title: Challenges of virtual talking therapies for substance misuse in New Zealand during the COVID-19 pandemic: an opinion piece

text: The COVID-19 pandemic requires us to rethink how virtual approaches might work for people who use alcohol and other drugs Are virtual clinics only suitable for clients with whom clinicians have already formed a therapeutic relationship? How well would virtual clinics work for new clients presenting to services, for clients in acute distress, and for those with complex problems? Addressing the sustained change required to maintain substance-free lives or a safe substance-use life requires robust psychotherapeutic approaches, which have traditionally been delivered through physical contact, whether they are one-to-one or group-based interventions The challenge during this time of the COVID-19 pandemic is to deliver effective talking therapies while avoiding physical contact How then should services continue to offer counselling and support in such an environment? How can we learn from the COVID-19 situation to deliver treatment to individuals who may have difficulties attending traditional clinic-based care, such as those in more rural areas with transport difficulties? This article focuses on identifying practical issues and providing some solutions


title: Incidental Findings Suggestive of COVID-19 in Asymptomatic Patients Undergoing Nuclear Medicine Procedures in a High-Prevalence Region

text: Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may remain asymptomatic, leading to under-recognition of the related disease, coronavirus disease, 2019 (COVID-19), and to incidental findings in nuclear imaging procedures performed for standard clinical indications. Here, we report about our local experience in a region with high COVID-19 prevalence and dynamically increasing infection rates. Methods: Within the 8-d period of March 16-24, 2020, hybrid imaging studies of asymptomatic patients who underwent 18F-FDG PET/CT or 131I SPECT/CT for standard oncologic indications at our institution in Brescia, Italy, were analyzed for findings suggestive of COVID-19. The presence, radiologic features, and metabolic activity of interstitial pneumonia were identified, correlated with the subsequent short-term clinical course, and described in a case series. Results: Six of 65 patients (9%) who underwent PET/CT for various malignancies showed unexpected signs of interstitial pneumonia on CT and elevated regional 18F-FDG avidity. Additionally, 1 of 12 patients who received radioiodine for differentiated thyroid carcinoma also showed interstitial pneumonia on SPECT/CT. Five of 7 patients had subsequent proof of COVID-19 by reverse-transcriptase polymerase chain reaction. The remaining 2 patients were not tested immediately but underwent quarantine and careful monitoring. Conclusion: Incidental findings suggestive of COVID-19 may not be infrequent in hybrid imaging of asymptomatic patients in regions with an expansive spread of SARS-CoV-2. Nuclear medicine services should prepare accordingly.


title: Operational considerations and challenges of biochemistry laboratories during the COVID-19 outbreak: an IFCC global survey

text: Objectives The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on COVID-19 conducted a global survey to understand how biochemistry laboratories manage the operational challenges during the coronavirus disease 2019 (COVID-19) pandemic. Materials and methods An electronic survey was distributed globally to record the operational considerations to mitigate biosafety risks in the laboratory. Additionally, the laboratories were asked to indicate the operational challenges they faced. Results A total of 1210 valid submissions were included in this analysis. Most of the survey participants worked in hospital laboratories. Around 15% of laboratories restricted certain tests on patients with clinically suspected or confirmed COVID-19 over biosafety concerns. Just over 10% of the laboratories had to restrict their test menu or services due to resource constraints. Approximately a third of laboratories performed temperature monitoring, while two thirds of laboratories increased the frequency of disinfection. Just less than 50% of the laboratories split their teams. The greatest reported challenge faced by laboratories during the COVID-19 pandemic is securing sufficient supplies of personal protective equipment (PPE), analytical equipment, including those used at the point of care, as well as reagents, consumables and other laboratory materials. This was followed by having inadequate staff, managing their morale, anxiety and deployment. Conclusions The restriction of tests and services may have undesirable clinical consequences as clinicians are deprived of important information to deliver appropriate care to their patients. Staff rostering and biosafety concerns require longer-term solutions as they are crucial for the continued operation of the laboratory during what may well be a prolonged pandemic.


title: Successful treatment of chronic myelomonocytic leukaemia with hydroxycarbamide in a patient presenting with acute hypoxic respiratory failure due to COVID-19 pneumonia

text: On 30th March 2020, a 57-year-old male patient presented to the Emergency Department with a 6-day history of cough, persistent fevers and worsening dyspnoea. His only known comorbidity was hypertension, managed with amlodipine and an angiotensin converting enzyme inhibitor. On admission, he was tachypnoeic and in severe hypoxic respiratory failure with dangerously low peripheral oxygen saturations (SpO2 ) 83% on 15L oxygen. Chest radiographic changes were consistent with COVID-19 infection and demonstrated bilateral changes with diffuse airspace shadowing with more confluence in the lower zones (Figure 1A).


COVID-19: counter-intuitive data on smoking prevalence and therapeutic implications for nicotine


Reply to Tognù et al: regional anesthesia for proximal humerus surgery during COVID-19 pandemic


title: Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods

text: SARS-CoV-2 has caused tens of thousands of infections and more than one thousand deaths. There are currently no registered therapies for treating coronavirus infections. Because of time consuming process of new drug development, drug repositioning may be the only solution to the epidemic of sudden infectious diseases. We systematically analyzed all the proteins encoded by SARS-CoV-2 genes, compared them with proteins from other coronaviruses, predicted their structures, and built 19 structures that could be done by homology modeling. By performing target-based virtual ligand screening, a total of 21 targets (including two human targets) were screened against compound libraries including ZINC drug database and our own database of natural products. Structure and screening results of important targets such as 3-chymotrypsin-like protease (3CLpro), Spike, RNA-dependent RNA polymerase (RdRp), and papain like protease (PLpro) were discussed in detail. In addition, a database of 78 commonly used anti-viral drugs including those currently on the market and undergoing clinical trials for SARS-CoV-2 was constructed. Possible targets of these compounds and potential drugs acting on a certain target were predicted. This study will provide new lead compounds and targets for further in vitro and in vivo studies of SARS-CoV-2, new insights for those drugs currently ongoing clinical studies, and also possible new strategies for drug repositioning to treat SARS-CoV-2 infections.


title: Principled decisions and virtuous care: an ethical assessment of the Siaarti guidelines for allocating intensive care resources

text: This article sets forth ethical principles for responding to extraordinary circumstances in which the demand for medical care threatens to overwhelms available resources, as in the COVID-19 pandemic. In light of these principles, the author then assesses the ethics of the SIAARTI guidelines for rationing ICU beds and ventilators under such circumstances.


La Dermatología española en la era de la COVID-19./ La Dermatología española en la era de la COVID-19./ Spanish Dermatology in the COVID-19 Era


title: Does Vitamin D play a role in the management of Covid-19 in Brazil?

text: The study discusses the possible role of adequate vitamin D status in plasma or serum for preventing acute respiratory infections during the Covid-19 pandemic. Our arguments respond to an article, published in Italy, that describes the high prevalence of hypovitaminosis D in older Italian women and raises the possible preventive and therapeutic role of optimal vitamin D levels. Based on literature review, we highlight the findings regarding the protective role of vitamin D for infectious diseases of the respiratory system. However, randomized controlled trials are currently lacking. Adequate vitamin D status is obtained from sun exposure and foods rich in vitamin D. Studies in Brazil have shown that hypovitaminosis D is quite common in spite of high insolation. Authors recommend ecological, epidemiological and randomized controlled trials studies to verify this hypothesis.


title: Positionspapier zur praktischen Umsetzung der apparativen Differenzialtherapie der akuten respiratorischen Insuffizienz bei COVID-19./ [Position Paper for the State of the Art Application of Respiratory Support in Patients with COVID-19 - German Respiratory Society]

text: Against the background of the pandemic caused by infection with the SARS-CoV-2, the German Society for Pneumology and Respiratory Medicine (DGP e.V.), in cooperation with other associations, has designated a team of experts in order to answer the currently pressing questions about therapy strategies in dealing with COVID-19 patients suffering from acute respiratory insufficiency (ARI).The position paper is based on the current knowledge that is evolving daily. Many of the published and cited studies require further review, also because many of them did not undergo standard review processes.Therefore, this position paper is also subject to a continuous review process and will be further developed in cooperation with the other professional societies.This position paper is structured into the following five topics:1. Pathophysiology of acute respiratory insufficiency in patients without immunity infected with SARS-CoV-22. Temporal course and prognosis of acute respiratory insufficiency during the course of the disease3. Oxygen insufflation, high-flow oxygen, non-invasive ventilation and invasive ventilation with special consideration of infectious aerosol formation4. Non-invasive ventilation in ARI5. Supply continuum for the treatment of ARIKey points have been highlighted as core statements and significant observations. Regarding the pathophysiological aspects of acute respiratory insufficiency (ARI), the pulmonary infection with SARS-CoV-2 COVID-19 runs through three phases: early infection, pulmonary manifestation and severe hyperinflammatory phase.There are differences between advanced COVID-19-induced lung damage and those changes seen in Acute Respiratory Distress Syndromes (ARDS) as defined by the Berlin criteria. In a pathophysiologically plausible - but currently not yet histopathologically substantiated - model, two types (L-type and H-type) are distinguished, which correspond to an early and late phase. This distinction can be taken into consideration in the differential instrumentation in the therapy of ARI.The assessment of the extent of ARI should be carried out by an arterial or capillary blood gas analysis under room air conditions and must include the calculation of the oxygen supply (measured from the variables of oxygen saturation, the Hb value, the corrected values of the Hüfner number and the cardiac output). In principle, aerosols can cause transmission of infectious viral particles. Open systems or leakage systems (so-called vented masks) can prevent the release of respirable particles. Procedures in which the invasive ventilation system must be opened, and endotracheal intubation must be carried out are associated with an increased risk of infection.The protection of personnel with personal protective equipment should have very high priority because fear of contagion must not be a primary reason for intubation. If the specifications for protective equipment (eye protection, FFP2 or FFP-3 mask, gown) are adhered to, inhalation therapy, nasal high-flow (NHF) therapy, CPAP therapy or NIV can be carried out according to the current state of knowledge without increased risk of infection to the staff. A significant proportion of patients with respiratory failure presents with relevant hypoxemia, often also caused by a high inspiratory oxygen fraction (FiO2) including NHF, and this hypoxemia cannot be not completely corrected. In this situation, CPAP/NIV therapy can be administered under use of a mouth and nose mask or a respiratory helmet as therapy escalation, as long as the criteria for endotracheal intubation are not fulfilled.In acute hypoxemic respiratory insufficiency, NIV should be performed in an intensive care unit or in a comparable unit by personnel with appropriate expertise. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring with readiness to carry out intubation must be ensured at all times. If CPAP/NIV leads to further progression of ARI, intubation and subsequent invasive ventilation should be carried out without delay if no DNI order is in place.In the case of patients in whom invasive ventilation, after exhausting all guideline-based measures, is not sufficient, extracorporeal membrane oxygenation procedure (ECMO) should be considered to ensure sufficient oxygen supply and to remove CO2.


title: Long Term Culture of Human Kidney Proximal Tubule Epithelial Cells Maintains Lineage Functions and Serves as an Ex vivo Model for Coronavirus Associated Kidney Injury

text: The mechanism of how SARS-CoV-2 causes severe multi-organ failure is largely unknown. Acute kidney injury (AKI) is one of the frequent organ damage in severe COVID-19 patients. Previous studies have shown that human renal tubule cells could be the potential host cells targeted by SARS-CoV-2. Traditional cancer cell lines or immortalized cell lines are genetically and phenotypically different from host cells. Animal models are widely used, but often fail to reflect a physiological and pathogenic status because of species tropisms. There is an unmet need for normal human epithelial cells for disease modeling. In this study, we successfully established long term cultures of normal human kidney proximal tubule epithelial cells (KPTECs) in 2D and 3D culture systems using conditional reprogramming (CR) and organoids techniques. These cells had the ability to differentiate and repair DNA damage, and showed no transforming property. Importantly, the CR KPTECs maintained lineage function with expression of specific transporters (SLC34A3 and cubilin). They also expressed angiotensin-converting enzyme 2 (ACE2), a receptor for SARS-CoV and SARS-CoV-2. In contrast, cancer cell line did not express endogenous SLC34A3, cubilin and ACE2. Very interestingly, ACE2 expression was around twofold higher in 3D organoids culture compared to that in 2D CR culture condition. Pseudovirion assays demonstrated that SARS-CoV spike (S) protein was able to enter CR cells with luciferase reporter. This integrated 2D CR and 3D organoid cultures provide a physiological ex vivo model to study kidney functions, innate immune response of kidney cells to viruses, and a novel platform for drug discovery and safety evaluation.


Effects of COVID-19 on Plastic Surgery Practices and Medi-Spas in Different Countries


Breastfeeding and Respiratory Antivirals: Coronavirus and Influenza


title: Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China

text: OBJECTIVE: In December 2019, coronavirus disease (COVID-19) emerged in Wuhan. However, the characteristics and risk factors associated with disease severity, unimprovement and mortality are unclear and our objective is to throw some light on these. METHODS: All consecutive patients diagnosed with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 11 to February 6, 2020, were enrolled in this retrospective cohort study. RESULTS: A total of 663 COVID-19 patients were included in this study. Among these, 247 (37.3%) had at least one kind of chronic disease; 0.5% of the patients (n = 3) were diagnosed with mild COVID-19, while 37.8% (251/663), 47.5% (315/663), and 14.2% (94/663) were in moderate, severe, and critical conditions, respectively. In our hospital, during follow-up 251 of 663 patients (37.9%) improved and 25 patients died, a mortality rate of 3.77%. Older patients (>60 years old) and those with chronic diseases were prone to have a severe to critical COVID-19 condition, to show unimprovement, and to die (p <0.001, <0.001). Multivariate logistic regression analysis identified being male (OR = 0.486, 95%CI 0.311-0.758; p 0.001), having a severe COVID-19 condition (OR = 0.129, 95%CI 0.082-0.201; p <0.001), expectoration (OR = 1.796, 95%CI 1.062-3.036; p 0.029), muscle ache (OR = 0.309, 95%CI 0.153-0.626; p 0.001), and decreased albumin (OR = 1.929, 95%CI 1.199-3.104; p 0.007) as being associated with unimprovement in COVID-19 patients. CONCLUSION: Male sex, a severe COVID-19 condition, expectoration, muscle ache, and decreased albumin were independent risk factors which influence the improvement of COVID-19 patients.


Covid-19: Trust withdraws guidance that doctors need not put "covid-19" on death certificates


title: COVID-19 mortality in patients on anticoagulants and antiplatelet agents

text: Coagulopathy (Tang, et al 2020) and a prothrombotic diathesis with high D-dimer and fibrinogen levels (Al-Samkari, et al 2020) are associated with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Extensive thrombosis in small vessels and the microvasculature in lungs and extrapulmonary organs has been confirmed histologically (Zhang et al 2020). Early studies showed that the venous thromboembolism (VTE) incidence in hospitalised COVID-19 patients can be as high as 25% (Songping, et al 2020), and more recent studies have indicated this can be expanded to other macrovascular thrombotic complications, such as a higher than expected prevalence of pulmonary emboli in patients with COVID-19 (Klok, et al 2020, Stoneham, et al).


Análisis de la amenaza percibida por la COVID-19 en población española


Joint Statement on Re-introduction of Hospital and Office-based Procedures for the Practicing Urogynecologist and Gynecologist


Discussion Board


title: Proxy reliability of the 12-item world health organization disability assessment schedule II among adult patients with mental disorders

text: PURPOSE: Despite the wide usage of World Health Organization Disability Assessment Schedule II (WHODAS 2.0) in psychiatry research and clinical practice, there was limited knowledge on its proxy reliability among people with mental disorders. This paper aimed to compare the 12-item WHODAS 2.0 responses of adult patients with mental disorders to their family caregivers. METHODS: In this study, 205 pairs of patients with mental disorders and primary family caregivers were consecutively recruited from one inpatient mental health department in a large hospital in China. All participants completed the 12-item version WHODAS 2.0 to assess patients' functioning in the 30 days prior to the hospitalization. Measurement invariance, including configural, metric and scalar invariance, was tested across patient and proxy groups, using multi-group confirmatory factor analysis. Agreement between patients and proxies was examined by paired Wilcoxon tests and intraclass correlation coefficients (ICC). Subgroup analyses for proxy reliability were conducted within strata of proxy kinship and patient psychiatric diagnosis. RESULTS: The 12-item WHODAS 2.0 achieved configural, metric and partial scalar invariance across patient and proxy groups. Unsatisfactory consistency was found for most items (ICC < 0.75, P < 0.05), especially for items on Cognition, Getting along, Life activities, and Participation in society (ICC < 0.4, P < 0.05). Spouses agreed with patients more often than parents (ICC ≥ 0.4, P < 0.05). The paired Wilcoxon tests found that impairment of patients with psychotic disorders tended to be overestimated by proxies while proxies tended to underestimate impairment of patients with mood disorders. CONCLUSION: Our study reveals inconsistency between self and proxy reports in the 12-item WHODAS 2.0 among adult patients with mental disorders. When proxy reports is needed, spouses are preferred than parents. We should be aware of proxies' impairment overestimation among patients with psychotic disorders and underestimation among patients with mood disorders.


Our Response to COVID-19 as Endocrinologists and Diabetologists


Potential impact of COVID-19 in people living with HIV: experience from previous 21st century coronaviruses epidemics


title: Facilitating transcatheter aortic valve implantation in the era of COVID-19: Recommendations for programmes

text: The COVID-19 pandemic continues to significantly impact the treatment of people living with aortic stenosis, and access to transcatheter aortic valve implantation. Transcatheter aortic valve implantation (TAVI) programmes require unique coordinated processes that are currently experiencing multiple disruptions and are guided by rapidly evolving protocols. We present a series of recommendations for TAVI programmes to adapt to the new demands, based on recent evidence and the international expertise of nurse leaders and collaborators in this field. Although recommended in most guidelines, the uptake of the role of the TAVI programme nurse is uneven across international regions. COVID-19 is further highlighting why a nurse-led central point of coordination and communication is a vital asset for patients and programmes. We propose an alternative streamlined evaluation pathway to minimize patients' pre-procedure exposure to the hospital environment while ensuring appropriate treatment decision and shared decision-making. The competing demands created by COVID-19 require vigilant wait list management, with risk stratification, telephone surveillance and optimized triage and prioritization. A minimalist approach with close scrutiny of all parts of the procedure has become an imperative to avoid any complications and ensure patients' accelerated recovery. Lastly, we outline a nurse-led protocol of rapid mobilization and reconditioning as an effective strategy to facilitate safe next-day discharge home. As the pandemic abates, TAVI programmes must facilitate access to care without compromising patient safety, enable hospitals to manage the competing demands created by COVID-19 and establish new processes to support patients living with valvular heart disease.


Complement as a target in COVID-19?


title: Repurposing Therapeutics for Potential Treatment of SARS-CoV-2: A Review

text: The need for proven disease-specific treatments for the novel pandemic coronavirus SARS-CoV-2 necessitates a worldwide search for therapeutic options. Since the SARS-CoV-2 virus shares extensive homology with SARS-CoV and MERS-CoV, effective therapies for SARS-CoV and MERS-CoV may also have therapeutic potential for the current COVID-19 outbreak. To identify therapeutics that might be repositioned for treatment of the SARS-CoV-2 disease COVID-19, we strategically reviewed the literature to identify existing therapeutics with evidence of efficacy for the treatment of the three coronaviruses that cause severe respiratory illness (SARS-CoV, MERS-CoV, and SARS-CoV-2). Mechanistic and in vitro analyses suggest multiple promising therapeutic options with potential for repurposing to treat patients with COVID-19. Therapeutics with particularly high potential efficacy for repurposing include camostat mesylate, remdesivir, favipiravir, tocilizumab, baricitinib, convalescent plasma, and humanized monoclonal antibodies. Camostat mesylate has shown therapeutic potential, likely by preventing viral entry into epithelial cells. In early research, the targeted antivirals remdesivir and favipiravir appear to benefit patients by decreasing viral replication; clinical trials suggest that remdesivir speeds recovery from COVID-19. Tocilizumab and baricitinib appear to improve mortality by preventing a severe cytokine storm. Convalescent plasma and humanized monoclonal antibodies offer passive immunity and decreased recovery time. This review highlights potential therapeutic options that may be repurposed to treat COVID-19 and suggests opportunities for further research.


title: Expression of SARS-CoV-2 receptor ACE2 and the spike protein processing enzymes in developing human embryos

text: The novel coronavirus disease, COVID-19 caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has resulted in thousands of critically ill patients and poses a serious threat globally. To investigate if SARS-CoV-2 can affect early human embryos, we analysed scRNA-seq datasets of human embryos for the SARS-CoV-2 receptors ACE2 and BSG (CD147), the serine protease TMPRSS2 for viral spike protein priming, and the endosomal protease CTSL for spike protein activation via the endosomal route. The results reveal that ACE2 and TMPRSS2 are co-expressed in a proportion of epiblast cells, and both BSG and CTSL are expressed in all the stages of embryonic development. The cells of the blastocysts express genes encoding for other coronavirus receptors such as DPP4 and ANPEP as well. Interestingly, the cells of the epiblast also express genes involved in viral endocytosis and replication. We further identified 194 genes that are differentially expressed in ACE2- and TMPRSS2-positive cells as compared to ACE2- and TMPRSS2-negative cells of the epiblast. Our results show that developing human embryos express the receptors for SARS-CoV-2 and other coronaviruses; embryos also harbour the necessary machinery for viral internalization and replication. We suggest that couples be advised to avoid conceiving during the pandemic and that IVF procedures be kept to a minimum to prevent any possible hazard to the developing embryos.


El Virus que cambió España: impacto del COVID-19 en las personas con VIH./ The Virus that Changed Spain: Impact of COVID-19 on People with HIV


"Once more unto the breach, dear friends" - Reflections on the novel coronavirus disease and emergency medicine in Canada


The COVID-19 pandemic and the true incidence of tuberculosis in Japan


Points & Pearls: Novel 2019 Coronavirus SARS-CoV-2 (COVID-19) An Overview for Emergency Clinicians


title: COVID-19 dynamic model: Balanced identification of general biological and country specific social features

text: Breaking a complex bio-social phenomenon (epidemic) into its components, considering the processes that determine its dynamics, formalizing the accepted hypotheses in mathematical equations, selecting appropriate experimental and statistical material, and constructing a mathematical model - those are typical tasks of scientific research. A specific data processing method (balanced identification) and appropriate information technology made it possible to consider a number of models, determine the general biological laws of the virus-human interaction (common to all populations), and the country specific social features of epidemic management in the countries (or cities) under consideration. As the initial data, only new cases are used. Data from different countries is taken from official sources and processed in a uniform way. The obtained estimates of the number of undetected infected are lower estimates.


title: Coping with COVID-19: ventilator splitting with differential driving pressures using standard hospital equipment

text: The global COVID-19 pandemic has led to a worldwide shortage of ventilators. This shortage has initiated discussions on how to support multiple patients with a single ventilator (ventilator splitting). Ventilator splitting is incompletely tested, experimental and the effects have not been fully characterised. This study investigated the effect of ventilator splitting on system variables (inspiratory pressure, flow and volume) and the possibility of different ventilation targets for each limb using only standard hospital equipment. Experiments were conducted on two test lungs with different compliances (0.02 l.cmH2 O-1 and 0.04 l.cmH2 O-1 ). The ventilator was used in both pressure and volume control modes and was set to ventilate the low compliance lungs at end-tidal volumes of 500 ± 20 ml. A flow restrictor apparatus consisting of a Hoffman clamp and tracheal tube was connected in series to the inspiratory limb of the high compliance test lungs and the resistance modified to achieve end-tidal volumes of 500 ± 20 ml. The restriction apparatus successfully modified the inspiratory pressure, minute ventilation and volume delivered to the high compliance test lungs in both pressure control (27.3-17.8 cmH2 O, 15.2-8.0 l.min-1 and 980-499 ml, respectively) and volume control (21.0-16.7 cmH2 O, 10.7-7.9 l.min-1 and 659-498 ml, respectively) ventilation modes. Ventilator splitting is not condoned by the authors. However, these experiments demonstrate the capacity to simultaneously ventilate two test lungs of different compliances, and using only standard hospital equipment, modify the delivered pressure, flow and volume in each test lung.


Coronavirus disease 2019 (COVID-19) outbreak at the Department of Ophthalmology, Oslo University Hospital, Norway


Coronavirus Disease 2019 (COVID-19) in Italy


title: Maximum Daily Temperature, Precipitation, Ultra-Violet Light and Rates of Transmission of SARS-Cov-2 in the United States

text: BACKGROUND: Previous reports have suggested that transmission of SARS-CoV-2 is reduced by higher temperatures and higher humidity. We analyzed case-data from the United States to investigate effects of temperature, precipitation, and UV Light on community transmission of SARS-CoV-2. METHODS: Daily reported cases of SARS-CoV-2 across the United States from 01/22/2020 to 04/03/2020 were analyzed. We used negative binomial regression modelling to investigate whether daily maximum temperature, precipitation, UV Index and the incidence 5 days later were related. We performed sensitivity analyses at 3 days, 7 days and 9 days to assess transmission lags. RESULTS: A maximum temperature greater than 52°F on a given day was associated with a lower rate of new cases at 5 days[IRR: 0.85(0.76,0.96)p=0.009]. Among observations with daily temperatures below 52°F, there was a significant inverse association between the maximum daily temperature and the rate of cases at 5 days [IRR 0.98(0.97,0.99)p=0.001]. The rate of new cases was predicted to be lower for theoretical states that maintained a stable maximum daily temperature above 52°F with a predicted 23-fewer cases per-million per-day by 25 days of the epidemic. A 1-unit higher UV index was associated with a lower rate at 5 days [IRR 0.97(0.95,0.99)p=0.004]. Precipitation was not associated with a greater rate of cases at 5 days [IRR 0.98(0.89,1.08)p=0.65]. CONCLUSION: The incidence of disease declines with increasing temperature up until 52°F and is lower at warmer versus cooler temperatures. However, the association between temperature and transmission is small and transmission is likely to remain high at warmer temperatures.


title: Complementary and alternative medicine use among outpatients during the 2015 MERS outbreak in South Korea: a cross-sectional study

text: BACKGROUND: The 2015 MERS outbreak in South Korea was the largest event outside of the Middle East. Under such circumstances, individuals tend to resort to non-conventional solutions such as complementary and alternative medicine (CAM) to manage health. Thus, this study aims to examine characteristics of CAM use among outpatients in a community hospital setting during the 2015 MERS outbreak and to assess potential predictors of CAM use during the epidemic. METHODS: A cross-sectional study was conducted among 331 patients (response rate: 82.75%) at a community hospital located in Seoul, South Korea. The survey instrument included 36 questions on the use of CAM, demographic characteristics, health status, and respondents' perceptions and concerns about MERS infection. Chi-square test and logistic regression were conducted for data analysis using SPSS ver. 21.0., and a p-value of less than 0.05 was considered statistically significant for all analyses. RESULTS: 76.1% of respondents used one or more types of CAM modalities during the MERS outbreak. Consumption of easily accessible modalities such as multivitamin (51.2%) and food products (32.1%) was most popular, and the majority of CAM users relied on mass media (52.4%) and the internet (27.4%) to obtain information on CAM. The use of CAM was associated with age between 40 and 49, age over 50, prior CAM use, and dissatisfaction with the government response to the MERS outbreak. CONCLUSIONS: CAM was commonly used by outpatients during the 2015 MERS outbreak in Korea, and mass media was the main source of information. Establishing a media platform is of paramount importance to provide reliable information and ensure the safety of its use.


title: Highlight of Immune Pathogenic Response and Hematopathologic Effect in SARS-CoV, MERS-CoV, and SARS-Cov-2 Infection

text: A sudden outbreak of COVID-19 caused by a novel coronavirus, SARS-CoV-2, in Wuhan, China in December 2019 quickly grew into a global pandemic, putting at risk not only the global healthcare system, but also the world economy. As the disease continues to spread rapidly, the development of prophylactic and therapeutic approaches is urgently required. Although some progress has been made in understanding the viral structure and invasion mechanism of coronaviruses that may cause severe cases of the syndrome, due to the limited understanding of the immune effects caused by SARS-CoV-2, it is difficult for us to prevent patients from developing acute respiratory distress syndrome (ARDS) and pulmonary fibrosis (PF), the major complications of coronavirus infection. Therefore, any potential treatments should focus not only on direct killing of coronaviruses and prevention strategies by vaccine development, but also on keeping in check the acute immune/inflammatory responses, resulting in ARDS and PF. In addition, potential treatments currently under clinical trials focusing on killing coronaviruses or on developing vaccines preventing coronavirus infection largely ignore the host immune response. However, taking care of SARS-CoV-2 infected patients with ARDS and PF is considered to be the major difficulty. Therefore, further understanding of the host immune response to SARS-CoV-2 is extremely important for clinical resolution and saving medication cost. In addition to a breif overview of the structure, infection mechanism, and possible therapeutic approaches, we summarized and compared the hematopathologic effect and immune responses to SARS-CoV, MERS-CoV, and SARS-CoV-2. We also discussed the indirect immune response caused by SARS and direct infection, replication, and destroying of immune cells by MERS-CoV. The molecular mechanisms of SARS-CoV and MERS-CoV infection-induced lymphopenia or cytokine storm may provide some hint toward fight against SARS-CoV-2, the novel coronavirus. This may provide guidance over using immune therapy as a combined treatment to prevent patients developing severe respiratory syndrome and largely reduce complications.


The Nucleocapsid Protein of SARS-CoV-2: a Target for Vaccine Development


How to Perform Pediatric Lung Ultrasound Examinations in the Time of COVID-19


title: Neurological diseases as mortality predictive factors for patients with COVID-19: a retrospective cohort study

text: INTRODUCTION: In the current study, we evaluated factors that increase the coronavirus disease (COVID-19) patient death rate by analyzing the data from two cohort hospitals. In addition, we studied whether underlying neurological diseases are risk factors for death. METHODS: In this retrospective cohort study, we included 103 adult inpatients (aged ≥ 18 years). We evaluated differences in demographic data between surviving and non-surviving COVID-19 patients. RESULTS: In a multivariate logistic analysis, age and the presence of chronic lung disease and Alzheimer's dementia (AD) were the only significant parameters for predicting COVID-19 non-survival (p < 0.05). However, hypertension, coronary vascular disease, dyslipidemia, chronic kidney disease, diabetes, and history of taking angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme (ACE) inhibitors, as well as nonsteroidal anti-inflammatory drugs (NSAIDs), were not significantly associated with the death of COVID-19 patients. The optimal cutoff value obtained from the maximum Youden index was 70 (sensitivity, 80.77%; specificity, 61.04%), and the odds ratio of non-survival increased 1.055 fold for every year of age. CONCLUSIONS: Clinicians should closely monitor and manage the symptoms of COVID-19 patients who are over the age of 70 years or have chronic lung disease or AD.


Actualización de la situación epidemiológica de la infección por SARS-CoV-2 en España. Comentarios a las recomendaciones de manejo de la infección en pediatría./ [Epidemiological update on SARS-CoV-2 infection in Spain. Comments on the management of infection in pediatrics]


title: The term "physical distancing" is recommended rather than "social distancing" during the COVID-19 pandemic for reducing feelings of rejection among people with mental health problems

text: As COVID-19 has plagued our world, the term "social distancing" has been widely used with the aim to encourage the general population to physically distance themselves from others in order to reduce the spread of the virus. However, this term can have unintended but detrimental effects, as it evokes negative feelings of being ignored, unwelcome, left alone with one's own fears, and even excluded from society. These feelings may be stronger in people with mental illnesses and in socio-economically disadvantaged groups, such as stigmatized minorities, migrants, and homeless persons [1], many of them also having high risk for suicidal behaviors [2]. Mental health disorders are pervasive worldwide; the global burden accounting for approximately 21.2-32.4% of years lived with disability-more than any other group of illnesses [3]. So, the vulnerable group of people with mental health disorders represents a considerable share of the total global population.


title: Challenge and strategies of infection control in psychiatric hospitals during biological disasters-From SARS to COVID-19 in Taiwan

text: Psychiatric hospitals play an important role in supporting patients with mental illness to relieve symptoms and improve functioning in a physically and psychologically safe environment. However, these hospitals are also vulnerable to emerging infectious diseases. In early 2020, a psychiatric hospital and a psychiatric unit were reported to have nosocomial coronavirus disease 2019 (COVID-19) infection. A large number of patients and staff were severely impacted. This type of nosocomial infection threatens patient safety and quality of care. By learning from previous experiences of severe acute respiratory syndrome (SARS) and previous studies, psychiatric hospitals can provide safeguards to prevent nosocomial infection among patients and staff during an epidemic or biological disaster. These strategies include a series of actions such as following national guidelines for infection control, reserving adequate support for disinfection equipment, providing relevant and sufficient pro-service and in-service education and training, establishing regular surveillance of hand hygiene habits, proper communication and health education, and providing opportunities for vaccination if possible. Based on the harm reduction concept, staff division of office breaks and ward classification and shunting are recommended and should be further implemented.


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


title: Breastfeeding and coronavirus disease-2019: Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies

text: The recent COVID-19 pandemic has spread to Italy with heavy consequences on public health and economics. Besides the possible consequences of COVID-19 infection on a pregnant woman and the fetus, a major concern is related to the potential effect on neonatal outcome, the appropriate management of the mother-newborn dyad, and finally the compatibility of maternal COVID-19 infection with breastfeeding. The Italian Society on Neonatology (SIN) after reviewing the limited scientific knowledge on the compatibility of breastfeeding in the COVID-19 mother and the available statements from Health Care Organizations has issued the following indications that have been endorsed by the Union of European Neonatal & Perinatal Societies (UENPS). If a mother previously identified as COVID-19 positive or under investigation for COVID-19 is asymptomatic or paucisymptomatic at delivery, rooming-in is feasible, and direct breastfeeding is advisable, under strict measures of infection control. On the contrary, when a mother with COVID-19 is too sick to care for the newborn, the neonate will be managed separately and fed fresh expressed breast milk, with no need to pasteurize it, as human milk is not believed to be a vehicle of COVID-19. We recognize that this guidance might be subject to change in the future when further knowledge will be acquired about the COVID-19 pandemic, the perinatal transmission of SARS-CoV-2, and clinical characteristics of cases of neonatal COVID-19.


First Impressions of Performing Bedside Cognitive Assessment of COVID-19 Inpatients


title: Experimental and numerical study of potential infection risks from exposure to bioaerosols in one BSL-3 laboratory

text: Laboratory-acquired infections (LAIs) are defined as infections of laboratory staff by exposure to pathogenic microorganisms during an experimental procedure. For a biosafety level-3 (BSL-3) laboratory with a high potential of exposure, reducing risks and threats relevant to LAIs has become a critical concern, especially after the recent outbreak of Novel Coronavirus causing COVID-19 in Wuhan, China. This study aimed to investigate the spatial-temporal characteristics of bioaerosol dispersion and deposition of two kinds of bioaerosols (Serratia marcescens and phage ΦX174). A combination of laboratory experiment and numerical simulation was adopted to explore bioaerosol removal. Three-dimensional concentration iso-surface mapping in conjunction with flow field analysis was employed to elucidate bioaerosol migration and deposition behavior. The total deposition number and unit area deposition ratio were calculated for different surfaces. The results indicate that bioaerosol concentration remains stable for up to 400 s after release, and that almost 70% of all bioaerosol particles become deposited on the surfaces of walls and equipment. Vortex flow regions and high-concentration regions were determined, and the most severely contaminated surfaces and locations were identified. Our results could provide the scientific basis for controlling the time interval between different experiments and also provide guidelines for a laboratory disinfection routine. Furthermore, future work regarding laboratory layout optimization and high efficiency air distribution for bioaerosol removal in a BSL-3 laboratory should be emphasized.


Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis


Reflections and new developments within the COVID-19 pandemic


title: Stopping Clinical Trials in Inflammatory Bowel Disease During the COVID-19 Pandemic is not a Responsible Act

text: The intense competition for resources to combat COVID-19 has greatly reduced access to health care for patients with other diseases. After the disastrous overrun of hospitals through COVID-19 patients in some jurisdictions, availability of resources for "elective" medical procedures including care for the chronically ill have been greatly reduced in many places as a pre-emptive measure before or during the blooming of infection clusters. Pharmaceutical companies have either stopped recruitment or even cancelled ongoing clinical trials in chronic diseases. Pre-emptive triage and its impact on medical ethics is discussed in the framework of care for inflammatory bowel disease.


Circulating levels of IL-2, IL-4, TNF-α, IFN-Î³, and C-reactive protein are not associated with severity of COVID-19 symptoms


Ethics in a time of coronavirus


Nano Research for COVID-19


title: High prevalence of disordered eating behavior in Danish children and adolescents with type 1 diabetes

text: OBJECTIVE: A higher prevalence of disordered eating behavior (DEB) has been demonstrated in children and adolescents with type 1 diabetes (T1D) compared to healthy aged-matched peers. DEB is associated with higher HbA1c levels and increased risk of developing complications to T1D. The aim of this study was to determine the prevalence of DEB in a Danish cohort of children and adolescents with T1D aged 11-19 years and to characterize them regarding metabolic control and relevant clinical data. RESEARCH DESIGN & METHODS: In a cross-sectional study, we determined the prevalence of DEB using the revised Diabetes Eating Problem Survey (DEPS-R) questionnaire. HbA1c and relevant clinical data were obtained at the time they filled in the questionnaire. RESULTS: 192 children and adolescents (46% girls) aged 11-19 years with T1D were included from the pediatric diabetes outpatient clinic. A total of 40 participants (21%) had DEB. The prevalence was higher amongst girls compared with boys (34.1% vs 8.9%) and those who had DEB were older (16.7 vs 15.0 years, P < 0.001), had longer duration of T1D (7.5 vs 4.9 years, P < 0.001), higher BMI Z-scores (1.2 vs 0.3, P < 0.001), higher HbA1c (72.8 (8.8%) vs 62.0 (7.8%) mmol/mol, P < 0.001), higher total cholesterol (4.6 mmoL/L vs 4.2 mmoL/L, P = 0.0048) and LDL (2.7 vs 2.3, P = 0.001) compared with those with no signs of DEB. CONCLUSION: As in other countries, the prevalence of DEB is high in Danish adolescents with T1D. Early detection of DEB is essential to prevent short- and long-term complications to T1D. This article is protected by copyright. All rights reserved.


Urticarial eruption in COVID-19 infection


title: Clinical features of 2019 novel coronavirus infection patients and a feasible screening procedure/ 中华急诊医学杂志

text: Objective@#To study the clinical characteristics of 2019 coronavirus (2019-nCoV) pneumonia patients and make a feasible screening process in fever clinic.@*Methods@#Epidemiologic features, clinical presentation, laboratory findings and image features of the screened patients were retrospectively collected and analyzed.@*Results@#Totally, 46 patients were screened, 9 of them were laboratory-confirmed 2019-nCoV infection, and others were defined as laboratory-excluded patients. Laboratory-confirmed patients had higher frequency of travelling or residence in Wuhan within two weeks of onset (P<0.05), but there were no differences on age, sex, other epidemiologic features and comorbidities between the two groups (P>0.05). The most common feature of the laboratory-confirmed patients was fever (100%), but the symptoms showed no differences between the two groups (P>0.05). Laboratory-confirmed patients had lower white blood cell count than the laboratory-excluded patients (P<0.05), and all of them had pneumonia in chest CT scan. None of the patients with normal chest CT had positive 2019-nCoV nucleic acid test.@*Conclusions@#No specific symptom was helpful in the diagnosis of 2019-nCoV infection. However, patients without chest CT scan changes had a very low risk of 2019-nCoV infection despite of the epidemiologic history and fever. We recommended a screening procedure that might be helpful to reduce the rate of miss diagnosis and improve screening efficiency.


title: SARS-CoV-2 perturbs the renin-angiotensin system and energy metabolism

text: The COVID-19 pandemic, caused by the novel coronavirus, SARS-CoV-2, is threating our health systems and daily lives and is responsible for causing substantial morbidity and mortality. In particular, aged individuals and individuals with comorbidities, including obesity, diabetes mellitus, and hypertension, have significantly higher risks of hospitalization and death than normal individuals. The renin-angiotensin system (RAS) plays a pivotal role in the pathogenesis of diabetes mellitus, obesity, and hypertension. Angiotensin-converting enzyme 2 (ACE2), belonging to the RAS family, has received much attention during this COVID-19 pandemic, owing to the fact that SARS-CoV-2 uses ACE2 as a receptor for cellular entry. Additionally, the RAS greatly affects energy metabolism in certain pathological conditions, including cardiac failure, diabetes mellitus, and viral infections. This article discusses the potential mechanisms by which SARS-CoV-2 modulates the RAS and energy metabolism in individuals with obesity and diabetes mellitus. The article aims to highlight the appropriate strategies for combating the COVID-19 pandemic in the clinical setting and emphasize on the areas that require further investigation in relation to COVID-19 infections in patients with obesity and diabetes mellitus from the viewpoint of endocrinology and metabolism.


Discarded Covid 19 gear: A looming threat


Reply to: 'No evidence for an increased liver uptake of SARS-CoV-2 in metabolic-associated fatty liver disease'


title: The Challenge of Maintaining Metabolic Health During a Global Pandemic

text: The ongoing global pandemic brought on by the spread of the novel coronavirus SARS-CoV-2 is having profound effects on human health and well-being. With no viable vaccine presently available and the virus being rapidly transmitted, governments and national health authorities have acted swiftly, recommending 'lockdown' policies and/or various levels of social restriction/isolation to attenuate the rate of infection. An immediate consequence of these strategies is reduced exposure to daylight, which can result in marked changes in patterns of daily living such as the timing of meals, and sleep. These disruptions to circadian biology have severe cardiometabolic health consequences for susceptible individuals. We discuss the consequences of reductions in patterns of daily physical activity and the resulting energy imbalance induced by periods of isolation, along with several home-based strategies to maintain cardiometabolic health in the forthcoming months.


The other side of COVID-19: Impact on obsessive compulsive disorder (OCD) and hoarding


title: Fighting COVID-19 Misinformation on Social Media: Experimental Evidence for a Scalable Accuracy-Nudge Intervention

text: Across two studies with more than 1,700 U.S. adults recruited online, we present evidence that people share false claims about COVID-19 partly because they simply fail to think sufficiently about whether or not the content is accurate when deciding what to share. In Study 1, participants were far worse at discerning between true and false content when deciding what they would share on social media relative to when they were asked directly about accuracy. Furthermore, greater cognitive reflection and science knowledge were associated with stronger discernment. In Study 2, we found that a simple accuracy reminder at the beginning of the study (i.e., judging the accuracy of a non-COVID-19-related headline) nearly tripled the level of truth discernment in participants' subsequent sharing intentions. Our results, which mirror those found previously for political fake news, suggest that nudging people to think about accuracy is a simple way to improve choices about what to share on social media.


title: Impact of COVID-19 on reproductive health and maternity services in low resource countries

text: Purpose: Coronavirus Disease-2019 (COVID-19) is a rapidly evolving pandemic. It is well-known that pregnant women are more susceptible to viral infection due to immune and anatomic factors. Therefore, the viral pandemic might affect the reproductive health and maternity services especially in low-resource countries.Materials and methods: In this article, we tried to highlight the impact of COVID-19 on reproductive health and maternity health services in low resource countries with emphasis on adapting some of the published best practice recommendations to suit a struggling environment.Conclusion: Pregnant women residing in low resource countries represent a uniquely vulnerable group in epidemics due to several factors. Maternity services in low resource countries are adapting to provide antenatal and postnatal care amidst a rapidly shifting health system environment due to the COVID-19 pandemic.


title: Essential oils from Citrus x aurantium and Citrus x latifolia (Rutaceae) have anesthetic activity and are effective in reducing ion loss in silver catfish ( Rhamdia quelen )

text: This study investigated the anesthetic effect of the essential oils (EOs) from the peel of Citrus x aurantium (EOCA) and Citrus x latifolia (EOCL) on silver catfish Rhamdia quelen. Fish were exposed to different concentrations of EOCA and EOCL to determine time of anesthesia induction and recovery. Induction of anesthesia was observed in all fish exposed to 400, 600 or 800 µL L−1 EOCA and 300, 400 or 500 µL L−1 EOCL. Another group of fish were exposed for 8 h to 50, 100, or 200 µL L−1 of either EOs. Overall, fish exposed to ethanol and both EOs presented higher ventilatory frequencies (VF) than the control group throughout the 8 h of exposure. Net ion (Na+, K+ and Cl−) effluxes and ammonia excretion were significantly lower in fish exposed to 50, 100 or 200 µL L−1 of either EOs compared to control fish. Mortality was 37% in fish exposed to 200 µL L−1 of either EOs after 8 h. These findings suggest that EOCA and EOCL are useful anesthetics and sedatives for Rhamdia quelen, but their usefulness as alternatives to reduce stress in fish transportation at the lower concentrations tested (50-100 µL L−1) deserves further study.(AU)


Management strategies and role of telemedicine in a surgery unit during COVID-19 outbreak


title: Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19)

text: Importance: Administration of hydroxychloroquine with or without azithromycin for the treatment of coronavirus disease 2019 (COVID-19)-associated pneumonia carries increased risk of corrected QT (QTc) prolongation and cardiac arrhythmias. Objective: To characterize the risk and degree of QT prolongation in patients with COVID-19 in association with their use of hydroxychloroquine with or without concomitant azithromycin. Design, Setting, and Participants: This was a cohort study performed at an academic tertiary care center in Boston, Massachusetts, of patients hospitalized with at least 1 positive COVID-19 nasopharyngeal polymerase chain reaction test result and clinical findings consistent with pneumonia who received at least 1 day of hydroxychloroquine from March 1, 2020, through April 7, 2020. Main Outcomes and Measures: Change in QT interval after receiving hydroxychloroquine with or without azithromycin; occurrence of other potential adverse drug events. Results: Among 90 patients given hydroxychloroquine, 53 received concomitant azithromycin; 44 (48.9%) were female, and the mean (SD) body mass index was 31.5 (6.6). Hypertension (in 48 patients [53.3%]) and diabetes mellitus (in 26 patients [28.9%]) were the most common comorbid conditions. The overall median (interquartile range) baseline QTc was 455 (430-474) milliseconds (hydroxychloroquine, 473 [454-487] milliseconds vs hydroxychloroquine and azithromycin, 442 [427-461] milliseconds; P < .001). Those receiving concomitant azithromycin had a greater median (interquartile range) change in QT interval (23 [10-40] milliseconds) compared with those receiving hydroxychloroquine alone (5.5 [-15.5 to 34.25] milliseconds; P = .03). Seven patients (19%) who received hydroxychloroquine monotherapy developed prolonged QTc of 500 milliseconds or more, and 3 patients (3%) had a change in QTc of 60 milliseconds or more. Of those who received concomitant azithromycin, 11 of 53 (21%) had prolonged QTc of 500 milliseconds or more and 7 of 53 (13 %) had a change in QTc of 60 milliseconds or more. The likelihood of prolonged QTc was greater in those who received concomitant loop diuretics (adjusted odds ratio, 3.38 [95% CI, 1.03-11.08]) or had a baseline QTc of 450 milliseconds or more (adjusted odds ratio, 7.11 [95% CI, 1.75-28.87]). Ten patients had hydroxychloroquine discontinued early because of potential adverse drug events, including intractable nausea, hypoglycemia, and 1 case of torsades de pointes. Conclusions and Relevance: In this cohort study, patients who received hydroxychloroquine for the treatment of pneumonia associated with COVID-19 were at high risk of QTc prolongation, and concurrent treatment with azithromycin was associated with greater changes in QTc. Clinicians should carefully weigh risks and benefits if considering hydroxychloroquine and azithromycin, with close monitoring of QTc and concomitant medication usage.


COVID-19 pandemic: is a gender-defined dosage effect responsible for the high mortality rate among males?


title: SARS-CoV-2 in the context of past coronaviruses epidemics: Consideration for prenatal care

text: Since December 2019, the novel SARS-CoV-2 outbreak has resulted in millions of cases and more than 200 000 deaths worldwide. The clinical course among nonpregnant women has been described, but data about potential risks for women and their fetus remain scarce. The SARS and MERS epidemics were responsible for miscarriages, adverse fetal and neonatal outcomes, and maternal deaths. For COVID-19 infection, only nine cases of maternal death have been reported as of 22 April 2020, and pregnant women seem to develop the same clinical presentation as the general population. However, severe maternal cases, as well as prematurity, fetal distress, and stillbirth among newborns have been reported. The SARS-CoV-2 pandemic greatly impacts prenatal management and surveillance and raise the need for clear unanimous guidelines. In this narrative review, we describe the current knowledge about coronaviruses (SARS, MERS, and SARS-CoV-2) risks and consequences on pregnancies, and we summarize available current candidate therapeutic options for pregnant women. Finally, we compare current guidance proposed by The Royal College of Obstetricians and Gynaecologists, The American College of Obstetricians and Gynecologists, and the World Health Organization to give an overview of prenatal management which should be utilized until future data appear.


Fighting COVID-19, a place for artificial intelligence


Estimating the risk of an anaesthetist acquiring COVID-19 by anaesthetising an asymptomatic patient


Regulatory T Cells for Treating Patients With COVID-19 and Acute Respiratory Distress Syndrome: Two Case Reports


Science in the Wake of the Pandemic: How Will COVID-19 Change the Way We Do Research?


title: The curative effects of shortwave diathermy on treating Novel coronavirus (COVID-19) pneumonia: A structured summary of a study protocol for a randomised controlled trial

text: OBJECTIVES: To evaluate the therapeutic effects of ultra-short-wave diathermy (SWD) on COVID-19 pneumonia. The hypothesis is that SWD may minimise pneumonic inflammation and shorten the duration of the time to positive-to-negative conversion of COVID-19 nucleic acid test. TRIAL DESIGN: This is a single centre, 2-arm (1:1 ratio), evaluator blinded, parallel group design superiority randomised, controlled clinical trial. PARTICIPANTS: The inclusion criteria were: (1) Age 18-65 years, (2) COVID-19 nucleic acid test is positive, (3) Lung CT showed multiple patchy ground glass shadows or other typical manifestations of both lungs. The exclusion criteria were: (1) Patients who need ICU management, (2) Positive tests for other pathogens such as Tuberculosis, Mycoplasma, (3) Patients with respiratory failure or requiring mechanical ventilation, (4) Patients with metal implants or pacemakers, (5) Those with shock (6) Those that have bleeding tendency or active bleeding in the lungs, (7) Patients with multiple organ failure who need ICU monitoring and treatment, (8) Cancer patients and those with severe underlying diseases, (9) Pregnant or lactating women, (10) Patients with severe cognitive impairment who cannot follow the instructions to complete the treatment, (11) Those without signed informed consent and (12) Those with other contraindications to short wave. This study will be conducted in Tongji Hospital, Caidian, Wuhan, People's Republic of China. INTERVENTION AND COMPARATOR: The experimental group will be given the nationally recommended standard medical treatment + ultra-short-wave diathermy treatment. Ultra-short-wave therapy treatment will be performed through application of ultra-short-wave therapy machine electrodes on the anterior and posterior parts of the trunk for 10 minutes, twice a day for 12 consecutive days. The comparator will be the control, not receiving ultra-short-wave therapy, and will be given only the nationally recommended standard medical treatment. MAIN OUTCOMES: The primary outcome measures will be time to positive-to-negative conversion of COVID-19 nucleic acid test by pharyngeal swab, in days assessed at 7th, 14th ,21st and 28th days. The secondary outcome measures include nucleic acid test rate and recovery from symptoms, Vital signs assessment, Computed Tomography, Complete blood count, serum analysis and SIRS scale scores. Blinded evaluation will be at baseline (the day of starting ultra-short-wave diathermy) and after 28 days following the interventions. RANDOMISATION: A Randomization plan will be generated online on www.randomization.com using permuted blocks method, by a statistician who will not be part of the study. Small blocks of various sizes will be used. Patients will be randomized (1:1) between the experimental and control groups BLINDING (MASKING): This will be an evaluator blinded study. Due to the nature of the intervention, blinding of patients and healthcare workers is not possible. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 410 patients will be randomised in 1:1 ratio to two groups: experimental group (n=205) and control group (n=205). TRIAL STATUS: Protocol version 1 was approved on 02/12/2020. Recruitment for this trial began on 02/18/2020 and will be ongoing till the required sample size is reached. The analysis deadline is August 2020. TRIAL REGISTRATION: This randomised controlled trial has been prospectively registered with the Chinese Clinical Trials ( ChiCTR2000029972 ) on 17 February 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol." The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Simultaneous ventilation of two simulated ARDS patients in COVID-19 pandemic


title: Characteristics of Hospitalized Pediatric COVID-19 Cases - Chicago, Illinois, March - April 2020

text: BACKGROUND: To date, no report on COVID-19 pediatric patients in a large urban center with data on underlying comorbidities and co-infection for hospitalized cases has been published. METHODS: Case series of Chicago COVID-19 patients aged 0-17 years reported to Chicago Department of Public Health (CDPH) from 3/5/20-4/8/20. Enhanced case investigation performed. Chi-square and Wilcoxon two-sample tests to compare characteristics among hospitalized and non-hospitalized cases. RESULTS: During March 5-April 8, 2020, 6369 lab-confirmed cases of COVID-19 were reported to CDPH; 64 (1.0%) were among children 0-17 years. Ten patients (16%) were hospitalized, seven (70%) required intensive care (ICU); median length of hospitalization 4 days (range: 1-14). Reported fever and dyspnea were significantly higher in hospitalized patients compared to non-hospitalized patients (9/10 vs. 28/54, p = 0.04 and 7/10 vs. 10/54, p = 0.002, respectively). Hospitalized patients were significantly younger than non-hospitalized patients (median, 3.5 years vs. 12 years; p = 0.03) and all either had an underlying comorbidity or co-infection. Among the 34 unique households with multiple laboratory-confirmed infections, median number of laboratory-confirmed infections was 2 (range: 2-5), and 31 (91%) households had at least one COVID-19 infected adult. For 15 households with available data to assess transmission, 11 (73%) were adult-to-child, 2 (13%) child-to-child, and 2 (13%) child-to-adult. CONCLUSIONS: Enhanced case investigation of hospitalized patients revealed that underlying comorbidities and co-infection might have contributed to severe disease. Given frequency of household transmission, healthcare providers should consider alternative dispositional planning for affected families of children living with comorbidities.


Nurses as heroes, warriors and political activists


COVID-19: The Importance of Multidisciplinary Approach


title: Exploitation of Human Trust, Curiosity and Ignorance by Malware

text: Despite defensive advances in the Internet realm, Malware (malicious software) remains a Cybersecurity threat. These days, Malware can be purchased and licensed on the Internet to further customize and deploy. With hundreds of Malware variants discovered every day, organizations and users experience enormous financial losses as cybercriminals steal financial and user data. In this article surveys the human characteristics that are key to the defense chain against Malware. The article starts with the attack models/vectors that humans often fall prey to and their fallouts. Next, analysis of their root cause and suggest preventive measures that may be employed is detailed. The article concludes that while Internet user education, training, awareness can reduce the chances of Malware attacks,it cannot entirely eliminate them.


Releasing Migrants from Detention During the Covid-19 Pandemic


title: Spatial-temporal characteristics of AIDS incidences in Mainland China

text: OBJECT: Revealed the spatial-temporal patterns of acquired immune deficiency syndrome (AIDS) incidences in Mainland China. METHODS: Empirical orthogonal function (EOF) technique was applied to analyze the major spatial distribution modes and the temporal changes of AIDS incidences in Mainland China during 2002-2017. RESULTS: The annual average AIDS incidences increased from 0.06 per 100 000 in 2002 to 4.15 per 100 000 in 2017, with an annual average increase of 0.31 per 100 000. The southwest regions were high-incidence areas, as well as Xinjiang province in the northwest. There were two typical spatial modes. EOF 1 represented an isodirectional spatial pattern that the incidences were relatively high in general, and the fluctuation ranges were relatively high in the southwest and northeast. EOF 2 represented a reverse spatial pattern that the incidences were relatively high (or low) in Guangxi, Yunnan, Xinjiang, Shanghai, and Henan, yet were relatively low (or high) in the remaining regions. CONCLUSION: The AIDS incidences in Mainland China were relatively low during 2002-2010, yet were kept in a relatively high level since 2012. The prevention and control of AIDS need further development, especially in the southwest regions.


title: [Nationwide survey on clinical treatment of coronavirus disease 2019 in 9 provinces and municipalities]

text: OBJECTIVE: To investigate the clinical treatment and assess the knowledge and use of the coronavirus disease 2019 (COVID-19) treatment plan issued by the nation. METHODS: A nationwide questionnaire survey on line was administered to medical staffs involved in COVID-19 treatment on February 28th, 2020. The questionnaire included drug treatment, respiratory support therapy, sedation and analgesia, continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO), etc. RESULTS: There were 1 103 respondents, of whom 699 (504 doctors and 195 nurses) participated in the treatment of COVID-19. Finally, 432 doctors and 170 nurses from 9 provinces submitted valid questionnaires. The results of the questionnaire surveys of doctors and nurses were basically the same. Considering that doctors dominated in the diagnosis and treatment of COVID-19, the results of the questionnaires of doctors were mainly analyzed. The doctors participating in the survey were mainly from Hubei (29.2%), followed by Henan (24.5%), Guizhou (22.7%), and Guangxi (14.6%), etc. 55.4% of the doctors came from tertiary three hospitals, and most of them have senior titles (56.4%). 232 doctors (53.7%) participated in the treatment of mild COVID-19, and 200 doctors (46.3%) participated in the treatment of severe and critically ill patients. More than 95% of the doctors expressed that they would carry out antiviral treatment for patients with COVID-19 regardless of disease severity. The main antiviral drugs included α-interferon (69.5%), lopinavir/ritonavir (65.0%), abidol (60.0%), and ribavirin (55.7%). The choice of antiviral drugs was highly consistent with the national treatment programs of COVID-19. At the same time, 95.5% of doctors would routinely prescribe antibiotics to severe and critically ill patients. 94.0% of doctors agreed to prescribe low-dose glucocorticoid therapy to severe and critically ill patients. About 2/3 of doctors would perform lung recruitment or prone position treatment for critical patients with invasive ventilation. 79.0% of doctors preferred to use deep sedation for patients with invasive ventilation. About 1/3 of doctors believed that CRRT should be initiated early, and nearly 1/3 of doctors suggested that ECMO should be used more aggressively in critically ill patients. CONCLUSIONS: Medical staffs are familiar with the national treatment plan of COVID-19 and willing to follow it. However, as a new disease, we have limited knowledge about COVID-19 and there are still many controversies. Further practical training is needed to make clinicians more aware of the disease, and more evidence-based evidence is needed to guide clinical treatment.


title: Covid-19: la nueva enfermedad causada por un coronavirus./ [Covid-19: the new pathology caused by a coronavirus]

text: In this special communication, a brief description is made of the main events of the new pathology (that WHO has named Covid-19) caused by coronavirus. The cases of Covid-19 occurred in mainland China and the rest of the world are mentioned. It is also emphasized the effort that China and other countries around the world are making to contain the epidemic. Also, it highlights the role that WHO and other international organizations are playing to prevent and control the epidemic.


American Association for Thoracic Surgery: Maintaining the Mission during the COVID-19 Pandemic


title: Managing common endocrine disorders amid COVID-19 pandemic

text: BACKGROUND AND AIMS: The novel coronavirus disease (COVID-19) pandemic and the resulting nationwide lockdowns have posed a major challenge to the management of pre-existing and newly diagnosed endocrine disorders. Herein, we have summarized the management approaches of common endocrine disorders amid the ongoing pandemic. METHODS: We have performed an extensive literature search for articles in PubMed, EMBASE and Google Scholar databases till 25 May 2020, with the following keywords: "COVID-19", "diabetes mellitus", "thyroid disorders", "primary adrenal insufficiency", "Cushing's syndrome", "pituitary tumors", "vitamin Dâ³", "osteoporosis", "primary hyperparathyroidism", "hypoparathyroidism", "management", "treatment" and "guidelines" with interposition of the Boolean operator "AND". RESULTS: We have summarized the most feasible strategies for the management of diabetes mellitus, thyroid disorders, primary adrenal insufficiency (including congenital adrenal hyperplasia), Cushing's syndrome, pituitary tumors, osteoporosis, primary hyperparathyroidism and hypoparathyroidism amid the constraints laid down by the raging pandemic. In general, medical management should be encouraged and surgical interventions should be deferred whenever possible. Ongoing medications should be continued. Sick-day rules should be sincerely adhered to. Regular contact with physicians can be maintained through teleconsultations and virtual clinics. CONCLUSIONS: Considering the burden of endocrine disorders in the general population, their management needs to be prioritized amid the ongoing COVID-19 pandemic.


title: Achieving a Covid-19 Free Country: Citizens Preventive Measures and Communication Pathways

text: The Coronavirus Disease 2019 (COVID-19) has spread on a global scale in an extremely short time, causing hundreds of thousands of deaths, and, at the same time, triggering extreme panic. Prevention in medicine is considered the best protection action for individuals in order to avoid infections. This study investigates whether Greek citizens (N = 3359) take the necessary precautions to prevent developing the COVID-19 disease, and it segments them based on homogenous behavior groups. Lastly, it provides communication techniques that should be implemented, targeting each citizen segment for a long-term COVID-19 free country. Data analysis revealed the extent of the applied precaution measures. The ones most applied by citizens were to avoid non-mandatory transportation, contact with individuals with respiratory symptoms, and individuals of high risk for severe illness (vulnerable groups). On the other hand, the least applied measures are daily checks of body temperature, monitoring for fever, cough, or dyspnea, use of a face mask when in public places, or when using public transportation. Additionally, cluster analysis revealed five groups of citizens based on self-reported behavior, namely, the Meticulous Proactive Citizens, the Self-isolated Citizens, the Cautious Citizens, the Occasionally Cautious Citizens, and the Unconcerned Citizens. Communication strategies targeting each segment are also discussed.


title: Coronavirus disease (COVID-19) and neonate: What neonatologist need to know

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause china epidemics with high morbidity and mortality, the infection has been transmitted to other countries. About three neonates and more than 230 children cases are reported. The disease condition of the main children was mild. There is currently no evidence that SARS-CoV-2 can be transmitted transplacentally from mother to the newborn. The treatment strategy for children with Coronavirus disease (COVID-19) is based on adult experience. Thus far, no deaths have been reported in the pediatric age group. This review describes the current understanding of COVID-19 infection in newborns and children.


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

text: OBJECTIVE: International studies describing COVID-19 in children have shown low proportions of paediatric cases and generally a mild clinical course. We aimed to present early data on children tested for SARS-CoV-2 at a large Australian tertiary children's hospital according to the state health department guidelines, which varied over time. METHODS: We conducted a retrospective cohort study at The Royal Children's Hospital, Melbourne, Australia. It included all paediatric patients (aged 0-18 years) who presented to the ED or the Respiratory Infection Clinic (RIC) and were tested for SARS-CoV-2. The 30-day study period commenced after the first confirmed positive case was detected at the hospital on 21 March 2020, until 19 April 2020. We recorded epidemiological and clinical data. RESULTS: There were 433 patients in whom SARS-CoV-2 testing was performed in ED (331 [76%]) or RIC (102 [24%]). There were four (0.9%) who had positive SARS-CoV-2 detected, none of whom were admitted to hospital or developed severe disease. Of these SARS-CoV-2 positive patients, 1/4 (25%) had a comorbidity, which was asthma. Of the SARS-CoV-2 negative patients, 196/429 (46%) had comorbidities. Risk factors for COVID-19 were identified in 4/4 SARS-CoV-2 positive patients and 47/429 (11%) SARS-CoV-2 negative patients. CONCLUSION: Our study identified a very low rate of SARS-CoV-2 positive cases in children presenting to a tertiary ED or RIC, none of whom were admitted to hospital. A high proportion of patients who were SARS-CoV-2 negative had comorbidities.


CORONA-steps for tracheotomy in COVID-19 patients: A staff-safe method for airway management


title: Cirugía durante la pandemia del SARS-COV-2 / COVID-19: el efecto de la generación de aerosoles de partículas en escenarios quirúrgicos

text: Hasta el momento no se ha publicado información conclusiva que respalde la teoría de que los virus respiratorios se transmitan a través del humo quirúrgico o el neumoperitoneo Por lo tanto, las alertas sobre los riesgos de la laparoscopia emitidas durante las primeras semanas de la pandemia deben ser analizadas con precaución y a la luz de la evidencia cambiante sobre el tema Tanto la cirugía abierta como la laparoscópica tienen el potencial de generar aerosoles de partículas y por lo tanto, en ambos escenarios es fundamental la protección de todo el equipo de trabajo dentro del quirófano En todos los procedimientos durante la época de pandemia, se deben buscar las estrategias más efectivas para controlar las potenciales fuentes de trasmisión y minimizar la exposición del personal en los momentos de mayor riesgo, relacionados con el manejo de la vía aérea y las cavidades del paciente La siguiente es una revisión narrativa de literatura sobre las cirugías durante la pandemia del SARS-CoV-2 / COVID-19 y el efecto de los aerosoles durante estos procedimientos, con el fin de integrar y dar a conocer las principales medidas que se han propuesto a nivel global, para manejar este nuevo grupo de pacientesTo date no conclusive information has been published to support the theory that respiratory viruses are transmitted through surgical smoke or pneumoperitoneum Therefore, alerts about the risks of laparoscopy issued during the first weeks of the pandemic should be viewed with caution and in light of changing evidence on the subject Both open and laparoscopic surgery have the potential to generate aerosols of particles and therefore, in both scenarios, the protection of all the surgical team within the operating room is essential In all procedures during the pandemic season, the most effective strategies should be sought to control potential sources of transmission and minimize staff exposure at times of greatest risk related to the management of the patient's airway and cavities The following is a narrative review of the literature on surgeries during the SARS-CoV-2 / COVID-19 pandemic and the effect of aerosols during these procedures, in order to integrate and publicize the main measures that have been proposed globally, to manage this new group of patients


title: Modeling the Dynamics of the COVID-19 Population in Australia: A Probabilistic Analysis

text: The novel Corona Virus COVID-19 arrived on Australian shores around 25 January 2020. This paper presents a novel method of dynamically modeling and forecasting the COVID-19 pandemic in Australia with a high degree of accuracy and in a timely manner using limited data; a valuable resource that can be used to guide government decision-making on societal restrictions on a daily and/or weekly basis. The"partially-observable stochastic process"used in this study predicts not only the future actual values with extremely low error, but also the percentage of unobserved COVID-19 cases in the population. The model can further assist policy makers to assess the effectiveness of several possible alternative scenarios in their decision-making processes.


title: The impact of negative lymph nodes in the survival outcomes of pN+ patients following radical gastrectomy: the inverse lymph node ratio as a better score to study negative lymph nodes

text: The impact of negative lymph nodes (LNs) on survival of pN+ patients has been recognized. The weight of negative LNs in an inverse lymph node ratio (nR) should be related to its prognostic impact. Five hundred and two consecutive gastric cancer patients, who underwent radical gastrectomy, were included. Patients were split into groups according to the number of harvested nodes and a cross-tabulation with pTNM stages was performed to test differences in the tumor burden. pN+ patients (n = 296) were split into groups of negative LNs harvested. We tested an alternative formula for computing a lymph node ratio: nR = total number of harvested nodes/total number of positive nodes. The median number of negative LNs was significantly different (p < 0.01) between dissection groups, but not the median of positive nodes (p > 0.05). No difference in pTNM percentage distribution was found between these groups (p > 0.05). When tested, the overall survival improved significantly for groups with larger numbers of negative LNs (p < 0.001). A cutoff of nR ≥ 6 was an independent prognostic factor for survival (p = 0.001), and the survival of pN+ patients with nR ≥ 6 was not different from pN0 patients. The impact of the number of negative LNs on the survival of the pN+ patients was demonstrated. The higher numbers in the numerator of the nR was due to the disproportion between harvested negative LNs and metastatic LNs. Larger ratios imply more negative lymph nodes in relation to positive lymph nodes, which was significantly associated with survival. We believe that the proposed nR is a friendlier to use format because of its intuitive interpretation.


title: COVID-19 and Long-Term Care Policy for Older People in Canada

text: Older people are especially vulnerable to COVID-19, including and especially people living in long-term care facilities. In this Perspective, we discuss the impact of the COVID-19 pandemic on long-term care policy in Canada. More specifically, we use the example of recent developments in Quebec, where a tragedy in a specific facility is acting as a dramatic "focusing event". It draws attention to the problems facing long-term care facilities, considering existing policy legacies and the opening of a "policy window" that may facilitate comprehensive reforms in the wake of the COVID-19 pandemic.


title: The epidemiology, diagnosis and treatment of COVID-19

text: In December 2019, the outbreak of the novel coronavirus disease (COVID-19) in China spread worldwide, becoming an emergency of major international concern. SARS-CoV-2 infection causes clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus. Human-to-human transmission via droplets, contaminated hands or surfaces has been described, with incubation times of 2-14 days. Early diagnosis, quarantine, and supportive treatments are essential to cure patients. This paper reviews the literature on all available information about the epidemiology, diagnosis, isolation and treatments of COVID-19. Treatments, including antiviral agents, chloroquine and hydroxychloroquine, corticosteroids, antibodies, convalescent plasma transfusion and vaccines, are discussed in this article. In addition, registered trials investigating treatment options for COVID-19 infection are listed.


title: Usefulness of echocardiography to detect cardiac involvement in COVID-19 patients

text: Coronavirus disease 2019 (COVID-19) outbreak is a current global healthcare burden, leading to the life-threatening severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, evidence showed that, even if the prevalence of COVID-19 damage consists in pulmonary lesions and symptoms, it could also affect other organs, such as heart, liver, and spleen. Particularly, some infected patients refer to the emergency department for cardiovascular symptoms, and around 10% of COVID-19 victims had finally developed heart injury. Therefore, the use of echocardiography, according to the safety local protocols and ensuring the use of personal protective equipment, could be useful firstly to discriminate between primary cardiac disease or COVID-19-related myocardial damage, and then for assessing and monitoring COVID-19 cardiovascular complications: acute myocarditis and arrhythmias, acute heart failure, sepsis-induced myocardial impairment, and right ventricular failure derived from treatment with high-pressure mechanical ventilation. The present review aims to enlighten the applications of transthoracic echocardiography for the diagnostic and therapeutic management of myocardial damage in COVID-19 patients.


title: Intraoperative Diagnosis of Coronavirus Disease 2019 in an Asymptomatic Patient: A Case Report

text: Patients with coronavirus disease 2019 (COVID-19) with variable clinical presentations are encountered in the perioperative setting. While some have already been diagnosed and are symptomatic, others have undiagnosed, asymptomatic COVID-19. The latter group poses the greatest risk of transmission. Given limited capacities in most health care systems, diagnostic testing is mainly performed in symptomatic patients or those with relevant exposure. We report an intraoperative diagnosis of COVID-19 in an asymptomatic patient, prompted by clinical signs. To control a pandemic such as COVID-19, a high index of suspicion is pivotal when caring for asymptomatic patients in the perioperative setting.


title: Process-Oriented In Situ Simulation Is a Valuable Tool to Rapidly Ensure Operating Room Preparedness for COVID-19 Outbreak

text: STATEMENT: Process-oriented in situ simulation has been gaining widespread acceptance in the evaluation of the safety of new healthcare teams and facilities. In this article, we highlight learning points from our proactive use of in situ simulation as part of plan-do-study-act cycles to ensure operating room facility preparedness for COVID-19 outbreak. We found in situ simulation to be a valuable tool in disease outbreak preparedness, allowing us to ensure proper use of personal protective equipment and protocol adherence, and to identify latent safety threats and novel problems that were not apparent in the initial planning stage. Through this, we could refine our workflow and operating room setup to provide timely surgical interventions for potential COVID-19 patients in our hospital while keeping our staff and patients safe. Running a simulation may be time and resource intensive, but it is a small price to pay if it can help prevent disease spread in an outbreak.


title: Guillain-Barré syndrome during SARS-CoV-2 pandemic: A case report and review of recent literature

text: Acute demyelinating inflammatory polyneuropathy (AIDP) is the most common type of Guillain-Barré syndrome (GBS) in Europe, following several viral and bacterial infections. Data on AIDP-patients associated with SARS-CoV-2 (coronavirus-2) infection are scarce. We describe the case of a 54-years-old Caucasian female patient with typical clinical and electrophysiological manifestations of AIDP, who was reported positive with PCR for SARS-CoV-2, 3 weeks prior to onset of the neurological symptoms. She did not experience a preceding fever or respiratory symptoms, but a transient loss of smell and taste. At the admission to our neurological department, a progressive proximally pronounced paraparesis, areflexia, and sensory loss with tingling of all extremities were found, which began 10 days before. The modified Erasmus Giullain-Barré Syndrome outcome score (mEGOS) was 3/9 at admission and 1/12 at day 7 of hospitalization. The electrophysiological assessment proved a segmental demyelinating polyneuropathy and cerebrospinal fluid examination showed an albuminocytologic dissociation. The neurological symptoms improved significantly during treatment with immunoglobulins. Our case draws attention to the occurrence of GBS also in patients with COVID-19 (coronavirus disease 2019), who did not experience respiratory or general symptoms. It emphasizes that SARS-CoV-2 induces immunological processes, regardless from the lack of prodromic symptoms. However, it is likely that there is a connection between the severity of the respiratory syndrome and further neurological consequences.


What's the way out? Potential exit strategies from the COVID-19 lockdown


ACEing COVID-19: A Role for Angiotensin Axis Inhibition in SARS-CoV-2 Infection?


title: Novel biosensor platforms for the detection of coronavirus infection and SARS-CoV-2

text: The recent outbreak of the SARS-CoV-2 pandemic has been causing respiratory diseases globally, damaging wide-ranges of social-economical activities. This virus is transmitted through personal contact and possibly also through ambient air. Effective biosensor platforms for the detection of this virus and the related host response are in urgent demand. These platforms can facilitate routine diagnostic assays in certified clinical labs. They can also be integrated into point-of-care products. Furthermore, environmental biosensors can be designed to detect SARS-CoV-2 in the ambient air or in the intensive care ventilators. Here, we evaluate technical components of biosensors, including the biological targets of recognition, the recognition methods and the signal amplification and transduction systems. Effective SARS-CoV-2 detectors can be designed by adequate combination of these technologies.


title: Surveillance and taxonomic analysis of the coronavirus dominant in pigeons in China

text: Coronaviruses (CoVs) are found in humans and a wide variety of wild and domestic animals, and of substantial impact on human and animal health. In poultry, the genetic diversity, evolution, distribution and taxonomy of CoVs dominant in birds other than chickens remain enigmatic. In our previous study, we proposed that the CoVs dominant (i.e. mainly circulating) in ducks (DdCoVs) should represent a novel species, which was different from the one represented by the CoVs dominant in chickens (CdCoVs). In this study, we conducted a large-scale surveillance of CoVs in chickens, ducks, geese, pigeons and other birds (quails, sparrows and partridges) using a conserved RT-PCR assay. The surveillance demonstrated that CdCoVs, DdCoVs and the CoVs dominant in pigeons (PdCoVs) belong to different lineages, and they are all prevalent in live poultry markets and the backyard flocks in some regions of China. We further sequenced seven Coronaviridae-wide conserved domains in their replicase polyprotein pp1ab of seven PdCoVs and found that the genetic distances in these domains between PdCoVs and DdCoVs or CdCoVs are large enough to separate PdCoVs into a novel species, which were different from the ones represented by DdCoVs or CdCoVs within the genus Gammacoronavirus, per the species demarcation criterion of International Committee on Taxonomy of Viruses. This report shed novel insight into the genetic diversity, distribution, evolution and taxonomy of avian CoVs.


title: Did the lockdown curb the spread of COVID-19 infection rate in India: A data-driven analysis

text: In order to analyze the effectiveness of three successive nationwide lockdown enforced in India, we present a data-driven analysis of four key parameters, reducing the transmission rate, restraining the growth rate, flattening the epidemic curve and improving the health care system. These were quantified by the consideration of four different metrics, namely, reproduction rate, growth rate, doubling time and death to recovery ratio. The incidence data of the COVID-19 (during the period of 2nd March 2020 to 31st May 2020) outbreak in India was analyzed for the best fit to the epidemic curve, making use of the exponential growth, the maximum likelihood estimation, sequential Bayesian method and estimation of time-dependent reproduction. The best fit (based on the data considered) was for the time-dependent approach. Accordingly, this approach was used to assess the impact on the effective reproduction rate. The period of pre-lockdown to the end of lockdown 3, saw a $45\%$ reduction in the rate of effective reproduction rate. During the same period the growth rate reduced from $393\%$ during the pre-lockdown to $33\%$ after lockdown 3, accompanied by the average doubling time increasing form $4$-$6$ days to $12$-$14$ days. Finally, the death-to-recovery ratio dropped from $0.28$ (pre-lockdown) to $0.08$ after lockdown 3. In conclusion, all the four metrics considered to assess the effectiveness of the lockdown, exhibited significant favourable changes, from the pre-lockdown period to the end of lockdown 3. Analysis of the data in the post-lockdown period with these metrics will provide greater clarity with regards to the extent of the success of the lockdown.


title: Epidemic model on a network: analysis and applications to COVID-19

text: We analyze an epidemic model on a network consisting of susceptible-infected-recovered equations at the nodes coupled by diffusion using a graph Laplacian. We introduce an epidemic criterion and examine different vaccination/containment strategies: we prove that it is most effective to vaccinate a node of highest degree. The model is also useful to evaluate deconfinement scenarios and prevent a so-called second wave. The model has few parameters enabling fitting to the data and the essential ingredient of importation of infected; these features are particularly important for the current COVID-19 epidemic.


title: Caution in the management of SARS-CoV-2 infection in males

text: The coronavirus 2 (SARS-CoV-2) pandemic carries clinical, economic and social burdens that are currently being disclosed. The key steps of virus life cycle have been recently clarified, highlighting the role of host type 2 angiotensin converting enzyme (ACE2) and TMPRSS2 serine protease in virus-cell binding and entry, respectively. Importantly, major concerns derive from the androgen-dependent tissue-expression of both TMPRSS2 and ACE2, suggesting a differential clinical course of the infection between genders. In agreement with this model, available epidemiological data show that the disease in males has an higher risk to display an heavier pattern and associates with both an increased access to critical care unit and higher mortality rate. In this opinion article, available evidence linking the androgen activity with the gender differences observed in SARS-CoV-2 infection are discussed, hypothesizing possible therapeutic approaches in male based on the disruption of androgen signaling. On these bases, gender-specific recommendations for the management of male patients affected by SARS-CoV-2 infection are warmly suggested, in order to improve the clinical course of the disease.


Psychosis and Infodemic Isolation Resulting in First Inpatient Hospitalization During the COVID-19 Pandemic A Case Series


Of mice and men: COVID-19 challenges translational neuroscience


Fatal outcome of COVID-19 disease in a 5-month infant with comorbidities


title: Management of Female and Functional Urology Patients During the COVID Pandemic

text: CONTEXT: Coronavirus disease 19 (COVID-19) has changed standard urology practice around the world. The situation is affecting not only uro-oncological patients but also patients with benign and disabling conditions who are suffering delays in medical attention that impact their quality of life. OBJECTIVE: To propose, based on expert advice and current evidence where available, a strategy to reorganize female and functional urological (FFU) activity (diagnosis and treatment). EVIDENCE ACQUISITION: The present document is based on a narrative review of the limited data available in the urological literature on SARS-Cov-2 and the experience of FFU experts from several countries around the world. EVIDENCE SYNTHESIS: In all the treatment schemes proposed in the literature on the COVID-19 pandemic, FFU surgery is not adequately covered and usually grouped into the category that is not urgent or can be delayed, but in a sustained pandemic scenario there are cases that cannot be delayed that should be considered for surgery as a priority. The aim of this document is to provide a detailed management plan for noninvasive and invasive FFU consultations, investigations, and operations. A classification of FFU surgical activity by indication and urgency is proposed, as well as recommendations adopted from the literature for good surgical practice and by surgical approach in FFU in the COVID-19 era. CONCLUSIONS: Functional, benign, and pelvic floor conditions have often been considered suitable for delay in challenging times. The long-term implications of this reduction in functional urology clinical activity are currently unknown. This document will help functional urology departments to reorganize their activity to best serve their patients. PATIENT SUMMARY: Many patients will suffer delays in urology treatment because of COVID-19, with consequent impairment of their physical and psychological health and deterioration of their quality of life. Efforts should be made to minimize the burden for this patient group, without endangering patients and health care workers.


Letter: Covid-19, and vitamin D


title: Filling in the gaps

text: The COVID-19 pandemic, and our response to it, has created many voids in our lives, with no-one spared of its effects. As a result, we have all looked for, and found ways to fill in the gaps. In the midst of the epidemic, with healthcare providers in New York City pushed to the extremes of what can be asked of them, they have found ways to bridge the gulf between how they were trained to practice medicine, and what they are being asked to do now.