title: The Rapid Assessment and Early Warning Models for COVID-19

text: Human beings have experienced a serious public health event as the new pneumonia (COVID-19), caused by the severe acute respiratory syndrome coronavirus has killed more than 3000 people in China, most of them elderly or people with underlying chronic diseases or immunosuppressed states. Rapid assessment and early warning are essential for outbreak analysis in response to serious public health events. This paper reviews the current model analysis methods and conclusions from both micro and macro perspectives. The establishment of a comprehensive assessment model, and the use of model analysis prediction, is very efficient for the early warning of infectious diseases. This would significantly improve global surveillance capacity, particularly in developing regions, and improve basic training in infectious diseases and molecular epidemiology.


title: A moonshot approach toward the management of cancer patients in the COVID-19 time: what have we learned and what could the Italian network of cancer centers (Alliance Against Cancer, ACC) do after the pandemic wave?

text: If we focus our attention on seven main features of COVID-19 infection (heterogeneity, fragility, lack of effective treatments and vaccines, "miraculous cures", psychological suffering, deprivation, and globalization), we may establish parallelism with the challenges faced in the steep road to the understanding and treatment of neoplastic diseases. How the similarities between these two conditions can help us cope with the emergency effort represented by the management of cancer patients in the COVID-19 era, today and in the future? In a manner similar to the Cancer Moonshot initiative in the United States, we can hypothesize a multinational moonshot project towards the management of cancer patients during COVID-19 pandemic. In particular, we believe that the main road to elaborate meaningful scientific evidence is represented by the collection of all the data on COVID-19 and cancer comorbidity that are and will become available in cancer centers, coupled with the design of large clinical studies. To address this goal, it is essential to identify the entity that can produce this scientific evidences and the potentially most successful research strategy to undertake. The largest Italian organization for cancer research, Alliance Against Cancer (Alleanza Contro il Cancro, ACC), is called to play a scientific leadership in addressing these challenges, which requires the coordination of oncology teams at regional, national, and international levels. To fulfill this commitment, ACC will create a liaison with health government agencies in order to develop "dynamic" indications able to fight such an unpredictable pandemic.


title: COVID-19: Symptome und Frühzeichen auch bei leichten Verlaufsformen  Bedeutung von Riechstörungen und Ruhepuls./ [COVID-19: Variable symptoms in mild course: olfactory loss and increased resting heart rate]

text: HISTORY: A 56-year-old, previously healthy male and long distance runner noticed short episodes of parosmia, followed by anosmia. Few days later, he monitored an increase in his resting heart rate. This was followed by a dry cough, fatigue, and myalgia. At the same time, symptoms occurred in all four family members. CLINICAL FINDINGS: The patient had a dry cough. The medical examination was normal. Heart rate was 60/min, sinus rhythm, body temperature 36.6â°C. Complete anosmia was present. The RT-PCR for SARS-CoV-2 from a deep pharyngeal swab was positive in all five family members. THERAPY AND COURSE: Symptoms were present for almost two weeks. All family members had anosmia, that started earlier and lasted longer than the other symptoms, and myalgia. Reduced taste sensation, fatigue, dry cough and sore throat were present in four of five persons. Shortness of breath at rest or gastrointestinal symptoms were absent. Four affected persons had sleep disturbances in the later course of the disease. None of the affected persons had raised temperature at any time during the disease. Specific medical or drug treatment was not necessary. All patients made full recoveries without signs of organ dysfunction, and with full restitution of physical strength. DISCUSSION: We describe a family of 5 previously healthy persons with a mild course of COVID-19 disease. The symptoms and course are described in detail. Anosmia can precede other symptoms by several days and can indicate an early phase of infection. An increase in resting heart rate can occur in the absence of raised temperature or fever. The symptoms and course are discussed in the context of the ongoing pandemic, and efforts to control infection chains.


Managing Hand Trauma during the COVID-19 pandemic using a One-Stop Clinic


title: Clinical Characteristics and Outcomes of 74 Patients With Severe or Critical COVID-19

text: BACKGROUND: The outbreak of the coronavirus disease (COVID-19) has led to a major concern and caused a pandemic globally. The goal of this study was to clarify the clinical characteristics of recovery and death in patients with severe or critical COVID-19. MATERIALS AND METHODS: In this retrospective single-center study, clinical data were collected from 74 severe or critical COVID-19 patients in Wuhan Fourth Hospital between Jan. 25th and Feb. 26th, 2020. All patients were divided into a recovery group or a death group according to clinical outcomes, and the differences between the groups were compared. RESULTS: Of the 74 patients enrolled in the study, 48 (64.9%) were severe cases and 26 (35.1%) were critical cases. Sixty (81.1%) patients were recovered and 14 (18.9%) died. Compared with recovery patients, patients in the death group were older, and had higher incidences of hypertension, coronary disease and dyspnea at admission. Laboratory tests for lactate dehydrogenase, creatine kinase, myoglobin, brain natriuretic peptide and D-dimer indicated higher levels in the death group. The PaO2:FiO2 ratio and minimum SpO2 were lower in the death group, and a higher proportion of these patients received noninvasive mechanical ventilation, invasive mechanical ventilation and extracorporeal membrane oxygenation treatment. CONCLUSIONS: Elderly patients with comorbidities are at higher risk of severe COVID-19 or death. Patients with a low blood gas index and poor coagulation function at admission had a high mortality rate. For such patients, comprehensive treatment should be performed as soon as possible to improve the prognosis and reduce mortality.


title: Redesigning a Department of Surgery during the COVID-19 Pandemic

text: BACKGROUND: COVID-19 has created an urgent need for reorganization and surge planning among departments of surgery across the USA. METHODS: Review of the COVID-19 planning process and work products in preparation for a patient surge. Organizational and process changes, workflow redesign, and communication plans are presented. RESULTS: The planning process included widespread collaboration among leadership from many disciplines. The department of surgery played a leading role in establishing clinical protocols, guidelines, and policies in preparation for a surge of COVID-19 patients. A multidisciplinary approach with input from clinical and nonclinical stakeholders is critical to successful crisis planning. A clear communication plan should be implemented early and input from trainees, staff, and faculty should be solicited. CONCLUSION: Major departmental and health system reorganization is required to adapt academic surgical practices to a widespread crisis. Surgical leadership, innovation, and flexibility are critical to successful planning and implementation.


title: COVID-19 emergency in the cruise's ship: a case report of conjunctivitis

text: Little is known about the Covid-19 transmission through ocular tissue, and more research needs to be carried out in order to confirm its ability to infect ocular tissue and its pathogenic mechanisms. Covid-19 may be detected in the tears and conjunctival secretions in novel coronavirus pneumonia patients with conjunctivitis. This case report shows a severe viral conjunctivitis in a patient diagnosed with Covid-19 on the Diamond Princess ship, characterized by both red, irritated and swollen eyes, with transparent serous secretions, conjunctival chemosis, pseudomembranes of fibrin and inflammatory cells on the tarsal conjunctiva accompanied by preauricular lymph nodes and enlarged submaxillaries.


title: Solidarity in response to COVID-19 outbreak in the Eastern Mediterranean Region

text: The coronavirus disease 2019 (COVID-19) outbreak that began in Wuhan, Hubei Province, China in late 2019 has spread globally within a few months. The Director General of the World Health Organization (WHO) declared the COVID-19 outbreak to be a public health emergency of international concern (PHEIC) after the second meeting of the IHR (2005) Emergency Committee on 30 January 2020. On 12 March 2020, the outbreak of COVID-19 was characterized as a pandemic.


title: Dietary recommendations during the COVID-19 pandemic

text: Optimal nutrition can improve well-being and might mitigate the risk and morbidity associated with coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review summarizes nutritional guidelines to support dietary counseling provided by dietitians and health-related professionals. The majority of documents encouraged the consumption of fruits, vegetables, and whole grain foods. Thirty-one percent of the guidelines highlighted the importance of minerals and vitamins such as zinc and vitamins C, A, and D to maintain a well-functioning immune system. Dietary supplementation has not been linked to COVID-19 prevention. However, supplementation with vitamins C and D, as well as with zinc and selenium, was highlighted as potentially beneficial for individuals with, or at risk of, respiratory viral infections or for those in whom nutrient deficiency is detected. There was no convincing evidence that food or food packaging is associated with the transmission of COVID-19, but good hygiene practices for handling and preparing foods were recommended. No changes to breastfeeding recommendations have been made, even in women diagnosed with COVID-19.


title: Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke

text: BACKGROUND: Emergence of the novel corona virus (severe acute respiratory syndrome (SARS)-CoV-2) in December 2019 has led to the covid-19 pandemic. The extent of covid-19 involvement in the central nervous system is not well established, and the presence or the absence of SARS-CoV-2 particles in the cerebrospinal fluid (CSF) is a topic of debate. CASE DESCRIPTION: We present two patients with covid-19 and concurrent neurological symptoms. Our first patient is a 31-year-old man who had flu-like symptoms due to covid-19 and later developed an acute-onset severe headache and loss of consciousness and was diagnosed with a Hunt and Hess grade 3 subarachnoid haemorrhage from a ruptured aneurysm. Our second patient is a 62-year-old woman who had an ischaemic stroke with massive haemorrhagic conversion requiring a decompressive hemicraniectomy. Both patients' CSF was repeatedly negative on real-time PCR analysis despite concurrent neurological disease. CONCLUSION: Our report shows that patients' CSF may be devoid of viral particles even when they test positive for covid-19 on a nasal swab. Whether SARS-CoV-2 is present in CSF may depend on the systemic disease severity and the degree of the virus' nervous tissue tropism and should be examined in future studies.


title: Resuming elective surgical activity after the COVID-19 wave: what the patients need to know

text: As COVID-19 outbreak enters its second phase of lockdown ease, healthcare plans involve elective surgery re-establishment to provide essential life-saving care. Patients are increasingly requesting information about their facility's readiness for safely performing surgery. This information should be open and transparent including patient's education with objective data regarding the state of the pandemic in the country and the control measures undertaken by the facility.


title: A virus that has gone viral: amino acid mutation in S protein of Indian isolate of Coronavirus COVID-19 might impact receptor binding, and thus, infectivity

text: Since 2002, ß coronaviruses (CoVs) have caused three zoonotic outbreaks, SARS-CoV in 2002, MERS-CoV in 2012, and the recent outbreak of SARS-CoV-2 late in 2019 (also named as COVID-19 or novel coronavirus 2019 or nCoV2019). Spike (S) protein, one of the structural proteins of this virus plays key role in receptor (ACE2) binding and thus virus entry. Thus, this protein has attracted scientists for detailed study and therapeutic targeting. As the nCoV2019 takes its course throughout the world, more and more sequence analyses are being done and genome sequences are being deposited in various databases. From India, two clinical isolates have been sequenced and the full genome has been deposited in GenBank. We have performed sequence analyses of the Spike protein of the Indian isolates and compared with that of the Wuhan, China (where the outbreak was first reported). While all the sequences of Wuhan isolates are identical, we found point mutations in the Indian isolates. Out of the two isolates, one was found to harbor a mutation in its receptor-binding domain (RBD) at position 407. At this site, arginine (a positively charged amino acid) was replaced by isoleucine (a hydrophobic amino acid that is also a C-ß branched amino acid). This mutation has been seen to change the secondary structure of the protein at that region and this can potentially alter receptor binding of the virus. Although this finding needs further validation and more sequencing, the information might be useful in rational drug designing and vaccine engineering.


Letter by Weir Regarding Article, "Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2"


title: Rescheduling Nonurgent Care in Radiology: Implementation During the Coronavirus Disease 2019 (COVID-19) Pandemic

text: OBJECTIVE: To meet hospital preparedness for the coronavirus disease 2019 pandemic, the Centers for Disease Control and Prevention and ACR recommended delay of all nonemergent tests and elective procedures. The purpose of this article is to report our experience for rescheduling nonemergent imaging and procedures during the pandemic at our tertiary academic institution. METHODS: We rescheduled the nonemergent imaging and procedures in our hospitals and outpatient centers from March 16 to May 4, 2020. We created a tiered priority system to reschedule patients for whom imaging could be delayed with minimal clinical impact. The radiologists performed detailed chart reviews for decision making. We conducted daily virtual huddles with discussion of rescheduling strategies and issue tracking. RESULTS: Using a snapshot during the rescheduling period, there was a 53.4% decrease in imaging volume during the period of March 16 to April 15, 2020, compared with the same time period in 2019. The total number of imaging studies decreased from 38,369 in 2019 to 17,891 in 2020 during this period. Although we saw the largest reduction in outpatient imaging (72.3%), there was also a significant decrease in inpatient (40.5%) and emergency department (48.9%) imaging volumes. DISCUSSION: The use of multiple communication channels was critical in relaying the information to all our stakeholders, patients, referring physicians, and the radiology workforce. Teamwork, quick adoption, and adaptation of changing strategies was important given the fluidity of the situation.


text: OBJECTIVE: To meet hospital preparedness for the coronavirus disease 2019 pandemic, the Centers for Disease Control and Prevention and ACR recommended delay of all nonemergent tests and elective procedures. The purpose of this article is to report our experience for rescheduling nonemergent imaging and procedures during the pandemic at our tertiary, academic institution. METHODS: We rescheduled the nonemergent imaging and procedures in our hospitals and outpatient centers from March 16 to May 4, 2020. We created a tiered priority system to reschedule patients for whom imaging could be delayed with minimal clinical impact. The radiologists performed detailed chart reviews for decision making. We conducted daily virtual huddles with discussion of rescheduling strategies and issue tracking. RESULTS: Using a snapshot during the rescheduling period, there was a 53.4% decrease in imaging volume during the period of March 16 to April 15, 2020, compared with same time period in 2019. The total number of imaging studies decreased from 38,369 in 2019 to 17,891 in 2020 during this period. Although we saw the largest reduction in outpatient imaging (72.3%), there was also a significant decrease in inpatient (40.5%) and emergency department (48.9%) imaging volumes. DISCUSSION: The use of multiple communication channels was critical in relaying the information to all our stakeholders, patients, referring physicians, and the radiology workforce. Teamwork, quick adoption, and adaptation of changing strategies was important given the fluidity of the situation.


title: Self-reported COVID-19 symptoms on Twitter: an analysis and a research resource

text: OBJECTIVE: To mine Twitter and quantitatively analyze COVID-19 symptoms self-reported by users, compare symptom distributions across studies, and create a symptom lexicon for future research. MATERIALS AND METHODS: We retrieved tweets using COVID-19-related keywords, and performed semiautomatic filtering to curate self-reports of positive-tested users. We extracted COVID-19-related symptoms mentioned by the users, mapped them to standard concept IDs in the Unified Medical Language System, and compared the distributions to those reported in early studies from clinical settings. RESULTS: We identified 203 positive-tested users who reported 1002 symptoms using 668 unique expressions. The most frequently-reported symptoms were fever/pyrexia (66.1%), cough (57.9%), body ache/pain (42.7%), fatigue (42.1%), headache (37.4%), and dyspnea (36.3%) amongst users who reported at least 1 symptom. Mild symptoms, such as anosmia (28.7%) and ageusia (28.1%), were frequently reported on Twitter, but not in clinical studies. CONCLUSION: The spectrum of COVID-19 symptoms identified from Twitter may complement those identified in clinical settings.


title: Children's (in)visibility in social vulnerability and the impact of the novel coronavirus (COVID-19)

text: OBJECTIVE: To examine the impact of the infection by the novel coronavirus on Brazilian children in situation of social vulnerability based on the Millennium Sustainable Development Goals. METHOD: Reflective study based on discursive formulation in three aspects: principles of the objectives and goals for the millennium sustainable development; impact of the pandemic on the health of children and their families living in social vulnerability; and the role of pediatric nursing in the care provided - limits and challenges. RESULTS: In January 2020, the news of COVID 19 is released as a pandemic. In Brazil, children and families are still without access to basic rights, thereby increasing their risks of social vulnerability because of the quarantine. The nursing field has an important role in monitoring children and their families, offering guidance in search for solutions and preventing contamination. CONCLUSION: There are still challenges to be overcome by the children and their families in situations of vulnerability against COVID-19.


title: Coronavirus disease 2019: reassembly attack of coronavirus

text: There have been three major global outbreaks of acute respiratory disease caused by coronavirus in the last two decades. The ongoing Coronavirus Disease 2019 (COVID-19) first emerged in Wuhan, China, is the most dangerous, which spread to 163 countries and 6 continents and caused a major public health emergency worldwide. The outbreak is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) originated from bats, which spreads rapidly from human to human. As of 17 March 2020, there have been 179,112 confirmed cases and 7426 deaths worldwide, with a mortality rate of 4.1%. There is currently no effective treatment or approved vaccine, so isolating the source of infection and blocking the routes of transmission is important. In this article, we summarized the worldwide epidemic trend of COVID-19 and discussed its epidemiological characteristics, prevention and control measures. We hope this article could provide experience and help for global epidemic prevention and control.


Mortality, Admissions, and Patient Census at SNFs in 3 US Cities During the COVID-19 Pandemic


Ethical considerations of the duty to care and physician safety in the COVID-19 pandemic


title: A multi-group SEIRA model for the spread of COVID-19 among heterogeneous populations

text: The outbreak and propagation of COVID-19 have posed a considerable challenge to modern society. In particular, the different restrictive actions taken by governments to prevent the spread of the virus have changed the way humans interact and conceive interaction. Due to geographical, behavioral, or economic factors, different sub-groups among a population are more (or less) likely to interact, and thus to spread/acquire the virus. In this work, we present a general multi-group SEIRA model for representing the spread of COVID-19 among a heterogeneous population and test it in a numerical case of study. By highlighting its applicability and the ease with which its general formulation can be adapted to particular studies, we expect our model to lead us to a better understanding of the evolution of this pandemic and to better public-health policies to control it.


Frequency of arrhythmia in novel coronavirus 2019 infection


title: Modified percutaneous tracheostomy in COVID-19 critically ill patients

text: BACKGROUND: Percutaneous tracheostomy (PT) in patients with coronavirus disease (COVID-19) included several critical steps associated with increased risk of aerosol generation. We reported a modified PT technique aiming to minimize the risk of aerosol generation and to increase the staff safety in COVID-19 patients. METHODS: PT was performed with a modified technique including the use of a smaller endotracheal tube (ETT) cuffed at the carina during the procedure. RESULTS: The modified technique we proposed was successfully performed in three critically ill patients with COVID-19. CONCLUSIONS: In COVID-19 critically ill patients, a modified PT technique, including the use of a smaller ETT cuffed at the carina and fiber-optic bronchoscope inserted between the tube and the inner surface of the trachea, may ensure a better airway management, respiratory function, patient comfort, and great safety for the staff.


title: Crosstalk between endoplasmic reticulum stress and anti-viral activities: A novel therapeutic target for COVID-19

text: The outbreak of COVID-19 caused by 2019-nCov/SARS-CoV-2 has become a pandemic with an urgent need for understanding the mechanisms and identifying a treatment. Viral infections including SARS-CoV are associated with increased levels of reactive oxygen species, disturbances of Ca++ caused by unfolded protein response (UPR) mediated by endoplasmic reticulum (ER) stress and is due to the exploitation of virus's own protein i.e., viroporins into the host cells. Several clinical trials are on-going including testing Remdesivir (anti-viral), Chloroquine and Hydroxychloroquine derivatives (anti-malarial drugs) etc. Unfortunately, each drug has specific limitations. Herein, we review the viral protein involvement to activate ER stress transducers (IRE-1, PERK, ATF-6) and their downstream signals; and evaluate combination therapies for COVID-19 mediated ER stress alterations. Melatonin is an immunoregulator, anti-pyretic, antioxidant, anti-inflammatory and ER stress modulator during viral infections. It enhances protective mechanisms for respiratory tract disorders. Andrographolide, isolated from Andrographis paniculata, has versatile biological activities including immunomodulation and determining SARS-CoV-2 binding site. Considering the properties of both compounds in terms of anti-inflammatory, antioxidant, anti-pyrogenic, anti-viral and ER stress modulation and computational approaches revealing andrographolide docks with the SARS-CoV2 binding site, we predict that this combination therapy may have potential utility against COVID-19.


title: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review

text: Importance: The current rapid worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection justifies the global effort to identify effective preventive strategies and optimal medical management. While data are available for adult patients with coronavirus disease 2019 (COVID-19), limited reports have analyzed pediatric patients infected with SARS-CoV-2. Objective: To evaluate currently reported pediatric cases of SARS-CoV-2 infection. Evidence Review: An extensive search strategy was designed to retrieve all articles published from December 1, 2019, to March 3, 2020, by combining the terms coronavirus and coronavirus infection in several electronic databases (PubMed, Cochrane Library, and CINAHL), and following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Retrospective cross-sectional and case-control studies, case series and case reports, bulletins, and national reports about the pediatric SARS-CoV-2 infection were included. The risk of bias for eligible observational studies was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline. Findings: A total of 815 articles were identified. Eighteen studies with 1065 participants (444 patients were younger than 10 years, and 553 were aged 10 to 19 years) with confirmed SARS-CoV-2 infection were included in the final analysis. All articles reflected research performed in China, except for 1 clinical case in Singapore. Children at any age were mostly reported to have mild respiratory symptoms, namely fever, dry cough, and fatigue, or were asymptomatic. Bronchial thickening and ground-glass opacities were the main radiologic features, and these findings were also reported in asymptomatic patients. Among the included articles, there was only 1 case of severe COVID-19 infection, which occurred in a 13-month-old infant. No deaths were reported in children aged 0 to 9 years. Available data about therapies were limited. Conclusions and Relevance: To our knowledge, this is the first systematic review that assesses and summarizes clinical features and management of children with SARS-CoV-2 infection. The rapid spread of COVID-19 across the globe and the lack of European and US data on pediatric patients require further epidemiologic and clinical studies to identify possible preventive and therapeutic strategies.


Will children reveal their secret? The coronavirus dilemma


The show must go on


title: Redefining diabetic foot disease management service during COVID-19 pandemic

text: BACKGROUND & AIMS: Diabetic Foot Disease (DFD) management had to be redefined during COVID-19. We aim to evaluate the impact of this on diabetic foot care services and the strategies adopted to mitigate them. METHODS: We have performed a comprehensive review of the literature using suitable keywords on the Search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first two weeks of May 2020. We have reviewed how the diabetic foot service in the hospital and community setting has been affected by the current Coronavirus outbreak. RESULTS: We found considerable disruption in diabetic foot service provisions both in the primary care and in the hospital settings. Social distancing and shielding public health guidelines have impacted the delivery of diabetic foot services. CONCLUSION: As the COVID-19 pandemic spreads worldwide, health care systems are facing the tough challenges in delivering diabetic foot service to patients. Public health guidelines and the risk of virus transmission have resulted in reconfiguration of methods to support and manage diabetic foot patients including remote consultations.


title: Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms

text: We investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination in 2 rooms of a quarantine hotel after 2 presymptomatic persons who stayed there were laboratory-confirmed as having coronavirus disease. We detected SARS-CoV-2 RNA on 8 (36%) of 22 surfaces, as well as on the pillow cover, sheet, and duvet cover.


title: It's a small world after all: A Canadian resident's perspective on COVID-19

text: COVID-19 has infected millions of people, with an estimated total dead in the hundreds of thousands. This has significantly impacted health care, including who is delivering it, how it is delivered, and how it is taught. This article describes challenges of the COVID-19 pandemic from the perspective of a Canadian nuclear medicine resident, including new risks with nuclear imaging, navigating new and sometimes challenging guidelines, as well as working and living within the confines of social distancing.


Changes in the interaction of ophthalmologists and ophthalmic industry during and after COVID-19 lockdown: A perspective


title: Acute upper limb ischemia in a patient with COVID-19

text: Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection mainly present with upper and lower respiratory tract symptoms, with complications related to cytokine storm syndrome and acute respiratory distress syndrome. It has also been described to predispose to venous and arterial thromboembolism; however, limited published data is available regarding thrombosis in coronavirus disease 2019 (COVID-19). Here we are presenting a case of arterial thrombosis in a patient with COVID-19 and a systematic review on coagulopathy associated with COVID-19.


title: A Systematic Review of CT Chest in COVID-19 Diagnosis and its Potential Application in a Surgical Setting

text: AIM: To investigate the sensitivity and utility of computed tomography (CT) of the chest in diagnosing active Coronavirus 2019 (COVID-19) infection, and its potential application to the surgical setting. METHODS: A literature review was conducted using Google Scholar® and MEDLINE®/PubMed® to identify current available evidence regarding the sensitivity of CT chest in comparison to RT-PCR for diagnosis of COVID-19 positive patients. GRADE criteria and the QUADAS 2 tool was used to assess the level of evidence. RESULTS: A total of 20 articles were identified that addressed the question of sensitivity of CT for diagnosis of COVID-19 positive symptomatic and asymptomatic patients. Overall sensitivity of CT scan ranged from 57%-100% for symptomatic and 46%-100% for asymptomatic COVID-19 patients, while that of RT-PCR ranged from 39%-89%. CT chest was a better diagnostic modality and capable of detecting active infection earlier in the time course of infection than RT-PCR in symptomatic patients. In asymptomatic patients, disease prevalence seems to play a role in the positive predictive value. Minimal evidence exists regarding the sensitivity of CT in patients who are asymptomatic. CONCLUSIONS: In surgical patients, CT Chest should be considered as an important adjunct for detection of COVID-19 infection in patients who are symptomatic with negative RT-PCR prior to any operation. For surgical patients who are asymptomatic, there is insufficient evidence to recommend routine preoperative CT Chest for COVID-19 screening.


title: Management of the COVID-19 epidemic by public health establishments-Analysis by the Fédération Hospitalière de France

text: The objective of this article is to detail the measures taken in public institutions to cope with the COVID-19 epidemic. It details the initial strategy, organizational evolution towards "all-COVID", coordination between the various stakeholders and the strategy for maintaining continuity of care. The Quebec experience is also used as an example. Finally, an exit strategy must be anticipated at this phase of the epidemic.


title: Palliative Care Team Involvement in Patients With COVID-19 in New York City

text: BACKGROUND: With the highest number of cases in the world as of April 13, 2020, New York City (NYC) became the epicenter of the global coronavirus disease 2019 (COVID-19) pandemic. The data regarding palliative team involvement in patients with COVID-19, however, remains scarce. We aimed to investigate outcomes of palliative team involvement for the patients with COVID-19 in NYC. METHODS: Consecutive 225 patients with confirmed COVID-19 requiring hospitalization in our urban academic medical center in NYC were analyzed. Patients were divided into 2 groups, those with a palliative care consult (palliative group: 14.2% [n = 32]) versus those with no palliative care consult (no palliative group: 85.8% [n = 193]). RESULTS: The palliative group was older and had more comorbidities. During the hospital course, the palliative group had more intensive care unit stays, rapid response team activations, and more use of vasopressors (P < .05). Patients with palliative care had higher rates of invasive mechanical ventilation than those without (46.9% vs 10.4%, P < .001). Cardiopulmonary resuscitation was performed in 12 patients (6.5% vs 5.2%, P = .77) and death rate was 100% in both subsets. Notably, initial code status was not different between the 2 groups, however, code status at discharge was significantly different between them (P < .001). The rate of full code decreased by 70% in the palliative group and by 47.5% in the no palliative care group from admission to the time of death. CONCLUSIONS: Critically ill patients hospitalized for COVID-19 benefit from palliative team consults by helping to clarify advanced directives and minimize futile resuscitative efforts.


'We are always lagging behind the facts': Experiences from the general practice at the time of COVID-19


Radiotherapy & Oncology during the COVID-19 pandemic


A clinicopathological study of eight patients with COVID-19 pneumonia and a late-onset exanthema


title: The clinics of HHV-6 infection in COVID-19 pandemic: Pityriasis rosea and Kawasaki disease

text: A new type of coronavirus family (SARS-CoV-2), which can be found in humans and animals, with many varieties and clinical symptoms, was first seen in Wuhan, China in late 2019, under the name novel Coronavirus Disease 2019 (COVID-19). In the literature, cutaneous symptoms related to the disease are generally emphasized. However, it is not yet known whether this new SARS-CoV-2 virus, which has entered our lives, plays a role in the etiopathogenesis of dermatological diseases. The patients who were admitted to the dermatology outpatient clinic between 1 April and 15 May 2019, and on 1 April and 15 May 2020 were retrospectively analyzed by searching the hospital automation system and patient files. The reason for the same months to be included in the study was to exclude seasonal effects on the diseases. After pandemic, the number of patients with Pityriasis rosea and Kawasaki disease increased significantly in patients who applied to the dermatology outpatient clinic. Our study is the first study showing Pityriasis rosea increase during the pandemic period. We think that this increase is related to HHV-6 reactivation. Herein, we wanted to draw attention to two diseases in which Human Herpes 6 (HHV-6) was accused in etiopathogenesis: Kawasaki disease and Pityriasis rosea.


title: Evidence of Increasing Diversification of Emerging SARS-CoV-2 Strains

text: BACKGROUND: On January 30th, 2020, an outbreak of atypical pneumonia caused by a novel Betacoronavirus (ßCoV), named SARS-CoV-2, was declared a public health emergency of international concern by the World Health Organization. For this reason, a detailed evolutionary analysis of SARS-CoV-2 strains currently circulating in different geographic regions of the world was performed. METHODS: A compositional analysis as well as a Bayesian coalescent analysis of complete genome sequences of SARS-CoV-2 strains recently isolated in Europe, North America, South America and Asia was performed. RESULTS: The results of these studies revealed a diversification of SARS-CoV-2 strains in three different genetic clades. Co-circulation of different clades in different countries, as well as different genetic lineages within different clades were observed. The time of the most recent common ancestor (tMRCA) was established to be around November 1, 2019. A mean rate of evolution of 6.57 x 10-4 substitutions per site per year was found. A significant migration rate per genetic lineage per year from Europe to South America was also observed. CONCLUSION: The results of these studies revealed an increasing diversification of SARS-CoV-2 strains. High evolutionary rates and fast population growth characterizes the population dynamics of SARS-CoV-2 strains. This article is protected by copyright. All rights reserved.


title: [Screening for novel coronavirus related conjunctivitis among the patients with corona virus disease-19]

text: Objective: Screening for novel coronavirus related conjunctivitis among the patients with coronavirus disease-19. Methods: Prospective series case study. Eighty-one patients diagnosed as coronavirus disease-19 in Guangxi Zhuang Autonomous Region People's Hospital were enrolled with ophthalmological consultation screening for novel coronavirus related conjunctivitis, including the inquiring of eye symptoms and checking for conjunctivitis-related signs. Conjunctival swab novel coronavirus nucleic acid test was performed on patients with clinical manifestation of conjunctivitis. Results: Only 3 of the 81 patients (3.70%) complained of eye discomfort, which appeared on the day 16.67±9.29 after the diagnosis of coronavirus disease-19. The eye signs did not meet the characteristics of viral conjunctivitis. Bilateral conjunctival swab novel coronavirus nucleic acid tests were negative. There was no evidence to support the diagnosis of novel coronavirus related conjunctivitis. Screening of clinical symptoms and signs of conjunctivitis in the remaining 78 patients showed no significant abnormalities. Conclusions: There wasn't any novel coronavirus related conjunctivitis in 81 patients with coronavirus disease-19.(Chin J Ophthalmol, 2020, 56:).


Validity of the UK early access to medicines scheme criteria for Remdesivir use in patients with COVID-19 disease


Utilising multiplex PCR technology for rapid microbial diagnosis in hand and upper limb infections


title: What is the next innovation after the internet of things?

text: The world had witnessed several generations of the Internet. Starting with the Fixed Internet, then the Mobile Internet, scientists now focus on many types of research related to the"Thing"Internet (or Internet of Things). The question is"what is the next Internet generation after the Thing Internet?"This paper envisions about the Tactile Internet which could be the next Internet generation in the near future. The paper will introduce what is the tactile internet, why it could be the next future Internet, as well as the impact and its application in the future society. Furthermore, some challenges and the requirements are presented to guide further research in this near future field.


Inducing senescence sensitizes pancreatic tumours to therapies


title: Clinical Validity of Serum Antibodies to SARS-CoV-2: A Case-Control Study

text: BACKGROUND: The clinical utility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies remains undefined. OBJECTIVE: To determine the clinical validity and utility of SARS-CoV-2 antibodies. DESIGN: Case-control study. SETTING: First month of testing for coronavirus disease 2019 (COVID-19) by using a nucleic acid amplification test (NAAT) on nasopharyngeal swabs at the Johns Hopkins Hospital, Baltimore, Maryland (11 066 persons). PARTICIPANTS: Of the 11 066 tested persons, 115 (1%) were hospitalized adults investigated for COVID-19. Clinical record review was performed to classify them into a COVID-19 case group (n = 60) or a non-COVID-19 control group (n = 55). The laboratory control groups comprised 513 persons not tested by NAAT: 160 healthy laboratory employees, 101 persons positive for IgG antibodies against Epstein-Barr virus capsid antigen, 215 positive for thyroperoxidase antibody, and 37 positive for rheumatoid factor. MEASUREMENTS: Serum IgG and IgA antibodies against SARS-CoV-2 spike protein were detected by using enzyme-linked immunosorbent assay. RESULTS: Sensitivity and specificity of the SARS-CoV-2 IgG assay were 0.976 (95% CI, 0.928 to 0.995) and 0.988 (CI, 0.974 to 0.995), respectively, when performed 14 days or later after symptom onset, but sensitivity decreased at earlier time points. Immunoglobulin G developed rapidly and was sustained at high levels throughout follow-up (up to 58 days). Antibodies to SARS-CoV-2 predicted the odds of developing acute respiratory distress syndrome, which increased by 62% (CI, 48% to 81%; P < 0.001) for every 2-fold increase in IgG. Of 11 066 NAAT-tested patients, 457 were repeatedly NAAT-negative, and serum samples were obtained for 18 such patients: 6 COVID-19 case patients and 12 non-COVID-19 control patients. Antibodies were present in 5 of 6 case patients and none of the 12 control patients (P = 0.001). LIMITATIONS: The study was retrospective and performed at a single-center; the sample was small; follow-up was limited; and selection bias may have occurred. CONCLUSION: Antibodies to SARS-CoV-2 demonstrate infection when measured at least 14 days after symptom onset, associate with clinical severity, and provide valuable diagnostic support in patients who test negative by NAAT but remain clinically suspicious for COVID-19. PRIMARY FUNDING SOURCE: Clinical Immunology Laboratory, Department of Pathology, Johns Hopkins Hospital.


Age, "Life-Cycles," and the Allocation of Scarce Medical Resources∗


title: Clinical Features of COVID-19-Related Liver Functional Abnormality

text: BACKGROUND & AIMS: Some patients with SARS-CoV-2 infection have abnormal liver function. We aimed to clarify the features of COVID-19-related liver damage to provide references for clinical treatment. METHODS: We performed a retrospective, single-center study of 148 consecutive patients with confirmed COVID-19 (73 female, 75 male; mean age, 50 years) at the Shanghai Public Health Clinical Center from January 20 through January 31, 2020. Patient outcomes were followed until February 19, 2020. Patients were analyzed for clinical features, laboratory parameters (including liver function tests), medications, and length of hospital stay. Abnormal liver function was defined as increased levels of alanine and aspartate aminotransferase, gamma glutamyltransferase, alkaline phosphatase, and total bilirubin. RESULTS: Fifty-five patients (37.2%) had abnormal liver function at hospital admission; 14.5% of these patients had high fever (14.5%), compared with 4.3% of patients with normal liver function (P = .027). Patients with abnormal liver function were more likely to be male, and had higher levels of procalcitonin and C-reactive protein. There was no statistical difference between groups in medications taken before hospitalization; a significantly higher proportion of patients with abnormal liver function (57.8%) had received lopinavir/ritonavir after admission compared to patients with normal liver function (31.3%). Patients with abnormal liver function had longer mean hospital stays (15.09 ± 4.79 days) than patients with normal liver function (12.76 ± 4.14 days) (P = .021). CONCLUSIONS: More than one third of patients admitted to the hospital with SARS-CoV-2 infection have abnormal liver function, and this is associated with longer hospital stay. A significantly higher proportion of patients with abnormal liver function had received lopinavir/ritonavir after admission; these drugs should be given with caution.


title: COVID-19 and tuberculosis: A mathematical model based forecasting in Delhi, India

text: BACKGROUND: There is emerging evidence that patients with Latent Tuberculosis Infection(LTBI) and Tuberculosis(TB) disease have an increased risk of the SARS-CoV-2 infection and predisposition towards developing severe COVID-19 pneumonia. In this study we attempted to estimate the number of TB patients infected with SARS-CoV-2 and have severe disease during the COVID-19 epidemic in Delhi, India. METHODS: Susceptible-Exposed-Infectious-Recovered (SEIR) model was used to estimate the number of COVID-19 cases in Delhi. Assuming the prevalence of TB in Delhi to be 0.55%, 53% of SARS-CoV2 infected TB cases to present with severe disease we estimated the number of SARS-CoV2 infected TB cases and the number of severe patients. The modelling used estimated R0 for two scenarios, without any intervention and with public health interventions. RESULTS: We observed that the peak of SARS-CoV-2-TB co-infected patients would occur on the 94th day in absence of public health interventions and on 138th day in presence of interventions. There could be 20,880 SARS-CoV-2 infected TB cases on peak day of epidemic when interventions are implemented and 27,968 cases in the absence of intervention. Among them, there could be 14,823 patients with severe disease when no interventions are implemented and 11,066 patients with severe disease in the presence of intervention. CONCLUSION: The importance of primary prevention measures needs to be emphasized especially in TB patients. The TB treatment centres and hospitals needs to be prepared for early diagnosis and management of severe COVID-19 in TB patients.


Budgeting for covid-19: changing the narrative and narrating the change


The Materials Genome and COVID-19 Pandemic


title: Influenza vaccination in the COVID-19 era

text: Influenza spreads globally annually with significant paediatric and adult attack rates and considerable morbidity, mortality and the exacerbation of extant chronic disease. In the northern and southern hemispheres, outbreaks occur mainly in the respective winter seasons. Influenza vaccination is available but only partially effective. In the absence of a vaccine, in winter, novel coronavirus COVID-19 will also circulate in parallel with seasonal influenza. Thus far it appears that with the current strains of these two viruses, the clinical outcome of co-infection is not significantly worse than infection with COVID-19 alone. However, several strains of influenza circulate, including strains still to come. Similarly, COVID-19 has several strains, with probably more to come. This paper discusses these issues and estimates ideal minimum influenza vaccination coverage based on an estimated influenza Basic Reproduction Number (R0) of 0.9-2.1 so as to obtain herd immunity or approach it. There is a strong argument for attempting near universal population coverage with the annual influenza vaccine leading up to next winter.


The preventive strategies of GI physicians during the COVID-19 pandemic


Incidentally Diagnosed COVID-19 Infection in Trauma Patients;a Clinical Experience


Covid-19: Contact tracing requires ending the hostile environment


In reply: Physical distancing or social distancing: that is the question


title: Assessment of SARS-CoV-2 in human semen-a cohort study

text: OBJECTIVE: To investigate the presence of viral RNA in human semen of patients with severe acute-respiratory syndrome coronavirus 2 (SARS-CoV-2) and to evaluate its presence and relevance in semen parameters. DESIGN: Pilot cohort study. SETTING: University hospital. PATIENT(S): Thirty-four men were distributed as: 1) patients in convalescence (patients with confirmed SARS-CoV-2 infection in pharyngeal swab according to reverse-transcription polymerase chain reaction [RT-PCR] or antibodies); 2) negative control group (no antibodies); and 3) patients with an acute infection (detection of SARS-CoV-2 in pharyngeal swab). INTERVENTION: Semen and a blood sample were collected from each individual. MAIN OUTCOME MEASURE(S): Analysis of semen quality according to the World Health Organization standards. Detection of SARS-CoV-2 by RT-PCR in the native semen sample and after density gradient preparation. Confirmation of immunoglobulin (Ig) A und IgG antibodies in the blood. RESULT(S): Eighteen semen samples from recovered men were obtained 8-54 days after absence of symptoms, 14 from control subjects, and 2 from patients with an active COVID-19 infection. No RNA was detected by means of RT-PCR in the semen, including semen samples from two patients with an acute COVID-19 infection. Subjects with a moderate infection showed an impairment of sperm quality. CONCLUSION(S): A mild COVID-19 infection is not likely to affect testis and epididymis function, whereas semen parameters did seem impaired after a moderate infection. SARS-CoV-2 RNA could not be detected in semen of recovered and acute COVID-19-positive men. This suggests no viral transmission during sexual contact and assisted reproductive techniques, although further data need to be obtained.


Mental health effects of school closures during COVID-19


title: [Response plan in the neonatal intensive care unit during epidemic of SARS-CoV-2 infection (2nd Edition)]

text: Since December 2019, an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread from China to other countries. In order to effectively respond to possible neonatal SARS-CoV-2 infection, neonatologists from the Medical Association of Chinese People's Liberation Army and the Editorial Committee of Chinese Journal of Contemporary Pediatrics proposed the response plan in the neonatal intensive care unit during epidemic of SARS-CoV-2 infection (1st edition) at the end of January of 2020. Based on the further knowledge and experience on SARS-CoV-2 infection, the neonatologists updated the plan according to the current evidence, so as to provide a better guide for clinical medical staff to deal with the SARS-CoV-2 infection in the NICU.


title: Imaging Features of Coronavirus disease 2019 (COVID-19): Evaluation on Thin-Section CT

text: RATIONALE AND OBJECTIVES: To retrospectively analyze the chest imaging findings in patients with coronavirus disease 2019 (COVID-19) on thin-section CT. MATERIALS AND METHODS: Fifty-three patients with confirmed COVID-19 infection underwent thin-section CT examination. Two chest radiologists independently evaluated the imaging in terms of distribution, ground-glass opacity (GGO), consolidation, air bronchogram, stripe, enlarged mediastinal lymph node, and pleural effusion. RESULTS: Fourty-seven cases (88.7%) had findings of COVID-19 infection, and the other six (11.3%) were normal. Among the 47 cases, 78.7% involved both lungs, and 93.6% had peripheral infiltrates distributed along the subpleural area. All cases showed GGO, 59.6% of which were round and 40.4% patchy. Other imaging features included "crazy-paving pattern" (89.4%), consolidation (63.8%), and air bronchogram (76.6%). Air bronchograms were observed within GGO (61.7%) and consolidation (70.3%). Neither enlarged mediastinal lymph nodes nor pleural effusion were present. Thirty-three patients (62.3%) were followed an average interval of 6.2 ± 2.9 days. The lesions increased in 75.8% and resorbed in 24.2% of patients. CONCLUSION: COVID-19 showed the pulmonary lesions in patients infected with COVID-19 were predominantly distributed peripherally in the subpleural area.


Telephone-based postoperative surveillance protocol for hepatobiliary cancer during the COVID-19 outbreak


A case of coronavirus disease 2019 (COVID-19) presenting after coronary artery bypass grafting


title: Posttraumatic stress symptoms of health care workers during the corona virus disease 2019

text: Corona virus disease 2019 (COVID-19) outbreak has attracted worldwide attention. The COVID-19 outbreak is unique in its rapid transmission and results in heavy stress for the front-line health care workers (HCWs). The current study aimed to exam posttraumatic stress symptoms (PTSSs) of HCWs fighting for the COVID-19 and to evaluate their sleep quality after 1-month stressful suffering. Three hundred seventy-seven HCWs working in different provinces of China participated in the survey between February 1 and 5. The demographic information was collected first. Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Pittsburgh Sleep Quality Index (PSQI) were selected to measure PTSSs and sleep quality. Results showed that 1 month after the outbreak, the prevalence of PTSSs was 3.8% in HCWs. Female HCWs were more vulnerable to PTSSs with hazard ratio of 2.136 (95% CI = 1.388-3.286). HCWs with higher exposure level also significantly rated more hyperarousal symptoms (hazard ratio = 4.026, 95% CI = 1.233-13.140). There was a significant difference of sleep quality between participants with and without PTSSs (z value = 6.014, p < .001) and among different groups with various contact frequencies (chi-square = 7.307, p = .026). Path analysis showed that there was a significant indirect effect from exposure level to PTSSs through sleep quality (coefficient = 1.750, 95% CI of Boostroop test = 0.543-2.998). In summary, targeted interventions on sleep contribute to the mental recovery during the outbreak of COVID-19. Understanding the mental health response after a public health emergency might help HCWs and communities prepare for a population's response to disaster.


The Landscape of Medical Literature in the Era of COVID-19: Original Research Versus Opinion Pieces


title: Optic nerve analysis in COVID-19 patients

text: We read with great interest the recent article of Baig and Sanders1 regarding the neurological manifestations and the possible neuroinvasive routes opted by SARS-CoV-2. We congratulate the authors for their excellent review. This article is protected by copyright. All rights reserved.


title: [Severe inflammation in children - cause for awareness during the current pandemic]

text: Clinical manifestations of COVID-19 in children are generally mild and many are asymptomatic However, recent international reports have described clusters of children presenting with an unusual syndrome of high, persistent fever, severe inflammation and single- or multiorgan dysfunction, with a suspected association to COVID-19 pandemic It is recommended that clinicians are aware of this rare syndrome and that suspected cases are treated in a multidisciplinary setting


title: Severe inflammation in children - cause for awareness during the current pandemic/ Hyperinflammation hos barn kan ha samband med covid-19


title: Diagnosis of COVID-19 pneumonia despite missing detection of viral nucleic acid and initially inconspicuous radiologic findings

text: The diagnosis of coronavirus disease 2019 (COVID-19) is mainly based on a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) result. PCR samples are obtained from upper or lower respiratory tract specimens. However, the sensitivity of PCR is known to have some limitations. We report on a patient who was admitted to our hospital with dyspnea, fever, cough, and history of contact with a SARS-CoV-2 infected relative. The initial chest computed tomography (CT) showed only minimal changes and SARS-CoV-2 PCR from a nasopharyngeal swab sample was negative. PCR results obtained from further nasopharyngeal swabs, qualified sputum samples, and from a lower respiratory tract specimen also remained negative. At day 13 after admission, a second chest CT showed radiological findings suspicious for viral pneumonia. Finally, serologic results showed high levels of immunoglobulin G and immunoglobulin A antibodies against the S1 domain of the SARS-CoV-2 spike protein, and the patient was diagnosed with COVID-19 pneumonia.


Training Oncologists in the Time of COVID-19


Modified mask for aesthetic procedures on face during COVID-19 era: Chiseling our armamentarium


title: NewsStand CoronaViz: A Map Query Interface for Spatio-Temporal and Spatio-Textual Monitoring of Disease Spread

text: With the rapid continuing spread of COVID-19, it is clearly important to be able to track the progress of the virus over time in order to be better prepared to anticipate its emergence and spread in new regions as well as declines in its presence in regions thereby leading to or justifying"reopening"decisions. There are many applications and web sites that monitor officially released numbers of cases which are likely to be the most accurate methods for tracking the progress of the virus; however, they will not necessarily paint a complete picture. To begin filling any gaps in official reports, we have developed the NewsStand CoronaViz web application (https://coronaviz.umiacs.io) that can run on desktops and mobile devices that allows users to explore the geographic spread in discussions about the virus through analysis of keyword prevalence in geotagged news articles and tweets in relation to the real spread of the virus as measured by confirmed case numbers reported by the appropriate authorities. NewsStand CoronaViz users have access to dynamic variants of the disease-related variables corresponding to the numbers of confirmed cases, active cases, deaths, and recoveries (where they are provided) via a map query interface. It has the ability to step forward and backward in time using both a variety of temporal window sizes (day, week, month, or combinations thereof) in addition to user-defined varying spatial window sizes specified by direct manipulation actions (e.g., pan, zoom, and hover) as well as textually (e.g., by the name of the containing country, state or province, or county as well as textually-specified spatially-adjacent combinations thereof), and finally by the amount of spatio-temporally-varying news and tweet volume involving COVID-19.


title: Challenges of Covid-19 testing

text: No abstract available.


Safer intubation and extubation of patients with COVID-19


Bailout-Coil-Embolisation der Arteria vertebralis bei Gefäßverletzung und lebensbedrohender Blutung als Komplikation eines neurochirurgischen Eingriffs


Doctors and healthcare workers at frontline of COVID 19 epidemic: Admiration, a pat on the back, and need for extreme caution


title: A New Drug-Drug Interaction Between Hydroxychloroquine and Metformin? A Signal Detection Study

text: INTRODUCTION: Hydroxychloroquine was recently promoted in patients infected with COVID-19 infection. A recent experimental study has suggested an increased toxicity of hydroxychloroquine in association with metformin in mice. OBJECTIVE: The present study was undertaken to investigate the reality of this putative drug-drug interaction between hydroxychloroquine and metformin using pharmacovigilance data. METHODS: Using VigiBase®, the WHO pharmacovigilance database, we performed a disproportionality analysis (case/non-case study). Cases were reports of fatal outcomes with the drugs of interest and non-cases were all other reports for these drugs registered between 1 January 2000 and 31 December 2019. Data with hydroxychloroquine (or metformin) alone were compared with the association hydroxychloroquine + metformin. Results are reported as ROR (reporting odds ratio) with their 95% confidence interval. RESULTS: Of the 10,771 Individual Case Safety Reports (ICSR) involving hydroxychloroquine, 52 were recorded as 'fatal outcomes'. In comparison with hydroxychloroquine alone, hydroxychloroquine + metformin was associated with an ROR value of 57.7 (23.9-139.3). In comparison with metformin alone, hydroxychloroquine + metformin was associated with an ROR value of 6.0 (2.6-13.8). CONCLUSION: Our study identified a signal for the association hydroxychloroquine + metformin that appears to be more at risk of fatal outcomes (particularly by completed suicides) than one of the two drugs when given alone.


Covid-19: scientific advisers must do more than just voice their concerns behind closed doors


title: Gastrointestinal manifestations of COVID-19

text: Gastrointestinal (GI) symptoms are seen in patients with COVID-19. The prevalence could be as high as 50%, but most studies show ranges from 16% to 33%. Presenting with GI symptoms increases the risk of testing positive for SARs-CoV-2. Approximately 50% of patients with COVID-19 have detectable virus in their stool. Having GI symptoms has been associated with more severe disease. Management of GI symptoms is mainly supportive, given the lack of FDA-approved treatments for COVID-19. Healthcare providers should be aware of the GI manifestations of COVID-19 and perform SARS-CoV-2 testing for patients presenting with digestive changes, especially in those with respiratory symptoms.


title: Characterization of heparin and severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) spike glycoprotein binding interactions

text: Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has resulted in a pandemic and continues to spread around the globe at an unprecedented rate. To date, no effective therapeutic is available to fight its associated disease, COVID-19. Our discovery of a novel insertion of glycosaminoglycan (GAG)-binding motif at S1/S2 proteolytic cleavage site (681-686 (PRRARS)) and two other GAG-binding-like motifs within SARS-CoV-2 spike glycoprotein (SGP) led us to hypothesize that host cell surface GAGs may interact SARS-CoV-2 SGPs to facilitate host cell entry. Using a surface plasmon resonance direct binding assay, we found that both monomeric and trimeric SARS-CoV-2 spike bind more tightly to immobilized heparin (KD = 40 pM and 73 pM, respectively) than the SARS-CoV and MERS-CoV SGPs (500 nM and 1 nM, respectively). In competitive binding studies, the IC50 of heparin, tri-sulfated non-anticoagulant heparan sulfate, and non-anticoagulant low molecular weight heparin against SARS-CoV-2 SGP binding to immobilized heparin were 0.056 µM, 0.12 µM, and 26.4 µM, respectively. Finally, unbiased computational ligand docking indicates that heparan sulfate interacts with the GAG-binding motif at the S1/S2 site on each monomer interface in the trimeric SARS-CoV-2 SGP, and at another site (453-459 (YRLFRKS)) when the receptor-binding domain is in an open conformation. The current study serves a foundation to further investigate biological roles of GAGs in SARS-CoV-2 pathogenesis. Furthermore, our findings may provide additional basis for further heparin-based interventions for COVID-19 patients exhibiting thrombotic complications.


The Importance of Physical Activity to Care for Frail Older Adults During the COVID-19 Pandemic


title: Coronavirus Disease 2019 (COVID-19) Pandemic Implications in Pediatric and Adult Congenital Heart Disease

text: The corona virus disease -2019 (COVID-19) is a recently described infectious disease caused by the severe acute respiratory syndrome corona virus 2 with significant cardiovascular implications. Given the increased risk for severe COVID-19 observed in adults with underlying cardiac involvement, there is concern that patients with pediatric and congenital heart disease (CHD) may likewise be at increased risk for severe infection. The cardiac manifestations of COVID-19 include myocarditis, arrhythmia and myocardial infarction. Importantly, the pandemic has stretched health care systems and many care team members are at risk for contracting and possibly transmitting the disease which may further impact the care of patients with cardiovascular disease. In this review, we describe the effects of COVID-19 in the pediatric and young adult population and review the cardiovascular involvement in COVID-19 focusing on implications for patients with congenital heart disease in particular.


Faith, Politics and the COVID-19 Pandemic: The Turkish Response


title: A Poisson Kalman filter for disease surveillance

text: An optimal filter for Poisson observations is developed as a variant of the traditional Kalman filter. Poisson distributions are characteristic of infectious diseases, which model the number of patients recorded as presenting each day to a health care system. We develop both a linear and nonlinear (extended) filter. The methods are applied to a case study of neonatal sepsis and postinfectious hydrocephalus in Africa, using parameters estimated from publicly available data. Our approach is applicable to a broad range of disease dynamics, including both noncommunicable and the inherent nonlinearities of communicable infectious diseases and epidemics.


Response letter: Handling of COVID-19 positive lung cancer patients during the pandemic


Editorial: A COVID-19 Support Platform for Long Term Care Facilities


A strategy for management of ECT patients during the COVID-19 pandemic


Immune evasion via SARS-CoV-2 ORF8 protein?


CoronaVirus Disease 2019: Withdrawing Mechanical Ventilation to Reallocate Life Support Under Crisis Standards of Care-Nonequivalence of the Equivalence Thesis


Isolation and Growth Characteristics of SARS-CoV-2 in Vero Cell


COVID 19: Surgery & the question of race


Towards a better world after COVID-19


The thromboembolic risk in covid-19 women under hormonal treatment group


CAPACITY-COVID: a European Registry to determine the role of cardiovascular disease in the COVID-19 pandemic


Procalcitonin for patient stratification and identification of bacterial co-infection in COVID-19


COVID-19: the new challenge for rheumatologists


title: Insights in Public Health: COVID-19 Special Column: The Crisis of Non-Communicable Diseases in the Pacific and the Coronavirus Disease 2019 Pandemic

text: Globally, coronavirus disease 2019 (COVID-19) is threatening human health and changing the way people live. With the increasing evidence showing comorbidities of COVID-19 and non-communicable diseases (NCDs), the Pacific region, where approximately 75% of deaths are due to NCDs, is significantly vulnerable during this crisis unless urgent action is taken. Whilst enforcing the critical mitigation measures of the COVID-19 pandemic in the Pacific, it is also paramount to incorporate and strengthen NCD prevention and control measures to safeguard people with NCDs and the general population; keep people healthy and minimise the impact of COVID-19. To sustain wellbeing of health, social relationships, and the economy in the Pacific, it is a critical time for all governments, development partners and civil societies to show regional solidarity in the fight against emerging COVID-19 health crisis and existing Pacific NCDs crisis through a whole of government and whole of society approach.


title: Prompt Predicting of Early Clinical Deterioration of Moderate-to-Severe COVID-19 Patients: Usefulness of a Combined Score Using IL-6 in a Preliminary Study

text: BACKGROUND: The early identification of patients at risk of clinical deterioration is of interest considering the timeline of COVID-19 after the onset of symptoms. OBJECTIVE: The aim of our study was to evaluate the usefulness of testing serum IL-6 and other serological and clinical biomarkers, to predict a short-term negative clinical course of patients with noncritical COVID-19. METHODS: A total of 208 patients with noncritical COVID-19 pneumonia at admission were consecutively enrolled. Clinical and laboratory findings obtained on admission were analyzed by using survival analysis and stepwise logistic regression for variable selection. Three-day worsening as outcome in a logistic model to generate a prognostic score was used. RESULTS: Clinical worsening occurred in 63 patients (16 = died; 39 = transferred to intensive care unit; 8 worsening of respiratory failure). Forty-five of them worsened within 3 days after admission. The risk of clinical worsening was progressively enhanced along with increasing quartiles of IL-6 levels. Multivariate analysis showed that IL-6 (P = .005), C-reactive protein (CRP) (P = .003), and SaO2/FiO2 (P = .014) were the best predictors for clinical deterioration in the first 3 days after admission. The combined score yielded an area under the curve = 0.88 (95% confidence interval: 0.83-0.93). A nomogram predicting the probability of 3-day worsening was generated. The score also showed good performance for 7-day and 14- or 21-day worsening and in predicting death occurring during all the follow-up. CONCLUSIONS: Combining IL-6, CRP, and SaO2/FiO2 in a score may help clinicians to identify on admission those patients with COVID-19 who are at high risk for a further 3-day clinical deterioration.


title: Managing anticoagulation in the COVID-19 era between lockdown and reopening phases

text: Patients on anticoagulant treatment are constantly increasing, with an estimated prevalence in Italy of 2% of the total population. The recent spreadout of the COVID-19 pandemic requires a re-organization of Anticoagulation Clinics to prevent person-to-person viral diffusion and continue to offer the highest possible quality of assistance to patients. In this paper, based on the Italian Federation of Anticoagulation Clinics statements, we offer some advice aimed at improving patient care during COVID-19 pandemic, with particular regard to the lockdown and reopening periods. We give practical guidance regarding the following points: (1) re-thinking the AC organization, (2) managing patients on anticoagulants when they become infected by the virus, (3) managing anticoagulation surveillance in non-infected patients during the lockdown period, and (4) organizing the activities during the reopening phases.


title: Psychological impact of COVID-19 in Spain: Early data report

text: By the end of March 2020, Spain was one of the countries most affected by the COVID-19 pandemic. This commentary provides an initial picture of the psychological impact of the COVID-19 outbreak during its initial stage in Spain. Data of 3055 participants aged 18-88 years old were collected over a week (March 17th-24th 2020) using an online forms platform. Participants provided information regarding sociodemographic data and completed the Spanish version of the Impact of Event Scale-Revised, which assesses psychological distress caused by a traumatic life event in terms of three symptomatic responses (avoidance, intrusion, and hyperarousal). Results revealed that 36.6% of participants showed psychological distress due to the COVID-19 pandemic. Avoidance was the most prevalent symptom in the total sample and for all genders studied. The psychological impact was consistently higher for young people, and for women compared to men. Our data confirm the great psychological toll that the COVID-19 crisis took on the Spanish general population during the first week of confinement. Women and young people seem particularly vulnerable to the negative psychological impact of the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


COVID-19 among fit patients with CLL treated with venetoclax-based combinations


Double Jeopardy: Methamphetamine Use and HIV as Risk Factors for COVID-19


title: Clinical testing for COVID-19

text: As the novel coronavirus severe acute respiratory syndrome coronavirus 2 caused coronavirus disease 2019 cases in the United States, the initial test was developed and performed at the Centers for Disease Control and Prevention. As the number of cases increased, the demand for tests multiplied, leading the Centers for Disease Control and Prevention to use the Emergency Utilization Authorization to allow clinical and commercial laboratories to develop tests to detect the presence of the virus. Many nucleic acid tests based on RT-PCR were developed, each with different techniques, specifications, and turnaround time. As the illnesses turned into a pandemic, testing became more crucial. The test supply became inadequate to meet the need and so it had to be prioritized according to guidance. For surveillance, the need for serologic tests emerged. Here, we review the timeline of test development, the turnaround times, and the various approved tests, and compare them as regards the genes they detect. We concentrate on the point-of-care tests and discuss the basis for new serologic tests. We discuss the testing guidance for prioritization and their application in a hospital setting.


title: Population Pharmacokinetics and Pharmacodynamics of Chloroquine in a Plasmodium vivax Volunteer Infection Study

text: Chloroquine has been used for the treatment of malaria for > 70 years; however, chloroquine pharmacokinetic (PK) and pharmacodynamic (PD) profile in Plasmodium vivax malaria is poorly understood. The objective of this study was to describe the PK/PD relationship of chloroquine and its major metabolite, desethylchloroquine, in a P. vivax volunteer infection study. We analyzed data from 24 healthy subjects who were inoculated with blood-stage P. vivax malaria and administered a standard treatment course of chloroquine. The PK of chloroquine and desethylchloroquine was described by a two-compartment model with first-order absorption and elimination. The relationship between plasma and whole blood concentrations of chloroquine and P. vivax parasitemia was characterized by a PK/PD delayed response model, where the equilibration half-lives were 32.7 hours (95% confidence interval (CI) 27.4-40.5) for plasma data and 24.1 hours (95% CI 19.0-32.7) for whole blood data. The estimated parasite multiplication rate was 17 folds per 48 hours (95% CI 14-20) and maximum parasite killing rate by chloroquine was 0.213 hour-1 (95% CI 0.196-0.230), translating to a parasite clearance half-life of 4.5 hours (95% CI 4.1-5.0) and a parasite reduction ratio of 400 every 48 hours (95% CI 320-500). This is the first study that characterized the PK/PD relationship between chloroquine plasma and whole blood concentrations and P. vivax clearance using a semimechanistic population PK/PD modeling. This PK/PD model can be used to optimize dosing scenarios and to identify optimal dosing regimens for chloroquine where resistance to chloroquine is increasing.


Risks of COVID-19 for surgical cancer patients: The importance of the informed consent process


Coronavirus pandemic threatens launch of world's most-expensive telescope


Medical Ethics During a Public Health Crisis: COVID-19


title: A mechanism-based parameterisation scheme to investigate the association between transmission rate of COVID-19 and meteorological factors on plains in China

text: The novel coronavirus disease 2019 (COVID-19), which first emerged in Hubei province, China, has become a pandemic. However, data regarding the effects of meteorological factors on its transmission are limited and inconsistent. A mechanism-based parameterisation scheme was developed to investigate the association between the scaled transmission rate (STR) of COVID-19 and the meteorological parameters in 20 provinces/municipalities located on the plains in China. We obtained information on the scale of population migrated from Wuhan, the world epicentre of the COVID-19 outbreak, into the study provinces/municipalities using mobile-phone positioning system and big data techniques. The highest STRs were found in densely populated metropolitan areas and in cold provinces located in north-eastern China. Population density had a non-linear relationship with disease spread (linearity index, 0.9). Among various meteorological factors, only temperature was significantly associated with the STR after controlling for the effect of population density. A negative and exponential relationship was identified between the transmission rate and the temperature (correlation coefficient, -0.56; 99% confidence level). The STR increased substantially as the temperature in north-eastern China decreased below 0 °C (the STR ranged from 3.5 to 12.3 when the temperature was between -9.41 °C and -13.87 °C), whilst the STR showed less temperature dependence in the study areas with temperate weather conditions (the STR was 1.21 ± 0.57 when the temperature was above 0 °C). Therefore, a higher population density was linearly whereas a lower temperature (<0 °C) was exponentially associated with an increased transmission rate of COVID-19. These findings suggest that the mitigation of COVID-19 spread in densely populated and/or cold regions will be a great challenge.


title: How much did the Tourism Industry Lost? Estimating Earning Loss of Tourism in the Philippines

text: The study aimed to forecast the total earnings lost of the tourism industry of the Philippines during the COVID-19 pandemic using seasonal autoregressive integrated moving average. Several models were considered based on the autocorrelation and partial autocorrelation graphs. Based on the Akaike's Information Criterion (AIC) and Root Mean Squared Error, ARIMA(1,1,1)$\times$(1,0,1)$_{12}$ was identified to be the better model among the others with an AIC value of $-414.51$ and RMSE of $47884.85$. Moreover, it is expected that the industry will have an estimated earning loss of around 170.5 billion pesos if the COVID-19 crisis will continue up to July. Possible recommendations to mitigate the problem includes stopping foreign tourism but allowing regions for domestic travels if the regions are confirmed to have no cases of COVID-19, assuming that every regions will follow the stringent guidelines to eliminate or prevent transmissions; or extending this to countries with no COVID-19 cases.


title: [Usage of ethnomedicine on COVID-19 in China]

text: In December 2019, an outbreak of viral pneumonia began in Wuhan, Hubei Province, which caused the spread of infectious pneumonia to a certain extent in China and neighboring countries and regions, and triggered the epidemic crisis. The coronavirus disease 2019(COVID-19) is an acute respiratory infectious disease listed as a B infectious disease, which is managed according to standards for A infectious disease. Traditional Chinese medicine and integrated traditional Chinese and Western medicine have played an active role in the prevention and control of this epidemic. China's ethnomedicine has recognized infectious diseases since ancient times, and formed a medical system including theory, therapies, formula and herbal medicines for such diseases. Since the outbreak of the COVID-19 epidemic, Tibet Autonomous Region, Qinghai Province, Inner Mongolia Autonomous Region, Xinjiang Uygur Autonomous Region and Chuxiong Autonomous Prefecture of Yunnan, Qiandongnan Autonomous Prefecture of Guizhou have issued the prevention and control programs for COVID-19 using Tibetan, Mongolian, Uygur, Yi and Miao medicines. These programs reflect the wisdom of ethnomedicine in preventing and treating diseases, which have successfully extracted prescriptions and preventive measures for the outbreak of the epidemic from their own medical theories and traditional experiences. In this paper, we summarized and explained the prescriptions and medicinal materials of ethnomedicine in these programs, and the origin of Tibetan medicine prescriptions and Mongolian medicine prescriptions in ancient books were studied. These become the common characteristics of medical prevention and treatment programs for ethnomedicine to formulate therapeutic programs under the guidance of traditional medicine theories, recommend prescriptions and prevention and treatment methods with characteristics of ethnomedicine, and focus on the conve-nience and standardization. However, strengthening the support of science and technology and the popularization to the public, and improving the participation of ethnomedicine in national public health services and the capacity-building to deal with sudden and critical diseases are key contents in the development of ethnomedicine in the future.


title: Importation and early local transmission of COVID-19 in Brazil, 2020

text: We conducted the genome sequencing and analysis of the first confirmed COVID-19 infections in Brazil. Rapid sequencing coupled with phylogenetic analyses in the context of travel history corroborate multiple independent importations from Italy and local spread during the initial stage of COVID-19 transmission in Brazil.


title: Application of a Modified Endoscopy Face Mask for Flexible Laryngoscopy During the COVID-19 Pandemic

text: Diagnostic flexible laryngoscopy (DFL) is a critical tool in the armamentarium of an otolaryngologist. However, in the midst of the COVID-19 pandemic, DFL represents a high-risk procedure for patients and otolaryngologists due to the risk of aerosolization. In cases where DFL is required, in patients with COVID-19 positivity or unknown COVID-19 status, we describe the use of a modified endoscopy face mask as an adjunct to personal protection equipment to reduce occupational transmission of COVID-19 while performing DFL. Our modified endoscopy mask provides an additional barrier against the transmission of airborne pathogens. The modified endoscopy face mask may also serve as a useful tool for otolaryngologists as they return to performing more aerosol-generating procedures in the outpatient setting.


Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China


COVID-19: Thoughts and comments from a tertiary liver transplant center in France


Ultrafast control of anisotropy


title: Investigation and Serologic Follow-Up of Contacts of Early Confirmed Case-Patient with COVID-19, United States

text: We describe the contact investigation for an early confirmed case of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the United States. Contacts of the case-patient were identified, actively monitored for symptoms, interviewed for a detailed exposure history, and tested for SARS-CoV-2 infection by real-time reverse transcription PCR (rRT-PCR) and ELISA. Fifty contacts were identified and 38 (76%) were interviewed, of whom 11 (29%) reported unprotected face-to-face interaction with the case-patient. Thirty-seven (74%) had respiratory specimens tested by rRT-PCR, and all tested negative. Twenty-three (46%) had ELISA performed on serum samples collected ≈6 weeks after exposure, and none had detectable antibodies to SARS-CoV-2. Among contacts who were tested, no secondary transmission was identified in this investigation, despite unprotected close interactions with the infectious case-patient.


title: Structural and Biochemical Characterization of the nsp12-nsp7-nsp8 Core Polymerase Complex from SARS-CoV-2

text: The ongoing global pandemic of coronavirus disease 2019 (COVID-19) has caused a huge number of human deaths. Currently, there are no specific drugs or vaccines available for this virus (SARS-CoV-2). The viral polymerase is a promising antiviral target. Here, we describe the near-atomic-resolution structure of the SARS-CoV-2 polymerase complex consisting of the nsp12 catalytic subunit and nsp7-nsp8 cofactors. This structure highly resembles the counterpart of SARS-CoV with conserved motifs for all viral RNA-dependent RNA polymerases and suggests a mechanism of activation by cofactors. Biochemical studies reveal reduced activity of the core polymerase complex and lower thermostability of individual subunits of SARS-CoV-2 compared with SARS-CoV. These findings provide important insights into RNA synthesis by coronavirus polymerase and indicate adaptation of SARS-CoV-2 toward humans with a relatively lower body temperature than the natural bat hosts.


Aged Patients With Mental Disorders in the COVID-19 Era: The Experience of Northern Italy


title: COVID-19 in the Nuclear Medicine Department, be prepared for ventilation scans as well! [Letter]

text: We read with great interest the recent editorial by Huang et al [1] regarding the unfortunately timely topic of considerations attendant to running a nuclear medicine department in the context of the COVID-19 epidemic, which complements similar work on diagnostic imaging [2] and hospital-wide preparedness [3] As the pandemic has unfolded in a somewhat sequential manner [4], lessons learned in one geographic domain are of great value to physicians who practice in locations that are earlier on the learning curve One area of concern which we did not see covered in the comprehensive treatment relates to performance of ventilation scans, a standard component of ventilation/perfusion studies performed to exclude pulmonary embolus [5] The population of patients who are short-of-breath and considered for pulmonary embolus certainly overlap with individuals who may be suffering effects of COVID-19 infection Beyond standard methods of decontamination, which are relevant to all patients with suspicion of infection [2,6], is there a specific concern that patients performing ventilation studies will expose others to airborne virus by exhalation into the aerosolization system? Do we need to take any additional precautions to minimize airborne distribution of virus, such as requiring technologists to don respiratory mask to protect against airborne virus? Are there any changes in protocol that we can implement to mitigate risk?


title: PPIs and Beyond: A Framework for Managing Anticoagulation-Related Gastrointestinal Bleeding in the Era of COVID-19

text: Coronavirus disease of 2019 (COVID-19) can be associated with high morbidity and mortality; patients with severe clinical manifestations may develop significant coagulopathy as well as unexpected thromboembolic complications. In response, centers are increasingly treating selected patients with intermediate-dose prophylactic or even therapeutic dose anticoagulation in order to prevent potentially catastrophic thrombotic complications. With this changing practice, the authors suspect that inpatient gastrointestinal consult teams across the country will be frequently managing COVID-19 patients with gastrointestinal bleeding (GIB). In order to reduce potentially avoidable hospital readmissions for GIB while improving patient outcomes, it is imperative to appropriately risk-stratify patients prior to initiation of anticoagulation. In this review, we discuss how to appropriately identify high-risk patients for GIB and how to mitigate GIB risk with proton-pump inhibitor co-therapy, medication reconciliation, and Helicobacter pylori testing and treating in this complex and morbid population.


COVID-19 in a patient with severe asthma treated with Omalizumab


title: Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report

text: Corona Virus Infectious Disease 2019 (COVID-19) was first reported in Cape Town in March 2020 and the transmission was soon observed in local communities. Cape Town has many vulnerable communities because of poverty, overcrowding and comorbidities, although it has a relatively small elderly population. Amongst the unique and early responses to the pandemic in South Africa has been the strategy of community screening and testing (CST). This process has been drawn from health department's prior adoption of a community-orientated primary care (COPC) approach, which relies on teams of community health workers working in delineated communities to prevent disease and provide early interventions for those at higher risk. The COPC principles were applied in the CST programme, which involved collaboration between facility and community-based teams, linking public health and primary care approaches, careful mapping of cases in highly vulnerable communities, targeted screening around cases, testing of those that screened positive, health education and linkage to primary care. The overall aim was to slow down transmission through early identification and isolation of diagnosed cases. Key challenges involved the designing of a screening tool with appropriate sensitivity and specificity as well as the logistics of staffing, transport, consumables, data collection and capture, security, ablutions and personal protective equipment. Key opportunities included synergies between CST and evolving commitment to COPC in the health system. Key threats were the deteriorating security situation in the most vulnerable communities because of loss of income, food insecurity and CST distrust as well as increasing turn-around-times for test results.


title: Characteristics of Doctors' Fatality due to COVID-19 in Western Europe and Asia-Pacific countries

text: Under the COVID-19 pandemic, the deaths of healthcare professionals have been increasingly reported worldwide. We performed a cross-sectional, observational study using news reports on the websites among selected countries as of April, 2020. We found 120 dead medical doctors due to COVID-19 in Western Europe and Asia-Pacific countries; 67 in Italy (47 in the Northern part), 34 in China (22 in Hubei), 6 in France, 4 in the UK, the US, and Spain, and 1 in South Korea, respectively. Among them, 90% were men, and specialties were reported as general practitioners for 30% and as physicians for 11.6%. The overall proportions of dead medical doctors amounted to 1.9 per 10,000 confirmed cases and 30.2 per 10,000 dead cases, respectively. Proactive measures are warranted to protect doctors especially who often encounters with COVID-19 patients.


title: COVID-19 rehabilitation units are twice as expensive as regular rehabilitation units

text: OBJECTIVE: The COVID-19 pandemic has caused significant motor, cognitive, psychological, neurological and cardiological disabilities in many infected patients. Functional rehabilitation of infectious COVID-19 patients has been implemented in the acute care wards and in appropriate, ad hoc, multidisciplinary COVID-19 rehabilitation units. However, because COVID-19 rehabilitation units are a clinical novelty, clinical and organizational benchmarks are not yet available. The aim of this study is to describe the organizational needs and operational costs of such a unit, by comparing its activity, organization, and costs with 2 other functional rehabilitation units, in San Raffaele Hospital, Milan, Italy. METHODS: The 2-month activity of the COVID-19 Rehabilitation Unit at San Raffaele Hospital, Milan, Italy, which was created in response to the emergency need for rehabilitation of COVID-19 patients, was compared with the previous year's activity of the Cardiac Rehabilitation and Motor Rehabilitation Units of the same institute. RESULTS: The COVID-19 Rehabilitation Unit had the same number of care beds as the other units, but required twice the amount of staff and instrumental equipment, leading to a deficit in costs. DISCUSSION: The COVID-19 Rehabilitation Unit was twice as expensive as the 2 other units studied. World health systems are organizing to respond to the pandemic by expanding capacity in acute intensive care and sub-intensive care units. This study shows that COVID-19 rehabilitation units must be organized and equiped according to the clinical and rehabilitative needs of patients, following specific measures to prevent the spread of infection amongs patients and workers.


Large artery ischemic stroke in severe COVID-19


title: O Efeito da Doença de Coronavírus 2019 nas Doenças Cardiovasculares./ O Efeito da Doença de Coronavírus 2019 nas Doenças Cardiovasculares./ The Effect of Coronavirus Disease 2019 on Cardiovascular Diseases

text: Coronavirus disease 2019 (COVID-19) is a global pandemic affecting the world, seen in more than 1,300,000 patients. COVID-19 acts through the angiotensin-converting enzyme 2 (ACE2) receptor. Cardiovascular comorbidities are more common with COVID-19, and nearly 10% of cases develop myocarditis (22% of critical patients). Further research is needed to continue or discontinue ACE inhibitors and angiotensin receptor blockers, which are essential in hypertension and heart failure in COVID-19. Intensive research is promising for the treatment and prevention of COVID-19.


title: Clinically significant anticardiolipin antibodies associated with COVID-19

text: The novel coronavirus strain known as SARS-CoV-2 has rapidly spread around the world creating distinct challenges to the healthcare workforce. Coagulopathy contributing to significant morbidity in critically ill patients with SARS-CoV-2 has now been well documented. We discuss two cases selected from patients requiring critical care in April 2020 in New York City with a unique clinical course. Both cases reveal significant thrombotic events noted on imaging during their hospital course. Obtaining serial inflammatory markers in conjunction with anti-phospholipid antibody testing revealed clinically significant Antiphospholipid syndrome (APS). This case series reviews the details preceding APS observed in SARS-CoV-2 and aims to report findings that could potentially further our understanding of the disease.


The effect of quarantine and isolation for COVID-19 in general population and dermatologic treatments


Challenges and Potential Solutions of Stroke Care During the Coronavirus Disease 2019 (COVID-19) Outbreak


title: Maximising the Benefits of an Acutely Limited Number of COVID-19 Tests

text: We propose a novel testing and containment strategy in order to contain the spread of SARS-CoV2 while permitting large parts of the population to resume social and economic activity. Our approach recognises the fact that testing capacities are severely constrained in many countries. In this setting, we show that finding the best way to utilise this limited number of tests during a pandemic can be formulated concisely as an allocation problem. Our problem formulation takes into account the heterogeneity of the population and uses pooled testing to identify and isolate individuals while prioritising key workers and individuals with a higher risk of spreading the disease. In order to demonstrate the efficacy of our testing and containment mechanism, we perform simulations using a network-based SIR model. Our simulations indicate that applying our mechanism on a population of $100,000$ individuals with only $16$ tests per day reduces the peak number of infected individuals by approximately $20\%$, when compared to the scenario where no intervention is implemented.


Experience of a Radiation Oncology Center Operating During the COVID-19 Outbreak


What can we do for people exposed to multiple traumatic events during the coronavirus pandemic?


title: Scientists ‘strongly condemn’ rumors and conspiracy theories about origin of coronavirus outbreak ;Science ;AAAS

text: A group of 27 prominent public health scientists from outside China is pushing back against a steady stream of stories and even a scientific paper suggesting a laboratory in Wuhan, China, may be the origin of the outbreak of COVID-19 “The rapid, open, and transparent sharing of data on this outbreak is now being threatened by rumours and misinformation around its origins,” the scientists, from nine countries, write in a statement published online by The Lancet yesterday


Covid-19: risk factors for severe disease and death


A practical approach for the management of obstetric and infertile women during the phase two of the novel coronavirus disease 2019 (COVID -19) pandemic


Mental Health Care for Military Personnel in the COVID-19 Epidemic


title: Coronavirus Disease 2019 in Geriatrics and Long-Term Care: The ABCDs of COVID-19

text: The pandemic of coronavirus disease of 2019 (COVID-19) is having a global impact unseen since the 1918 worldwide influenza epidemic. All aspects of life have changed dramatically for now. The group most susceptible to COVID-19 are older adults and those with chronic underlying medical disorders. The population residing in long-term care facilities generally are those who are both old and have multiple comorbidities. In this article we provide information, insights, and recommended approaches to COVID-19 in the long-term facility setting. Because the situation is fluid and changing rapidly, readers are encouraged to access frequently the resources cited in this article. J Am Geriatr Soc 68:912-917, 2020.


COVID-19 presenting as acute pancreatitis: Lessons from a patient in Iran


SARS-CoV-2 and prostatitis: Dangerous relationship for male sexual and reproductive health


Why children avoid the worst coronavirus complications might lie in their arteries


Speeding tumor genotyping during the SARS-CoV-2 outbreak through liquid biopsy


title: Self-awareness based resource allocation strategy for containment of epidemic spreading

text: Resource support between individuals is of particular importance in controlling or mitigating epidemic spreading, especially during pandemics. Whereas there remains the question of how we can protect ourselves from being infected while helping others by donating resources in fighting against the epidemic. To answer the question, we propose a novel resource allocation model by considering the awareness of self-protection of individuals. In the model, a tuning parameter is introduced to quantify the reaction strength of individuals when they are aware of the disease. And then, a coupled model of resource allocation and disease spreading is proposed to study the impact of self-awareness on resource allocation and, its impact on the dynamics of epidemic spreading. Through theoretical analysis and extensive Monte Carlo simulations, we find that in the stationary state, the system converges to two states: the whole healthy or the completely infected, which indicates an abrupt increase in the prevalence when there is a shortage of resources. More importantly, we find that too cautious and too selfless for the people during the outbreak of an epidemic are both not suitable for disease control. Through extensive simulations, we find the optimal point, at which there is a maximum value of the epidemic threshold, and an outbreak can be delayed to the greatest extent. At last, we study further the effects of network structure on the coupled dynamics. We find that the degree heterogeneity promotes the outbreak of disease, and the network structure does not alter the optimal phenomenon in behavior response.


COVID-19 deaths in long term care facilities - a critical piece of the pandemic puzzle


The neurological impact of COVID-19