title: Computational insights into tetracyclines as inhibitors against SARS-CoV-2 Mpro via combinatorial molecular simulation calculations

text: The COVID-19 pandemic raised by SARS-CoV-2 is a public health emergency. However, lack of antiviral drugs and vaccine against human coronaviruses demands a concerted approach to challenge the SARS-CoV-2 infection. Under limited resource and urgency, combinatorial computational approaches to identify the potential inhibitor from known drugs could be applied against risen COVID-19 pandemic. Thereof, this study attempted to purpose the potent inhibitors from the approved drug pool against SARS-CoV-2 main protease (Mpro). To circumvent the issue of lead compound from available drugs as antivirals, antibiotics with broad spectrum of viral activity, i.e. doxycycline, tetracycline, demeclocycline, and minocycline were chosen for molecular simulation analysis against native ligand N3 inhibitor in SARS-CoV-2 Mpro crystal structure. Molecular docking simulation predicted the docking score >-7â¯kcal/mol with significant intermolecular interaction at the catalytic dyad (His41 and Cys145) and other essential substrate binding residues of SARS-CoV-2 Mpro. The best ligand conformations were further studied for complex stability and intermolecular interaction profiling with respect to time under 100â¯ns classical molecular dynamics simulation, established the significant stability and interactions of selected antibiotics by comparison to N3 inhibitor. Based on combinatorial molecular simulation analysis, doxycycline and minocycline were selected as potent inhibitor against SARS-CoV-2 Mpro which can used in combinational therapy against SARS-CoV-2 infection.


Emergency department operations in a large health system during COVID-19


title: A Report of the Telepsychiatric Evaluation of SARS-CoV-2 Patients

text: Objective: During the current coronavirus disease 2019 (COVID-19) pandemic, telemedicine has been brought to the forefront of attention. This report aimed to assess psychiatric comorbidities in COVID-19 patients by utilizing telepsychiatry. Methods: COVID-19 patients admitted in Fasa University Hospital and nonhospitalized outpatients of Fasa city were interviewed by a psychiatrist through video chat for a 1-month period (March-April, 2020). Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Assessment (GAD-7), and Perceived Stress Scale-14 (PSS 14) questionnaires were administered for all patients. Each patient's mental status was recorded, and if any psychiatric problem was diagnosed, supportive psychotherapy, pharmacotherapy, and follow-up visits based on the patient's condition were started. Result: From a total of 82 COVID-19 patients who entered the study, 32 (39.03%) and 50 (60.97%) subjects were inpatients and outpatients, respectively. Moreover, 32 (39.03%) subjects were male and 50 (60.97%) were female. Insomnia seen in 24 (29.3%) patients and adjustment disorder in 13 (15.9%) patients were the most common psychiatric disorders among a total of 33 (40.2%) patients suffering from mental illness. Female and hospitalized patients presented significantly more frequent comorbidities than males and outpatients. Conclusions: Psychiatric disorders were significantly more common in patients with hospital admission than those without and more frequent in female versus male subjects. There were no significant differences between male and female subjects with and without admission according to the PHQ-9, GAD-7, and PSS-14 scores. It was concluded that telepsychiatry in the early stages of mental problems during a catastrophic event like the coronavirus pandemic, can be an efficient instrument for the screening of psychosomatic comorbidities, so that pharmacological treatment (considering possible drug interactions with COVID-19 medications) and psychotherapeutic intervention can be optimized by psychiatrists.


title: Aerosol-generating otolaryngology procedures and the need for enhanced PPE during the COVID-19 pandemic: a literature review

text: BACKGROUND: Adequate personal protective equipment is needed to reduce the rate of transmission of COVID-19 to health care workers. Otolaryngology groups are recommending a higher level of personal protective equipment for aerosol-generating procedures than public health agencies. The objective of the review was to provide evidence that a.) demonstrates which otolaryngology procedures are aerosol-generating, and that b.) clarifies whether the higher level of PPE advocated by otolaryngology groups is justified. MAIN BODY: Health care workers in China who performed tracheotomy during the SARS-CoV-1 epidemic had 4.15 times greater odds of contracting the virus than controls who did not perform tracheotomy (95% CI 2.75-7.54). No other studies provide direct epidemiological evidence of increased aerosolized transmission of viruses during otolaryngology procedures. Experimental evidence has shown that electrocautery, advanced energy devices, open suctioning, and drilling can create aerosolized biological particles. The viral load of COVID-19 is highest in the upper aerodigestive tract, increasing the likelihood that aerosols generated during procedures of the upper aerodigestive tract of infected patients would carry viral material. Cough and normal breathing create aerosols which may increase the risk of transmission during outpatient procedures. A significant proportion of individuals infected with COVID-19 may not have symptoms, raising the likelihood of transmission of the disease to inadequately protected health care workers from patients who do not have probable or confirmed infection. Powered air purifying respirators, if used properly, provide a greater level of filtration than N95 masks and thus may reduce the risk of transmission. CONCLUSION: Direct and indirect evidence suggests that a large number of otolaryngology-head and neck surgery procedures are aerosol generating. Otolaryngologists are likely at high risk of contracting COVID-19 during aerosol generating procedures because they are likely exposed to high viral loads in patients infected with the virus. Based on the precautionary principle, even though the evidence is not definitive, adopting enhanced personal protective equipment protocols is reasonable based on the evidence. Further research is needed to clarify the risk associated with performing various procedures during the COVID-19 pandemic, and the degree to which various personal protective equipment reduces the risk.


Infection à SARS-CoV-2/COVID 19 et cancers solides : synthèse des recommandations à l'attention des professionnels de santé./ [SARS-CoV-2/COVID 19 Infection and Solid Cancers: Synthesis of Recommendations for Health Professionals]


title: Covid-19, cocooning and vitamin d intake requirements

text: The purpose of this report is to clarify what constitutes best practice on vitamin D supplement use, particularly among older adults, who are at highest risk of Covid-19 On Friday 3rd April, three reports were published on how vitamin D may protect against Covid-19 Two reports are aligned with national and international guidelines on vitamin intake requirements for health: one looked at the importance of vitamin D adequacy in protecting children from respiratory illness but included important advice cautioning against high dose vitamin D;the other is from The Irish Longitudinal Study on Ageing (TILDA) that looked at specific ’at risk’ groups for vitamin D deficiency in those over 50 years in a representative sample from the 26 counties TILDA provides a strong evidence base for intervening in older adults with supplemental vitamin D (10 µg to 20 µg daily) A third report advises that every adult should take high doses of vitamin D (20 µg to 50 µg daily) in order to protect against Covid-19 The authors make no mention about other sources of vitamin D in adults This creates confusion at a time when there is widespread fear and anxiety about the Covid-19 pandemic The following provides a review of the evidence and summarises best practice regarding vitamin D nutrition to protect against Covid-19


title: Conducting clinical trials during the COVID-19 pandemic

text: The COVID-19 pandemic has greatly impacted dermatology clinical trial operations due to mandated governmental and institutional shut-downs and newly implemented restrictions. During this unprecedented time, measures should be taken to maintain research conduct compliance while also ensuring the safety of trial staff and participants. Herein, we underscore the challenges facing dermatology trials during the COVID-19 pandemic, and offer strategies to maintain compliant and safe conduct.


title: COVID-ResNet: A Deep Learning Framework for Screening of COVID19 from Radiographs

text: In the last few months, the novel COVID19 pandemic has spread all over the world. Due to its easy transmission, developing techniques to accurately and easily identify the presence of COVID19 and distinguish it from other forms of flu and pneumonia is crucial. Recent research has shown that the chest Xrays of patients suffering from COVID19 depicts certain abnormalities in the radiography. However, those approaches are closed source and not made available to the research community for re-producibility and gaining deeper insight. The goal of this work is to build open source and open access datasets and present an accurate Convolutional Neural Network framework for differentiating COVID19 cases from other pneumonia cases. Our work utilizes state of the art training techniques including progressive resizing, cyclical learning rate finding and discriminative learning rates to training fast and accurate residual neural networks. Using these techniques, we showed the state of the art results on the open-access COVID-19 dataset. This work presents a 3-step technique to fine-tune a pre-trained ResNet-50 architecture to improve model performance and reduce training time. We call it COVIDResNet. This is achieved through progressively re-sizing of input images to 128x128x3, 224x224x3, and 229x229x3 pixels and fine-tuning the network at each stage. This approach along with the automatic learning rate selection enabled us to achieve the state of the art accuracy of 96.23% (on all the classes) on the COVIDx dataset with only 41 epochs. This work presented a computationally efficient and highly accurate model for multi-class classification of three different infection types from along with Normal individuals. This model can help in the early screening of COVID19 cases and help reduce the burden on healthcare systems.


SARS-CoV-2 and COVID-19: facing the pandemic together as citizens and cardiovascular practitioners


title: Challenges of COVID-19 in children in low- and middle-income countries

text: As the coronavirus pandemic extends to low and middle income countries (LMICs), there are growing concerns about the risk of coronavirus disease (COVID-19) in populations with high prevalence of comorbidities, the impact on health and economies more broadly and the capacity of existing health systems to manage the additional burden of COVID-19. The direct effects of COVID are less of a concern in children, who seem to be largely asymptomatic or to develop mild illness as occurs in high income countries; however children in LMICs constitute a high proportion of the population and may have a high prevalence of risk factors for severe lower respiratory infection such as HIV or malnutrition. Further diversion of resources from child health to address the pandemic among adults may further impact on care for children. Poor living conditions in LMICs including lack of sanitation, running water and overcrowding may facilitate transmission of SARS-CoV-2. The indirect effects of the pandemic on child health are of considerable concern, including increasing poverty levels, disrupted schooling, lack of access to school feeding schemes, reduced access to health facilities and interruptions in vaccination and other child health programs. Further challenges in LMICs include the inability to implement effective public health measures such as social distancing, hand hygiene, timely identification of infected people with self-isolation and universal use of masks. Lack of adequate personal protective equipment, especially N95 masks is a key concern for health care worker protection. While continued schooling is crucial for children in LMICs, provision of safe environments is especially challenging in overcrowded resource constrained schools. The current crisis is a harsh reminder of the global inequity in health in LMICs. The pandemic highlights key challenges to the provision of health in LMICs, but also provides opportunities to strengthen child health broadly in such settings.


Preterm delivery, maternal death, and vertical transmission in a pregnant woman with COVID-19 infection


title: Telehealth in Psychiatry of Old Age: Ordinary Care in Extraordinary Times in Rural North-West Ireland

text: The COVID-19 pandemic has required a rapid evolution of services to maintain routine care in Ireland. Services which had been previously slow to adapt technology in their practices are suddenly integrating various telehealth measures to continue routine practice where possible. In this article, we discuss the challenges we face in rapidly implementing telehealth in a rural Psychiatry of Old Age service in the North-West of Ireland.


Coronavirus (covid-19) Pandemic: Personal View to a New Model of Paediatric Practice


title: A reductive analysis of a compartmental model for COVID-19: data assimilation and forecasting for the United Kingdom

text: We introduce a deterministic model that partitions the total population into the susceptible, infected, quarantined, and those traced after exposure, the recovered and the deceased. We hypothesize 'accessible population for transmission of the disease' to be a small fraction of the total population, for instance when interventions are in force. This hypothesis, together with the structure of the set of coupled nonlinear ordinary differential equations for the populations, allows us to decouple the equations into just two equations. This further reduces to a logistic type of equation for the total infected population. The equation can be solved analytically and therefore allows for a clear interpretation of the growth and inhibiting factors in terms of the parameters in the full model. The validity of the 'accessible population' hypothesis and the efficacy of the reduced logistic model is demonstrated by the ease of fitting the United Kingdom data for the cumulative infected and daily new infected cases. The model can also be used to forecast further progression of the disease. In an effort to find optimized parameter values compatible with the United Kingdom coronavirus data, we first determine the relative importance of the various transition rates participating in the original model. Using this we show that the original model equations provide a very good fit with the United Kingdom data for the cumulative number of infections and the daily new cases. The fact that the model calculated daily new cases exhibits a turning point, suggests the beginning of a slow-down in the spread of infections. However, since the rate of slowing down beyond the turning point is small, the cumulative number of infections is likely to saturate to about $3.52 \times 10^5$ around late July, provided the lock-down conditions continue to prevail.


Per- and Polyfluoroalkyl Substances, Microplastics, and COVID-19: Will We Ever Learn?


Impact of anti-rheumatic drugs and steroids on clinical course and prognosis of COVID-19


title: Strategies for the development of drugs targeting novel coronavirus 2019-nCoV/ 药学学报

text: @# There is no specific drug that has been approved for 2019-nCoV. There are a number of factors that pose major challenges in their development. Approaches to the development of anti-2019-nCoV include screening existing broad-spectrum antiviral drugs, repositioning of readily available clinical compounds, and <italic>de novo</italic> development of novel and specific agents for 2019-nCoV. Candidate compounds can be developed either to inhibit virus-based targets, such as RNA proteases, polymerase, spike glycoproteins, and viral envelop and membrane proteins, or to inhibit host-based targets, such as receptors and proteases that are utilized by virus for viral entry and endocytosis. Recently, the RNA polymerase remdesivir had demonstrated clinical efficacy in one patient with severe novel coronavirus pneumonia (NCP). The broad-spectrum viral protease inhibitor Kaletra<sup>®</sup> is also recommended in the current NCP clinical practice. Both drugs had lately been proceeded into multiple controlled phase III clinical trials to test their safety and efficacy in NCP. Combinational therapies consisting of multiple drugs provide other viable options against 2019-nCoV, based on scientific and clinical rationales. Using bioinformatics and database analysis, we have identified 75 clinically compounds, including 20 marketed compounds, that are efficacious in inhibiting key targets in virus- and host-based approaches, which may facilitate the development of new therapeutic options for 2019-nCoV.


Key Highlights of the Canadian Thoracic Society's Position Statement on the Optimization of COPD Management During the COVID-19 Pandemic


The COVID-19 intubation experience in Wuhan


title: Persistent SARS-CoV-2 infection and the risk for cancer

text: The current SARS-CoV-2 has put significant strain on healthcare services worldwide due to acute COVID-19. However, the potential long-term effects of this infection haven't been extensively discussed. We hypothesize that SARS-CoV-2 may be able to cause persistent infection in some individuals, and should this be the case, that in a few years we may see a rise in cancer incidence due to carcinogenic effects of this coronavirus. Non-retroviral RNA viruses such as Coronaviridae have been shown to cause persistent infection in hosts. Empirical evidence of viral genomic material shedding weeks after apparent clinical and laboratorial resolution of COVID-19 may be an indirect proof for persistent viral infection. Furthermore, tropism towards certain immune-privileged territories may facilitate immune evasion by this virus. Structural homology with SARS-CoV-1 indicates that SARS-CoV-2 may be able to directly impair pRb and p53, which are key gatekeepers with tumor suppressor functions. Additionally, COVID-19 features preeminent inflammatory response with marked oxidative stress, which acts as both as initiator and promotor of carcinogenesis. Should there be a carcinogenic risk associated with SARS-CoV-2, the implications for public health are plenty, as infected patients should be closely watched during long periods of follow-up. Additional investigation to establish or exclude the possibility for persistent infection is paramount to identify and prevent possible complications in the future.


title: Viral indicators for tracking domestic wastewater contamination in the aquatic environment

text: Waterborne enteric viruses are an emerging cause of disease outbreaks and represent a major threat to global public health. Enteric viruses may originate from human wastewater and can undergo rapid transport through aquatic environments with minimal decay. Surveillance and source apportionment of enteric viruses in environmental waters is therefore essential for accurate risk management. However, individual monitoring of the >100 enteric viral strains that have been identified as aquatic contaminants is unfeasible. Instead, viral indicators are often used for quantitative assessments of wastewater contamination, viral decay and transport in water. An ideal indicator for tracking wastewater contamination should be (i) easy to detect and quantify, (ii) source-specific, (iii) resistant to wastewater treatment processes, and (iv) persistent in the aquatic environment, with similar behaviour to viral pathogens. Here, we conducted a comprehensive review of 127 peer-reviewed publications, to critically evaluate the effectiveness of several viral indicators of wastewater pollution, including common enteric viruses (mastadenoviruses, polyomaviruses, and Aichi viruses), the pepper mild mottle virus (PMMoV), and gut-associated bacteriophages (Type II/III FRNA phages and phages infecting human Bacteroides species, including crAssphage). Our analysis suggests that overall, human mastadenoviruses have the greatest potential to indicate contamination by domestic wastewater due to their easy detection, culturability, and high prevalence in wastewater and in the polluted environment. Aichi virus, crAssphage and PMMoV are also widely detected in wastewater and in the environment, and may be used as molecular markers for human-derived contamination. We conclude that viral indicators are suitable for the long-term monitoring of viral contamination in freshwater and marine environments and that these should be implemented within monitoring programmes to provide a holistic assessment of microbiological water quality and wastewater-based epidemiology, improve current risk management strategies and protect global human health.


title: Unemployment in the time of COVID-19: A research agenda

text: This essay represents the collective vision of a group of scholars in vocational psychology who have sought to develop a research agenda in response to the massive global unemployment crisis that has been evoked by the COVID-19 pandemic. The research agenda includes exploring how this unemployment crisis may differ from previous unemployment periods; examining the nature of the grief evoked by the parallel loss of work and loss of life; recognizing and addressing the privilege of scholars; examining the inequality that underlies the disproportionate impact of the crisis on poor and working class communities; developing a framework for evidence-based interventions for unemployed individuals; and examining the work-family interface and unemployment among youth.


title: Pesquisa de contaminantes no doce de leite produzido no setor de laticínios de instituição pública de ensino superior no estado do Ceará

text: O Doce de leite é um importante derivado do leite, amplamente consumido em nosso País e possui uma grande importância nutricional. Diante do crescimento do consumo do doce de leite por parte da população, surge a preocupação de garantir que este alimento esteja isento de qualquer sujidade, mantendo-se o padrão de qualidade e identidade do produto. O objetivo do trabalho foi investigar a presença de contaminantes físicos e biológicos em quinze amostras de doce de leite processadas no setor de laticínio de uma instituição pública de ensino superior do Ceará. A pesquisa, de caráter experimental com abordagem qualitativa, foi desenvolvida no Laboratório de Segurança Alimentar e Nutricional (LABSAN) da Universidade Estadual do Ceará, no período de 11 de novembro de 2015 a 12 de fevereiro de 2016. As metodologias empregadas na avaliação das amostras foram: pesquisa macroscópica e microscópica de contaminantes físicos e biológicos. Foi realizada a inspeção das amostras sob uma superfície plana e os materiais estranhos foram removidos fazendo-se o uso de pinça dente de rato e colher de aço inoxidável estéril, onde os contaminantes foram identificados e caracterizados. A contaminação biológica foi avaliada por meio do método de sedimentação espontânea, com modificação. Verificou-se que todas as amostras estavam contaminadas, dentre a amostragem, 29% estavam contaminadas com ácaros, 23% tinham fibras, 18% com pelos, 12% apresentavam fragmentos de insetos e 12% continham larva de inseto. Os achados significativos e sua comparação com os padrões estabelecidos pelas legislações sanitárias vigentes, permitiram sugerir que as amostras do doce de leite estão inapropriadas para o consumo humano, sendo importante adotar medidas que reduzam as chances de contaminação, a fim de favorecer a prevenção de doenças veiculadas por esses produtos.(AU)


All hands on deck: Creation of an online internal medicine redeployment curriculum


Urgency and uncertainty: covid-19, face masks, and evidence informed policy


Adherence of infusible biologics during the time of COVID-19 among patients with Inflammatory Bowel Disease: A nationwide VA cohort study


Use of negative pressure individual isolation system for CT scan of patients with suspected COVID-19


title: Radical change in osteosarcoma surgical plan due to COVID-19 pandemic

text: A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.


COVID-19 pandemic and rural generalism: the West Coast's rural workforce solution


A Commentary on Rural-Urban Disparities in COVID-19 Testing Rates per 100,000 and Risk Factors


title: Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China

text: A woman with coronavirus disease in her 35th week of pregnancy delivered an infant by cesarean section in a negative-pressure operating room. The infant was negative for severe acute respiratory coronavirus 2. This case suggests that mother-to-child transmission is unlikely for this virus.


title: Threatening increase in alcohol consumption in physicians quarantined due to coronavirus outbreak in Poland: the ALCOVID survey

text: BACKGROUND: The potential risks of increased alcohol use and of the development of alcohol dependence during COVID-19 pandemic were identified. So far there have been no studies concerning pandemic influence on alcohol consumption in medical professionals in quarantine or isolation. METHODS: The 12 point 'online' ALCOVID survey with a cover letter was designed and addressed to physicians, recruited online via accessible networks, who underwent isolation or quarantine during recent pandemic. The AUDIT-3 scale was included. RESULTS: A representative trial of 113 physicians participated in the study. Over 53% of screened doctors revealed that the amounts of the consumed alcohol have escalated; almost 20% of subjects binged over seven standard drinks for one occasion. Close to every second used six or more drinks on one occasion. Over 40% used alcohol more than four times per week. Female used alcohol more often and more standard drinks per occasion. Male binged more. Anxiety and hopelessness were the most common motives to drink. CONCLUSIONS: Alcohol consumption in physicians in quarantine has threateningly increased. It is important to identify the group of people at the risk of problem drinking and dependence development, especially when it concerns key professional branches in the fight against the current crisis.


title: Different longitudinal patterns of nucleic acid and serology testing results based on disease severity of COVID-19 patients

text: Effective strategy to mitigate the ongoing pandemic of 2019 novel coronavirus (COVID-19) require a comprehensive understanding of humoral responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the emerging virus causing COVID-19. The dynamic profile of viral replication and shedding along with viral antigen specific antibody responses among COVID-19 patients started to be reported but there is no consensus on their patterns. Here, we conducted a serial investigation on 21 individuals infected with SARS-CoV-2 in two medical centres from Jiangsu Province, including 11 non-severe COVID-19 patients, and 5 severe COVID-19 patients and 5 asymptomatic carriers based on nucleic acid test and clinical symptoms. The longitudinal swab samples and sera were collected from these people for viral RNA testing and antibody responses, respectively. Our data revealed different pattern of seroconversion among these groups. All 11 non-severe COVID-19 patients and 5 severe COVID-19 patients were seroconverted during hospitalization or follow-up period, suggesting that serological testing is a complementary assay to nucleic acid test for those symptomatic COVID-19 patients. Of note, immediate antibody responses were identified among severe cases, compared to non-severe cases. On the other hand, only one were seroconverted for asymptomatic carriers. The SARS-CoV-2 specific antibody responses were well-maintained during the observation period. Such information is of immediate relevance and would assist COVID-19 clinical diagnosis, prognosis and vaccine design.


title: The pathological autopsy of coronavirus disease 2019 (COVID-2019) in China: a review

text: The coronavirus disease 2019 (COVID-2019) that emerged in Wuhan, China, has rapidly spread to many countries across all six WHO regions. However, its pathobiology remains incompletely understood and many efforts are underway to study it worldwide. To clarify its pathogenesis to some extent, it will inevitably require lots of COVID-2019-associated pathological autopsies. Pathologists from all over the world have raised concerns with pathological autopsy relating to COVID-2019. The issue of whether a person died from COVID-2019 infection or not is always an ambiguous problem in some cases, and ongoing epidemiology from China may shed light on it. This review retrospectively summarizes the research status of pathological autopsy for COVID-2019 deaths in China, which will be important for the cause of death, prevention, control and clinical strategies of COVID-2019. Moreover, it points out several challenges at autopsy. We believe pathological studies from China enable to correlate clinical symptoms and pathological features of COVID-2019 for doctors and provide an insight into COVID-2019 disease.


title: The effect of extended closure of red-light areas on COVID-19 transmission in India

text: The novel coronavirus disease (COVID-19) pandemic has resulted in over 200,000 cases in India. Thus far, India has implemented lockdown measures to curb disease transmission. However, commercial sex work in red-light areas (RLAs) has potential to lead to COVID-19 resurgence after lockdown. We developed a model of COVID-19 transmission in RLAs, evaluating the impact of extended RLA closure compared with RLA reopening on cases, hospitalizations, and mortality rates within the RLAs of five major Indian cities, within the cities, and across India. Closure lowered transmission at all scales. More than 90% of cumulative cases and deaths among RLA residents of Kolkata, Pune, and Nagpur could be averted by the time the epidemic would peak under a re-opening scenario. Across India, extended closure of RLAs would benefit the population at large, delaying the peak of COVID-19 cases by 8 to 23 days, and avert 32% to 60.2% of cumulative cases and 43% to 67.6% of cumulative deaths at the peak of the epidemic. Extended closure of RLAs until better prevention and treatment strategies are developed would benefit public health in India.


Correspondence COVID-19: Melatonin as a potential adjuvant treatment


title: COVID-19 Literature Knowledge Graph Construction and Drug Repurposing Report Generation

text: To combat COVID-19, clinicians and scientists all need to digest the vast amount of relevant biomedical knowledge in literature to understand the disease mechanism and the related biological functions. We have developed a novel and comprehensive knowledge discovery framework, COVID-KG, which leverages novel semantic representation and external ontologies to represent text and images in the input literature data, and then performs various extraction components to extract fine-grained multimedia knowledge elements (entities, relations and events). We then exploit the constructed multimedia KGs for question answering and report generation, using drug repurposing as a case study. Our framework also provides detailed contextual sentences, subfigures and knowledge subgraphs as evidence. All of the data, KGs, resources, and shared services are publicly available.


The Treatment Paradigm of Chronic Rhinosinusitis with Nasal Polyps in the COVD-19 Era


title: Invasion Science and the Global Spread of SARS-CoV-2

text: Emerging infectious diseases, such as coronavirus disease 2019 (COVID-19), are driven by ecological and socioeconomic factors, and their rapid spread and devastating impacts mirror those of invasive species. Collaborations between biomedical researchers and ecologists, heretofore rare, are vital to limiting future outbreaks. Enhancing the crossdisciplinary framework offered by invasion science could achieve this goal.


Open Synthesis and the coronavirus (COVID-19) pandemic in 2020


title: Biorisk assessment for infrastructure & biosafety requirements for the laboratories providing coronavirus SARS-CoV-2/(COVID-19) diagnosis

text: Novel coronavirus infection [coronavirus disease 2019 (COVID-19)] has spread to more than 203 countries of various regions including Africa, America, Europe, South East Asia and Western Pacific. The WHO had declared COVID-19 as the global public health emergency and subsequently as pandemic because of its worldwide spread. It is now one of the top-priority pathogens to be dealt with, because of high transmissibility, severe illness and associated mortality, wide geographical spread, lack of control measures with knowledge gaps in veterinary and human epidemiology, immunity and pathogenesis. The quick detection of cases and isolating them has become critical to contain it. To meet the increasing demand of the diagnostic services, it is necessary to enhance and expand laboratory capabilities since existing laboratories cannot meet the emerging demand. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a BSL-2 (Biosafety Level 2) agent and needs to be handled in biosafety cabinet using standard precautions. This review highlights minimum requirements for the diagnostic laboratories opting testing of material for the diagnosis of COVID-19 and associated biorisk to the individuals and to the community.


title: Influence of COVID-19 confinement in students performance in higher education

text: This study explores the effects of COVID-19 confinement in the students performance in higher education. Using a field experiment of 458 students from three different subjects in Universidad Autonoma de Madrid (Spain), we study the differences in assessments by dividing students into two groups. The first group (control) corresponds to academic years 2017/2018 and 2018/2019. The second group (experimental) corresponds to students from 2019/2020, which is the group of students that interrupted their face-to-face activities because of the confinement. The results show that there is a significant positive effect of the COVID-19 confinement on students performance. This effect is also significative in activities that did not change their format when performed after the confinement. We find that this effect is significative both in subjects that increased the number of assessment activities and subjects that did not change the workload of students. Additionally, an analysis of students learning strategies before confinement shows that students did not study in a continuous basis. Based on these results, we conclude that COVID-19 confinement changed students learning strategies to a more continuous habit, improving their efficiency. For these reasons, better scores in students assessment are expected due to COVID-19 confinement that can be explained by an improvement in their learning performance.


title: Clinical characteristics of 80 hospitalized frontline medical workers infected with COVID-19 in Wuhan, China

text: More than 1,000 medical workers have been infected with COVID-19 in China. The 80 hospitalized patients included 57 SARS-CoV-2 confirmed and 23 clinically diagnosed. The median age was 39 years, 49 (61.25%) were women, and one patient died. The most common symptoms at onset were fever (65, 81.25%), cough (47, 58.75%), fatigue (28, 35%), myalgia (19, 23.75%), expectoration (19, 23.75%), and diarrhea (15, 18.75%). Patients of frontline medical workers at a single-center hospital showed some unique clinical and laboratory findings compared with other patients in Wuhan and outside of Wuhan. This study provides our experience for other frontline medical workers.


Update on the neurology of COVID-19


The impact of COVID-19 on sporting events and high-performance athletes


title: COVID-19 and Headache Medicine: A Narrative Review of Non-Steroidal Anti-Inflammatory Drug (NSAID) and Corticosteroid Use

text: OBJECTIVE: To summarize the current literature on non-steroidal anti-inflammatory drug and corticosteroid use during the coronavirus disease 2019 (COVID-19) pandemic, recognizing that these are commonly used treatments in the field of headache medicine. BACKGROUND: The use of non-steroidal anti-inflammatory drugs and corticosteroids in patients during the COVID-19 pandemic has been a controversial topic within the medical community and international and national health organizations. Lay press and social media outlets have circulated opinions on this topic despite the fact that the evidence for or against the use of these medications is sparse. In the field of headache medicine, these medications are used commonly and both patients and clinicians may have questions or hesitations pertaining to their use during the COVID-19 pandemic. METHODS: A detailed search of the scientific and popular literature was performed. RESULTS: There is limited literature pertaining to the safety of non-steroidal anti-inflammatory drugs and corticosteroids during the COVID-19 pandemic. To date, there are no clear scientific data that preclude the use of non-steroidal anti-inflammatory drugs in the general population who may acquire COVID-19 or in those acutely infected with the virus. Several health organizations have concluded that treatment with corticosteroids during active infection should be avoided due to concerns of prolonged viral shedding in the respiratory tract and the lack of survival benefit based on the data from past coronaviruses and influenza virus; specific exceptions exist including treatment for underlying asthma or chronic obstructive pulmonary disease, septic shock, and acute respiratory distress syndrome. CONCLUSION: Scientific information regarding the COVID-19 pandemic is constantly evolving, and limited or contradictory information can lead to confusion for both patients and clinicians. It is recommended that prior to prescribing non-steroidal anti-inflammatory drugs and steroids for the treatment of headache, clinicians have open discussions with their patients about the potential risks and benefits of using these medications during the COVID-19 pandemic. This manuscript summarizes the currently available evidence and understanding about these risks and benefits to help clinicians navigate such discussions.


The Immunocompromised Transplant Recipient and SARS-CoV-2 Infection


Investigation of a nosocomial outbreak of coronavirus disease 2019 in a paediatric ward in South Korea: successful control by early detection and extensive contact tracing with testing


title: Development Path and Urgency of further Strengthening Construction of Public Hospitals Based on Novel Coronavirus Pneumonia Treatment

text: During the outbreak of novel coronavirus pneumonia (NCP) in Wuhan, public hospitals have played an important role in intensive care, case guidance and scheme optimization. At the same time, it also faces unprecedented challenges and tests. Based on the treatment of severe patients in Wuhan, combined with the treatment practice in Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, this paper puts forward the urgency of further strengthening the construction of public hospitals, discusses the feasible path for promoting the development of public hospitals, so as to meet the growing medical needs of the people, improve the ability to respond to major public health emergencies, and effectively guarantee the safety of people's lives and the promotion of a healthy China construction.


title: An outbreak of malignant catarrhal fever in Sambar deer (Rusa unicolor)/ Surto de febre catarral maligna em cervos Sambar (Rusa Unicolor)

text: Malignant catarrhal fever (MCF) is an infectious, pansystemic and highly fatal disease with wide geographic distribution. The species that are clinically prone to it include cattle, deer and bison. In Brazil, the disease in ruminants and deer is associated with the contact with sheep, especially during labor, when the fetal remains that are eliminated contain the ovine herpesvirus 2 (OvHV-2). The outbreak took place in a conservationist property in the city of Casimiro de Abreu/RJ, which hosted 23 Sambar deer, and, of these, 19 died, showing neurological signs. The deer lived in a location together with 15 male and female meat sheep. A female specimen of the Sambar deer (Rusa unicolor), aged approximately three years, which had presented with neurological clinical signs was referred to necropsy in the Setor de Anatomia Patológica at Universidade Federal Rural do Rio de Janeiro (SAP/UFRRJ). During necropsy, cerebrospinal fluid was sampled for analysis; fragments of several organs were fixated in 10% buffered formalin and processed for histopathological analysis. Fragments of occipital lobe, cerebellum and bulb were collected to perform the polymerase chain reaction (PCR). The diagnosis of this outbreak was based on epidemiological, clinical and pathological findings, and on the amplification of the OvHV-2 DNA through PCR. The histological changes were the base to confirm the MCF case and were characterized by degeneration of vascular endothelial cells, fibrinoid vasculitis, hyperplasia and necrosis of lymphoid organs. However, PCR was an important tool to confirm the diagnosis. MCF as an important disease with nervous symptomatology in deer.(AU)


The Dilemma of Coronavirus Disease 2019, Aging, and Cardiovascular Disease: Insights From Cardiovascular Aging Science


title: [Diagnosztikus lépések és a betegség prognózisának becslése COVID19-fertozött betegeken]/ Diagnostic consideration and bedside estimation of the prognosis in COVID-19 patients

text: In December 2019, a cluster of pneumonia cases of unknown origin occured in Wuhan, China. The identified infective agent is a novel corona virus called "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) and the respiratory disease caused by this agent aquired the name "coronavirus disease 2019" (COVID-19). In March 2020, the World Health Organization (WHO) declared the novel coronavirus outbreak a pandemic. We reviewed the international literature regarding the novel coronavirus outbreak. Here below, we focus mainly on the diagnostic issues of COVID-19 and on the estimation of the prognosis. We detail the relevant anamnestic factors and initial examination results which serve as basics for the clinical suspicion of COVID-19. We also focus on the proper method of microbiological sampling and the relevant informations regarding diagnostic tests like the gold standard real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2. We also cite the current national epidemiologic regulations of testing for novel coronavirus. In the last section, we emphasize the importance and the potential way of early identification of high-risk patients. The COVID-19 pandemic may cause substantial epidemiological and healthcare burden even in Hungary. In addition to the epidemiologic interventions aiming the deceleration of the outbreak, the early identification and the correct hospital treatment remain key issues since these may influence mortality. The chances of the critically ill patients could be improved solely by a high-quality and careful critical care. It is prudent to meet the experiences of colleagues working hard with these patients in the already heavily infected countries. Orv Hetil. 2020; 161(17): 667671.


title: Combating COVID-19 and Building Immune Resilience: A Potential Role for Magnesium Nutrition?

text: BACKGROUND: In December 2019, the viral pandemic of respiratory illness caused by COVID-19 began sweeping its way across the globe. Several aspects of this infectious disease mimic metabolic events shown to occur during latent subclinical magnesium deficiency. Hypomagnesemia is a relatively common clinical occurrence that often goes unrecognized since magnesium levels are rarely monitored in the clinical setting. Magnesium is the second most abundant intracellular cation after potassium. It is involved in >600 enzymatic reactions in the body, including those contributing to the exaggerated immune and inflammatory responses exhibited by COVID-19 patients. METHODS: A summary of experimental findings and knowledge of the biochemical role magnesium may play in the pathogenesis of COVID-19 is presented in this perspective. The National Academy of Medicine's Standards for Systematic Reviews were independently employed to identify clinical and prospective cohort studies assessing the relationship of magnesium with interleukin-6, a prominent drug target for treating COVID-19. RESULTS: Clinical recommendations are given for prevention and treatment of COVID-19. Constant monitoring of ionized magnesium status with subsequent repletion, when appropriate, may be an effective strategy to influence disease contraction and progression. The peer-reviewed literature supports that several aspects of magnesium nutrition warrant clinical consideration. Mechanisms include its "calcium-channel blocking" effects that lead to downstream suppression of nuclear factor-Kß, interleukin-6, c-reactive protein, and other related endocrine disrupters; its role in regulating renal potassium loss; and its ability to activate and enhance the functionality of vitamin D, among others. CONCLUSION: As the world awaits an effective vaccine, nutrition plays an important and safe role in helping mitigate patient morbidity and mortality. Our group is working with the Academy of Nutrition and Dietetics to collect patient-level data from intensive care units across the United States to better understand nutrition care practices that lead to better outcomes.


A new normal for hypertension medicine with coronavirus disease-2019 (COVID-19): proposal from the president of the Japanese Society of Hypertension


Drone delivery of AED's and personal protective equipment in the era of SARS-CoV-2


An effective protocol for heart transplantation during COVID-19 outbreak


First organ donation in Wuhan after ending of the coronavirus lockdown


title: Antiviral Action of Tryptanthrin Isolated from Strobilanthes cusia Leaf against Human Coronavirus NL63

text: Strobilanthes cusia (Nees) Kuntze is a Chinese herbal medicine used in the treatment of respiratory virus infections. The methanol extract of S. cusia leaf contains chemical components such as ß-sitosterol, indirubin, tryptanthrin, betulin, indigodole A, and indigodole B that have diverse biological activities. However, the antiviral action of S. cusia leaf and its components against human coronavirus remains to be elucidated. Human coronavirus NL63 infection is frequent among immunocompromised individuals, young children, and in the elderly. This study investigated the anti-Human coronavirus NL63 (HCoV-NL63) activity of the methanol extract of S. cusia leaf and its major components. The methanol extract of S. cusia leaf effectively inhibited the cytopathic effect (CPE) and virus yield (IC50 = 0.64 µg/mL) in HCoV-NL63-infected cells. Moreover, this extract potently inhibited the HCoV-NL63 infection in a concentration-dependent manner. Among the six components identified in the methanol extract of S. cusia leaf, tryptanthrin and indigodole B (5aR-ethyltryptanthrin) exhibited potent antiviral activity in reducing the CPE and progeny virus production. The IC50 values against virus yield were 1.52 µM and 2.60 µM for tryptanthrin and indigodole B, respectively. Different modes of time-of-addition/removal assay indicated that tryptanthrin prevented the early and late stages of HCoV-NL63 replication, particularly by blocking viral RNA genome synthesis and papain-like protease 2 activity. Notably, tryptanthrin (IC50 = 0.06 µM) and indigodole B (IC50 = 2.09 µM) exhibited strong virucidal activity as well. This study identified tryptanthrin as the key active component of S. cusia leaf methanol extract that acted against HCoV-NL63 in a cell-type independent manner. The results specify that tryptanthrin possesses antiviral potential against HCoV-NL63 infection.


title: Coronavirus disease 2019 (COVID-19): A literature review

text: In early December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurred in Wuhan City, Hubei Province, China. On January 30, 2020 the World Health Organization declared the outbreak as a Public Health Emergency of International Concern. As of February 14, 2020, 49,053 laboratory-confirmed and 1,381 deaths have been reported globally. Perceived risk of acquiring disease has led many governments to institute a variety of control measures. We conducted a literature review of publicly available information to summarize knowledge about the pathogen and the current epidemic. In this literature review, the causative agent, pathogenesis and immune responses, epidemiology, diagnosis, treatment and management of the disease, control and preventions strategies are all reviewed.


Recommendations for the use of vascular access in the COVID-19 patients: an Italian perspective


title: The role of pets in managing uncertainty from COVID-19

text: In an effort to manage the uncertainty brought on by the COVID-19 pandemic, many people have turned to their social support networks. With limited access to in-person human social networks, many people are turning to pets for social support. Pets may be a complementary social support to supplement virtual human-to-human interaction. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


How the andrological sector suffered from the dramatic Covid 19 outbreak in Italy: supportive initiatives of the Italian Association of Andrology (SIA)


title: Why all COVID-19 hospitals should have mental health professionals: The importance of mental health in a worldwide crisis!

text: COVID-19 pandemic has led to a worldwide crisis. At present, everyone is focusing on the prevention of COVID-19 infection, preparing and discussing issues related to physical health consequences. However, it is important to understand that the life-threatening negative physical health consequences are going to be faced by a few, but everyone is going to face the negative mental health consequences of the pandemic. At various places COVID-19 hospitals are being established, to address the physical health consequences of the pandemic. However, mental health professionals have not been very actively involved in the management of people going through this pandemic. This viewpoint discusses the mental health consequences of the pandemic for the health care workers, people who are undergoing quarantine, people who are admitted to the COVID-19 hospitals, and those who have recovered from the infection. The article also highlights the mental health needs of people at different levels and the kind of interventions, which may be carried out.


An underestimated "false negative COVID cholecystitis" in Northern Italy and the contagion of a surgical ward: it can happen everywhere


Steam inhalation and paediatric burns during the COVID-19 pandemic


title: Discrimination and Social Exclusion in the Outbreak of COVID-19

text: This paper is aimed to document the observed social exclusion and discrimination in the outbreak of COVID-19 across the world and inside of China. Discrimination and social exclusion has occurred in various forms, while 25.11% of respondents overseas experienced discrimination in the breakout of COVID-19, and 90% of respondents inside of China exhibited discriminatory attitudes. The discrimination and social exclusion also lead to a range of damaging social outcomes. Thus, this is an urgent call for the inclusiveness in policy and media in the face of this public health emergency.


title: Remdesivir for severe acute respiratory syndrome coronavirus 2 causing COVID-19: An evaluation of the evidence

text: The novel coronavirus infection that initially found at the end of 2019 has attracted great attention. So far, the number of infectious cases has increased globally to more than 100 thousand and the outbreak has been defined as a pandemic situation, but there are still no "specific drug" available. Relevant reports have pointed out the novel coronavirus has 80% homology with SARS. In the difficulty where new synthesized drug cannot be applied immediately to patients, "conventional drug in new use" becomes a feasible solution. The first medication experience of the recovered patients in the US has led remdesivir to be the "specific drug". China has also taken immediate action to put remdesivir into clinical trials with the purpose of applying it into clinical therapeutics for Corona Virus Disease 2019 (COVID-19). We started from the structure, immunogenicity, and pathogenesis of coronavirus infections of the novel coronavirus. Further, we analyzed the pharmacological actions and previous trials of remdesivir to identify the feasibility of conducting experiments on COVID-19.


title: Investigating the challenges and generalizability of deep learning brain conductivity mapping

text: PURPOSE: To investigate deep learning electrical properties tomography (EPT) for application on different simulated and in-vivo datasets including pathologies for brain conductivity reconstructions. METHODS: 3D patch-based convolutional neural networks were trained to predict conductivity maps from B1 transceive phase data. To compare the performance of DL-EPT networks on different datasets, three datasets were used throughout this work, one from simulations and two from in-vivo measurements from healthy volunteers and cancer patients, respectively. At first, networks trained on simulations were tested on all datasets with different levels of homogeneous Gaussian noise introduced in training and testing. Secondly, to investigate potential robustness towards systematical differences between simulated and measured phase maps, in-vivo data with conductivity labels from conventional EPT were used for training. RESULTS: High quality conductivity reconstructions from networks trained on simulations with and without noise confirms the potential of deep learning for EPT. However, when this network is used for in-vivo reconstructions, measurement related artifacts affect the quality of conductivity maps. Training DL-EPT networks using conductivity labels from conventional EPT improves the quality of the results. CONCLUSIONS: Networks trained on realistic simulations yield reconstruction artifacts when applied to in-vivo data. Training with realistic phase data and conductivity labels from conventional EPT allows for reducing these artifacts.


title: Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT?

text: PURPOSE: To evaluate the diagnostic value of computed tomography (CT) and real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) for COVID-19 pneumonia. METHODS: This retrospective study included all patients with COVID-19 pneumonia suspicion, who were examined by both CT and rRT-PCR at initial presentation. The sensitivities of both tests were then compared. For patients with a final confirmed diagnosis, clinical and laboratory data, in addition to CT imaging findings were evaluated. RESULTS: A total of 36 patients were finally diagnosed with COVID-19 pneumonia. Thirty-five patients had abnormal CT findings at presentation, whereas one patient had a normal CT. Using rRT-PCR, 30 patients were tested positive, with 6 cases initially missed. Amongst these 6 patients, 3 became positive in the second rRT-PCR assay(after 2 days, 2 days and 3 days respectively), and the other 3 became positive only in the third round of rRT-PCR tests(after 5 days, 6 days and 8 days respectively). At presentation, CT sensitivity was therefore 97.2%, whereas the sensitivity of initial rRT-PCR was only 83.3%. CONCLUSION: rRT-PCR may produce initial false negative results. We suggest that patients with typical CT findings but negative rRT-PCR results should be isolated, and rRT-PCR should be repeated to avoid misdiagnosis.


COVID-19 in a Kidney Transplant Patient


title: Prone positioning in conscious patients on medical wards: A review of the evidence and its relevance to patients with COVID-19 infection

text: Medical teams continue to treat many patients with COVID-19 infection. This disease can result in profound hypoxaemia that may necessitate intubation and invasive mechanical ventilation in those who are critically ill. This intervention carries risk to both patients and healthcare workers and utilises significant hospital resource for prolonged periods. Simple, safe interventions that can be used before critical deterioration are highly desirable. The prone position in conscious non-ventilated patients with COVID-19 infection may improve oxygenation in the short term and defer or prevent the need for intubation in some. However, clinicians must be aware that there is a small evidence base for this intervention currently. This review sets out evidence regarding the use of this technique to aid the decision making of frontline staff.


Call for ensuring cancer care continuity during COVID-19 pandemic


title: Two hits to the renin-angiotensin system may play a key role in severe COVID-19

text: The spike glycoprotein on the virion surface docking onto the angiotensin-converting enzyme (ACE) 2 dimer is an essential step in the process of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in human cells-involves downregulation of ACE2 expression with systemic renin-angiotensin system (RAS) imbalance and promotion of multi-organ damage. In general, the RAS induces vasoconstriction, hypertension, inflammation, fibrosis, and proliferation via the ACE/Ang II/Ang II type 1 receptor (AT1R) axis and induces the opposite effects via the ACE2/Ang (1-7)/Mas axis. The RAS may be activated by chronic inflammation in hypertension, diabetes, obesity, and cancer. SARS-CoV-2 induces the ACE2 internalization and shedding, leading to the inactivation of the ACE2/Ang (1-7)/Mas axis. Therefore, we hypothesize that two hits to the RAS drives COVID-19 progression. In brief, the first hit originates from chronic inflammation activating the ACE/Ang II/AT1R axis, and the second originates from the COVID-19 infection inactivating the ACE2/Ang (1-7)/Mas axis. Moreover, the two hits to the RAS may be the primary reason for increased mortality in patients with COVID-19 who have comorbidities and may serve as a therapeutic target for COVID-19 treatment.


Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City


SARS-CoV-2 as a protective factor for cardiovascular mortality?


title: Case Report: Diagnosis of COVID-19 versus Tropical Diseases in Pakistan

text: A 25-year-old medical student presented in Multan, Pakistan with a high fever, cough, myalgia, and diarrhea consistent with the typical signs and symptoms of novel coronavirus disease (COVID-19). The patient had traveled to high COVID-19-risk areas within Pakistan and had no significant medical and surgical history. Based on nasopharyngeal and oropharyngeal swab testing, the patient was found to be negative for COVID-19. He subsequently developed a diffuse rash and had serology consistent with dengue and measles. The patient was treated symptomatically, and his condition gradually improved over 7 days. This case highlights the high prevalence of many tropical diseases in low-income countries and the need for clinicians to consider alternate diagnoses in addition to testing for COVID-19 during the pandemic.


Self-Reported Loss of Smell and Taste in SARS-CoV-2 Patients: Primary Care Data to Guide Future Early Detection Strategies


Letter to the Editor: Safety and Efficacy of Bedside Peritoneal Dialysis Catheter Placement in the COVID-19 Era: Initial Experience at a New York City Hospital


The clinical course and short-term outcome of COVID-19 in a cohort of hemodialysis patients


title: Canonical and Noncanonical Autophagy as Potential Targets for COVID-19

text: The SARS-CoV-2 pandemic necessitates a review of the molecular mechanisms underlying cellular infection by coronaviruses, in order to identify potential therapeutic targets against the associated new disease (COVID-19). Previous studies on its counterparts prove a complex and concomitant interaction between coronaviruses and autophagy. The precise manipulation of this pathway allows these viruses to exploit the autophagy molecular machinery while avoiding its protective apoptotic drift and cellular innate immune responses. In turn, the maneuverability margins of such hijacking appear to be so narrow that the modulation of the autophagy, regardless of whether using inducers or inhibitors (many of which are FDA-approved for the treatment of other diseases), is usually detrimental to viral replication, including SARS-CoV-2. Recent discoveries indicate that these interactions stretch into the still poorly explored noncanonical autophagy pathway, which might play a substantial role in coronavirus replication. Still, some potential therapeutic targets within this pathway, such as RAB9 and its interacting proteins, look promising considering current knowledge. Thus, the combinatory treatment of COVID-19 with drugs affecting both canonical and noncanonical autophagy pathways may be a turning point in the fight against this and other viral infections, which may also imply beneficial prospects of long-term protection.


Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany


title: Development of an indirect ELISA for detecting porcine deltacoronavirus IgA antibodies

text: Porcine deltacoronavirus (PDCoV) is a novel coronavirus that can cause vomiting and watery diarrhea in pigs and death in piglets. Since PDCoV was first detected in 2009 in Hong Kong, the prevalence of PDCoV has increased in recent years, resulting in serious economic losses to the swine industry. The coronavirus spike (S) protein is an antigen that has been demonstrated to contain epitopes that induce neutralizing antibodies. The presence of serum and milk IgA antibodies against pathogens that replicate primarily on mucosal surfaces is important for mucosal immunity. Here, an indirect anti-PDCoV IgA antibody enzyme-linked immunosorbent assay (PDCoV S1 IgA ELISA) using the purified S1 portion of S protein as the coating antigen was developed to detect PDCoV IgA antibodies in serum and sow's milk. A receiver operating characteristic (ROC) curve analysis showed high specificity and sensitivity of the PDCoV-S1-IgA-ELISA based on samples confirmed by IFA. Anti-PDCoV IgA antibodies in 152 serum samples and 65 milk samples collected from six farms that had experienced diarrhea outbreaks within previous last two years were detected by this assay, and 62.5% of the serum samples and 100% of the milk samples were positive for PDCoV. The indirect ELISA method established in this study will provide a convenient tool for measurement of serum and milk IgA levels against PDCoV in pig herds, rapid detection of PDCoV infection in pigs, and evaluation of the immunogenicity of vaccines.


title: Large-scale, in-house production of viral transport media to support SARS-CoV-2 PCR testing in a multi-hospital healthcare network during the COVID-19 pandemic

text: The COVID-19 pandemic has severely disrupted worldwide supplies of viral transport media (VTM) due to widespread demand for SARS-CoV-2 RT-PCR testing. In response to this ongoing shortage, we began production of VTM in-house in support of diagnostic testing in our hospital network. As our diagnostic laboratory was not equipped for reagent production, we took advantage of space and personnel that became available due to closure of the research division of our medical center. We utilized a formulation of VTM described by the CDC that was simple to produce, did not require filtration for sterilization, and used reagents that were available from commercial suppliers. Performance of VTM was evaluated by several quality assurance measures. Based on Ct values of spiking experiments, we found that our VTM supported highly consistent amplification of the SARS-CoV-2 target (coefficient of variation = 2.95%) using the Abbott RealTime SARS-CoV-2 EUA assay on the Abbott m2000 platform. VTM was also found to be compatible with multiple swab types and, based on accelerated stability studies, able to maintain functionality for at least four months at room temperature. We further discuss how we met logistical challenges associated with large-scale VTM production in a crisis setting including use of staged, assembly line for VTM transport tube production.


title: Covid-19 and the digestive system

text: The novel coronavirus disease is currently causing a major pandemic. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the Betacoronavirus genus that also includes the SARS-CoV and Middle East respiratory syndrome coronavirus. While patients typically present with fever and a respiratory illness, some patients also report gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain. Studies have identified the SARS-CoV-2 RNA in stool specimens of infected patients, and its viral receptor angiotensin converting enzyme 2 was found to be highly expressed in gastrointestinal epithelial cells. These suggest that SARS-CoV-2 can actively infect and replicate in the gastrointestinal tract. This has important implications to the disease management, transmission, and infection control. In this article, we review the important gastrointestinal aspects of the disease.


title: Impact of the COVID-19 pandemic on the management of patients with end-stage renal disease

text: A novel infectious disease, coronavirus disease-2019 (COVID-19), spread globally since December 2019. Without effective treatment and vaccination, the strategies to restrain this disease are only keeping social distance, maintaining personal hygiene, quarantine, and isolation. However, thrice-a-week treatment is inevitable for all hemodialysis patients. In addition to the high risk of cluster infection and compromised immunity in patients with end-stage renal disease (ESRD), an atypical disease presentation could also make the medial system neglect these patients during CVOID-19 pandemic. To avoid COVID-19 transmission among patients on dialysis, the major societies of nephrology around the world have provided their guidelines for screening, dialysis facilities adjustment, and health education, respectively. In this review, we summarized the main contents and differences of these guidelines and addressed the prompt management for patients with ESRD to reduce the risk of infection during COVID-19 pandemic.


title: Impact of the COVID-19 Pandemic on the Management of End-Stage Renal Disease Patients

text: A novel infectious disease, Coronavirus disease -2019 (COVID-19), spread globally since Dec. 2019. Without effective treatment and vaccination, the strategies to restrain this disease is only keeping social distance, maintaining personal hygiene, quarantine and isolation. However, thrice-a-week treatment is inevitable for all hemodialysis patients. In addition to the high risk of cluster infection and compromised immunity in patients with end-stage renal disease (ESRD), an atypical disease presentation could also make the medial system neglect these patients during CVOID-19 pandemic. To avoid COVID-19 transmission among dialysis patients, the major societies of nephrology around the world have provided their guidelines of screening, dialysis facilities adjustment, and health education, respectively. In this review, we summarized the main contents and difference of these guidelines and addressed the prompt management for ESRD patients to reduce the risk of infection during COVID-19 pandemic.


title: In vivo effect of UV-photofunctionalization of CoCrMo in processes of guided bone regeneration and tissue engineering

text: Photofunctionalization of implant materials with ultraviolet radiation (UV) have been subject of study in the last two decades, and previous research on CoCrMo discs have showed good results in terms of bioactivity and the findings of apatite-like crystals in vitro. In the current study, CoCrMo domes were photofunctionalized with UV radiation of 254 nm on their internal faces during 24 hours; they were implanted in rabbit tibia and remained for 3, 4 and 6 weeks. The potential to induce bone formation beneath the dome-shaped membranes was evaluated through morphometric, histologic and density measurements; and the results were compared with those obtained under control untreated domes. Higher density values were observed for irradiated domes at 3 weeks, while higher volumes were obtained under photofunctionalized domes for longer periods (4 and 6 weeks). Histologically, woven bone was formed by endochondral ossification in all cases; differences in the architecture and size of the trabeculae and in the number of osteoblasts were noted between irradiated and non-irradiated samples. The UV radiation of 254 nm generated a larger bone volume fraction compared to that found in the absence of UVC radiation, and induced an increase of density in the early stages of healing, leading to a better initial bone quality and improved osseointegration.


title: COVID-19 pandemic: overview of protective-ventilation strategy in ARDS patients

text: Objectives: In the context of COVID-19 pandemic, the aim of this manuscript is to provide a standard of care of patients with ARDS for non-emergency medicine trained physicians who are not customary with mechanical ventilation.Methods: We conducted a systematic review of the literature to investigate the best practice recommendations regarding the mechanical ventilation of patients with ARDS.Conclusion: We summarized the principal strategies for lung-protective ventilation of patients with ARDS. This focus is particularly addressed to physicians who are not experienced in the invasive respiratory management of ARDS patients. Nevertheless, it remains fundamental to acknowledge that new insights concerning this quickly spreading illness become available on a regular base.


Baricitinib for COVID-19: a suitable treatment? - Authors' reply


Covid-19: Confidentiality agreements allow antibody test manufacturers to withhold evaluation results


title: COVID-19, Australia: Epidemiology Report 5 (Reporting week ending 19:00 AEDT 29 February 2020)

text: This is the fifth epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 19:00 Australian Eastern Daylight Time [AEDT] 29 February 2020. It includes data on COVID-19 cases diagnosed in Australia, the international situation and a review of current evidence.


title: Pandemic Risks and Equilibrium Social Distancing in Heterogeneous Networks

text: We study a SIRD epidemic process among a heterogeneous population that interacts through a network. We give general upper bounds for the size of the epidemic starting from a (small) set of initially infected individuals. Moreover, we characterize the epidemic reproduction numbers in terms of the spectral properties of a relevant matrix based on the network adjacency matrix and the infection rates. We suggest that this can be used to identify sub-networks that have high reproduction numbers before the epidemic reaches and picks up in them. When we base social contact on a random graph with given vertex degrees, we give limit theorems on the fraction of infected individuals. For a given social distancing individual strategies, we establish the epidemic reproduction number $\mathfrak{R}_0$ which can be used to identify network vulnerability and inform vaccination policies. In the second part of the paper we study the equilibrium of the social distancing game and we show that voluntary social distancing will always be socially sub-optimal. Our numerical study using Covid-19 data serves to quantify the absolute and relative utility gaps across age cohorts.


title: Experiencing the Surge: Report from a Large New York Radiation Oncology Department During the COVID-19 Pandemic

text: Purpose/Objective(s): The COVID-19 pandemic is impacting all aspects of life and changing the practice of medicine. Multiple recommendations exist on how radiation oncology practices should deal with this crisis, but little information is available on what actually happens when the COVID-19 surge arrives. New York City experienced the first surge of COVID-19 in the United States and is now the epicenter of the global pandemic. This study reviews the impact of COVID-19 on a hospital system in New York on aspects of medicine, nursing, radiation therapy, and administration.Materials/Methods: A retrospective review was conducted of the department of radiation oncology in a single health system in New York from 3/1/20 to 4/1/20. Collaboration was obtained from physicians, nursing, radiation therapy, and administration to recall their policies and impact on specific duties. A timeline was reconstructed to chronicle significant events. Numbers were obtained for patients on treatment, treatments breaks, and COVID-19 infections amongst staff and patients. Results: The COVID-19 surge had a tremendous impact on the health system including cessation of all of surgeries, including oncologic surgery, as well as transfer of all inpatient oncology services to makeshift outpatient facilities. Radiation Oncology made aggressive efforts to reduce patients on treatment to protect patients and staff as well reallocate staff and space for more acute clinical needs. Patients on-beam were reduced by 27% from 172 to 125 by 4/1/20. Almost all visits were changed to telemedicine within 2 weeks. Infection rates and quarantine were quite low amongst staff and patients. The majority of residents were deployed into COVID-19 clinical settings. Conclusion: While "planning for the worst", our health system was able to make necessary changes to still function at a reduced capacity. Our experience will give other departments a concrete experience to help them make their own policies and manage expectations.


How the Lives of Neuroradiologists and Neurosurgeons Have Been Changed by COVID-19


title: Estimation and prediction of COVID-19 cases in Brazilian metropolises

text: OBJECTIVE: to estimate the transmission rate, the epidemiological peak, and the number of deaths by the new coronavirus. METHOD: a mathematical and epidemiological model of susceptible, infected, and recovered cases was applied to the nine Brazilian capitals with the highest number of cases of the infection. The number of cases for the 80 days following the first case was estimated by solving the differential equations. The results were logarithmized and compared with the actual values to observe the model fit. In all scenarios, it was considered that no preventive measures had been taken. RESULTS: the nine metropolises studied showed an upward curve of confirmed cases of COVID-19. The prediction data point to the peak of the infection between late April and early May. Fortaleza and Manaus had the highest transmission rates (≥2·0 and ≥1·8, respectively). Rio de Janeiro may have the largest number of infected people (692,957) and Florianópolis the smallest (24,750). CONCLUSION: the estimates of the transmission rate, epidemiological peak, and number of deaths from coronavirus in Brazilian metropolises presented expressive and important numbers the Brazilian Ministry of Health needs to consider. The results confirm the rapid spread of the virus and its high mortality in the country.


title: Liver injury in COVID-19: The current evidence

text: Patients with novel coronavirus disease 2019 (COVID-19) experience various degrees of liver function abnormalities. Liver injury requires extensive work-up and continuous surveillance and can be multifactorial and heterogeneous in nature. In the context of COVID-19, clinicians will have to determine whether liver injury is related to an underlying liver disease, drugs used for the treatment of COVID-19, direct effect of the virus, or a complicated disease course. Recent studies proposed several theories on potential mechanisms of liver injury in these patients. This review summarizes current evidence related to hepatobiliary complications in COVID-19, provides an overview of the available case series and critically elucidates the proposed mechanisms and provides recommendations for clinicians.


title: Degenerate Fermion Dark Matter from a Broken $U(1)_{\rm B-L}$ Gauge Symmetry

text: The extension of the Standard model by assuming $U(1)_{\rm B-L}$ gauge symmetry is very well-motivated since it naturally explains the presence of heavy right-handed neutrinos required to account for the small active neutrino masses via the seesaw mechanism and thermal leptogenesis. Traditionally, we introduce three right handed neutrinos to cancel the $[U(1)_{\rm B-L}]^3$ anomaly. However, it suffices to introduce two heavy right-handed neutrinos for these purposes and therefore we can replace one right-handed neutrino by new chiral fermions to cancel the $U(1)_{\rm B-L}$ gauge anomaly. Then, one of the chiral fermions can naturally play a role of a dark matter candidate. In this paper, we demonstrate how this framework produces a dark matter candidate which can address the so-called"core-cusp problem". As one of the small scale problems that $\Lambda$CDM paradigm encounters, it may imply an important clue for a nature of dark matter. One of resolutions among many is hypothesizing that sub-keV fermion dark matter halos in dwarf spheroidal galaxies are in (quasi) degenerate configuration. We show how the degenerate sub-keV fermion dark matter candidate can be non-thermally originated in our model and thus can be consistent with Lyman-$\alpha$ forest observation. Thereby, the small neutrino mass, baryon asymmetry, and the sub-keV dark matter become consequences of the broken B-L gauge symmetry.


Ramadan and COVID-19: A Challenge amongst Challenges


title: Fisioterapia na recuperação funcional e qualidade de vida de cães paraplégicos por doença do disco intervertebral (Hansen tipo I) toracolombar submetidos à cirurgia descompressiva/ Physiotherapy in functional recovery and quality of life of paraplegic dogs due to thoracolumbar intervertebral disc disease (Hansen type I) submitted to decompressive surgery

text: Este estudo retrospectivo incluiu cães paraplégicos com ausência de percepção a dor profunda secundário a doença do disco intervertebral toracolombar e submetidos à cirurgia descompressiva. Teve como objetivo comparar a recuperação funcional e a qualidade de vida (QV) quando submetidos a um protocolo em um centro especializado ou a domicílio realizado pelo tutor. Vinte e oito cães foram distribuídos no grupo A (GA) e submetidos ao protocolo domiciliar e 38 denominados grupo B (GB) em um centro especializado. Recuperaram a habilidade de caminhar 43% dos cães em uma média de 40 dias de pós-operatório (PO) no GA e 42% em uma média de 36 dias no GB. Em 53% dos casos (35/66) os cães permaneceram paraplégicos sem percepção a dor profunda ao final do período de 90 dias de PO. Vinte e cinco tutores do GA e 26 do GB responderam um questionário sobre a QV, com no mínimo seis meses de PO. A avaliação do tempo de sobrevida dos animais, realização de eutanásia e nota atribuída a QV demonstraram que os cães do GB provavelmente foram beneficiados pelo estreito acompanhamento e orientação aos tutores até 90 dias PO.(AU)


Re: Delayed Radical Prostatectomy is not Associated with Adverse Oncological Outcomes: Implications for Men Experiencing Surgical Delay due to the COVID-19 Pandemic


title: COVID-19, Australia: Epidemiology Report 8 (Reporting period from 19:00 AEDT 14 March to 23:59 AEDT 22 March 2020)

text: This is the eighth epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 23:59 Australian Eastern Daylight Time [AEDT] 22 March 2020. It includes data on COVID-19 cases diagnosed in Australia, the international situation and a review of current evidence.


title: Aerosolization of COVID-19 and Contamination Risks During Respiratory Treatments

text: Background: Aerosolized medications are frequently administered across the health care continuum to acutely ill patients During viral pandemics, the World Health Organization and the Centers for Disease Control and Prevention advise the application of airborne precautions when performing aerosol-generating medical procedures, such as aerosolized medications Observations: Appropriate personal protective equipment (PPE), including fit-tested particulate respirators should be worn when administering nebulized medications to patients These PPEs have been in short supply in the US during early phases of the COVID-19 pandemic, which is increasing the risk faced by health care workers (HCWs) who are treating patients using aerosolized medications Despite taking appropriate precautions, HCWs are becoming infected with COVID-19 This may be related to secondary exposure related to viral longevity in fugitive emissions and viability on fomites Conclusions: We have expanded on non-US public health recommendations to provide guidance to frontline HCWs to enhance collaboration between clinicians, who are often siloed in their clinical practices, and ultimately to protect the federal workforce, which cannot sustain a significant loss of frontline HCWs


A Simple Three-Tier Classification System for Triage, Communication, and Resource Utilization by Patients Afflicted with COVID-19 Disease


title: Ayurveda and COVID-19: Where psychoneuroimmunology and the meaning response meet

text: The COVID-19 pandemic has led to high levels of psychological distress in the general public, including symptoms of anxiety and depression. Such distress is associated with alterations in immune function, including an elevated risk of viral respiratory tract infections. In this light, the possible effects of Ayurveda, a traditional system of medicine promoted by the Indian government as an "immune booster", are examined from the point of view of psychoneuroimmune mechanisms as well as the "meaning response" described by Moerman. It was found that many of the measures advocated in their guidelines could positively influence immunity either by direct effects on symptoms of depression or anxiety, or through their symbolic significance. Therefore, it is possible that such traditional practices could be beneficial both in terms of psychological quality of life, and in terms of moderating the risk of infection.


title: Anxiety and Depression Scores in Maternity Healthcare Workers during the Covid-19 Pandemic

text: While Severe-Acute-Respiratory-Syndrome-CoronaVirus-2 (SARSCoV-2/Covid-19) causes physical morbidity for healthcare workers (HCWs), Covid-19 also carries psychological morbidity for HCWs. This morbidity translates to anxiety and depressive symptomatology. To this end, we assessed anxiety and depression among HCWs during Covid-19 pandemic.


title: Experimental Treatment with Favipiravir for COVID-19: An Open-Label Control Study

text: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its caused coronavirus disease 2019 (COVID-19) has been reported in China since December 2019. More than 16% of patients developed acute respiratory distress syndrome, and the fatality ratio was about 1%-2%. No specific treatment has been reported. Herein, we examine the effects of Favipiravir (FPV) versus Lopinavir (LPV)/ritonavir (RTV) for the treatment of COVID-19. Patients with laboratory-confirmed COVID-19 who received oral FPV (Day 1: 1600 mg twice daily; Days 2-14: 600 mg twice daily) plus interferon (IFN)-α by aerosol inhalation (5 million U twice daily) were included in the FPV arm of this study, whereas patients who were treated with LPV/RTV (Days 1-14: 400 mg/100 mg twice daily) plus IFN-α by aerosol inhalation (5 million U twice daily) were included in the control arm. Changes in chest computed tomography (CT), viral clearance, and drug safety were compared between the two groups. For the 35 patients enrolled in the FPV arm and the 45 patients in the control arm, all baseline characteristics were comparable between the two arms. A shorter viral clearance time was found for the FPV arm versus the control arm (median (interquartile range, IQR), 4 (2.5-9) d versus 11 (8-13) d, P < 0.001). The FPV arm also showed significant improvement in chest imaging compared with the control arm, with an improvement rate of 91.43% versus 62.22% (P = 0.004). After adjustment for potential confounders, the FPV arm also showed a significantly higher improvement rate in chest imaging. Multivariable Cox regression showed that FPV was independently associated with faster viral clearance. In addition, fewer adverse reactions were found in the FPV arm than in the control arm. In this open-label nonrandomized control study, FPV showed significantly better treatment effects on COVID-19 in terms of disease progression and viral clearance; if causal, these results should be important information for establishing standard treatment guidelines to combat the SARS-CoV-2 infection.


title: Preliminary Estimate of Excess Mortality During the COVID-19 Outbreak - New York City, March 11-May 2, 2020

text: SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), was first identified in December 2019 in Wuhan, China, and has since spread worldwide. On March 11, 2020, the World Health Organization declared COVID-19 a pandemic (1). That same day, the first confirmed COVID-19-associated fatality occurred in New York City (NYC). To identify confirmed COVID-19-associated deaths, defined as those occurring in persons with laboratory-confirmed SARS-CoV-2 infection, on March 13, 2020, the New York City Department of Health and Mental Hygiene (DOHMH) initiated a daily match between all deaths reported to the DOHMH electronic vital registry system (eVital) (2) and laboratory-confirmed cases of COVID-19. Deaths for which COVID-19, SARS-CoV-2, or an equivalent term is listed on the death certificate as an immediate, underlying, or contributing cause of death, but that do not have laboratory-confirmation of COVID-19 are classified as probable COVID-19-associated deaths. As of May 2, a total of 13,831 laboratory-confirmed COVID-19-associated deaths, and 5,048 probable COVID-19-associated deaths were recorded in NYC (3). Counting only confirmed or probable COVID-19-associated deaths, however, likely underestimates the number of deaths attributable to the pandemic. The counting of confirmed and probable COVID-19-associated deaths might not include deaths among persons with SARS-CoV-2 infection who did not access diagnostic testing, tested falsely negative, or became infected after testing negative, died outside of a health care setting, or for whom COVID-19 was not suspected by a health care provider as a cause of death. The counting of confirmed and probable COVID-19-associated deaths also does not include deaths that are not directly associated with SARS-CoV-2 infection. The objective of this report is to provide an estimate of all-cause excess deaths that have occurred in NYC in the setting of widespread community transmission of SARS-CoV-2. Excess deaths refer to the number of deaths above expected seasonal baseline levels, regardless of the reported cause of death. Estimation of all-cause excess deaths is used as a nonspecific measure of the severity or impact of pandemics (4) and public health emergencies (5). Reporting of excess deaths might provide a more accurate measure of the impact of the pandemic.


title: Spatiotemporal pattern of COVID-19 and government response in South Korea (as of May 31, 2020)

text: OBJECTIVES: The aim of this study is to assess how COVID-19 clustered across districts in South Korea and to assess whether the pattern and duration of clusters changed following the country's containment strategy. METHODS: We conducted spatiotemporal analysis of COVID-19 daily confirmed cases by 250 districts in South Korea from January 20 to May 31, 2020, obtained from the Korea Centers for Disease Control and Prevention and each provincial website. Global Moran's I statistic was used for spatial autocorrelation analysis and retrospective space-time scan statistic was used to analyze spatiotemporal clusters of COVID-19. RESULTS: The geographical distribution showed strong spatial autocorrelation, with a global Moran's I coefficient of 0.784 (p = 0.0001). Twelve statistically significant spatiotemporal clusters were identified by space-time scan statistic using a discrete Poisson model. The spatial pattern of clusters changed and the duration of clusters became shorter over time. CONCLUSIONS: Results indicate that South Korea's containment strategy of COVID-19 was highly effective in both early detection and mitigation, with recent clusters being small in size and duration. Lessons from South Korea should spark a discussion on epidemic response.


Musculoskeletal symptoms in SARS-CoV-2 (COVID-19) patients


title: [Emergency surgery during COVID-19 pandemia.]

text: INTRODUCTION: The crisis in the SARSCoV-2 coronavirus causing COVID-19 is putting health systems around the world to the test In a great effort to standardize the management and treatment guidelines, the different health authorities and scientific associations have tried to issue recommendations on how to act in this new and complex scenario OBJECTIVE: To synthesize the existing evidence and recommendations about urological emergency surgery during the COVID-19 pandemic situation Furthermore, we propose a general action protocol for these patients MATERIAL AND METHODS: The document is based ont he scarce evidence on SARS / Cov-2 and the experience of the authors in the management of COVID-19 in their institutions, including specialists from Andalusia, Cantabria, Madrid and the Basque Country A web and PubMed search was performed using the keywords "SARS-CoV-2", "COVID19", "COVID Urology", "COVID19 surgery" and "emergency care" A narrative review of the literature was carried out until April 30, 2020, including only articles and documents written in Spanish and English After the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria Finally, a definitive version was made, agreed by all the authors on May 12, 2020 RESULTS: General principles of action are set out, as well as specific recommendations for the most frequent urgent urological procedures CONCLUSIONS: Given the exceptional nature of the situation, there is a lack of evidence regarding the optimal management of the patient with urgent urological pathology The information is changing, as the epidemiological knowledge of the disease advances The establishment of multidisciplinary surgical committees that develop and implement action protocols appropriate to the different resources and particular situations of each center is recommended Likewise, these committees must individually assess each possible urological surgical emergency situation and ensure compliance with protective measures for the patient and other healthcare personnel


title: COVID-19: Regulatory Landscape of Medicinal and Medical Device Products for Human Use

text: Against the backdrop of the COVID pandemic, the scientific and medical communities are working with all deliberate speed with state-of-the-art technologies to develop diagnostic and therapeutic products that can identify, treat, and prevent infection with SARS-CoV-2. These activities may only be legally conducted with the necessary statutes and regulations in place to facilitate the timely development, manufacturing, evaluation, and distribution of products that meet quality standards. The present regulatory landscape for medicinal and medical products for human use has been shaped by nearly 12 decades of statutory history that followed in reaction to disasters and tragedies. Five distinct, closely woven threads of statutory history have led to the regulatory infrastructure we have in place: (1) standardized processes for routine development of medicinal and medical device products for human use; (2) processes for expedited development to shorten time frames and expand patient populations; (3) mechanisms of Expanded Access to make medicinal products available to patients prior to approval of the US Food and Drug Administration; (4) Emergency Use Authorization during public health emergencies; and (5) the development of pathways for bringing generic drugs and biosimilar biologics to market. These mechanisms are being brought to bear to facilitate the defeat of infection with SARS-CoV-2.


Peripheral nerve blocks in a patient with suspected COVID-19 infection


Highlights of the May issue


title: Earliest cases of coronavirus disease 2019 (COVID-19) identified in solid organ transplant recipients in the United States

text: With the rapidly expanding pandemic of SARS-CoV-2, there is concern that solid organ transplant recipients will be particularly vulnerable to infection and may experience a more severe clinical course. We report four cases of COVID-19 in solid organ transplant recipients including recipients of kidney, liver, lung, and heart transplants. We describe each patient's medical history including transplantation history, their clinical presentation and workup, and their course from diagnosis to either hospital discharge or to improvement in symptoms. These reports demonstrate a range of symptoms, clinical severity, and disease course in solid organ transplant recipients with COVID-19, including two hospitalized patients and two patients managed entirely in the outpatient setting.


title: The Psychological Impacts of a COVID-19 Outbreak on College Students in China: A Longitudinal Study

text: An outbreak in Wuhan, China in late 2019 of a highly infectious new coronary pneumonia (COVID-19) led to the imposition of countrywide confinement measures from January to March 2020. This is a longitudinal study on changes in the mental health status of a college population before and after their COVID-19 confinement for the first two weeks, focusing on states of psychological distress, depression, anxiety and affectivity. The influence of possible stressors on their mental health were investigated, including inadequate supplies and fears of infection. Five hundred and fifty-five undergraduate students were recruited from Hebei Agricultural University in Baoding, China. The participants completed two online surveys-on anxiety and depression, and on positive and negative affect. One survey was conducted before the confinement and the other was conducted 15-17 days after the start of the confinement. Increases in negative affect and symptoms of anxiety and depression (p-values < 0.001) were observed after 2 weeks of confinement. Inadequate supplies of hand sanitizers, a higher year of study, and higher scores on anxiety and depression were common predictors of increased negative affect, anxiety, and depression across the confinement period. The results suggest that healthcare policymakers should carefully consider the appropriate confinement duration, and ensure adequate supplies of basic infection-control materials.


title: Longitudinal study of interventional radiology activity in a large metropolitan Italian tertiary care hospital: how the COVID-19 pandemic emergency has changed our activity

text: OBJECTIVES: To retrospectively analyze interventional radiology (IR) activity changes in the COVID-19 era and to describe how to safely and effectively reorganize IR activity. METHODS: All IR procedures performed between January 30 and April 8, 2020 (COVID-era group) and the same 2019 period (non-COVID-era group) were retrospectively included and compared. A sub-analysis for the lockdown period (LDP: 11 March-8 April) was also conducted. Demographic, hospitalization, clinical, and procedural data were obtained for both groups and statistically compared with univariable analysis. RESULTS: A total of 1496 procedures (non-COVID era, 825; COVID era, 671) performed in 1226 patients (64.9 ± 15.1 years, 618 women) were included. The number of procedures decreased by 18.6% between 2019 and 2020 (825 vs 671, p < .001), with a reduction by 48.2% in LDP (188 vs 363, p < .0001). In the LDP COVID era, bedside procedures were preferred (p = .013), with an increase in procedures from the intensive care unit compared with the emergency department and outpatients (p = .048), and an increased activity for oncological patients (p = .003). No incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of healthcare workers in the IR service was registered. CONCLUSIONS: Coronavirus disease outbreak changed the interventional radiology activity with an overall reduction in the number of procedures. However, this study confirms that interventional radiology continuum of care can be safely performed also during the pandemic, following defined measures and protocols, taking care of all patients. KEY POINTS: â¢ Coronavirus disease pandemic determined a reduction of interventional radiology activity as compared to the same period of the previous year. â¢ Interventional radiology procedures for life-threatening conditions and non-deferrable oncologic treatments were prioritized as opposed to elective procedures. â¢ Strict adoption of safe procedures allowed us to have until now no incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of HCWs in the IR service.


Thousands of people will help scientists to track the long-term health effects of the coronavirus crisis


COVID-19 diagnostic process in mainland China: The math beyond pneumonia