title: Early experience with convalescent plasma as immunotherapy for COVID-19 in China: Knowns and unknowns

text: BACKGROUND AND OBJECTIVES: In the absence of a vaccine or specific drug treatment options for coronavirus disease (COVID-19), attention has been shifted in China to the possible therapeutic use of convalescent plasma. COVID-19 convalescent plasma (CCP) is currently under investigation. We summarized clinical studies and other research data available as of May 5, 2020, on CCP therapy according to the Clinical Treatment Guideline of COVID-19 Convalescent Plasma in China, as well as clinical experience at the First Affiliated Hospital of Zhejiang University, as part of a comprehensive anti-epidemic strategy. MATERIALS AND METHODS: As of May 5, 2020, when the epidemic was well-controlled in China, healthcare databases and sources of English literature relating to convalescent plasma were searched and reviewed. Sources of clinical and methodological heterogeneity were identified. RESULTS: As of May 5, 2020, up to 2,000 samples of CCP had been collected across China and administered to 700 COVID-19 patients. From donors, 200-400 mL of plasma were collected at each donation, with antibody titers >1:160. We identified three clinical studies for COVID-19 in China. Analyses showed a statistically significant improvement in clinical outcomes compared with untreated cases (P<0.001). No adverse effects were reported. CONCLUSION: From initial studies, convalescent plasma therapy appears effective and safe for COVID-19. However, there is clearly a need for well-designed RCTs (randomized controlled trials) or other formal studies to further evaluate the efficacy and any potential adverse effects of CCP.


Nursing to combat the COVID-19 pandemic


title: Severe respiratory SARS-CoV2 infection: Does ACE2 receptor matter?

text: SARS-CoV-2 is a novel virus of the Coronaviridiae family that represents a major global health issue. Mechanisms implicated in virus/host cells interaction are central for cell infection and replication that in turn lead to disease onset and local damage. To enter airway and lung epithelia, SARS-CoV-2 attaches to ACE2 receptors by spike (S) glycoproteins. Molecular mechanisms that promote interaction between SARS-CoV-2 virus and host with particular focus on virus cell entry receptor ACE2 are described. We further explore the impact of underlying medical conditions and therapies including renin-angiotensin inhibitors on modulating ACE 2, which is the major SARS-CoV-2 cell entry receptor.


title: Heterogeneity of COVID-19 outbreak in Italy

text: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in December 2019 in China and was declared a pandemic on 11.03.2020 by WHO. Italy is one of the most afflicted Country by this epidemic with 136,110 confirmed cases and 16,654 deaths on 9.4.2020 (at the same date, the Ministry of Health was reporting 143,626 cases). During these few months the National Health Service have made a great effort to cope with the increasing request of intensive care beds and all the elective activities in hospital have been suspended. Data from the different Italian regions shows different patterns of positive and dead for this syndrome. Moreover, striking differences of the observed lethality of the infections among different areas were immediately evident from the epidemic reports. It will be of critical relevance to understand the expected evolution of the first lock-down phase, driving the exhaustion of the Covid-19 outbreak.(www.actabiomedica.it).


title: [Study on traditional Chinese medicine common syndrome characteristic of coronavirus disease 2019 based on latent structure combined with system clustering analysis]

text: OBJECTIVE: To investigate traditional Chinese medicine (TCM) common syndrome characteristic of coronavirus disease 2019 (COVID-19), thus providing evidence for clinical differentiation. METHODS: The COVID-19 TCM treatment plan and syndrome related literature published before February 24, 2020 was searched and a database was established. TCM common syndrome characteristics of COVID-19 were analyzed by the method of latent structure and system clustering combined with frequency and constituent ratio, which were conducted by Lantern 5.0 and SPSS 20.0. RESULTS: Forty-two literatures about treatment plans, and 212 syndromes records were enrolled. Latent structure model was established based on 53 symptoms with frequency over 10, and 14 latent variables and 7 syndromes were concluded by comprehensive clustering, including syndrome of pathogenic heat invading lung, internal block and outward desertion, syndrome of dampness heat accumulating lung, syndrome of Qi and Yin deficiency, syndrome of epidemic virus closing lung, syndrome of cold dampness closing lung and syndrome of Qi deficiency of lung and spleen. Factor analysis was conducted for 53 symptoms, which were reported more than 10 times, and 14 common factors were obtained. Symptoms with load coefficient over 0.3 were clustered and 6 syndromes were obtained, including syndrome of epidemic virus closing lung, syndrome of pathogenic heat invading lung, syndrome of Qi and Yin deficiency, internal block and outward desertion, syndrome of cold dampness closing lung, and syndrome of dampness heat accumulating lung. The literatures included 25 syndromes, and the syndromes with constituent ratio over 5% were internal block and outward desertion (14.62%), syndrome of epidemic virus closing lung (13.68%), syndrome of dampness heat accumulating lung (12.74%), syndrome of Qi deficiency of lung (10.85%), spleen and syndrome of cold dampness closing lung (8.50%), syndrome of Qi and Yin deficiency (8.50%), syndrome of pathogenic heat invading lung (8.02%) and syndrome of dampness repressing defensive Qi of lung (5.66%). Eighty-seven symptoms whose cumulative frequency was 2 838 were referred, including greasy fur (5.25%), fever (4.83%), red tongue (4.37%), rapid pulse (3.74%) and fatigue (3.46%). According to the results above, the common syndromes and their symptoms of COVID-19 were: (1) syndrome of pathogenic heat invading lung: fever, cough, throat-drying, headache, all of the body distressed and constipation, etc.; (2) syndrome of cold dampness closing lung: aversion to cold, all of the body distressed, nausea and vomiting, abdominal distention and loose stool, etc.; (3) syndrome of dampness heat accumulating lung: cough, sticky phlegm, anorexia, thirst without desire to drink and constipation, etc.; (4) syndrome of epidemic virus closing lung: fever, cough, yellow phlegm, wheezing, suffocation and purple lips, etc.; (5) internal block and outward desertion: coma, feel fidgety, suffocation, sweating and feel cold and purple lips, etc.; (6) syndrome of Qi and Yin deficiency: dry cough, sweating, fatigue, thirsty, feverish feeling in palms and soles and loose stool, etc.; (7) syndrome of Qi deficiency of lung and spleen: cough, wheezing, sweating, fatigue, nausea and vomiting, and loose stool, et al. CONCLUSIONS: The common syndromes of COVID-19 were syndrome of pathogenic heat invading lung, syndrome of cold dampness closing lung, syndrome of dampness heat accumulating lung, syndrome of epidemic virus closing lung, internal block and outward desertion, syndrome of Qi and Yin deficiency and syndrome of Qi deficiency of lung and spleen. This study could provide reference for clinical differentiation.


Comment on: "Controversies regarding mask usage in ophthalmic units in the United Kingdom during the COVID-19 pandemic"


Cancer diagnosis and treatment in the COVID-19 era


High-Sensitivity Cardiac Troponin Can Be an Ally in the Fight Against COVID-19


COVID-19: Phylogenetic approaches may help in finding resources for natural cure


Food protein-derived antihypertensive peptides in the COVID-19 pandemic: friends of foes?


title: A prospective, randomized, controlled study assessing vagus nerve stimulation using the gammaCore®-Sapphire device for patients with moderate to severe CoViD-19 Respiratory Symptoms (SAVIOR): A structured summary of a study protocol for a randomised controlled trial"

text: OBJECTIVES: Primary Objective: The primary objective is to reduce initiation of mechanical ventilator dependency in patients with moderate to severe CoViD- 19. This will be measured as the difference between the control group and active group for subjects admitted to the hospital for CoViD-19. Secondary Objectives: â¢ To evaluate cytokine trends / Prevent cytokine storms â¢ To evaluate supplemental oxygen requirements â¢ To decrease mortality of CoViD-19 patients â¢ Delay onset of ventilation TRIAL DESIGN: The study is a single centre, 2-arm, prospective, randomized (ratio 1:1), controlled trial with parallel groups design to compare the reduction of respiratory distress in a CoViD-19 population, using the intervention of the gammaCore®-Sapphire device plus standard of care (active) vs. standard of care alone (SoC) - the control group. The gammaCore® treatments will be used acutely and prophylactically. The active and control groups will be matched for disease and severity. PARTICIPANTS: i. Inclusion Criteria The subjects have to meet all of the following criteria to be eligible to enter the trial: 1.Patient older than 18 years2.Been tested positive or suspected/presumed positive for CoViD-19 Has a cough, shortness of breath or respiratory O2 Saturation less than or equal to 92% without need for mechanical ventilation or acute respiratory failure 3.Agree to use the gammaCore®-Sapphire device as intended and to follow all of the requirements of the study including recording required study data4.Patient is able to provide signed and witnessed Informed Consent ii. Exclusion Criteria Subjects meeting any of the following criteria cannot be included in this research study: 1.Pregnant women2.On home/therapy oxygen (i.e. for patients with Chronic Obstructive Pulmonary Disease) at baseline prior to development of CoViD-193.Patient already enrolled in a clinical trial using immunotherapeutic regimen for CoViD-194.History of aneurysm, intracranial hemorrhage, brain tumors, or significant head trauma5.Known or suspected severe atherosclerotic cardiovascular disease, severe carotid artery disease (eg, bruits or history of transient ischemic attack or cerebrovascular accident), congestive heart failure, known severe coronary artery disease, or recent myocardial infarction6.Uncontrolled high blood pressure (>140/90)7.Current implantation of an electrical and/or neurostimulator device, including but not limited to a cardiac pacemaker or defibrillator, vagal neurostimulator, deep brain stimulator, spinal stimulator, bone growth stimulator, or cochlear implant8.Current implantation of metal cervical spine hardware or a metallic implant near the gammaCore stimulation site9.Belongs to a vulnerable population or has any condition such that his or her ability to provide informed consent, comply with the follow-up requirements, or provide self-assessments is compromised (e.g. homeless, developmentally disabled and prisoner) Participants will be recruited from Hospital Clínico Universitario de Valencia in Spain. INTERVENTION AND COMPARATOR: Intervention: Prophylactic: Administer 2 doses (at 2 minutes each) of gammaCore®-Sapphire, one dose on each side of the neck scheduled three times a day (morning, mid-day and 1 hour before bed at night).Acute respiratory failure or shortness of breath: Administer 2 doses (at 2 minutes each) of gammaCore®-Sapphire, one on each side of the neck. If shortness of breath (SOB) persists 20 minutes after the start of the first treatment, a second dose will be administered. Max doses per day is 9 or 18 stimulations.Plus standard of care Control: Standard of care: oxygen therapy, antibiotics and ventilatory support if necessary depending on the clinic MAIN OUTCOMES: Primary Endpoint: Initiation of mechanical ventilation, from randomization until ICU admission or hospital discharge, whatever occurs first Secondary Endpoints: Safety; ascertainment of Adverse Effects/Serious Adverse Events, from randomisation to ICU admission or hospital discharge, whatever occurs firstCytokine Storm measured by: Tumor necrosis factor α, Interleukin 6, Interleukin 1ß. Days 1,3,5,10,15 and/or at hospital dischargeMortality and/or need for Critical Care admission, from randomisation until ICU admission or hospital discharge, whatever occurs first,O2 saturation levels , from randomization until ICU admission or hospital discharge, whatever occurs firstNeed for supplemental oxygen, from randomisation until ICU admission or hospital discharge, whatever occurs first RANDOMISATION: The patients are classified according to their oxygen levels as mild, moderate and severe and randomized according to their classification to the intervention and control in a ratio of 1:1. The randomization will be stratified for gender and age. BLINDING (MASKING): This is an open label study, it is not possible to blind the participants and healthcare providers to the intervention. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The total number of patients to be included in the study is 90, with 45 in each study group TRIAL STATUS: The protocol version is 8.0 from 07th April 2020. The recruitment began 20th April 2020 and is expected to be complete 31st July 2020. TRIAL REGISTRATION: The study is registered in clinicaltrials.gov on 29th April 2020 with the identification number: NCT04368156 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


First, Do No Harm: Lessons Learned From a Storytelling Event for Pediatric Residents During the COVID-19 Pandemic


Antenatal corticosteroid therapy and COVID-19: Pathophysiological considerations


Asymptomatiske smittebærere av sars-CoV-2 i sykehjem


Letter: liver disease and COVID-19-not the perfect storm. Authors' reply"


title: Association of clinical and radiographic findings with the outcomes of 93 patients with COVID-19 in Wuhan, China

text: Rationale: To retrospectively analyze serial chest CT and clinical features in patients with coronavirus disease 2019 (COVID-19) for the assessment of temporal changes and to investigate how the changes differ in survivors and nonsurvivors. Methods: The consecutive records of 93 patients with confirmed COVID-19 who were admitted to Wuhan Union Hospital from January 10, 2020, to February 22, 2020, were retrospectively reviewed. A series of chest CT findings and clinical data were collected and analyzed. The serial chest CT scans were scored on a semiquantitative basis according to the extent of pulmonary abnormalities. Chest CT scores in different periods (0 - 5 days, 6 - 10 days, 11 - 15 days, 16 - 20 days, and > 20 days) since symptom onset were compared between survivors and nonsurvivors, and the temporal trend of the radiographic-clinical features was analyzed. Results: The final cohort consisted of 93 patients: 68 survivors and 25 nonsurvivors. Nonsurvivors were significantly older than survivors. For both survivors and nonsurvivors, the chest CT scores were not different in the first period (0 - 5 days) but diverged afterwards. The mortality rate of COVID-19 monotonously increased with chest CT scores, which positively correlated with the neutrophil-to-lymphocyte ratio, neutrophil percentage, D-dimer level, lactate dehydrogenase level and erythrocyte sedimentation rate, while negatively correlated with the lymphocyte percentage and lymphocyte count. Conclusions: Chest CT scores correlate well with risk factors for mortality over periods, thus they may be used as a prognostic indicator in COVID-19. While higher chest CT scores are associated with a higher mortality rate, CT images taken at least 6 days since symptom onset may contain more prognostic information than images taken at an earlier period.


title: Experimental investigation of far-field human cough airflows from healthy and influenza-infected subjects

text: Seasonal influenza epidemics have been responsible for causing increased economic expenditures and many deaths worldwide. Evidence exists to support the claim that the virus can be spread through the air, but the relative significance of airborne transmission has not been well defined. Particle image velocimetry (PIV) and hot-wire anemometry (HWA) measurements were conducted at 1 m away from the mouth of human subjects to develop a model for cough flow behavior at greater distances from the mouth than were studied previously. Biological aerosol sampling was conducted to assess the risk of exposure to airborne viruses. Throughout the investigation, 77 experiments were conducted from 58 different subjects. From these subjects, 21 presented with influenza-like illness. Of these, 12 subjects had laboratory-confirmed respiratory infections. A model was developed for the cough centerline velocity magnitude time history. The experimental results were also used to validate computational fluid dynamics (CFD) models. The peak velocity observed at the cough jet center, averaged across all trials, was 1.2 m/s, and an average jet spread angle of Î¸ = 24° was measured, similar to that of a steady free jet. No differences were observed in the velocity or turbulence characteristics between coughs from sick, convalescent, or healthy participants.


Active smoking and severity of coronavirus disease 2019 (COVID-19): The use of significance testing leads to an erroneous conclusion


title: Can Efficient Detection and Isolation Control an Epidemic?

text: The World Health Organisation (WHO) has very strongly recommended testing and isolation as a strategy for controlling the ongoing COVID-19 pandemic. The goal of this paper is to quantify the effects of detection and isolation in formal models of epidemics of varying complexity. A key parameter of such models is the basic reproduction ratio. We show that an effective detection and isolation strategy leads to a reduction of the basic reproduction ratio and can even lead to this ratio becoming lower than one.


Incidence, clinical outcomes, and transmission dynamics of severe coronavirus disease 2019 in California and Washington: prospective cohort study


text: OBJECTIVE: To understand the epidemiology and burden of severe coronavirus disease 2019 (covid-19) during the first epidemic wave on the west coast of the United States. DESIGN: Prospective cohort study. SETTING: Kaiser Permanente integrated healthcare delivery systems serving populations in northern California, southern California, and Washington state. PARTICIPANTS: 1840 people with a first acute hospital admission for confirmed covid-19 by 22 April 2020, among 9 596 321 healthcare plan enrollees. Analyses of hospital length of stay and clinical outcomes included 1328 people admitted by 9 April 2020 (534 in northern California, 711 in southern California, and 83 in Washington). MAIN OUTCOME MEASURES: Cumulative incidence of first acute hospital admission for confirmed covid-19, and subsequent probabilities of admission to an intensive care unit (ICU) and mortality, as well as duration of hospital stay and ICU stay. The effective reproduction number (RE ) describing transmission dynamics was estimated for each region. RESULTS: As of 22 April 2020, cumulative incidences of a first acute hospital admission for covid-19 were 15.6 per 100 000 cohort members in northern California, 23.3 per 100 000 in southern California, and 14.7 per 100 000 in Washington. Accounting for censoring of incomplete hospital stays among those admitted by 9 April 2020, the estimated median duration of stay among survivors was 9.3 days (with 95% staying 0.8 to 32.9 days) and among non-survivors was 12.7 days (1.6 to 37.7 days). The censoring adjusted probability of ICU admission for male patients was 48.5% (95% confidence interval 41.8% to 56.3%) and for female patients was 32.0% (26.6% to 38.4%). For patients requiring critical care, the median duration of ICU stay was 10.6 days (with 95% staying 1.3 to 30.8 days). The censoring adjusted case fatality ratio was 23.5% (95% confidence interval 19.6% to 28.2%) among male inpatients and 14.9% (11.8% to 18.6%) among female inpatients; mortality risk increased with age for both male and female patients. Reductions in RE were identified over the study period within each region. CONCLUSIONS: Among residents of California and Washington state enrolled in Kaiser Permanente healthcare plans who were admitted to hospital with covid-19, the probabilities of ICU admission, of long hospital stay, and of mortality were identified to be high. Incidence rates of new hospital admissions have stabilized or declined in conjunction with implementation of social distancing interventions.


title: The index case of SARS-CoV-2 in Scotland

text: Since its identification in December 2019, SARS-CoV-2 has infected 125,048 persons globally with cases identified in 118 countries across all continents. We report on the Scottish index case of SARS-CoV-2 infection, the virus causing COVID-19.


Who speaks for nursing? COVID-19 highlighting gaps in leadership


title: Clinical evaluation of the BioFire® Respiratory Panel 2.1 and detection of SARS-CoV-2

text: We evaluated the performance of the BioFire® Respiratory Panel 2.1 (RP2.1) in the detection of SARS CoV-2 in comparison against three other SARS CoV-2 EUA assays. In these studies, the RP2.1 panel had 98 % positive percent agreement (48/49) and 100 % negative percent agreement (49/49). Since 30 % of nasopharyngeal swab specimens have a SARS CoV-2 Ct >30 and thus detection of virus in low titers is clinically relevant, a sample with a high titer was diluted and each 10 fold dilution was tested in triplicate and compared against 6 other EUA approved SARS CoV-2 assays. These data suggested that the BioFire® RP2.1 panel, along with four other SARS CoV-2 assays (Roche cobas, Cepheid Xpert Xpress, BioFire® Defense COVID19, and NECoV19), consistently detected viral RNA at the 10-7 dilution. Overall, these studies suggest that the BioFire® RP2.1 assay can be used to detect acute cases of SARS CoV2 in addition to patients with low viral titer later in disease presentation.


Editorial. Neurosurgical priority setting during a pandemic: COVID-19


title: Treatment of COVID-19-exacerbated asthma: should systemic corticosteroids be used?

text: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a new rapidly spreading infectious disease. Current guidance from the World Health Organization (WHO) highlights asthmatics as a high-risk group for severe illness from COVID-19. Viruses are common triggers of asthma exacerbations and the current SARS-CoV-2 pandemic raises several questions regarding the optimum management strategies. Here, we discuss the contentious issue of whether the mainstay therapy systemic corticosteroids should be used in the routine management of COVID-19-associated asthma exacerbations. Recent guidance from the WHO has advised against the use of corticosteroids if COVID-19 is suspected due to concerns that these agents may impair protective innate antiviral immune responses. This may not be appropriate in the unique case of asthma exacerbation, a syndrome associated with augmented type 2 inflammation, a disease feature that is known to directly inhibit antiviral immunity. Corticosteroids, through their suppressive effects on type 2 inflammation, are thus likely to restore impaired antiviral immunity in asthma and, in contrast to non-asthmatic subjects, have beneficial clinical effects in the context of SARS-CoV-2 infection.


Inhaled corticosteroids and COVID-19: a systematic review and clinical perspective


title: Covid-19 and the N95 respirator shortage: Closing the gap

text: Due to extreme shortages of personal protective equipment caused by the COVID-19 pandemic, many healthcare workers will be forced to recycle protective masks intended for disposal after a single use. We propose investigating the use of ultraviolet germicidal irradiation to sterilize masks of SARS-CoV-2 for safer reuse.


title: Strategies to Prevent SARS-CoV-2-Mediated Eosinophilic Disease in Association with COVID-19 Vaccination and Infection

text: A vaccine to protect against COVID-19 is urgently needed. Such a vaccine should efficiently induce high-affinity neutralizing antibodies which neutralize SARS-CoV-2, the cause of COVID-19. However, there is a concern regarding both vaccine-induced eosinophilic lung disease and eosinophil-associated Th2 immunopotentiation following infection after vaccination. Here, we review the anticipated characteristics of a COVID-19 vaccine to avoid vaccine-associated eosinophil immunopathology.


title: On the problem of comparing Covid-19 fatality rates

text: Understanding Covid-19 lethality and its variation from country to country is essential for supporting governments in the choice of appropriate strategies. Adopting correct indicators to monitor the lethality of the infection in the course of the outbreak is a crucial issue. This works highlights how far the time-dependent case fatality rate is a misleading indicator for estimating the fatality in the course of the outbreak, even if our attention is only restricted to the subset of confirmed cases. Our analysis proves that the final case fatality ratio for several major European countries is bound to largely exceed 10%. The largely discussed difference in the fatality ratio between Italy and other major European countries, is to be mostly attributed (except for the case of Germany) to the more advanced stage of the Italian epidemic.


Low-Income Children and Coronavirus Disease 2019 (COVID-19) in the US


Maintaining mask stockpiles in the COVID-19 pandemic: Taiwan as a learning model


title: Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study

text: BACKGROUND: An outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was first detected in Wuhan, Hubei, China. People of all ages are susceptible to SARS-CoV-2 infection. No information on severe pediatric patients with COVID-19 has been reported. We aimed to describe the clinical features of severe pediatric patients with COVID-19. METHODS: We included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU), Wuhan Children's Hospital from January 24 to February 24. We collected information including demographic data, symptoms, imaging data, laboratory findings, treatments and clinical outcomes of the patients with severe COVID-19. RESULTS: The onset age of the eight patients ranged from 2 months to 15 years; six were boys. The most common symptoms were polypnea (8/8), followed by fever (6/8) and cough (6/8). Chest imaging showed multiple patch-like shadows in seven patients and ground-glass opacity in six. Laboratory findings revealed normal or increased whole blood counts (7/8), increased C-reactive protein, procalcitonin and lactate dehydrogenase (6/8), and abnormal liver function (4/8). Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8), increased CD3 (2/8), CD4 (4/8) and CD8 (1/8), IL-6 (2/8), IL-10 (5/8) and IFN-Î³ (2/8). Treatment modalities were focused on symptomatic and respiratory support. Two critically ill patients underwent invasive mechanical ventilation. Up to February 24, 2020, three patients remained under treatment in ICU, the other five recovered and were discharged home. CONCLUSIONS: In this series of severe pediatric patients in Wuhan, polypnea was the most common symptom, followed by fever and cough. Common imaging changes included multiple patch-like shadows and ground-glass opacity; and a cytokine storm was found in these patients, which appeared more serious in critically ill patients.


title: Detecting the Coronavirus (COVID-19)

text: The COVID-19 pandemic has created huge damage to society and brought panics around the world. Such panics can be ascribed to the seemingly deceptive features of the COVID-19: compared to other deadly viral outspreads, it has medium transmission and mortality rates. As a result, the severity of the causative coronavirus, SARS-CoV-2, was deeply underestimated by the society at the beginning of the COVID-19 outbreak. Based on this, in this review, we define the viruses with features similar to those of SARS-CoV-2 as the Panic Zone viruses. To contain those viruses, accurate and fast diagnosis followed by effective isolation and treatment of patients are pivotal at the early stage of virus breakouts. This is especially true when there is no cure or vaccine available for a transmissible disease, which is the case for current COVID-19 pandemic. As of July 2020, more than one hundred kits for the COVID-19 diagnosis on the market are surveyed in this review, while emerging sensing techniques for the SARS-CoV-2 are also discussed. It is of critical importance to rationally use these kits for the efficient management and control of the Panic Zone viruses. Therefore, we discuss guidelines to select diagnostic kits at different outbreak stages of the Panic Zone viruses, SARS-CoV-2 in particular. While it is of utmost importance to use nucleic-acid based detection kits with low false negativity (high sensitivity) at the early stage of an outbreak, the low false positivity (high specificity) gains its importance at later stages of the outbreak. When the society is set to reopen from the lock-down stage of the COVID-19 pandemic, it becomes critical to have immunoassay based kits with high specificity to identify people who can safely return to the society after their recovery of SARS-CoV-2 infections. Finally, since a massive attack from a viral pandemic requires a massive defense from the whole society, we urge both government and private sectors to research and develop affordable and reliable point-of-care testing (POCT) kits, which can be used massively by the general public (and therefore called as massive POCT) to contain Panic Zone viruses in future.


title: Within host dynamics of SARS-CoV-2 in humans: Modeling immune responses and antiviral treatments

text: In December 2019, a newly discovered SARS-CoV-2 virus was emerged from China and propagated worldwide as a pandemic. In the absence of preventive medicine or a ready to use vaccine, mathematical models can provide useful scientific insights about transmission patterns and targets for drug development. In this study, we propose a within-host mathematical model of SARS-CoV-2 infection considering innate and adaptive immune responses. We analyze the equilibrium points of the proposed model and obtain an expression of the basic reproduction number. We then numerically show the existence of a transcritical bifurcation. The proposed model is calibrated to real viral load data of two COVID-19 patients. Using the estimated parameters, we perform global sensitivity analysis with respect to the peak of viral load. Finally, we study the efficacy of antiviral drugs and vaccination on the dynamics of SARS-CoV-2 infection. Our results suggest that blocking the production of the virus by infected cells decreases the viral load more than reducing the infection rate of healthy cells. Vaccination is also found useful but during the vaccine development phase, blocking virus production from infected cells can be targeted for antiviral drug development.


title: Entangling COVID-19 associated thrombosis into a secondary antiphospholipid antibody syndrome: Diagnostic and therapeutic perspectives (Review)

text: The severe acute respiratory syndrome coronavirus 2 (SARSCoV2) is a novel ß coronavirus that is the etiological agent of the pandemic coronavirus disease 2019 (COVID19) that at the time of writing (June 16, 2020) has infected almost 6 million people with some 450,000 deaths. These numbers are still rising daily. Most (some 80%) cases of COVID19 infection are asymptomatic, a substantial number of cases (15%) require hospitalization and an additional fraction of patients (5%) need recovery in intensive care units. Mortality for COVID19 infection appears to occur globally between 0.1 and 0.5% of infected patients although the frequency of lethality is significantly augmented in the elderly and in patients with other comorbidities. The development of acute respiratory distress syndrome and episodes of thromboembolism that may lead to disseminated intravascular coagulation (DIC) represent the primary causes of lethality during COVID19 infection. Increasing evidence suggests that thrombotic diathesis is due to multiple derangements of the coagulation system including marked elevation of Ddimer that correlate negatively with survival. We propose here that the thromboembolic events and eventually the development of DIC provoked by SARSCoV2 infection may represent a secondary antiphospholipid antibody syndrome (APS). We will apply both Baconian inductivism and Cartesian deductivism to prove that secondary APS is likely responsible for coagulopathy during the course of COVID19 infection. Diagnostic and therapeutic implications of this are also discussed.


Covid-19: surge in cases in Italy and South Korea makes pandemic look more likely


First case of COVID-19 in a kidney transplant recipient treated with belatacept


title: Control measures to prevent Coronavirus disease 2019 ï¼COVID-19ï¼pandemic in endoscopy centers: a multi-centre study

text: AIMS: To investigate control measures for COVID-19 pandemic in GIE centers in China. METHODS: This is a retrospective multi-centre research, including seven centers. Data collection was from 1st Feb to 31st Mar 2020 and the same period last year. RESULTS: There were a total of 28 COVID-19 definite cases in these hospitals. Six out of seven GIE centers were arranged to shut down on 1st Feb, with a mean shutdown days of 23.6±5.3. The actual workloads were only 10.3%-62.9% compared to those last year. All centers had a preoperative COVID-19 screening process. Epidemiological questionnaire, temperature taking and QR-code of journey were conducted. Chest CT scan were conducted during the shutdown period and continued in five centers after return to work. Antibody and nucleic acid test were applied in 1-3 centers. All endoscopists had advanced PPE. Five centers used surgical mask and the rest used N95 mask. Six centers used goggles or face shield. Five centers selected isolation gowns and the rest selected protective suits. The change frequency of these PPE was 4 hours. Sterilizing measures were improved in six centers. Five centers utilized ultraviolet and six centers strengthened natural ventilation. Four and six centers used peracetic acid during the period of shutdown and return to work, alone or matched with OPA or acidified water. CONCLUSIONS: Many effective control measures were conducted in GIE centers during the outbreak, including patients' volume limitation, preoperative COVID-19 screening, advanced PPE and disinfection methods.


Wie sich das Coronavirus in unsere Praxis schlich


title: Eliciting Disease Data from Wikipedia Articles

text: Traditional disease surveillance systems suffer from several disadvantages, including reporting lags and antiquated technology, that have caused a movement towards internet-based disease surveillance systems. Internet systems are particularly attractive for disease outbreaks because they can provide data in near real-time and can be verified by individuals around the globe. However, most existing systems have focused on disease monitoring and do not provide a data repository for policy makers or researchers. In order to fill this gap, we analyzed Wikipedia article content. We demonstrate how a named-entity recognizer can be trained to tag case counts, death counts, and hospitalization counts in the article narrative that achieves an F1 score of 0.753. We also show, using the the 2014 West African Ebola virus disease epidemic article as a case study, that there are detailed time series data that are consistently updated that closely align with ground truth data. We argue that Wikipedia can be used to create the first community-driven open-source emerging disease detection, monitoring, and repository system.


title: Spinal muscular atrophy care in the COVID-19 pandemic era

text: The coronavirus disease 2019 (COVID-19) pandemic has resulted in reorganization of healthcare settings affecting the delivery of clinical care to patients with spinal muscular atrophy (SMA). There is a concern that patients with SMA may be at increased risk of manifesting severe symptoms of COVID-19. Currently approved therapies for SMA improve survival and motor function; however, their delivery requires an increased exposure to the health system and a dedicated healthcare team. In this study, we discuss consensus recommendations pertaining to care of SMA patients during the pandemic. We highlight that SMA treatments should not be perceived as elective. Decisions regarding the delay of treatments should be made with consideration of the potential risks of COVID-19 exposure and the risk of that delay. We emphasize the importance of collaborative treatment decisions between the patient, family, and healthcare provider, considering any geographic- or institution-specific policies and precautions for COVID-19.


Initial Gastrointestinal Manifestations in Patients with SARS-CoV-2 in 112 patients from Veracruz (Southeastern Mexico)


title: A Time-dependent SIR model for COVID-19 with Undetectable Infected Persons

text: In this paper, we conduct mathematical and numerical analyses to address the following crucial questions for COVID-19: (Q1) Is it possible to contain COVID-19? (Q2) When will be the peak and the end of the epidemic? (Q3) How do the asymptomatic infections affect the spread of disease? (Q4) What is the ratio of the population that needs to be infected to achieve herd immunity? (Q5) How effective are the social distancing approaches? (Q6) What is the ratio of the population infected in the long run? For (Q1) and (Q2), we propose a time-dependent susceptible-infected-recovered (SIR) model that tracks 2 time series: (i) the transmission rate at time t and (ii) the recovering rate at time t. Such an approach is more adaptive than traditional static SIR models and more robust than direct estimation methods. Using the data provided by China, we show that the one-day prediction errors for the numbers of confirmed cases are almost in 3%, and the total number of confirmed cases is precisely predicted. Also, the turning point, defined as the day that the transmission rate is less than the recovering rate can be accurately predicted. After that day, the basic reproduction number $R_0$ is less than 1. For (Q3), we extend our SIR model by considering 2 types of infected persons: detectable and undetectable infected persons. Whether there is an outbreak in such a model is characterized by the spectral radius of a 2 by 2 matrix that is closely related to $R_0$. For (Q4), we show that herd immunity can be achieved after at least 1-1/$R_0$ fraction of individuals being infected. For (Q5) and (Q6), we analyze the independent cascade (IC) model for disease propagation in a configuration random graph. By relating the propagation probabilities in the IC model to the transmission rates and recovering rates in the SIR model, we show 2 approaches of social distancing that can lead to a reduction of $R_0$.


title: Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes

text: Tobacco smoking is a leading cause of non-communicable disease globally and is a major risk factor for cardiovascular disease (CVD) and lung disease. Importantly, recent data by the World Health Organizations (WHO) indicate that in the last two decades global tobacco use has significantly dropped, which was largely driven by decreased numbers of female smokers. Despite such advances, the use of e-cigarettes and waterpipes (shisha, hookah, narghile) is an emerging trend, especially among younger generations. There is growing body of evidence that e-cigarettes are not a harm-free alternative to tobacco cigarettes and there is considerable debate as to whether e-cigarettes are saving smokers or generating new addicts. Here, we provide an updated overview of the impact of tobacco/waterpipe (shisha) smoking and e-cigarette vaping on endothelial function, a biomarker for early, subclinical, atherosclerosis from human and animal studies. Also their emerging adverse effects on the proteome, transcriptome, epigenome, microbiome, and the circadian clock are summarized. We briefly discuss heat-not-burn tobacco products and their cardiovascular health effects. We discuss the impact of the toxic constituents of these products on endothelial function and subsequent CVD and we also provide an update on current recommendations, regulation and advertising with focus on the USA and Europe. As outlined by the WHO, tobacco cigarette, waterpipe, and e-cigarette smoking/vaping may contribute to an increased burden of symptoms due to coronavirus disease 2019 (COVID-19) and to severe health consequences.


Perioperative Echocardiography During the Coronavirus Crisis: Considerations in Pediatrics and Congenital Heart Disease


title: Expert consensus on emergency surgery management for traumatic orthopedics under prevention and control of novel coronavirus pneumonia/ 中华创伤杂志

text: Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.


Overcoming challenges in preventive cardiology research


The fear of COVID-19 infection is the main cause of the new diagnoses of hand eczema: Report from the frontline in Milan


Eosinophil count in severe coronavirus disease 2019


title: Is the ACE2 Overexpression a Risk Factor for COVID-19 Infection?

text: In the recent coronavirus disease (COVID-19) outbreak, a higher proportion of patients with severe disease were found in older persons with comorbidities. This observation has been related to the use of drugs that can increase the cellular expression of angiotensin-converting enzyme 2 (ACE2) that has been recognized as target to which the virus bind to cells. Although this hypothesis is possible, it may also have other explanations which are discussed.


title: Clinical characteristics and outcomes of COVID-19 hospitalized patients with diabetes in the United Kingdom: A retrospective single centre study

text: AIM: To describe the clinical characteristics and outcomes of hospitalized COVID-19 patients with diabetes. METHODS: A retrospective cross-sectional study was conducted among patients admitted to the William Harvey Hospital in England between March 10th and May10th, 2020 with a laboratory-confirmed severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), known as COVID-19. Variation in characteristics, length of stay in hospital, diabetes status, duration of diabetes, control of diabetes, comorbidities and outcomes were examined. RESULTS: There were 232 COVID-19 presentations. Mean (standard deviation (SD), range) age was 70.5 (±15.7, 30-101) years, 62.5% were male, and 37.5% were having diabetes. There were 43.4% males and 27.6 females, p = 0.016, with diabetes admitted to our hospital due to COVID-19. Patients with diabetes were more likely to have longer length of stay (LOS) in hospital, 14.4 (SD ± 9.6) days, compared to the patients without diabetes, 9.8 (SD ± 17.1) days, p < 0.0001. Patients with diabetic ketoacidosis (DKA) were more likely to survive (87.1%) compared to patients without DKA (50.6%), p = 0.046. CONCLUSION: Males were more likely to be admitted to hospital with COVID-19 illness than females. Hospitalized COVID-19 patients with diabetes had a longer LOS in hospital than patients without diabetes. Older age COVID-19 patients with diabetes and patients without DKA were less likely to survive compared to younger patients and patients with DKA, respectively. Further studies with large sample size are needed.


title: Anesthesia Considerations and Infection Precautions for Trauma and Acute Care Cases During the COVID-19 Pandemic

text: Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide. During the ongoing COVID-19 epidemic, most hospitals have postponed elective surgeries. However, some emergency surgeries especially for trauma patients are inevitable. For patients with suspected or confirmed COVID-19, a standard protocol addressing preoperative preparation, intraoperative management and postoperative surveillance should be implemented to avoid nosocomial infection and ensure the safety of patients and the healthcare workforce. With reference to the guidelines and recommendations issued by the National Health Commission and Chinese Society of Anesthesiology, this article provides recommendations for anesthesia management of trauma and emergency surgery cases during the COVID-19 pandemic.


Simulation as a tool for assessing and evolving your current personal protective equipment: lessons learned during the coronavirus disease (COVID-19) pandemic


title: Outbreak of bovine herpetic meningoencephalomyelitis in Southern Brazil

text: Background: Herpetic meningoencephalitis is an infectious contagious disease worldwide distributed, most often caused by bovine alphaherpesvirus type 5 (BoHV-5), although bovine alphaherpesvirus type 1 (BoHV-1) may occasionally be the causative agent. The disease is characterized by subacute to acute clinical onset, often affecting animals submitted to stressful situations. Clinical signs are mainly neurologic due to meningoencephalitis and cortical necrosis. The involvement of the spinal cord has also been reported, however in BoHV-1 associated disease only. The aim of this report is to describe an outbreak of bovine meningoencephalomyelitis associated to BoHV-5.Case: In August 2017, nine 1-year-old calves died in a beef cattle farm with a flock of approximately 400 bovines. The animals presented neurological clinical signs characterized by excessive salivation, nasal and ocular discharges, incoordination, apathy, head tremors, head pressing, wide-based stance, recumbency followed by convulsions and paddling. According to the owner and referring veterinarian, affected animals displayed severe clinical signs with rapid progression and often leading to death in up to seven days. Four of these calves were submitted for necropsy, and gross lesions were present in the brain, characterized by mild to moderate multifocal hemorrhagic and soft areas. On cut surface, extensive areas of dark brown discoloration and malacia were observed. Histologically, lesions were characterized by extensive areas of liquefactive necrosis in the cerebral cortex grey matter, associated with inflammatory infiltrates composed of neutrophils, lymphocytes, plasma cells and foamy macrophages, as well as multifocal to coalescing areas of hemorrhage and fibrin deposition. Intranuclear eosinophilic inclusion bodies were rarely observed in neurons and astrocytes. On leptomeninges, there was diffuse inflammatory infiltrates of lymphocytes and plasma cells.[...](AU)


title: Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group

text: INTRODUCTION: This statement was planned on 11 March 2020 to provide clinical guidance and aid staff preparation for the coronavirus disease 2019 (COVID-19) pandemic in Australia and New Zealand. It has been widely endorsed by relevant specialty colleges and societies. MAIN RECOMMENDATIONS: Generic guidelines exist for the intubation of different patient groups, as do resources to facilitate airway rescue and transition to the "can't intubate, can't oxygenate" scenario. They should be followed where they do not contradict our specific recommendations for the COVID-19 patient group. Consideration should be given to using a checklist that has been specifically modified for the COVID-19 patient group. Early intubation should be considered to prevent the additional risk to staff of emergency intubation and to avoid prolonged use of high flow nasal oxygen or non-invasive ventilation. Significant institutional preparation is required to optimise staff and patient safety in preparing for the airway management of the COVID-19 patient group. The principles for airway management should be the same for all patients with COVID-19 (asymptomatic, mild or critically unwell). Safe, simple, familiar, reliable and robust practices should be adopted for all episodes of airway management for patients with COVID-19. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Airway clinicians in Australia and New Zealand should now already be involved in regular intensive training for the airway management of the COVID-19 patient group. This training should focus on the principles of early intervention, meticulous planning, vigilant infection control, efficient processes, clear communication and standardised practice.


title: Correction to: Predictors of localization, outcome, and etiology of spontaneous intracerebral hemorrhages: focus on cerebral amyloid angiopathy

text: The original version of this article unfortunately contained a mistake.


title: Rapid telepsychology deployment during the COVID-19 pandemic: A special issue commentary and lessons from primary care psychology training

text: OBJECTIVE: This article positions the special issue on telepsychology amidst the COVID-19 pandemic, which has dramatically accelerated the adoption and dissemination of telepsychology. METHOD: The article makes general observations about the themes emerging in the special issue with considerations for application, training, theory-driven research, and policy. It then presents as a case example the rapid deployment during the pandemic of telepsychology doctoral training and services at the Virginia Commonwealth University (VCU) Primary Care Psychology Collaborative. RESULTS: Facilitators to VCU telepsychology deployment included trainee and supervisor resources, strong telepsychology training, and prior experience. Barriers to overcome included limited clinic capacity, scheduling, technology, and accessibility and diversity issues. Lessons learned involved presenting clinical issues, supervision, and working with children and adolescents. CONCLUSIONS: Telepsychology is crucial for psychological service provision, during the COVID-19 pandemic more than ever, and that is unlikely to change as psychologists and patients increasingly continue to appreciate its value.


Lung ultrasound in the frontline diagnosis of COVID-19 infection


Covid-19: how doctors and healthcare systems are tackling coronavirus worldwide


title: Towards Efficient COVID-19 CT Annotation: A Benchmark for Lung and Infection Segmentation

text: Accurate segmentation of lung and infection in COVID-19 CT scans plays an important role in the quantitative management of patients. Most of the existing studies are based on large and private annotated datasets that are impractical to obtain from a single institution, especially when radiologists are busy fighting the coronavirus disease. Furthermore, it is hard to compare current COVID-19 CT segmentation methods as they are developed on different datasets, trained in different settings, and evaluated with different metrics. In this paper, we created a COVID-19 3D CT dataset with 20 cases that contains 1800+ annotated slices and made it publicly available. To promote the development of annotation-efficient deep learning methods, we built three benchmarks for lung and infection segmentation that contain current main research interests, e.g., few-shot learning, domain generalization, and knowledge transfer. For a fair comparison among different segmentation methods, we also provide unified training, validation and testing dataset splits, and evaluation metrics and corresponding code. In addition, we provided more than 40 pre-trained baseline models for the benchmarks, which not only serve as out-of-the-box segmentation tools but also save computational time for researchers who are interested in COVID-19 lung and infection segmentation. To the best of our knowledge, this work presents the largest public annotated COVID-19 CT volume dataset, the first segmentation benchmark, and the most pre-trained models up to now. We hope these resources (\url{https://gitee.com/junma11/COVID-19-CT-Seg-Benchmark}) could advance the development of deep learning methods for COVID-19 CT segmentation with limited data.


Impact of COVID-19 on Tourism in Nepal


title: Immunization with porcine epidemic diarrhea virus harbouring Fc domain of IgG enhances antibody production in pigs

text: Background: Outbreaks of porcine epidemic diarrhea virus (PEDV) infection have re-emerged and spread rapidly worldwide, resulting in significant economic losses. Vaccination is the best way to prevent PEDV infection in young piglets.Objective: To enhance the efficacy of an inactivated vaccine against PEDV, we evaluated the adjuvant properties of Fc domain of IgG.Methods: Fifteen crossbred gilts (180 â¼ 210 days old) were used. Five pigs in group 1 were intramuscularly vaccinated twice at 4 weeks and 2 weeks prior to farrowing with 106 TCID50 of inactivated PEDV. Five pigs in group 2 were intramuscularly vaccinated twice at 4 weeks and 2 weeks prior to farrowing with 106 TCID50 of inactivated PEDV-sFc. Five pigs in group 3 were not vaccinated and served as negative controls. Serum samples were collected at farrowing and subjected to ELISA, a serum neutralizing (SN) test, and a cytokine assay. Statistical analysis was performed by a two-tailed unpaired t-test.Results: Vero cells expressing swine IgG Fc on its surface was established. When PEDV was propagated in the cells expressing the swine Fc, PEDV virion incorporated the Fc. Immunization of pigs with inactivated PEDV harbouring Fc induced significantly higher antibody production against PEDV, comparing to the immunization with normal inactivated PEDV. In addition, we observed significantly increased IFN-Î³ levels in sera.Conclusion: Our results indicate that Fc molecule facilitate immune responses and PEDV harbouring Fc molecule could be a possible vaccine candidate. However, a challenge experiment would be needed to investigate the protective efficacy of PEDV harbouring Fc.


title: Expressive Interviewing: A Conversational System for Coping with COVID-19

text: The ongoing COVID-19 pandemic has raised concerns for many regarding personal and public health implications, financial security and economic stability. Alongside many other unprecedented challenges, there are increasing concerns over social isolation and mental health. We introduce \textit{Expressive Interviewing}--an interview-style conversational system that draws on ideas from motivational interviewing and expressive writing. Expressive Interviewing seeks to encourage users to express their thoughts and feelings through writing by asking them questions about how COVID-19 has impacted their lives. We present relevant aspects of the system's design and implementation as well as quantitative and qualitative analyses of user interactions with the system. In addition, we conduct a comparative evaluation with a general purpose dialogue system for mental health that shows our system potential in helping users to cope with COVID-19 issues.


Relation between BCG coverage rate and COVID-19 infection worldwide


Covid-19: Disproportionate impact on ethnic minority healthcare workers will be explored by government


title: SARS-CoV-2/COVID-19 Pandemisi

text: Aralık 2019’un son günlerinde Çin’in Hubei eyaleti Wuhan kentinde etiyolojisi bilinmeyenpnömoni vakaları görülmeye başlanmıştır Kısa süre sonra Dünya Sağlık Örgütü (DSÖ) buvakalardaki etkenin Coronavirus ailesinin yeni bir üyesi olduğunu duyurmuş ve genetikanalizler sonucu bu etkenin 2003 yılında salgın yapan SARS (Şiddetli Akut SolunumSendromu) ile yüksek oranda benzerlik gösterdiği belirlenmiştir DSÖ tarafından virüsün güncelisimlendirmesi SARS-CoV-2, oluşturduğu hastalık ise COVID-19 olarak kabul edilmiştir Küresel önlem ve karantina çabalarına rağmen virüsün insidansı artmaya devam etmektedir Laboratuvar yöntemleri ile 145 000’in üzerinde kişiyi infekte ettiği ve 5 400’den fazla ölümleilişkilendirilmesinin belirlenmesi ve 130’dan fazla ülkede görülmesi nedenleri ile SARS-CoV-2,DSÖ tarafından 11 Mart 2020 tarihinde pandemik olarak değerlendirilmiştir Bu derlemedeSARS-CoV-2/COVID-19 ile ilgili güncel durum özetlenmiştir


title: Report on Electroencephalographic Findings in Critically Ill Patients with COVID-19

text: In March 2020, we treated a cohort of 26 critically ill hospitalized SARS-CoV-2-infected patients who underwent electroencephalography to assess unexplained altered mental status, loss of consciousness, or poor arousal and responsiveness. Of the 26 patients studied, 5 patients had electroencephalograms that showed periodic discharges consisting of high-amplitude frontal monomorphic delta waves with absence of epileptic activity. These findings may suggest central nervous system injury potentially related to COVID-19 in these patients. ANN NEUROL 2020.


title: Assessment of imidacloprid related exposure using imidacloprid-olefin and desnitro-imidacloprid: Neonicotinoid insecticides in human urine in Wuhan, China

text: While neonicotinoid insecticides (NNIs) have been widely used worldwide, limited studies have measured specific metabolites of imidacloprid (IMI, the most commonly used NNI) in human urine. To better understand human exposure to NNIs, 10 parent compounds, and 6 of their metabolites were analyzed in 408 urine samples collected from 129 healthy adults in Wuhan, Central China, during autumn and winter of 2018. These specimens included repeated urine samples taken in 3 d from 75 volunteers. The urinary concentrations of desnitro-imidacloprid (DN-IMI), imidacloprid-olefin (IMI-olefin), and desmethyl-acetamiprid (DM-ACE) were higher (4-40 times) than those of their parent compounds (IMI and acetamiprid, ACE). DN-IMI and IMI-olefin accounted for 92% of the urinary Σ3IMI (the sum of IMI and its specific metabolites measured). Positive correlations (r) were observed between DN-IMI and IMI (0.50), IMI-olefin and IMI (0.75), and DM-ACE and ACE (0.53). Good to excellent inter-day reliabilities (unadjusted intraclass correlation coefficients) were observed for IMI-olefin (0.61) and DM-ACE (0.81), while moderate inter-day reliability was observed for DN-IMI (0.43). The urinary NNI concentrations were significantly higher in autumn than in winter, and higher in urban areas than in rural areas, while no significant gender or age-related differences were observed. To our knowledge, this is the first report on DN-IMI and IMI-olefin in human urine.


C3 and ACE1 polymorphisms are more important confounders in the spread and outcome of COVID-19 in comparison with ABO polymorphism


title: The underlying changes and predicting role of peripheral blood inflammatory cells in severe COVID-19 patients: A sentinel?

text: BACKGROUND: The underlying changes of peripheral blood inflammatory cells (PBICs) in COVID-19 patients are little known. Moreover, the risk factors for the underlying changes of PBICs and their predicting role in severe COVID-19 patients remain uncertain. MATERIAL AND METHODS: This retrospective study including two cohorts: the main cohort enrolling 45 patients of severe type serving as study group, and the secondary cohort enrolling 12 patients of no-severe type serving as control group. The PBICs analysis was based on blood routine and lymphocyte subsets. The inflammatory cell levels were compared among patients according to clinical classifications, disease-associated phases, as well as one-month outcomes. RESULTS: Compared with patients of non-severe type, the patients of severe type suffered from significantly decreased counts of lymphocytes, eosinophils, basophils, but increased counts of neutrophils. These PBICs alterations got improved in recovery phase, but persisted or got worse in aggravated phase. Compared with patients in discharged group, the patients in un-discharged/died group suffered from decreased counts of total T lymphocytes, CD4 + T lymphocytes, CD8 + T lymphocytes, as well as NK cells at 2 weeks after treatment. Clinical classification-critically severe was the independently risk factor for lymphopenia (OR = 7.701, 95%CI:1.265-46.893, P = 0.027), eosinopenia (OR = 5.595, 95%CI:1.008-31.054, P = 0.049), and worse one-month outcome (OR = 8.984; 95%CI:1.021-79.061, P = 0.048). CONCLUSION: Lymphopenia and eosinopenia may serve as predictors of disease severity and disease progression in COVID-19 patients, and enhancing the cellular immunity may contribute to COVID-19 treatment. Thus, PBICs might become a sentinel of COVID-19, and it deserves attention during COVID-19 treatment.


Pandémie de Covid-19 : mesures barrières renforcées pendant le confinement et en phase de sortie de confinement


COVID-19: Driving while looking in the rear-view mirror


title: Assessment of the Severity of Coronavirus Disease: Quantitative Computed Tomography Parameters versus Semiquantitative Visual Score

text: OBJECTIVE: To compare the accuracies of quantitative computed tomography (CT) parameters and semiquantitative visual score in evaluating clinical classification of severity of coronavirus disease (COVID-19). MATERIALS AND METHODS: We retrospectively enrolled 187 patients with COVID-19 treated at Tongji Hospital of Tongji Medical College from February 15, 2020, to February 29, 2020. Demographic data, imaging characteristics, and clinical data were collected, and based on the clinical classification of severity, patients were divided into groups 1 (mild) and 2 (severe/critical). A semiquantitative visual score was used to estimate the lesion extent. A three-dimensional slicer was used to precisely quantify the volume and CT value of the lung and lesions. Correlation coefficients of the quantitative CT parameters, semiquantitative visual score, and clinical classification were calculated using Spearman's correlation. A receiver operating characteristic curve was used to compare the accuracies of quantitative and semi-quantitative methods. RESULTS: There were 59 patients in group 1 and 128 patients in group 2. The mean age and sex distribution of the two groups were not significantly different. The lesions were primarily located in the subpleural area. Compared to group 1, group 2 had larger values for all volume-dependent parameters (p < 0.001). The percentage of lesions had the strongest correlation with disease severity with a correlation coefficient of 0.495. In comparison, the correlation coefficient of semiquantitative score was 0.349. To classify the severity of COVID-19, area under the curve of the percentage of lesions was the highest (0.807; 95% confidence interval, 0.744-0.861: p < 0.001) and that of the quantitative CT parameters was significantly higher than that of the semiquantitative visual score (p = 0.001). CONCLUSION: The classification accuracy of quantitative CT parameters was significantly superior to that of semiquantitative visual score in terms of evaluating the severity of COVID-19.


Oncology Treatment in the Era of COVID-19: We Cannot Afford to Hit the Pause Button


Covid-19-The real role of NSAIDs in Italy


title: Emerging mechanisms for the new coronavirus-related myocardial injury and ischemia: A review of the literature

text: A history of cardiovascular comorbidity or experiencing acute cardiac injury during the coronavirus disease 2019 is accompanied by a poor prognosis. Also, it seems myocardial ischemia (or infarction) accounts for a major part of the cardiac involvement observed in this disease. Therefore, particular consideration is needed to protect the cardiovascular system during this pandemic. The gaps highlighted in this review are an issue to be explored through future research.


Psychosocial Implications for Transplant Patients During the Global Pandemic


title: Impact of international travel and border control measures on the global spread of the novel 2019 coronavirus outbreak

text: The novel coronavirus outbreak (COVID-19) in mainland China has rapidly spread across the globe. Within 2 mo since the outbreak was first reported on December 31, 2019, a total of 566 Severe Acute Respiratory Syndrome (SARS CoV-2) cases have been confirmed in 26 other countries. Travel restrictions and border control measures have been enforced in China and other countries to limit the spread of the outbreak. We estimate the impact of these control measures and investigate the role of the airport travel network on the global spread of the COVID-19 outbreak. Our results show that the daily risk of exporting at least a single SARS CoV-2 case from mainland China via international travel exceeded 95% on January 13, 2020. We found that 779 cases (95% CI: 632 to 967) would have been exported by February 15, 2020 without any border or travel restrictions and that the travel lockdowns enforced by the Chinese government averted 70.5% (95% CI: 68.8 to 72.0%) of these cases. In addition, during the first three and a half weeks of implementation, the travel restrictions decreased the daily rate of exportation by 81.3% (95% CI: 80.5 to 82.1%), on average. At this early stage of the epidemic, reduction in the rate of exportation could delay the importation of cases into cities unaffected by the COVID-19 outbreak, buying time to coordinate an appropriate public health response.


Can the COVID-19 crisis strengthen our treatment escalation planning and resuscitation decision making?


Opinion: What models can and cannot tell us about COVID-19


Proposed model for hospital and community pharmacy services during COVID-19 pandemic in Nigeria


title: The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis

text: OBJECTIVES: An outbreak of novel coronavirus in 2019 threatens the health of people, and there is no proven pharmacological treatment. Although corticosteroids were widely used during outbreaks of severe acute respiratory syndrome and Middle East respiratory syndrome, their efficacy remainedhighly controversial. We aimed to further evaluate the influence of corticosteroids on patients with coronavirus infection. METHODS: We conducted a comprehensive search of literature published in PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure (CNKI) from January 1, 2002 to March 15, 2020. All statistical analyses in this study were performed on stata14.0. RESULTS: A total of 5270 patients from 15 studies were included in this meta-analysis. The result indicated that critical patients were more likely to require corticosteroids therapy (risk ratio [RR]â¯=â¯1.56, 95% confidence interval [CI]â¯=â¯1.28-1.90, P<0.001). However, corticosteroid treatment was associated with higher mortality (RRâ¯=â¯2.11, 95%CIâ¯=â¯1.13-3.94, Pâ¯=â¯0.019), longer length of stay (weighted mean difference [WMD]â¯=â¯6.31, 95%CIâ¯=â¯5.26-7.37, P<0.001), a higher rate of bacterial infection (RRâ¯=â¯2.08, 95%CIâ¯=â¯1.54-2.81, P<0.001), and hypokalemia (RRâ¯=â¯2.21, 95%CIâ¯=â¯1.07-4.55, Pâ¯=â¯0.032) but not hyperglycemia (RRâ¯=â¯1.37, 95%CI=0.68-2.76, P = 0.376) or hypocalcemia (RRâ¯=â¯1.35, 95%CIâ¯=â¯0.77-2.37, Pâ¯=â¯0.302). CONCLUSIONS: Patients with severe conditions are more likely to require corticosteroids. Corticosteroid use is associated with increased mortality in patients with coronavirus pneumonia.


ACE2, COVID19 and serum ACE as a possible biomarker to predict severity of disease


How to Reorganize an Ear, Nose, and Throat Outpatient Service During the COVID-19 Outbreak: Report From Northern Italy


title: Vertical Transmission of Coronavirus Disease 19 (COVID-19) from Infected Pregnant Mothers to Neonates: A Review

text: Background: Since early December 2019, the Coronavirus Disease 19 (COVID-19) infection has been prevalent in China and eventually spread to other countries. There are a few published cases of COVID-19 occurring during pregnancy and due the possibility of mother-fetal vertical transmission, there is a concern that the fetuses may be at risk of congenital COVID-19. Methods: We reviewed the risk of vertical transmission of COVID-19 to the fetus of infected mothers by using data of published articles or official websites up to March 4, 2020. Results: A total of 31 infected pregnant mothers with COVID-19 were reported. No COVID-19 infection was detected in their neonates or placentas. Two mothers died from COVID-19-related respiratory complications after delivery. Conclusions: Currently, based on limited data, there is no evidence for intrauterine transmission of COVID-19 from infected pregnant women to their fetuses. Mothers may be at increased risk for more severe respiratory complications.


title: [Epidemiological analysis on 1 052 cases of COVID-19 in epidemic clusters]

text: Objective: To understand the epidemiological characteristics of the cases of COVID-19 epidemic clusters, and explore the influence of family factors and social factors such as group activities on the spread of the disease. Methods: The data of cases of COVID-19 epidemic clusters from 19 January, 2020 to 25 February, 2020 were collected from the official platforms of 36 cities in 6 provinces in China. Descriptive statistical methods, χ(2) test and curve fitting were used to analyze the epidemiological characteristics of the clustered cases. Results: By 25 February, 2020, the data of 1 052 cases in 366 epidemic clusters were collected. In these clustered cases, 86.9%(914/1 050) occurred in families. Among the 1 046 cases with gender information, 513 were males (49.0%) and 533 were females (51.0%). The cases were mainly young adults between 18 and 59 years old, accounting for 68.5% (711/1 038). In the 366 epidemic clusters , the clusters in which the first confirmed cases with the history of sojourn in Wuhan or Hubei accounted for 47.0%(172/366). From 19 January to 3 February, 2020, the first confirmed cases with Wuhan or Hubei sojourn history accounted for 66.5%. From 4 to 25 February, the first confirmed cases who had Wuhan or Hubei sojourn history accounted for only 18.2%. The median of interval between the first generation case onset and the second generation case onset was 5 (2-8) days. The median of onset- diagnosis interval of the initial cases was 6 (3-9) days, and the median of onset-diagnosis interval of the secondary cases was 5 (3-8) days. Conclusions: Epidemic clusters of COVID-19 were common in many cities outside Wuhan and Hubei. Close contact in family was one of the main causes for the spread of household transmission of the virus. After 4 February, the epidemic clusters were mainly caused by the first generation or second generation cases in local areas, and the time for diagnosis became shorter.


[Cluster Investigation Technical Guideline for the 2019 Novel Coronavirus Pneumonia (COVID- 19), China (1st Trial Version)]


title: Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action

text: On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) outbreak as a pandemic, with over 720,000 cases reported in more than 203 countries as of 31 March. The response strategy included early diagnosis, patient isolation, symptomatic monitoring of contacts as well as suspected and confirmed cases, and public health quarantine. In this context, telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission, especially in the United Kingdom and the United States of America. Based on a literature review, the first conceptual framework for telemedicine implementation during outbreaks was published in 2015. An updated framework for telemedicine in the COVID-19 pandemic has been defined. This framework could be applied at a large scale to improve the national public health response. Most countries, however, lack a regulatory framework to authorize, integrate, and reimburse telemedicine services, including in emergency and outbreak situations. In this context, Italy does not include telemedicine in the essential levels of care granted to all citizens within the National Health Service, while France authorized, reimbursed, and actively promoted the use of telemedicine. Several challenges remain for the global use and integration of telemedicine into the public health response to COVID-19 and future outbreaks. All stakeholders are encouraged to address the challenges and collaborate to promote the safe and evidence-based use of telemedicine during the current pandemic and future outbreaks. For countries without integrated telemedicine in their national health care system, the COVID-19 pandemic is a call to adopt the necessary regulatory frameworks for supporting wide adoption of telemedicine.


Challenges of community point-of-care antibody testing for COVID-19 herd-immunity in Japan


title: Stroke in patients with SARS-CoV-2 infection: case series

text: BACKGROUND: Italy is one of the most affected countries by the coronavirus disease 2019 (COVID-19). The responsible pathogen is named severe acute respiratory syndrome coronavirus (SARS-CoV-2). The clinical spectrum ranges from asymptomatic infection to severe pneumonia, leading to intensive care unit admission. Evidence of cerebrovascular complications associated with SARS-CoV-2 is limited. We herein report six patients who developed acute stroke during COVID-19 infection. METHODS: A retrospective case series of patients diagnosed with COVID-19 using reverse-transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs, who developed clinical and neuroimaging evidence of acute stroke during SARS-CoV-2 infection. RESULTS: Six patients were identified (5 men); median age was 69 years (range 57-82). Stroke subtypes were ischemic (4, 67%) and hemorrhagic (2, 33%). All patients but one had pre-existing vascular risk factors. One patient developed encephalopathy prior to stroke, characterized by focal seizures and behavioral abnormalities. COVID-19-related pneumonia was severe (i.e., requiring critical care support) in 5/6 cases (83%). Liver enzyme alteration and lactate dehydrogenase (LDH) elevation were registered in all cases. Four patients (67%) manifested acute kidney failure prior to stroke. Four patients (67%) had abnormal coagulation tests. The outcome was poor in the majority of the patients: five died (83%) and the remaining one (17%) remained severely neurologically affected (mRS: 4). CONCLUSIONS: Both ischemic and hemorrhagic stroke can complicate the course of COVI-19 infection. In our series, stroke developed mostly in patients with severe pneumonia and multiorgan failure, liver enzymes and LDH were markedly increased in all cases, and the outcome was poor.


Owner concerns that pets have Covid-19


title: Viral shedding dynamics in asymptomatic and mildly symptomatic patients infected with SARS-CoV-2

text: OBJECTIVES: Asymptomatic patients, together with those with mild symptoms of COVID-19, may play an important role in SARS-CoV-2 transmission. However, the dynamics of viral shedding during the various phases of the clinical course of COVID-19 remains unclear at this stage. METHODS: A total of 18 patients found positive for SARS-CoV-2 infection by real-time reverse transcription PCR (RT-PCR) assay, and admitted to Chongqing University Central Hospital between Jan 29 and Feb 5 were enrolled in this study. Medical data, pulmonary CT scan images, and RT-PCR results were periodically collected during the patients' hospital stay. All participants were actively followed-up for 2 weeks after discharge. RESULTS: A total of nine (50%) asymptomatic patients and nine 9 (50%) mildly mild symptom COVID-19 patients were identified on admission. Six (66.7%) asymptomatic patients on admission developed subjective symptoms during hospitalization were recategorized as 'pre-symptomatic'. The median duration of viral shedding was 11.5, 28 and 31 days for pre-symptomatic, asymptomatic and mild symptomatic patients, separately. Seven (38.9%) patients continued to shed virus after hospital discharge. During the convalescent phase, detectable antibodies to SARS-CoV-2 and RNA were simultaneously observed in five (27.8%) patients. CONCLUSIONS: Long-term viral shedding was presented in patients with mild symptoms and asymptomatic cases, and specific antibody production to SARS-CoV-2 may not guarantee viral clearance after discharge. These observations should be considered when making decisions regarding clinical and public health and strategies for prevention and control of SARS-CoV-2 infection.


title: COVID-19 Pandemic: Impact on psychiatric care in the United States

text: The World Health Organization declared the coronavirus outbreak a pandemic on March 11, 2020. Infection by the SARS-CoV2 virus leads to the COVID-19 disease which can be fatal, especially in older patients with medical co-morbidities. The impact to the US healthcare system has been disruptive, and the way healthcare services are provided has changed drastically. Here, we present a compilation of the impact of the COVID-19 pandemic on psychiatric care in the US, in the various settings: outpatient, emergency room, inpatient units, consultation services, and the community. We further present effects seen on psychiatric physicians in the setting of new and constantly evolving protocols where adjustment and flexibility have become the norm, training of residents, leading a team of professionals with different expertise, conducting clinical research, and ethical considerations. The purpose of this paper is to provide examples of "how to" processes based on our current front-line experiences and research to practicing psychiatrists and mental health clinicians, inform practitioners about national guidelines affecting psychiatric care during the pandemic, and inform health care policy makers and health care systems about the challenges and continued needs of financial and administrative support for psychiatric physicians and mental health systems.


title: Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study

text: OBJECTIVES: COVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear. DESIGN: This Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death). RESULTS: Between 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death. CONCLUSIONS: Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.


A Safe and Efficient, Naturally Ventilated Structure for COVID-19 Surge Capacity in Singapore


The role of 18F-FDG PET for COVID-19 infection: myth versus reality


title: Discussions on the emergency medical procedure of children's hospitals against COVID-19 epidemic/ 中华医院管理杂志

text: December 2019 witnessed the outbreak of COVID-19 in Wuhan, Hubei province of China, which has soon spread nationwide and across national borders, posting a menacing pandemic threat. Children are themselves highly susceptible infectious diseases in normal times not to mention an epidemic period. Coupled with the high incidence of seasonal influenza, it is imperative to strengthen epidemiological screening of children, along with effective isolation, treatment, prevention and control measures. In view of specifics of the hospital, the authors proposed to further improve the medical emergency procedure, strictly enforcing screening and isolation regulations, and standardizing medical procedure. They also proposed scientific layout and use of the infection wards. These measures are designed to control the epidemic and protect the safety of medical staff.


title: PPE or not PPE - that is the question

text: The world is in the middle of the COVID-19 pandemic and healthcare workers as well as dentists are having to make every difficult decision about their responsibilities in caring for their patients. Compounding this is the shortage of personal protective equipment (PPE), which makes patient-centred care ethically more challenging. Our first response to these ethical challenges should be to start with ourselves to make sure we are safe before we think about the patients. This is not the approach we would normally adopt when treating our patients outside of a pandemic.


title: The EPICENTRE (ESPNIC Covid pEdiatric Neonatal Registry) initiative: background and protocol for the international SARS-CoV-2 infections registry

text: The outbreak of SARS-CoV-2 is the worst healthcare emergency of this century, and its impact on pediatrics and neonatology is still largely unknown. The European Society for Pediatric and Neonatal Intensive Care (ESPNIC) launched the EPICENTRE (ESPNIC Covid pEdiatric Neonatal Registry) international, multicenter, and multidisciplinary initiative to study the epidemiology, clinical course, and outcomes of pediatric and neonatal SARS-CoV-2 infections. EPICENTRE background and aims are presented together with protocol details. EPICENTRE is open to centers all over the world, and this will allow to provide a pragmatic picture of the epidemic, with a particular attention to pediatric and neonatal critical care issues.Conclusions: EPICENTRE will allow researchers to clarify the epidemiology, clinical presentation, and outcomes of pediatric and neonatal SARS-CoV-2 infection, refining its clinical management and hopefully providing new insights for clinicians. What is Known: â¢ COVID19 is the new disease caused by SARS-CoV-2 infection and is spreading around the globe. â¢ Majority of data available about SARS-CoV-2 infections originates from adult patients. What is New: â¢ EPICENTRE is the first international, multicenter, multidisciplinary, meta-data driven, hospital-based, online, prospective cohort registry dedicated to neonatal and pediatric SARS-CoV-2 infections. â¢ EPICENTRE will allow to understand epidemiology and physiopathology of COVID19.


title: Case Report: The Gold Standard: The Case for Inclusion of a Medical Student-Specific Counseling Center and Wellness Programming in Early Medical Education

text: Medical student's mental health and wellness is a multifactorial discussion that requires a multidimensional and comprehensive approach. The high prevalence of burnout and its recent recognition by the World Health Organization as a work-related syndrome has scholars questioning if experiences in early medical education have an impact. The Herbert Wertheim College of Medicine at Florida International University in 2009 created an in-house counseling and wellness center. In assessing programming and services, approximately 55% of the medical student body has sought out individualized services from the Medical Student Counseling and Wellness Center. Moreover, the Association of American Medical Colleges Graduate Questionnaire results regarding the satisfaction of students in personal counseling, mental health services, and wellness programming have been 20% or higher than the national average. This is a call to action highly encouraging other medical schools to emulate and consider implementing a detailed and comprehensive program to be offered early in medical education.


Recommendations for prevention and management of COVID-19 in peritoneal dialysis patients


title: P-ODN: Prototype-based Open Deep Network for Open Set Recognition

text: Most of the existing recognition algorithms are proposed for closed set scenarios, where all categories are known beforehand. However, in practice, recognition is essentially an open set problem. There are categories we know called "knowns", and there are more we do not know called "unknowns". Enumerating all categories beforehand is never possible, consequently, it is infeasible to prepare sufficient training samples for those unknowns. Applying closed set recognition methods will naturally lead to unseen-category errors. To address this problem, we propose the prototype-based Open Deep Network (P-ODN) for open set recognition tasks. Specifically, we introduce prototype learning into open set recognition. Prototypes and prototype radiuses are trained jointly to guide a CNN network to derive more discriminative features. Then P-ODN detects the unknowns by applying a multi-class triplet thresholding method based on the distance metric between features and prototypes. Manual labeling the unknowns which are detected in the previous process as new categories. Predictors for new categories are added to the classification layer to "open" the deep neural networks to incorporate new categories dynamically. The weights of new predictors are initialized exquisitely by applying a distances based algorithm to transfer the learned knowledge. Consequently, this initialization method speeds up the fine-tuning process and reduce the samples needed to train new predictors. Extensive experiments show that P-ODN can effectively detect unknowns and needs only few samples with human intervention to recognize a new category. In the real world scenarios, our method achieves state-of-the-art performance on the UCF11, UCF50, UCF101 and HMDB51 datasets.


title: P-ODN: Prototype based Open Deep Network for Open Set Recognition

text: Most of the existing recognition algorithms are proposed for closed set scenarios, where all categories are known beforehand. However, in practice, recognition is essentially an open set problem. There are categories we know called"knowns", and there are more we do not know called"unknowns". Enumerating all categories beforehand is never possible, consequently it is infeasible to prepare sufficient training samples for those unknowns. Applying closed set recognition methods will naturally lead to unseen-category errors. To address this problem, we propose the prototype based Open Deep Network (P-ODN) for open set recognition tasks. Specifically, we introduce prototype learning into open set recognition. Prototypes and prototype radiuses are trained jointly to guide a CNN network to derive more discriminative features. Then P-ODN detects the unknowns by applying a multi-class triplet thresholding method based on the distance metric between features and prototypes. Manual labeling the unknowns which are detected in the previous process as new categories. Predictors for new categories are added to the classification layer to"open"the deep neural networks to incorporate new categories dynamically. The weights of new predictors are initialized exquisitely by applying a distances based algorithm to transfer the learned knowledge. Consequently, this initialization method speed up the fine-tuning process and reduce the samples needed to train new predictors. Extensive experiments show that P-ODN can effectively detect unknowns and needs only few samples with human intervention to recognize a new category. In the real world scenarios, our method achieves state-of-the-art performance on the UCF11, UCF50, UCF101 and HMDB51 datasets.


title: Malaysia Stroke Council guide on acute stroke care service during COVID-19 Pandemic

text: On the 18th of March 2020, the Malaysia government declared a movement control order (MCO) due to the unprecedented COVID-19 pandemic. Although the majority of patients presented with respiratory-related symptoms, COVID-19 patients may present atypically with neurological manifestations and may even have an increased risk of stroke. The Malaysia Stroke Council is concerned regarding the level of care given to stroke patients during this pandemic. During the recent National Stroke Workflow Steering Committee meeting, a guide was made based on the currently available evidences to assist Malaysian physicians providing acute stroke care in the hospital setting in order to provide the best stroke care while maintaining their own safety. The guide comprises of prehospital stroke awareness, hyperacute stroke care, stroke care unit and intensive care unit admission, post-stroke rehabilitation and secondary prevention practice. We urge continuous initiative to provide the best stroke care possible and ensure adequate safety for both patients and the stroke care team.


title: Sample-Efficient Optimization in the Latent Space of Deep Generative Models via Weighted Retraining

text: Many important problems in science and engineering, such as drug design, involve optimizing an expensive black-box objective function over a complex, high-dimensional, and structured input space. Although machine learning techniques have shown promise in solving such problems, existing approaches substantially lack sample efficiency. We introduce an improved method for efficient black-box optimization, which performs the optimization in the low-dimensional, continuous latent manifold learned by a deep generative model. In contrast to previous approaches, we actively steer the generative model to maintain a latent manifold that is highly useful for efficiently optimizing the objective. We achieve this by periodically retraining the generative model on the data points queried along the optimization trajectory, as well as weighting those data points according to their objective function value. This weighted retraining can be easily implemented on top of existing methods, and is empirically shown to significantly improve their efficiency and performance on synthetic and real-world optimization problems.


title: COVID-19 in older adults The Consequences of Neoliberalism in the Current Pandemic

text: The advent of the SARS-CoV-2 and COVID-19 pandemic has generated a lot of publications at a rapid pace We know that older adults disproportionately suffer the most severe of COVID outcomes Here we attempt to coalesce the key knowledge of SARS-CoV-2 biology to the disease and clinical care concepts in the context of older adults This article analyzes how the neoliberal policies, such as the politics of austerity (with considerable cuts to social policy expenditures including medical care and public health services) and the privatization of health services, imposed by many governments on both sides of the North Atlantic, considerably weakened the capacity of the response to the coronavirus pandemic in Italy, Spain, and the United States


title: The Consequences of Neoliberalism in the Current Pandemic

text: This article analyzes how the neoliberal policies, such as the politics of austerity (with considerable cuts to social policy expenditures including medical care and public health services) and the privatization of health services, imposed by many governments on both sides of the North Atlantic, considerably weakened the capacity of the response to the coronavirus pandemic in Italy, Spain, and the United States.


title: Chest-CT findings of COVID-19 in patients with pre-existing malignancies; a pictorial review

text: As of April 17th, 2020, more than 2,190,010 COVID-19 cases with 147,010 deaths have been recorded worldwide. It has been suggested that a high mortality rate occurs in patients with severe disease and is associated with advanced age and underlying comorbidities, such as malignancies. To the best of our knowledge, no study has been conducted to evaluate chest CT features in patients with malignancy and concomitant COVID-19 infection. In fact, the imaging findings can be challenging and have not yet been fully understood in this setting. In this manuscript, we go over imaging findings in chest CT of patients with COVID-19 and known cancer. With the ongoing COVID-19 pandemic and exponentially increasing incidence throughout the world, in at-risk and vulnerable populations such as patients with known malignancies, infection with SARS-CoV-2 should be included in the differential considerations even with atypical image pictures. Detection of superimposed infection in patients with cancers who present with pulmonary infiltrations warrant correlation with clinical picture, contact history, and RT-PCR confirmatory testing.


Iatrogenic dermatitis in times of COVID-19: a pandemic within a pandemic


title: Modeling strict age-targeted mitigation strategies for COVID-19

text: We use a simple SIR-like epidemic model which integrates known age-contact patterns for the United States to model the effect of age-targeted mitigation strategies for a COVID-19-like epidemic. We find that, among strategies which end with population immunity, strict age-targeted mitigation strategies have the potential to greatly reduce mortalities and ICU utilization for natural parameter choices.


title: Anticipating the impact of the COVID-19 pandemic on TB patients and TB control programmes

text: The COVID-19 pandemic has currently overtaken every other health issue throughout the world. There are numerous ways in which this will impact existing public health issues. Here we reflect on the interactions between COVID-19 and tuberculosis (TB), which still ranks as the leading cause of death from a single infectious disease globally. There may be grave consequences for existing and undiagnosed TB patients globally, particularly in low and middle income countries (LMICs) where TB is endemic and health services poorly equipped. TB control programmes will be strained due to diversion of resources, and an inevitable loss of health system focus, such that some activities cannot or will not be prioritised. This is likely to lead to a reduction in quality of TB care and worse outcomes. Further, TB patients often have underlying co-morbidities and lung damage that may make them prone to more severe COVID-19. The symptoms of TB and COVID-19 can be similar, with for example cough and fever. Not only can this create diagnostic confusion, but it could worsen the stigmatization of TB patients especially in LMICs, given the fear of COVID-19. Children with TB are a vulnerable group especially likely to suffer as part of the "collateral damage". There will be a confounding of symptoms and epidemiological data through co-infection, as happens already with TB-HIV, and this will require unpicking. Lessons for COVID-19 could be learned from the vast experience of running global TB control programmes, while the astonishingly rapid and relatively well co-ordinated response to COVID-19 demonstrates how existing programmes could be significantly improved.


title: Acute Stroke Care in the Coronavirus Disease 2019 Pandemic

text: Coronavirus disease 2019 (COVID-19) is a pandemic respiratory disease with serious public health risk and has taken the world off-guard with its rapid spread. As the COVID-19 pandemic intensifies, overwhelming the healthcare system and the medical community, current practice for the management of acute ischemic stroke (AIS) will require modification, and guidelines should be relaxed while maintaining high standard quality of care. The aim of these suggestions is to avoid contributing to the rapid spread of COVID-19 as well as to conserve what are likely to be very limited resources (including personnel, intensive care/hospital beds as well as physicians) while maintaining high quality care for patients with AIS. We present our recommendations for the management of acute stroke during the COVID-19 pandemics.


Can early treatment of patients with risk factors contribute to managing the COVID-19 pandemic?


Oxygen provision to fight COVID-19 in sub-Saharan Africa


title: The transition from objectively structured practical examination (OSPE) to electronic OSPE in the era of COVID-19

text: The coronavirus (COVID-19) pandemic is forcing the medical educators to innovate and embrace online education and assessment platform. One of the most significant challenges we are facing is the formative assessment of practical skills in the undergraduate medical biochemistry education. We have designed the electronic objectively structured practical examination to facilitate the formative assessment.


Risks to children during the covid-19 pandemic: some essential epidemiology