title: A rapid review of evidence and recommendations from the SIOPE radiation oncology working group to help mitigate for reduced paediatric radiotherapy capacity during the COVID-19 pandemic or other crises

text: OBJECTIVE: To derive evidence-based recommendations for the optimal utilisation of resources during unexpected shortage of radiotherapy capacity. METHODS AND MATERIALS: We have undertaken a rapid review of published literature on the role of radiotherapy in the multimodality treatment of paediatric cancers governing the European practise of paediatric radiotherapy. The derived data has been discussed with expert paediatric radiation oncologists to derive a hierarchy of recommendations. RESULTS: The general recommendations to mitigate the potential detriment of an unexpected shortage of radiotherapy facilities include: (1) maintain current standards of care as long as possible (2) refer to another specialist paediatric radiotherapy department with similar level of expertise (3) prioritise use of existing radiotherapy resources to treat patients with tumours where radiotherapy has the most effect on clinical outcome (4) use chemotherapy to defer the start of radiotherapy where timing of radiotherapy is not expected to be detrimental (5) active surveillance for low-grade tumours if appropriate and (6) consider iso-effective hypofractionated radiotherapy regimens only for selected patients with predicted poor prognosis. The effectiveness of radiotherapy and recommendations for prioritisation of its use for common and challenging paediatric tumours are discussed. CONCLUSION: This review provides evidence-based treatment recommendations during unexpected shortage of paediatric radiotherapy facilities. It has wider applications for the optimal utilisation of facilities, to improve clinical outcome in low- and middle-income countries, where limited resources continue to be a challenge.


A simple and effective protective shield for the ophthalmoscope to prevent COVID-19


Supraglottic airways in the management of COVID-19 patients


title: [Nursing Education Strategies During the COVID-19 Epidemic]

text: The ongoing new coronavirus disease (COVID-19) pandemic, which arose at the end of 2019, poses a severe challenge to world public health systems. Frontline medical staffs bear a great burden to provide health care services. The Taiwan government has taken rapid and decisive actions to reduce the risk of community transmission and campus cluster infection. Nursing education includes both classroom teaching and clinical practicum components. In preparing for their practicum, students must learn not only fundamental nursing care knowledge but also basic knowledge on emerging infectious diseases. All schools nationwide have complied with the Ministry of Education order to postpone the opening of the fall semester in response to the rapid evolution of the COVID-19 pandemic. Campus epidemic prevention measures were implemented through student counseling networks, and flexible teaching strategies, including online teaching and distance teaching, were implemented to protect the learning rights of students. This paper explores the strategies implemented in response to emerging infectious diseases in nursing education based on the core values of professional nursing. Examining the precautions taken at campuses and teaching strategies adopted in response to the COVID 19 pandemic may provide valuable insights that may be applied to the future development of nursing education.


title: A global treatments for coronaviruses including COVID-19

text: In late December 2019 in Wuhan, China, several patients with viral pneumonia were identified as 2019 novel coronavirus (2019-nCoV). So far, there are no specific treatments for patients with coronavirus disease-19 (COVID-19), and the treatments available today are based on previous experience with similar viruses such as severe acute respiratory syndrome-related coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and Influenza virus. In this article, we have tried to reach a therapeutic window of drugs available to patients with COVID-19. Cathepsin L is required for entry of the 2019-nCoV virus into the cell as target teicoplanin inhibits virus replication. Angiotensin-converting-enzyme 2 (ACE2) in soluble form as a recombinant protein can prevent the spread of coronavirus by restricting binding and entry. In patients with COVID-19, hydroxychloroquine decreases the inflammatory response and cytokine storm, but overdose causes toxicity and mortality. Neuraminidase inhibitors such as oseltamivir, peramivir, and zanamivir are invalid for 2019-nCoV and are not recommended for treatment but protease inhibitors such as lopinavir/ritonavir (LPV/r) inhibit the progression of MERS-CoV disease and can be useful for patients of COVID-19 and, in combination with Arbidol, has a direct antiviral effect on early replication of SARS-CoV. Ribavirin reduces hemoglobin concentrations in respiratory patients, and remdesivir improves respiratory symptoms. Use of ribavirin in combination with LPV/r in patients with SARS-CoV reduces acute respiratory distress syndrome and mortality, which has a significant protective effect with the addition of corticosteroids. Favipiravir increases clinical recovery and reduces respiratory problems and has a stronger antiviral effect than LPV/r. currently, appropriate treatment for patients with COVID-19 is an ACE2 inhibitor and a clinical problem reducing agent such as favipiravir in addition to hydroxychloroquine and corticosteroids.


Ramadan fasting during Covid-19 pandemic


title: Daily Situation Report on Coronavirus disease (COVID-19) in Iran;March 14, 2020

text: After detection of the first confirmed cases of COVID-19 in Iran, the National Committee on COVID-19 Epidemiology in Ministry of Health and Medical Education was established This Committee is official source of gathering, analyzing, and reporting the COVID-19 data in Iran The data of all sources in the country including, medical care monitoring center (MCMC), Hospitals' Information Systems (HIS), Laboratory portal, the data of the center for communicable disease control (MOH), as well as the data from community health centers are integrated and used in this regards This factsheet contain daily situation report on coronavirus disease (covid-19) in Iran;March 14, 2020


The immunological case for staying active during the COVID-19 pandemic


Coronavirus blood-clot mystery intensifies


Covid-19 makes the future of UK clinical research uncertain


Pulmonary embolism and screening for concomitant proximal deep vein thrombosis in noncritically ill hospitalized patients with coronavirus disease 2019


Personalizing Invasive Mechanical Ventilation Strategies in COVID-19-associated lung injury: the Utility of Lung Ultrasound


COVID-19 in MS: Initial observations from the Pacific Northwest


How to transform a general hospital into an "infectious disease hospital" during the epidemic of COVID-19


Covid-19: Trump threatens to stop funding WHO amid "China-centric" claims


title: Endoscopic skull base and transoral surgery during COVID-19 pandemic: Minimizing droplet spread with negative-pressure otolaryngology viral isolation drape

text: BACKGROUND: The coronavirus disease (COVID-19) pandemic has raised concern of transmission of infectious organisms through aerosols formation in endonasal and transoral surgery. METHODS: Retrospective review. We introduce the negative-pressure otolaryngology viral isolation drape (NOVID) system to reduce the risk of aerosol. NOVID consists of a plastic drape suspended above the patient's head and surgical field with a smoke evacuator suction placed inside the chamber. RESULTS: Four patients underwent endonasal (4) and endo-oral surgery (1). Fluorescein was applied to the surgical field. Black light examination of fluorescein-treated operative fields revealed minimal contamination distant to the surgical field. In two prolonged cases with high-speed drilling, droplets were identified under the barrier and on the tip of the smoke evacuator. Instruments and cottonoids appeared to be a greater contributor to field contamination. CONCLUSIONS: Negative-pressure aspiration of air under a chamber barrier, which appears to successfully keep aerosol and droplet contamination to a minimum.


COVID-19 and ischemic stroke: Should we systematically look for lupus anticoagulant and antiphospholipid antibodies?


title: Anesthesia Management and Perioperative Infection Control in Patients With the Novel Coronavirus

text: Anesthesiologists have a high risk of infection with COVID-19 during perioperative care and as first responders to airway emergencies. The potential of becoming infected can be reduced by a systematic and integrated approach that assesses infection risk. The latter leads to an acceptable choice of materials and techniques for personal protection and prevention of cross-contamination to other patients and staff. The authors have presented a protocolized approach that uses diagnostic criteria to clearly define benchmarks from the medical history along with clinical symptoms and laboratory tests. Patients can then be rapidly assigned into 1 of 3 risk categories that direct the choice of protective materials and/or techniques. Each hospital can adapt this approach to develop a system that fits its individual resources. Educating medical staff about the proper use of high-risk areas for containment serves to protect staff and patients.


COVID-19: Shining the Light on Africa


Covid-19: Cases of inflammatory syndrome in children surge after urgent alert


title: The Covid-19 'infodemic': a new front for information professionals

text: The virus, commonly known as COVID-19 which emerged in Wuhan, China, in December 2019, has spread in 213 countries, areas or territories around the globe, with nearly 144 683 deaths worldwide on 18 April 2020. In the wake of this pandemic, we have witnessed a massive infodemic with the public being bombarded with vast quantities of information, much of which is not scientifically correct. Fighting fake news is now the new front in the COVID-19 battle. This regular feature comments on the role of health sciences librarians and information professionals in combating the COVID-19 infodemic. To support their work, it draws attention to the myth busters, fact-checkers and credible sources relating to COVID-19. It also documents the guides that libraries have put together to help the general public, students and faculty recognise fake news.


title: Saliva: potential diagnostic value and transmission of 2019-nCoV

text: 2019-nCoV epidemic was firstly reported at late December of 2019 and has caused a global outbreak of COVID-19 now. Saliva, a biofluid largely generated from salivary glands in oral cavity, has been reported 2019-nCoV nucleic acid positive. Besides lungs, salivary glands and tongue are possibly another hosts of 2019-nCoV due to expression of ACE2. Close contact or short-range transmission of infectious saliva droplets is a primary mode for 2019-nCoV to disseminate as claimed by WHO, while long-distance saliva aerosol transmission is highly environment dependent within indoor space with aerosol-generating procedures such as dental practice. So far, no direct evidence has been found that 2019-nCoV is vital in air flow for long time. Therefore, to prevent formation of infectious saliva droplets, to thoroughly disinfect indoor air and to block acquisition of saliva droplets could slow down 2019-nCoV dissemination. This review summarizes diagnostic value of saliva for 2019-nCoV, possibly direct invasion into oral tissues, and close contact transmission of 2019-nCoV by saliva droplets, expecting to contribute to 2019-nCoV epidemic control.


Covid-19 in China: ten critical issues for intensive care medicine


title: A data-driven hypothesis on the epigenetic dysregulation of host metabolism by SARS coronaviral infection: Potential implications for the SARS-CoV-2 modus operandi

text: COVID-19, the disease caused by the novel SARS-CoV-2, a betacoronavirus structurally similar to SARS-CoV. Based on both structural and syndromic similarities with SARS-CoV, a hypothesis is formed on SARS-CoV-2 potential to affect the host's metabolism as part of its lifecycle. This hypothesis is evaluated by (a) exploratory analysis of SARS-CoV/human transcriptomic interaction data and gene set enrichment analysis (b) a confirmatory, focused review of the literature based on the findings by (a). A STRING Viruses (available search for human - SARS-CoV (NCBI taxonomy Id: 9606 vs. NCBI taxonomy Id: 694009) genomic interactions reveals ten human proteins, interacting with SARS-CoV: SGTA, FGL2, SPECC1, STAT3, PHB, BCL2L1, PPP1CA, CAV1, JUN, XPO1. Gene set enrichment analyses (GSEA) with STRING on this network revealed their role as a putative protein - protein interaction network (PPI; Enrichment p-value = 0.0296) mediating, viral parasitism, interleukin as well as insulin signaling, diabetes and triglyceride catabolism. In the literature, SARS-CoV has been known to cause de novo diabetes by ACE2-dependent uptake on pancreatic isle cells, and furthermore dysregulate lipid autophagy in favor of the viral lifecycle. Conversely, currently there are only non-causative, observational evidence of worse outcomes for COVID-19 patients with comorbid diabetes or hyperglycemia. No study has reported on the lipid profiles of COVID-19 patients; however, lipid-targeting molecules have been proposed as agents against SARS-CoV-2. Future studies, reporting on lipid and glucose metabolism of COVID-19 patients could help elucidate the disease's seculae and aid drug design.


title: Planning for a pandemic: Mitigating risk to radiation therapy service delivery in the COVID-19 era

text: The novel coronavirus (COVID-19) has rapidly impacted all of our lives following its escalation to pandemic status on 11 March 2020. Government guidelines and restrictions implemented to mitigate the risk of COVID-19 community transmission have forced radiation therapy departments to promptly adjust to the significant impact on our ability to deliver best clinical care. The inherent nature of our tri-partied professions relies heavily on multidisciplinary teamwork and patient-clinician interactions. Teamwork and patient interaction are critical to the role of a radiation therapist. The aim of this paper is to describe the experience of the Peter MacCallum Cancer Centre's (Peter Mac) radiation therapy services during the preliminary stages of the COVID-19 pandemic in minimising risk to patients, staff and our clinical service. Four critical areas were identified in developing risk mitigation strategies across our service: (a) Workforce planning, (b) Workforce communication, (c) Patient safety and wellbeing, and (d) Staff safety and wellbeing. Each of these initiatives had a focus on continuum of clinical care, whilst minimising risk of cross infection for our radiation therapy workforce and patients alike. Initiatives included, but were not limited to, establishing COVID-Eclipse clinical protocols, remote access to local applications, implementation of Microsoft Teams, personal protective equipment (PPE) guidelines and virtual 'Division of Radiation Oncology' briefing/updates. The COVID-19 pandemic has dictated change in conventional radiation therapy practice. It is hoped that by sharing our experiences, the radiation therapy profession will continue to learn, adapt and navigate this period together, to ensure optimal outcomes for ourselves and our patients.


Clinical characteristics and 28-day mortality of medical patients admitted with COVID-19 to a central London teaching hospital


title: I may never see the ocean again: Loss and grief among older adults during the COVID-19 pandemic

text: The COVID-19 pandemic has disproportionately affected older adults, not only through greater risk of illness and death but also by exacerbating underlying distress related to aging and mortality. Older adults' struggles with loneliness, fear of dying, and the sequelae of untreated medical conditions are viewed through the lens of anticipatory grief, and coping and treatment strategies are offered. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


COVID-19 precautions: easier said than done when patients are homeless


COVID-19 in a pediatric heart transplant recipient: Emergence of donor-specific antibodies


title: Bi-stability of SUDR+K model of epidemics and test kits applied to COVID-19

text: Motivated with various responses of world governments to COVID-19, here we develop a toy model of the dependence epidemics spreading on the availability of tests for disease. Our model, that we call SUDR+K, is based on usual SIR model, but it splits the total fraction of infected individuals into two components: those that are undetected and those that are detected through tests. Moreover, we assume that available tests increase at a constant rate from the beginning of epidemics but are consumed to detect infected individuals. Strikingly we find a bi-stable behavior between a phase with a giant fraction of infected and a phase with a very small fraction. We show that the separation between these two regimes is governed by a match between the rate of testing and a rate of infection spread at given time. We also show that the existence of two phases does not depend on the mathematical choice of the form of the term describing the rate at which undetected individuals are tested and detected. Presented research implies that a vigorous early testing activity, before the epidemics enters into its giant phase, can potentially keep epidemics under control, and that even a very small change in rate of testing can increase or decrease the size of the whole epidemics of various orders of magnitude. For the real application of realistic model to ongoing epidemics, we would gladly collaborate with field epidemiologists in order to develop quantitative models of testing process.


Failing the Test - The Tragic Data Gap Undermining the U.S. Pandemic Response


title: Recomendaciones de «hacer¼ y «no hacer¼ en el tratamiento de los pacientes críticos ante la pandemia por coronavirus causante de COVID-19 de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)./ Recomendaciones de «hacer¼ y «no hacer¼ en el tratamiento de los pacientes críticos ante la pandemia por coronavirus causante de COVID-19 de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)./ Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)

text: On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.


title: Human-Computer Interaction Considerations When Developing Cyber Ranges

text: The number of cyber-attacks are continuing to rise globally. It is therefore vital for organisations to develop the necessary skills to secure their assets and to protect critical national infrastructure. In this short paper, we outline upon human-computer interaction elements which should be considered when developing a cybersecurity training platform, in an effort to maintain levels of user engagement. We provide an overview of existing training platforms before covering specialist cyber ranges. Aspects of human-computer interaction are noted with regards to their relevance in the context of cyber ranges. We conclude with design suggestions when developing a cyber range platform.


Emotional Health in the Midst of the Coronavirus Disease 2019 (COVID-19) Pandemic


Covid-19: decisive action is the hallmark of South Africa's early success against coronavirus


title: Inferring epistasis from genomic data by Gaussian closure

text: We consider a population evolving due to mutation, selection, genetic drift and recombination, where selection is only two-loci terms (pairwise epistatic fitness). We further consider the problem of inferring fitness in the evolutionary dynamics from one or several snap-shots of the distribution of genotypes in the population. We show that this is possible using a recently developed theory that relates parameters of such a distribution to parameters of the evolutionary dynamics. This extends classical results on the Quasi-Linkage Equilibrium (QLE) regime first obtained by Kimura, and more recently studied by Neher and Shraiman. In particular, the new theory outperforms the Kimura-Neher-Shraiman theory in the interesting regime where the effects of mutations are comparable to or larger than recombination. Additionally, it can work when recombination is absent. The findings are validated through numerical simulations.


Use of a Protective Shield Successfully Prevents Exposure to Aerosols and Droplets during Transesophageal Echocardiography


Epithelial cilia is the first line of defence against Coronavirus; addressing the observed age-gradient in the COVID-19 infection


Gratitude and Good Outcomes: Rediscovering Positivity and Perspective in an Uncertain Time


The Case for Masks: Health Care Workers Can Benefit Too


title: Efficacy of internet-based integrated intervention on depression and anxiety symptoms in patients with COVID-19

text: Public health crises, such as the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since Dec. 2019, are widely acknowledged as severe traumatic events that impose threats not only because of physical concerns but also because of the psychological distress of infected patients. We designed an internet-based integrated intervention and evaluated its efficacy on depression and anxiety symptoms in patients infected by SARS-CoV-2.


title: Helping Couples in the Shadow of COVID-19

text: The pandemic caused by the SARS-CoV-2 virus (coronavirus) and the associated illness, COVID-19, has caused a level of worldwide upheaval unlike any most people now living have seen in their lifetimes. This crisis affects people in their most important, committed, and intimate relationships. Although this crisis has damaged the health and well-being of individuals, crushed economies, and led to an extensive period of uncertainty about the future, there may also be positive outcomes in the motivation people have to protect their relationships. In this paper, we focus on strategies that therapists and relationship educators can use to help couples preserve and protect their relationships during such a time. We describe four foundations of safety that allow relationships to thrive: physical, emotional, commitment, and community. We then highlight three keys from our body of work that can help guide individuals and couples in protecting their relationships on a day-to-day and moment-to-moment basis: (1) decide, don't slide; (2) make it safe to connect; (3) do your part.


text: The pandemic caused by the SARS-CoV-2 virus (Corona virus) and the associated illness, COVID-19, has caused a level of world-wide upheaval unlike any most people now living have seen in their lifetimes. This crisis affects people in their most important, committed, and intimate relationships. Although this crisis has damaged the health and wellbeing of individuals, crushed economies, and led to an extensive period of uncertainty about the future, there may also be positive outcomes in the motivation people have to protect their relationships. In this paper, we focus on strategies that therapists and relationship educators can use to help couples preserve and protect their relationships during such a time. We describe four foundations of safety that allow relationships to thrive: physical, emotional, commitment, and community. We then highlight three keys from our body of work that can help guide individuals and couples in protecting their relationships on a day-to-day, moment-to-moment basis: 1) Decide, don't slide. 2) Make it safe to connect. 3) Do your part.


title: Estimating the instant case fatality rate of COVID-19 in China

text: OBJECTIVE: The outbreak of coronavirus disease 2019 (COVID-19) in China has been basically controlled. However, the global epidemic of COVID-19 is worsening. We established a method to estimate the instant case fatality rate (CFR) and cure rate of COVID-19 in China. METHODS: A total of 82 735 confirmed cases released officially by the Chinese authorities from December 8, 2019 to April 18, 2020 were collected. The estimated diagnosis dates of deaths and cured cases were calculated based on the median cure time or median death time of individual cases. Following this, the instant CFR was calculated according to the number of deaths and cured cases on the same estimated diagnosis date. RESULTS: In China, the instant CFR of COVID-19 was 3.8-14.6% from January 1 to January 17; it then declined gradually and stabilized at 5.7% in April. The average CFR in China was 6.1±2.9%, while the CFR was 1.0±0.4% in China except Hubei Province. The cure rate of COVID-19 was 93.9±2.9% in China, and stabilized at 94.3%, while it was 99.0±0.4% in China except Hubei Province. CONCLUSIONS: The instant CFR of COVID-19 in China overall was much higher than that in China except Hubei Province. The CFR of COVID-19 in China was underestimated.


title: Facile and low-cost fabrication of humidity sensor using naturally available sepiolite nanofibers

text: While a lot of effort are focusing on the enhancement of humidity sensing performances of humidity sensors, their fabrication with facile and low-cost methods are desirable as well. In this work, a humidity sensor based on naturally available nanomaterials sepiolite nanofibers (SNFs) was facilely fabricated without any expensive raw materials or complex processes. Characterization results show that the SNFs have natural slender nanofiber structure (diameter: 20-50 nm) and abundant hydrophilic functional group (-OH). Humidity sensing test results show that the SNFs humidity sensor has outstanding humidity sensing properties (i.e., large response, good linearity and repeatability) within the relative humidity range from 10.9% to 91.5% at room temperature (25 ï°C). This work offers a moderate and cost-effective strategy for the fabrication of high-performance humidity sensors by using the natural nanomaterials of SNFs.


title: Response of Chinese Anesthesiologists to the COVID-19 Outbreak

text: The coronavirus disease 2019, named COVID-19 officially by the World Health Organization (Geneva, Switzerland) on February 12, 2020, has spread at unprecedented speed. After the first outbreak in Wuhan, China, Chinese anesthesiologists encountered increasing numbers of infected patients since December 2019. Because the main route of transmission is via respiratory droplets and close contact, anesthesia providers are at a high risk when responding to the devastating mass emergency. So far, actions have been taken including but not limited to nationwide actions and online education regarding special procedures of airway management, oxygen therapy, ventilation support, hemodynamic management, sedation, and analgesia. As the epidemic situation has lasted for months (thus far), special platforms have also been set up to provide free mental health care to all anesthesia providers participating in acute and critical caring for COVID-19 patients. The current article documents the actions taken, lesson learned, and future work needed.


Fight COVID-19 Beyond the Borders: Emergency Department Patient Diversion in Taiwan


Etoposide treatment adjunctive to immunosuppressants for critically ill COVID-19 patients


title: Statistical analysis of forecasting COVID-19 for upcoming month in Pakistan

text: In this paper, we have conducted analysis based on data obtained from National Institute of Health (NIH) - Islamabad and produced a forecast of COVID-19 confirmed cases as well as the number of deaths and recoveries in Pakistan using the Auto-Regressive Integrated Moving Average Model (ARIMA). The fitted forecasting models revealed high exponential growth in the number of confirmed cases, deaths and recoveries in Pakistan. Based on our model prediction the number of confirmed cases will be increased by 2.7 times, 95% prediction interval for the number of cases at the end of May 2020 = (5681 to 33079). There could be up to 500 deaths, 95% prediction interval = (168 to 885) and there could be eightfold increase in the number of recoveries, 95% prediction interval = (2391 to 16126). The forecasting results of COVID-19 are alarming for May in Pakistan. The health officials and government should adopt new strategies to control the pandemic from further spread until a proper treatment or vaccine is developed.


title: Challenges in early phase clinical trials for childhood cancer during the COVID-19 pandemic: a report from the new agents group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP)

text: PURPOSE: The COVID-19 pandemic has forced healthcare stakeholders towards challenging decisions. We analyse the impact of the pandemic on the conduct of phase I-II trials for paediatric cancer during the first month of state of alarm in Spain. METHODS: A questionnaire was sent to all five ITCC-accredited Spanish Paediatric Oncology Early Phase Clinical Trial Units, including questions about impact on staff activities, recruitment, patient care, supply of investigational products, and legal aspects. RESULTS: All units suffered personnel shortages and difficulties in enrolling patients, treatment continuity, or performing trial assessments. Monitoring activity was frequently postponed (73%), and 49% of on-going trials interrupted recruitment. Only two patients could be recruited during this period (75% reduction in the expected rate). CONCLUSIONS: The COVID-19 crisis has significantly impacted clinical research practice and access to innovation for children with cancer. Structural and functional changes are under way to better cope with the expected future restrictions.


title: Analysis of the molecular mechanism of Pudilan (PDL) treatment for COVID-19 by network pharmacology tools

text: BACKGROUND: Pudilan (PDL), a four-herb prescription with the traditional function of heat-clearing and detoxifying, has been clinically used as an anti-SARS-CoV-2 infectory agent in China. PDL might also have therapeutic potentials for COVID-19 while the underlying mechanisms remain to be clarified. METHODS: We used network pharmacology analysis and selected 68 co-targeted genes/proteins as targets of both PDL and COVID-19. These co-targeted genes/proteins were predicted by SwissDock Server for their high-precision docking simulation, and analyzed by STRING for proteins to protein interaction (PPI), pathway and GO (gene ontology) enrichment. The therapeutic effect for PDL treatment on COVID-19 was validated by the TCMATCOV (TCM Anti COVID-19) platform. RESULTS: PDL might prevent the entrance of SARS-CoV-2 entry into cells by blocking the angiotensin-converting enzyme 2 (ACE2). It might inhibit the cytokine storm by affecting C-reactive protein (CRP), interferon-Î³ (IFN-Î³), interleukin- 6 (IL-6), interleukin- 10 (IL-10), tumor necrosis factor (TNF), epidermal growth factor receptor (EGFR), C-C motif chemokine ligand 5 (CCL5), transforming growth factor-ß1 (TGFß1), and other proteins. PDL might moderate the immune system to shorten the course of the disease, delay disease progression, and reduce the mortality rate. CONCLUSION: PDL might have a therapeutic effect on COVID-19 through three aspects, including the moderate immune system, anti-inflammation, and anti-virus entry into cells.


title: The COVID-19 infection control arms race

text: US hospitals are engaged in an infection control arms race. Hospitals, specialties, and professional groups are spurring one another on to adopt progressively more aggressive measures in response to COVID-19 that often exceed federal and international standards. Examples include universal masking of providers and patients; decreasing thresholds to test asymptomatic patients; using face shields and N95 respirators regardless of symptoms and test results; novel additions to the list of aerosol-generating procedures; and more comprehensive personal protective equipment including hair, shoe, and leg covers. Here, we review the factors underlying this arms race, including fears about personal safety, ongoing uncertainty around how SARS-CoV-2 is transmitted, confusion about what constitutes an aerosol-generating procedure, increasing recognition of the importance of asymptomatic infection, and the limited accuracy of diagnostic tests. We consider the detrimental effects of a maximal infection control approach and the research studies that are needed to eventually de-escalate hospitals and to inform more evidence-based and measured strategies.


title: Cutaneous manifestations in SARS-CoV-2 infection (COVID-19): a French experience and a systematic review of the literature

text: Skin manifestations have been increasingly reported in the setting of COVID-19. However, their incidence and presentation are debated, and the role, direct or undirect, of SARS-CoV-2 in their pathogenesis has yet to be determined. In this work, we aimed to analyze our experience in a French referral center and to perform a systematic review of the literature to evaluate the incidence and prognosis of cutaneous lesions observed in COVID-19 patients. Cutaneous manifestations were assessed in COVID-19 patients admitted to Cochin Hospital (Paris, France) between March 16th and April 27th 2020. 759 confirmed moderate-to-severe COVID-19 cases were diagnosed in our institution. Eight patients (1%, 6 males, 2 females, mean age 55.6) presented with skin lesions, mainly disseminated maculo-papular exanthema, but also digitate papulo-squamous rash (reported in1 ), herpes recurrence, papulo-vesicular rash and Grover's disease. The mean delay between respiratory/systemic and dermatological signs was 13 days.


Management of healthcare areas for the prevention of COVID-19 emergency in an Italian teaching hospital (Pisa, Tuscany): A hospital renovation plan


An unusual case of bullous haemorrhagic vasculitis in a COVID-19 patient


title: An unusual case of bullous hemorrhagic vasculitis in a COVID-19 patient

text: A novel Coronavirus strain, named "Severe Acute Respiratory Syndrome Coronavirus 2" (SARS-CoV-2) was recently identified as the etiological agent of the COronaVIrus Disease 2019 (COVID-19). Interestingly, a consistent number of COVID-19-associated skin manifestations seem to share a certain degree of vascular damage as common pathogenetic mechanism1 . Vascular injury may be due to the direct damage of endothelial cells by the virus or may represents an epiphenomenon of a dysregulated host inflammatory responses triggered by the infection2 . Here, we describe an unprecedented case of leukocytoclastic vasculitis presenting with a hemorrhagic bullous eruption in a patient affected by COVID-19.


A mental health workforce crisis in China: A pre-existing treatment gap coping with the COVID-19 pandemic challenges


Virtual Cancer Care During and Beyond the COVID-19 Pandemic: We Need to Get It Right


The dark side of COVID-19: The need of integrated medicine for children with special care needs


Open access epidemiologic data and an interactive dashboard to monitor the COVID-19 outbreak in Canada


Preprints bring 'firehose' of outbreak data


Protective potential of Expectorants against COVID-19


Safety first: evidence for delay of radical prostatectomy without use of androgen deprivation therapy during COVID-19


title: A Case of Coronavirus Infection Incidentally Found on FDG PET/CT Scan

text: We present a highly suspicious case of COVID-19 infection, incidentally found on F-FDG PET/CT images. Patient was scanned on February, 25, 2020, when COVID-19 outbreak was unrecognized in our country. She admitted having recent occasional dry cough and fever. A retrospective review of her clinical and laboratory data was strongly suggestive for diagnosis of COVID-19 infection. PET/CT images demonstrated hypermetabolic diffuse ground glass opacities in both lungs with bilateral nodules. There was no evidence of pleural effusion or prominent mediastinal or hilar lymphadenopathy. Radiologists must be aware of COVID-19 presentations on PET/CT scan images during COVID-19 outbreak.


title: The current understanding and potential therapeutic options to combat COVID-19

text: The ongoing wreaking global outbreak of the novel human beta coronavirus (CoV) pathogen was presumed to be from a seafood wholesale market in Wuhan, China, belongs to the Coronaviridae family in the Nidovirales order. The virus is highly contagious with potential human-human transmission which was named as the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread across six continents and emerged as a global pandemic in short span with alarming levels of spread and severity. This virus associated symptoms and infectious respiratory illness is designated as coronavirus disease 19 (COVID-19). The SARS-CoV-2 possesses enveloped club-like spike protein projections with positive-sense large RNA genome and has a unique replication strategy. This virus was believed to have zoonotic origin with genetical identity to bat and pangolin CoV. In the current review, we introduce a general overview about the human CoVs and the associated diseases, the origin, structure, replication and key clinical events that occur in the COVID-19 pathogenicity. Furthermore, we focused on possible therapeutic options such as repurposing drugs including antimalarials, antivirals, antiparasitic drugs, and anti-HIV drugs, as well as monoclonal antibodies, vaccines as potential treatment options. Also we have summarized the latest research progress on the usage of stem cell therapy, human convalescent serum, interferon's, in the treatment of COVID-19.


title: Cancer treatment during the coronavirus disease 2019 pandemic: Do not postpone, do it!

text: At the end of January 2020, a novel betacoronavirus, known as severe acute respiratory syndrome coronavirus 2, progressively spread in Italy. Patients with cancer are considered more prone to infections because of the immunosuppressive status due to both malignancy and anticancer treatments. From the first Italian government restrictions (23rd February), Modena Cancer Center adopted practical health vigilance recommendations to minimise the risk of exposure to the virus without overlooking cancer management. From 23rd February to 31st March 2020, 1257 patients on active anticancer treatment for oncological or haematological malignancies attended our institution. All the staff activities were rescheduled following our practical coronavirus disease 2019 (COVID-19) guideline. During this period, we have tallied 9 cases of COVID-19 infection (0.71%) in patients with cancer and 3 cases (1.66%) in health workers. The mortality rate of our patients with cancer was 22%, consistent with the data reported in the literature. In conclusion, following our practical health vigilance recommendations, physicians should be confident in maintaining life-saving anticancer treatment without exceedingly increasing the risk of nosocomial COVID-19 infection. The high rate of mortality suggested that all patients on active anticancer treatment with flu-like symptoms have to be carefully screened for COVID-19 infection.


title: SARS-CoV-2 pathophysiology and assessment of coronaviruses in CNS diseases with a focus on therapeutic targets

text: The novel Coronavirus disease of 2019 (nCOV-19) is a viral outbreak noted first in Wuhan, China. This disease is caused by Severe Acute Respiratory Syndrome (SARS) Coronavirus (CoV)-2. In the past, other members of the coronavirus family, such as SARS and Middle East Respiratory Syndrome (MERS), have made an impact in China and the Arabian peninsula respectively. Both SARS and COVID-19 share similar symptoms such as fever, cough, and difficulty in breathing that can become fatal in later stages. However, SARS and MERS infections were epidemic diseases constrained to limited regions. By March 2020 the SARS-CoV-2 had spread across the globe and on March 11th, 2020 the World Health Organization (WHO) declared COVID-19 as pandemic disease. In severe SARS-CoV-2 infection, many patients succumbed to pneumonia. Higher rates of deaths were seen in older patients who had co-morbidities such as diabetes mellitus, hypertension, cardiovascular disease (CVD), and dementia. In this review paper, we discuss the effect of SARS-CoV-2 on CNS diseases, such as Alzheimer's-like dementia, and diabetes mellitus. We also focus on the virus genome, pathophysiology, theranostics, and autophagy mechanisms. We will assess the multiorgan failure reported in advanced stages of SARS-CoV-2 infection. Our paper will provide mechanistic clues and therapeutic targets for physicians and investigators to combat COVID-19.


title: Factors associated with prolonged viral RNA shedding in patients with COVID-19

text: BACKGROUND: An outbreak of coronavirus disease 2019 (COVID-19) is becoming a public health emergency. Data are limited on the duration and host factors related to viral shedding. METHODS: In this retrospective study, risk factors associated with severe acute respiratory coronavirus 2 (SARS-CoV-2) RNA shedding were evaluated in a cohort of 113 symptomatic patients from two hospitals outside Wuhan. RESULTS: The median duration of SARS-CoV-2 RNA detection was 17 days (Interquartile Range [IQR], 13-22 days) as measured from illness onset. When comparing patients with early (<15 days) and late viral RNA clearance (≥15 days after illness onset), prolonged SARS-CoV-2 RNA shedding was associated with male sex (p=0.009), old age (p=0.033), concomitated with hypertension (p=0.009), delayed admission to hospital after illness onset (p=0.001), severe illness at admission (p=0.049), invasive mechanical ventilation (p=0.006), and corticosteroid treatment (p=0.025). Patients with longer SARS-CoV-2 RNA shedding duration had slower recovery of body temperature (p<0.001) and focal absorption on radiograph images (p<0.001) than patients with early SARS-CoV-2 RNA clearance. Male sex (odds ratio [OR], 3.24 [95% CI, 1.31-8.02]), delayed hospital admission (OR, 1.30 [95% CI, 1.10-1.54]), and invasive mechanical ventilation (OR, 9.88 [95% CI, 1.11-88.02]) were independent risk factors for prolonged SARS-CoV-2 RNA shedding. CONCLUSIONS: Male sex, delayed admission to hospital after illness onset, and invasive mechanical ventilation were associated with prolonged SARS-CoV-2 RNA shedding. Hospital admission and general treatments should be started as soon as possible in symptomatic COVID-19 patients, especially male patients.


SARS-CoV-2 and the hidden carriers: Sewage, feline, and blood transfusion


Reorganization of a Northern Italy dermatology department during the COVID-19 pandemic: is it temporary or the beginning of a new era in dermatology?


Early phases of COVID-19 management in a low-income country: Bangladesh


title: A Hierarchical Framework for Long-term and Robust Deployment of Field Ground Robots in Large-Scale Farming

text: Achieving long term autonomy of robots operating in dynamic environments such as farms remains a significant challenge. Arguably, the most demanding factors to achieve this are the on-board resource constraints such as energy, planning in the presence of moving individuals such as livestock and people, and handling unknown and undulating terrain. These considerations require a robot to be adaptive in its immediate actions in order to successfully achieve long-term, resource-efficient and robust autonomy. To achieve this, we propose a hierarchical framework that integrates a local dynamic path planner with a longer term objective based planner and advanced motion control methods, whilst taking into consideration the dynamic responses of moving individuals within the environment. The framework is motivated by and synthesizes our recent work on energy aware mission planning, path planning in dynamic environments, and receding horizon motion control. In this paper we detail the proposed framework and outline its integration on a robotic platform. We evaluate the strategy in extensive simulated trials, traversing between objective waypoints to complete tasks such as soil sampling, weeding and recharging across a dynamic environment, demonstrating its capability to robustly adapt long term mission plans in the presence of moving individuals and obstacles for real world applications such as large scale farming.


title: The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings

text: Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness. Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders. Detailed clinical and paraclinical data were collected from cases where the diagnosis of COVID-19 was confirmed through RNA PCR, or where the diagnosis was probable/possible according to World Health Organization criteria. Of 43 patients, 29 were SARS-CoV-2 PCR positive and definite, eight probable and six possible. Five major categories emerged: (i) encephalopathies (n = 10) with delirium/psychosis and no distinct MRI or CSF abnormalities, and with 9/10 making a full or partial recovery with supportive care only; (ii) inflammatory CNS syndromes (n = 12) including encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis (n = 9), with haemorrhage in five, necrosis in one, and myelitis in two, and isolated myelitis (n = 1). Of these, 10 were treated with corticosteroids, and three of these patients also received intravenous immunoglobulin; one made a full recovery, 10 of 12 made a partial recovery, and one patient died; (iii) ischaemic strokes (n = 8) associated with a pro-thrombotic state (four with pulmonary thromboembolism), one of whom died; (iv) peripheral neurological disorders (n = 8), seven with Guillain-Barré syndrome, one with brachial plexopathy, six of eight making a partial and ongoing recovery; and (v) five patients with miscellaneous central disorders who did not fit these categories. SARS-CoV-2 infection is associated with a wide spectrum of neurological syndromes affecting the whole neuraxis, including the cerebral vasculature and, in some cases, responding to immunotherapies. The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking. This complication was not related to the severity of the respiratory COVID-19 disease. Early recognition, investigation and management of COVID-19-related neurological disease is challenging. Further clinical, neuroradiological, biomarker and neuropathological studies are essential to determine the underlying pathobiological mechanisms, which will guide treatment. Longitudinal follow-up studies will be necessary to ascertain the long-term neurological and neuropsychological consequences of this pandemic.


Obesity, adipokines and COVID-19


title: Obesity, adipokines and COVID-19

text: The SARS-CoV-2 pandemic has led to worldwide research aiming to identify the risk factors for developing critical illness and mortality caused by COVID-19. It quickly became apparent that besides older age, obesity is one of the most important risk factors for a more severe course of COVID-19, although the mechanisms remain largely unknown [1-3]. Notably, with respect to acute respiratory distress syndrome (ARDS) and acute lung injury (ALI), evidence is mounting that obesity is a risk factor for ARDS/ALI, but among people with ARDS/ALI, obesity is associated with better outcome, a phenomenon which has been called the "obesity paradox" [4,5].


title: Early Intervention of Tongxinluo () on Right Ventricular Function Assessed by Echocardiography in Rats with Pulmonary Arterial Hypertension Induced by Monocrotaline

text: OBJECTIVE: To investigate the effect of early intervention of Tongxinluo (, TXL) on right ventricular function (RVF) of rats with pulmonary arterial hypertension (PAH) induced by monocrotaline (MCT). METHODS: A total of 30 adult male Sprague-Dawley rats were assigned to 5 groups with complete random experiment design: Sham group (Sham), MCT group, TXL group, sildenafil (SIL) group and combination group (TXL+SIL), 6 rats in each group. Rats were injected with 50 mg/kg MCT solution for inducing PAH model except for those in the sham group. From the day of modeling, rats of TXL, SIL and TXL+SIL groups were given TXL (1.2 g/kg), SIL (10 mg/kg) and combination solution (TXL:1.2 g/kg, SIL: 10 mg/kg) respectively, and rats in Sham and MCT groups were given normal saline (5 mL/kg). The samples were collected and tested after 21 consecutive days of intragastric administration. Echocardiography was used to measure the related indices of RVF, including pulmonary arterial flow spectrum, pulmonary artery diameter (PAD), right ventricular wall thickness (RVWT), right ventricular diameter (RVD), tricuspidannular plane systolic excursion (TAPSE), right atrium transverse diameter (RAT), and inferior vena cava diameter (IVCD). Elastic Verhoeff-Van Gieson staining was adopted to measure the percentage of wall thickness (WT%) of pulmonary arteriols. Hematoxylin-eosin staining was used to measure the cross-sectional area (CSA) of right ventricular cardiomyocytes. RESULTS: MCT-induced PAH rat model was successfully established. In MCT group the wall of pulmonary arterioles exhibited a prominent-increase thickness, PAD, RVWT, RVD, RAT, IVCD, WT%, right ventricular hypertrophy index (RVHI) as well as CSA of RV cardiomyocyte significantly increased (all P<0.01), and TAPSE markedly decreased (P<0.01). At the same time, TXL prominently improved all of the above indices (all P<0.01). In comparison with SIL, TXL significantly reduced RVD (P<0.05) and decreased CAS of RV cardiomyocytes (P<0.01), but TAPSE in SIL group was much larger than in TXL group (P<0.01). Moreover, TAPSE in TXL+SIL group was larger than that in TXL group (P<0.01), while the two groups performed equally well in terms of the other indices. CONCLUSION: Early intervention of TXL could inhibit pulmonary arterioles remodeling, and improve RVF by attenuating right ventricular hypertrophy, and TXL has a stronger effect on inhibiting right ventricular remodeling than SIL.


Kidney involvement in COVID-19 and rationale for extracorporeal therapies


HIV/SARS-CoV-2 coinfected patients in Istanbul, Turkey


Tele-rounding in a university hospital pulmonary ward during the COVID-19 pandemic: a pilot study


Innovation in a post-Covid 'new normal'


title: Initial impacts of global risk mitigation measures taken during the combatting of the COVID-19 pandemic

text: This paper presents an analysis of risk mitigation measures taken by countries around the world facing the current COVID-19 outbreak. In light of the current pandemic the authors collated and clustered (using harmonised terminology) the risk mitigation measures taken around the globe in the combat to contain, and since March 11 2020, to limit the spread of the SARS-CoV-2 virus known to cause the Coronavirus disease 2019 (COVID-19). This overview gathers lessons learnt, providing an update on the current knowledge for authorities, sectors and first responders on the effectiveness of said measures, and may allow enhanced prevention, preparedness and response for future outbreaks. Various measures such as mobility restrictions, physical distancing, hygienic measures, socio-economic restrictions, communication and international support mechanisms have been clustered and are reviewed in terms of the nature of the actions taken and their qualitative early-perceived impact. At the time of writing, it is still too premature to express the quantitative effectiveness of each risk mitigation cluster, but it seems that the best mitigation results are reported when applying a combination of voluntary and enforceable measures.


title: Overview: The history and pediatric perspectives of severe acute respiratory syndromes: Novel or just like SARS

text: Many respiratory viral infections such as influenza and measles result in severe acute respiratory symptoms and epidemics. In the spring of 2003, an epidemic of coronavirus pneumonia spread from Guangzhou to Hong Kong and subsequently to the rest of the world. The WHO coined the acronym SARS (severe acute respiratory syndrome) and subsequently the causative virus as SARS-CoV. In the summer of 2012, epidemic of pneumonia occurred again in Saudi Arabia which was subsequently found to be caused by another novel coronavirus. WHO coined the term MERS (Middle East respiratory syndrome) to denote the Middle East origin of the novel virus (MERS-CoV). In the winter of 2019, another outbreak of pneumonia occurred in Wuhan, China which rapidly spread globally. Yet another novel coronavirus was identified as the culprit and has been named SARS-CoV-2 due to its similarities with SARS-CoV, and the disease as coronavirus disease-2019. This overview aims to compare and contrast the similarities and differences of these three major episodes of coronavirus outbreak, and conclude that they are essentially the same viral respiratory syndromes caused by similar strains of coronavirus with different names. Coronaviruses have caused major epidemics and outbreaks worldwide in the last two decades. From an epidemiological perspective, they are remarkably similar in the mode of spread by droplets. Special focus is placed on the pediatric aspects, which carry less morbidity and mortality in all three entities.


Análisis de la amenaza percibida por la COVID-19 en población española./ [Analysis of the threat perceived by the COVID-19 in the Spanish population]


COVID-19 Pandemic: A Collection of Relevant Publications from Military Medicine


Rapid Development and Deployment of an International Omaha System Evidence-Based Guideline to Support the COVID-19 Response


title: What orthopedic surgeons need to know about Covid-19 pandemic

text: The ongoing outbreak of COVID-19, also known as SARS-CoV-2 and coronavirus disease 2019, is considered a major public concern that propagates steadily by the increased number of the infected cases and the mortality rate. In this article, we provide a brief review for Orthopedic surgeons as regard COVID-19 virus microbiology, epidemiology, clinical picture, and diagnosis. Moreover, what measures should be taken amid this pandemic to assess its control, maintain the urgent duties, and protect health care workers (HCW) are also discussed.


title: Knowledge, attitude and preventive practices related to COVID-19: a cross-sectional study in two Pakistani university populations

text: Objective: The aim of this study was to assess COVID-19-related knowledge, attitudes, and preventive practices of two Pakistani university populations. Methods: A cross-sectional study was conducted among students and employees of two higher education institutions in Lahore, Pakistan, namely the University of Lahore and the Gulab Devi Educational Complex. Participants were recruited using a convenient sampling method. A validated 45-item, self-administered questionnaire was used to collect data. Total possible scores were 0-14 for knowledge (scores < 7, 7-10 and > 10 were considered to indicate poor, moderate and good knowledge, respectively); 0-7 for attitude (scores > 5 were considered to indicate a good attitude); and 0-18 for COVID-19 preventative practices (scores > 12 were considered to indicate good preventative practices). Results: Of the 417 enrolled participants, 416 reported that they were aware of COVID-19 and social media was the major source of their information. Mean scores were 10.12 ± 2.20 for knowledge (good, moderate and poor knowledge in 50.2%, 42.8% and 7.0% of participants, respectively); 5.74 ± 1.28 for attitude (65.4% of individuals had a positive attitude); and 11.04 ± 3.34 for COVID-19 preventative practices (only 36.5% of participants had good preventive practices). Conclusion: Pakistani university students and employees have good knowledge and attitudes regarding COVID-19, but unsatisfactory preventive practices. Therefore, health regulators should use multiple communication approaches, such as electronic, print and social media, phone messages, etc., to increase awareness and improve practices related to COVID-19.


title: Spatial network connectivity of population and development in the USA; Implications for disease transmission

text: Zipfs Law states that rank-size distributions of city populations follow a power law with an exponent of -1. The assertion of a universal power law is controversial because the linearity and slope appear to vary over time and among countries. We compare census enumerations and night light luminance as proxies for population density and intensity of development in the contiguous United States. Treating population density and development intensity as continuous quantities allows for the definition of spatial networks based on the level of spatial connectivity. The resulting distributions of spatial network components (subsets of connected nodes) vary with degree of connectivity, but maintain consistent scaling over a wide range of network sizes. At continental scales, spatial network rank-size distributions obtained from both population density and night light brightness are well-fit by power laws with exponents near -1 for a wide range of density and luminance thresholds. However, the largest components (10,000 - 100,000 sq.km) are far larger than individual cities and represent spatially contiguous agglomerations of urban, suburban and periurban development. Projecting county-level numbers of confirmed cases of SARS-CoV-2 for the US onto spatial networks of population and development allows the spatiotemporal evolution of the epidemic to be quantified as propagation within networks of varying connectivity.. The results show an abrupt transition from slow increases in confirmed cases in a small number of network components to rapid geographic dispersion to a larger number of components before mobility reductions occurred in March 2020.


Mental Health in Chronic Disease Patients during the COVID-19 Quarantine in Greece


COVID-19 in Madrid


Obesity Is a Risk Factor for Greater COVID-19 Severity


title: Desafios na condução de pesquisas sobre a COVID-19 envolvendo seres humanos no Brasil

text: Objetivo:analisar aspectoséticos e regulatórios adotados para a realização de pesquisas científicas, em situação de excepcionalidade provocada pela pandemia daCOVID-19 Método:Estudo exploratório realizado a partir da análise documental e de informações existentes nas páginas da Comissão Nacional de Ética em Pesquisa (Conep), Plataforma Brasil e da Agência Nacional de Vigilância Sanitária (Anvisa) Resultados:A análise dos documentos encontrados nas páginas pesquisadas, revelou que a Conep (incluindo a Plataforma Brasil) e Anvisa divulgaram as estratégias adotadas para dar celeridade à revisão ética e científica para os projetos relacionados à COVID-19 A Conep inicialmente revisou todos os protocolos submetidos e posteriormente dividiu essa responsabilidade com todo osistema A Anvisa divulgou uma Resolução da Diretoria Colegiada (RDC) e três Notas Técnicas contendo procedimentos extraordinários e temporários para a realização de pesquisas clínicas com medicamentos, estudos de bioequivalência e produtos para terapia avançada Conclusão:As medidas adotadas demonstraram efetividade, considerando-se que a Conep avaliou até o dia 20/04/2020, 146 protocolos de pesquisas provenientes de todo o Brasil e de diferentes áreas do conhecimento, incluindo 30 ensaios clínicos Essas pesquisas representam a possibilidade de produzir evidências para o enfrentamento da doença,assim comoa proteção das pessoas mais vulneráveis nesse contexto (AU)


title: Medical Education During the COVID-19 Pandemic: A Single Institution Experience

text: Social distancing to curb the COVID-19 pandemic has caused suspension of classroom teaching in all educational institutions We implemented a novel online classroom platform at our institute to continue medical education The program attracted encouraging feedback from the students It may serve as a model for uninterrupted teaching and training during times of crisis


Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm


Ten work-life balance tips for researchers based at home during the pandemic


title: Scalable Identification of Partially Observed Systems with Certainty-Equivalent EM

text: System identification is a key step for model-based control, estimator design, and output prediction. This work considers the offline identification of partially observed nonlinear systems. We empirically show that the certainty-equivalent approximation to expectation-maximization can be a reliable and scalable approach for high-dimensional deterministic systems, which are common in robotics. We formulate certainty-equivalent expectation-maximization as block coordinate-ascent, and provide an efficient implementation. The algorithm is tested on a simulated system of coupled Lorenz attractors, demonstrating its ability to identify high-dimensional systems that can be intractable for particle-based approaches. Our approach is also used to identify the dynamics of an aerobatic helicopter. By augmenting the state with unobserved fluid states, a model is learned that predicts the acceleration of the helicopter better than state-of-the-art approaches. The codebase for this work is available at https://github.com/sisl/CEEM.


Glucocorticoid versus immunoglobulin in the treatment of COVID-19-associated fulminant myocarditis


title: Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019: A Review

text: Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019, causing human coronavirus disease 2019 (COVID-19), which has now spread into a worldwide pandemic. The pulmonary manifestations of COVID-19 have been well described in the literature. Two similar human coronaviruses that cause Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV-1) are known to cause disease in the central and peripheral nervous systems. Emerging evidence suggests COVID-19 has neurologic consequences as well. Observations: This review serves to summarize available information regarding coronaviruses in the nervous system, identify the potential tissue targets and routes of entry of SARS-CoV-2 into the central nervous system, and describe the range of clinical neurological complications that have been reported thus far in COVID-19 and their potential pathogenesis. Viral neuroinvasion may be achieved by several routes, including transsynaptic transfer across infected neurons, entry via the olfactory nerve, infection of vascular endothelium, or leukocyte migration across the blood-brain barrier. The most common neurologic complaints in COVID-19 are anosmia, ageusia, and headache, but other diseases, such as stroke, impairment of consciousness, seizure, and encephalopathy, have also been reported. Conclusions and Relevance: Recognition and understanding of the range of neurological disorders associated with COVID-19 may lead to improved clinical outcomes and better treatment algorithms. Further neuropathological studies will be crucial to understanding the pathogenesis of the disease in the central nervous system, and longitudinal neurologic and cognitive assessment of individuals after recovery from COVID-19 will be crucial to understand the natural history of COVID-19 in the central nervous system and monitor for any long-term neurologic sequelae.


title: COVID-19 with spontaneous pneumothorax,pneumomediastinum and subcutaneous emphysema

text: We present a case of COVID-19 pneumonia associated with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema.


title: Prevention and treatment strategies of Traditional Chinese and Western Medicine for acute abdomen during the outbreak of COVID-19/ 中国医师杂志

text: At present, the prevention and control of the COVID-19 is still severe, its pathogen SARS-CoV-2 is highly infectious and pathogenic, and the population is generally susceptible. In order to deal with the epidemic, selective operation can be postponed, but most of the patients with acute abdominal diseases are commonly in clinic, with acute onset and severe condition, and most of them are accompanied with fever and gastrointestinal symptoms, so emergency operation is needed.Under the condition of the current epidemic—COVID-19, it requires a higher standard to diagnose and treat patients with acute abdomen. The first step is to carry out procedures to identify whether the patient is infected or not. Those who are not infected can go through the normal treating procedures.For patients diagnosed with COVID-19 or suspected patients, the second step is to achieve classified diagnoses and treatments, and to adopt a treating plan that integrates TCM and western medicine.In order to protect patients and medical staff, the COVID-19 in hospital transmission must be avoided. For patients with COVID-19 who need emergency surgery, we must strictly comply with the hospital's protection regulations, closely coordinate the relevant departments of surgery, perform the three-level protection, operate in accordance with the principle of damage control in the negative pressure surgery room, and return to the isolation ward according to the prevention and control process after operation. For units without surgical conditions, patients should be transferred to hospital in time on the premise of maximum damage control, and patients must not be delayed for timely diagnosis and treatment due to the epidemic.


Self-harm and COVID-19 Pandemic: An emerging concern - A report of 2 cases from India


title: Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases/ 中华围产医学杂志

text: Objective To evaluate the clinical characteristics and pregnant outcomes of gravidae with COVID-19. Methods This study involved nine gravidae with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 22 to February 1, 2020. Their clinical data, including epidemiological history, clinical symptoms, laboratory examinations, chest CT, treatment, delivery mode, and pregnancy outcomes, were analyzed retrospectively. Specimens of maternal vaginal swab were collected in six pregnant women, and the specimens of amniotic fluid, cord blood, neonatal throat swab and breast milk samples were collected in four pregnant women who had a delivery during our study. All samples were tested for the existence of COVID-19. Descriptive analysis was applied in this study. Results (1) Among the nine cases, five were admitted in the third trimester and four in the second trimester. The median incubation period of COVID-19 was 8 (1-14) d. Fever was presented in all cases on admission, and the other commonly seen symptoms were cough (seven cases) and diarrhea (five cases). Other signs and symptoms were also reported, including shortness of breath, myalgia and fatigue (four cases in each), nasal obstruction, pharyngalgia, chest pain, and headache/dizziness (three cases in each), rash (two cases), and chills and expectoration (one case in each). The most common laboratory abnormalities were a decreased number of lymphocytes (seven cases) and elevated C-reactive protein (six cases). Chest CT scans were performed in seven women, and all showed patchy areas or ground-glass opacity in both lungs. Oligohydramnios was detected in only one case at 37 +5 weeks, which was 7 d after the diagnosis of COVID-19. (2) All nine cases received empiric antibiotic and antiviral therapy with Chinese medicine as adjuvant treatment. Eight patients required oxygen inhalation, and eight were treated with glucocorticoid. Six cases received immunotherapy. (3) Four of the nine cases had delivered, including three cesarean sections and one spontaneous vaginal preterm birth after premature rupture of membranes, and the mother was transferred to the intensive care unit 2 d after delivery due to acute respiratory distress syndrome. One case was terminated at 26 gestational weeks. Of the four neonates, there were two term and two premature babies, and one preterm baby was small-for-gestational-age. No neonatal asphyxia was observed. Serial real-time quantitative reverse transcription-polymerase chain reaction showed negative results in the detection of 2019-novel coronavirus in all samples obtained from amniotic fluid, umbilical cord blood, neonatal nasopharynx, breast milk, and vagina. Maternal conditions were all stable in all cases, including the four continuing pregnancy, and the terminated ones, except the case mentioned above. Conclusions There is no distinguishable clinical feature between pregnant and non-pregnant COVID-19 patients. So far, there is no evidence for vertical transmission or worsening perinatal outcome in mothers and babies.


The versatile heparin in COVID-19


Prevention and control of COVID-19 in neurointerventional surgery: expert consensus from the Chinese Federation of Interventional and Therapeutic Neuroradiology (CFITN) and the International Society for Neurovascular Disease (ISNVD)


title: COVID-19 mitigation strategies and overview on results from relevant studies in Europe

text: In December 2019, the first patients in Wuhan, China were diagnosed with a primary atypical pneumonia, which showed to be unknown and contagious. Since then, known as COVID-19 disease, the responsible viral pathogen, SARS-CoV-2, has spread around the world in a pandemic. Decisions on how to deal with the crisis are often based on simulations of the pandemic spread of the virus. The results of some of these, as well as their methodology and possibilities for improvement, will be described in more detail in this paper in order to inform beyond the current public health dogma called"flatten-the-curve". There are several ways to model an epidemic in order to simulate the spread of diseases. Depending on the timeliness, scope and quality of the associated real data, these multivariable models differ in the value of used parameters, but also in the selection of considered influencing factors. It was exemplarily shown that epidemics in their course are simulated more realistically by models that assume subexponential growth. Furthermore, various simulations of the COVID-19 pandemic were presented in an European perspective, compared against each other and discussed in more detail. It is difficult to estimate how credible the simulations of the pandemic models currently are, so it remains to be seen whether the spread of the pandemic can be effectively reduced by the measures taken. Whether a model works well in reality is largely determined by the quality and scope of its underlying data. Past studies have shown that countermeasures are able to reduce reproduction numbers or transmission rates in epidemics. In addition to that, the presented modelling study provides a good framework for the creation of subexponential-growth-models for assessing the spread of COVID-19.


title: A scalable method of applying heat and humidity for decontamination of N95 respirators during the COVID-19 crisis

text: A lack of N95 Filtering Facepiece Respirators (FFRs) during the COVID-19 crisis has placed healthcare workers at risk. It is important for any N95 reuse strategy to determine the effects that proposed protocols would have on the physical functioning of the mask, as well as the practical aspects of implementation. Here we propose and implement a method of heating N95 respirators with moisture (85°C, 60-85% humidity). We test both mask filtration efficiency and fit to validate this process. Our tests focus on the 3M 1860, 3M 1870, and 3M 8210 Plus N95 models. After five cycles of the heating procedure, all three respirators pass both quantitative fit testing (score of >100) and show no degradation of mask filtration efficiency. We also test the Chen Heng V9501 KN95 and HKYQ N95 finding no degradation of mask filtration efficiency, however even for unheated masks these scored <50 for every fit test. The heating method presented here is scalable from individual masks to over a thousand a day with a single industrial convection oven, making this method practical for local application inside health-care facilities.


title: Erythropoietin as candidate for supportive treatment of severe COVID-19

text: In light of the present therapeutic situation in COVID-19, any measure to improve course and outcome of seriously affected individuals is of utmost importance. We recap here evidence that supports the use of human recombinant erythropoietin (EPO) for ameliorating course and outcome of seriously ill COVID-19 patients. This brief expert review grounds on available subject-relevant literature searched until May 14, 2020, including Medline, Google Scholar, and preprint servers. We delineate in brief sections, each introduced by a summary of respective COVID-19 references, how EPO may target a number of the gravest sequelae of these patients. EPO is expected to: (1) improve respiration at several levels including lung, brainstem, spinal cord and respiratory muscles; (2) counteract overshooting inflammation caused by cytokine storm/ inflammasome; (3) act neuroprotective and neuroregenerative in brain and peripheral nervous system. Based on this accumulating experimental and clinical evidence, we finally provide the research design for a double-blind placebo-controlled randomized clinical trial including severely affected patients, which is planned to start shortly.


title: Learning from the Past: Possible Urgent Prevention and Treatment Options for Severe Acute Respiratory Infections Caused by 2019-nCoV

text: With the current trajectory of the 2019-nCoV outbreak unknown, public health and medicinal measures will both be needed to contain spreading of the virus and to optimize patient outcomes. Although little is known about the virus, an examination of the genome sequence shows strong homology with its better-studied cousin, SARS-CoV. The spike protein used for host cell infection shows key nonsynonymous mutations that might hamper the efficacy of previously developed therapeutics but remains a viable target for the development of biologics and macrocyclic peptides. Other key drug targets, including RNA-dependent RNA polymerase and coronavirus main proteinase (3CLpro), share a strikingly high (>95 %) homology to SARS-CoV. Herein, we suggest four potential drug candidates (an ACE2-based peptide, remdesivir, 3CLpro-1 and a novel vinylsulfone protease inhibitor) that could be used to treat patients suffering with the 2019-nCoV. We also summarize previous efforts into drugging these targets and hope to help in the development of broad-spectrum anti-coronaviral agents for future epidemics.


Future of Chernobyl research: the urgency for consolidated action


COVID-19: What Comes Next for IRs


title: Directiva administrativa que regula los procesos, registros y accesos a la información para garantizar el seguimiento integral de los casos sospechosos y confirmados de COVID-19 (Sistema Integrado para COVID-19-SICOVID-19)/ Administrative directive that regulates the processes, records and access to information to guarantee comprehensive monitoring of suspected and confirmed cases of COVID-19 (Integrated System for COVID-19-SICOVID-19)

text: El documento contiene los procesos, procedimientos, aplicaciones tecnológicas de captura de datos y acceso a la información con el objeto de hacer el seguimiento longitudinal en tiempo real de los casos sospechosos y confirmados de COVID-19 a nivel nacional regional y local.


title: COVID-19: animals, veterinary and zoonotic links

text: Coronavirus disease 2019 (COVID-19), has spread over 210 countries and territories beyond China shortly. On February 29, 2020, the World Health Organization (WHO) denoted it in a high-risk category, and on March 11, 2020, this virus was designated pandemic, after its declaration being a Public Health International Emergency on January 30, 2020. World over high efforts are being made to counter and contain this virus. The COVID-19 outbreak once again proves the potential of the animal-human interface to act as the primary source of emerging zoonotic diseases. Even though the circumstantial evidence suggests the possibility of an initial zoonotic emergence, it is too early to confirm the role of intermediate hosts such as snakes, pangolins, turtles, and other wild animals in the origin of SARS-CoV-2, in addition to bats, the natural hosts of multiple coronaviruses such as SARS-CoV and MERS-CoV. The lessons learned from past episodes of MERS-CoV and SARS-CoV are being exploited to retort this virus. Best efforts are being taken up by worldwide nations to implement effective diagnosis, strict vigilance, heightened surveillance, and monitoring, along with adopting appropriate preventive and control strategies. Identifying the possible zoonotic emergence and the exact mechanism responsible for its initial transmission will help us to design and implement appropriate preventive barriers against the further transmission of SARS-CoV-2. This review discusses in brief about the COVID-19/SARS-CoV-2 with a particular focus on the role of animals, the veterinary and associated zoonotic links along with prevention and control strategies based on One-health approaches.


title: Soy Isoflavones and Gastrointestinal Health

text: PURPOSE OF REVIEW: Soy isoflavones are known to have beneficial effects on several aspects of gastrointestinal physiological functions (contractility or motility, secretion, morphology, and barrier function). In this review, we discuss the effects of soy isoflavones on the overall gut function and inflammation and assess how these effects might be implicated in the treatment of several gut-related diseases. RECENT FINDINGS: Soy isoflavones influence several key aspects of gastrointestinal health: improve basal intestinal secretion, alleviate inflammation, limit intestinal morphological damage, and improve epithelial barrier function in several clinically relevant murine models of gastrointestinal diseases. Dietary supplementation with isoflavones proves to be a key means to improve the overall gut function and health. Future mechanistic studies with isoflavone interventions will help treat clinically related diseases such as cystic fibrosis and inflammatory-related gut problems such as colitis and diabetes.


Coronavirus: NHS staff get power to keep patients in isolation as UK declares "serious threat"


Letter to the Editor (COVID-19 and Stroke)


Stellungnahme der AG pneumologische Altersmedizin zu COVID-19 bei geriatrischen Patienten./ [Recommendations for the Treatment of Elderly Patients with COVID-19 from the Taskforce for Gerontopneumology]


title: COVID - A Caring Reflection

text: Those of us who can come to work every day and provide emotional and spiritual support to the patients, families, staff, and to each other despite all challenges. COVID-19 has not robbed us of our ability to care. COVID-19 has not robbed us of our voices in using kind words, thoughts, sentiments, and prayers to comfort others and each other. Most importantly, COVID-19 has not broken us.


The Roadmap to Pituitary in COVID-19 Crisis


title: Cambios a partir de la COVID-19. Una perspectiva desde la pediatría interna hospitalaria./ [Changes from COVID-19. A perspective from internal pediatric medicine]

text: SARS-CoV-2 pandemic dimension has affected the Hospital Pediatrics Medicine assistance in our country. New challenges generated by COVID-19 require a series of proactive measures, based on existing scientific knowledge and standards of good practice, that allow the Pediatric Hospital services readiness and operability. Hospital Internal Pediatrics, as responsible of integral care of the hospitalized child, plays a leading role in the new hospital model emerging from this crisis. This review analyzes the impact of the current SARS-CoV-2 epidemic on pediatric care, and perspective of new COVID-19 outbreaks in coexistence with other viral infections. Changes secondary to pandemic involved in Hospital Pediatric units, how to prepare for future epidemics, also the involvement of pediatric units in adult care and the possible opportunities for improvement need to be revised. Assistance of patients with chronic complex conditions in epidemic circumstances, safety aspects, opportunities for teaching and ethical considerations are reviewed. The Spanish Society of Hospital Pediatrics Medicine offers with this article a series of resources for Internal Pediatric Medicine practitioners responsible to face next challenges in pediatric hospitalization units.


Optimisation of Vitamin D Status for Enhanced Immuno-protection Against Covid-19


title: Surgical wait list management in Canada during a pandemic: many challenges ahead

text: Summary: The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact on waits for elective operations, with tens of thousands of scheduled surgeries being cancelled or postponed across Canada. Provincial governments will likely not only reopen elective surgical capacity when it is deemed safe, but also target new funding to address the backlog of cases. There is a dearth of research on whether the provinces' approaches to managing wait lists are equitable from a patients' needs perspective or if they are associated with patients' perception of outcomes. The surgical cost models used in the past won't be useful to governments and hospital managers. New models based on hospitals' marginal costs, associated with running on weekends or off-hours and social distancing parameters, will be needed. Surgeon input, collaboration and leadership during the strategy development, implementation and management of surgical wait lists postpandemic will be imperative, as these decisions will significantly affect the health and lives of many Canadians.


title: SARS-CoV-2 infection: The role of cytokines in COVID-19 disease

text: COVID-19 disease, caused by infection with SARS-CoV-2, is related to a series of physiopathological mechanisms that mobilize a wide variety of biomolecules, mainly immunological in nature. In the most severe cases, the prognosis can be markedly worsened by the hyperproduction of mainly proinflammatory cytokines, such as IL-1, IL-6, IL-12, IFN-Î³, and TNF-α, preferentially targeting lung tissue. This study reviews published data on alterations in the expression of different cytokines in patients with COVID-19 who require admission to an intensive care unit. Data on the implication of cytokines in this disease and their effect on outcomes will support the design of more effective approaches to the management of COVID-19.


title: Patient blood management during the COVID-19 pandemic: a narrative review

text: As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient blood management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on blood supply and specifies important aspects of donor management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient blood management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient blood management during the COVID-19 pandemic.


title: What Was the Change in Telehealth Usage and Proportion of No-show Visits for an Orthopaedic Trauma Clinic During the COVID-19 Pandemic?

text: BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Medicare and Medicaid Services pledged payment for telehealth visits for the duration of this public health emergency in an effort to decrease COVID-19 transmission and allow for deployment of residents and attending physicians to support critical-care services. Although the COVID-19 pandemic has vastly expanded telehealth use, no studies to our knowledge have analyzed the implementation and success of telehealth for orthopaedic trauma. This population is unique in that patients who have experienced orthopaedic trauma range in age from early childhood to late adulthood, they vary across the socioeconomic spectrum, may need to undergo emergent or urgent surgery, often have impaired mobility, and, historically, do not always follow-up consistently with healthcare providers. QUESTIONS/PURPOSES: (1) To what extent did telehealth usage increase for an outpatient orthopaedic trauma clinic at a Level 1 trauma center from the month before the COVID-19 stay-at-home order compared with the month immediately following the order? (2) What is the proportion of no-show visits before and after the implementation of telehealth? METHODS: After nonurgent clinic visits were postponed, telehealth visits were offered to all patients due to the COVID-19 stay-at-home order. Patients with internet access who had the ability to download the MyChart application on their mobile device and agreed to a telehealth visit were seen virtually between March 16, 2020 and April 10, 2020 (COVID-19) by three attending orthopaedic trauma surgeons at a large, urban, Level 1 trauma center. Clinic schedules and patient charts were reviewed to determine clinical volumes and no-show proportions. The COVID-19 period was compared with the 4 weeks before March 16, 2020 (pre-COVID-19), when all visits were conducted in-person. The overall clinic volume decreased from 340 to 233 (31%) between the two periods. The median (range) age of telehealth patients was 46 years (20 to 89). Eighty-four percent (72 of 86) of telehealth visits were postoperative and established nonoperative patient visits, and 16% (14 of 86) were new-patient visits. To avoid in-person suture or staple removal, patients seen for their 2-week postoperative visit had either absorbable closures, staples, or nonabsorbable sutures removed by a home health registered nurse or skilled nursing facility registered nurse. If radiographs were indicated, they were obtained at outside facilities or our institution before patients returned home for their telehealth visit. RESULTS: There was an increase in the percentage of office visits conducted via telehealth between the pre-COVID-19 and COVID-19 periods (0% [0 of 340] versus 37% [86 of 233]; p < 0.001), and by the third week of implementation, telehealth comprised approximately half of all clinic visits (57%; [30 of 53]). There was no difference in the no-show proportion between the two periods (13% [53 of 393] for the pre-COVID-19 period and 14% [37 of 270] for the COVID-19 period; p = 0.91). CONCLUSIONS: Clinicians should consider implementing telehealth strategies to provide high-quality care for patients and protect the workforce during a pandemic. In a previously telehealth-naïve clinic, we show successful implementation of telehealth for a diverse orthopaedic trauma population that historically has issues with mobility and follow-up. Our strategies include postponing long-term follow-up visits, having sutures or staples removed by a home health or skilled nursing facility registered nurse, having patients obtain pertinent imaging before the visit, and ensuring that patients have access to mobile devices and internet connectivity. Future studies should evaluate the incidence of missed infections or stiffness as a result of telehealth, analyze the subset of patients who may be more vulnerable to no-shows or technological failures, and conduct patient surveys to determine the factors that contribute to patient preferences for or against the use of telehealth. LEVEL OF EVIDENCE: Level III, therapeutic study.


EAHP launches COVID-19 resource centre for hospital pharmacists


title: The response of Synechococcus sp. PCC 7002 to micro-/nano polyethylene particles - Investigation of a key anthropogenic stressor

text: Microplastics or plastic particles less than 5 mm in size are a ubiquitous and damaging pollutant in the marine environment. However, the interactions between these plastic particles and marine microorganisms are just starting to be understood. The objective of this study was to measure the responses of a characteristic marine organism (Synechococcus sp. PCC 7002) to an anthropogenic stressor (polyethelene nanoparticles and microparticles) using molecular techniques. This investigation showed that polyethylene microparticles and nanoparticles have genetic, enzymatic and morphological effects on Synechococcus sp. PCC 7002. An RT-PCR analysis showed increases in the expression of esterase and hydrolase genes at 5 days of exposure to polyethylene nanoparticles and at 10 days of exposure to polyethylene microparticles. A qualitative enzymatic assay also showed esterase activity in nanoparticle exposed samples. Cryo-scanning electron microscopy was used to assess morphological changes in exopolymer formation resulting from exposure to polyethylene microparticles and nanoparticles. The data from this paper suggests that microplastic and nanoplastics could be key microbial stressors and should be investigated in further detail.


title: Estimation of the secondary attack rate of COVID-19 using proportional meta-analysis of nationwide contact tracing data in Taiwan

text: Crude secondary attack rate (SAR) of COVID-19 in Taiwan was 0.84% using nationwide contact-tracing data till April 8, 2020. The random-effect Bayesian metaanalysis yielded 95% credible intervals of 0.42%-1.69% and 0.08%-8.32%, respectively, for estimated SAR pooling from 15 case series and for predicted SAR in the future if pandemic continues.


Novel Coronavirus and Orthopaedic Surgery: Early Experiences from Singapore


title: COVID-19 and religious congregations: Implications for spread of novel pathogens

text: The COVID-19 pandemic is ravaging the world. A principal preventive strategy is practicing social distancing. Congregations of the faithful at the local and transnational levels are strongly recommended by several world religions and religious orders, however, a gathering of large numbers of people in close approximation could be fertile ground for the spread of novel pathogens. The refusal to suspend such gatherings could lead to potential widespread dispersal of infections.


title: Immunological and inflammatory profiles in mild and severe cases of COVID-19

text: COVID-19 is associated with 5.1% mortality. Although the virological, epidemiological, clinical, and management outcome features of COVID-19 patients have been defined rapidly, the inflammatory and immune profiles require definition as they influence pathogenesis and clinical expression of COVID-19. Here we show lymphopenia, selective loss of CD4+ T cells, CD8+ T cells and NK cells, excessive T-cell activation and high expression of T-cell inhibitory molecules are more prominent in severe cases than in those with mild disease. CD8+ T cells in patients with severe disease express high levels of cytotoxic molecules. Histochemical studies of lung tissue from one fatality show sub-anatomical distributions of SARS-CoV-2 RNA and massive infiltration of T cells and macrophages. Thus, aberrant activation and dysregulation of CD8+ T cells occur in patients with severe COVID-19 disease, an effect that might be for pathogenesis of SARS-CoV-2 infection and indicate that immune-based targets for therapeutic interventions constitute a promising treatment for severe COVID-19 patients.


The COvid-19 Vascular sERvice (COVER) Study: An International Vascular and Endovascular Research Network (VERN) Collaborative Study Assessing the Provision, Practice, and Outcomes of Vascular Surgery During the COVID-19 Pandemic


title: ASReview: Open Source Software for Efficient and Transparent Active Learning for Systematic Reviews

text: For many tasks - including guideline development for medical doctors and systematic reviews for research fields - the scientific literature needs to be checked systematically. The current practice is that scholars and practitioners screen thousands of studies by hand to find which studies to include in their review. This is error prone and inefficient. We therefore developed an open source machine learning (ML)-aided pipeline: Active learning for Systematic Reviews (ASReview). We show that by using active learning, ASReview can lead to far more efficient reviewing than manual reviewing, while exhibiting adequate quality. Furthermore, the presented software is fully transparent and open source.


title: Games of Social Distancing during an Epidemic: Local vs Statistical Information

text: The spontaneous behavioral changes of the agents during an epidemic can have significant effects on the delay and the prevalence of its spread. In this work, we study a social distancing game among the agents of a population, who determine their social interactions during the spread of an epidemic. The interconnections between the agents are modeled by a network and local interactions are considered. The payoffs of the agents depend on their benefits from their social interactions, as well as on the costs to their health due to their possible contamination. The information available to the agents during the decision making plays a crucial role in our model. We examine two extreme cases. In the first case, the agents know exactly the health states of their neighbors and in the second they have statistical information for the global prevalence of the epidemic. The Nash equilibria of the games are studied and, interestingly, in the second case the equilibrium strategies for an agent are either full isolation or no social distancing at all. Experimental studies are presented through simulations, where we observe that in the first case of perfect local information the agents can affect significantly the prevalence of the epidemic with low cost for their sociability, while in the second case they have to pay the burden of not being well informed. Moreover, the effects of the information quality (fake news), the health care system capacity and the network structure are discussed and relevant simulations are provided, which indicate that these parameters affect the size, the peak and the start of the outbreak, as well as the possibility of a second outbreak.


title: Glycyrrhizic-Acid-Based Carbon Dots with High Antiviral Activity by Multisite Inhibition Mechanisms

text: With the gradual usage of carbon dots (CDs) in the area of antiviral research, attempts have been stepped up to develop new antiviral CDs with high biocompatibility and antiviral effects. In this study, a kind of highly biocompatible CDs (Gly-CDs) is synthesized from active ingredient (glycyrrhizic acid) of Chinese herbal medicine by a hydrothermal method. Using the porcine reproductive and respiratory syndrome virus (PRRSV) as a model, it is found that the Gly-CDs inhibit PRRSV proliferation by up to 5 orders of viral titers. Detailed investigations reveal that Gly-CDs can inhibit PRRSV invasion and replication, stimulate antiviral innate immune responses, and inhibit the accumulation of intracellular reactive oxygen species (ROS) caused by PRRSV infection. Proteomics analysis demonstrates that Gly-CDs can stimulate cells to regulate the expression of some host restriction factors, including DDX53 and NOS3, which are directly related to PRRSV proliferation. Moreover, it is found that Gly-CDs also remarkably suppress the propagation of other viruses, such as pseudorabies virus (PRV) and porcine epidemic diarrhea virus (PEDV), suggesting the broad antiviral activity of Gly-CDs. The integrated results demonstrate that Gly-CDs possess extraordinary antiviral activity with multisite inhibition mechanisms, providing a promising candidate for alternative therapy for PRRSV infection.


title: Could India be the origin of next COVID-19 like epidemic?

text: The COVID-19 global pandemic is not even over yet but it has already taught us a lot of lessons - the hard way. The vast majority of the global community has blamed the Chinese Illegal wildlife markets for the origin of this pandemic. Through careful scientific analysis, I have explained in this article that we don't need such wildlife markets for these kinds of outbreaks to occur in the future. I have also explained how India which is the second-most populous country in the world, could be the origin of the next outbreak, even though such wildlife markets are either very rare or do not exist at all in India.