyTorch library to generate 3D data attention maps for medical deep learning

text: M3d-CAM is an easy to use library for generating attention maps of CNN-based PyTorch models improving the interpretability of model predictions for humans. The attention maps can be generated with multiple methods like Guided Backpropagation, Grad-CAM, Guided Grad-CAM and Grad-CAM++. These attention maps visualize the regions in the input data that influenced the model prediction the most at a certain layer. Furthermore, M3d-CAM supports 2D and 3D data for the task of classification as well as for segmentation. A key feature is also that in most cases only a single line of code is required for generating attention maps for a model making M3d-CAM basically plug and play.


title: Keeping people with epilepsy safe during the COVID-19 pandemic

text: OBJECTIVES: To provide information on the effect of the coronavirus disease of 2019 (COVID-19) pandemic on people with epilepsy and provide consensus recommendations on how to provide the best possible care for people with epilepsy while avoiding visits to urgent care facilities and hospitalizations during the novel coronavirus pandemic. METHODS: The authors developed consensus statements in 2 sections. The first was "How should we/clinicians modify our clinical care pathway for people with epilepsy during the COVID-19 pandemic?" The second was "What general advice should we give to people with epilepsy during this crisis? The authors individually scored statements on a scale of -10 (strongly disagree) to +10 (strongly agree). Five of 11 recommendations for physicians and 3/5 recommendations for individuals/families were rated by all the authors as 7 or above (strongly agree) on the first round of rating. Subsequently, a teleconference was held where statements for which there was a lack of strong consensus were revised. RESULTS: After revision, all consensus recommendations received a score of 7 or above. The recommendations focus on administration of as much care as possible at home to keep people with epilepsy out of health care facilities, where they are likely to encounter COVID-19 (including strategies for rescue therapy), as well as minimization of risk of seizure exacerbation through adherence, and through ensuring a regular supply of medication. We also provide helpful links to additional helpful information for people with epilepsy and health providers. CONCLUSION: These recommendations may help health care professionals provide optimal care to people with epilepsy during the coronavirus pandemic.


title: Cerebrovascular events in COVID-19 patients

text: Neurological manifestations in patients with COVID-19 are more frequently being reported. Cerebrovascular events have been reported in around 3% of patients. In this review we summarize the published literature on cerebrovascular events in patients with COVID-19 as available on the PubMed database. So far, 3 studies have reported cerebrovascular events. Cerebrovascular events were identified on screening patients with decreased consciousness or in the presence of focal neurological deficits. These events were common in elderly, critically ill patients and in patients with prior cardio-cerebrovascular comorbidities. The diagnosis of cerebrovascular events was confirmed with computed tomography of the brain in most studies reporting neurological events. Multiple pathological mechanisms have been postulated regarding the process of neurological and vascular injury among which cytokine storm is shown to correlate with mortality. Patients with severe illness are found to have a higher cardio- cerebrovascular comorbidity. With an increasing number of cases and future prospective studies, the exact mechanism by which these cerebrovascular events occur and attribute to the poor outcome will be better understood.


title: Facial Plastic and Reconstructive Surgery During the COVID-19 Pandemic: Implications in Craniomaxillofacial Trauma and Head and Neck Reconstruction

text: BACKGROUND: The global COVID-19 pandemic has had a profound impact on facial plastic and reconstructive surgery. Our review serves as a safety resource based on the current literature and is aimed at providing best-practice recommendations. Specifically, this article is focused on considerations in the management of craniomaxillofacial trauma as well as reconstructive procedures after head and neck oncologic resection. METHODS: Relevant clinical data were obtained from peer-reviewed journal articles, task force recommendations, and published guidelines from multiple medical organizations utilizing data sources including PubMed, Google Scholar, MEDLINE, and Google search queries. Relevant publications were utilized to develop practice guidelines and recommendations. CONCLUSIONS: The global COVID-19 pandemic has placed a significant strain on health care resources with resultant impacts on patient care. Surgeons operating in the head and neck are particularly at risk of occupational COVID-19 exposure during diagnostic and therapeutic procedures and must therefore be cognizant of protocols in place to mitigate exposure risk and optimize patient care.