title: Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis

text: BACKGROUND: An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 and triggered a Public Health Emergency of International Concern (PHEIC). We aimed to find risk factors for the progression of COVID-19 to help reducing the risk of critical illness and death for clinical help. METHODS: The data of COVID-19 patients until March 20, 2020 were retrieved from four databases. We statistically analyzed the risk factors of critical/mortal and non-critical COVID-19 patients with meta-analysis. RESULTS: Thirteen studies were included in Meta-analysis, including a total number of 3027 patients with SARS-CoV-2 infection. Male, older than 65, and smoking were risk factors for disease progression in patients with COVID-19 (male: ORâ¯=â¯1.76, 95% CI (1.41, 2.18), P < 0.00001; age over 65 years old: OR =6.06, 95% CI(3.98, 9.22), P < 0.00001; current smoking: OR =2.51, 95% CI(1.39, 3.32), Pâ¯=â¯0.0006). The proportion of underlying diseases such as hypertension, diabetes, cardiovascular disease, and respiratory disease were statistically significant higher in critical/mortal patients compared to the non-critical patients (diabetes: OR=3.68, 95% CI (2.68, 5.03), P < 0.00001; hypertension: ORâ¯=â¯2.72, 95% CI (1.60,4.64), Pâ¯=â¯0.0002; cardiovascular disease: ORâ¯=â¯5.19, 95% CI(3.25, 8.29), P < 0.00001; respiratory disease: ORâ¯=â¯5.15, 95% CI(2.51, 10.57), P < 0.00001). Clinical manifestations such as fever, shortness of breath or dyspnea were associated with the progression of disease [fever: 0Râ¯=â¯0.56, 95% CI (0.38, 0.82), Pâ¯=â¯0.003;shortness of breath or dyspnea: 0R=4.16, 95% CI (3.13, 5.53), P < 0.00001]. Laboratory examination such as aspartate amino transferase(AST) > 40U/L, creatinine(Cr) ≥ 133mol/L, hypersensitive cardiac troponin I(hs-cTnI) > 28pg/mL, procalcitonin(PCT) > 0.5ng/mL, lactatede hydrogenase(LDH) > 245U/L, and D-dimer > 0.5mg/L predicted the deterioration of disease while white blood cells(WBC)<4â¯×â¯109/L meant a better clinical status[AST > 40U/L:OR=4.00, 95% CI (2.46, 6.52), P < 0.00001; Cr ≥ 133µmol/L: ORâ¯=â¯5.30, 95% CI (2.19, 12.83), Pâ¯=â¯0.0002; hs-cTnI > 28 pg/mL: ORâ¯=â¯43.24, 95% CI (9.92, 188.49), P < 0.00001; PCT > 0.5 ng/mL: ORâ¯=â¯43.24, 95% CI (9.92, 188.49), P < 0.00001;LDH > 245U/L: ORâ¯=â¯43.24, 95% CI (9.92, 188.49), P < 0.00001; D-dimer > 0.5mg/L: ORâ¯=â¯43.24, 95% CI (9.92, 188.49), P < 0.00001; WBC < 4â¯×â¯109/L: ORâ¯=â¯0.30, 95% CI (0.17, 0.51), P < 0.00001]. CONCLUSION: Male, aged over 65, smoking patients might face a greater risk of developing into the critical or mortal condition and the comorbidities such as hypertension, diabetes, cardiovascular disease, and respiratory diseases could also greatly affect the prognosis of the COVID-19. Clinical manifestation such as fever, shortness of breath or dyspnea and laboratory examination such as WBC, AST, Cr, PCT, LDH, hs-cTnI and D-dimer could imply the progression of COVID-19.


How to manage an endoscopy unit during a COVID-19 pandemic


title: Rapid Conversion of an Outpatient Psychiatric Clinic to a 100% Virtual Telepsychiatry Clinic in Response to COVID-19

text: In anticipation of a surge of COVID-19 cases in Northern California, the outpatient psychiatric clinic at UC Davis Health, in which 98% of visits initially occurred in person, was converted to a telepsychiatry clinic, with all visits changed to virtual appointments within 3 business days. The clinic had 73 virtual appointments on its first day after full conversion. This column describes the process, challenges, and lessons learned from this rapid conversion. Patients were generally grateful, providers learned rapidly how to work from home, and the clinic remained financially viable with no immediate losses.


title: Massive cutback in orthopaedic healthcare services due to the COVID-19 pandemic

text: PURPOSE: Due to the lack of evidence, it was the aim of the study to investigate current possible cutbacks in orthopaedic healthcare due to the coronavirus disease 2019 pandemic (COVID-19). METHODS: An online survey was performed of orthopaedic surgeons in the German-speaking Arthroscopy Society (Gesellschaft für Arthroskopie und Gelenkchirurgie, AGA). The survey consisted of 20 questions concerning four topics: four questions addressed the origin and surgical experience of the participant, 12 questions dealt with potential cutbacks in orthopaedic healthcare and 4 questions addressed the influence of the pandemic on the particular surgeon. RESULTS: Of 4234 contacted orthopaedic surgeons, 1399 responded. Regarding arthroscopic procedures between 10 and 30% of the participants stated that these were still being performed-with actual percentages depending on the specific joint and procedure. Only 6.2% of the participants stated that elective total joint arthroplasty was still being performed at their centre. In addition, physical rehabilitation and surgeons' postoperative follow-ups were severely affected. CONCLUSION: Orthopaedic healthcare services in Austria, Germany, and Switzerland are suffering a drastic cutback due to COVID-19. A drastic reduction in arthroscopic procedures like rotator cuff repair and cruciate ligament reconstruction and an almost total shutdown of elective total joint arthroplasty were reported. Long-term consequences cannot be predicted yet. The described disruption in orthopaedic healthcare services has to be viewed as historic. LEVEL OF EVIDENCE: V.


title: Foraging through multiple nest holes: An impediment to collective decision-making in ants

text: In social insects, collective choices between food sources are based on self-organized mechanisms where information about resources are locally processed by the foragers. Such a collective decision emerges from the competition between pheromone trails leading to different resources but also between the recruiting stimuli emitted by successful foragers at nest entrances. In this study, we investigated how an additional nest entrance influences the ability of Myrmica rubra ant colonies to exploit two food sources of different quality (1M and 0.1M sucrose solution) and to select the most rewarding one. We found that the mobilisation of workers doubled in two-entrance nests compared to one-entrance nests but that ants were less likely to reach a food source once they exited the nest. Moreover, the collective selection of the most rewarding food source was less marked in two-entrance nests, with foragers distributing themselves evenly between the two feeders. Ultimately, multiple nest entrances reduced the foraging efficiency of ant colonies that consumed significantly less sugar out of the two available resources. Our results highlight that the nest structure, more specifically the number of nest entrances, can impede the ant's ability to process information about environmental opportunities and to select the most rewarding resource. This study opens new insights on how the physical interface between the nest interior and the outside environment can act upon collective decision-making and foraging efficiency in self-organized insect societies.


title: Mesenchymal Stem Cell-based Therapy for COVID-19: Possibility and Potential

text: A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged in Wuhan, China since the end of December 2019 and has quickly spread all over the world in a matter of two months. To date, no specific treatment has been proven to be effective for coronavirus disease 2019 (COVID-19). With the rapid increase of infected patients and deaths, it is urgent to explore an effective treatment for COVID-19. Current studies suggest that there exists cytokine storm in SARS-CoV-2-infected patient, some of the patients will develop to acute respiratory distress syndrome (ARDS) and multiple organ dysfunction, even death. Mesenchymal stem cells (MSCs) possess the property of immunomodulation. Given the previous preclinical and clinical studies, MSCs therapy has been shown safety and efficacy in the treatment of respiratory failure or ARDS. Based on similar principles, MSCs therapy may also be an effective therapy in the treatment of COVID-19. In this study, we summarized the clinical outcomes of MSCs for ARDS patients in some preclinical and clinical studies, and discussed the application of MSCs for patients with COVID-19 in China and the related important issues with MSCs use during the outbreak.


Breast unit Efficacy with the relocation of the surgical breast team during the COVID-19 pandemic


title: COVID-19 and chronological aging: senolytics and other anti-aging drugs for the treatment or prevention of corona virus infection?

text: COVID-19, also known as SARS-CoV-2, is a new emerging zoonotic corona virus of the SARS (Severe Acute Respiratory Syndrome) and the MERS (Middle East Respiratory Syndrome) family. COVID-19 originated in China and spread world-wide, resulting in the pandemic of 2020. For some reason, COVID-19 shows a considerably higher mortality rate in patients with advanced chronological age. This begs the question as to whether there is a functional association between COVID-19 infection and the process of chronological aging. Two host receptors have been proposed for COVID-19. One is CD26 and the other is ACE-2 (angiotensin-converting enzyme 2). Interestingly, both CD26 and the angiotensin system show associations with senescence. Similarly, two proposed therapeutics for the treatment of COVID-19 infection are Azithromycin and Quercetin, both drugs with significant senolytic activity. Also, Chloroquine-related compounds inhibit the induction of the well-known senescence marker, Beta-galactosidase. Other anti-aging drugs should also be considered, such as Rapamycin and Doxycycline, as they behave as inhibitors of protein synthesis, blocking both SASP and viral replication. Therefore, we wish to speculate that the fight against COVID-19 disease should involve testing the hypothesis that senolytics and other anti-aging drugs may have a prominent role in preventing the transmission of the virus, as well as aid in its treatment. Thus, we propose that new clinical trials may be warranted, as several senolytic and anti-aging therapeutics are existing FDA-approved drugs, with excellent safety profiles, and would be readily available for drug repurposing efforts. As Azithromycin and Doxycycline are both commonly used antibiotics that inhibit viral replication and IL-6 production, we may want to consider this general class of antibiotics that functionally inhibits cellular protein synthesis as a side-effect, for the treatment and prevention of COVID-19 disease.


title: Potential role for tissue factor in the pathogenesis of hypercoagulability associated with in COVID-19

text: In December 2019, a new and highly contagious infectious disease emerged in Wuhan, China. The etiologic agent was identified as a novel coronavirus, now known as Severe Acute Syndrome Coronavirus-2 (SARS-CoV-2). Recent research has revealed that virus entry takes place upon the union of the virus S surface protein with the type I transmembrane metallo-carboxypeptidase, angiotensin converting enzyme 2 (ACE-2) identified on epithelial cells of the host respiratory tract. Virus triggers the synthesis and release of pro-inflammatory cytokines, including IL-6 and TNF-α and also promotes downregulation of ACE-2, which promotes a concomitant increase in levels of angiotensin II (AT-II). Both TNF-α and AT-II have been implicated in promoting overexpression of tissue factor (TF) in platelets and macrophages. Additionally, the generation of antiphospholipid antibodies associated with COVID-19 may also promote an increase in TF. TF may be a critical mediator associated with the development of thrombotic phenomena in COVID-19, and should be a target for future study.


Detection of antibodies against SARS-CoV-2 in patients with COVID-19


Vascular surgery activity condition is a common language for uncommon times


Spinal anaesthesia and COVID-19 transmission to anaesthetists. Response to Br J Anaesth 2020; 124: 670-5


Covid-19: Free resources to support radiographers


Offline: Health in the unhappy time of COVID-19


title: COVID-19 diagnostics in context

text: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for different types of diagnostics, comparative validation of new tests, faster approval by federal agencies, and rapid production of test kits to meet global demands. In this Perspective, we discuss the utility and challenges of current diagnostics for COVID-19.


title: Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy: A Cohort Study

text: BACKGROUND: The incidence and severity of coronavirus disease 2019 (COVID-19) among HIV-positive persons receiving antiretroviral therapy (ART) have not been characterized in large populations. OBJECTIVE: To describe the incidence and severity of COVID-19 by nucleos(t)ide reverse transcriptase inhibitor (NRTI) use among HIV-positive persons receiving ART. DESIGN: Cohort study. SETTING: HIV clinics in 60 Spanish hospitals between 1 February and 15 April 2020. PARTICIPANTS: 77 590 HIV-positive persons receiving ART. MEASUREMENTS: Estimated risks (cumulative incidences) per 10 000 persons and 95% CIs for polymerase chain reaction-confirmed COVID-19 diagnosis, hospitalization, intensive care unit (ICU) admission, and death. Risk and 95% CIs for COVID-19 diagnosis and hospital admission by use of the NRTIs tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), tenofovir alafenamide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and others were estimated through Poisson regression models. RESULTS: Of 77 590 HIV-positive persons receiving ART, 236 were diagnosed with COVID-19, 151 were hospitalized, 15 were admitted to the ICU, and 20 died. The risks for COVID-19 diagnosis and hospitalization were greater in men and persons older than 70 years. The risk for COVID-19 hospitalization was 20.3 (95% CI, 15.2 to 26.7) among patients receiving TAF/FTC, 10.5 (CI, 5.6 to 17.9) among those receiving TDF/FTC, 23.4 (CI, 17.2 to 31.1) among those receiving ABC/3TC, and 20.0 (CI, 14.2 to 27.3) for those receiving other regimens. The corresponding risks for COVID-19 diagnosis were 39.1 (CI, 31.8 to 47.6), 16.9 (CI, 10.5 to 25.9), 28.3 (CI, 21.5 to 36.7), and 29.7 (CI, 22.6 to 38.4), respectively. No patient receiving TDF/FTC was admitted to the ICU or died. LIMITATION: Residual confounding by comorbid conditions cannot be completely excluded. CONCLUSION: HIV-positive patients receiving TDF/FTC have a lower risk for COVID-19 and related hospitalization than those receiving other therapies. These findings warrant further investigation in HIV preexposure prophylaxis studies and randomized trials in persons without HIV. PRIMARY FUNDING SOURCE: Instituto de Salud Carlos III and National Institutes of Health.


Skin reactions of N95 masks and medial masks among health-care personnel: A self-report questionnaire survey in China


Covid-19: US gives emergency approval to hydroxychloroquine despite lack of evidence


Covid-19: First severe pandemic of the 21st century


title: Hand disinfection in the combat against Covid-19

text: The World Health Organization (WHO) has declared a global health emergency over a new coronavirus. The new corona virus (SARS-CoV-2) has raised global attention with raising concerns of rapid spread from human-to-human. Like severe acute respiratory syndrome (SARS)-nCoV, 2019-nCoV can be passed directly from person to person by respiratory droplets, and may also be transmitted through contact and fomites.


title: Genomewide Association Study of Severe Covid-19 with Respiratory Failure

text: BACKGROUND: There is considerable variation in disease behavior among patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19). Genomewide association analysis may allow for the identification of potential genetic factors involved in the development of Covid-19. METHODS: We conducted a genomewide association study involving 1980 patients with Covid-19 and severe disease (defined as respiratory failure) at seven hospitals in the Italian and Spanish epicenters of the SARS-CoV-2 pandemic in Europe. After quality control and the exclusion of population outliers, 835 patients and 1255 control participants from Italy and 775 patients and 950 control participants from Spain were included in the final analysis. In total, we analyzed 8,582,968 single-nucleotide polymorphisms and conducted a meta-analysis of the two case-control panels. RESULTS: We detected cross-replicating associations with rs11385942 at locus 3p21.31 and with rs657152 at locus 9q34.2, which were significant at the genomewide level (P<5×10-8) in the meta-analysis of the two case-control panels (odds ratio, 1.77; 95% confidence interval [CI], 1.48 to 2.11; P = 1.15×10-10; and odds ratio, 1.32; 95% CI, 1.20 to 1.47; P = 4.95×10-8, respectively). At locus 3p21.31, the association signal spanned the genes SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6 and XCR1. The association signal at locus 9q34.2 coincided with the ABO blood group locus; in this cohort, a blood-group-specific analysis showed a higher risk in blood group A than in other blood groups (odds ratio, 1.45; 95% CI, 1.20 to 1.75; P = 1.48×10-4) and a protective effect in blood group O as compared with other blood groups (odds ratio, 0.65; 95% CI, 0.53 to 0.79; P = 1.06×10-5). CONCLUSIONS: We identified a 3p21.31 gene cluster as a genetic susceptibility locus in patients with Covid-19 with respiratory failure and confirmed a potential involvement of the ABO blood-group system. (Funded by Stein Erik Hagen and others.).


title: Depression, Anxiety and Stress Among Indians in Times of Covid-19 Lockdown

text: Covid-19 has caused significant distress around the globe. Apart from the evident physical symptoms in infected cases, it has caused serious damage to public mental health. India, like other countries, implemented a nationwide lockdown to contain and curb the transmission of the virus. The current research is an attempt to explore psychological distress among people residing in India during the lockdown. Four hundred and three participants were asked to complete a questionnaire with questions around symptoms of depression, anxiety, stress, and family affluence. The results indicated that people who do not have enough supplies to sustain the lockdown were most affected, and family affluence was found to be negatively correlated with stress, anxiety, and depression. Among different professions, students and healthcare professionals were found to experience stress, anxiety, and depression more than others. Despite the current situation, stress, anxiety, and depression were found to be in normal ranges for mental health professionals highlighting their capabilities to remain normal in times of distress. Policymakers and other authorities may take the assistance of mental health professionals to help overcome psychological issues related to Covid-19.


title: Esteatose hepática altera acúmulo celular em tilápias do Nilo durante aerocistite infecciosa/ Hepatic steatosis alters cellular recruitment during induced aerocystitis in Nile tilapia

text: O presente estudo avaliou a hepatotoxicidade induzida pelo CCl4 durante o efeito glicocorticoide da dexametasona (DEX) na fisiopatologia da reação inflamatória aguda em tilápias do Nilo, Oreochromis niloticus, correlacionando a funcionalidade hepática à cinética de acúmulo celular em aerocistite infecciosa. Para tal, utilizou-se 84 tilápias do Nilo distribuídas em 4 tratamentos: controle, CCl4, DEX e CCl4+DEX. Sendo amostrados 7 animais por tratamento em três períodos, isto é: seis, 24 e 48h após indução de inflamação. Utilizou-se CCl4 em dose única de 0,5mL/kg, via intraperitoneal para causar o transtorno hepático. Para indução da aerocistite utilizou-se inóculo de Aeromonas hydrophila. A dexametasona foi administrada via intramuscular na dose de 2 mg/kg de peso vivo. Os resultados revelaram que quanto maior foi à atividade sérica de aspartato aminotransferase (AST) maior foi a alteração somática do fígado, sendo estes achados inversamente proporcionais ao acúmulo celular no foco inflamatório, demonstrando menor número de células inflamatórias nos animais acometidos com maior grau de distúrbios hepáticos induzidos pelo CCl4. O estudo histopatológico revelou alterações degenerativas transitórias na fase mais aguda, pois os fígados das tilápias revelaram o acúmulo lipídeos nos hepatócitos 6h após administração de CCl4, sendo esta degeneração gordurosa não mais observada nos tempos de 24 e 48h. Contudo, a administração de CCl4 em tilápias do Nilo resultou em degeneração hepática aguda e transitória, caracterizada pelo acúmulo de gordura nos hepatócitos, aumento de AST no sangue e hepatomegalia. Com a disfunção hepática houve comprometimento do recrutamento celular em aerocistite infecciosa, indicando que há participação do fígado na resposta imune inata em peixes.(AU)


The Risks of Prescribing Hydroxychloroquine for Treatment of COVID-19-First, Do No Harm


title: Kidney transplant in the COVID era: Cautious optimism and continued vigilance

text: Since early March, transplant centers throughout the country have attempted to balance the risk of COVID-19 transmission in a newly immunosuppressed transplant recipient with the concern for wait list mortality and life years lost by remaining on dialysis. Much of the deliberation over this balance has occurred through online discussion groups where the sentiments are aligned, but the community risk, center resources, and population demographics are vastly different. Dr. Massie and coauthors provide data driven support for decision making by modeling the benefit to harm ratio of kidney transplant under varying environmental conditions, and providing a user-friendly calculator at transplantmodels.com/covid_sim.1.


title: COVID-19: A Worldwide, Zoonotic, Pandemic Outbreak

text: Context: An outbreak of a novel, zoonotic coronavirus occurred in December 2019 in the city of Wuhan, China and has now affected almost the entire world, with the maximum confirmed cases being 1 521 252 as of April 10, 2020. The WHO named this coronavirus 2019-nCoV, with COVID-19 being the name for diseases allied with it. Objective: The study intended to examine the features and characteristics of existing human coronaviruses and identify their resemblance to the newly identified 2019-nCoV. Design: The research team performed a literature review, searching relevant literature databases. We searched four databases, PubMed, EMBASE, Web of Science and CNKI (Chinese Database), to identify studies reporting COVID-19. Articles published on or before April 10, 2020 were eligible for inclusion. We used the following search terms: "Coronavirus" or "2019-nCoV" or "COVID-19" or "SARS-CoV" or "MERS-CoV" or "Bat SARS-CoV" or "ACE2 receptor". Setting: This study was take place in School of Pharmacy, Suresh Gyan Vihar University, Jaipur, India. Results: The undistinguishable similarity of the genomic sequences of Severe Respiratory Syndrome (SARS)-CoV, Middle East Respiratory Syndrome (MERS)-CoV, and Bat SARS-CoV-bat-SL-CoVZC45 and bat-SL-CoVZXC21-to nCoV-2019 has facilitated the process of identifying primary treatment measures. Researchers are presuming the existence of angiotensin-converting enzyme 2 (ACE2) receptor binding in nCoV-2019, as in SARS-CoV. Researchers have been examining human-to-human transmission, the possibility of an intermediate host between bats and humans, and the existence of asymptomatic cases. An incubation period of 0 to 14 days has been reported, with acute to chronic symptoms being cough, nasal congestion, high fever, dyspnea, pneumonia, invasive lesions in both lungs, respiratory failure, and even death, including in pediatric cases. Mechanical ventilation, extracorporeal membrane oxygenation, repurposing of antivirals, and plasma infusion have proven to be somewhat effective. Several countries have started clinical trials to evaluate the safety and effectiveness of some drugs, but the ability to vaccinate people with existing or new molecules will require time. Previously learned lessons from SARS and MERS have led some areas to be well equipped in terms of the ability to take speedy action. Conclusions: First-level treatments include repurposing antivirals and antimalarials, and plasma infusion should help, but development of existing or new molecules into vaccines will take time. The unpredictable trajectory of this outbreak demands careful surveillance to monitor the situation, draw strategies, implement control measures, and create proper ethical laws and medical guidelines.


title: Distress and Resilience in the Days of COVID-19: Comparing Two Ethnicities

text: The COVID-19 pandemic is an ongoing epidemic of coronavirus disease, caused by severe acute respiratory syndrome, which has spread recently worldwide. Efforts to prevent the virus from spreading include travel restrictions, lockdowns as well as national or regional quarantines throughout the international community. The major negative psychological outcome of the COVID-19 pandemic is the anxiety caused by it. The aim of the present study was to examine the level of concern and the contributions of modes of resilience, well-being and demographic attributes towards decreasing or enhancing anxiety and depression among two samples: Israeli Jews (majority group) and Israeli Arabs (minority group). These random samples included 605 Jews and 156 Arabs who participated in an internet survey. A previous study, which has been conducted in the context of terror attacks, has shown that compared to Israeli Jews, Israeli Arabs expressed a higher level of fear of war and lower levels of resilience supporting personality attributes. The results of the current study indicated a similar pattern that emerged in the context of the COVID-19 pandemic: the Israeli Arabs reported a higher level of distress and a lower level of resilience and well-being.


title: Treatment of SARS-CoV-2 with high dose oral zinc salts: A report on four patients

text: Coronavirus 2019 (COVID-19) is a pandemic with substantial mortality and no accepted therapy. We report here on four consecutive outpatients with clinical characteristics (CDC case definition) of and/or laboratory-confirmed COVID-19 who were treated with high dose zinc salt oral lozenges. All four patients experienced significant improvement in objective and symptomatic disease measures after one day of high dose therapy suggesting that zinc therapy was playing a role in clinical recovery. A mechanism for zinc's effects is proposed based on previously published studies on SARS- CoV-1, and randomized controlled trials assessing zinc shortening of common cold duration. The limited sample size and study design preclude a definitive statement about the effectiveness of zinc as a treatment for COVID-19 but suggest the variables to be addressed to confirm these initial findings in future trials.


title: A Dynamic Immune Response Shapes COVID-19 Progression

text: The inflammatory response to SARS-coronavirus-2 (SARS-CoV-2) infection is thought to underpin COVID-19 pathogenesis. We conducted daily transcriptomic profiling of three COVID-19 cases and found that the early immune response in COVID-19 patients is highly dynamic. Patient throat swabs were tested daily for SARS-CoV-2, with the virus persisting for 3 to 4 weeks in all three patients. Cytokine analyses of whole blood revealed increased cytokine expression in the single most severe case. However, most inflammatory gene expression peaked after respiratory function nadir, except expression in the IL1 pathway. Parallel analyses of CD4 and CD8 expression suggested that the pro-inflammatory response may be intertwined with T cell activation that could exacerbate disease or prolong the infection. Collectively, these findings hint at the possibility that IL1 and related pro-inflammatory pathways may be prognostic and serve as therapeutic targets for COVID-19. This work may also guide future studies to illuminate COVID-19 pathogenesis and develop host-directed therapies.


title: A dynamic immune response shapes COVID-19 progression

text: The inflammatory response to SARS-coronavirus-2 (SARS-CoV-2) infection is thought to underpin COVID-19 pathogenesis We conducted daily transcriptomic profiling of three COVID-19 cases and found that the early immune response in COVID-19 patients is highly dynamic Patient throat swabs were tested daily for SARS-CoV-2 with the virus persisting for 3-4 weeks in all three patients Cytokine analyses of whole blood revealed increased cytokine expression in the single more severe case However, most inflammatory gene expression peaked after respiratory function nadir, except those in the IL1 pathway Parallel analyses of CD4 and CD8 expression suggested that the pro-inflammatory response may be intertwined with T-cell activation that could exacerbate disease or prolong the infection Collectively, these findings hint at the possibility that IL1 and related pro-inflammatory pathways may be prognostic and serve as therapeutic targets for COVID-19 This work may also guide future studies to illuminate COVID-19 pathogenesis and develop host-directed therapies


title: Hypothesis for potential pathogenesis of SARS-CoV-2 infection--a review of immune changes in patients with viral pneumonia

text: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with droplets and contact as the main means of transmission Since the first case appeared in Wuhan, China, in December 2019, the outbreak has gradually spread nationwide Up to now, according to official data released by the Chinese health commission, the number of newly diagnosed patients has been declining, and the epidemic is gradually being controlled Although most patients have mild symptoms and good prognosis after infection, some patients developed severe and die from multiple organ complications The pathogenesis of SARS-CoV-2 infection in humans remains unclear Immune function is a strong defense against invasive pathogens and there is currently no specific antiviral drug against the virus This article reviews the immunological changes of coronaviruses like SARS, MERS and other viral pneumonia similar to SARS-CoV-2 Combined with the published literature, the potential pathogenesis of COVID-19 is inferred, and the treatment recommendations for giving high-doses intravenous immunoglobulin and low-molecular-weight heparin anticoagulant therapy to severe type patients are proposed


title: Framework for prioritizing head and neck surgery during the COVID-19 pandemic

text: The COVID-19 pandemic has placed an extraordinary demand on the United States health care system. Many institutions have canceled elective and non-urgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent-proceed with surgery, less urgent-consider postpone > 30 days, less urgent-consider postpone 30 to 90 days, and case-by-case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low-risk and high-risk surgery for transmission and role of preoperative COVID-19 testing.


title: COVID-19 and diabetes: The why, the what and the how

text: BACKGROUND: The novel coronavirus SARS-CoV-2 has taken the world by storm. Alongside COVID-19, diabetes is a long-standing global epidemic. The diabetes population has been reported to suffer adverse outcomes if infected by COVID-19. The aim was to summarise information and resources available on diabetes and COVID-19, highlighting special measures that individuals with diabetes need to follow. METHODS: A search using keywords "COVID-19" and "Diabetes" was performed using different sources, including PubMed and World Health Organization. RESULTS: COVID-19 may enhance complications in individuals with diabetes through an imbalance in angiotension-converting enzyme 2 (ACE2) activation pathways leading to an inflammatory response. ACE2 imbalance in the pancreas causes acute ß-cell dysfunction and a resultant hyperglycemic state. These individuals may be prone to worsened COVID-19 complications including vasculopathy, coagulopathy as well as psychological stress. Apart from general preventive measures, remaining hydrated, monitoring blood glucose regularly and monitoring ketone bodies in urine if on insulin is essential. All this while concurrently maintaining physical activity and a healthy diet. Different supporting entities are being set up to help this population. CONCLUSION: COVID-19 is a top priority. It is important to remember that a substantial proportion of the world's population is affected by other co-morbidities such as diabetes. These require special attention during this pandemic to avoid adding on to the burden of countries' healthcare systems.


The UIC COVID Coverage Protocol: A Technical Note for Pandemic Oral and Maxillofacial Surgery Call Coverage


title: Maternal Mortality From Coronavirus Disease 2019 (COVID-19) in the United States

text: Individual state maternal mortality review committees aim to comprehensively review all maternal deaths to not only evaluate the cause of death, but also to assess preventability and make recommendations for action to prevent future deaths. The maternal mortality review committee process remains critical during the coronavirus disease 2019 (COVID-19) pandemic. Maternal deaths due to COVID-19 have been reported in the United States. Some state maternal mortality review committees may choose to expedite review of these deaths in an effort to quickly provide clinicians with information intended to prevent other deaths during the ongoing pandemic. If states opt to pursue rapid review, entry of data into the Maternal Mortality Review Information Application system for submission to the Centers for Disease Control and Prevention will allow for aggregation nationally without duplication. It will be important to review not only deaths directly attributed to COVID-19, but also those that may be indirectly related to the COVID-19 pandemic, such as those influenced by changes in care practices or delays in seeking care during the pandemic. Therefore, regardless of the timing of the review, maternal deaths that occur during the time of the COVID-19 pandemic must be evaluated within that framework to ensure that all factors contributing to the death are considered to better understand the context of each of these tragic events.


title: Protein Coding and Long Noncoding RNA (lncRNA) Transcriptional Landscape in SARS-CoV-2 Infected Bronchial Epithelial Cells Highlight a Role for Interferon and Inflammatory Response

text: The global spread of COVID-19, caused by pathogenic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) underscores the need for an imminent response from medical research communities to better understand this rapidly spreading infection. Employing multiple bioinformatics and computational pipelines on transcriptome data from primary normal human bronchial epithelial cells (NHBE) during SARS-CoV-2 infection revealed activation of several mechanistic networks, including those involved in immunoglobulin G (IgG) and interferon lambda (IFNL) in host cells. Induction of acute inflammatory response and activation of tumor necrosis factor (TNF) was prominent in SARS-CoV-2 infected NHBE cells. Additionally, disease and functional analysis employing ingenuity pathway analysis (IPA) revealed activation of functional categories related to cell death, while those associated with viral infection and replication were suppressed. Several interferon (IFN) responsive gene targets (IRF9, IFIT1, IFIT2, IFIT3, IFITM1, MX1, OAS2, OAS3, IFI44 and IFI44L) were highly upregulated in SARS-CoV-2 infected NBHE cell, implying activation of antiviral IFN innate response. Gene ontology and functional annotation of differently expressed genes in patient lung tissues with COVID-19 revealed activation of antiviral response as the hallmark. Mechanistic network analysis in IPA identified 14 common activated, and 9 common suppressed networks in patient tissue, as well as in the NHBE cell model, suggesting a plausible role for these upstream regulator networks in the pathogenesis of COVID-19. Our data revealed expression of several viral proteins in vitro and in patient-derived tissue, while several host-derived long noncoding RNAs (lncRNAs) were identified. Our data highlights activation of IFN response as the main hallmark associated with SARS-CoV-2 infection in vitro and in human, and identified several differentially expressed lncRNAs during the course of infection, which could serve as disease biomarkers, while their precise role in the host response to SARS-CoV-2 remains to be investigated.


title: The true worth of a nurse..time to act!

text: The COVID-19 outbreak has shown the world the true value of the nursing profession to the healthcare system and to humanity. Indeed, without nurses (and midwives) there would be no health care!. The timing of this "freak" (although not unpredictable) viral pandemic with the World Health Assembly declaration that 2020 is the International Year of the Nurse and Midwife is a poignant coincidence. For almost 200 years we have witnessed the progressive growth of professionalisation, capacity and capability of the nursing profession globally. In most countries in the world that survey the public trust and confidence in professional groups, most select nursing in the top group, often ahead of doctors and other noble professions.


Supraglottic Devices in Children during the COVID-19 Pandemic


title: Safety and efficacy assessment of allogeneic human dental pulp stem cells to treat patients with severe COVID-19: structured summary of a study protocol for a randomized controlled trial (Phase I / II)

text: OBJECTIVES: To assess the safety and therapeutic effects of allogeneic human dental pulp stem cells (DPSCs) in treating severe pneumonia caused by COVID-19. TRIAL DESIGN: This is a single centre, two arm ratio 1:1, triple blinded, randomized, placebo-controlled, parallel group, clinical trial. PARTICIPANTS: Twenty serious COVID-19 cases will be enrolled in the trial from April 6th to December 31st 2020. INCLUSION CRITERIA: hospitalised patients at Renmin Hospital of Wuhan University satisfy all criteria as below: 1)Adults aged 18-65 years;2)Voluntarily participate in this clinical trial and sign the "informed consent form" or have consent from a legal representative.3)Diagnosed with severe pneumonia of COVID-19: nucleic acid test SARS-CoV-2 positive; respiratory distress (respiratory rate > 30 times / min); hypoxia (resting oxygen saturation < 93% or arterial partial pressure of oxygen / oxygen concentration < 300 mmHg).4)COVID-19 featured lung lesions in chest X-ray image. EXCLUSION CRITERIA: Patients will be excluded from the study if they meet any of the following criteria. 1.Patients have received other experimental treatment for COVID-19 within the last 30 days;2.Patients have severe liver condition (e.g., Child Pugh score >=C or AST> 5 times of the upper limit);3.Patients with severe renal insufficiency (estimated glomerular filtration rate <=30mL / min/1.73 m2) or patients receiving continuous renal replacement therapy, hemodialysis, peritoneal dialysis;4.Patients who are co-infected with HIV, hepatitis B, tuberculosis, influenza virus, adenovirus or other respiratory infection viruses;5.Female patients who have no sexual protection in the last 30 days prior to the screening assessment;6.Pregnant or lactating women or women using estrogen contraception;7.Patients who are planning to become pregnant during the study period or within 6 months after the end of the study period;8.Other conditions that the researchers consider not suitable for participating in this clinical trial. INTERVENTION AND COMPARATOR: There will be two study groups: experimental and control. Both will receive all necessary routine treatment for COVID-19. The experimental group will receive an intravenous injection of dental pulp stem cells suspension (3.0x107 human DPSCs in 30ml saline solution) on day 1, 4 and 7; The control group will receive an equal amount of saline (placebo) on the same days. Clinical and laboratory observations will be performed for analysis during a period of 28 days for each case since the commencement of the study. MAIN OUTCOMES: 1. Primary outcome The primary outcome is Time To Clinical Improvement (TTCI). By definition, TTCI is the time (days) it takes to downgrade two levels from the following six ordered grades [(grade 1) discharge to (grade 6) death] in the clinical state of admission to the start of study treatments (hDPSCs or placebo). Six grades of ordered variables: GradeDescriptionGrade 1:Discharged of patient;Grade 2:Hospitalized without oxygen supplement;Grade 3:Hospitalized, oxygen supplement is required, but NIV / HFNC is not required;Grade 4:Hospitalized in intensive care unit, and NIV / HFNC treatment is required;Grade 5:Hospitalized in intensive care unit, requiring ECMO and/or IMV;Grade 6:Death. ABBREVIATIONS: NIV, non-invasive mechanical ventilation; HFNC, high-flow nasal catheter; IMV, invasive mechanical ventilation. 2. Secondary outcomes 2.1 vital signs: heart rate, blood pressure (systolic blood pressure, diastolic blood pressure). During the screening period, hospitalization every day (additional time points of D1, D4, D7 30min before injection, 2h ± 30min, 24h ± 30min after the injection) and follow-up period D90 ± 3 days. 2.2 Laboratory examinations: during the screening period, 30 minutes before D1, D4, D7 infusion, 2h ± 30min, 24h ± 30min after the end of infusion, D10, D14, D28 during hospitalization or discharge day and follow-up period D90 ± 3 days. 2.3 Blood routine: white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils, neutrophils, lymphocytes, monocytes, eosinophils Acidic granulocyte count, basophil count, red blood cell, hemoglobin, hematocrit, average volume of red blood cells, average red blood cell Hb content, average red blood cell Hb concentration, RDW standard deviation, RDW coefficient of variation, platelet count, platelet specific platelet average Volume, platelet distribution width,% of large platelets; 2.4 Liver and kidney function tests: alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, Î³-glutamyl transferase, prealbumin, total protein, albumin, globulin, white / globule ratio , Total bilirubin, direct bilirubin, cholinesterase, urea, creatinine, total carbon dioxide, uric acid glucose, potassium, sodium, chlorine, calcium, corrected calcium, magnesium, phosphorus, calcium and phosphorus product, anion gap, penetration Pressure, total cholesterol, triacylglycerol, high density lipoprotein cholesterol, Low density lipoprotein cholesterol, lipoprotein a, creatine kinase, lactate dehydrogenase, estimated glomerular filtration rate. 2.5 Inflammation indicators: hypersensitive C-reactive protein, serum amyloid (SAA); 2.6 Infectious disease testing: Hepatitis B (HBsAg, HBsAb, HBeAg, HBeAb, HBcAb), Hepatitis C (Anti-HCV), AIDS (HIVcombin), syphilis (Anti-TP), cytomegalovirus CMV-IgM, cytomegalovirus CMV-IgG; only during the screening period and follow-up period D90 ± 3. 2.7 Immunological testing: Collect peripheral blood to detect the phenotype of T lymphocyte, B lymphocyte, natural killer cell, Macrophage and neutrophil by using flow cytometry. Collect peripheral blood to detect the gene profile of mononuclear cells by using single-cell analyses. Collect peripheral blood serum to detect various immunoglobulin changes: IgA, IgG, IgM, total IgE; Collect peripheral blood serum to explore the changes of cytokines, Th1 cytokines (IL-1 ß, IL-2, TNF-a, ITN-Î³), Th2 cytokines (IL-4, IL-6, IL -10). 2.8 Pregnancy test: blood ß-HCG, female subjects before menopause are examined during the screening period and follow-up period D90 ± 3. 2.9 Urine routine: color, clarity, urine sugar, bilirubin, ketone bodies, specific gravity, pH, urobilinogen, nitrite, protein, occult blood, leukocyte enzymes, red blood cells, white blood cells, epithelial cells, non-squamous epithelial cells , Transparent cast, pathological cast, crystal, fungus; 2.10 Stool Routine: color, traits, white blood cells, red blood cells, fat globules, eggs of parasites, fungi, occult blood (chemical method), occult blood (immune method), transferrin (2h ± 30min after the injection and not detected after discharge). RANDOMIZATION: Block randomization method will be applied by computer to allocate the participants into experimental and control groups. The random ratio is 1:1. BLINDING (MASKING): Participants, outcomes assessors and investigators (including personnel in laboratory and imaging department who issue the sample report or image observations) will be blinded. Injections of cell suspension and saline will be coded in accordance with the patient's randomisation group. The blind strategy is kept by an investigator who does not deliver the medical care or assess primary outcome results. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): Twenty participants will be randomized to the experimental and control groups (10 per group). TRIAL STATUS: Protocol version number, hDPSC-CoVID-2019-02-2020 Version 2.0, March 13, 2020. Patients screening commenced on 16th April and an estimated date of the recruitment of the final participants will be around end of July. . TRIAL REGISTRATION: Registration: World Health Organization Trial Registry: ChiCTR2000031319; March 27,2020. ClinicalTrials.gov Identifier: NCT04336254; April 7, 2020 Other Study ID Numbers: hDPSC-CoVID-2019-02-2020 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.


title: Targeting adenosinergic pathway and adenosine A2A receptor signaling for the treatment of COVID-19: A hypothesis

text: The most serious health issue today is the rapid outbreak of Coronavirus Disease 2019 (COVID-19). More than 6,973,427 confirmed cases were diagnosed in nearly 213 countries and territories around the world and two international conveyances, causing globally over 400,000 deaths. Epidemiology, risk factors, and clinical characteristics of COVID-19 patients have been identified, but the factors influencing the immune system against COVID-19 have not been well established. Upon infection or cell damage, high amounts of adenosine triphosphate (ATP) are released from damaged cells, which serve as mediators of inflammation through purinergic cell surface receptor signaling. As a protective mechanism to prevent excessive damage to host tissue, adenosine counteracts ATP's effects by adenosine receptor stimulation to suppress the pro-inflammatory response. Adenosine is seen as a major obstacle to the efficacy of immune therapies, and the adenosinergic axis components are critical therapeutic targets for cancer and microbial infections. Pharmacologic inhibitors or antibodies specific to adenosinergic pathway components or adenosine receptors in microbial and tumor therapy have shown efficacy in pre-clinical studies and are entering the clinical arena. In this review, we provide a novel hypothesis explaining the potential for improving the efficiency of innate and adaptive immune systems by targeting adenosinergic pathway components and adenosine A2A receptor signaling for the treatment of COVID-19.


title: Coping with the covid-19 Crisis: An overview of service adaptation and challenges encountered by a rural Psychiatry of Later Life (POLL) Team

text: The Covid-19 pandemic has posed many challenges in maintaining standards of care and treatment for patients while managing the increased anxieties of patients, carers and the public in general. This paper highlights several clinical, administrative, medicolegal and IT implications of Covid-19 on the delivery of mental healthcare to an elderly vulnerable patient cohort due to recommended social distancing measures. Our Psychiatry of Later Life team has adapted to this by restricting face-to-face consultation, while continuing to provide telephone support. We have modified our documentation standard and have improved some aspects of our team working by facilitating flexible working arrangement and relevant training for staff as well as by embracing new technology. Notwithstanding the challenges therefore, this exceptional time has also opened avenues for new and innovative opportunities that can be further explored even when the current crisis eventually passes.


Covid-19: The time to shield all pregnant frontline workers is now


title: [Novel coronavirus pneumonia (COVID-19) CT distribution and sign features]

text: Objective: To investigate the imaging findings of 2019 novel coronavirus pneumonia (COVID-19). Methods: From January 20 to February 5, 2020, a total of 130 patients diagnosed with COVID-19 from seven hospitals in China were collected. The imaging data were reviewed and analyzed in detail. Results: (1) Distribution: the lesion detected in the lung unilaterally in 14 cases (10.7%) and bilaterally in 116 cases (89.3%). According to the distribution in the lobes of the lung, all cases could be classified into subpleural distribution (102 cases, 78.4%), centrilobular distribution (99 cases, 76.1%) and diffused distribution (8 cases, 6.1%). (2) Number of lesions: single lesion 9 cases (6.9%); multiple lesions 113 cases (86.9%), diffuse lesions 8 cases (6.1%). (3) Imaging density: 70 cases (53.8%) of ground-glass opacity (GGO), 60 cases (46.2%) of GGO+consolidation. (4) Accompanying signs: 100 cases (76.9%) with vascular thickening, 98 cases (75.3%) with "pleural parallel sign" ; " intralobular septal thickening" in 100 cases (76.9%); "halo sign" in 13 cases (10%); "reversed-halo sign" in 6 cases (4.6%); pleural effusion in 3 cases (2.3%), and pneumatocele in 2 cases (1.5%); no case with pulmonary cavity. Among 35 patients that underwent follow-up CT, 21 patients (60%) improved while 14 (40%) exacerbated. Conclusions: COVID-19 imaging characteristic mainly has subpleural, centrilobular and diffused distribution. The first two distributions can overlap or progress to diffused distribution. In the later period, it was mainly manifested as organizing pneumonia and fibrosis. The most valuable characteristic is the pleural parallel sign.


title: Neonatal diabetes due to potassium channel mutation: response to sulfonylurea according to the genotype

text: OBJECTIVE: A precision medicine approach is used to improve treatment of patients with monogenic diabetes. Herein we searched SU efficiency according to the genotype-phenotype correlation, dosage used and side effects. RESEARCH DESIGN AND METHODS: Systematic review conducted according the PRISMA control criteria identifying relevant studies evaluating the in vivo and in vitro sensitivity of ATP-dependent potassium channels according to the characteristics of genetic mutation. RESULTS: 103 selected articles with complete data in 502 cases in whom 413 (82.3%) had mutations in KCNJ11 (#64) and 89 in ABCC8 (# 56). Successful transfer from insulin to SU was achieved in 91% and 86.5% patients, respectively at a mean age of 36.5 months (0-63 years). Among patients with KCNJ11 and ABCC8 mutations 64 & 46 were associated with constant success,5 & 5 to constant failure, and 10 and 4 to variable degrees of reported success rate, respectively. The glibenclamide dosage required for each genotype ranged from 0.017 to 2.8 mg / kg / day. Comparing both the in vivo and in vitro susceptibility results, some mutations appear more sensitive than others to sulfonylurea treatment. Side effects were reported in 17 /103 of the included articles: mild gastrointestinal symptoms and hypoglycaemia were the most common. One premature patient had an ulcerative necrotizing enterocolitis which association with SU is difficult to ascertain. CONCLUSIONS: Sulfonylurea are an effective treatment for monogenic diabetes due to KCNJ11 and ABCC8 genes mutations. The success of the treatment is conditioned by differences in pharmacogenetics, younger age, pharmacokinetics, compliance and maximal dose used. This article is protected by copyright. All rights reserved.


title: The dissemination of COVID-19: an expectant and preventive role in global health

text: Backgroung: Coronaviruses (CoV) make up a large family of viruses, known since the mid-1960s, which received this name due to the spikes on its surface, which resemble a crown (from the Latin corona). CoV infections can cause everything from a common cold to severe respiratory syndromes, such as severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV).COVID-19 (SARS-CoV2) is a new variant of the coronavirus, and its isolation occurred in China on January 7th, 2020. COVID-19 has stood out with a high impact on public health due to the high number of cases with infection in a short period of time. However, it is possible to observe that 17% of patients confirmed with COVID-19 have severe infections and about 2.5% of these patients die. Current studies have shown that the number of mild and asymptomatic cases may be even greater. Thus, the challenges for controlling unreported cases of patients with mild symptoms that are spreading the virus and interfering with the magnitude and real data of the cases stand out. The transmission of the coronavirus occurs between humans, and it can occur from person to person through the air, through coughing or sneezing, by touching or shaking hands or by contact with contaminated objects or surfaces, followed by contact with the mouth, nose or eyes. Given the fluctuation in the incidence and the lethality rate, it is essential to stand out the precepts of health promotion in search of reorienting hygiene practices, considering that there is validity in health care models, still with a curative approach and the current situation experienced by the world population requires a preventive stance.(AU)


title: Inactivation of three emerging viruses - severe acute respiratory syndrome coronavirus, Crimean-Congo haemorrhagic fever virus and Nipah virus - in platelet concentrates by ultraviolet C light and in plasma by methylene blue plus visible light

text: BACKGROUND: Emerging viruses like severe acute respiratory syndrome coronavirus (SARS-CoV), Crimean-Congo haemorrhagic fever virus (CCHFV) and Nipah virus (NiV) have been identified to pose a potential threat to transfusion safety. In this study, the ability of the THERAFLEX UV-Platelets and THERAFLEX MB-Plasma pathogen inactivation systems to inactivate these viruses in platelet concentrates and plasma, respectively, was investigated. MATERIALS AND METHODS: Blood products were spiked with SARS-CoV, CCHFV or NiV, and then treated with increasing doses of UVC light (THERAFLEX UV-Platelets) or with methylene blue (MB) plus increasing doses of visible light (MB/light; THERAFLEX MB-Plasma). Samples were taken before and after treatment with each illumination dose and tested for residual infectivity. RESULTS: Treatment with half to three-fourths of the full UVC dose (0·2 J/cm2 ) reduced the infectivity of SARS-CoV (≥3·4 log), CCHFV (≥2·2 log) and NiV (≥4·3 log) to the limit of detection (LOD) in platelet concentrates, and treatment with MB and a fourth of the full light dose (120 J/cm2 ) decreased that of SARS-CoV (≥3·1 log), CCHFV (≥3·2 log) and NiV (≥2·7 log) to the LOD in plasma. CONCLUSION: Our study demonstrates that both THERAFLEX UV-Platelets (UVC) and THERAFLEX MB-Plasma (MB/light) effectively reduce the infectivity of SARS-CoV, CCHFV and NiV in platelet concentrates and plasma, respectively.


title: Predictive factors for disease progression in hospitalized patients with coronavirus disease 2019 in Wuhan, China

text: BACKGROUND: A few studies have revealed the clinical characteristics of hospitalized patients with COVID-19. However, predictive factors for the outcomes remain unclear. OBJECTIVE: Attempted to determine the predictive factors for the poor outcomes of patients with COVID-19. STUDY DESIGN: This is a single-center, retrospective study. Clinical, laboratory, and treatment data were collected and analyzed from 111 hospitalized patients with laboratory-confirmed COVID-19 in Union Hospital. The gathered data of discharged and deteriorated patients were compared. RESULTS: Among these 111 patients, 93 patients were discharged and 18 patients were deteriorated. The lymphocyte count (0.56 G/L [0.47-0.63] vs 1.30 G/L [0.95-1.65]) was lower in the deteriorated group than those in the discharged group. The numbers of pulmonary lobe involved (5.00 [5.00-5.00] vs 4.00 [2.00-5.00]), serum C-reactive protein (CRP, 79.52 mg/L [61.25-102.98] vs 7.93 mg/L [3.14-22.50]), IL-6 (35.72 pg/mL [9.24-85.19] vs 5.09 pg/mL [3.16-9.72]), and IL-10 (5.35 pg/mL [4.48-7.84] vs 3.97 pg/mL [3.34-4.79]) concentrations in deteriorated patients were elevated compared with discharged patients. Multivariate logistic regression analysis showed that male gender (OR, 24.8 [1.8-342.1]), comorbidity (OR, 52.6 [3.6-776.4]), lymphopenia (OR, 17.3 [1.1-261.8]), and elevated CRP (OR, 96.5 [4.6-2017.6]) were the independent risk factors for the poor prognosis in COVID-19 patients. CONCLUSIONS: This finding would facilitate the early identification of high-risk COVID-19 patients.


title: The role of ecosystems in mitigation and management of Covid-19 and other zoonoses

text: There is rising international concern about the zoonotic origins of many global pandemics. Increasing human-animal interactions are perceived as driving factors in pathogen transfer, emphasising the close relationships between human, animal and environmental health. Contemporary livelihood and market patterns tend to degrade ecosystems and their services, driving a cycle of degradation in increasingly tightly linked socio-ecological systems. This contributes to reductions in the natural regulating capacities of ecosystem services to limit disease transfer from animals to humans. It also undermines natural resource availability, compromising measures such as washing and sanitation that may be key to managing subsequent human-to-human disease transmission. Human activities driving this degrading cycle tend to convert beneficial ecosystem services into disservices, exacerbating risks related to zoonotic diseases. Conversely, measures to protect or restore ecosystems constitute investment in foundational capital, enhancing their capacities to provide for greater human security and opportunity. We use the DPSIR (Drivers-Pressures-State change-Impact-Response) framework to explore three aspects of zoonotic diseases: (1) the significance of disease regulation ecosystem services and their degradation in the emergence of Covid-19 and other zoonotic diseases; and of the protection of natural resources as mitigating contributions to both (2) regulating human-to-human disease transfer; and (3) treatment of disease outbreaks. From this analysis, we identify a set of appropriate response options, recognising the foundational roles of ecosystems and the services they provide in risk management. Zoonotic disease risks are ultimately interlinked with biodiversity crises and water insecurity. The need to respond to the Covid-19 pandemic ongoing at the time of writing creates an opportunity for systemic policy change, placing scientific knowledge of the value and services of ecosystems at the heart of societal concerns as a key foundation for a more secure future. Rapid political responses and unprecedented economic stimuli reacting to the pandemic demonstrate that systemic change is achievable at scale and pace, and is also therefore transferrable to other existential, global-scale threats including climate change and the 'biodiversity crisis'. This also highlights the need for concerted global action, and is also consistent with the duties, and ultimately the self-interests, of developed, donor nations.


Better the drug you know: Commentary on "Daughton 2020, Natural experiment concept to accelerate the re-purposing of existing therapeutics for Covid-19"


To consider or not antimalarials as a prophylactic intervention in the SARS-CoV-2 (Covid-19) pandemic


Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn


title: Multisystem Inflammatory Syndrome in Children (MIS-C) Related to COVID-19: A New York City Experience

text: In December 2019, the 2019 novel coronavirus disease (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) first emerged in Wuhan, China. This has now spread worldwide and was declared a pandemic by March 2020. Initially, the pediatric population was described as low risk for severe COVID-19. However, reports have emerged recently of cases of COVID-19 in children with a systemic inflammatory disease, with features that overlap with Kawasaki Disease (KD). We describe the first 15 cases with multi-system inflammatory syndrome in children (MIS-C), temporally related to COVID-19, who presented for care to a tertiary pediatric referral center in New York City. We discuss the disproportionate burden of disease among Hispanic/Latino and black/African-American ancestry, the distinct cytokine signature across the disease spectrum (IL-1/IL-6), and the potential role and pathogenesis of SARS-CoV-2 in this new clinical entity. This article is protected by copyright. All rights reserved.


title: Just-In-Time Training in a Tertiary Referral Hospital During the COVID-19 Pandemic in Italy

text: The COVID-19 pandemic is threatening health systems worldwide, requiring extraordinary efforts to contain the virus and prepare health care systems for unprecedented situations. In this context, the entire health care workforce must be properly trained to guarantee an effective response. Just-in-time training has been an efficient solution for rapidly equipping health care workers with new knowledge, skills, and attitudes during emergencies; thus, it could also be an effective training technique in the context of the response to the COVID-19 pandemic. Because of the unexpected magnitude of this health crisis, the health care workforce must be trained in two areas: (1) basic infection prevention and control, including public health skills that are the core of population-based health management and (2) disaster medicine principles, such as surge capacity, allocation of scarce resources, triage, and the ethical dilemmas of rationing medical care. This perspective reports how just-in-time training concepts and methods were applied in a tertiary referral hospital in March 2020, during the COVID-19 pandemic in Northern Italy, one of the hardest hit places in the world.The COVID-19 just-in-time training was designed to provide hospital staff with the competencies they need to work proficiently and safely inside the hospital, including an understanding of the working principles and standard operating procedures in place and the correct use of personal protective equipment. Moreover, this training was intended to address the basic principles of disaster medicine applied to the COVID-19 pandemic. Such training was essential in enabling staff to rapidly attain competencies that most of them lacked because disaster medicine and global health are not included in the curricula of Italian medical and nursing schools. Although a formal evaluation was not performed, this is a useful example of how to create just-in-time training in a large hospital during a crisis of an unprecedented scale.


title: Einstellung von Patienten mit entzündlich-rheumatischen Erkrankungen zur immunsuppressiven Therapie im Rahmen der COVID-19 Pandemie  eine Situationsanalyse./ [A cross sectional study on patients with inflammatory rheumatic diseases in terms of their compliance to their immunsuppressive medication during COVID-19 pandemic]

text: The current COVID-19 pandemic inherits an unprecedented challenge for the treating rheumatologists. On the one hand, antirheumatic drugs can increase the risk of infection and potentially deteriorate the course of an infection. On the other hand, an active inflammatory rheumatic disease can also increase the risk for an infection. In the recommendations of the German Society for Rheumatology (www.dgrh.de), it is recommended that our patients continue the antirheumatic therapy to maintain remission or low state of activity despite the pandemic. In this study, patients with inflammatory rheumatic disease were asked in the first weeks of the pandemic on their opinion of their immunomodulating therapy. The result shows that over 90% of the patients followed the recommendation of the rheumatologist to continue the antirheumatic therapy, and only a small percentage of the patients terminated the therapy on their own. This result was independent of the individual anti-rheumatic therapy. Taken together, the results of this study illustrate not only the trustful patient-physician partnership in a threatening situation but also the high impact of state-of-the art recommendations by the respective scientific society.


Physical distancing or social distancing: that is the question


title: Prevention and control of COVID-19 in nursing homes, orphanages, and prisons

text: As the number of Coronavirus Disease (2019) (COVID-19) cases increase globally, countries are taking more aggressive preventive measures against this pandemic. Transmission routes of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) include droplet and contact transmissions. There are also evidence of transmission through aerosol generating procedures (AGP) in specific circumstances and settings. Institutionalized populations without mobility and living in close proximity with unavoidable contact are especially vulnerable to higher risks of COVID-19 infection, such as the elderly in nursing homes, children in orphanages, and inmates in prisons. In these places, higher prevention and control measures are needed. In this study, we proposed prevention and control strategies for these facilities and provided practical guidance for general measures, health management, personal protection measures, and prevention measures in nursing homes, orphanages, and prisons, respectively.


title: An update on origin of SARS-CoV-2: Despite closest identity, bat (RaTG13) and Pangolin derived Coronaviruses varied in the critical binding site and O-linked glycan residues

text: The initial cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) occurred in Wuhan, China, in December 2019 and swept the world by 23 June 2020 with 8,993,659 active cases, 469,587 deaths across 216 countries, areas or territories. This strongly implies global transmission occurred before the lockdown of China. However, the initial source's transmission routes of SARS-CoV-2 remain obscure and controversial. Research data suggest bat (RaTG13) and pangolin carried CoV were the proximal source of SARS-CoV-2. In this study, we used systematic phylogenetic analysis of Coronavirinae subfamily along with wild type human SARS-CoV, MERS-CoV, and SARS-CoV-2 strains. The key residues of the receptor-binding domain (RBD) and O-linked glycan were compared. SARS-CoV-2 strains were clustered with RaTG13 (97.41% identity), Pangolin-CoV (92.22% identity) and Bat-SL-CoV (80.36% identity), forms a new clade-2 in lineage B of beta-CoV. The alignments of RBD contact residues to ACE2 justified? Those SARS-CoV-2 strains sequences were 100% identical by each other, significantly varied in RaTG13 and pangolin-CoV. SARS-CoV-2 has a polybasic cleavage site with an inserted sequence of PRRA compared to RaTG13 and only PRR to pangolin. Only serine (Ser) in pangolin and both threonine (Thr) and serine (Ser) O-linked glycans were seen in RaTG13, suggesting that a detailed study needed in Pangolin (Manis javanica) and bat (Rhinolophus affinis) related CoV. This article is protected by copyright. All rights reserved.


Removing the handle of the Broad Street pump: measures to slow the spread of covid-19 in primary care teams


title: End-to-end learning for semiquantitative rating of COVID-19 severity on Chest X-rays

text: In this work we designed an end-to-end deep learning architecture for predicting, on Chest X-rays images (CRX), a multi-regional score conveying the degree of lung compromise in COVID-19 patients. Such semiquantitative scoring system, namely Brixia-score, was applied in serial monitoring of such patients, showing significant prognostic value, in one of the hospitals that experienced one of the highest pandemic peaks in Italy. To solve such a challenging visual task, we adopt a weakly supervised learning strategy structured to handle different tasks (segmentation, spatial alignment, and score estimation) trained with a"from part to whole"procedure involving different datasets. In particular, we exploited a clinical dataset of almost 5,000 CXR annotated images collected in the same hospital. Our BS-Net demonstrated self-attentive behavior and a high degree of accuracy in all processing stages. Through inter-rater agreement tests and a gold standard comparison, we were able to show that our solution outperforms single human annotators in rating accuracy and consistency, thus supporting the possibility of using this tool in contexts of computer-assisted monitoring. Highly resolved (super-pixel level) explainability maps were also generated, with an original technique, to visually help the understanding of the network activity on the lung areas. We eventually tested the performance robustness of our model on a variegated public COVID-19 dataset, for which we also provide Brixia-score annotations, observing good direct generalization and fine-tuning capabilities that favorably highlight the portability of BS-Net in other clinical settings.


Between-centre differences for COVID-19 ICU mortality from early data in England


title: COVID-19 and endoscopy services in intermediately affected countries: a position statement from the saudi gastroenterology association

text: With the global pandemic due to coronavirus disease 2019 (COVID-19), there has been a significant strain on healthcare facilities. The infectivity rate, as well as the rate of healthcare workers who have fallen ill to the disease, has raised concerns globally on the proper management of patients as well as the role of safe healthcare provision utilizing personal protective equipment (PPE). Furthermore, the limited supply of PPEs has mandated rationing their use to achieve maximum utility and preservation. Multiple gastroenterology associations have issued guidance and statements that would help healthcare providers in navigating these unprecedented and difficult times, and the Saudi Gastroenterology Association has provided this statement in an effort to bring the most up to date information for the management of endoscopy units in terms of resources, manpower planning, scheduling, as well as infection control policies and leadership.


title: COVID-19 patients with psoriasis and psoriatic arthritis on biologic immunosuppressant therapy versus apremilast in North Spain

text: Immunosuppressive and immunomodulatory treatments are critical for the management of inflammatory and autoimmune conditions such as psoriasis or psoriatic arthritis. Like in those illnesses, the lung injury and acute respiratory distress shown in COVID-19 patients are the result of a disruption in the balance of pro- and anti-inflammatory cytokines. This hyperinflammatory response to SARS-CoV-2, associated with the severity of the coronavirus disease, is called the cytokine storm. There is a growing concern regarding how patients on immunosuppressant biologic therapies might be at higher risk of being infected and whether they need to discontinue their treatment preemptively. Clinical data on COVID-19 infected patients with psoriasis or psoriatic arthritis are still scarce. Here, we presented seven cases of this type of patients. The patient infected with COVID-19 on apremilast and the one on apremilast with infected spouse showed the best safety profile and mildest symptoms. One of the secukinumab patients also presented a relatively good outcome. Infliximab patients and the one with serious comorbidities showed the worst outcome. Even though more clinical data are yet needed to draw strong conclusions, apremilast could be a safer alternative for dermatology and rheumatology patients in case of clinically important active infection. This article is protected by copyright. All rights reserved.


title: Utilizing integrating network pharmacological approaches to investigate the potential mechanism of Ma Xing Shi Gan Decoction in treating COVID-19

text: Beginning in December 2019, coronavirus disease 2019 (COVID-19), due to 2019-nCoV infection, emerged in Wuhan and spread rapidly throughout China and even worldwide. Employing combined therapy of modern medicine and traditional Chinese medicine has been proposed, in which Ma Xing Shi Gan Decoction (MXSGD) was recommended as a basic prescription and applied widely in the clinical treatment of COVID-19. We investigated the underlying mechanism of MXSGD in treating COVID-19 utilizing the approaches of integrating network pharmacology. A total of 97 active ingredients of MXSGD were screened out, and 169 targets were predicted. The protein-protein interaction network exhibited hub targets of MXSGD, such as Heat shock protein 90, RAC-alpha serine/threonine-protein kinase, Transcription factor AP-1, Mitogen-activated protein kinase 1, Cellular tumor antigen p53, Vascular endothelial growth factor A, and Tumour necrosis factor. Gene Ontology functional enrichment analysis demonstrated that the biological processes altered within the body after taking MXSGD were closely related to the regulation of such processes as the acute inflammatory response, chemokine production, vascular permeability, response to oxygen radicals, oxidative stress-induced apoptosis, T cell differentiation involved in the immune response, immunoglobulin secretion, and extracellular matrix disassembly. KEGG enrichment analysis indicated that the targets of MXSGD were significantly enriched in inflammation-related pathways, immunomodulation-related pathways, and viral infection-related pathways. The therapeutic mechanisms of MXSGD on COVID-19 may primarily involve the following effects: reducing inflammation, suppressing cytokine storm, protecting the pulmonary alveolar-capillary barrier, alleviating pulmonary edema, regulating the immune response, and decreasing fever.


title: A Second Pandemic: Mental Health Spillover From the Novel Coronavirus (COVID-19)

text: The novel coronavirus (COVID-19) pandemic has created an unprecedented global health challenge. There is risk that the outbreak will create a "second pandemic" of mental health crises in health systems and communities. Thus, a comprehensive public health response to the pandemic must include (a) attention to the psychological aspects of hospitalization for patients, families, and staff affected by COVID-19; (b) planning for emergency and acute psychiatric patient care if hospitals become overwhelmed with COVID-19 patients; and (c) innovations for providing mental health care in communities while social distancing is required and health system resources are strained. Nurses and nurse leaders must anticipate these mental health challenges, assist with preparedness in health systems and communities, and advocate for a coordinated response to promote mental wellness and resilience.


title: Projections for COVID-19 pandemic in India and effect of temperature and humidity

text: BACKGROUND AND AIMS: As, the COVID-19 has been deemed a pandemic by World Health Organization (WHO), and since it spreads everywhere throughout the world, investigation in relation to this disease is very much essential. Investigation of pattern in the occurrence of COVID-19, to check the influence of different meteorological factors on the incidence of COVID-19 and prediction of incidence of COVID-19 are the objectives of this paper. METHODS: For trend analysis, Sen's Slope and Man-Kendall test have been used, Generalized Additive Model (GAM) of regression has been used to check the influence of different meteorological factors on the incidence and to predict the frequency of COVID-19, and Verhulst (Logistic) Population Model has been used. RESULTS: Statistically significant linear trend found for the daily-confirmed cases of COVID-19. The regression analysis indicates that there is some influence of the interaction of average temperature (AT) and average relative humidity (ARH) on the incidence of COVID-19. However, this result is not consistent throughout the study area. The projections have been made up to 21st May, 2020. CONCLUSIONS: Trend and regression analysis give an idea of the incidence of COVID-19 in India while projection made by Verhulst (Logistic) Population Model for the confirmed cases of the study area are encouraging as the sample prediction is as same as the actual number of confirmed COVID-19 cases.


title: Strategies and recommendations for urolithiasis treatment and follow-up in COVID-19 pandemia./ Estrategias y recomendaciones para el tratamiento y seguimiento de la patologia litiasica en el periodo de la pandemia COVID-19

text: INTRODUCTION: The health crisis caused by COVID-19 pandemic has led to a restructuring of urological activity in order not to delay priority situations An important part to prioritize within Urologyis Urolithiasis The objective of this article is to establish strategies and recommendations for the treatment and follow-up in COVID-19 pandemic in phases I, II and III, based on available scientific evidence and the consensus of a group of experts in these pathologies MATERIAL AND METHODS: The document is based on the evidence available in the literature so far on SARSCoV-2 and the experience of the authors in the management of COVID-19 in their institutions A narrative review of the literature was conducted, and a modified nominal group technique was used due to the extraordinary restrictions of assembly and mobility during the pandemic RESULTS: Recommendations are made regarding the epidemiological evaluation of patients before surgery ,the management of positive patients, the epidemiological measures for healthcare personnel, the management of renal colic, the type of anesthesia, endourological surgery, shockwave lithotripsy, hospitalization, clinicalt ests, out-patient service and priorities on the surgical waiting list CONCLUSION: Treatment of Urolithiasis in COVID-19 pandemic calls for prioritization of patients, maximum efficiency in treatments, adequate protection of healthcare personnel, and the implementation of telemedicine as a measure to reduce patient attendance to the hospital INTRODUCCION: La crisis sanitaria provocada por la pandemia COVID-19 ha obligado a reestructurar la actividad urologica para no demorar situaciones que requieran preferencia Una parte importante para priorizar dentro de la Urologia es la patologia litiasica El objetivo de este articulo es establecer estrategias y recomendaciones para el tratamiento y seguimiento de esta en el periodo de pandemia COVID-19 en las fases I II y III, basadas en la evidencia cientifica publicada y el consenso de un grupo de expertos en esta patologia MATERIAL Y METODOS: El documento se basa en la escasa evidencia en la literatura sobre SARS-CoV-2 y la experiencia de los autores en el manejo de COVID-19 en sus instituciones Se realizo una revision narrativa de la literatura y se utilizo una tecnica de grupo nominal modificada debido a las restricciones extraordinarias de reunion y movilidad durante la pandemia RESULTADOS: Se establecen recomendaciones sobre la evaluacion epidemiologica de los pacientes antes de la cirugia, el manejo de los pacientes positivos, las medidas epidemiologicas para los profesionales, el manejo del colico renal, el tipo de anestesia, la cirugia endourologica, la litotricia extracorporea por ondas de choque, la hospitalizacion, las pruebas complementarias, la consulta y las prioridades en la lista de espera quirurgica CONCLUSION: El tratamiento de la patologia litiasica durante la pandemia COVID-19 hace necesaria la priorizacion de pacientes, la maxima eficiencia en los tratamientos, una proteccion adecuada del personal sanitario y la implementacion de la telemedicina como medida para reducir la asistencia de los pacientes al medio hospitalario


title: [Strategies and recommendations for urolithiasis treatment and follow-up in COVID-19 pandemia.]

text: INTRODUCTION: The health crisis caused by COVID-19 pandemic has led to a restructuring of urological activity in order not to delay priority situations An important part to prioritize within Urologyis Urolithiasis The objective of this article is to establish strategies and recommendations for the treatment and follow-up in COVID-19 pandemic in phases I, II and III, based on available scientific evidence and the consensus of a group of experts in these pathologies MATERIAL AND METHODS: The document is based on the evidence available in the literature so far on SARSCoV-2 and the experience of the authors in the management of COVID-19 in their institutions A narrative review of the literature was conducted, and a modified nominal group technique was used due to the extraordinary restrictions of assembly and mobility during the pandemic RESULTS: Recommendations are made regarding the epidemiological evaluation of patients before surgery ,the management of positive patients, the epidemiological measures for healthcare personnel, the management of renal colic, the type of anesthesia, endourological surgery, shockwave lithotripsy, hospitalization, clinicalt ests, out-patient service and priorities on the surgical waiting list CONCLUSION: Treatment of Urolithiasis in COVID-19 pandemic calls for prioritization of patients, maximum efficiency in treatments, adequate protection of healthcare personnel, and the implementation of telemedicine as a measure to reduce patient attendance to the hospital


Features and Limitations of LitCovid Hub for Quick Access to Literature About COVID-19


title: Infiltración con onabotulinumtoxinA y bloqueos en el paciente con cefalea y neuralgia: recomendaciones de seguridad frente a la infección por SARS-CoV-2./ Infiltración con onabotulinumtoxinA y bloqueos en el paciente con cefalea y neuralgia: recomendaciones de seguridad frente a la infección por SARS-CoV-2./ OnabotulinumtoxinA infiltration and nerve blocks in patients with headache and neuralgia: safety recommendations to prevent SARS-CoV-2 infection

text: INTRODUCTION: The COVID-19 pandemic has given rise to the need for changes in clinical practice, with new strategies to enable integrated care for patients with headache and neuralgia. MATERIAL AND METHODS: Given the high spreadability of SARS-CoV-2, new safety measures are required in such procedures as onabotulinumtoxinA infiltration and nerve blocks. RESULTS: We present a series of recommendations based on the measures implemented to prevent infection in our healthcare system. We differentiate between measures related to patients and physicians, to technique, to infrastructure (waiting room and consultation), and to healthcare management.


title: SARS-COV-2 Pandemic: Understanding the Impact of Lockdown in the Most Affected States of India

text: SARS-COV-2 has stopped the world in its footsteps and a third of the population has been forced to stay at home. Here we present a comparative study of the performance of states of India, in curbing the spread of the disease, that are most affected by the pandemic. We have done so based on the data collected between 14th March, 2020 to 17th April, 2020. We do this by comparing the smoothened time series and percentage changes along with change point detection of the daily confirmed cases. We also discuss the different policies and strategies adopted by the states in curbing the disease and the ground level implementation. We have developed ARIMA(p,d,q) models where (p,d,q) are obtained by minimising the AIK(Akaike Information Criterion). These models are used to make forecasts for the country which show that by 7th May, 2020, India would have around 50,237 confirmed cases and a doubling rate of 11 days. On the basis of the performance, of each state, we argue that a local level strategy which is based on the demographics of that particular region be developed instead of a central and uniform one.


COVID-19 in Egypt: Uncovered figures or a different situation?


title: Incidentally discovered COVID-19 in low-suspicion patients-a threat to front line health care workers

text: PURPOSE: The COVID-19 pandemic has been responsible for thousands of deaths worldwide. Testing remains at a premium, and criteria for testing remains reserved for those with lower respiratory infection symptoms and/or a known high-risk exposure. The role of imaging in COVID-19 is rapidly evolving; however, few algorithms include imaging criteria, and it is unclear what should be done in low-suspicion patients with positive imaging findings. METHODS: From 03/01/2020-03/20/2020, a retrospective review of all patients with suspected COVID-19 on imaging was performed. Imaging was interpreted by a board-certified, fellowship-trained radiologist. Patients were excluded if COVID-19 infection was suspected at the time of presentation, was the reason for imaging, or if any lower respiratory symptoms were present. RESULTS: Eight patients with suspected COVID-19 infection on imaging were encountered. Seven patients received testing due to suspicious imaging findings with subsequent lab-confirmed COVID-19. No patients endorsed prior exposure to COVID-19 or recent international travel. COVID-19 was suggested in six patients incidentally on abdominal CT and two on chest radiography. At the time of presentation, no patients were febrile, and seven endorsed gastrointestinal symptoms. Five COVID-19 patients eventually developed respiratory symptoms and required intubation. Two patients expired during the admission. CONCLUSIONS: Patients with imaging findings suspicious for COVID-19 warrant prompt reverse transcription polymerase chain reaction (RT-PCR) testing even in low clinical suspicion cases. The prevalence of disease in the population may be underestimated by the current paradigm of RT-PCR testing with the current clinical criteria of lower respiratory symptoms and exposure risk.


title: Religious Cliché and Stigma: A Brief Response to Overlooked Barriers in COVID-19 Management

text: For decades, religion has provided explanations and answers to existential questions and queries that can emerge during a pandemic. This characteristic of religion has helped communities in finding answers and meanings to their confusions. During a pandemic, healthcare professionals are often unprepared in answering the patients' religious beliefs regarding the diseases. Moreover, patients are faced with religious clichés and stigma that results because of religious beliefs and practices. To overcome the religious stigma, a deeper understanding of religious beliefs and values is required so that a perception or practice change can take place. Therefore, the inclusion and collaboration of spiritual leaders with healthcare professionals are needed to ensure a holistic understanding and overcome the stigma that can shape as a barrier for reaching an optimal therapeutic outcome.


Restructuring the surgical service during the COVID-19 pandemic: experience from a tertiary institution in Singapore


RILI model and the Covid-19 pneumonia: The radiation oncologist point of view


title: High host density favors greater virulence: a model of parasite-host dynamics based on multi-type branching processes

text: We use a multitype continuous time Markov branching process model to describe the dynamics of the spread of parasites of two types that can mutate into each other in a common host population. Instead of using a single virulence characteristic which is typical of most mathematical models for infectious diseases, our model uses a combination of two characteristics: lethality and transmissibility. This makes the model capable of reproducing the empirically observed fact that the increase in the host density can lead to the prevalence of the more virulent pathogen type. We provide some numerical illustrations and discuss the effects of the size of the enclosure containing the host population on the encounter rate in our model that plays the key role in determining what pathogen type will eventually prevail. We also present a multistage extension of the model to situations where there are several populations and parasites can be transmitted from one of them to another.


title: An update on COVID-19 for the otorhinolaryngologist - a Brazilian Association of Otolaryngology and Cervicofacial Surgery (ABORL-CCF) Position Statement

text: INTRODUCTION: We are facing a pandemic with a great impact worldwide, as a result of the rapid spread of the novel coronavirus (COVID-19). The medical community is still getting to know behavior of this virus and the consequences from a population point of view. All this knowledge is extremely dynamic, so some behaviors are still not well established. Otorhinolaryngologists have a central role in the management of this situation, in which they must assess the patient, avoid contamination to and by health professionals and other patients. Thus, the recommendations of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery (ABORL-CCF) have the main objective of reducing the spread of the new coronavirus during otorhinolaryngological care and assisting in the management of these patients. METHODS: Review of the main recommendations of national and international scientific societies, decisions by government agencies and class councils. The topics will be related to the general aspects of COVID-19, personal protective equipment, care in patient assistance, endoscopic exam routines and the management of sinonasal, otological and pediatric evaluations related to COVID-19. RESULTS: The use of personal protective equipment is considered crucial in routine ENT care. We recommend postponing appointments, exams and elective surgeries to reduce the spread of COVID-19. Similarly, we recommend changing routines in several areas of otolaryngology. Additionally, guidance is provided on the use of telemedicine resources during the pandemic period. CONCLUSIONS: We are still at the beginning of the COVID-19 pandemic and scientific evidence is still scarce and incomplete, so these ABORL-CCF recommendations for otorhinolaryngologists may be updated based on new knowledge and the pattern of the new coronavirus spread.


title: Combating sars-cov-2 through lipoxins, proteasome, caveolin and nuclear factor-κb pathways in non-pregnant and pregnant populations

text: It can be misleading to think that the new severe acute respiratory syndrome coronavirus (SARS-CoV2) which has a very strong mutation and adaptation capabilities, uses only the angiotensin-converting enzyme II (ACE2) pathway to reach target cells. Despite all the precautions taken, the pandemic attack continues and the rapid increase in the number of deaths suggest that this virus has entered the cell through different pathways and caused damage through different mechanisms. The main reason why the ACE2 pathway comes to the fore in all scientific studies is that this receptor is located at the entry point of basic mechanisms that provide alveolo-capillary homeostasis. SARS-CoV-2 has to use nuclear factor-κB (NF-kB), caveloae, clathrin, lipoxin, serine protease and proteasome pathways in addition to ACE2 to enter the target cell and initiate damage. For this reason, while new drug development studies are continuing, in order to be beneficial to patients in their acute period, it is imperative that we are able to come up with drugs that activate or inhibit these pathways and are currently in clinical use. It is also critical that we adopt these new pathways to the treatment of pregnant women affected by SARS-CoV-2, based on the scientific data we use to treat the general population.


title: Combating sars-cov-2 through lipoxins, proteasome, caveolin and nuclear factor-kappab pathways in non-pregnant and pregnant populations

text: It can be misleading to think that the new severe acute respiratory syndrome coronavirus (SARS-CoV2) which has a very strong mutation and adaptation capabilities, uses only the angiotensin-converting enzyme II (ACE2) pathway to reach target cells Despite all the precautions taken, the pandemic attack continues and the rapid increase in the number of deaths suggest that this virus has entered the cell through different pathways and caused damage through different mechanisms The main reason why the ACE2 pathway comes to the fore in all scientific studies is that this receptor is located at the entry point of basic mechanisms that provide alveolo-capillary homeostasis SARS-CoV-2 has to use nuclear factor-kappaB (NF-kB), caveloae, clathrin, lipoxin, serine protease and proteasome pathways in addition to ACE2 to enter the target cell and initiate damage For this reason, while new drug development studies are continuing, in order to be beneficial to patients in their acute period, it is imperative that we are able to come up with drugs that activate or inhibit these pathways and are currently in clinical use It is also critical that we adopt these new pathways to the treatment of pregnant women affected by SARS-CoV-2, based on the scientific data we use to treat the general population


Role of the pharmacist during the COVID-19 pandemic: a time to rethink strategies


title: COVID-19 Contact-tracing Apps: a Survey on the Global Deployment and Challenges

text: To address the massive spike in uncertainties triggered by the coronavirus disease (COVID-19), there is an ever-increasing number of national governments that are rolling out contact-tracing Apps to aid the containment of the virus. The first hugely contentious issue facing the Apps is the deployment framework, i.e. centralized or decentralized. Based on this, the debate branches out to the corresponding technologies that underpin these architectures, i.e. GPS, QR codes, and Bluetooth. This work conducts a pioneering review of the above scenarios and contributes a geolocation mapping of the current deployment. The Apps vulnerabilities and the directions of research are identified, with a special focus on the Bluetooth-inspired decentralized paradigm.


title: Maximizing Safety in the Conduct of Alzheimer's Disease Fluid Biomarker Research in the Era of COVID-19

text: The coronavirus disease 2019 (COVID-19) pandemic led to an abrupt halt of many Alzheimer's disease (AD) research studies at sites spanning the world. This is especially true for studies requiring in-person contact, such as studies collecting biofluids. Since COVID-19 is likely to remain a threat for an extended period, the resumption of fluid biomarker studies requires the development and implementation of procedures that minimize the risk of in-person visits to participants, staff, and individuals handling the biofluid samples. Some issues to consider include structuring the visit workflow to minimize contacts and promote social distancing; screening and/or testing participants and staff for COVID-19; wearing masks and performing hand hygiene; and precautions for handling, storing, and analyzing biofluids. AD fluid biomarker research remains a vitally important public health priority and resuming studies requires appropriate safety procedures to protect research participants and staff.


COVID-19: Wer stirbt, wer überlebt? : Coronavirus-Pandemie


Comment on Melatonin as a potential adjuvant treatment for COVID-19


Coronavirus and the hearts of doctors


Protecting Our Front Line


title: Epidemic and pandemic viral infections: impact on tuberculosis and the lung. A consensus by the World Association for Infectious Diseases and Immunological Disorders (WAidid), Global Tuberculosis Network (GTN) and members# of ESCMID Study Group for Mycobacterial Infections (ESGMYC)

text: Major epidemics including some that qualify as pandemics, such as Severe Acute Respiratory Syndrome (SARS), Middle-Eastern Respiratory Syndrome (MERS), Human Immunodeficiency Virus, pandemic H1N1/09 and most recently COVID-19 affect the lung. Tuberculosis (TB) remains the top infectious disease killer but apart from the TB-HIV syndemic, little is known regarding the interaction of viral epidemics and pandemics with TB. The aim of this consensus-based document is to describe the effects of the viral infections resulting in epidemics and pandemics that affect the lung (MERS, SARS, HIV, influenza A (H1N1)pdm/09 and COVID-19) and their interactions with TB. A search of the scientific literature was performed. A writing committee of international experts including the European Centre for Disease Prevention and Control Public Health Emergency (ECDC PHE) team, the World Association for Infectious Diseases and Immunological Disorders (WAidid), the Global Tuberculosis Network (GTN) and members of ESCMID Study Group for Mycobacterial Infections (ESGMYC) was established. Consensus was achieved after multiple rounds of revisions between the writing committee and a larger expert group. A Delphi process involving the core group of authors, excluding the ECDC PHE team identified the areas requiring review/consensus, followed by a second round to refine the definitive consensus elements. The epidemiology, immunology of these viral infections and their interactions with TB are discussed with implications on diagnosis, treatment and prevention of airborne infections (infection control, viral containment and workplace safety). This consensus document represents a rapid and comprehensive summary on what is known on the topic.