title: Antigen Capture Enzyme-Linked Immunosorbent Assay for Detecting Middle East Respiratory Syndrome Coronavirus in Humans

text: The Middle East respiratory syndrome (MERS) is the second novel zoonotic disease infecting humans caused by coronavirus (CoV) in this century. To date, more than 2200 laboratory-confirmed human cases have been identified in 27 countries, and more than 800 MERS-CoV associated deaths have been reported since its outbreak in 2012. Rapid laboratory diagnosis of MERS-CoV is the key to successful containment and prevention of the spread of infection. Though the gold standard for diagnosing MERS-CoV infection in humans is still nucleic acid amplification test (NAAT) of the up-E region, an antigen capture enzyme-linked immunosorbent assay (ELISA) could also be of use for early diagnosis in less developed locations. In the present method, a step-by-step guide to perform a MERS-CoV nucleocapsid protein (NP) capture ELISA using two NP-specific monoclonal antibodies is provided for readers to develop their in-house workflow or diagnostic kit for clinical use and for mass-screening project of animals (e.g., dromedaries and bats) to better understand the spread and evolution of the virus.


title: The Brain Retains: Nonhuman Primate Models for Pediatric HIV-1 in the CNS

text: PURPOSE OF REVIEW: Perinatal HIV-1 infection is associated with an increased risk for neurologic impairments. With limited access to clinical specimens, animal models could advance our understanding of pediatric central nervous system (CNS) disease and viral persistence. Here, we summarize current findings on HIV-1 CNS infection from nonhuman primate (NHP) models and discuss their implications for improving pediatric clinical outcomes. RECENT FINDINGS: SIV/SHIV can be found in the CNS of infant macaques within 48 h of challenge. Recent studies show an impermeable BBB during SIV infection, suggesting neuroinvasion in post-partum infection is likely not wholly attributed to barrier dysfunction. Histopathological findings reveal dramatic reductions in hippocampal neuronal populations and myelination in infected infant macaques, providing a link for cognitive impairments seen in pediatric cases. Evidence from humans and NHPs support the CNS as a functional latent reservoir, harbored in myeloid cells that may require unique eradication strategies. Studies in NHP models are uncovering early events, causes, and therapeutic targets of CNS disease as well as highlighting the importance of age-specific studies that capture the distinct features of pediatric HIV-1 infection.


title: Clinical outcomes in COVID-19 patients treated with tocilizumab: An individual patient data systematic review

text: BACKGROUND: Current evidence suggests an important role of the interleukin-6 (IL-6) pathway in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cytokine release storm in severely ill coronavirus disease 2019 (COVID-19) patients. Inhibition of the IL-6 pathway with tocilizumab has been employed successfully in some of these patients but the data is mostly consistent of case reports and series. METHODS: We performed a systematic search of PubMed, Embase, and Medline from 22nd April 2020 and again on 27th April 2020 using the following search terms alone or in combination: "COVID-19," "coronavirus," "SARS-CoV-2," "COVID," "anti-interleukin-6 receptor antibodies," "anti-IL-6," "tocilizumab," "sarilumab," "siltuximab." We included studies that reported individual patient data. We extracted and analyzed individual level data on baseline characteristics, laboratory findings, and clinical outcomes. The primary endpoint was in-hospital mortality. Secondary endpoints included in-hospital complications, recovery rates, effect of patient characteristics on the primary outcome and changes in levels of inflammatory markers. RESULTS: Three hundred fifty-two records were identified through a systematic search, of which 10 studies met the inclusion criteria. A single study currently under review was also added. Eleven observational studies encompassing 29 patients were included in the present review. There were more males (24 [82.8%]), and hypertension was the most common comorbidity (16 [48.3%]). Over an average of 5.4 hospital days, the primary endpoint occurred in 6 (20.7%) patients. Among surviving patients, about 10% had worsened disease and 17% recovered. The most common complication was acute respiratory distress syndrome (8 [27.6%]). The IL-6 level was significantly higher after the initiation of tocilizumab with median (interquartile range) of 376.6 (148-900.6) pg/mL compared to the baseline of 71.1 (31.9-122.8) pg/mL (P = .002). Mean (standard deviation) levels of C-reactive protein (CRP) were significantly decreased following treatment 24.6 (26.9) mg/L compared to baseline 140.4 (77) mg/L (P < .0001). Baseline demographics were not significantly different among survivors and nonsurvivors by Fisher's exact test. CONCLUSION: In COVID-19 patients treated with tocilizumab, IL-6 levels are significantly elevated, which are supportive of cytokine storm. Following initiation of tocilizumab, there is elevation in the IL-6 levels and CRP levels dramatically decrease, suggesting an improvement in this hyperinflammatory state. Ongoing randomized control trials will allow for further evaluation of this promising therapy. IMPORTANCE: Recent data indicate that severe COVID-19 causes a cytokine release storm and is associated with worse clinical outcomes and IL-6 plays an important role. It is suggestive that anti-IL-6 results in the improvement of this hyperinflammatory state. However, to our knowledge, there is no individual patient data systematic review performed to summarize baseline characteristics and clinical outcomes of COVID-19 patients who received tocilizumab.


title: COVID-19 pandemic: Lessons learned and future directions

text: Emerging pandemics show that humans are not infallible and communities need to be prepared. Coronavirus outbreak was first reported towards the end of 2019 and has now been declared a pandemic by the World Health Organization. Worldwide countries are responding differently to the virus outbreak. A delay in detection and response has been recorded in China, as well as in other major countries, which led to an overburdening of the local health systems. On the other hand, some other nations have put in place effective strategies to contain the infection and have recorded a very low number of cases since the beginning of the pandemics. Restrictive measures like social distancing, lockdown, case detection, isolation, contact tracing, and quarantine of exposed had revealed the most efficient actions to control the disease spreading. This review will help the readers to understand the difference in response by different countries and their outcomes. Based on the experience of these countries, India responded to the pandemic accordingly. Only time will tell how well India has faced the outbreak. We also suggest the future directions that the global community should take to manage and mitigate the emergency.


COVID-19, sweat, tears and myopia?


Psychiatric burdens or stress during hospitalization and concerns after discharge in patients with severe acute respiratory syndrome coronavirus-2 isolated in a tertiary care hospital


title: Bracing for the Big Ones: Novel Diseases like COVID-19 Could Test Texas' Public Health System

text: Novel diseases like COVID-19 could be a tough test for Texas' public health system.


Chest-X-ray is a mainstay for follow-up in critically ill patients with covid-19 induced pneumonia


title: Au-decorated BN nanotube as a breathalyzer for potential medical applications

text: Respiratory viral infections such as coronavirus (COVID-19) will cause a great mortality, especially in people who underly lung diseases such as chronic obstructive pulmonary and asthma. Very recently, the COVID-19 outbreak has exposed the lack of quick approaches for screening people who may have risen risk of pathogen contact. One proposed non-invasive potential approach to recognize the viral infection is analysis of exhaled gases. It has been indicated that the nitric oxide is one of most important biomarkers which might be emanated by respiratory epithelial cells. Using density functional theory calculations, here, we introduced a novel Au-decorated BN nanotube-based breathalyzer for probable recognition of NO gas released from the respiratory epithelial cells in the presence of interfering CO2 and H2O gases. This breathalyzer benefits from different advantages including high sensitivity (sensing responseâ¯=â¯101.5), high selectivity, portability, short recovery time (1.8â¯µs at 298â¯K), and low cost.


Clinical Insights for Gastroenterology and Hepatology Providers during the COVID-19 Pandemic


title: COVID-19: Immunology and treatment options

text: The novel coronavirus SARS-CoV2 causes COVID-19, a pandemic threatening millions. As protective immunity does not exist in humans and the virus is capable of escaping innate immune responses, it can proliferate, unhindered, in primarily infected tissues. Subsequent cell death results in the release of virus particles and intracellular components to the extracellular space, which result in immune cell recruitment, the generation of immune complexes and associated damage. Infection of monocytes/macrophages and/or recruitment of uninfected immune cells can result in massive inflammatory responses later in the disease. Uncontrolled production of pro-inflammatory mediators contributes to ARDS and cytokine storm syndrome. Antiviral agents and immune modulating treatments are currently being trialled. Understanding immune evasion strategies of SARS-CoV2 and the resulting delayed massive immune response will result in the identification of biomarkers that predict outcomes as well as phenotype and disease stage specific treatments that will likely include both antiviral and immune modulating agents.


The effects of the COVID-19 virus on mental healthcare for older people in The Netherlands


COVID-19: the use of immunotherapy in metastatic lung cancer


title: Review of Artificial Intelligence Techniques in Imaging Data Acquisition, Segmentation and Diagnosis for COVID-19

text: The pandemic of coronavirus disease 2019 (COVID-19) is spreading all over the world. Medical imaging such as X-ray and computed tomography (CT) plays an essential role in the global fight against COVID-19, whereas the recently emerging artificial intelligence (AI) technologies further strengthen the power of the imaging tools and help medical specialists. We hereby review the rapid responses in the community of medical imaging (empowered by AI) toward COVID-19. For example, AI-empowered image acquisition can significantly help automate the scanning procedure and also reshape the workflow with minimal contact to patients, providing the best protection to the imaging technicians. Also, AI can improve work efficiency by accurate delineation of infections in X-ray and CT images, facilitating subsequent quantification. Moreover, the computer-aided platforms help radiologists make clinical decisions, i.e., for disease diagnosis, tracking, and prognosis. In this review paper, we thus cover the entire pipeline of medical imaging and analysis techniques involved with COVID-19, including image acquisition, segmentation, diagnosis, and follow-up. We particularly focus on the integration of AI with X-ray and CT, both of which are widely used in the frontline hospitals, in order to depict the latest progress of medical imaging and radiology fighting against COVID-19.


title: Effect of Underlying Comorbidities on the Infection and Severity of COVID-19 in Korea: a Nationwide Case-Control Study

text: BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an emerging threat worldwide. It remains unclear how comorbidities affect the risk of infection and severity of COVID-19. METHODS: This is a nationwide retrospective case-control study of 219,961 individuals, aged 18 years or older, whose medical costs for COVID-19 testing were claimed until May 15, 2020. COVID-19 diagnosis and infection severity were identified from reimbursement data using diagnosis codes and on the basis of respiratory support use, respectively. Odds ratios (ORs) were estimated using multiple logistic regression, after adjusting for age, sex, region, healthcare utilization, and insurance status. RESULTS: The COVID-19 group (7,341 of 219,961) was young and had a high proportion of female. Overall, 13.0% (954 of 7,341) of the cases were severe. The severe COVID-19 group had older patients and a proportion of male ratio than did the non-severe group. Diabetes (odds ratio range [ORR], 1.206-1.254), osteoporosis (ORR, 1.128-1.157), rheumatoid arthritis (ORR, 1.207-1.244), substance use (ORR, 1.321-1.381), and schizophrenia (ORR, 1.614-1.721) showed significant association with COVID-19. In terms of severity, diabetes (OR, 1.247; 95% confidential interval, 1.009-1.543), hypertension (ORR, 1.245-1.317), chronic lower respiratory disease (ORR, 1.216-1.233), chronic renal failure, and end-stage renal disease (ORR, 2.052-2.178) were associated with severe COVID-19. CONCLUSION: We identified several comorbidities associated with COVID-19. Health care workers should be more careful while diagnosing and treating COVID-19 when patients have the abovementioned comorbidities.


Child poverty, food insecurity, and respiratory health during the COVID-19 pandemic


title: Changes to management of a non-pandemic illness during the COVID-19 pandemic: case study of invasive management of acute coronary syndrome

text: The coronavirus 2019 (COVID-19) pandemic requires significant changes to standard operating procedures for non-COVID-19 related illnesses Balancing the benefit from standard evidence-based treatments with the risks posed by COVID-19 to patients, healthcare workers and to the population at large is difficult due to incomplete and rapidly changing information In this article, we use management of acute coronary syndromes as a case study to show how these competing risks and benefits can be resolved, albeit incompletely While the risks due to COVID-19 in patients with acute coronary syndromes is unclear, the benefits of standard management are well established in this condition As an aid to decision making, we recommend systematic estimation of the risks and benefits for management of any condition where there is likely to be an increase in non-COVID-19 related mortality and morbidity due to changes in routine care


title: SARS-CoV-2 spike protein favors ACE2 from Bovidae and Cricetidae

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the recent COVID-19 public health crisis. Bat is the widely believed original host of SARS-CoV-2. However, its intermediate host before transmitting to humans is not clear. Some studies proposed pangolin, snake, or turtle as the intermediate hosts. Angiotensin-converting enzyme 2 (ACE2) is the receptor for SARS-CoV-2, which determines the potential host range for SARS-CoV-2. On the basis of structural information of the complex of human ACE2 and SARS-CoV-2 receptor-binding domain (RBD), we analyzed the affinity to S protein of the 20 key residues in ACE2 from mammal, bird, turtle, and snake. Several ACE2 proteins from Primates, Bovidae, Cricetidae, and Cetacea maintained the majority of key residues in ACE2 for associating with SARS-CoV-2 RBD. The simulated structures indicated that ACE2 proteins from Bovidae and Cricetidae were able to associate with SARS-CoV-2 RBD. We found that nearly half of the key residues in turtle, snake, and bird were changed. The simulated structures showed several key contacts with SARS-CoV-2 RBD in turtle and snake ACE2 were abolished. This study demonstrated that neither snake nor turtle was the intermediate hosts for SARS-CoV-2, which further reinforced the concept that the reptiles are resistant against infection of coronavirus. This study suggested that Bovidae and Cricetidae should be included in the screening of intermediate hosts for SARS-CoV-2.


The prominence of asymptomatic superspreaders in transmission mean universal face masking should be part of COVID-19 de-escalation strategies


Ventilators by Lottery: The Least Unjust Form of Allocation in the COVID-19 Pandemic


title: The psychosocial impact of COVID-19 pandemic in Italy: A lesson for mental health prevention in the first severely hit European country

text: Italy was the first European country severely hit by the COVID-19 pandemic. While the containment measures were relatively effective in the acute phase, the current postemergency phase addressing the long-term psychosocial consequences is the key challenge for our healthcare system, where the importance of mental health prevention is not sufficiently recognized. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


COVID-19 and the 'Spanish' flu


A "paper diaper" in N95 respirator


title: Manejo Emocional De La Crisis Sanitaria Ante El Coronavirus: Una Revisión Narrativa./ [Emotional management of the health crisis by coronavirus: A narrative review]

text: OBJECTIVE: To make a synthesis of the available scientific evidence in the emotional management of the declared health crisis in the face of coronavirus. METHODS: A bibliographic search was made, without date limit, in Medline, CINAHL, PsycINFO, Scopus and Web of Science databases using the following keywords: "emotional management"; "health crisis" and "health crisis response". Initially; 73 studies were identified and; after selecting them according to eligibility criteria; 10 were included. RESULTS: The main recommendations based on the available evidence indicate emotional management measures such as offering support groups to professionals, ensuring their social non-discrimination, strengthening their confidence and control capacity through training actions, as well as reinforcing the recognition of nurses by the community. DISCUSSION AND CONCLUSIONS: The accumulated evidence comes from experience with previous outbreaks of SARS-CoV-1 and MERS-CoV. Stress was the most studied aspect, concerning issues such as social stigma, professionalism, intention to care, burnout, ethical conflicts, anxiety, depression or guilt. The emotional management of health crises in the face of the coronavirus requires an individual, collective, social and institutional strategy to reinforce security on all fronts and reduce fear through effective control measures using sufficient and adequate material and human resources.


title: Improved Clinical Symptoms and Mortality on Severe/Critical COVID-19 Patients Utilizing Convalescent Plasma Transfusion

text: Coronavirus disease 2019 (COVID-19) is causing worldwide pandemic with no specific therapeutic agents, especially for severe or critical patients. To comprehensively evaluate the effectiveness, safety, and indications of convalescent plasma transfusion (CPT) therapy for severe or critical COVID-19 patients, we analyzed the clinical, laboratory, and radiologic characteristics of 1,568 patients from a single center, in which 138 patients received ABO-compatible CPT. The median time from the first symptom to CPT was 45 days. 2.2% and 4.1% of cases died in the CPT group and in the standard-treatment group, respectively. 2.4% and 5.1% of patients in the CPT and the standard-treatment group have been admitted to ICU eventually. 70% of the patients who had severe respiratory symptoms got improved and removed oxygen supports within 7 days after CPT. The viral loads and C-reactive protein (CRP) concentration significantly decreased (P<0.001), and the percentage of lymphocytes increased (P=0.006), 76.8% of cases received radiological improvements within 14 days after CPT. Patients with a higher percentage of lymphocytes and a lower percentage of neutrophils and CRP concentration respond better to CPT (P<0.05). Notably, for the patients who received CPT within 7 weeks after symptom onset, the median time from CPT to clinical improvements was approximately 10 days. But the time to clinical improvements was significantly prolonged for patients who received CPT later than 7 weeks after onset. Our study will provide important information for the clinical practice in COVID-19 treatment, as well as provide real-world observations and clinical data for the development of monoclonal antibodies.


title: Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19

text: The role of clinical laboratory data in the differential diagnosis of the severe forms of COVID-19 has not been definitely established. The aim of this study was to look for the warning index in severe COVID-19 patients. We investigated 43 adult patients with COVID-19. The patients were classified into mild group (28 patients) and severe group (15 patients). A comparison of the hematological parameters between the mild and severe groups showed significant differences in interleukin-6 (IL-6), d-dimer (d-D), glucose, thrombin time, fibrinogen, and C-reactive protein (P < .05). The optimal threshold and area under the receiver operator characteristic curve (ROC) of IL-6 were 24.3 and 0.795 µg/L, respectively, while those of d-D were 0.28 and 0.750 µg/L, respectively. The area under the ROC curve of IL-6 combined with d-D was 0.840. The specificity of predicting the severity of COVID-19 during IL-6 and d-D tandem testing was up to 93.3%, while the sensitivity of IL-6 and d-D by parallel test in the severe COVID-19 was 96.4%. IL-6 and d-D were closely related to the occurrence of severe COVID-19 in the adult patients, and their combined detection had the highest specificity and sensitivity for early prediction of the severity of COVID-19 patients, which has important clinical value.


title: Challenges of diabetes care management in developing countries with a high incidence of COVID-19: A brief report

text: BACKGROUND AND AIMS: Diabetes mellitus (DM) is one of the most critical risk factors for complications and death in COVID-19 patients. The present study aims to highlight challenges in the management of diabetic patients during the COVID-19 outbreak in developing countries. METHODS: We reviewed the literature to obtain information about diabetic care during the Covid-19 crisis. We also seek opinions of clinicians working in undeveloped countries. RESULTS: Current challenges faced by clinicians in the management of diabetic patients in developing countries are as follows: lack of preventive measures, inadequate number of visits, loss of the traditional method of communication with the patient, shortage of medications, impaired routine diabetic care, and absence of telehealth services. CONCLUSIONS: Developing countries are faced with many challenges in diabetes management due to a lack of resources.


The key role of palliative care in response to the COVID-19 tsunami of suffering


title: Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study

text: BACKGROUND: In December, 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China. The number of affected pregnant women is increasing, but scarce information is available about the clinical features of COVID-19 in pregnancy. This study aimed to clarify the clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19. METHODS: In this retrospective, single-centre study, we included all pregnant women with COVID-19 who were admitted to Tongji Hospital in Wuhan, China. Clinical features, treatments, and maternal and fetal outcomes were assessed. FINDINGS: Seven patients, admitted to Tongji Hospital from Jan 1, to Feb 8, 2020, were included in our study. The mean age of the patients was 32 years (range 29-34 years) and the mean gestational age was 39 weeks plus 1 day (range 37 weeks to 41 weeks plus 2 days). Clinical manifestations were fever (six [86%] patients), cough (one [14%] patient), shortness of breath (one [14%] patient), and diarrhoea (one [14%] patient). All the patients had caesarean section within 3 days of clinical presentation with an average gestational age of 39 weeks plus 2 days. The final date of follow-up was Feb 12, 2020. The outcomes of the pregnant women and neonates were good. Three neonates were tested for SARS-CoV-2 and one neonate was infected with SARS-CoV-2 36 h after birth. INTERPRETATION: The maternal, fetal, and neonatal outcomes of patients who were infected in late pregnancy appeared very good, and these outcomes were achieved with intensive, active management that might be the best practice in the absence of more robust data. The clinical characteristics of these patients with COVID-19 during pregnancy were similar to those of non-pregnant adults with COVID-19 that have been reported in the literature. FUNDING: National Natural Science Foundation of China, Hubei Provincial Natural Science Foundation of China.


Providing equitable care to patients with limited dominant language proficiency amid the COVID-19 pandemic


title: Cross Hashing: Anonymizing encounters in Decentralised Contact Tracing Protocols

text: During the COVID-19 (SARS-CoV-2) epidemic, Contact Tracing emerged as an essential tool for managing the epidemic. App-based solutions have emerged for Contact Tracing, including a protocol designed by Apple and Google (influenced by an open-source protocol known as DP3T). This protocol contains two well-documented de-anonymisation attacks. Firstly that when someone is marked as having tested positive and their keys are made public, they can be tracked over a large geographic area for 24 hours at a time. Secondly, whilst the app requires a minimum exposure duration to register a contact, there is no cryptographic guarantee for this property. This means an adversary can scan Bluetooth networks and retrospectively find who is infected. We propose a novel"cross hashing"approach to cryptographically guarantee minimum exposure durations. We further mitigate the 24-hour data exposure of infected individuals and reduce computational time for identifying if a user has been exposed using k-Anonymity buckets of hashes and Private Set Intersection.


Long-Term Care Policy after Covid-19 - Solving the Nursing Home Crisis


The place of early rehabilitation in ICU for Covid-19


title: [Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia]

text: At the end of December 2019, a novel coronavirus (COVID-19) caused an outbreak in Wuhan, and has quickly spread to all provinces in China and 26 other countries around the world, leading to a serious situation for epidemic prevention. So far, there is still no specific medicine. Previous studies have shown that chloroquine phosphate (chloroquine) had a wide range of antiviral effects, including anti-coronavirus. Here we found that treating the patients diagnosed as novel coronavirus pneumonia with chloroquine might improve the success rate of treatment, shorten hospital stay and improve patient outcome. In order to guide and regulate the use of chloroquine in patients with novel coronavirus pneumonia, the multicenter collaboration group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for chloroquine in the treatment of novel coronavirus pneumonia developed this expert consensus after extensive discussion. It recommended chloroquine phosphate tablet, 500mg twice per day for 10 days for patients diagnosed as mild, moderate and severe cases of novel coronavirus pneumonia and without contraindications to chloroquine.


title: Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey

text: Background: The evolving outbreak of coronavirus disease 2019 (COVID-19) is requiring social distancing and other measures to protect public health. However, messaging has been inconsistent and unclear. Objective: To determine COVID-19 awareness, knowledge, attitudes, and related behaviors among U.S. adults who are more vulnerable to complications of infection because of age and comorbid conditions. Design: Cross-sectional survey linked to 3 active clinical trials and 1 cohort study. Setting: 5 academic internal medicine practices and 2 federally qualified health centers. Patients: 630 adults aged 23 to 88 years living with 1 or more chronic conditions. Measurements: Self-reported knowledge, attitudes, and behaviors related to COVID-19. Results: A fourth (24.6%) of participants were "very worried" about getting the coronavirus. Nearly a third could not correctly identify symptoms (28.3%) or ways to prevent infection (30.2%). One in 4 adults (24.6%) believed that they were "not at all likely" to get the virus, and 21.9% reported that COVID-19 had little or no effect on their daily routine. One in 10 respondents was very confident that the federal government could prevent a nationwide outbreak. In multivariable analyses, participants who were black, were living below the poverty level, and had low health literacy were more likely to be less worried about COVID-19, to not believe that they would become infected, and to feel less prepared for an outbreak. Those with low health literacy had greater confidence in the federal government response. Limitation: Cross-sectional study of adults with underlying health conditions in 1 city during the initial week of the COVID-19 U.S. outbreak. Conclusion: Many adults with comorbid conditions lacked critical knowledge about COVID-19 and, despite concern, were not changing routines or plans. Noted disparities suggest that greater public health efforts may be needed to mobilize the most vulnerable communities. Primary Funding Source: National Institutes of Health.


title: Predicting infectious SARS-CoV-2 from diagnostic samples

text: BACKGROUND: RT-PCR has become the primary method to diagnose viral diseases, including SARS-CoV-2. RT-PCR detects RNA, not infectious virus, thus its ability to determine duration of infectivity of patients is limited. Infectivity is a critical determinant in informing public health guidelines/interventions. Our goal was to determine the relationship between E gene SARS-CoV-2 RT-PCR cycle threshold (Ct) values from respiratory samples, symptom onset to test (STT) and infectivity in cell culture. METHODS: In this retrospective cross-sectional study, we took SARS-CoV-2 RT-PCR confirmed positive samples and determined their ability to infect Vero cell lines. RESULTS: Ninety RT-PCR SARS-CoV-2 positive samples were incubated on Vero cells. Twenty-six samples (28.9%) demonstrated viral growth. Median TCID50/ml was 1780 (282-8511). There was no growth in samples with a Ct > 24 or STT > 8 days. Multivariate logistic regression using positive viral culture as a binary predictor variable, STT and Ct demonstrated an odds ratio for positive viral culture of 0.64 (95% CI 0.49-0.84, p<0.001) for every one unit increase in Ct. Area under the receiver operating characteristic curve for Ct vs. positive culture was OR 0.91 (95% CI 0.85-0.97, p<0.001), with 97% specificity obtained at a Ct of >24. CONCLUSIONS: SARS-CoV-2 Vero cell infectivity was only observed for RT-PCR Ct < 24 and STT < 8 days. Infectivity of patients with Ct >24 and duration of symptoms >8 days may be low. This information can inform public health policy and guide clinical, infection control and occupational health decisions. Further studies of larger size are needed.


title: Ischemic stroke associated with novel coronavirus 2019: a report of three cases

text: Introduction: There is limited evidence about the neurological manifestations of COVID-19 in infected patients. In this report, we describe three patients with ischemic stroke associated with COVID-19 infection.Methods: We report 3 cases of adult patients with ischemic stroke and novel coronavirus 2019 infection. Case 1 is an 88-year-old female with acute left hemiplegia and right peripheral facial paresis that she had a fever along with stroke symptoms. Case 2 is an 85-year-old female with left hemiplegia and drowsiness who had a weakness, asthenia, and dry cough 3 days before appearing stroke signs. Case 3 is a 55-year-old male with acute Broca's aphasia and right hemiplegia who experience fever and respiratory problems 3 days after admission.Results: The clinical symptoms of infected patients with COVID-19 have been associated with severe symptoms of ischemic stroke. Two patients were admitted to the ICU. RT-PCR of the oropharyngeal sample was positive in three cases. All patients had the involvement of large cerebral arteries.Conclusion: The mechanism by which COVID-19 causes ischemic stroke is unknown but it is likely by production inflammatory cytokines or direct infection of cerebral arteries. Therefore, regarding the current situation of the COVID-19 pandemic, it is indispensable that the possible diagnosis of COVID-19 vasculopathy is considered in all ischemic strokes of unclear etiology.


title: Obstetric and perinatal care units functioning during the COVID-19 pandemic ;О принципах работы перинатального стационара в условиях пандемии коронавируса

text: The rapid spread of COVID-19 and the large number of cases put a significant burden on the health systems of any developed country Specialists in natural disasters and military medicine should be involved in the provision of medical care and observance of anti-epidemic measures In some countries, including Italy, they were involved only after the situation was dramatically worsening with many clinical units and hospitals overloaded by infected patients To curb the spread of COVID-19, most countries declared a state of emergency, and unprecedented measures have been taken to strengthen quarantine in suspected or positive symptomatic subjects Nevertheless, the crisis associated with the unexpectedly global scale and tragedy of the pandemic and the inconsistency of actions of both society and individuals and specialized medical services, lead to insufficient effectiveness of the measures taken in a number of regions In the present day, it is vital for every person to change its mindset â€• relying on personal responsibility to comply with all recommendations of quarantine and anti-epidemic measures, and to reorganize departments and resources of medical institutions at all levels in order to withstand the spread of infection and at the same time provide all those in need with the necessary and appropriate medical care Particular attention should be paid to the obstetric care service, given that even in normal times, the obstetric hospital is an area of increased responsibility for the life and health of mother and child and future mankind Fulfillment of existing orders, instructions of national and regional committees, international and national protocols and clinical protocols should undoubtedly lead to a positive result, but this requires additional training of medical personnel at all levels The purpose of this review is to propose quick key strategies for reassessing the maternity and neonatal wards/ hospitals based on the experience of health systems and organizations which faced the spread of this new coronavirus;this advice may be applied along with binding tight instructions in obstetric hospitals in order to proactively respond to a likely wave of growth in COVID-19 ;ÐÐºÑ‚ÑƒÐ°Ð»ÑŒÐ½Ð¾ÑÑ‚ÑŒ Ð‘Ñ‹ÑÑ‚Ñ€Ð¾Ðµ Ñ€Ð°ÑÐ¿Ñ€Ð¾ÑÑ‚Ñ€Ð°Ð½ÐµÐ½Ð¸Ðµ COVID-19 Ð¸ Ð±Ð¾Ð»ÑŒÑˆÐ¾Ðµ ÐºÐ¾Ð»Ð¸Ñ‡ÐµÑÑ‚Ð²Ð¾ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²ÑˆÐ¸Ñ… Ð½Ð°ÐºÐ»Ð°Ð´Ñ‹Ð²Ð°ÐµÑ‚ Ð·Ð½Ð°Ñ‡Ð¸Ñ‚ÐµÐ»ÑŒÐ½ÑƒÑŽ Ð½Ð°Ð³Ñ€ÑƒÐ·ÐºÑƒ Ð½Ð° ÑÐ¸ÑÑ‚ÐµÐ¼Ñ‹ Ð·Ð´Ñ€Ð°Ð²Ð¾Ð¾Ñ…Ñ€Ð°Ð½ÐµÐ½Ð¸Ñ Ñ€Ð°Ð·Ð²Ð¸Ñ‚Ñ‹Ñ… Ð³Ð¾ÑÑƒÐ´Ð°Ñ€ÑÑ‚Ð² Ð’ Ñ€ÑÐ´Ðµ ÑÑ‚Ñ€Ð°Ð½ Ðº Ð¾ÐºÐ°Ð·Ð°Ð½Ð¸ÑŽ Ð¼ÐµÐ´Ð¸Ñ†Ð¸Ð½ÑÐºÐ¾Ð¹ Ð¿Ð¾Ð¼Ð¾Ñ‰Ð¸ Ð¸ ÑÐ¾Ð±Ð»ÑŽÐ´ÐµÐ½Ð¸ÑŽ Ð¿Ñ€Ð¾Ñ‚Ð¸Ð²Ð¾ÑÐ¿Ð¸Ð´ÐµÐ¼Ð¸Ñ‡ÐµÑÐºÐ¸Ñ… Ð¼ÐµÑ€Ð¾Ð¿Ñ€Ð¸ÑÑ‚Ð¸Ð¹ Ð¿Ñ€Ð¸Ð²Ð»ÐµÐºÐ°ÑŽÑ‚ÑÑ ÑÐ¿ÐµÑ†Ð¸Ð°Ð»Ð¸ÑÑ‚Ñ‹ Ð¿Ð¾ ÑÑ‚Ð¸Ñ…Ð¸Ð¹Ð½Ñ‹Ð¼ Ð±ÐµÐ´ÑÑ‚Ð²Ð¸ÑÐ¼ Ð¸ Ð²Ð¾ÐµÐ½Ð½Ð¾Ð¹ Ð¼ÐµÐ´Ð¸Ñ†Ð¸Ð½Ðµ, Ð¾Ð´Ð½Ð°ÐºÐ¾ Ð² Ð½ÐµÐºÐ¾Ñ‚Ð¾Ñ€Ñ‹Ñ… ÑÑ‚Ñ€Ð°Ð½Ð°Ñ…, Ð² Ñ‚Ð¾Ð¼ Ñ‡Ð¸ÑÐ»Ðµ Ð² Ð˜Ñ‚Ð°Ð»Ð¸Ð¸, Ð¾Ð½Ð¸ Ð±Ñ‹Ð»Ð¸ Ð·Ð°Ð´ÐµÐ¹ÑÑ‚Ð²Ð¾Ð²Ð°Ð½Ñ‹ Ð¿Ð¾ÑÐ»Ðµ Ñ‚Ð¾Ð³Ð¾, ÐºÐ°Ðº Ð¼Ð½Ð¾Ð³Ð¸Ðµ ÐºÐ»Ð¸Ð½Ð¸Ñ‡ÐµÑÐºÐ¸Ðµ Ð¿Ð¾Ð´Ñ€Ð°Ð·Ð´ÐµÐ»ÐµÐ½Ð¸Ñ 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Ð¾Ð±ÑÐ·Ð°Ñ‚ÐµÐ»ÑŒÐ½Ñ‹Ð¼Ð¸ Ðº Ð¸ÑÐ¿Ð¾Ð»Ð½ÐµÐ½Ð¸ÑŽ Ð´ÐµÐ¹ÑÑ‚Ð²ÑƒÑŽÑ‰Ð¸Ð¼Ð¸ Ð¿Ñ€Ð¸ÐºÐ°Ð·Ð°Ð¼Ð¸ Ð¸ Ñ€Ð°ÑÐ¿Ð¾Ñ€ÑÐ¶ÐµÐ½Ð¸ÑÐ¼Ð¸ Ð² Ð°ÐºÑƒÑˆÐµÑ€ÑÐºÐ¸Ñ… ÑÑ‚Ð°Ñ†Ð¸Ð¾Ð½Ð°Ñ€Ð°Ñ…, Ñ‡Ñ‚Ð¾Ð±Ñ‹ Ð¿Ñ€ÐµÐ²ÐµÐ½Ñ‚Ð¸Ð²Ð½Ð¾ Ð¾Ñ‚Ñ€ÐµÐ°Ð³Ð¸Ñ€Ð¾Ð²Ð°Ñ‚ÑŒ Ð½Ð° Ð²ÐµÑ€Ð¾ÑÑ‚Ð½ÑƒÑŽ Ð²Ð¾Ð»Ð½Ñƒ Ñ€Ð¾ÑÑ‚Ð° Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°ÐµÐ¼Ð¾ÑÑ‚Ð¸ Ð¸ Ð½Ð¾ÑÐ¸Ñ‚ÐµÐ»ÑŒÑÑ‚Ð²Ð° COVID-19


Superspreaders and the spread pattern of COVID-19: Response to: "Do superspreaders generate new superspreaders? A hypothesis to explain the propagation pattern of COVID-19", International Journal of Infectious Diseases 96 (2020) 461-463


title: Recommendations on Management of Locally Advanced Rectal Cancer During the COVID-19 Pandemic: an Iranian Consensus

text: PURPOSE: Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era. METHODS: In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. RESULTS: We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19. CONCLUSION: Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.


title: [Analysis on the theory and clinical ideas of acupuncture and moxibustion for the prevention and treatment of coronavirus disease 2019]

text: Acupuncture and moxibustion has a wealth of experience in the prevention and control of epidemic disease since ancient times, which was used for all kinds of acute infectious diseases in modern times and its efficacy has been clearly and reliably reported. This article proposes the theoretical feasibility and reliability of acupuncture and moxibustion interventional prevention and treatment by discussing the recognition of coronavirus disease 2019 (COVID-19) from the perspective of acupuncture and moxibustion. The unique "acupuncture and moxibustion program" for COVID-19 is presented including treatment in different stages, selecting acupoints by distinguishing meridians, applying needle technique by various methods. The article also proposes a new understanding of acupuncture and moxibustion at related acupoints on the surface of the body that can directly affect the "moyuan" to treat the disease.


Transforming graduate nursing education during an era of social distancing: Tools from the field


title: Coswara -- A Database of Breathing, Cough, and Voice Sounds for COVID-19 Diagnosis

text: The COVID-19 pandemic presents global challenges transcending boundaries of country, race, religion, and economy. The current gold standard method for COVID-19 detection is the reverse transcription polymerase chain reaction (RT-PCR) testing. However, this method is expensive, time-consuming, and violates social distancing. Also, as the pandemic is expected to stay for a while, there is a need for an alternate diagnosis tool which overcomes these limitations, and is deployable at a large scale. The prominent symptoms of COVID-19 include cough and breathing difficulties. We foresee that respiratory sounds, when analyzed using machine learning techniques, can provide useful insights, enabling the design of a diagnostic tool. Towards this, the paper presents an early effort in creating (and analyzing) a database, called Coswara, of respiratory sounds, namely, cough, breath, and voice. The sound samples are collected via worldwide crowdsourcing using a website application. The curated dataset is released as open access. As the pandemic is evolving, the data collection and analysis is a work in progress. We believe that insights from analysis of Coswara can be effective in enabling sound based technology solutions for point-of-care diagnosis of respiratory infection, and in the near future this can help to diagnose COVID-19.


Response to Kim et al. re: "Exosomes Derived from Bone Marrow Mesenchymal Stem Cells as Treatment for Severe COVID-19"


title: The Emerging Threat of (Micro)Thrombosis in COVID-19 and Its Therapeutic Implications

text: The recent emergence of SARS-CoV-2 and the ensuing global pandemic has presented a health emergency of unprecedented magnitude. Recent clinical data has highlighted that COVID-19 is associated with a significant risk of thrombotic complications ranging from microvascular thrombosis, venous thromboembolic disease and stroke. Importantly, thrombotic complications are markers of severe COVID-19 and are associated with multi-organ failure and increased mortality. The evidence to date supports the concept that the thrombotic manifestations of severe COVID-19 is due to the ability of SARS-CoV-2 to invade endo¬thelial cells via angiotensin-converting enzyme 2 (ACE2), which is expressed on the endothelial cell surface. However, in patients with COVID-19 the subsequent endothelial inflammation, complement activation, thrombin generation, platelet and leukocyte recruitment, and the initiation of innate and adaptive immune responses culminate in immunothrombosis, ultimately causing (micro)thrombotic compli¬cations such as deep vein thrombosis, pulmonary embolism and stroke. Accordingly, the activation of coagulation (e.g. as measured with plasma D-dimer) and thrombocytopenia have emerged as prognostic markers in COVID-19. Given thrombotic complications are central determinants of the high mortality rate in COVID-19, strategies to prevent thrombosis are of critical importance. A number of antithrombotic drugs have been proposed as potential therapies to prevent COVID-19-associated thrombosis, including, heparin, FXII inhibitors, fibrinolytic drugs, nafamostat and dipyridamole, many of which also possess pleiotropic anti-inflammatory or anti-viral effects. The growing awareness and mechanistic understanding of the prothrombotic state of COVID-19 patients is driving efforts to more stringent diagnostic screening for thrombotic compli¬cations and to the early institution of antithrombotic drugs, for both the prevention and therapy of thrombotic complications. The shifting paradigm of diagnostic and treatment strategies holds significant promise to reduce the burden of thrombotic complications and ultimately improve the prognosis for patients with COVID-19.


title: [Be alert to superposed effect of seasonal influenza while fighting against novel coronavirus pneumonia]

text: The novel coronavirus pneumonia (NCP) continues to spread throughout the country, and the prevention and control of the epidemic has entered a critical period. However, southern cities with severe outbreaks are about to enter the seasonal influenza season. We should strengthen the epidemiological investigation, optimize the laboratory testing strategy, take effective measures, strengthen the prevention and control of influenza epidemic, and minimize the interference to the new coronavirus epidemic.


Pandemia por COVID-19: el mayor reto de la historia del intensivismo./ Pandemia por COVID-19: el mayor reto de la historia del intensivismo./ COVID-19 Pandemic: the greatest challenge in the history of critical care


Vertical Transmission of SARS-CoV-2: What is the Optimal Definition?


The potential danger of suboptimal antibody responses in COVID-19


title: Osteoporosis in the age of COVID-19

text: As the world grapples with the crisis of COVID-19, established economies and healthcare systems have been brought to their knees. Tough decisions regarding redirection of resources away from the management of conditions deemed "nonessential" are being made. How can we balance urgent resourcing of our acute crisis while not abandoning the real need of patients with osteoporosis? This article offers a few practical solutions.


title: Detecting fake news for the new coronavirus by reasoning on the Covid-19 ontology

text: In the context of the Covid-19 pandemic, many were quick to spread deceptive information. I investigate here how reasoning in Description Logics (DLs) can detect inconsistencies between trusted medical sources and not trusted ones. The not-trusted information comes in natural language (e.g."Covid-19 affects only the elderly"). To automatically convert into DLs, I used the FRED converter. Reasoning in Description Logics is then performed with the Racer tool.


title: CORDITE: The Curated CORona Drug InTERactions Database for SARS-CoV-2

text: Since the outbreak in 2019, researchers are trying to find effective drugs against the SARS-CoV-2 virus based on de novo drug design and drug repurposing. The former approach is very time consuming and needs extensive testing in humans, whereas drug repurposing is more promising, as the drugs have already been tested for side effects, etc. At present, there is no treatment for COVID-19 that is clinically effective, but there is a huge amount of data from studies that analyze potential drugs. We developed CORDITE to efficiently combine state-of-the-art knowledge on potential drugs and make it accessible to scientists and clinicians. The web interface also provides access to an easy-to-use API that allows a wide use for other software and applications, e.g., for meta-analysis, design of new clinical studies, or simple literature search. CORDITE is currently empowering many scientists across all continents and accelerates research in the knowledge domains of virology and drug design.


Correspondence regarding research letter to the editor by Mathian et al, 'Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus under long-term treatment with hydroxychloroquine'


title: Olfactory and taste disorders in COVID-19: a systematic review

text: INTRODUCTION: The SARS-CoV-2 virus causes COVID-19, and it is responsible for the largest pandemic since the 1918 H1N1 influenza outbreak. The classic symptoms of the disease have been well defined by the World Health Organization; however, olfactory/gustatory disorders have been reported in some studies, but there are still several missing points in the understanding and in the consensus about the clinical management of these cases. OBJECTIVE: To identify evidence in the scientific literature about olfactory/gustatory disorders, their clinical presentation, prevalence and possible specific treatments associated with COVID-19. METHODS: A systematic review of articles published up to April 25, 2020 was performed in Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus and Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine and Reasearch Gate. INCLUSION CRITERIA: (1) Studies on patients with COVID-19; (2) Records of COVID-19 signs/symptoms, and olfactory/gustatory functions. EXCLUSION CRITERIA: (1) Studies on non-human coronavirus; (2) Review articles; (3) Experimental studies (in animals or in vitro); (4) Olfactory/gustatory disorders initiated prior to SARS-CoV-2 infection. The risk assessment of bias of the selected studies was performed using the Newcastle-Ottawa scale. RESULTS: Six articles from the 1788 records met the inclusion criteria and were analyzed. A total of 1457 patients of different ethnicities were assessed; of them, 885 (60.7%) and 822 (56.4%) had smell and taste disorders, respectively, with women being most often affected. There were olfactory/gustatory disorders even without nasal obstruction/rhinorrhea and beginning even before the signs/symptoms of COVID-19; the recovery of smell/taste, when it occurs, usually happened in the first two weeks after COVID-19 resolution. There is evidence that olfactory/gustatory disorders are strong predictors of infection by SARS-CoV-2, and it is possible to recommend patient isolation, as early as of the medical consultation, preventing the spread of the virus. No scientific evidence has been identified for effective treatments for any of the disorders. CONCLUSION: Olfactory/gustatory disorders may occur at varying intensities and prior to the general symptoms of COVID-19 and should be considered as part of the clinical features of COVID-19, even in mild cases. There is still no scientific evidence of specific treatments for such disorders in COVID-19 disease.


title: SARS-CoV-2, COVID-19, and inherited arrhythmia syndromes

text: Ever since the first case was reported at the end of 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and the associated lung disease "coronavirus disease 2019" (COVID-19) has become a serious threat to public health globally in short time. At this point in time, there is no proven effective therapy. The interactions with concomitant disease are largely unknown, and that may be particularly pertinent to inherited arrhythmia syndrome. An arrhythmogenic effect of COVID-19 can be expected, potentially contributing to disease outcome. This may be of importance for patients with an increased risk of cardiac arrhythmias, either secondary to acquired conditions or comorbidities or consequent to inherited syndromes. Management of patients with inherited arrhythmia syndromes such as long QT syndrome, Brugada syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia in the setting of the COVID-19 pandemic may prove particularly challenging. Depending on the inherited defect involved, these patients may be susceptible to proarrhythmic effects of COVID-19-related issues such as fever, stress, electrolyte disturbances, and use of antiviral drugs. Here, we describe the potential COVID-19-associated risks and therapeutic considerations for patients with distinct inherited arrhythmia syndromes and provide recommendations, pending local possibilities, for their monitoring and management during this pandemic.


title: High prevalence for obesity in severe COVID-19: Possible links and perspectives towards patient stratification

text: It is becoming obvious that in addition to aging and various hearth pathologies, excess of body weight, especially obesity is a major risk factor for severity of COVID-19 infection. Intriguingly the receptor for SARS-CoV-2 is ACE2, a member of the angiotensin receptor family that has a relatively large tissue distribution. This observation likely explains the multitude of symptoms that have been described from human patients. The adipose tissue also expresses ACE2, suggesting that adipocytes are potentially infected by SARS-CoV-2. Here we discuss some of the potential contribution of the adipose tissue to the severity of the infection and propose some aspects of obese patients metabolic phenotyping to help stratification of individuals with high risk of severe disease.


Recurrent PCR positivity after hospital discharge of people with coronavirus disease 2019 (COVID-19)


The curious case of coronavirus disease 2019 (COVID-19) in children


title: [Recommendations for normalizing the medical practices of burn treatment during the outbreak of coronavirus disease 2019]

text: 2019 novel coronavirus (2019-nCoV) is one of the beta coronaviruses and is identified as the pathogen of the severe " coronavirus disease 2019 (COVID-19)" in 2019. China manages COVID-19 according to the reguirement of the highest level infectious diseases in China. Currently, the prevention and control of COVID-19 in China is at a critical period. Burn Department as an emergency discipline is confronted with risk of 2019-nCoV infection. Based on the guidelines for the diagnosis and treatment of COVID-19 (6th trial edition), in combination with the latest literature at home and abroad, the features of the COVID-19, the recommendations for the COVID-19 prevention and control issued by the National Health Commission of China, and the management experience of COVID-19 diagnosis and treatment of other related disciplines, we put forward some recommendations for the medical practices of burn treatment during the outbreak of the COVID-19 in outpatient and emergency, inpatient treatment, and the management of operation theatres and wards, etc. We hope these recommendations could benefit the medical professionals in the field of burn treatment and relevant hospital management during the outbreak of COVID-19, improve burn treatment, and avoid or reduce the risk of infection of medical staff.


title: [Recommendations for the regulation of medical practices of burn treatment during the outbreak of the coronavirus disease 2019]

text: 2019 novel coronavirus (2019-nCoV) is one of the beta coronaviruses and was identified as the pathogen of the severe "coronavirus disease 2019 (COVID-19)" in 2019. China has formally included the 2019-nCoV in the statutory notification and control system for infectious diseases according to the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases. Currently, the national defending actions on the 2019-nCoV in China is in a critical period. Burn Department is also confronted with risk of infection by the 2019-nCoV. According to the guidelines on the diagnosis and treatment of COVID-19 (6(th) trial edition), the latest relative literature at home and abroad, the features of the COVID-19, recommendations for the COVID-19 prevention and control issued by the National Health Commission of China, and management experience of diagnosis and treatment in the related disciplines, we put forward recommendations for the medical practices of burn treatment during the outbreak of the COVID-19 in outpatient and emergency treatment, inpatient treatment, operation and ward management, etc. We hope these recommendations could benefit the professionals of the same occupation as us and related hospital managers, improve the treatment of burn during the outbreak of the COVID-19, and avoid or reduce the risk of infection of medical staff .


title: Recommendations for the regulation of medical practices of burn treatment during the outbreak of the coronavirus disease 2019/ 中华烧伤杂志

text: 2019 novel coronavirus (2019-nCoV) is one of the beta coronaviruses and was identified as the pathogen of the severe "coronavirus disease 2019 (COVID-19)" in 2019. China has formally included the 2019-nCoV in the statutory notification and control system for infectious diseases according to the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases. Currently, the national defending actions on the 2019-nCoV in China is in a critical period. Burn Department is also confronted with risk of infection by the 2019-nCoV. According to the guidelines on the diagnosis and treatment of COVID-19 (6th trial edition), the latest relative literature at home and abroad, the features of the COVID-19, recommendations for the COVID-19 prevention and control issued by the National Health Commission of China, and management experience of diagnosis and treatment in the related disciplines, we put forward recommendations for the medical practices of burn treatment during the outbreak of the COVID-19 in outpatient and emergency treatment, inpatient treatment, operation and ward management, etc. We hope these recommendations could benefit the professionals of the same occupation as us and related hospital managers, improve the treatment of burn during the outbreak of the COVID-19, and avoid or reduce the risk of infection of medical staff .


Moral Injury: The Invisible Epidemic in COVID Health Care Workers


title: COVID-19 among Health Workers in Germany and Malaysia

text: We report on the suspected case reports filed for SARS-CoV-2 infections and COVID-19 illnesses among health and social welfare workers in Germany. In addition, we report about COVID-19 in health workers in Malaysia. Claims for occupational diseases caused by SARS-CoV-2 are recorded separately in a database of the Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW). This database is analyzed according to its content as of May 22, 2020. In addition, the notifiable cases of SARS-CoV-2 infections from personnel in medical institutions (e.g., clinics and doctor's office) and social welfare institutions (e.g., nursing homes, shelters and refugee camps) following the German Infection Protection Act are analyzed. The report from Malaysia is based on personal experience and publications of the government. In Germany at present, 4398 suspected case reports for the diagnosis of SARS-CoV-2 infections among health and social workers have been filed. This figure is four times the number of all reported infections normally received per year. The majority of claims, regardless of being a confirmed infection, concerned nurses (n = 6927, 63.9%). The mortality rate for workers infected with SARS-CoV-2 is 0.2% to 0.5%. Doctors are affected by severe illness more frequently than other occupational groups (8.1% vs. 4.1%). In Malaysia, work-related infection of health workers (HW) occurred mainly when COVID-19 was not suspected in patients and no adequate personal protective equipment (PPE) was worn. Although knowledge on the spread of SARS-CoV-2 infections among workers remains limited, the impact appears to be substantial. This is supported by the mortality rate among infected workers. Occupational health check-ups carried out at the present time should be systematically analyzed in order to gain more information on the epidemiology of COVID-19 among HW. Since the supply and use of PPE improved, the infection risk of HW in Malaysia seems to have decreased.


title: COVID-19 and diabetes mellitus: An unholy interaction of two pandemics

text: BACKGROUND AND AIMS: Diabetes mellitus is associated with poor prognosis in patients with COVID-19. On the other hand, COVID-19 contributes to worsening of dysglycemia in people with diabetes mellitus over and above that contributed by stress hyperglycemia. Herein, we have reviewed the two-way interactions between COVID-19 and diabetes mellitus. METHODS: We have performed an extensive literature search for articles in PubMed, EMBASE and Google Scholar databases till April 25, 2020, with the following keywords: "COVID-19", "SARS-CoV-2", "diabetes", "diabetes mellitus", "SARS", "infection" and "management of diabetes mellitus" with interposition of the Boolean operator "AND". RESULTS: Compromised innate immunity, pro-inflammatory cytokine milieu, reduced expression of ACE2 and use of renin-angiotensin-aldosterone system antagonists in people with diabetes mellitus contribute to poor prognosis in COVID-19. On the contrary, direct ß-cell damage, cytokine-induced insulin resistance, hypokalemia and drugs used in the treatment of COVID-19 (like corticosteroids, lopinavir/ritonavir) can contribute to worsening of glucose control in people with diabetes mellitus. CONCLUSIONS: The two-way interaction between COVID-19 and diabetes mellitus sets up a vicious cycle wherein COVID-19 leads to worsening of dysglycemia and diabetes mellitus, in turn, exacerbates the severity of COVID-19. Thus, it is imperative that people with diabetes mellitus take all necessary precautions and ensure good glycemic control amid the ongoing pandemic.


title: Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis

text: A growing body of literature on the 2019 novel coronavirus (SARS-CoV-2) is becoming available, but a synthesis of available data has not been conducted We performed a scoping review of currently available clinical, epidemiological, laboratory, and chest imaging data related to the SARS-CoV-2 infection We searched MEDLINE, Cochrane CENTRAL, EMBASE, Scopus and LILACS from 01 January 2019 to 24 February 2020 Study selection, data extraction and risk of bias assessment were performed by two independent reviewers Qualitative synthesis and meta-analysis were conducted using the clinical and laboratory data, and random-effects models were applied to estimate pooled results A total of 61 studies were included (59,254 patients) The most common disease-related symptoms were fever (82%, 95% confidence interval (CI) 56%–99%;n = 4410), cough (61%, 95% CI 39%–81%;n = 3985), muscle aches and/or fatigue (36%, 95% CI 18%–55%;n = 3778), dyspnea (26%, 95% CI 12%–41%;n = 3700), headache in 12% (95% CI 4%–23%, n = 3598 patients), sore throat in 10% (95% CI 5%–17%, n = 1387) and gastrointestinal symptoms in 9% (95% CI 3%–17%, n = 1744) Laboratory findings were described in a lower number of patients and revealed lymphopenia (0 93 ×109/L, 95% CI 0 83–1 03 ×109/L, n = 464) and abnormal C-reactive protein (33 72 mg/dL, 95% CI 21 54–45 91 mg/dL;n = 1637) Radiological findings varied, but mostly described ground-glass opacities and consolidation Data on treatment options were limited All-cause mortality was 0 3% (95% CI 0 0%–1 0%;n = 53,631) Epidemiological studies showed that mortality was higher in males and elderly patients The majority of reported clinical symptoms and laboratory findings related to SARS-CoV-2 infection are non-specific Clinical suspicion, accompanied by a relevant epidemiological history, should be followed by early imaging and virological assay


Positive conversion of COVID-19 after two consecutive negative RT-PCR results: A role of low-dose CT


title: Daily Travel and Wellbeing among the Elderly

text: The purpose of this Special Issue is to introduce and demonstrate the importance of daily travel in elderly people's lives [...].


Multi-drug-resistant infections in the COVID-19 era: a framework for considering the potential impact


Clare Gerada: Doctors on the covid-19 front line also need to protect themselves and their colleagues


title: The importance of (shared) human values for containing the COVID-19 pandemic

text: The COVID-19 pandemic poses an exceptional challenge for humanity. Because public behaviour is key to curbing the pandemic at an early stage, it is important for social psychological researchers to use their knowledge to promote behaviours that help manage the crisis. Here, we identify human values as particularly important in driving both behavioural compliance to government guidelines and promoting prosocial behaviours to alleviate the strains arising from a prolonged pandemic. Existing evidence demonstrates the importance of human values, and the extent to which they are shared by fellow citizens, for tackling the COVID-19 crisis. Individuals who attach higher importance to self-transcendence (e.g., responsibility) and conservation (e.g., security) values are likely to be more compliant with COVID-19 behavioural guidelines and to help others who are struggling with the crisis. Further, believing that fellow citizens share one's values has been found to elicit a sense of connectedness that may be crucial in promoting collective efforts to contain the pandemic. The abstract nature of values, and cross-cultural agreement on their importance, suggests that they are ideally suited to developing and tailoring effective, global interventions to combat this pandemic.


title: How Has COVID-19 Affected the Costs of the Surgical Fellowship Interview Process?

text: OBJECTIVE: To evaluate the effect of COVID-19 on the costs of the surgical fellowship interview process. DESIGN: A literature review of the historical costs of surgical fellowship interviews and a summary of how the shift to virtual interviews has unintended positive and negative effects on costs for applicants and training programs. RESULTS: Transitioning fellowship interviews to virtual platforms affects expenditures of finances and time. Each fellowship candidate saves close to $6,000 in interview travel expenses. Applicants require less time off from their residency programs during this critical time of need for frontline healthcare workers. However, applicants miss some of the live aspects of interviewing, and training programs invest more effort upfront altering their interviews to virtual formats. CONCLUSIONS: The COVID-19 public health crisis has had a significant impact on surgical education, including how selection is conducted. Virtual recruitment has the potential for cost savings but should continue to be refined. This is an opportune time to innovate and rethink how to recruit prospective surgical residency and fellowship candidates during the current and forthcoming interview seasons.


Health care for chronic neurological patients after COVID-19


Disappearing act: COVID-19 and paediatric emergency department attendances


title: Preparedness is Essential for Western Pacific Islands During the COVID-19 Pandemic

text: OBJECTIVES: To clarify the pandemic status in Western Pacific countries or territories. METHODS: The WHO's daily situation reports of COVID-19 were reviewed from January 20, 2020, to March 24, 2020. Changes in the infections, deaths, and the case fatality rate (CFR) in Western Pacific countries or territories were counted. RESULTS: As of March 24, a total of 17 countries or territories had reported the presence of COVID-19 in the Western Pacific Region, 96,580 people have been infected and a total of 3502 deaths. Fifty-three percent (9/17) of these countries or territories had their first case within 2 wk since the WHO's first report, most are China's neighbors with a large and dense population. No other country or territory in this region reported a new infection from January 30 to February 28. However, 8 (47.0%) countries or territories have reported the first cases in 3 wk since February 28, almost all are islands. Many countries maintained a small number of infections for a long time after the first report, but a rapid increase occurred later. Deaths occurred in 8 countries with a total CFR of 3.63%, and the CFR varies widely, from 0.39% (Singapore) to 7.14% (Philippines). CONCLUSIONS: The regional spread of COVID-19 urgently requires an aggressive preparedness for the Western Pacific Islands.


Neuropathology of COVID-19: where are the neuropathologists?


title: Computed tomography manifestations in super early stage 2019 novel coronavirus pneumonia

text: BACKGROUND: The recent outbreak of pneumonia cases in Wuhan, PR China, was caused by a novel beta coronavirus, the 2019 novel coronavirus (COVID-19). PURPOSE: To summarize chest computed tomography (CT) manifestations of the early stage of COVID-19 infection and provide a piece of reliable imaging evidence for initial screening and diagnosis. MATERIAL AND METHODS: From 10 January 2020 to 10 February 2020, we continuously observed chest CT imaging of 14 patients with clinically suspected new coronavirus infection in the two weeks after onset of symptoms. Ground-glass opacity (GGO), consolidation, reticular pattern, and ground-glass mimic nodules in each patient's chest CT image were recorded. RESULTS: We enrolled 14 patients, of which nine patients had the infection confirmed by reverse transcription polymerase chain reaction (RT-PCR). Five patients were highly suspected of infection. All cases had epidemiological evidence. GGO was a dominant imaging manifestation in the initial days of infection. GGO performance accounts for 40% in 1- 2 days, 90% in 3- 6 days, and 85% in 7- 10 days. With disease progression, consolidation appeared on follow-up CT. Consolidation performance accounts for 0% in 1- 2 days, 40% in 3- 6 days, and 71% in 7- 10 days. The lesions are mostly near the pleura. The number of lesions and the extent of the lesions increased as the disease progressed. CONCLUSION: Patients with novel coronavirus pneumonia have characteristic CT features in the initial stage of infection, which can be used as an essential supplement for nucleic acid examination.


Severe respiratory failure in the course of COVID-19, treated with extracorporeal membrane oxygenation (ECMO)


title: Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore

text: Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019 and has spread globally with sustained human-to-human transmission outside China. Objective: To report the initial experience in Singapore with the epidemiologic investigation of this outbreak, clinical features, and management. Design, Setting, and Participants: Descriptive case series of the first 18 patients diagnosed with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection at 4 hospitals in Singapore from January 23 to February 3, 2020; final follow-up date was February 25, 2020. Exposures: Confirmed SARS-CoV-2 infection. Main Outcomes and Measures: Clinical, laboratory, and radiologic data were collected, including PCR cycle threshold values from nasopharyngeal swabs and viral shedding in blood, urine, and stool. Clinical course was summarized, including requirement for supplemental oxygen and intensive care and use of empirical treatment with lopinavir-ritonavir. Results: Among the 18 hospitalized patients with PCR-confirmed SARS-CoV-2 infection (median age, 47 years; 9 [50%] women), clinical presentation was an upper respiratory tract infection in 12 (67%), and viral shedding from the nasopharynx was prolonged for 7 days or longer among 15 (83%). Six individuals (33%) required supplemental oxygen; of these, 2 required intensive care. There were no deaths. Virus was detectable in the stool (4/8 [50%]) and blood (1/12 [8%]) by PCR but not in urine. Five individuals requiring supplemental oxygen were treated with lopinavir-ritonavir. For 3 of the 5 patients, fever resolved and supplemental oxygen requirement was reduced within 3 days, whereas 2 deteriorated with progressive respiratory failure. Four of the 5 patients treated with lopinavir-ritonavir developed nausea, vomiting, and/or diarrhea, and 3 developed abnormal liver function test results. Conclusions and Relevance: Among the first 18 patients diagnosed with SARS-CoV-2 infection in Singapore, clinical presentation was frequently a mild respiratory tract infection. Some patients required supplemental oxygen and had variable clinical outcomes following treatment with an antiretroviral agent.


title: Predicting the evolution of the COVID-19 epidemic with the A-SIR model: Lombardy, Italy and S\~ao Paulo state, Brazil

text: The presence of a large number of infected individuals with few or no symptoms is an important epidemiological difficulty and the main mathematical feature of COVID-19. The A-SIR model, i.e. a SIR (Susceptible-Infected-Removed) model with a compartment for infected individuals with no symptoms or few symptoms was proposed by Giuseppe Gaeta, arXiv:2003.08720 [q-bio.PE] (2020). In this paper we investigate a slightly generalized version of the same model and propose a scheme for fitting the parameters of the model to real data using the time series only of the deceased individuals. The scheme is applied to the concrete cases of Lombardy, Italy and S\~ao Paulo state, Brazil, showing different aspects of the epidemics. For each case we show that we may have good fits to the data up to the present, but with very large differences in the future behavior. The reasons behind such disparate outcomes are the uncertainty on the value of a key parameter, the probability that an infected individual is fully symptomatic, and on the intensity of the social distancing measures adopted. This conclusion enforces the necessity of trying to determine the real number of infected individuals in a population, symptomatic or asymptomatic.


title: Discussion on the Management of Fever Clinic during the Epidemic Period of Corona Virus Disease 2019/ 中华急诊医学杂志

text: Objective@#To investigate the role of epidemiological history in the screening of Corona Virus Disease 2019 (COVID-19) in fever clinic, to improve the efficiency in fever clinic and reduce the incidence of cross infection.@*Methods@#This is a retrospective study. Patients who were admitted to the fever clinic in West China Hospital of Sichuan University from January 23th, 2020 to February 11th, 2020 included the study. According to epidemiological history, the patients were divided into epidemiological history group (the experimental group) and no epidemiological history group (the control group). The two groups of patients were admitted and treated separately. The clinical data, NEWS score, etiology results, viral pneumonia showed on CT, time of visit, COVID-19 patient ratio, and admission composition ratio were compared between the two groups. The measurement data were presented as the mean ± standard deviation (SD), and the numeration data were expressed as ratio or constituent ratio. The measurement data of normal distribution between the two groups were compared by independent sample t test. The measurement data of skewed distribution are expressed by the median (interquartile range), and the comparison between the two groups is tested by non-parameter. The differences between enumeration data were assessed by chi-square test. A P<0.05 was considered statistically significant.@*Results@#A total of 2423 patients were included, including 927 patients in the experimental group and 1296 patients in the control group. There were no significant differences in gender, NEWS score and clinical symptoms between the two groups (P> 0.05). The age (35.00 ± 12.80 vs 38.13 ± 15.57 years) , the proportion of fever patients (28.80% vs 32.75%) and waiting time (31.72 vs 58.08 min) of the experimental group were lower than the control group, the difference was statistically significant (P <0.05). The CT examination ratio (37.54% vs 20.39%), viral pneumonia ratio showed on CT (9.77% vs 2.95%), ratio of examined COVID-19 nucleic acid test (85.44% vs 56.75%), and the admission ratio (16.72% vs 9.63%) of the experimental group were higher than the control group, and the differences were statistically significant (P <0.05); There was no significant difference in the positive rates of influenza virus and rhinovirus between the two groups (P> 0.05).@*Conclusion@#It is necessary to adjust the management mode of fever clinic during the Corona Virus Disease 2019, and to manage the patients according to the epidemiological history which can improve the screening efficiency and reduce the risk of cross infection.


COVID-19 can present with a rash and be mistaken for dengue


title: Remdesivir and SARS-CoV-2: Structural requirements at both nsp12 RdRp and nsp14 Exonuclease active-sites

text: The rapid global emergence of SARS-CoV-2 has been the cause of significant health concern, highlighting the immediate need for antivirals. Viral RNA-dependent RNA polymerases (RdRp) play essential roles in viral RNA synthesis, and thus remains the target of choice for the prophylactic or curative treatment of several viral diseases, due to high sequence and structural conservation. To date, the most promising broad-spectrum class of viral RdRp inhibitors are nucleoside analogues (NAs), with over 25 approved for the treatment of several medically important viral diseases. However, Coronaviruses stand out as a particularly challenging case for NA drug design due to the presence of an exonuclease (ExoN) domain capable of excising incorporated NAs and thus providing resistance to many of these available antivirals. Here we use the available structures of the SARS-CoV RdRp and ExoN proteins, as well as Lassa virus N exonuclease to derive models of catalytically competent SARS-CoV-2 enzymes. We then map a promising NA candidate, GS-441524 (the active metabolite of Remdesivir) to the nucleoside active site of both proteins, identifying the residues important for nucleotide recognition, discrimination, and excision. Interestingly, GS-441524 addresses both enzyme active sites in a manner consistent with significant incorporation, delayed chain termination, and altered excision due to the ribose 1'-CN group, which may account for the increased antiviral effect compared to other available analogues. Additionally, we propose structural and function implications of two previously identified RdRp resistance mutations in relation to resistance against Remdesivir. This study highlights the importance of considering the balance between incorporation and excision properties of NAs between the RdRp and ExoN.


title: Emergency department 'outbreak rostering' to meet challenges of COVID-19

text: The COVID-19 outbreak has posed unique challenges to the emergency department rostering. Additional infection control, the possibility of quarantine of staff and minimising contact among staff have significant impact on the work of doctors in the emergency department. Infection of a single healthcare worker may require quarantine of close contacts at work. This may thus affect a potentially large number of staff. As such, we developed an Outbreak Response Roster. This Outbreak Response Roster had fixed teams of doctors working in rotation, each team that staff the emergency department in turn. Members within teams remained constant and were near equally balanced in terms of manpower and seniority of doctors. Each team worked fixed 12 hours shifts with as no overlapping of staff or staggering of shifts. Handovers between shifts were kept as brief as possible. All these were measures to limit interactions among healthcare workers. With the implementation of the roster, measures were also taken to bolster the psychological wellness of healthcare workers. With face-to-face contact limited, we also had to maintain clear, open channels for communication through technology and continue educating residents through innovative means.


Can hydroxychloroquine protect patients with rheumatic diseases from COVID-19? Response to: 'Does hydroxychloroquine prevent the transmission of COVID-19?' by Heldwein and Calado and 'SLE, hydroxychloroquine and no SLE patients with COVID-19: a comment' by Joob and Wiwanitkit


What COVID-19 has taught us: lessons from around the globe


From the insight of glucose metabolism disorder: Oxygen therapy and blood glucose monitoring are crucial for quarantined COVID-19 patients


Sleep medicine durable medical equipment management during COVID-19 pandemic: our center's initial experience


Covid-19: Doctors challenge legality of government's PPE guidance


title: SaYoPillow: A Blockchain-Enabled, Privacy-Assured Framework for Stress Detection, Prediction and Control Considering Sleeping Habits in the IoMT

text: Considering today's lifestyle, people just sleep forgetting the benefits it provides to the human body. The reasons for not having a productive sleep could be many. Smart-Yoga Pillow (SaYoPillow) is envisioned as a device that may help in recognizing the importance of a good quality sleep to alleviate stress while establishing a measurable relationship between stress and sleeping habits. A system that analyzes the sleeping habits by continuously monitoring the physiological changes that occur during rapid eye movement (REM) and non-rapid eye movement (NREM) stages of sleep is proposed in the current work. In addition to the physiological parameter changes, factors such as sleep duration, snoring range, eye movement, and limb movements are also monitored. The SaYoPillow system is processed at the edge level with the storage being at the cloud. Not having to compromise the user's privacy, SaYoPillow proposes secure data transmission for both uploading and retrieving, and secure storage and communications as an attempt to reduce malicious attacks on healthcare. A user interface is provided for the user to control data accessibility and visibility. SaYoPillow has 96% accuracy which is close to other existing research works. However, SaYoPillow is the only work with security features as well as only work that considers sleeping habits for stress.


title: Endoscopic Findings in Patients Infected With 2019 Novel Coronavirus in Lombardy, Italy

text: Coronavirus disease 2019 (COVID-19) is a major worldwide threat caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rapidly spreading to a global pandemic. As of May 11, 2020, 4,176,346 cases have been reported worldwide, 219,814 in Italy, and of them, 81,871 occurred in the Lombardy region.1 Although the respiratory manifestations of COVID-19 have been widely described, the impact on the gastrointestinal (GI) system remains less clear. The reported prevalence of digestive symptoms ranges from 3% to 79%, depending on the setting,2-5 but data on GI endoscopic and histologic findings in COVID-19 patients are lacking. Therefore, the aim of this study is to describe the GI endoscopic and histologic findings in COVID-19 patients.


Evolving ART crisis for people living with HIV in Indonesia


title: Off-label prescribing in the midst of a pandemic: The case of hydroxychloroquine

text: There is currently no robust evidence to support prescribing hydroxychloroquine as a treatment or prophylaxis for COVID-19.


Clinically suspected myocarditis in the course of coronavirus infection


Bronchiolitis and Potential Pathophysiological Implications in Coronavirus Disease 2019 ARDS Patients With Near-Normal Respiratory Compliance


title: Childhood COVID-19: a multicentre retrospective study

text: OBJECTIVES: To investigate the clinical and epidemiological characteristics of paediatric patients with coronavirus disease-19 (COVID-19). METHODS: Paediatric patients diagnosed with COVID-19 between January 15 and March 15, 2020, from seven hospitals in Zhejiang Province, China, were collected retrospectively and analysed. RESULTS: Thirty-two children with COVID-19, ranging in age from 3 months to 18 years, were enrolled. Family aggregation occurred in 87.5% of infant and preschool-aged children (7/8), and also school-aged children (14/16), but in only 12.5% (1/8) of adolescents (p < 0.05, p < 0.001). Most of these patients had mild symptoms: mainly fever (20/32) followed by cough (10/32) and fatigue (4/32). The average durations of viral RNA in respiratory samples and gastrointestinal samples were 15.8 d and 28.9 d, respectively. Detox duration in faeces decreased with age: 39.8 d, 27.5 d and 20.4 d in infants and preschool children, school children, and adolescents respectively (p0-6, -18 <0.01, p0-6, -14 <0.05). Pneumonia was found in 14 children, but there was no statistical significance in the incidence of pneumonia between different age groups. Thirty patients were treated with antiviral drugs, and all patients were stable and gradually improved after admission. CONCLUSIONS: Most children with COVID-19 had a mild process and a good prognosis. More attention should be paid to investigation of household contact history in the diagnosis of COVID-19 in young children. Viral RNA lasts longer in the gastrointestinal system than in the respiratory tract, especially in younger children.


title: Using posterior predictive distributions to analyse epidemic models: COVID-19 in Mexico City

text: Epidemiological models contain a set of parameters that must be adjusted based on available observations. Once a model has been calibrated, it can be used as a forecasting tool to make predictions and to evaluate contingency plans. It is customary to employ only point estimators for such predictions. However, some models may fit the same data reasonably well for a broad range of parameter values, and this flexibility means that predictions stemming from such models will vary widely, depending on the particular parameter values employed within the range that give a good fit. When data are poor or incomplete, model uncertainty widens further. A way to circumvent this problem is to use Bayesian statistics to incorporate observations and use the full range of parameter estimates contained in the posterior distribution to adjust for uncertainties in model predictions. Specifically, given the epidemiological model and a probability distribution for observations, we use the posterior distribution of model parameters to generate all possible epidemiological curves via the posterior predictive distribution. From the envelope of all curves one can extract the worst-case scenario and study the impact of implementing contingency plans according to this assessment. We apply this approach to the potential evolution of COVID-19 in Mexico City and assess whether contingency plans are being successful and whether the epidemiological curve has flattened.


A 10-step guide to convert a surgical unit into a COVID-19 unit during the COVID-19 pandemic


Reassessing advance care planning in the light of covid-19


Covid-19: medical students to be employed by NHS as part of epidemic response


title: Analysis of 2019 novel coronavirus infection and clinical characteristics of outpatients: An epidemiological study from a fever clinic in Wuhan, China

text: BACKGROUND: Since the outbreak of 2019 novel coronavirus (SARS-CoV-2) pneumonia, thousands of patients with fever or cough were flocked into fever clinic of designated hospitals in Wuhan, China. To date, no data have ever been reported to reflect the prevalence of Corona Virus Disease 2019 (COVID-19) among these outpatients. Moreover, it is almost unknown to discriminate COVID-19 and nucleic acid negative patients based on clinical features in the fever clinics. METHODS: The infectious status of SARS-CoV-2 was estimated among the outpatients. The epidemiological and clinical characteristics were compared between COVID-19 and nucleic acid negative patients. RESULTS: The nucleic acid positive rate for SARS-CoV-2 in the outpatients from our fever clinic was 67·1%, while the majority of COVID-19 patients were mild cases. The predominant initial symptom in those COVID-19 patients was fever (78.2%), followed by cough (15.6%). Very significantly lower number of eosinophils was characterized in COVID-19 patients as compared to that of nucleic acid negative patients. More importantly, the proportion of subjects with eosinophil counts lower than normal levels in COVID-19 patients was much higher than that of nucleic acid negative patients. Fever combined with bilateral ground-glass opacities in CT imaging and eosinophil count below the normal level are probably a valuable indicator of COVID-19 infection in those outpatients. CONCLUSIONS: Those findings may provide critical information for the regions such as Europe and United States that are facing the same situation as Wuhan experienced, and could be valuable to prevent those nucleic acid negative patients from misdiagnosis before antibody testing. This article is protected by copyright. All rights reserved.


title: Correction to: European Hernia Society (EHS) guidance for the management of adult patients with a hernia during the COVID19 pandemic

text: The originally published article: The surname and given name of authors, M. Pawlak and A.C. de Beaux has been incorrectly published.


title: Health systems preparedness for COVID-19 pandemic

text: Some nations in the world and some states in India have had more success in containing this pandemic. Recent efforts in strengthening the health sector have focused largely on reforms in modes of financing, but as the pandemic brings home to us, the main challenge in India remains the challenge of the organization of public services using a health systems understanding. A close to community comprehensive primary health care, quality assurance, and planned excess capacity in public health systems, a more robust disease surveillance systems that can integrate data on new outbreaks and the indigenous technological capacity to scale up innovation and manufacture of essential health commodities are some of our most important requirements for both epidemic preparedness and response.


title: Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID-19

text: AIM: To evaluate the association between different degrees of hyperglycaemia and the risk of all-cause mortality among hospitalized patients with COVID-19. MATERIALS AND METHODS: In a retrospective study conducted from 22 January to 17 March 2020, 453 patients were admitted to Union Hospital in Wuhan, China, with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Patients were classified into four categories: normal glucose, hyperglycaemia (fasting glucose 5.6-6.9 mmol/L and/or HbA1c 5.7%-6.4%), newly diagnosed diabetes (fasting glucose ≥7 mmol/L and/or HbA1c ≥6.5%) and known diabetes. The major outcomes included in-hospital mortality, intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). RESULTS: Patients with newly diagnosed diabetes constituted the highest percentage to be admitted to the ICU (11.7%) and require IMV (11.7%), followed by patients with known diabetes (4.1%; 9.2%) and patients with hyperglycaemia (6.2%; 4.7%), compared with patients with normal glucose (1.5%; 2.3%), respectively. The multivariable-adjusted hazard ratios of mortality among COVID-19 patients with normal glucose, hyperglycaemia, newly diagnosed diabetes and known diabetes were 1.00, 3.29 (95% confidence interval [CI] 0.65-16.6), 9.42 (95% CI 2.18-40.7) and 4.63 (95% CI 1.02-21.0), respectively. CONCLUSION: We showed that COVID-19 patients with newly diagnosed diabetes had the highest risk of all-cause mortality compared with COVID-19 patients with known diabetes, hyperglycaemia and normal glucose. Patients with COVID-19 need to be kept under surveillance for blood glucose screening.


How Cyberpsychology and Virtual Reality Can Help Us to Overcome the Psychological Burden of Coronavirus


title: Prognostic Value of Novel Liquid Biomarkers in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Enzalutamide: A Prospective Observational Study

text: BACKGROUND: Several treatment options were recently added for metastatic castration-resistant prostate cancer (mCRPC). However, response to therapy is variable, and biomarkers that can guide treatment selection and response evaluation are lacking. Circulating RNAs are a promising source of biomarkers. We explored messenger RNAs (mRNAs), microRNAs (miRNAs), and long noncoding RNAs (lncRNAs) as potential biomarkers in liquid biopsies of patients with mCRPC treated with enzalutamide. METHODS: Forty patients were included in this prospective multicenter observational study. Whole blood was drawn at baseline and 1, 3, and 6 months after start of therapy. Four mRNAs, 6 miRNAs, and 5 lncRNAs were analyzed by quantitative PCR. RNA levels in 30 healthy individuals were used as controls. RNA expression data were analyzed by Kaplan-Meier and Cox regression analyses, and the primary end point was progression-free survival. Clinical factors were included in the multivariable Cox regression analysis. RESULTS: Levels of 2 miRNAs, miR-375 and miR-3687, and 1 lncRNA, N-acetylated alpha-linked acidic dipeptidase like 2 antisense RNA 2 (NAALADL2-AS2), were more than 2-fold higher in patients with mCRPC compared with healthy volunteers. Patients with higher levels of miR-375 or miR-3687 showed a shorter time to progression. Patients with higher levels of NAALADL2-AS2 showed a longer time to progression. In the multivariable Cox regression analysis, higher miR-375, miR-3687 and serum prostate-specific antigen concentrations were shown to be independent predictors for shorter time to progression. CONCLUSIONS: We identified miR-3687 as a novel prognostic marker for response in patients with CRPC treated with enzalutamide, and we confirmed the prognostic value of miR-375.


Neurologic complications of coronavirus infections


title: Covid-19: the renin-angiotensin system imbalance hypothesis

text: The emergency of SARS-CoV-2 in China started a novel challenge to the scientific community. As the virus turns pandemic, scientists try to map the cellular mechanisms and pathways of SARS-CoV-2 related to the pathogenesis of Coronavirus Disease 2019 (Covid-19). After transmembrane angiotensin-converting enzyme 2 (ACE2) has been found to be SARS-CoV-2 receptor, we hypothesized an immune-hematological mechanism for Covid-19 based on renin-angiotensin system (RAS) imbalance to explain clinical, laboratory and imaging findings on disease course. We believe that exaggerated activation of ACE/Angiotensin II (Ang II)/Angiotensin Type 1 (AT1) receptor RAS axis in line with reduction of ACE2/Angiotensin-(1-7)/Mas receptor may exert a pivotal role in the pathogenesis of Covid-19. In this perspective, we discuss potential mechanisms and evidence on this hypothesis.


Distribution in Place of Death for Coronavirus 2019 (COVID-19)-Related Mortality in the United States


title: Reduction in effective reproduction number of COVID-19 is higher in countries employing active case detection with prompt isolation

text: Countries that implemented liberal testing with active case finding and prompt isolation, combined with contact tracing and quarantine, were more successful in reducing the reproduction number compared to countries that primarily relied on social distancing and lockdown measures.


title: Kinetic patterns of liver enzyme elevation with COVID-19 in the USA

text: COVID-19 is a global pandemic that started in Wuhan, China. COVID-19 related liver enzyme elevations have been described however the clinical presentation, enzyme kinetics, and associated laboratory abnormalities of these patients have not been well described. Five cases of COVID-19 associated liver enzyme elevations are reported here. We found that COVID-19 related liver enzyme elevations occurred in a hepatocellular pattern and persisted throughout the initial hospitalization in all patients. Abnormalities in lactate dehydrogenase and ferritin levels were seen in all five cases. In conclusion, abnormalities in aminotransferase, lactate dehydrogenase, and ferritin levels are commonly seen in COVID-19 related liver injury. Elevated aminotransferase levels often persist throughout the entire hospitalization. However, the clinical course of COVID-19 related liver injury appears benign.


title: C-reactive protein: A promising biomarker for poor prognosis in COVID-19 infection

text: BACKGROUND: The novel coronavirus disease 2019 (COVID-19) first broke out in Wuhan, China, spread over 227 countries and caused approximately 0.3 million death worldwide. Several biomolecules have been explored for possible biomarkers for prognosis outcome. Although increased C reactive protein (CRP) is associated with death due to COVID-19 infections, results from different populations remain inconsistent. For a conclusive result, the present meta-analysis was performed. METHODS: We conducted a literature search in PubMed and Scopus database for the association of CRP concentration with COVID-19 disease outcomes. A total of 16 eligible studies were enrolled in the present analysis comprising of 1896 survivors and 849 non-survivors cases. Concentrations of CRP were compared and analyzed by a meta-analysis. RESULTS: Egger's regression analysis (intercept = 0.04, P = 0.98, 95%CI = -5.48 to 5.58) and funnel plot revealed an absence of publication bias in the included studies. Due to the presence of significant heterogeneity across the studies (Q = 252.03, Pheterogeneity = 0.000, I2 = 93.65) random model was used for the analysis of the present study. The results of the meta-analysis demonstrated a significant role of CRP in COVID-19 infection outcome (Standard difference in means = 1.371, P = 0.000). CONCLUSIONS: Concentrations of CRP remained high in patients who died of COVID-19 infection and could be a promising biomarker for assessing disease lethality.


A Geriatric Psychiatry Virtual Rotation during Covid-19


title: Pilgrimage and COVID-19: The risk among returnees from Muslim countries

text: COVID-19 has now spread to become a pandemic. We confirmed six Muslim pilgrims with COVID-19 among the passengers on a flight from Pakistan, following a border inspection in Guangzhou, China. We subsequently alerted home countries to prepare early in order to manage the risk from returning pilgrims. The resulting strategies of inspection and quarantine needed to cover those returning from all Muslim countries, not just Saudi Arabia.