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Euro Surveill

Infection prevention guidelines and considerations for paediatric risk groups when reopening primary schools during COVID-19 pandemic, Norway, April 2020.

In response to the coronavirus disease (COVID-19) pandemic, most countries implemented school closures. In Norway, schools closed on 13 March 2020. The evidence of effect on disease transmission was limited, while negative consequences were evident. Before reopening, risk-assessment for paediatric risk groups was performed, concluding that most children can attend school with few conditions requiring preventative homeschooling. We here present infection prevention and control guidelines for primary schools and recommendations for paediatric risk groups.

covid-19;infection prevention and control guidelines;paediatric risk groups;primary schools;school closure;transmission of covid-19 in children

Journal Article

Johansen, Tone Bjordal;Astrup, Elisabeth;Jore, Solveig;Nilssen, Hege;Dahlberg, Bente Barton;Klingenberg, Claus;Berg, Are Stuwitz;Greve-Isdahl, Margrethe

10.2807/1560-7917.ES.2020.25.22.2000921

[Title]: Infection prevention guidelines and considerations for paediatric risk groups when reopening primary schools during COVID-19 pandemic, Norway, April 2020. [Abstract]: In response to the coronavirus disease (COVID-19) pandemic, most countries implemented school closures. In Norway, schools closed on 13 March 2020. The evidence of effect on disease transmission was limited, while negative consequences were evident. Before reopening, risk-assessment for paediatric risk groups was performed, concluding that most children can attend school with few conditions requiring preventative homeschooling. We here present infection prevention and control guidelines for primary schools and recommendations for paediatric risk groups. [Keywords]: covid-19;infection prevention and control guidelines;paediatric risk groups;primary schools;school closure;transmission of covid-19 in children

JMIR Public Health Surveill

Use of Health Belief Model-Based Deep Learning Classifiers for COVID-19 Social Media Content to Examine Public Perceptions of Physical Distancing: Model Development and Case Study.

BACKGROUND: Public health authorities have been recommending interventions such as physical distancing and face masks, to curtail the transmission of coronavirus disease (COVID-19) within the community. Public perceptions toward such interventions should be identified to enable public health authorities to effectively address valid concerns. The Health Belief Model (HBM) has been used to characterize user-generated content from social media during previous outbreaks, with the aim of understanding the health behaviors of the public. OBJECTIVE: This study is aimed at developing and evaluating deep learning-based text classification models for classifying social media content posted during the COVID-19 outbreak, using the four key constructs of the HBM. We will specifically focus on content related to the physical distancing interventions put forth by public health authorities. We intend to test the model with a real-world case study. METHODS: The data set for this study was prepared by analyzing Facebook comments that were posted by the public in response to the COVID-19-related posts of three public health authorities: the Ministry of Health of Singapore (MOH), the Centers for Disease Control and Prevention, and Public Health England. The comments made in the context of physical distancing were manually classified with a Yes/No flag for each of the four HBM constructs: perceived severity, perceived susceptibility, perceived barriers, and perceived benefits. Using a curated data set of 16,752 comments, gated recurrent unit-based recurrent neural network models were trained and validated for text classification. Accuracy and binary cross-entropy loss were used to evaluate the model. Specificity, sensitivity, and balanced accuracy were used to evaluate the classification results in the MOH case study. RESULTS: The HBM text classification models achieved mean accuracy rates of 0.92, 0.95, 0.91, and 0.94 for the constructs of perceived susceptibility, perceived severity, perceived benefits, and perceived barriers, respectively. In the case study with MOH Facebook comments, specificity was above 96% for all HBM constructs. Sensitivity was 94.3% and 90.9% for perceived severity and perceived benefits, respectively. In addition, sensitivity was 79.6% and 81.5% for perceived susceptibility and perceived barriers, respectively. The classification models were able to accurately predict trends in the prevalence of the constructs for the time period examined in the case study. CONCLUSIONS: The deep learning-based text classifiers developed in this study help to determine public perceptions toward physical distancing, using the four key constructs of HBM. Health officials can make use of the classification model to characterize the health behaviors of the public through the lens of social media. In future studies, we intend to extend the model to study public perceptions of other important interventions by public health authorities.

covid-19;deep learning;health belief model;physical distancing;recurrent neural network;social media;text classification

Journal Article

Sesagiri Raamkumar, Aravind;Tan, Soon Guan;Wee, Hwee Lin

10.2196/20493

[Title]: Use of Health Belief Model-Based Deep Learning Classifiers for COVID-19 Social Media Content to Examine Public Perceptions of Physical Distancing: Model Development and Case Study. [Abstract]: BACKGROUND: Public health authorities have been recommending interventions such as physical distancing and face masks, to curtail the transmission of coronavirus disease (COVID-19) within the community. Public perceptions toward such interventions should be identified to enable public health authorities to effectively address valid concerns. The Health Belief Model (HBM) has been used to characterize user-generated content from social media during previous outbreaks, with the aim of understanding the health behaviors of the public. OBJECTIVE: This study is aimed at developing and evaluating deep learning-based text classification models for classifying social media content posted during the COVID-19 outbreak, using the four key constructs of the HBM. We will specifically focus on content related to the physical distancing interventions put forth by public health authorities. We intend to test the model with a real-world case study. METHODS: The data set for this study was prepared by analyzing Facebook comments that were posted by the public in response to the COVID-19-related posts of three public health authorities: the Ministry of Health of Singapore (MOH), the Centers for Disease Control and Prevention, and Public Health England. The comments made in the context of physical distancing were manually classified with a Yes/No flag for each of the four HBM constructs: perceived severity, perceived susceptibility, perceived barriers, and perceived benefits. Using a curated data set of 16,752 comments, gated recurrent unit-based recurrent neural network models were trained and validated for text classification. Accuracy and binary cross-entropy loss were used to evaluate the model. Specificity, sensitivity, and balanced accuracy were used to evaluate the classification results in the MOH case study. RESULTS: The HBM text classification models achieved mean accuracy rates of 0.92, 0.95, 0.91, and 0.94 for the constructs of perceived susceptibility, perceived severity, perceived benefits, and perceived barriers, respectively. In the case study with MOH Facebook comments, specificity was above 96% for all HBM constructs. Sensitivity was 94.3% and 90.9% for perceived severity and perceived benefits, respectively. In addition, sensitivity was 79.6% and 81.5% for perceived susceptibility and perceived barriers, respectively. The classification models were able to accurately predict trends in the prevalence of the constructs for the time period examined in the case study. CONCLUSIONS: The deep learning-based text classifiers developed in this study help to determine public perceptions toward physical distancing, using the four key constructs of HBM. Health officials can make use of the classification model to characterize the health behaviors of the public through the lens of social media. In future studies, we intend to extend the model to study public perceptions of other important interventions by public health authorities. [Keywords]: covid-19;deep learning;health belief model;physical distancing;recurrent neural network;social media;text classification

BMJ Case Rep

Spontaneous tension pneumothorax and acute pulmonary emboli in a patient with COVID-19 infection.

The COVID-19 pandemic has had a significant impact on the structure and operation of healthcare services worldwide. We highlight a case of a 64-year-old man who presented to the emergency department with acute dyspnoea on a background of a 2-week history of fever, dry cough and shortness of breath. On initial assessment the patient was hypoxic (arterial oxygen saturation (SaO2) of 86% on room air), requiring 10 L/min of oxygen to maintain 98% SaO2 Examination demonstrated left-sided tracheal deviation and absent breath sounds in the right lung field on auscultation. A chest radiograph revealed a large right-sided tension pneumothorax which was treated with needle thoracocentesis and a definitive chest drain. A CT pulmonary angiogram demonstrated segmental left lower lobe acute pulmonary emboli, significant generalised COVID-19 parenchymal features, surgical emphysema and an iatrogenic pneumatocoele. This case emphasises the importance of considering coexisting alternative diagnoses in patients who present with suspected COVID-19.

pneumothorax;pulmonary embolism;radiology;respiratory medicine;tropical medicine (infectious disease)

Case Reports;Journal Article

Khurram, Ruhaid;Johnson, Franklin T F;Naran, Revati;Hare, Samanjit

10.1136/bcr-2020-237475

[Title]: Spontaneous tension pneumothorax and acute pulmonary emboli in a patient with COVID-19 infection. [Abstract]: The COVID-19 pandemic has had a significant impact on the structure and operation of healthcare services worldwide. We highlight a case of a 64-year-old man who presented to the emergency department with acute dyspnoea on a background of a 2-week history of fever, dry cough and shortness of breath. On initial assessment the patient was hypoxic (arterial oxygen saturation (SaO2) of 86% on room air), requiring 10 L/min of oxygen to maintain 98% SaO2 Examination demonstrated left-sided tracheal deviation and absent breath sounds in the right lung field on auscultation. A chest radiograph revealed a large right-sided tension pneumothorax which was treated with needle thoracocentesis and a definitive chest drain. A CT pulmonary angiogram demonstrated segmental left lower lobe acute pulmonary emboli, significant generalised COVID-19 parenchymal features, surgical emphysema and an iatrogenic pneumatocoele. This case emphasises the importance of considering coexisting alternative diagnoses in patients who present with suspected COVID-19. [Keywords]: pneumothorax;pulmonary embolism;radiology;respiratory medicine;tropical medicine (infectious disease)

J Health Polit Policy Law

Pandemic Politics: Timing State-Level Social Distancing Responses to COVID-19.

CONTEXT: Social distancing is an essential but economically painful measure to flatten the curve of emergent infectious diseases. As the novel coronavirus that causes COVID-19 spread throughout the United States in early 2020, the federal government left to the states the difficult and consequential decisions about when to cancel events, close schools and businesses, and issue stay-at-home orders. METHODS: We present an original, detailed dataset of state-level social distancing policy responses to the epidemic, then apply event history analysis to study the timing of implementation of five social distancing policies across all fifty states. RESULTS: The most important predictor of when states adopted social distancing policies is political: All else equal, states led by Republican governors were slower to implement such policies during a critical window of early COVID-19 response. CONCLUSIONS: Continuing actions driven by partisanship, rather than public health expertise and scientific recommendations, may exact greater tolls on health and broader society.

covid-19;us states;partisan politics;social distancing policy

Journal Article

Adolph, Christopher;Amano, Kenya;Bang-Jensen, Bree;Fullman, Nancy;Wilkerson, John

10.1215/03616878-8802162

[Title]: Pandemic Politics: Timing State-Level Social Distancing Responses to COVID-19. [Abstract]: CONTEXT: Social distancing is an essential but economically painful measure to flatten the curve of emergent infectious diseases. As the novel coronavirus that causes COVID-19 spread throughout the United States in early 2020, the federal government left to the states the difficult and consequential decisions about when to cancel events, close schools and businesses, and issue stay-at-home orders. METHODS: We present an original, detailed dataset of state-level social distancing policy responses to the epidemic, then apply event history analysis to study the timing of implementation of five social distancing policies across all fifty states. RESULTS: The most important predictor of when states adopted social distancing policies is political: All else equal, states led by Republican governors were slower to implement such policies during a critical window of early COVID-19 response. CONCLUSIONS: Continuing actions driven by partisanship, rather than public health expertise and scientific recommendations, may exact greater tolls on health and broader society. [Keywords]: covid-19;us states;partisan politics;social distancing policy

Expert Rev Anticancer Ther

Clinical risk factors for mortality in patients with cancer and COVID-19: a systematic review and meta-analysis of recent observational studies.

INTRODUCTION: Patients with cancer are more vulnerable to COVID-19 than the general population. Accordingly, it is necessary to identify the risk factors for death in patients with cancer and COVID-19. METHODS: PubMed, Cochrane Library, and Embase Ovid databases were searched for relevant articles published before July 31(st), 2020. Studies that explored the risk factors for mortality were included. The effect size was relative risk (RR) and 95% confidence interval (CI). RESULTS: We included 17 observational studies involving 3268 patients. The pooled mortality was 24.8%. Male gender, age above 65 years, and comorbidities (especially hypertension and COPD) were risk factors for death (RR 1.16, 1.27, 1.12; 95% CI 0.7-1.95, 1.08-1.49, 1.04-1.2; P = 0.006, 0.004, and 0.002, respectively). Recent anti-cancer treatments did not increase mortality (P > 0.05). Dyspnea, cough, and sputum canused an elevated risk of death (P < 0.05). Antibiotics, glucocorticoids, interferons, invasive ventilation, and complications were associated with a high probability of death (P < 0.05). CONCLUSIONS: Various demographic and clinical characteristics, such as male gender, advanced age, comorbidities, and symptoms, were risk factors for mortality in patients with cancer and COVID-19. Our findings suggest recent anti-cancer treatments do not increase mortality.

cancer;covid-19;meta-analysis;mortality;risk factors

Journal Article;Meta-Analysis;Research Support, Non-U.S. Gov't;Systematic Review

Liu, Yang;Lu, Huan;Wang, Wei;Liu, Qi;Zhu, Changju

10.1080/14737140.2021.1837628

[Title]: Clinical risk factors for mortality in patients with cancer and COVID-19: a systematic review and meta-analysis of recent observational studies. [Abstract]: INTRODUCTION: Patients with cancer are more vulnerable to COVID-19 than the general population. Accordingly, it is necessary to identify the risk factors for death in patients with cancer and COVID-19. METHODS: PubMed, Cochrane Library, and Embase Ovid databases were searched for relevant articles published before July 31(st), 2020. Studies that explored the risk factors for mortality were included. The effect size was relative risk (RR) and 95% confidence interval (CI). RESULTS: We included 17 observational studies involving 3268 patients. The pooled mortality was 24.8%. Male gender, age above 65 years, and comorbidities (especially hypertension and COPD) were risk factors for death (RR 1.16, 1.27, 1.12; 95% CI 0.7-1.95, 1.08-1.49, 1.04-1.2; P = 0.006, 0.004, and 0.002, respectively). Recent anti-cancer treatments did not increase mortality (P > 0.05). Dyspnea, cough, and sputum canused an elevated risk of death (P < 0.05). Antibiotics, glucocorticoids, interferons, invasive ventilation, and complications were associated with a high probability of death (P < 0.05). CONCLUSIONS: Various demographic and clinical characteristics, such as male gender, advanced age, comorbidities, and symptoms, were risk factors for mortality in patients with cancer and COVID-19. Our findings suggest recent anti-cancer treatments do not increase mortality. [Keywords]: cancer;covid-19;meta-analysis;mortality;risk factors

Psychol Trauma

Inequity and the disproportionate impact of COVID-19 on communities of color in the United States: The need for a trauma-informed social justice response.

COVID-19 has had disproportionate contagion and fatality in Black, Latino, and Native American communities and among the poor in the United States. Toxic stress resulting from racial and social inequities have been magnified during the pandemic, with implications for poor physical and mental health and socioeconomic outcomes. It is imperative that our country focus and invest in addressing health inequities and work across sectors to build self-efficacy and long-term capacity within communities and systems of care serving the most disenfranchised, now and in the aftermath of the COVID-19 epidemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Journal Article

Fortuna, Lisa R;Tolou-Shams, Marina;Robles-Ramamurthy, Barbara;Porche, Michelle V

10.1037/tra0000889

[Title]: Inequity and the disproportionate impact of COVID-19 on communities of color in the United States: The need for a trauma-informed social justice response. [Abstract]: COVID-19 has had disproportionate contagion and fatality in Black, Latino, and Native American communities and among the poor in the United States. Toxic stress resulting from racial and social inequities have been magnified during the pandemic, with implications for poor physical and mental health and socioeconomic outcomes. It is imperative that our country focus and invest in addressing health inequities and work across sectors to build self-efficacy and long-term capacity within communities and systems of care serving the most disenfranchised, now and in the aftermath of the COVID-19 epidemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved). [Keywords]:

Indian J Otolaryngol Head Neck Surg

Robotic Surgery in Otolaryngology During the Covid-19 Pandemic: A Safer Approach?

The COVID-19 outbreak was announced a pandemic by the World Health Organization in March 2020. The contagious nature of this virus to spread through droplets, puts the ENT surgeon at an added risk of exposure and infection, particularly while performing various aerosol generating procedures of the oral cavity and upper airway. While it is being recommended worldwide to postpone all elective surgeries to a later date, certain emergency procedures must be undertaken promptly but in a manner that minimizes the exposure of the surgeon and health care staff to the SARS-CoV-2. This article is meant to provide an insight into the possible role of robotic surgery in Otolaryngology and Head and Neck during the Covid-19 pandemic along with providing a brief review of its pros and cons.

covid-19;cons;otolaryngology;pros;robotic surgery

Journal Article

Sharma, Akriti;Bhardwaj, Rohit

10.1007/s12070-020-02032-3

[Title]: Robotic Surgery in Otolaryngology During the Covid-19 Pandemic: A Safer Approach? [Abstract]: The COVID-19 outbreak was announced a pandemic by the World Health Organization in March 2020. The contagious nature of this virus to spread through droplets, puts the ENT surgeon at an added risk of exposure and infection, particularly while performing various aerosol generating procedures of the oral cavity and upper airway. While it is being recommended worldwide to postpone all elective surgeries to a later date, certain emergency procedures must be undertaken promptly but in a manner that minimizes the exposure of the surgeon and health care staff to the SARS-CoV-2. This article is meant to provide an insight into the possible role of robotic surgery in Otolaryngology and Head and Neck during the Covid-19 pandemic along with providing a brief review of its pros and cons. [Keywords]: covid-19;cons;otolaryngology;pros;robotic surgery

J Hosp Infect

Super-factors associated with transmission of occupational COVID-19 infection among healthcare staff in Wuhan, China.

BACKGROUND: Globally, there have been many cases of coronavirus disease 2019 (COVID-19) among medical staff; however, the main factors associated with the infection are not well understood. AIM: To identify the super-factors causing COVID-19 infection in medical staff in China. METHODS: A cross-sectional study was conducted between January 1(st) and February 30(th), 2020, in which front-line members of medical staff who took part in the care and treatment of patients with COVID-19 were enrolled. Epidemiological and demographic data between infected and uninfected groups were collected and compared. Social network analysis (SNA) was used to establish socio-metric social links between influencing factors. FINDINGS: A total of 92 medical staff were enrolled. In all participant groups, the super-factor identified by the network was wearing a medical protective mask or surgical mask correctly (degree: 572; closeness: 25; betweenness centrality: 3.23). Touching the cheek, nose, and mouth while working was the super-factor in the infected group. This was the biggest node in the network and had the strongest influence (degree: 370; closeness: 29; betweenness centrality: 0.37). Self-protection score was the super-factor in the uninfected group but was the isolated factor in the infected group (degree: 201; closeness: 28; betweenness centrality: 5.64). For family members, the exposure history to Huanan Seafood Wholesale Market and the contact history to wild animals were two isolated nodes. CONCLUSION: High self-protection score was the main factor that prevented medical staff from contracting COVID-19 infection. The main factor contributing to COVID-19 infections among medical staff was touching the cheek, nose, and mouth while working.

infection;medical staff;sars-cov-2;social network analysis;super-factors

Journal Article

Wang, Y;Wu, W;Cheng, Z;Tan, X;Yang, Z;Zeng, X;Mei, B;Ni, Z;Wang, X

10.1016/j.jhin.2020.06.023

[Title]: Super-factors associated with transmission of occupational COVID-19 infection among healthcare staff in Wuhan, China. [Abstract]: BACKGROUND: Globally, there have been many cases of coronavirus disease 2019 (COVID-19) among medical staff; however, the main factors associated with the infection are not well understood. AIM: To identify the super-factors causing COVID-19 infection in medical staff in China. METHODS: A cross-sectional study was conducted between January 1(st) and February 30(th), 2020, in which front-line members of medical staff who took part in the care and treatment of patients with COVID-19 were enrolled. Epidemiological and demographic data between infected and uninfected groups were collected and compared. Social network analysis (SNA) was used to establish socio-metric social links between influencing factors. FINDINGS: A total of 92 medical staff were enrolled. In all participant groups, the super-factor identified by the network was wearing a medical protective mask or surgical mask correctly (degree: 572; closeness: 25; betweenness centrality: 3.23). Touching the cheek, nose, and mouth while working was the super-factor in the infected group. This was the biggest node in the network and had the strongest influence (degree: 370; closeness: 29; betweenness centrality: 0.37). Self-protection score was the super-factor in the uninfected group but was the isolated factor in the infected group (degree: 201; closeness: 28; betweenness centrality: 5.64). For family members, the exposure history to Huanan Seafood Wholesale Market and the contact history to wild animals were two isolated nodes. CONCLUSION: High self-protection score was the main factor that prevented medical staff from contracting COVID-19 infection. The main factor contributing to COVID-19 infections among medical staff was touching the cheek, nose, and mouth while working. [Keywords]: infection;medical staff;sars-cov-2;social network analysis;super-factors

Monaldi Arch Chest Dis

COVID-19 and clinical mimics. Correct diagnosis is the key to appropriate therapy.

As of 29 April 2020, across the globe, there are 3,216,353 confirmed Coronavirus disease 2019 (COVID-19 disease) with 227,894 deaths. The health care infrastructure of most of the countries is overwhelmed due to the gigantic upsurge of the new cases within a short time period. Most of the beds in the regular wards and critical care units are currently occupied by either people under investigation (PUI) or COVID-19 confirmed cases. We hereby discuss the challenges faced while approaching any case of shortness of breath, or other common upper respiratory symptoms during the current COVID-19 pandemic era.

Case Reports;Journal Article

Sahu, Kamal Kant;Mishra, Ajay Kumar;Martin, Kevin;Chastain, Iryana

10.4081/monaldi.2020.1327

[Title]: COVID-19 and clinical mimics. Correct diagnosis is the key to appropriate therapy. [Abstract]: As of 29 April 2020, across the globe, there are 3,216,353 confirmed Coronavirus disease 2019 (COVID-19 disease) with 227,894 deaths. The health care infrastructure of most of the countries is overwhelmed due to the gigantic upsurge of the new cases within a short time period. Most of the beds in the regular wards and critical care units are currently occupied by either people under investigation (PUI) or COVID-19 confirmed cases. We hereby discuss the challenges faced while approaching any case of shortness of breath, or other common upper respiratory symptoms during the current COVID-19 pandemic era. [Keywords]:

BMJ Evid Based Med

Asthma and COVID-19: review of evidence on risks and management considerations.

BACKGROUND: Respiratory illnesses typically present increased risks to people with asthma (PWA). However, data on the risks of COVID-19 to PWA have presented contradictory findings, with implications for asthma management. OBJECTIVE: To assess the risks and management considerations of COVID-19 in people with asthma (PWA). METHOD: We conducted a rapid literature review. We searched PubMed, medRxiv, LitCovid, TRIP, Google and Google Scholar for terms relating to asthma and COVID-19, and for systematic reviews related to specific management questions within our review, in April 2020. References were screened and data were extracted by one reviewer. RESULTS: We extracted data from 139 references. The evidence available is limited, with some sources suggesting an under-representation of PWA in hospitalised cases and others showing an increased risk of worse outcomes in PWA, which may be associated with disease severity. Consensus broadly holds that asthma medications should be continued as usual. Almost all aspects of asthma care will be disrupted during the pandemic due not only to limits in face-to-face care but also to the fact that many of the diagnostic tools used in asthma are considered aerosol-generating procedures. Self-management and remote interventions may be of benefit for asthma care during this time but have not been tested in this context. CONCLUSIONS: Evidence on COVID-19 and asthma is limited and continuing to emerge. More research is needed on the possible associations between asthma and COVID-19 infection and severity, as well as on interventions to support asthma care in light of constraints and disruptions to healthcare systems. We found no evidence regarding health inequalities, and this urgently needs to be addressed in the literature as the burdens of asthma and of COVID-19 are not equally distributed across the population.

respiratory tract diseases;virus diseases

Journal Article;Review

Hartmann-Boyce, Jamie;Gunnell, James;Drake, Jonny;Otunla, Afolarin;Suklan, Jana;Schofield, Ella;Kinton, Jade;Inada-Kim, Matt;Hobbs, F D Richard;Dennison, Paddy

10.1136/bmjebm-2020-111506

[Title]: Asthma and COVID-19: review of evidence on risks and management considerations. [Abstract]: BACKGROUND: Respiratory illnesses typically present increased risks to people with asthma (PWA). However, data on the risks of COVID-19 to PWA have presented contradictory findings, with implications for asthma management. OBJECTIVE: To assess the risks and management considerations of COVID-19 in people with asthma (PWA). METHOD: We conducted a rapid literature review. We searched PubMed, medRxiv, LitCovid, TRIP, Google and Google Scholar for terms relating to asthma and COVID-19, and for systematic reviews related to specific management questions within our review, in April 2020. References were screened and data were extracted by one reviewer. RESULTS: We extracted data from 139 references. The evidence available is limited, with some sources suggesting an under-representation of PWA in hospitalised cases and others showing an increased risk of worse outcomes in PWA, which may be associated with disease severity. Consensus broadly holds that asthma medications should be continued as usual. Almost all aspects of asthma care will be disrupted during the pandemic due not only to limits in face-to-face care but also to the fact that many of the diagnostic tools used in asthma are considered aerosol-generating procedures. Self-management and remote interventions may be of benefit for asthma care during this time but have not been tested in this context. CONCLUSIONS: Evidence on COVID-19 and asthma is limited and continuing to emerge. More research is needed on the possible associations between asthma and COVID-19 infection and severity, as well as on interventions to support asthma care in light of constraints and disruptions to healthcare systems. We found no evidence regarding health inequalities, and this urgently needs to be addressed in the literature as the burdens of asthma and of COVID-19 are not equally distributed across the population. [Keywords]: respiratory tract diseases;virus diseases

Crit Care Explor

Tracheostomy for Coronavirus Disease 2019 Patients: Maintaining the Standard of Care.

Objectives: To respond to the new recommendations for delaying tracheostomy for coronavirus disease 2019 patients to day 21 post-intubation to ensure viral clearance. Design: Prospective observational cohort from April 1, 2020, to April 30, 2020, with 60 days follow-up. Setting: Academic medical center with nine adult ICUs dedicated to caring for coronavirus disease 2019 patients requiring mechanical ventilation. Patients: Mechanically ventilated patients with coronavirus disease 2019 pneumonia requiring tracheostomy for prolonged ventilatory support. Interventions: Adherence to the standard of care for timing of tracheostomy as deemed necessary by the intensivist without delay and utilizing the existing tracheostomy team in performing the needed procedures within 1 day of the request. Measurements and Main Results: One hundred eleven patients with coronavirus disease 2019 received tracheostomy in the month of April 2020. Median time to tracheostomy was 11 days. All procedures were performed percutaneously at bedside under bronchoscopic guidance. Sixty-three percent of patients who received tracheostomy either weaned or discharged alive within 60 days of the procedure. Performing tracheostomy on these patients without delay did not lead to coronavirus disease 2019 viral transmission to the tracheostomy team as evident by lack of symptoms and negative antibody testing. Conclusions: Adherence to standard of care in timing of tracheostomy is safe. Recommending delaying the procedure may lead to harmful consequences from prolonging mechanical ventilation and sedation without apparent benefit.

coronavirus disease 2019;timing;tracheostomy

Journal Article

Bassily-Marcus, Adel;Leibner, Evan S;Kohli-Seth, Roopa

10.1097/CCE.0000000000000190

[Title]: Tracheostomy for Coronavirus Disease 2019 Patients: Maintaining the Standard of Care. [Abstract]: Objectives: To respond to the new recommendations for delaying tracheostomy for coronavirus disease 2019 patients to day 21 post-intubation to ensure viral clearance. Design: Prospective observational cohort from April 1, 2020, to April 30, 2020, with 60 days follow-up. Setting: Academic medical center with nine adult ICUs dedicated to caring for coronavirus disease 2019 patients requiring mechanical ventilation. Patients: Mechanically ventilated patients with coronavirus disease 2019 pneumonia requiring tracheostomy for prolonged ventilatory support. Interventions: Adherence to the standard of care for timing of tracheostomy as deemed necessary by the intensivist without delay and utilizing the existing tracheostomy team in performing the needed procedures within 1 day of the request. Measurements and Main Results: One hundred eleven patients with coronavirus disease 2019 received tracheostomy in the month of April 2020. Median time to tracheostomy was 11 days. All procedures were performed percutaneously at bedside under bronchoscopic guidance. Sixty-three percent of patients who received tracheostomy either weaned or discharged alive within 60 days of the procedure. Performing tracheostomy on these patients without delay did not lead to coronavirus disease 2019 viral transmission to the tracheostomy team as evident by lack of symptoms and negative antibody testing. Conclusions: Adherence to standard of care in timing of tracheostomy is safe. Recommending delaying the procedure may lead to harmful consequences from prolonging mechanical ventilation and sedation without apparent benefit. [Keywords]: coronavirus disease 2019;timing;tracheostomy

Am J Prev Cardiol

State-of-the-Art review: Hypertension practice guidelines in the era of COVID-19.

The global burden of hypertension (HTN) is immense and increasing. In fact, HTN is the leading risk factor for adverse cardiovascular disease outcomes. Due to the critical significance and increasing prevalence of the disease, several national and international societies have recently updated their guidelines for the diagnosis and treatment of HTN. In consideration of the COVID-19 pandemic, this report provides clinicians with the best strategies to prevent HTN, manage the acute and long-term cardiac complications of HTN, and provide the best evidence-based care to patients in an ever-changing healthcare environment. The overarching goal of the various HTN guidelines is to provide easily accessible information to healthcare providers and public health officials, which is key for optimal clinical practice. However, the COVID-19 pandemic has challenged the ability to provide safe care to the most vulnerable hypertensive populations throughout the world. Therefore, this review compares the most recent guidelines of the 2017 American College of Cardiology/American Heart Association and multiple U.S. societies, the 2018 European Society of Cardiology/European Society of Hypertension, the 2019 National Institute for Care and Health Excellence, and the 2020 International Society of Hypertension. While a partial emphasis is placed on the management of HTN in the midst of COVID-19, this review will summarize current concepts and emerging data from the listed HTN guidelines on the diagnosis, monitoring, management, and evidence-based treatments in adults.

covid-19;guidelines;hypertension;prevention;public health

Journal Article;Review

Ferdinand, Keith C;Vo, Thanh N;Echols, Melvin R

10.1016/j.ajpc.2020.100038

[Title]: State-of-the-Art review: Hypertension practice guidelines in the era of COVID-19. [Abstract]: The global burden of hypertension (HTN) is immense and increasing. In fact, HTN is the leading risk factor for adverse cardiovascular disease outcomes. Due to the critical significance and increasing prevalence of the disease, several national and international societies have recently updated their guidelines for the diagnosis and treatment of HTN. In consideration of the COVID-19 pandemic, this report provides clinicians with the best strategies to prevent HTN, manage the acute and long-term cardiac complications of HTN, and provide the best evidence-based care to patients in an ever-changing healthcare environment. The overarching goal of the various HTN guidelines is to provide easily accessible information to healthcare providers and public health officials, which is key for optimal clinical practice. However, the COVID-19 pandemic has challenged the ability to provide safe care to the most vulnerable hypertensive populations throughout the world. Therefore, this review compares the most recent guidelines of the 2017 American College of Cardiology/American Heart Association and multiple U.S. societies, the 2018 European Society of Cardiology/European Society of Hypertension, the 2019 National Institute for Care and Health Excellence, and the 2020 International Society of Hypertension. While a partial emphasis is placed on the management of HTN in the midst of COVID-19, this review will summarize current concepts and emerging data from the listed HTN guidelines on the diagnosis, monitoring, management, and evidence-based treatments in adults. [Keywords]: covid-19;guidelines;hypertension;prevention;public health

Sci Total Environ

Mapping community-level determinants of COVID-19 transmission in nursing homes: A multi-scale approach.

Deaths from the COVID-19 pandemic have disproportionately affected older adults and residents in nursing homes. Although emerging research has identified place-based risk factors for the general population, little research has been conducted for nursing home populations. This GIS-based spatial modeling study aimed to determine the association between nursing home-level metrics and county-level, place-based variables with COVID-19 confirmed cases in nursing homes across the United States. A cross-sectional research design linked data from Centers for Medicare & Medicaid Services, American Community Survey, the 2010 Census, and COVID-19 cases among the general population and nursing homes. Spatial cluster analysis identified specific regions with statistically higher COVID-19 cases and deaths among residents. Multivariate analysis identified risk factors at the nursing home level including, total count of fines, total staffing levels, and LPN staffing levels. County-level or place-based factors like per-capita income, average household size, population density, and minority composition were significant predictors of COVID-19 cases in the nursing home. These results provide a framework for examining further COVID-19 cases in nursing homes and highlight the need to include other community-level variables when considering risk of COVID-19 transmission and outbreaks in nursing homes.

covid-19;multilevel models;nursing homes;spatial analysis

Journal Article

Sugg, Margaret M;Spaulding, Trent J;Lane, Sandi J;Runkle, Jennifer D;Harden, Stella R;Hege, Adam;Iyer, Lakshmi S

10.1016/j.scitotenv.2020.141946

[Title]: Mapping community-level determinants of COVID-19 transmission in nursing homes: A multi-scale approach. [Abstract]: Deaths from the COVID-19 pandemic have disproportionately affected older adults and residents in nursing homes. Although emerging research has identified place-based risk factors for the general population, little research has been conducted for nursing home populations. This GIS-based spatial modeling study aimed to determine the association between nursing home-level metrics and county-level, place-based variables with COVID-19 confirmed cases in nursing homes across the United States. A cross-sectional research design linked data from Centers for Medicare & Medicaid Services, American Community Survey, the 2010 Census, and COVID-19 cases among the general population and nursing homes. Spatial cluster analysis identified specific regions with statistically higher COVID-19 cases and deaths among residents. Multivariate analysis identified risk factors at the nursing home level including, total count of fines, total staffing levels, and LPN staffing levels. County-level or place-based factors like per-capita income, average household size, population density, and minority composition were significant predictors of COVID-19 cases in the nursing home. These results provide a framework for examining further COVID-19 cases in nursing homes and highlight the need to include other community-level variables when considering risk of COVID-19 transmission and outbreaks in nursing homes. [Keywords]: covid-19;multilevel models;nursing homes;spatial analysis

Chest

Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic: A Position Paper From the National PERT Consortium.

The coexistence of coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE), two life-threatening illnesses, in the same patient presents a unique challenge. Guidelines have delineated how best to diagnose and manage patients with PE. However, the unique aspects of COVID-19 confound both the diagnosis and treatment of PE, and therefore require modification of established algorithms. Important considerations include adjustment of diagnostic modalities, incorporation of the prothrombotic contribution of COVID-19, management of two critical cardiorespiratory illnesses in the same patient, and protecting patients and health-care workers while providing optimal care. The benefits of a team-based approach for decision-making and coordination of care, such as that offered by pulmonary embolism response teams (PERTs), have become more evident in this crisis. The importance of careful follow-up care also is underscored for patients with these two diseases with long-term effects. This position paper from the PERT Consortium specifically addresses issues related to the diagnosis and management of PE in patients with COVID-19.

covid-19;pert;catheter-directed thrombolysis;follow-up;prevention;pulmonary embolism;pulmonary embolism response team;systemic thrombolysis

Consensus Development Conference;Journal Article;Review

Rosovsky, Rachel P;Grodzin, Charles;Channick, Richard;Davis, George A;Giri, Jay S;Horowitz, James;Kabrhel, Christopher;Lookstein, Robert;Merli, Geno;Morris, Timothy A;Rivera-Lebron, Belinda;Tapson, Victor;Todoran, Thomas M;Weinberg, Aaron S;Rosenfield, Kenneth

10.1016/j.chest.2020.08.2064

[Title]: Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic: A Position Paper From the National PERT Consortium. [Abstract]: The coexistence of coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE), two life-threatening illnesses, in the same patient presents a unique challenge. Guidelines have delineated how best to diagnose and manage patients with PE. However, the unique aspects of COVID-19 confound both the diagnosis and treatment of PE, and therefore require modification of established algorithms. Important considerations include adjustment of diagnostic modalities, incorporation of the prothrombotic contribution of COVID-19, management of two critical cardiorespiratory illnesses in the same patient, and protecting patients and health-care workers while providing optimal care. The benefits of a team-based approach for decision-making and coordination of care, such as that offered by pulmonary embolism response teams (PERTs), have become more evident in this crisis. The importance of careful follow-up care also is underscored for patients with these two diseases with long-term effects. This position paper from the PERT Consortium specifically addresses issues related to the diagnosis and management of PE in patients with COVID-19. [Keywords]: covid-19;pert;catheter-directed thrombolysis;follow-up;prevention;pulmonary embolism;pulmonary embolism response team;systemic thrombolysis

Clin Med (Lond)

Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection.

A 40-year-old man developed acute brainstem dysfunction 3 days after hospital admission with symptoms of the novel SARS-CoV-2 infection (COVID-19). Magnetic resonance imaging showed changes in keeping with inflammation of the brainstem and the upper cervical cord, leading to a diagnosis of rhombencephalitis. No other cause explained the patient's abnormal neurological findings. He was managed conservatively with rapid spontaneous improvement in some of his neurological signs and was discharged home with continued neurology follow up.

covid-19;mri;brainstem encephalitis;hepatitis;rhombencephalitis

Journal Article

Wong, Po Fung;Craik, Sam;Newman, Piers;Makan, Annabel;Srinivasan, Koottalai;Crawford, Emma;Dev, Devapriya;Moudgil, Harmesh;Ahmad, Nawaid

10.7861/clinmed.2020-0182

[Title]: Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection. [Abstract]: A 40-year-old man developed acute brainstem dysfunction 3 days after hospital admission with symptoms of the novel SARS-CoV-2 infection (COVID-19). Magnetic resonance imaging showed changes in keeping with inflammation of the brainstem and the upper cervical cord, leading to a diagnosis of rhombencephalitis. No other cause explained the patient's abnormal neurological findings. He was managed conservatively with rapid spontaneous improvement in some of his neurological signs and was discharged home with continued neurology follow up. [Keywords]: covid-19;mri;brainstem encephalitis;hepatitis;rhombencephalitis

Chaos Solitons Fractals

Comparative analysis and forecasting of COVID-19 cases in various European countries with ARIMA, NARNN and LSTM approaches.

In this study, confirmed COVID-19 cases of Denmark, Belgium, Germany, France, United Kingdom, Finland, Switzerland and Turkey were modeled with Auto-Regressive Integrated Moving Average (ARIMA), Nonlinear Autoregression Neural Network (NARNN) and Long-Short Term Memory (LSTM) approaches. Six model performance metric were used to select the most accurate model (MSE, PSNR, RMSE, NRMSE, MAPE and SMAPE). According to the results of the first step of the study, LSTM was found the most accurate model. In the second stage of the study, LSTM model was provided to make predictions in a 14-day perspective that is yet to be known. Results of the second step of the study shows that the total cumulative case increase rate is expected to decrease slightly in many countries.

arima;covid-19;forecasting;lstm;modeling;narnn

Journal Article

Kirbas, Ismail;Sozen, Adnan;Tuncer, Azim Dogus;Kazancioglu, Fikret Sinasi

10.1016/j.chaos.2020.110015

[Title]: Comparative analysis and forecasting of COVID-19 cases in various European countries with ARIMA, NARNN and LSTM approaches. [Abstract]: In this study, confirmed COVID-19 cases of Denmark, Belgium, Germany, France, United Kingdom, Finland, Switzerland and Turkey were modeled with Auto-Regressive Integrated Moving Average (ARIMA), Nonlinear Autoregression Neural Network (NARNN) and Long-Short Term Memory (LSTM) approaches. Six model performance metric were used to select the most accurate model (MSE, PSNR, RMSE, NRMSE, MAPE and SMAPE). According to the results of the first step of the study, LSTM was found the most accurate model. In the second stage of the study, LSTM model was provided to make predictions in a 14-day perspective that is yet to be known. Results of the second step of the study shows that the total cumulative case increase rate is expected to decrease slightly in many countries. [Keywords]: arima;covid-19;forecasting;lstm;modeling;narnn

Arch Cardiol Mex

COVID-19 and the renin, angiotensin, aldosterone system. A complex relationship.

The COVID-19 pandemic has had major negative health, psychological, social and economic repercussions for individuals, families, communities, countries and for humanity in general. The interrelation with age and the presence of chronic non-communicable diseases (hypertension, diabetes, obesity, smoking) seems to go further than what would be explained by the prevalence and distribution of both. The drugs that act on the renin-angiotensin-aldosterone system are in many cases the backbone for the management of these diseases, it has been known for a long time that these drugs significantly increase the expression of receptors for angiotensin conversion enzyme type 2 in the lung tissue. This fact, together with the knowledge that the route of entry of the virus into the cell is precisely the ACE-2 receptor, initiated a hypothesis, based on very low-quality evidence, which quickly became generalized in the media, that the use of these drugs could be negative and that they should be interrupted immediately. The response of practically all Scientific Societies was almost immediate, with the precise indication that treatment with these drugs should not be discontinued, since the evidence of their usefulness is based on very solid and high-quality evidence. Simultaneously, a different hypothesis also appeared, also based on very preliminary evidence, that these drugs are not only harmful but also beneficial, however these medicaments are not yet accepted as agents for the prevention or treatment of this disease or its complications. This review reports current knowledge on the relationship between COVID-19 and SRAA.

angiotensin conversion enzyme type 2;covid-19;coronavirus sars- cov-2 2019;coronavirus sars-cov-2 2019;enzima de conversion de angiotensina-2;renin-angiotensin-aldosterone system;sistema renina angiotensina aldosterona

Journal Article;Review

Alcocer-Diaz-Barreiro, Luis;Cossio-Aranda, Jorge;Verdejo-Paris, Juan;Odin-de-Los-Rios, Manuel;Galvan-Oseguera, Hector;Alvarez-Lopez, Humberto;Alcocer-Gamba, Marco A

10.24875/ACM.M20000063

[Title]: COVID-19 and the renin, angiotensin, aldosterone system. A complex relationship. [Abstract]: The COVID-19 pandemic has had major negative health, psychological, social and economic repercussions for individuals, families, communities, countries and for humanity in general. The interrelation with age and the presence of chronic non-communicable diseases (hypertension, diabetes, obesity, smoking) seems to go further than what would be explained by the prevalence and distribution of both. The drugs that act on the renin-angiotensin-aldosterone system are in many cases the backbone for the management of these diseases, it has been known for a long time that these drugs significantly increase the expression of receptors for angiotensin conversion enzyme type 2 in the lung tissue. This fact, together with the knowledge that the route of entry of the virus into the cell is precisely the ACE-2 receptor, initiated a hypothesis, based on very low-quality evidence, which quickly became generalized in the media, that the use of these drugs could be negative and that they should be interrupted immediately. The response of practically all Scientific Societies was almost immediate, with the precise indication that treatment with these drugs should not be discontinued, since the evidence of their usefulness is based on very solid and high-quality evidence. Simultaneously, a different hypothesis also appeared, also based on very preliminary evidence, that these drugs are not only harmful but also beneficial, however these medicaments are not yet accepted as agents for the prevention or treatment of this disease or its complications. This review reports current knowledge on the relationship between COVID-19 and SRAA. [Keywords]: angiotensin conversion enzyme type 2;covid-19;coronavirus sars- cov-2 2019;coronavirus sars-cov-2 2019;enzima de conversion de angiotensina-2;renin-angiotensin-aldosterone system;sistema renina angiotensina aldosterona

IEEE Trans Biomed Circuits Syst

Low-Complexity System and Algorithm for an Emergency Ventilator Sensor and Alarm.

In response to anticipated shortages of ventilators caused by the COVID-19 pandemic, many organizations have designed low-cost emergency ventilators. Many of these devices are pressure-cycled pneumatic ventilators, which are easy to produce but often do not include the sensing or alarm features found on commercial ventilators. This work reports a low-cost, easy-to-produce electronic sensor and alarm system for pressure-cycled ventilators that estimates clinically useful metrics such as pressure and respiratory rate and sounds an alarm when the ventilator malfunctions. A low-complexity signal processing algorithm uses a pair of nonlinear recursive envelope trackers to monitor the signal from an electronic pressure sensor connected to the patient airway. The algorithm, inspired by those used in hearing aids, requires little memory and performs only a few calculations on each sample so that it can run on nearly any microcontroller.

Journal Article

Corey, Ryan M;Widloski, Evan M;Null, David;Ricconi, Brian;Johnson, Mark A;White, Karen C;Amos, Jennifer R;Pagano, Alexander;Oelze, Michael L;Switzky, Rachel D;Wheeler, Matthew B;Bethke, Eliot B;Shipley, Clifford F;Singer, Andrew C

10.1109/TBCAS.2020.3020702

[Title]: Low-Complexity System and Algorithm for an Emergency Ventilator Sensor and Alarm. [Abstract]: In response to anticipated shortages of ventilators caused by the COVID-19 pandemic, many organizations have designed low-cost emergency ventilators. Many of these devices are pressure-cycled pneumatic ventilators, which are easy to produce but often do not include the sensing or alarm features found on commercial ventilators. This work reports a low-cost, easy-to-produce electronic sensor and alarm system for pressure-cycled ventilators that estimates clinically useful metrics such as pressure and respiratory rate and sounds an alarm when the ventilator malfunctions. A low-complexity signal processing algorithm uses a pair of nonlinear recursive envelope trackers to monitor the signal from an electronic pressure sensor connected to the patient airway. The algorithm, inspired by those used in hearing aids, requires little memory and performs only a few calculations on each sample so that it can run on nearly any microcontroller. [Keywords]:

J Thromb Thrombolysis

Markers of coagulation dysfunction and inflammation in diabetic and non-diabetic COVID-19.

Coagulation dysfunction and inflammatory status were compared between diabetic and non-diabetic COVID-19 patients. The standardized mean difference (SMD) and its 95% confidence interval (CI) was computed for the difference of inflammatory and hypercoagulability markers. The levels of serum ferritin (standardized mean difference-SMD: 0.47, CI 0.17-0.77, p = 0.002), C-reactive protein (SMD = 0.53, CI 0.20-0.86, p = 0.002), interleukin-6 (SMD = 0.31, CI 0.09-0.52, p = 0.005), fibrinogen (SMD = 0.31, CI 0.09-0.54, p = 0.007) and D-dimers (SMD = 0.54, CI 0.16-0.91, p = 0.005) were significantly higher in diabetic COVID-19 cases as compared to non-diabetic COVID-19 patients, suggesting more susceptibility of diabetic COVID-19 patients to coagulation dysfunction and inflammatory storm.

covid-19;d-dimer;diabetes;inflammation

Letter

Varikasuvu, Seshadri Reddy;Varshney, Saurabh;Dutt, Naveen

10.1007/s11239-020-02270-w

[Title]: Markers of coagulation dysfunction and inflammation in diabetic and non-diabetic COVID-19. [Abstract]: Coagulation dysfunction and inflammatory status were compared between diabetic and non-diabetic COVID-19 patients. The standardized mean difference (SMD) and its 95% confidence interval (CI) was computed for the difference of inflammatory and hypercoagulability markers. The levels of serum ferritin (standardized mean difference-SMD: 0.47, CI 0.17-0.77, p = 0.002), C-reactive protein (SMD = 0.53, CI 0.20-0.86, p = 0.002), interleukin-6 (SMD = 0.31, CI 0.09-0.52, p = 0.005), fibrinogen (SMD = 0.31, CI 0.09-0.54, p = 0.007) and D-dimers (SMD = 0.54, CI 0.16-0.91, p = 0.005) were significantly higher in diabetic COVID-19 cases as compared to non-diabetic COVID-19 patients, suggesting more susceptibility of diabetic COVID-19 patients to coagulation dysfunction and inflammatory storm. [Keywords]: covid-19;d-dimer;diabetes;inflammation

Phytomedicine

Caffeic acid derivatives (CAFDs) as inhibitors of SARS-CoV-2: CAFDs-based functional foods as a potential alternative approach to combat COVID-19.

BACKGROUND: SARS-CoV-2, an emerging strain of coronavirus, has affected millions of people from all the continents of world and received worldwide attention. This emerging health crisis calls for the urgent development of specific therapeutics against COVID-19 to potentially reduce the burden of this emerging pandemic. PURPOSE: This study aims to evaluate the anti-viral efficacy of natural bioactive entities against COVID-19 via molecular docking and molecular dynamics simulation. METHODS: A library of 27 caffeic-acid derivatives was screened against 5 proteins of SARS-CoV-2 by using Molegro Virtual Docker 7 to obtain the binding energies and interactions between compounds and SARS-CoV-2 proteins. ADME properties and toxicity profiles were investigated via www.swissadme.ch web tools and Toxtree respectively. Molecular dynamics simulation was performed to determine the stability of the lead-protein interactions. RESULTS: Our obtained results has uncovered khainaoside C, 6-O-Caffeoylarbutin, khainaoside B, khainaoside C and vitexfolin A as potent modulators of COVID-19 possessing more binding energies than nelfinavir against COVID-19 M(pro), Nsp15, SARS-CoV-2 spike S2 subunit, spike open state and closed state structure respectively. While Calceolarioside B was identified as pan inhibitor, showing strong molecular interactions with all proteins except SARS-CoV-2 spike glycoprotein closed state. The results are supported by 20 ns molecular dynamics simulations of the best complexes. CONCLUSION: This study will hopefully pave a way for development of phytonutrients-based antiviral therapeutic for treatment or prevention of COVID-19 and further studies are recommended to evaluate the antiviral effects of these phytochemicals against SARS-CoV-2 in in vitro and in vivo models.

bioactive phytochemicals;covid-19;caffeic acid derivative;sars-cov-2

Journal Article

Adem, Sevki;Eyupoglu, Volkan;Sarfraz, Iqra;Rasul, Azhar;Zahoor, Ameer Fawad;Ali, Muhammad;Abdalla, Mohnad;Ibrahim, Ibrahim M;Elfiky, Abdo A

10.1016/j.phymed.2020.153310

[Title]: Caffeic acid derivatives (CAFDs) as inhibitors of SARS-CoV-2: CAFDs-based functional foods as a potential alternative approach to combat COVID-19. [Abstract]: BACKGROUND: SARS-CoV-2, an emerging strain of coronavirus, has affected millions of people from all the continents of world and received worldwide attention. This emerging health crisis calls for the urgent development of specific therapeutics against COVID-19 to potentially reduce the burden of this emerging pandemic. PURPOSE: This study aims to evaluate the anti-viral efficacy of natural bioactive entities against COVID-19 via molecular docking and molecular dynamics simulation. METHODS: A library of 27 caffeic-acid derivatives was screened against 5 proteins of SARS-CoV-2 by using Molegro Virtual Docker 7 to obtain the binding energies and interactions between compounds and SARS-CoV-2 proteins. ADME properties and toxicity profiles were investigated via www.swissadme.ch web tools and Toxtree respectively. Molecular dynamics simulation was performed to determine the stability of the lead-protein interactions. RESULTS: Our obtained results has uncovered khainaoside C, 6-O-Caffeoylarbutin, khainaoside B, khainaoside C and vitexfolin A as potent modulators of COVID-19 possessing more binding energies than nelfinavir against COVID-19 M(pro), Nsp15, SARS-CoV-2 spike S2 subunit, spike open state and closed state structure respectively. While Calceolarioside B was identified as pan inhibitor, showing strong molecular interactions with all proteins except SARS-CoV-2 spike glycoprotein closed state. The results are supported by 20 ns molecular dynamics simulations of the best complexes. CONCLUSION: This study will hopefully pave a way for development of phytonutrients-based antiviral therapeutic for treatment or prevention of COVID-19 and further studies are recommended to evaluate the antiviral effects of these phytochemicals against SARS-CoV-2 in in vitro and in vivo models. [Keywords]: bioactive phytochemicals;covid-19;caffeic acid derivative;sars-cov-2

Cureus

Delayed Tracheostomy in a Patient With Prolonged Invasive Mechanical Ventilation due to COVID-19.

Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS) that is associated with high mortality among patients requiring invasive mechanical ventilation. We present a case of a 56-year-old male with hypertension and obesity who presented with chest pain from COVID-19. The patient required endotracheal intubation due to worsening hypoxia and remained intubated for 33 days. Tracheostomy placement was delayed in part due to persistent COVID-19 positive testing until hospital day 37. The patient required a total of 52 days in the ICU prior to discharge to a rehabilitation facility. This case highlights the extensive resources needed for critically ill patients with COVID-19 and the long duration that patients may test positive for the virus after onset of symptoms. It also raises questions about the timing and safety of tracheostomy placement among those patients requiring mechanical ventilation from COVID-19.

acute respiratory distress syndrome;endotracheal intubation;tracheostomy placement

Case Reports

Holmen, Ian C;Kent, Andrew;Lakritz, Stephanie;Brickson, Claire;Mastalerz, Katarzyna

10.7759/cureus.8644

[Title]: Delayed Tracheostomy in a Patient With Prolonged Invasive Mechanical Ventilation due to COVID-19. [Abstract]: Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS) that is associated with high mortality among patients requiring invasive mechanical ventilation. We present a case of a 56-year-old male with hypertension and obesity who presented with chest pain from COVID-19. The patient required endotracheal intubation due to worsening hypoxia and remained intubated for 33 days. Tracheostomy placement was delayed in part due to persistent COVID-19 positive testing until hospital day 37. The patient required a total of 52 days in the ICU prior to discharge to a rehabilitation facility. This case highlights the extensive resources needed for critically ill patients with COVID-19 and the long duration that patients may test positive for the virus after onset of symptoms. It also raises questions about the timing and safety of tracheostomy placement among those patients requiring mechanical ventilation from COVID-19. [Keywords]: acute respiratory distress syndrome;endotracheal intubation;tracheostomy placement

Cardiovasc Res

COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options.

The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer. The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically, SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane angiotensin-converting enzyme 2 (ACE2) -a homologue of ACE-to enter type 2 pneumocytes, macrophages, perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis. Hence, patients should not discontinue their use. Moreover, renin-angiotensin-aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm [interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures (social distancing and social isolation) also increase cardiovascular risk. Cardiovascular considerations of therapies currently used, including remdesivir, chloroquine, hydroxychloroquine, tocilizumab, ribavirin, interferons, and lopinavir/ritonavir, as well as experimental therapies, such as human recombinant ACE2 (rhACE2), are discussed.

ace2;acute coronary syndrome;covid-19;cardiac;endothelium;microvascular;myocardial infarction;myocarditis;vascular;virus

Journal Article;Research Support, Non-U.S. Gov't

Guzik, Tomasz J;Mohiddin, Saidi A;Dimarco, Anthony;Patel, Vimal;Savvatis, Kostas;Marelli-Berg, Federica M;Madhur, Meena S;Tomaszewski, Maciej;Maffia, Pasquale;D'Acquisto, Fulvio;Nicklin, Stuart A;Marian, Ali J;Nosalski, Ryszard;Murray, Eleanor C;Guzik, Bartlomiej;Berry, Colin;Touyz, Rhian M;Kreutz, Reinhold;Wang, Dao Wen;Bhella, David;Sagliocco, Orlando;Crea, Filippo;Thomson, Emma C;McInnes, Iain B

10.1093/cvr/cvaa106

[Title]: COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. [Abstract]: The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer. The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically, SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane angiotensin-converting enzyme 2 (ACE2) -a homologue of ACE-to enter type 2 pneumocytes, macrophages, perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis. Hence, patients should not discontinue their use. Moreover, renin-angiotensin-aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm [interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures (social distancing and social isolation) also increase cardiovascular risk. Cardiovascular considerations of therapies currently used, including remdesivir, chloroquine, hydroxychloroquine, tocilizumab, ribavirin, interferons, and lopinavir/ritonavir, as well as experimental therapies, such as human recombinant ACE2 (rhACE2), are discussed. [Keywords]: ace2;acute coronary syndrome;covid-19;cardiac;endothelium;microvascular;myocardial infarction;myocarditis;vascular;virus

Zhongguo Zhong Yao Za Zhi

[Analysis of potential role of Chinese classic prescriptions in treatment of COVID-19 based on TCMATCOV platform].

With the global outbreak of coronavirus disease 2019(COVID-19), screening of effective drugs has became the emphasis of research today; furthermore, screening of Chinese classic prescriptions has became one of the directions for drug development. This study analyzed the application of classic prescriptions in the diagnosis and treatment schemes based on the Diagnosis and Treatment Schemes for Coronavirus Disease at the country, provincial and municipal levels, and further explored its disrobing effect on COVID-19 disease severe phase network, and selected representative prescriptions for core target screening and gene enrichment analysis, so as to reveal its mechanism of action. Among them, 13 prescriptions were found to be used for 10 times or more, including Maxing Shigan Tang, Yinqiao San, Shengjiang San, Dayuan Drink, Xuanbai Chengqi Decoction. In addition, the COVID-19 efficacy prediction analysis platform(TCMATCOV platform) was used to calculate the network disturbances of the Chinese classic prescriptions involved. Based on the prediction results, 68 classic prescriptions were assessed on the COVID-19 disease network robustness disturbance. The average disturbance scores for the interaction confidence scores were ranked to be 0.4, 0.5, and 0.6 from the highest to the lowest. There were 7 prescriptions with a score of 17 or more, and 50 prescriptions with a score of 13 or more. Among them, the top three prescriptions were Ganlu Xiaodu Dan(18.19), Lengxiao Wan(17.74), and Maxing Shigan Tang(17.62). After further mining the action targets of these three prescriptions, it was found that COVID-19 disease-specific factors Ccl2, IL10, IL6 and TNF were all the targets of three prescriptions. Through the enrichment analysis of the biological processes of the core targets, it was found that the three prescriptions may prevent the development of the disease by affecting cell-to-cell adhesion, cytokine-mediated signaling pathway, and chronic inflammatory responses to COVID-19 at the severe phase. This study showed that the TCMATCOV platform could evaluate the disturbance effect of different prescriptions on the COVID-19 disease network, and predict potential effectiveness based on the robustness of drug-interfered pneumonia disease networks, so as to provide a reference for further experiments or clinical verification.

covid-19;chinese classical prescriptions;tcmatcov platform

Journal Article

Tang, Xuan;Tong, Lin;Guo, Fei-Fei;Tang, Shi-Huan;Yang, Hong-Jun

10.19540/j.cnki.cjcmm.20200405.401

[Title]: [Analysis of potential role of Chinese classic prescriptions in treatment of COVID-19 based on TCMATCOV platform]. [Abstract]: With the global outbreak of coronavirus disease 2019(COVID-19), screening of effective drugs has became the emphasis of research today; furthermore, screening of Chinese classic prescriptions has became one of the directions for drug development. This study analyzed the application of classic prescriptions in the diagnosis and treatment schemes based on the Diagnosis and Treatment Schemes for Coronavirus Disease at the country, provincial and municipal levels, and further explored its disrobing effect on COVID-19 disease severe phase network, and selected representative prescriptions for core target screening and gene enrichment analysis, so as to reveal its mechanism of action. Among them, 13 prescriptions were found to be used for 10 times or more, including Maxing Shigan Tang, Yinqiao San, Shengjiang San, Dayuan Drink, Xuanbai Chengqi Decoction. In addition, the COVID-19 efficacy prediction analysis platform(TCMATCOV platform) was used to calculate the network disturbances of the Chinese classic prescriptions involved. Based on the prediction results, 68 classic prescriptions were assessed on the COVID-19 disease network robustness disturbance. The average disturbance scores for the interaction confidence scores were ranked to be 0.4, 0.5, and 0.6 from the highest to the lowest. There were 7 prescriptions with a score of 17 or more, and 50 prescriptions with a score of 13 or more. Among them, the top three prescriptions were Ganlu Xiaodu Dan(18.19), Lengxiao Wan(17.74), and Maxing Shigan Tang(17.62). After further mining the action targets of these three prescriptions, it was found that COVID-19 disease-specific factors Ccl2, IL10, IL6 and TNF were all the targets of three prescriptions. Through the enrichment analysis of the biological processes of the core targets, it was found that the three prescriptions may prevent the development of the disease by affecting cell-to-cell adhesion, cytokine-mediated signaling pathway, and chronic inflammatory responses to COVID-19 at the severe phase. This study showed that the TCMATCOV platform could evaluate the disturbance effect of different prescriptions on the COVID-19 disease network, and predict potential effectiveness based on the robustness of drug-interfered pneumonia disease networks, so as to provide a reference for further experiments or clinical verification. [Keywords]: covid-19;chinese classical prescriptions;tcmatcov platform

Diabetes Metab Syndr

The effect of COVID-19 lockdown on glycemic control in patients with type 2 diabetes mellitus in Turkey.

BACKGROUND AND AIMS: A national lockdown to prevent the spread of coronavirus disease (COVID-19) in Turkey was introduced in March 2020. We think that lockdowns may lead to weight gain and worsening of glycemic parameters in patients with type 2 diabetes mellitus (DM). The purpose of this study was to investigate how type 2 DM patients were affected by the lockdown. METHOD: Type 2 DM patients unable to attend regular follow-ups due to lockdown over a 75-day period between March and June 2020 and who again attended polyclinic follow-up when the lockdown was lifted were included in the study. These patients' glycemic control and weight status were compared with the pre-lockdown period. In addition, patients' general habits, and adherence to diet and exercise were evaluated, while their general health was assessed using the Short-Form 36-item survey. RESULT: The research involved 101 type 2 DM patients, 57 men (56.5%) and 44 women (44.5%), with a mean age of 55 +/- 13. Patients' mean pre-lockdown weight was 84.7 +/- 16.4 kg, rising to 85.5 +/- 16.8 kg post-lockdown, although the increase was not statistically significant (p = 0.781). In terms of glycemic parameters, Hba1c rose from 7.67 +/- 1.76 to 8.11 +/- 2.48, and fasting glucose from 157.9 (83-645) mg/dl to 163.2 (84-550) mg/dl, none of which were statistically significant (p = 0.253, p = 0.079, respectively). CONCLUSION: In addition to weight gain among type 2 DM patients during the Covid 19 lockdown, statistically insignificant increases were also observed in such glycemic parameters. This was a small sample and further studies with larger sample are needed.

covid 19;diabetes;lockdown;outbreak;sars-cov 2;sf-36

Journal Article;Observational Study

Onmez, Attila;Gamsizkan, Zerrin;Ozdemir, Seyma;Kesikbas, Enis;Gokosmanoglu, Feyzi;Torun, Serkan;Cinemre, Hakan

10.1016/j.dsx.2020.10.007

[Title]: The effect of COVID-19 lockdown on glycemic control in patients with type 2 diabetes mellitus in Turkey. [Abstract]: BACKGROUND AND AIMS: A national lockdown to prevent the spread of coronavirus disease (COVID-19) in Turkey was introduced in March 2020. We think that lockdowns may lead to weight gain and worsening of glycemic parameters in patients with type 2 diabetes mellitus (DM). The purpose of this study was to investigate how type 2 DM patients were affected by the lockdown. METHOD: Type 2 DM patients unable to attend regular follow-ups due to lockdown over a 75-day period between March and June 2020 and who again attended polyclinic follow-up when the lockdown was lifted were included in the study. These patients' glycemic control and weight status were compared with the pre-lockdown period. In addition, patients' general habits, and adherence to diet and exercise were evaluated, while their general health was assessed using the Short-Form 36-item survey. RESULT: The research involved 101 type 2 DM patients, 57 men (56.5%) and 44 women (44.5%), with a mean age of 55 +/- 13. Patients' mean pre-lockdown weight was 84.7 +/- 16.4 kg, rising to 85.5 +/- 16.8 kg post-lockdown, although the increase was not statistically significant (p = 0.781). In terms of glycemic parameters, Hba1c rose from 7.67 +/- 1.76 to 8.11 +/- 2.48, and fasting glucose from 157.9 (83-645) mg/dl to 163.2 (84-550) mg/dl, none of which were statistically significant (p = 0.253, p = 0.079, respectively). CONCLUSION: In addition to weight gain among type 2 DM patients during the Covid 19 lockdown, statistically insignificant increases were also observed in such glycemic parameters. This was a small sample and further studies with larger sample are needed. [Keywords]: covid 19;diabetes;lockdown;outbreak;sars-cov 2;sf-36

Int J Infect Dis

Sensitivity of different RT-qPCR solutions for SARS-CoV-2 detection.

OBJECTIVES: The ongoing COVID-19 pandemic continues to impose demands on diagnostic screening. In anticipation that the recurrence of outbreaks and the measures for lifting the lockdown worldwide may cause supply chain issues over the coming months, this study assessed the sensitivity of a number of one-step retrotranscription and quantitative polymerase chain reaction (RT-qPCR) solutions to detect SARS-CoV-2. METHODS: Six different RT-qPCR alternatives were evaluated for SARS-CoV-2/COVID-19 diagnosis based on standard RNA extractions. The one with best sensitivity was also assessed with direct nasopharyngeal swab viral transmission medium (VTM) heating; thus overcoming the RNA extraction step. RESULTS: A wide variability in the sensitivity of RT-qPCR solutions was found that was associated with a range of false negatives from 2% (0.3-7.9%) to 39.8% (30.2-50.2%). Direct preheating of VTM combined with the best solution provided a sensitivity of 72.5% (62.5-81.0%), in the range of some of the solutions based on standard RNA extractions. CONCLUSIONS: Sensitivity limitations of currently used RT-qPCR solutions were found. These results will help to calibrate the impact of false negative diagnoses of COVID-19, and to detect and control new SARS-CoV-2 outbreaks and community transmissions.

covid-19;diagnosis;false negatives;sars-cov-2;sensitivity;solution comparisons

Journal Article

Alcoba-Florez, Julia;Gil-Campesino, Helena;Artola, Diego Garcia-Martinez de;Gonzalez-Montelongo, Rafaela;Valenzuela-Fernandez, Agustin;Ciuffreda, Laura;Flores, Carlos

10.1016/j.ijid.2020.07.058

[Title]: Sensitivity of different RT-qPCR solutions for SARS-CoV-2 detection. [Abstract]: OBJECTIVES: The ongoing COVID-19 pandemic continues to impose demands on diagnostic screening. In anticipation that the recurrence of outbreaks and the measures for lifting the lockdown worldwide may cause supply chain issues over the coming months, this study assessed the sensitivity of a number of one-step retrotranscription and quantitative polymerase chain reaction (RT-qPCR) solutions to detect SARS-CoV-2. METHODS: Six different RT-qPCR alternatives were evaluated for SARS-CoV-2/COVID-19 diagnosis based on standard RNA extractions. The one with best sensitivity was also assessed with direct nasopharyngeal swab viral transmission medium (VTM) heating; thus overcoming the RNA extraction step. RESULTS: A wide variability in the sensitivity of RT-qPCR solutions was found that was associated with a range of false negatives from 2% (0.3-7.9%) to 39.8% (30.2-50.2%). Direct preheating of VTM combined with the best solution provided a sensitivity of 72.5% (62.5-81.0%), in the range of some of the solutions based on standard RNA extractions. CONCLUSIONS: Sensitivity limitations of currently used RT-qPCR solutions were found. These results will help to calibrate the impact of false negative diagnoses of COVID-19, and to detect and control new SARS-CoV-2 outbreaks and community transmissions. [Keywords]: covid-19;diagnosis;false negatives;sars-cov-2;sensitivity;solution comparisons

Circ Cardiovasc Interv

Fibrinolytic Strategy for ST-Segment-Elevation Myocardial Infarction: A Contemporary Review in Context of the COVID-19 Pandemic.

The ongoing coronavirus disease 2019 pandemic has resulted in additional challenges for systems designed to perform expeditious primary percutaneous coronary intervention for patients presenting with ST-segment-elevation myocardial infarction. There are 2 important considerations: the guideline-recommended time goals were difficult to achieve for many patients in high-income countries even before the pandemic, and there is a steep increase in mortality when primary percutaneous coronary intervention cannot be delivered in a timely fashion. Although the use of fibrinolytic therapy has progressively decreased over the last several decades in high-income countries, in circumstances when delays in timely delivery of primary percutaneous coronary intervention are expected, a modern fibrinolytic-based pharmacoinvasive strategy may need to be considered. The purpose of this review is to systematically discuss the contemporary role of an evidence-based fibrinolytic reperfusion strategy as part of a pharmacoinvasive approach, in the context of the emerging coronavirus disease 2019 pandemic.

coronavirus;fibrinolysis;myocardial infarction;pandemic;reperfusion

Journal Article;Systematic Review

Engel Gonzalez, Pedro;Omar, Wally;Patel, Kunal V;de Lemos, James A;Bavry, Anthony A;Koshy, Thomas P;Mullasari, Ajit S;Alexander, Thomas;Banerjee, Subhash;Kumbhani, Dharam J

10.1161/CIRCINTERVENTIONS.120.009622

[Title]: Fibrinolytic Strategy for ST-Segment-Elevation Myocardial Infarction: A Contemporary Review in Context of the COVID-19 Pandemic. [Abstract]: The ongoing coronavirus disease 2019 pandemic has resulted in additional challenges for systems designed to perform expeditious primary percutaneous coronary intervention for patients presenting with ST-segment-elevation myocardial infarction. There are 2 important considerations: the guideline-recommended time goals were difficult to achieve for many patients in high-income countries even before the pandemic, and there is a steep increase in mortality when primary percutaneous coronary intervention cannot be delivered in a timely fashion. Although the use of fibrinolytic therapy has progressively decreased over the last several decades in high-income countries, in circumstances when delays in timely delivery of primary percutaneous coronary intervention are expected, a modern fibrinolytic-based pharmacoinvasive strategy may need to be considered. The purpose of this review is to systematically discuss the contemporary role of an evidence-based fibrinolytic reperfusion strategy as part of a pharmacoinvasive approach, in the context of the emerging coronavirus disease 2019 pandemic. [Keywords]: coronavirus;fibrinolysis;myocardial infarction;pandemic;reperfusion

Molecules

Synthesis and Biological Evaluation of Novel (thio)semicarbazone-Based Benzimidazoles as Antiviral Agents against Human Respiratory Viruses.

Respiratory RNA viruses are responsible for recurrent acute respiratory illnesses that still represent a major medical need. Previously we developed a large variety of benzimidazole derivatives able to inhibit these viruses. Herein, two series of (thio)semicarbazone- and hydrazone-based benzimidazoles have been explored, by derivatizing 5-acetyl benzimidazoles previously reported by us, thereby evaluating the influence of the modification on the antiviral activity. Compounds 6, 8, 16 and 17, bearing the 5-(thio)semicarbazone and 5-hydrazone functionalities in combination with the 2-benzyl ring on the benzimidazole core structure, acted as dual inhibitors of influenza A virus and human coronavirus. For respiratory syncytial virus (RSV), activity is limited to the 5-thiosemicarbazone (25) and 5-hydrazone (22) compounds carrying the 2-[(benzotriazol-1/2-yl)methyl]benzimidazole scaffold. These molecules proved to be the most effective antiviral agents, able to reach the potency profile of the licensed drug ribavirin. The molecular docking analysis explained the SAR of these compounds around their binding mode to the target RSV F protein, revealing the key contacts for further assessment. The herein-investigated benzimidazole-based derivatives may represent valuable hit compounds, deserving subsequent structural improvements towards more efficient antiviral agents for the treatment of pathologies caused by these human respiratory viruses.

(thio)semicarbazone-based benzimidazoles;anti-rsv activity;anti-coronavirus activity;anti-influenza activity;hydrazone-based benzimidazoles;molecular modelling studies

Journal Article

Francesconi, Valeria;Cichero, Elena;Schenone, Silvia;Naesens, Lieve;Tonelli, Michele

10.3390/molecules25071487

[Title]: Synthesis and Biological Evaluation of Novel (thio)semicarbazone-Based Benzimidazoles as Antiviral Agents against Human Respiratory Viruses. [Abstract]: Respiratory RNA viruses are responsible for recurrent acute respiratory illnesses that still represent a major medical need. Previously we developed a large variety of benzimidazole derivatives able to inhibit these viruses. Herein, two series of (thio)semicarbazone- and hydrazone-based benzimidazoles have been explored, by derivatizing 5-acetyl benzimidazoles previously reported by us, thereby evaluating the influence of the modification on the antiviral activity. Compounds 6, 8, 16 and 17, bearing the 5-(thio)semicarbazone and 5-hydrazone functionalities in combination with the 2-benzyl ring on the benzimidazole core structure, acted as dual inhibitors of influenza A virus and human coronavirus. For respiratory syncytial virus (RSV), activity is limited to the 5-thiosemicarbazone (25) and 5-hydrazone (22) compounds carrying the 2-[(benzotriazol-1/2-yl)methyl]benzimidazole scaffold. These molecules proved to be the most effective antiviral agents, able to reach the potency profile of the licensed drug ribavirin. The molecular docking analysis explained the SAR of these compounds around their binding mode to the target RSV F protein, revealing the key contacts for further assessment. The herein-investigated benzimidazole-based derivatives may represent valuable hit compounds, deserving subsequent structural improvements towards more efficient antiviral agents for the treatment of pathologies caused by these human respiratory viruses. [Keywords]: (thio)semicarbazone-based benzimidazoles;anti-rsv activity;anti-coronavirus activity;anti-influenza activity;hydrazone-based benzimidazoles;molecular modelling studies

Lancet Child Adolesc Health

Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study.

BACKGROUND: The risk of vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, which causes COVID-19), the most appropriate management, and the neonate's risk of developing COVID-19 during the perinatal period are unknown. Therefore, we aimed to elucidate best practices regarding infection control in mother-newborn dyads, and identify potential risk factors associated with transmission. METHODS: In this observational cohort study, we identified all neonates born between March 22 and May 17, 2020, at three New York Presbyterian Hospitals in New York City (NY, USA) to mothers positive for SARS-CoV-2 at delivery. Mothers could practice skin-to-skin care and breastfeed in the delivery room, but had to wear a surgical mask when near their neonate and practice proper hand hygiene before skin-to-skin contact, breastfeeding, and routine care. Unless medically required, neonates were kept in a closed Giraffe isolette in the same room as their mothers, and were held by mothers for feeding after appropriate hand hygiene, breast cleansing, and placement of a surgical mask. Neonates were tested for SARS-CoV-2 by use of real-time PCR on nasopharyngeal swabs taken at 24 h, 5-7 days, and 14 days of life, and were clinically evaluated by telemedicine at 1 month of age. We recorded demographics, neonatal, and maternal clinical presentation, as well as infection control practices in the hospital and at home. FINDINGS: Of 1481 deliveries, 116 (8%) mothers tested positive for SARS-CoV-2; 120 neonates were identified. All neonates were tested at 24 h of life and none were positive for SARS-CoV-2. 82 (68%) neonates completed follow-up at day 5-7 of life. Of the 82 neonates, 68 (83%) roomed in with the mothers. All mothers were allowed to breastfeed; at 5-7 days of life, 64 (78%) were still breastfeeding. 79 (96%) of 82 neonates had a repeat PCR at 5-7 days of life, which was negative in all; 72 (88%) neonates were also tested at 14 days of life and none were positive. None of the neonates had symptoms of COVID-19. INTERPRETATION: Our data suggest that perinatal transmission of COVID-19 is unlikely to occur if correct hygiene precautions are undertaken, and that allowing neonates to room in with their mothers and direct breastfeeding are safe procedures when paired with effective parental education of infant protective strategies. FUNDING: None.

Journal Article;Multicenter Study;Observational Study

Salvatore, Christine M;Han, Jin-Young;Acker, Karen P;Tiwari, Priyanka;Jin, Jenny;Brandler, Michael;Cangemi, Carla;Gordon, Laurie;Parow, Aimee;DiPace, Jennifer;DeLaMora, Patricia

10.1016/S2352-4642(20)30235-2

[Title]: Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study. [Abstract]: BACKGROUND: The risk of vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, which causes COVID-19), the most appropriate management, and the neonate's risk of developing COVID-19 during the perinatal period are unknown. Therefore, we aimed to elucidate best practices regarding infection control in mother-newborn dyads, and identify potential risk factors associated with transmission. METHODS: In this observational cohort study, we identified all neonates born between March 22 and May 17, 2020, at three New York Presbyterian Hospitals in New York City (NY, USA) to mothers positive for SARS-CoV-2 at delivery. Mothers could practice skin-to-skin care and breastfeed in the delivery room, but had to wear a surgical mask when near their neonate and practice proper hand hygiene before skin-to-skin contact, breastfeeding, and routine care. Unless medically required, neonates were kept in a closed Giraffe isolette in the same room as their mothers, and were held by mothers for feeding after appropriate hand hygiene, breast cleansing, and placement of a surgical mask. Neonates were tested for SARS-CoV-2 by use of real-time PCR on nasopharyngeal swabs taken at 24 h, 5-7 days, and 14 days of life, and were clinically evaluated by telemedicine at 1 month of age. We recorded demographics, neonatal, and maternal clinical presentation, as well as infection control practices in the hospital and at home. FINDINGS: Of 1481 deliveries, 116 (8%) mothers tested positive for SARS-CoV-2; 120 neonates were identified. All neonates were tested at 24 h of life and none were positive for SARS-CoV-2. 82 (68%) neonates completed follow-up at day 5-7 of life. Of the 82 neonates, 68 (83%) roomed in with the mothers. All mothers were allowed to breastfeed; at 5-7 days of life, 64 (78%) were still breastfeeding. 79 (96%) of 82 neonates had a repeat PCR at 5-7 days of life, which was negative in all; 72 (88%) neonates were also tested at 14 days of life and none were positive. None of the neonates had symptoms of COVID-19. INTERPRETATION: Our data suggest that perinatal transmission of COVID-19 is unlikely to occur if correct hygiene precautions are undertaken, and that allowing neonates to room in with their mothers and direct breastfeeding are safe procedures when paired with effective parental education of infant protective strategies. FUNDING: None. [Keywords]:

J Med Virol

Determining host factors contributing to disease severity in a family cluster of 29 hospitalized SARS-CoV-2 patients: Could genetic factors be relevant in the clinical course of COVID-19?

In this study, we report a large family cluster consisting of 29 genetically related patients hospitalized with coronavirus disease-2019 (COVID-19). We sought to determine the clinical characteristics relevant to the clinical course of COVID-19 by comparing the family cluster to unrelated patients with SARS-CoV-2 infection so that the presence of potential determinants of disease severity, other than traditional risk factors previously reported, could be investigated. Twenty-nine patient files were investigated in group 1 and group 2 was created with 52 consecutive patients with COVID-19 having age and gender compatibility. The virus was detected for diagnosis. The clinical, laboratory and imaging features of all patients were retrospectively screened. Disease course was assessed using records regarding outcome from patient files retrospectively. Groups were compared with respect to baseline characteristics, disease severity on presentation, and disease course. There was no difference between the two groups in terms of comorbidity and smoking history. In terms of inhospital treatment, use differed not significantly between two groups. We found that all 29 patients in the group 1 had severe pneumonia, 18 patients had severe pneumonia. Hospitalization rates, length of hospital stay, and transferred to intensive care unit were found to be statistically significantly higher in the group 1. In the present study, COVID-19 cases in the large family cluster were shown to have more severe disease and worse clinical course compared with consecutive patients with COVID-19 presenting to the same time. We believe further studies into potential genetic mechanisms of host susceptibility to COVID-19 should include such family clusters.

covid-19;family cluster;pneumonia;severity

Journal Article

Ikitimur, Hande;Borku Uysal, Betul;Cengiz, Mahir;Ikitimur, Baris;Uysal, Harun;Ozcan, Erkan;Islamoglu, Mehmet Sami;Seyhan, Serhat;Yavuzer, Hakan;Yavuzer, Serap

10.1002/jmv.26106

[Title]: Determining host factors contributing to disease severity in a family cluster of 29 hospitalized SARS-CoV-2 patients: Could genetic factors be relevant in the clinical course of COVID-19? [Abstract]: In this study, we report a large family cluster consisting of 29 genetically related patients hospitalized with coronavirus disease-2019 (COVID-19). We sought to determine the clinical characteristics relevant to the clinical course of COVID-19 by comparing the family cluster to unrelated patients with SARS-CoV-2 infection so that the presence of potential determinants of disease severity, other than traditional risk factors previously reported, could be investigated. Twenty-nine patient files were investigated in group 1 and group 2 was created with 52 consecutive patients with COVID-19 having age and gender compatibility. The virus was detected for diagnosis. The clinical, laboratory and imaging features of all patients were retrospectively screened. Disease course was assessed using records regarding outcome from patient files retrospectively. Groups were compared with respect to baseline characteristics, disease severity on presentation, and disease course. There was no difference between the two groups in terms of comorbidity and smoking history. In terms of inhospital treatment, use differed not significantly between two groups. We found that all 29 patients in the group 1 had severe pneumonia, 18 patients had severe pneumonia. Hospitalization rates, length of hospital stay, and transferred to intensive care unit were found to be statistically significantly higher in the group 1. In the present study, COVID-19 cases in the large family cluster were shown to have more severe disease and worse clinical course compared with consecutive patients with COVID-19 presenting to the same time. We believe further studies into potential genetic mechanisms of host susceptibility to COVID-19 should include such family clusters. [Keywords]: covid-19;family cluster;pneumonia;severity

Diabetes Metab Syndr

Vitamin D concentrations and COVID-19 infection in UK Biobank.

BACKGROUND AND AIMS: COVID-19 and low levels of vitamin D appear to disproportionately affect black and minority ethnic individuals. We aimed to establish whether blood 25-hydroxyvitamin D (25(OH)D) concentration was associated with COVID-19 risk, and whether it explained the higher incidence of COVID-19 in black and South Asian people. METHODS: UK Biobank recruited 502,624 participants aged 37-73 years between 2006 and 2010. Baseline exposure data, including 25(OH)D concentration and ethnicity, were linked to COVID-19 test results. Univariable and multivariable logistic regression analyses were performed for the association between 25(OH)D and confirmed COVID-19, and the association between ethnicity and both 25(OH)D and COVID-19. RESULTS: Complete data were available for 348,598 UK Biobank participants. Of these, 449 had confirmed COVID-19 infection. Vitamin D was associated with COVID-19 infection univariably (OR = 0.99; 95% CI 0.99-0.999; p = 0.013), but not after adjustment for confounders (OR = 1.00; 95% CI = 0.998-1.01; p = 0.208). Ethnicity was associated with COVID-19 infection univariably (blacks versus whites OR = 5.32, 95% CI = 3.68-7.70, p-value<0.001; South Asians versus whites OR = 2.65, 95% CI = 1.65-4.25, p-value<0.001). Adjustment for 25(OH)D concentration made little difference to the magnitude of the association. CONCLUSIONS: Our findings do not support a potential link between vitamin D concentrations and risk of COVID-19 infection, nor that vitamin D concentration may explain ethnic differences in COVID-19 infection.

covid-19;ethnicity;vitamin d

Journal Article

Hastie, Claire E;Mackay, Daniel F;Ho, Frederick;Celis-Morales, Carlos A;Katikireddi, Srinivasa Vittal;Niedzwiedz, Claire L;Jani, Bhautesh D;Welsh, Paul;Mair, Frances S;Gray, Stuart R;O'Donnell, Catherine A;Gill, Jason Mr;Sattar, Naveed;Pell, Jill P

10.1016/j.dsx.2020.04.050

[Title]: Vitamin D concentrations and COVID-19 infection in UK Biobank. [Abstract]: BACKGROUND AND AIMS: COVID-19 and low levels of vitamin D appear to disproportionately affect black and minority ethnic individuals. We aimed to establish whether blood 25-hydroxyvitamin D (25(OH)D) concentration was associated with COVID-19 risk, and whether it explained the higher incidence of COVID-19 in black and South Asian people. METHODS: UK Biobank recruited 502,624 participants aged 37-73 years between 2006 and 2010. Baseline exposure data, including 25(OH)D concentration and ethnicity, were linked to COVID-19 test results. Univariable and multivariable logistic regression analyses were performed for the association between 25(OH)D and confirmed COVID-19, and the association between ethnicity and both 25(OH)D and COVID-19. RESULTS: Complete data were available for 348,598 UK Biobank participants. Of these, 449 had confirmed COVID-19 infection. Vitamin D was associated with COVID-19 infection univariably (OR = 0.99; 95% CI 0.99-0.999; p = 0.013), but not after adjustment for confounders (OR = 1.00; 95% CI = 0.998-1.01; p = 0.208). Ethnicity was associated with COVID-19 infection univariably (blacks versus whites OR = 5.32, 95% CI = 3.68-7.70, p-value<0.001; South Asians versus whites OR = 2.65, 95% CI = 1.65-4.25, p-value<0.001). Adjustment for 25(OH)D concentration made little difference to the magnitude of the association. CONCLUSIONS: Our findings do not support a potential link between vitamin D concentrations and risk of COVID-19 infection, nor that vitamin D concentration may explain ethnic differences in COVID-19 infection. [Keywords]: covid-19;ethnicity;vitamin d

J Ethnopharmacol

Potential anti-influenza effective plants used in Turkish folk medicine: A review.

ETHNOPHARMACOLOGICAL RELEVANCE: Due to the outbreaks such as SARS, bird flu and swine flu, which we frequently encounter in our century, we need fast solutions with no side effects today more than ever. Due to having vast ethnomedical experience and the richest flora (34% endemic) of Europe and the Middle East, Turkey has a high potential for research on this topic. Plants that locals have been using for centuries for the prevention and treatment of influenza can offer effective alternatives to combat this problem. In this context, 224 herbal taxa belonging to 45 families were identified among the selected 81 studies conducted in the seven regions of Turkey. However, only 35 (15.6%) of them were found to be subjected to worldwide in vitro and in vivo research conducted on anti-influenza activity. Quercetin and chlorogenic acid, the effectiveness of which has been proven many times in this context, have been recorded as the most common (7.1%) active ingredients among the other 56 active substances identified. AIM OF THE STUDY: This study has been carried out to reveal the inventory of plant species that have been used in flu treatment for centuries in Turkish folk medicine, which could be used in the treatment of flu or flu-like pandemics, such as COVID 19, that humanity has been suffering with, and also compare them with experimental studies in the literature. MATERIALS AND METHODS: The investigation was conducted in two stages on the subject above by using electronic databases, such as Web of Science, Scopus, ScienceDirect, ProQuest, Medline, Cochrane Library, EBSCO, HighWire Press, PubMed and Google Scholar. The results of both scans are presented in separate tables, together with their regional comparative analysis. RESULTS: Data obtained on taxa are presented in a table, including anti-influenza mechanism of actions and the active substances. Rosa canina (58.7%) and Mentha x piperita (22.2%) were identified as the most common plants used in Turkey. Also, Sambucus nigra (11.6%), Olea europaea (9.3%), Eucalyptus spp., Melissa officinalis, and Origanum vulgare (7.0%) emerged as the most investigated taxa. CONCLUSION: This is the first nationwide ethnomedical screening work conducted on flu treatment with plants in Turkey. Thirty-nine plants have been confirmed in the recent experimental anti-influenza research, which strongly shows that these plants are a rich pharmacological source. Also, with 189 (84.4%) taxa, detections that have not been investigated yet, they are an essential resource for both national and international pharmacological researchers in terms of new natural medicine searches. Considering that the production of antimalarial drugs and their successful use against COVID-19 has begun, this correlation was actually a positive and remarkable piece of data, since there are 15 plants, including Centaurea drabifolia subsp. Phlocosa (an endemic taxon), that were found to be used in the treatment of both flu and malaria.

anti-influenza;antimalarial;antiviral;covid-19;traditional treatment;turkey

Journal Article;Review

Sargin, Seyid Ahmet

10.1016/j.jep.2020.113319

[Title]: Potential anti-influenza effective plants used in Turkish folk medicine: A review. [Abstract]: ETHNOPHARMACOLOGICAL RELEVANCE: Due to the outbreaks such as SARS, bird flu and swine flu, which we frequently encounter in our century, we need fast solutions with no side effects today more than ever. Due to having vast ethnomedical experience and the richest flora (34% endemic) of Europe and the Middle East, Turkey has a high potential for research on this topic. Plants that locals have been using for centuries for the prevention and treatment of influenza can offer effective alternatives to combat this problem. In this context, 224 herbal taxa belonging to 45 families were identified among the selected 81 studies conducted in the seven regions of Turkey. However, only 35 (15.6%) of them were found to be subjected to worldwide in vitro and in vivo research conducted on anti-influenza activity. Quercetin and chlorogenic acid, the effectiveness of which has been proven many times in this context, have been recorded as the most common (7.1%) active ingredients among the other 56 active substances identified. AIM OF THE STUDY: This study has been carried out to reveal the inventory of plant species that have been used in flu treatment for centuries in Turkish folk medicine, which could be used in the treatment of flu or flu-like pandemics, such as COVID 19, that humanity has been suffering with, and also compare them with experimental studies in the literature. MATERIALS AND METHODS: The investigation was conducted in two stages on the subject above by using electronic databases, such as Web of Science, Scopus, ScienceDirect, ProQuest, Medline, Cochrane Library, EBSCO, HighWire Press, PubMed and Google Scholar. The results of both scans are presented in separate tables, together with their regional comparative analysis. RESULTS: Data obtained on taxa are presented in a table, including anti-influenza mechanism of actions and the active substances. Rosa canina (58.7%) and Mentha x piperita (22.2%) were identified as the most common plants used in Turkey. Also, Sambucus nigra (11.6%), Olea europaea (9.3%), Eucalyptus spp., Melissa officinalis, and Origanum vulgare (7.0%) emerged as the most investigated taxa. CONCLUSION: This is the first nationwide ethnomedical screening work conducted on flu treatment with plants in Turkey. Thirty-nine plants have been confirmed in the recent experimental anti-influenza research, which strongly shows that these plants are a rich pharmacological source. Also, with 189 (84.4%) taxa, detections that have not been investigated yet, they are an essential resource for both national and international pharmacological researchers in terms of new natural medicine searches. Considering that the production of antimalarial drugs and their successful use against COVID-19 has begun, this correlation was actually a positive and remarkable piece of data, since there are 15 plants, including Centaurea drabifolia subsp. Phlocosa (an endemic taxon), that were found to be used in the treatment of both flu and malaria. [Keywords]: anti-influenza;antimalarial;antiviral;covid-19;traditional treatment;turkey

Tumori

Treating patients with cancer amidst the COVID-19 pandemic: experience of a regional hospital in the Piedmont region in northern Italy.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is posing an unprecedented dilemma to oncologists worldwide, forcing them to decide whether to continue or suspend treatments in order to protect their most vulnerable patients from infection. After the first report from China, the outbreak spread rapidly worldwide. To, date no clear indications on how to treat patients with cancer with COVID-19 infection are available. METHODS: We report data on 21 patients with cancer referred to a single medical oncology unit of a general hospital from mid-March to April 23, 2020. RESULTS: Nine patients were on active cancer therapy during the infection and all stopped medical treatments. Overall 8 patients developed pneumonia and 6 patients died of COVID-19. CONCLUSION: The management of patients with cancer during the pandemic should be carefully balanced and discussed among oncologists and other key professionals involved in the treatment of this vulnerable group of patients, in order to balance the risk of treatment and the risk of infection.

covid-19;cancer;management;pandemic;treatment

Journal Article

Garrone, Ornella;Denaro, Nerina;Ruatta, Fiorella;Vanella, Paola;Granetto, Cristina;Vandone, Anna Maria;Occelli, Marcella;Cauchi, Carolina;Ricci, Vincenzo;Fea, Elena;Di Costanzo, Gianna;Colantonio, Ida;Crosetto, Nicola;Merlano, Marco C

10.1177/0300891620942313

[Title]: Treating patients with cancer amidst the COVID-19 pandemic: experience of a regional hospital in the Piedmont region in northern Italy. [Abstract]: BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is posing an unprecedented dilemma to oncologists worldwide, forcing them to decide whether to continue or suspend treatments in order to protect their most vulnerable patients from infection. After the first report from China, the outbreak spread rapidly worldwide. To, date no clear indications on how to treat patients with cancer with COVID-19 infection are available. METHODS: We report data on 21 patients with cancer referred to a single medical oncology unit of a general hospital from mid-March to April 23, 2020. RESULTS: Nine patients were on active cancer therapy during the infection and all stopped medical treatments. Overall 8 patients developed pneumonia and 6 patients died of COVID-19. CONCLUSION: The management of patients with cancer during the pandemic should be carefully balanced and discussed among oncologists and other key professionals involved in the treatment of this vulnerable group of patients, in order to balance the risk of treatment and the risk of infection. [Keywords]: covid-19;cancer;management;pandemic;treatment

Diabetes Res Clin Pract

COVID-19 and diabetes: Knowledge in progress.

AIMS: We aimed to briefly review the general characteristics of the novel coronavirus (SARS-CoV-2) and provide a better understanding of the coronavirus disease (COVID-19) in people with diabetes, and its management. METHODS: We searched for articles in PubMed and Google Scholar databases till 02 April 2020, with the following keywords: "SARS-CoV-2", "COVID-19", "infection", "pathogenesis", "incubation period", "transmission", "clinical features", "diagnosis", "treatment", "diabetes", with interposition of the Boolean operator "AND". RESULTS: The clinical spectrum of COVID-19 is heterogeneous, ranging from mild flu-like symptoms to acute respiratory distress syndrome, multiple organ failure and death. Older age, diabetes and other comorbidities are reported as significant predictors of morbidity and mortality. Chronic inflammation, increased coagulation activity, immune response impairment, and potential direct pancreatic damage by SARS-CoV-2 might be among the underlying mechanisms of the association between diabetes and COVID-19. No conclusive evidence exists to support the discontinuation of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers or thiazolidinediones because of COVID-19 in people with diabetes. Caution should be taken to potential hypoglycemic events with the use of chloroquine in these subjects. Patient tailored therapeutic strategies, rigorous glucose monitoring and careful consideration of drug interactions might reduce adverse outcomes. CONCLUSIONS: Suggestions are made on the possible pathophysiological mechanisms of the relationship between diabetes and COVID-19, and its management. No definite conclusions can be made based on current limited evidence. Further research regarding this relationship and its clinical management is warranted.

covid-19;clinical management;diabetes;pathogenesis;sars-cov-2

Journal Article;Review

Hussain, Akhtar;Bhowmik, Bishwajit;do Vale Moreira, Nayla Cristina

10.1016/j.diabres.2020.108142

[Title]: COVID-19 and diabetes: Knowledge in progress. [Abstract]: AIMS: We aimed to briefly review the general characteristics of the novel coronavirus (SARS-CoV-2) and provide a better understanding of the coronavirus disease (COVID-19) in people with diabetes, and its management. METHODS: We searched for articles in PubMed and Google Scholar databases till 02 April 2020, with the following keywords: "SARS-CoV-2", "COVID-19", "infection", "pathogenesis", "incubation period", "transmission", "clinical features", "diagnosis", "treatment", "diabetes", with interposition of the Boolean operator "AND". RESULTS: The clinical spectrum of COVID-19 is heterogeneous, ranging from mild flu-like symptoms to acute respiratory distress syndrome, multiple organ failure and death. Older age, diabetes and other comorbidities are reported as significant predictors of morbidity and mortality. Chronic inflammation, increased coagulation activity, immune response impairment, and potential direct pancreatic damage by SARS-CoV-2 might be among the underlying mechanisms of the association between diabetes and COVID-19. No conclusive evidence exists to support the discontinuation of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers or thiazolidinediones because of COVID-19 in people with diabetes. Caution should be taken to potential hypoglycemic events with the use of chloroquine in these subjects. Patient tailored therapeutic strategies, rigorous glucose monitoring and careful consideration of drug interactions might reduce adverse outcomes. CONCLUSIONS: Suggestions are made on the possible pathophysiological mechanisms of the relationship between diabetes and COVID-19, and its management. No definite conclusions can be made based on current limited evidence. Further research regarding this relationship and its clinical management is warranted. [Keywords]: covid-19;clinical management;diabetes;pathogenesis;sars-cov-2

Int J Antimicrob Agents

In silico study of azithromycin, chloroquine and hydroxychloroquine and their potential mechanisms of action against SARS-CoV-2 infection.

Coronavirus disease 2019 (COVID-19) is a highly transmissible viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical trials have reported improved outcomes resulting from an effective reduction or absence of viral load when patients were treated with chloroquine (CQ) or hydroxychloroquine (HCQ). In addition, the effects of these drugs were improved by simultaneous administration of azithromycin (AZM). The receptor-binding domain (RBD) of the SARS-CoV-2 spike (S) protein binds to the cell surface angiotensin-converting enzyme 2 (ACE2) receptor, allowing virus entry and replication in host cells. The viral main protease (M(pro)) and host cathepsin L (CTSL) are among the proteolytic systems involved in SARS-CoV-2 S protein activation. Hence, molecular docking studies were performed to test the binding performance of these three drugs against four targets. The findings showed AZM affinity scores (DeltaG) with strong interactions with ACE2, CTSL, M(pro) and RBD. CQ affinity scores showed three low-energy results (less negative) with ACE2, CTSL and RBD, and a firm bond score with M(pro). For HCQ, two results (ACE2 and M(pro)) were firmly bound to the receptors, however CTSL and RBD showed low interaction energies. The differences in better interactions and affinity between HCQ and CQ with ACE2 and M(pro) were probably due to structural differences between the drugs. On other hand, AZM not only showed more negative (better) values in affinity, but also in the number of interactions in all targets. Nevertheless, further studies are needed to investigate the antiviral properties of these drugs against SARS-CoV-2.

azithromycin;covid-19;chloroquine;coronavirus;hydroxychloroquine;molecular docking

Journal Article

Braz, Helyson Lucas Bezerra;Silveira, Joao Alison de Moraes;Marinho, Aline Diogo;de Moraes, Maria Elisabete Amaral;Moraes Filho, Manoel Odorico de;Monteiro, Helena Serra Azul;Jorge, Roberta Jeane Bezerra

10.1016/j.ijantimicag.2020.106119

[Title]: In silico study of azithromycin, chloroquine and hydroxychloroquine and their potential mechanisms of action against SARS-CoV-2 infection. [Abstract]: Coronavirus disease 2019 (COVID-19) is a highly transmissible viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical trials have reported improved outcomes resulting from an effective reduction or absence of viral load when patients were treated with chloroquine (CQ) or hydroxychloroquine (HCQ). In addition, the effects of these drugs were improved by simultaneous administration of azithromycin (AZM). The receptor-binding domain (RBD) of the SARS-CoV-2 spike (S) protein binds to the cell surface angiotensin-converting enzyme 2 (ACE2) receptor, allowing virus entry and replication in host cells. The viral main protease (M(pro)) and host cathepsin L (CTSL) are among the proteolytic systems involved in SARS-CoV-2 S protein activation. Hence, molecular docking studies were performed to test the binding performance of these three drugs against four targets. The findings showed AZM affinity scores (DeltaG) with strong interactions with ACE2, CTSL, M(pro) and RBD. CQ affinity scores showed three low-energy results (less negative) with ACE2, CTSL and RBD, and a firm bond score with M(pro). For HCQ, two results (ACE2 and M(pro)) were firmly bound to the receptors, however CTSL and RBD showed low interaction energies. The differences in better interactions and affinity between HCQ and CQ with ACE2 and M(pro) were probably due to structural differences between the drugs. On other hand, AZM not only showed more negative (better) values in affinity, but also in the number of interactions in all targets. Nevertheless, further studies are needed to investigate the antiviral properties of these drugs against SARS-CoV-2. [Keywords]: azithromycin;covid-19;chloroquine;coronavirus;hydroxychloroquine;molecular docking

J Am Coll Nutr

COVID-19 Infection Pandemic: From the Frontline in Italy.

The infection caused by COVID-19 (i.e. corona virus disease 2019) has caused more than 5.2 million cases and more than 337,000 deaths worldwide. Italy was the European epicenter for virus spread and one with most cases and deaths. The first Italian patient was diagnosed on February 18(th), a young man hospitalized in Lombardy (Northern Italy). The Italian government not only isolated the village where he lived, but a few days later put the entire country in lockdown. We have here analyzed the COVID-19 Italian data during the first three months after the outbreak and the effect of lockdown. COVID-19 virus has a high transmission rate and is associated with high fatality rate especially in the older population. The initial reproduction rate of the virus (R0) in Italy was between 2.1 and 3.3 in different Italian regions, with a doubling time between 2.7 and 3.2 days. The number of confirmed cases has now reached 229,000 but after the lockdown R0 is finally below 1. Despite the lockdown, the number of infected and deceased patients in Italy was very high, with a lethality rate higher than in other countries. It is likely that number of cases is underestimating the real since the number of asymptomatic and paucisymptomatic is relatively high. It is important to investigate which patients are more vulnerable and also if other co-factors can account for this high fatality rate, since this pandemia is far from being resolved.

covid-19;italy;comorbidities;diet;symptoms

Journal Article

Gastaldelli, Amalia;Gastaldelli, Mirco;Bastianoni, Simone

10.1080/07315724.2020.1779147

[Title]: COVID-19 Infection Pandemic: From the Frontline in Italy. [Abstract]: The infection caused by COVID-19 (i.e. corona virus disease 2019) has caused more than 5.2 million cases and more than 337,000 deaths worldwide. Italy was the European epicenter for virus spread and one with most cases and deaths. The first Italian patient was diagnosed on February 18(th), a young man hospitalized in Lombardy (Northern Italy). The Italian government not only isolated the village where he lived, but a few days later put the entire country in lockdown. We have here analyzed the COVID-19 Italian data during the first three months after the outbreak and the effect of lockdown. COVID-19 virus has a high transmission rate and is associated with high fatality rate especially in the older population. The initial reproduction rate of the virus (R0) in Italy was between 2.1 and 3.3 in different Italian regions, with a doubling time between 2.7 and 3.2 days. The number of confirmed cases has now reached 229,000 but after the lockdown R0 is finally below 1. Despite the lockdown, the number of infected and deceased patients in Italy was very high, with a lethality rate higher than in other countries. It is likely that number of cases is underestimating the real since the number of asymptomatic and paucisymptomatic is relatively high. It is important to investigate which patients are more vulnerable and also if other co-factors can account for this high fatality rate, since this pandemia is far from being resolved. [Keywords]: covid-19;italy;comorbidities;diet;symptoms

Front Med (Lausanne)

Spread and Impact of COVID-19 in China: A Systematic Review and Synthesis of Predictions From Transmission-Dynamic Models.

Background: Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, in December 2019 and quickly spread throughout China and the rest of the world. Many mathematical models have been developed to understand and predict the infectiousness of COVID-19. We aim to summarize these models to inform efforts to manage the current outbreak. Methods: We searched PubMed, Web of science, EMBASE, bioRxiv, medRxiv, arXiv, Preprints, and National Knowledge Infrastructure (Chinese database) for relevant studies published between 1 December 2019 and 21 February 2020. References were screened for additional publications. Crucial indicators were extracted and analysed. We also built a mathematical model for the evolution of the epidemic in Wuhan that synthesised extracted indicators. Results: Fifty-two articles involving 75 mathematical or statistical models were included in our systematic review. The overall median basic reproduction number (R0) was 3.77 [interquartile range (IQR) 2.78-5.13], which dropped to a controlled reproduction number (Rc) of 1.88 (IQR 1.41-2.24) after city lockdown. The median incubation and infectious periods were 5.90 (IQR 4.78-6.25) and 9.94 (IQR 3.93-13.50) days, respectively. The median case-fatality rate (CFR) was 2.9% (IQR 2.3-5.4%). Our mathematical model showed that, in Wuhan, the peak time of infection is likely to be March 2020 with a median size of 98,333 infected cases (range 55,225-188,284). The earliest elimination of ongoing transmission is likely to be achieved around 7 May 2020. Conclusions: Our analysis found a sustained Rc and prolonged incubation/ infectious periods, suggesting COVID-19 is highly infectious. Although interventions in China have been effective in controlling secondary transmission, sustained global efforts are needed to contain an emerging pandemic. Alternative interventions can be explored using modelling studies to better inform policymaking as the outbreak continues.

fatality;incubation;infectious period;mathematical model;the reproduction number

Systematic Review

Lin, Yi-Fan;Duan, Qibin;Zhou, Yiguo;Yuan, Tanwei;Li, Peiyang;Fitzpatrick, Thomas;Fu, Leiwen;Feng, Anping;Luo, Ganfeng;Zhan, Yuewei;Liang, Bowen;Fan, Song;Lu, Yong;Wang, Bingyi;Wang, Zhenyu;Zhao, Heping;Gao, Yanxiao;Li, Meijuan;Chen, Dahui;Chen, Xiaoting;Ao, Yunlong;Li, Linghua;Cai, Weiping;Du, Xiangjun;Shu, Yuelong;Zou, Huachun

10.3389/fmed.2020.00321

[Title]: Spread and Impact of COVID-19 in China: A Systematic Review and Synthesis of Predictions From Transmission-Dynamic Models. [Abstract]: Background: Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, in December 2019 and quickly spread throughout China and the rest of the world. Many mathematical models have been developed to understand and predict the infectiousness of COVID-19. We aim to summarize these models to inform efforts to manage the current outbreak. Methods: We searched PubMed, Web of science, EMBASE, bioRxiv, medRxiv, arXiv, Preprints, and National Knowledge Infrastructure (Chinese database) for relevant studies published between 1 December 2019 and 21 February 2020. References were screened for additional publications. Crucial indicators were extracted and analysed. We also built a mathematical model for the evolution of the epidemic in Wuhan that synthesised extracted indicators. Results: Fifty-two articles involving 75 mathematical or statistical models were included in our systematic review. The overall median basic reproduction number (R0) was 3.77 [interquartile range (IQR) 2.78-5.13], which dropped to a controlled reproduction number (Rc) of 1.88 (IQR 1.41-2.24) after city lockdown. The median incubation and infectious periods were 5.90 (IQR 4.78-6.25) and 9.94 (IQR 3.93-13.50) days, respectively. The median case-fatality rate (CFR) was 2.9% (IQR 2.3-5.4%). Our mathematical model showed that, in Wuhan, the peak time of infection is likely to be March 2020 with a median size of 98,333 infected cases (range 55,225-188,284). The earliest elimination of ongoing transmission is likely to be achieved around 7 May 2020. Conclusions: Our analysis found a sustained Rc and prolonged incubation/ infectious periods, suggesting COVID-19 is highly infectious. Although interventions in China have been effective in controlling secondary transmission, sustained global efforts are needed to contain an emerging pandemic. Alternative interventions can be explored using modelling studies to better inform policymaking as the outbreak continues. [Keywords]: fatality;incubation;infectious period;mathematical model;the reproduction number

Cell Signal

Janus sword actions of chloroquine and hydroxychloroquine against COVID-19.

Chloroquine (CQ) and its analogue hydroxychloroquine (HCQ) have been thrust into our everyday vernacular because some believe, based on very limited basic and clinical data, that they might be helpful in preventing and/or lessening the severity of the pandemic coronavirus disease 2019 (COVID-19). However, lacking is a temperance in enthusiasm for their possible use as well as sufficient perspective on their effects and side-effects. CQ and HCQ have well-known properties of being diprotic weak bases that preferentially accumulate in acidic organelles (endolysosomes and Golgi apparatus) and neutralize luminal pH of acidic organelles. These primary actions of CQ and HCQ are responsible for their anti-malarial effects; malaria parasites rely on acidic digestive vacuoles for survival. Similarly, de-acidification of endolysosomes and Golgi by CQ and HCQ may block severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) integration into host cells because SARS-CoV-2 may require an acidic environment for its entry and for its ability to bud and infect bystander cells. Further, de-acidification of endolysosomes and Golgi may underly the immunosuppressive effects of these two drugs. However, modern cell biology studies have shown clearly that de-acidification results in profound changes in the structure, function and cellular positioning of endolysosomes and Golgi, in signaling between these organelles and other subcellular organelles, and in fundamental cellular functions. Thus, studying the possible therapeutic effects of CQ and HCQ against COVID-19 must occur concurrent with studies of the extent to which these drugs affect organellar and cell biology. When comprehensively examined, a better understanding of the Janus sword actions of these and other drugs might yield better decisions and better outcomes.

covid-19;chloroquine;endolysosome;golgi;hydroxychloroquine;de-acidification

Journal Article;Research Support, N.I.H., Extramural

Chen, Xuesong;Geiger, Jonathan D

10.1016/j.cellsig.2020.109706

[Title]: Janus sword actions of chloroquine and hydroxychloroquine against COVID-19. [Abstract]: Chloroquine (CQ) and its analogue hydroxychloroquine (HCQ) have been thrust into our everyday vernacular because some believe, based on very limited basic and clinical data, that they might be helpful in preventing and/or lessening the severity of the pandemic coronavirus disease 2019 (COVID-19). However, lacking is a temperance in enthusiasm for their possible use as well as sufficient perspective on their effects and side-effects. CQ and HCQ have well-known properties of being diprotic weak bases that preferentially accumulate in acidic organelles (endolysosomes and Golgi apparatus) and neutralize luminal pH of acidic organelles. These primary actions of CQ and HCQ are responsible for their anti-malarial effects; malaria parasites rely on acidic digestive vacuoles for survival. Similarly, de-acidification of endolysosomes and Golgi by CQ and HCQ may block severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) integration into host cells because SARS-CoV-2 may require an acidic environment for its entry and for its ability to bud and infect bystander cells. Further, de-acidification of endolysosomes and Golgi may underly the immunosuppressive effects of these two drugs. However, modern cell biology studies have shown clearly that de-acidification results in profound changes in the structure, function and cellular positioning of endolysosomes and Golgi, in signaling between these organelles and other subcellular organelles, and in fundamental cellular functions. Thus, studying the possible therapeutic effects of CQ and HCQ against COVID-19 must occur concurrent with studies of the extent to which these drugs affect organellar and cell biology. When comprehensively examined, a better understanding of the Janus sword actions of these and other drugs might yield better decisions and better outcomes. [Keywords]: covid-19;chloroquine;endolysosome;golgi;hydroxychloroquine;de-acidification

Rev Bras Enferm

Hand hygiene in high-complexity sectors as an integrating element in the combat of Sars-CoV-2.

OBJECTIVE: to perform a situational diagnosis of the behavior of health professionals concerning hand hygiene practices in highly-complex sectors. METHODS: this quantitative and retrospective study was based on reports (2016 and 2017) of Adult and Pediatric ICUs of a Federal hospital in Rio de Janeiro. RESULTS: one thousand two hundred fifty-eight opportunities for hand hygiene were analysed. The chance of professionals sanitizing hands in Pediatric ICUs is 41.61% higher than in Adult ICUs. Concerning proper hand hygiene, the medical team had a 39.44% lower chance than the nursing team. Others had a 30.62% lower chance when compared to the nursing team. The moment "after contact with the patient" presented 4.5275 times the chance in relation "before contact with the patient". CONCLUSION: in front of hand hygiene recommendations to control COVID-19, diagnostic assessment and previous analysis of the behavior of professionals proved to be positive.

Journal Article

Paula, Danielle Galdino de;Francisco, Marianna Ramos;Freitas, Juliana Dias;Levachof, Renata Christine Quintella;Fonseca, Bianca de Oliveira;Simoes, Bruno Francisco Teixeira;Bilio, Rafael de Lima

10.1590/0034-7167-2020-0316

[Title]: Hand hygiene in high-complexity sectors as an integrating element in the combat of Sars-CoV-2. [Abstract]: OBJECTIVE: to perform a situational diagnosis of the behavior of health professionals concerning hand hygiene practices in highly-complex sectors. METHODS: this quantitative and retrospective study was based on reports (2016 and 2017) of Adult and Pediatric ICUs of a Federal hospital in Rio de Janeiro. RESULTS: one thousand two hundred fifty-eight opportunities for hand hygiene were analysed. The chance of professionals sanitizing hands in Pediatric ICUs is 41.61% higher than in Adult ICUs. Concerning proper hand hygiene, the medical team had a 39.44% lower chance than the nursing team. Others had a 30.62% lower chance when compared to the nursing team. The moment "after contact with the patient" presented 4.5275 times the chance in relation "before contact with the patient". CONCLUSION: in front of hand hygiene recommendations to control COVID-19, diagnostic assessment and previous analysis of the behavior of professionals proved to be positive. [Keywords]:

Wellcome Open Res

Adoption and impact of non-pharmaceutical interventions for COVID-19.

Background: Several non-pharmaceutical interventions (NPIs) have been implemented across the world to control the coronavirus disease (COVID-19) pandemic. Social distancing (SD) interventions applied so far have included school closures, remote working and quarantine. These measures have been shown to have large impacts on pandemic influenza transmission. However, there has been comparatively little examination of such measures for COVID-19. Methods: We examined the existing literature, and collated data, on implementation of NPIs to examine their effects on the COVID-19 pandemic so far. Data on NPIs were collected from official government websites as well as from media sources. Results: Measures such as travel restrictions have been implemented in multiple countries and appears to have slowed the geographic spread of COVID-19 and reduced initial case numbers. We find that, due to the relatively sparse information on the differences with and without interventions, it is difficult to quantitatively assess the efficacy of many interventions. Similarly, whilst the comparison to other pandemic diseases such as influenza can be helpful, there are key differences that could affect the efficacy of similar NPIs. Conclusions: The timely implementation of control measures is key to their success and must strike a balance between early enough application to reduce the peak of the epidemic and ensuring that they can be feasibly maintained for an appropriate duration. Such measures can have large societal impacts and they need to be appropriately justified to the population. As the pandemic of COVID-19 progresses, quantifying the impact of interventions will be a vital consideration for the appropriate use of mitigation strategies.

covid-19;non-pharmaceutical interventions

Journal Article

Imai, Natsuko;Gaythorpe, Katy A M;Abbott, Sam;Bhatia, Sangeeta;van Elsland, Sabine;Prem, Kiesha;Liu, Yang;Ferguson, Neil M

10.12688/wellcomeopenres.15808.1

[Title]: Adoption and impact of non-pharmaceutical interventions for COVID-19. [Abstract]: Background: Several non-pharmaceutical interventions (NPIs) have been implemented across the world to control the coronavirus disease (COVID-19) pandemic. Social distancing (SD) interventions applied so far have included school closures, remote working and quarantine. These measures have been shown to have large impacts on pandemic influenza transmission. However, there has been comparatively little examination of such measures for COVID-19. Methods: We examined the existing literature, and collated data, on implementation of NPIs to examine their effects on the COVID-19 pandemic so far. Data on NPIs were collected from official government websites as well as from media sources. Results: Measures such as travel restrictions have been implemented in multiple countries and appears to have slowed the geographic spread of COVID-19 and reduced initial case numbers. We find that, due to the relatively sparse information on the differences with and without interventions, it is difficult to quantitatively assess the efficacy of many interventions. Similarly, whilst the comparison to other pandemic diseases such as influenza can be helpful, there are key differences that could affect the efficacy of similar NPIs. Conclusions: The timely implementation of control measures is key to their success and must strike a balance between early enough application to reduce the peak of the epidemic and ensuring that they can be feasibly maintained for an appropriate duration. Such measures can have large societal impacts and they need to be appropriately justified to the population. As the pandemic of COVID-19 progresses, quantifying the impact of interventions will be a vital consideration for the appropriate use of mitigation strategies. [Keywords]: covid-19;non-pharmaceutical interventions

Comput Methods Programs Biomed

Machine learning-based mortality rate prediction using optimized hyper-parameter.

OBJECTIVE AND BACKGROUND: The current scenario of the Pandemic of COVID-19 demands multi-channel investigations and predictions. A variety of prediction models are available in the literature. The majority of these models are based on extrapolating by the parameters related to the diseases, which are history-oriented. Instead, the current research is designed to predict the mortality rate of COVID-19 by Regression techniques in comparison to the models followed by five countries. METHODS: The Regression method with an optimized hyper-parameter is used to develop these models under training data by Machine Learning Technique. RESULTS: The validity of the proposed model is endorsed by considering the case study on the data for Pakistan. Five distinct models for mortality rate prediction are built using Confirmed cases data as a predictor variable for France, Spain, Turkey, Sweden, and Pakistan, respectively. The results evidenced that Sweden has a fewer death case over 20,000 confirmed cases without observing lockdown. Hence, by following the strategy adopted by Sweden, the chosen entity will control the death rate despite the increase of the confirmed cases. CONCLUSION: The evaluated results notice the high mortality rate and low RMSE for Pakistan by the GPR method based Mortality model. Therefore, the morality rate based MRP model is selected for the COVID-19 death rate in Pakistan. Hence, the best-fit is the Sweden model to control the mortality rate.

covid-19 deaths rate;hyper-parameter;mortality rate;optimization;prediction

Journal Article

Khan, Y A;Abbas, S Z;Truong, Buu-Chau

10.1016/j.cmpb.2020.105704

[Title]: Machine learning-based mortality rate prediction using optimized hyper-parameter. [Abstract]: OBJECTIVE AND BACKGROUND: The current scenario of the Pandemic of COVID-19 demands multi-channel investigations and predictions. A variety of prediction models are available in the literature. The majority of these models are based on extrapolating by the parameters related to the diseases, which are history-oriented. Instead, the current research is designed to predict the mortality rate of COVID-19 by Regression techniques in comparison to the models followed by five countries. METHODS: The Regression method with an optimized hyper-parameter is used to develop these models under training data by Machine Learning Technique. RESULTS: The validity of the proposed model is endorsed by considering the case study on the data for Pakistan. Five distinct models for mortality rate prediction are built using Confirmed cases data as a predictor variable for France, Spain, Turkey, Sweden, and Pakistan, respectively. The results evidenced that Sweden has a fewer death case over 20,000 confirmed cases without observing lockdown. Hence, by following the strategy adopted by Sweden, the chosen entity will control the death rate despite the increase of the confirmed cases. CONCLUSION: The evaluated results notice the high mortality rate and low RMSE for Pakistan by the GPR method based Mortality model. Therefore, the morality rate based MRP model is selected for the COVID-19 death rate in Pakistan. Hence, the best-fit is the Sweden model to control the mortality rate. [Keywords]: covid-19 deaths rate;hyper-parameter;mortality rate;optimization;prediction

Virusdisease

Decoding the global outbreak of COVID-19: the nature is behind the scene.

The sudden emergence of SARS-CoV-2 causing the global pandemic is a major public health concern. Though the virus is considered as a novel entity, it is not a completely new member. It is just a new version of previously emerged human SARS corona virus. The rapid evolving nature by changing host body environment and extreme environmental stability, collectively makes SARS-CoV-2 into an extremely virulent genetic variant. The evolution of the virus has been occurred by the continuous process of molecular genetic manipulation, through mutation, deletion and genetic recombinationevents. Different host body environment acts as the supportive system for the pathogen which creates extreme selective pressure. By the process of genetic evolution the pathogen developes new characters. Then the new version of the virus has been naturally selected by susceptible human host and adapt itself inside the host body causing deadly effect. Moreover, extreme environmental stability helps in the process of viral survival outside the host and its transmission. Thus both the host body or internal environment and the external environment performs equally as a source, responsible for shaping the genetic evolution of the SARS-CoV-2 towards theCOVID-19 disease fitness in nature in a pandemic form.

covid-19 pandemic;environment stability;external environment;host body environment;molecular genetic evolution;sars-cov-2

Journal Article;Review

Das, Piyanki;Choudhuri, Tathagata

10.1007/s13337-020-00605-y

[Title]: Decoding the global outbreak of COVID-19: the nature is behind the scene. [Abstract]: The sudden emergence of SARS-CoV-2 causing the global pandemic is a major public health concern. Though the virus is considered as a novel entity, it is not a completely new member. It is just a new version of previously emerged human SARS corona virus. The rapid evolving nature by changing host body environment and extreme environmental stability, collectively makes SARS-CoV-2 into an extremely virulent genetic variant. The evolution of the virus has been occurred by the continuous process of molecular genetic manipulation, through mutation, deletion and genetic recombinationevents. Different host body environment acts as the supportive system for the pathogen which creates extreme selective pressure. By the process of genetic evolution the pathogen developes new characters. Then the new version of the virus has been naturally selected by susceptible human host and adapt itself inside the host body causing deadly effect. Moreover, extreme environmental stability helps in the process of viral survival outside the host and its transmission. Thus both the host body or internal environment and the external environment performs equally as a source, responsible for shaping the genetic evolution of the SARS-CoV-2 towards theCOVID-19 disease fitness in nature in a pandemic form. [Keywords]: covid-19 pandemic;environment stability;external environment;host body environment;molecular genetic evolution;sars-cov-2

Mult Scler Relat Disord

Neuromyelitis optica spectrum disorder after presumed coronavirus (COVID-19) infection: A case report.

Neuromyelitis optica spectrum disorder is an inflammatory autoimmune condition, predominantly affecting the optic nerves and spinal cord. It has been stated that viral infections play a role in the development of neuromyelitis optica. Several murine coronaviruses can cause inflammatory demyelinating diseases, including optic neuritis. Here we report, to the best of our knowledge, the first human case linking a presumed SARS-CoV-2 infection to the development of NMOSD.

coronavirus;nmosd;optic neuritis;sars-cov-2

Case Reports;Journal Article

de Ruijter, Naomi S;Kramer, Gerrit;Gons, Rob A R;Hengstman, Gerald J D

10.1016/j.msard.2020.102474

[Title]: Neuromyelitis optica spectrum disorder after presumed coronavirus (COVID-19) infection: A case report. [Abstract]: Neuromyelitis optica spectrum disorder is an inflammatory autoimmune condition, predominantly affecting the optic nerves and spinal cord. It has been stated that viral infections play a role in the development of neuromyelitis optica. Several murine coronaviruses can cause inflammatory demyelinating diseases, including optic neuritis. Here we report, to the best of our knowledge, the first human case linking a presumed SARS-CoV-2 infection to the development of NMOSD. [Keywords]: coronavirus;nmosd;optic neuritis;sars-cov-2

West J Emerg Med

Point-of-Care Ultrasound for Intubation Confirmation of COVID-19 Patients.

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients.

Journal Article

Gottlieb, Michael;Alerhand, Stephen;Long, Brit

10.5811/westjem.2020.7.48657

[Title]: Point-of-Care Ultrasound for Intubation Confirmation of COVID-19 Patients. [Abstract]: The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients. [Keywords]:

J Antimicrob Chemother

Sofosbuvir and daclatasvir compared with standard of care in the treatment of patients admitted to hospital with moderate or severe coronavirus infection (COVID-19): a randomized controlled trial.

BACKGROUND: Currently no effective antiviral therapy has been found to treat COVID-19. The aim of this trial was to assess if the addition of sofosbuvir and daclatasvir improved clinical outcomes in patients with moderate or severe COVID-19. METHODS: This was an open-label, multicentre, randomized controlled clinical trial in adults with moderate or severe COVID-19 admitted to four university hospitals in Iran. Patients were randomized into a treatment arm receiving sofosbuvir and daclatasvir plus standard care, or a control arm receiving standard care alone. The primary endpoint was clinical recovery within 14 days of treatment. The study is registered with IRCT.ir under registration number IRCT20200128046294N2. RESULTS: Between 26 March and 26 April 2020, 66 patients were recruited and allocated to either the treatment arm (n = 33) or the control arm (n = 33). Clinical recovery within 14 days was achieved by 29/33 (88%) in the treatment arm and 22/33 (67%) in the control arm (P = 0.076). The treatment arm had a significantly shorter median duration of hospitalization [6 days (IQR 4-8)] than the control group [8 days (IQR 5-13)]; P = 0.029. Cumulative incidence of hospital discharge was significantly higher in the treatment arm versus the control (Gray's P = 0.041). Three patients died in the treatment arm and five in the control arm. No serious adverse events were reported. CONCLUSIONS: The addition of sofosbuvir and daclatasvir to standard care significantly reduced the duration of hospital stay compared with standard care alone. Although fewer deaths were observed in the treatment arm, this was not statistically significant. Conducting larger scale trials seems prudent.

Clinical Trial, Phase III;Comparative Study;Journal Article;Multicenter Study;Randomized Controlled Trial;Research Support, Non-U.S. Gov't

Sadeghi, Anahita;Ali Asgari, Ali;Norouzi, Alireza;Kheiri, Zahedin;Anushirvani, Amir;Montazeri, Mahnaz;Hosamirudsai, Hadiseh;Afhami, Shirin;Akbarpour, Elham;Aliannejad, Rasoul;Radmard, Amir Reza;Davarpanah, Amir H;Levi, Jacob;Wentzel, Hannah;Qavi, Ambar;Garratt, Anna;Simmons, Bryony;Hill, Andrew;Merat, Shahin

10.1093/jac/dkaa334

[Title]: Sofosbuvir and daclatasvir compared with standard of care in the treatment of patients admitted to hospital with moderate or severe coronavirus infection (COVID-19): a randomized controlled trial. [Abstract]: BACKGROUND: Currently no effective antiviral therapy has been found to treat COVID-19. The aim of this trial was to assess if the addition of sofosbuvir and daclatasvir improved clinical outcomes in patients with moderate or severe COVID-19. METHODS: This was an open-label, multicentre, randomized controlled clinical trial in adults with moderate or severe COVID-19 admitted to four university hospitals in Iran. Patients were randomized into a treatment arm receiving sofosbuvir and daclatasvir plus standard care, or a control arm receiving standard care alone. The primary endpoint was clinical recovery within 14 days of treatment. The study is registered with IRCT.ir under registration number IRCT20200128046294N2. RESULTS: Between 26 March and 26 April 2020, 66 patients were recruited and allocated to either the treatment arm (n = 33) or the control arm (n = 33). Clinical recovery within 14 days was achieved by 29/33 (88%) in the treatment arm and 22/33 (67%) in the control arm (P = 0.076). The treatment arm had a significantly shorter median duration of hospitalization [6 days (IQR 4-8)] than the control group [8 days (IQR 5-13)]; P = 0.029. Cumulative incidence of hospital discharge was significantly higher in the treatment arm versus the control (Gray's P = 0.041). Three patients died in the treatment arm and five in the control arm. No serious adverse events were reported. CONCLUSIONS: The addition of sofosbuvir and daclatasvir to standard care significantly reduced the duration of hospital stay compared with standard care alone. Although fewer deaths were observed in the treatment arm, this was not statistically significant. Conducting larger scale trials seems prudent. [Keywords]:

Eur J Ophthalmol

Ophthalmology and SARS-CoV-2: Blind toward those who fight blindness?

SARS-CoV-2 infection recently reached pandemic proportions, with high risk of death for the worldwide population. In this dramatic scenario, all the resources are addressed to the intensive care units for the assessment of the emergency. However, more attention should be paid with respect to the risk of viral diffusion among asymptomatic people. Italy is the second most involved country in the world, and we needed to gain a lot of experience in a very limited time. At least 1 m of distance among people is recommended; however, some clinical practices cannot allow this distance. In this context, we believe that the careful safety assessment of clinical settings, like ophthalmologic ones, may have a remarkable impact on the fight against SARS-CoV-2 spread.

covid-19;cornea/external disease;eyelid disease: infections/inflammations;immunology;infectious diseases affecting lid/conjunctiva;preventive medicine/screening

Journal Article;Review

Arrigo, Alessandro;Aragona, Emanuela;Parodi, Maurizio Battaglia;Loperfido, Francesco;Bandello, Francesco

10.1177/1120672120929961

[Title]: Ophthalmology and SARS-CoV-2: Blind toward those who fight blindness? [Abstract]: SARS-CoV-2 infection recently reached pandemic proportions, with high risk of death for the worldwide population. In this dramatic scenario, all the resources are addressed to the intensive care units for the assessment of the emergency. However, more attention should be paid with respect to the risk of viral diffusion among asymptomatic people. Italy is the second most involved country in the world, and we needed to gain a lot of experience in a very limited time. At least 1 m of distance among people is recommended; however, some clinical practices cannot allow this distance. In this context, we believe that the careful safety assessment of clinical settings, like ophthalmologic ones, may have a remarkable impact on the fight against SARS-CoV-2 spread. [Keywords]: covid-19;cornea/external disease;eyelid disease: infections/inflammations;immunology;infectious diseases affecting lid/conjunctiva;preventive medicine/screening

Can J Cardiol

Guidance on Minimizing Risk of Drug-Induced Ventricular Arrhythmia During Treatment of COVID-19: A Statement from the Canadian Heart Rhythm Society.

The COVID-19 pandemic has led to efforts at rapid investigation and application of drugs which may improve prognosis but for which safety and efficacy are not yet established. This document attempts to provide reasonable guidance for the use of antimicrobials which have uncertain benefit but may increase risk of QT interval prolongation and ventricular proarrhythmia, notably, chloroquine, hydroxychloroquine, azithromycin, and lopinavir/ritonavir. During the pandemic, efforts to reduce spread and minimize effects on health care resources mandate minimization of unnecessary medical procedures and testing. We recommend that the risk of drug proarrhythmia be minimized by 1) discontinuing unnecessary medications that may also increase the QT interval, 2) identifying outpatients who are likely to be at low risk and do not need further testing (no history of prolonged QT interval, unexplained syncope, or family history of premature sudden cardiac death, no medications that may prolong the QT interval, and/or a previous known normal corrected QT interval [QTc]), and 3) performing baseline testing in hospitalized patients or those who may be at higher risk. If baseline electrocardiographic testing reveals a moderately prolonged QTc, optimization of medications and electrolytes may permit therapy. If the QTc is markedly prolonged, drugs that further prolong it should be avoided, or expert consultation may permit administration with mitigating precautions. These recommendations are made while there are no known effective treatments for COVID-19 and should be revisited when further data on efficacy and safety become available.

Journal Article;Practice Guideline

Sapp, John L;Alqarawi, Wael;MacIntyre, Ciorsti J;Tadros, Rafik;Steinberg, Christian;Roberts, Jason D;Laksman, Zachary;Healey, Jeff S;Krahn, Andrew D

10.1016/j.cjca.2020.04.003

[Title]: Guidance on Minimizing Risk of Drug-Induced Ventricular Arrhythmia During Treatment of COVID-19: A Statement from the Canadian Heart Rhythm Society. [Abstract]: The COVID-19 pandemic has led to efforts at rapid investigation and application of drugs which may improve prognosis but for which safety and efficacy are not yet established. This document attempts to provide reasonable guidance for the use of antimicrobials which have uncertain benefit but may increase risk of QT interval prolongation and ventricular proarrhythmia, notably, chloroquine, hydroxychloroquine, azithromycin, and lopinavir/ritonavir. During the pandemic, efforts to reduce spread and minimize effects on health care resources mandate minimization of unnecessary medical procedures and testing. We recommend that the risk of drug proarrhythmia be minimized by 1) discontinuing unnecessary medications that may also increase the QT interval, 2) identifying outpatients who are likely to be at low risk and do not need further testing (no history of prolonged QT interval, unexplained syncope, or family history of premature sudden cardiac death, no medications that may prolong the QT interval, and/or a previous known normal corrected QT interval [QTc]), and 3) performing baseline testing in hospitalized patients or those who may be at higher risk. If baseline electrocardiographic testing reveals a moderately prolonged QTc, optimization of medications and electrolytes may permit therapy. If the QTc is markedly prolonged, drugs that further prolong it should be avoided, or expert consultation may permit administration with mitigating precautions. These recommendations are made while there are no known effective treatments for COVID-19 and should be revisited when further data on efficacy and safety become available. [Keywords]:

EJHaem

Ibrutinib for chronic lymphocytic leukemia in the setting of respiratory failure from severe COVID-19 infection: Case report and literature review.

Ibrutinib, a known Burton's tyrosine kinase (BTK) and interleukin-2 inducible T-cell kinase (ITK) inhibitor, is used for the treatment of B-cell disorders (chronic lymphocytic leukemia [CLL] and various other lymphomas) and chronic graft versus host disease following allogeneic hematopoietic cell transplantation. Because it is considered an immunosuppressant, continuation of ibrutinib is often debated when patients have an active infection, and this becomes an especially difficult decision in the setting of coronavirus disease 2019 (COVID-19). Here, we describe a patient with CLL who was on ibrutinib then developed severe COVID-19 infection requiring mechanical ventilation. We elected to continue ibrutinib the same day he was intubated, reasoning that BTK inhibition in myeloid immune cells has been shown to reduce or even reverse influenza-mediated acute lung injury and that ITK inhibition in T cells has correlated with reduction in viral replication, and therefore may have an advantage in this setting. Ibrutinib also has been shown to block Src family kinases, which potentially could result in reduction of viral entry and the inflammatory cytokine response in the lungs. The patient was extubated after 9 days with a complex hospital course and eventually discharged on room air. The only way to rationally inform these decisions and explore similar potentially promising leads in this pandemic is to conduct carefully done clinical trials.

btk inhibitor;covid-19;ibrutinib;acute respiratory distress syndrome;chronic lymphocytic leukemia

Case Reports

Lin, Adam Yuh;Cuttica, Michael J;Ison, Michael G;Gordon, Leo I

10.1002/jha2.98

[Title]: Ibrutinib for chronic lymphocytic leukemia in the setting of respiratory failure from severe COVID-19 infection: Case report and literature review. [Abstract]: Ibrutinib, a known Burton's tyrosine kinase (BTK) and interleukin-2 inducible T-cell kinase (ITK) inhibitor, is used for the treatment of B-cell disorders (chronic lymphocytic leukemia [CLL] and various other lymphomas) and chronic graft versus host disease following allogeneic hematopoietic cell transplantation. Because it is considered an immunosuppressant, continuation of ibrutinib is often debated when patients have an active infection, and this becomes an especially difficult decision in the setting of coronavirus disease 2019 (COVID-19). Here, we describe a patient with CLL who was on ibrutinib then developed severe COVID-19 infection requiring mechanical ventilation. We elected to continue ibrutinib the same day he was intubated, reasoning that BTK inhibition in myeloid immune cells has been shown to reduce or even reverse influenza-mediated acute lung injury and that ITK inhibition in T cells has correlated with reduction in viral replication, and therefore may have an advantage in this setting. Ibrutinib also has been shown to block Src family kinases, which potentially could result in reduction of viral entry and the inflammatory cytokine response in the lungs. The patient was extubated after 9 days with a complex hospital course and eventually discharged on room air. The only way to rationally inform these decisions and explore similar potentially promising leads in this pandemic is to conduct carefully done clinical trials. [Keywords]: btk inhibitor;covid-19;ibrutinib;acute respiratory distress syndrome;chronic lymphocytic leukemia

Australas Psychiatry

To tele- or not to telehealth? Ongoing COVID-19 challenges for private psychiatry in Australia.

OBJECTIVES: Following a very rapid and significant uptake of metropolitan telepsychiatry in private practice in Australia during COVID-19, practical questions remain: How long should psychiatrists continue telepsychiatry? Are there benefits of continuing: reduced COVID-19 risks to patient and psychiatrist, and flexibility of appointments? Will the Medicare Benefits Schedule (MBS) telehealth items be retained? How does metropolitan telepsychiatry fit into the overall mix of public and private services? This is an important debate. CONCLUSIONS: Private psychiatrists may continue to offer the majority of care, where practical, via telepsychiatry to reduce COVID-19 exposure risks, as well as allow for the realities of practice management for pandemic public health measures. However, consideration has to be given to the potential drawbacks for patients with sight, hearing and illness-related disabilities or risks, when in-person consultation is required. There are also risks: some patients may not benefit from telepsychiatry due to the nature of their illness, and will patients feel rapport is lost? However, the retention of COVID-19 MBS telehealth items is needed for ongoing flexible and comprehensive private practice psychiatry.

covid-19;private practice;psychiatrist;telehealth;telepsychiatry

Journal Article

Looi, Jeffrey Cl;Pring, William

10.1177/1039856220950081

[Title]: To tele- or not to telehealth? Ongoing COVID-19 challenges for private psychiatry in Australia. [Abstract]: OBJECTIVES: Following a very rapid and significant uptake of metropolitan telepsychiatry in private practice in Australia during COVID-19, practical questions remain: How long should psychiatrists continue telepsychiatry? Are there benefits of continuing: reduced COVID-19 risks to patient and psychiatrist, and flexibility of appointments? Will the Medicare Benefits Schedule (MBS) telehealth items be retained? How does metropolitan telepsychiatry fit into the overall mix of public and private services? This is an important debate. CONCLUSIONS: Private psychiatrists may continue to offer the majority of care, where practical, via telepsychiatry to reduce COVID-19 exposure risks, as well as allow for the realities of practice management for pandemic public health measures. However, consideration has to be given to the potential drawbacks for patients with sight, hearing and illness-related disabilities or risks, when in-person consultation is required. There are also risks: some patients may not benefit from telepsychiatry due to the nature of their illness, and will patients feel rapport is lost? However, the retention of COVID-19 MBS telehealth items is needed for ongoing flexible and comprehensive private practice psychiatry. [Keywords]: covid-19;private practice;psychiatrist;telehealth;telepsychiatry

Drug Dev Res

Telmisartan as tentative angiotensin receptor blocker therapeutic for COVID-19.

In late 2019, a new coronavirus emerged in Wuhan Province, China, causing lung complications similar to those produced by the SARS coronavirus in the 2002-2003 epidemic. This new disease was named COVID-19 and the causative virus SARS-CoV-2. The SARS-CoV-2 virus enters the airway and binds, by means of the S protein on its surface to the membrane protein ACE2 in type 2 alveolar cells. The S protein-ACE2 complex is internalized by endocytosis leading to a partial decrease or total loss of the enzymatic function ACE2 in the alveolar cells and in turn increasing the tissue concentration of pro-inflammatory angiotensin II by decreasing its degradation and reducing the concentration of its physiological antagonist angiotensin 1-7. High levels of angiotensin II on the lung interstitium can promote apoptosis initiating an inflammatory process with release of proinflammatory cytokines, establishing a self-powered cascade, leading eventually to ARDS. Recently, Gurwitz proposed the tentative use of agents such as losartan and telmisartan as alternative options for treating COVID-19 patients prior to development of ARDS. In this commentary article, the authors make the case for the election of telmisartan as such alternative on the basis of its pharmacokinetic and pharmacodynamic properties and present an open-label randomized phase II clinical trial for the evaluation of telmisartan in COVID-19 patients (NCT04355936).

ace2;ards;covid-19;sars-cov-2;angiotensin ii;clinical trial;telmisartan

Journal Article

Rothlin, Rodolfo Pedro;Vetulli, Hector Miguel;Duarte, Mariano;Pelorosso, Facundo German

10.1002/ddr.21679

[Title]: Telmisartan as tentative angiotensin receptor blocker therapeutic for COVID-19. [Abstract]: In late 2019, a new coronavirus emerged in Wuhan Province, China, causing lung complications similar to those produced by the SARS coronavirus in the 2002-2003 epidemic. This new disease was named COVID-19 and the causative virus SARS-CoV-2. The SARS-CoV-2 virus enters the airway and binds, by means of the S protein on its surface to the membrane protein ACE2 in type 2 alveolar cells. The S protein-ACE2 complex is internalized by endocytosis leading to a partial decrease or total loss of the enzymatic function ACE2 in the alveolar cells and in turn increasing the tissue concentration of pro-inflammatory angiotensin II by decreasing its degradation and reducing the concentration of its physiological antagonist angiotensin 1-7. High levels of angiotensin II on the lung interstitium can promote apoptosis initiating an inflammatory process with release of proinflammatory cytokines, establishing a self-powered cascade, leading eventually to ARDS. Recently, Gurwitz proposed the tentative use of agents such as losartan and telmisartan as alternative options for treating COVID-19 patients prior to development of ARDS. In this commentary article, the authors make the case for the election of telmisartan as such alternative on the basis of its pharmacokinetic and pharmacodynamic properties and present an open-label randomized phase II clinical trial for the evaluation of telmisartan in COVID-19 patients (NCT04355936). [Keywords]: ace2;ards;covid-19;sars-cov-2;angiotensin ii;clinical trial;telmisartan

J Surg Res

Impact of COVID-19 on Away Rotations in Surgical Fields.

The COVID-19 pandemic has presented a variety of challenges in the medical education curriculum, one of which is the possible loss of summer and fall away rotations for fourth year students applying into surgical subspecialties. Subsequently, a lack of in-person evaluations may have a major impact on an applicant's perception of the residency and the program's ability to assess the individual applicant. This is especially crucial for applicants without a home program in their specialty of interest, as away rotations are an important opportunity to confirm interest in pursuit of a subspecialty, obtain letters of recommendation, and make positive impressions at programs of interest. The objective of this article is to assess the current COVID-19 pandemic situation in light of away rotations and to provide recommendations for surgical subspecialty programs and applicants to have the best outcome during this upcoming application cycle. In particular, we emphasize the importance of implementing universal processes within each individual subspecialty. This will provide equitable opportunities for all applicants, minimizing potential biases or disadvantages based on geographic location or availability of a program at an applicant's home institution.

away rotations;covid-19;coronavirus;match;residency applications;surgery

Journal Article

Boyd, Carter J;Inglesby, Dani C;Corey, Britney;Greene, Benjamin J;Harrington, Michael A;Johnson, Michael D;King, Timothy W;Rais-Bahrami, Soroush;Tavana, M Lance

10.1016/j.jss.2020.05.049

[Title]: Impact of COVID-19 on Away Rotations in Surgical Fields. [Abstract]: The COVID-19 pandemic has presented a variety of challenges in the medical education curriculum, one of which is the possible loss of summer and fall away rotations for fourth year students applying into surgical subspecialties. Subsequently, a lack of in-person evaluations may have a major impact on an applicant's perception of the residency and the program's ability to assess the individual applicant. This is especially crucial for applicants without a home program in their specialty of interest, as away rotations are an important opportunity to confirm interest in pursuit of a subspecialty, obtain letters of recommendation, and make positive impressions at programs of interest. The objective of this article is to assess the current COVID-19 pandemic situation in light of away rotations and to provide recommendations for surgical subspecialty programs and applicants to have the best outcome during this upcoming application cycle. In particular, we emphasize the importance of implementing universal processes within each individual subspecialty. This will provide equitable opportunities for all applicants, minimizing potential biases or disadvantages based on geographic location or availability of a program at an applicant's home institution. [Keywords]: away rotations;covid-19;coronavirus;match;residency applications;surgery

Eur J Oper Res

Forecasting and planning during a pandemic: COVID-19 growth rates, supply chain disruptions, and governmental decisions.

Policymakers during COVID-19 operate in uncharted territory and must make tough decisions. Operational Research - the ubiquitous 'science of better' - plays a vital role in supporting this decision-making process. To that end, using data from the USA, India, UK, Germany, and Singapore up to mid-April 2020, we provide predictive analytics tools for forecasting and planning during a pandemic. We forecast COVID-19 growth rates with statistical, epidemiological, machine- and deep-learning models, and a new hybrid forecasting method based on nearest neighbors and clustering. We further model and forecast the excess demand for products and services during the pandemic using auxiliary data (google trends) and simulating governmental decisions (lockdown). Our empirical results can immediately help policymakers and planners make better decisions during the ongoing and future pandemics.

covid-19;excess demand;forecasting;lockdown;pandemic

Journal Article

Nikolopoulos, Konstantinos;Punia, Sushil;Schafers, Andreas;Tsinopoulos, Christos;Vasilakis, Chrysovalantis

10.1016/j.ejor.2020.08.001

[Title]: Forecasting and planning during a pandemic: COVID-19 growth rates, supply chain disruptions, and governmental decisions. [Abstract]: Policymakers during COVID-19 operate in uncharted territory and must make tough decisions. Operational Research - the ubiquitous 'science of better' - plays a vital role in supporting this decision-making process. To that end, using data from the USA, India, UK, Germany, and Singapore up to mid-April 2020, we provide predictive analytics tools for forecasting and planning during a pandemic. We forecast COVID-19 growth rates with statistical, epidemiological, machine- and deep-learning models, and a new hybrid forecasting method based on nearest neighbors and clustering. We further model and forecast the excess demand for products and services during the pandemic using auxiliary data (google trends) and simulating governmental decisions (lockdown). Our empirical results can immediately help policymakers and planners make better decisions during the ongoing and future pandemics. [Keywords]: covid-19;excess demand;forecasting;lockdown;pandemic

Sci Total Environ

Correlation between climate indicators and COVID-19 pandemic in New York, USA.

This study analyzed the association between COVID-19 and climate indicators in New York City, USA. We used secondary published data from New York city health services and National weather service, USA. The climate indicators included in the study are average temperature, minimum temperature, maximum temperature, rainfall, average humidity, wind speed, and air quality. Kendall and Spearman rank correlation tests were chosen for data analysis. We find that average temperature, minimum temperature, and air quality were significantly associated with the COVID-19 pandemic. The findings of this study will help World Health Organization and health regulators such as Center for Disease Control (CDC) to combat COVID-19 in New York and the rest of the world.

covid-19;coronavirus;humidity;new york;rainfall;temperature

Journal Article

Bashir, Muhammad Farhan;Ma, Benjiang;Bilal;Komal, Bushra;Bashir, Muhammad Adnan;Tan, Duojiao;Bashir, Madiha

10.1016/j.scitotenv.2020.138835

[Title]: Correlation between climate indicators and COVID-19 pandemic in New York, USA. [Abstract]: This study analyzed the association between COVID-19 and climate indicators in New York City, USA. We used secondary published data from New York city health services and National weather service, USA. The climate indicators included in the study are average temperature, minimum temperature, maximum temperature, rainfall, average humidity, wind speed, and air quality. Kendall and Spearman rank correlation tests were chosen for data analysis. We find that average temperature, minimum temperature, and air quality were significantly associated with the COVID-19 pandemic. The findings of this study will help World Health Organization and health regulators such as Center for Disease Control (CDC) to combat COVID-19 in New York and the rest of the world. [Keywords]: covid-19;coronavirus;humidity;new york;rainfall;temperature

Scott Med J

Delivery of urological services (telemedicine and urgent surgery) during COVID-19 lockdown: experience and lessons learnt from a university hospital in United Kingdom.

BACKGROUND AND AIMS: Our departmental planning for COVID-19 was actioned a week before the lockdown (13th March 2020). We look at a 7- week lockdown activity for all scheduled outpatient clinics and urgent procedures. METHODS AND RESULTS: A total of 2361 outpatient clinic slots (52.6% oncology slots and 47.4% benign urology slots) were scheduled during this period. The oncology slots included 330 (26.5%) flexible cystoscopy, 555 (44.7%) prostate cancer and 357(28.8%) non-prostate cancer slots. The benign urology slots included 323 (28.8%) andrology, 193 (17.2%) stones and 603 (54%) lower urinary tract symptoms (LUTS) slots. Of the total oncology outpatient slots (n = 1242), 66.3% were virtual consultations, 20% were face-to-face and 13.6% were cancelled. Of the total benign outpatient slots (n = 1119), 81% were virtual consultations, 9.7% were face-to-face and 9.3% were cancelled. A total of 116 anaesthetic surgical procedures were carried out, of which 54 (46.5%) were oncological procedures, 18 (15.5%) were benign urological procedures, and 44 (38%) were diagnostic procedures. CONCLUSIONS: Hospitals and urologists can benefit from the model used by our hospital to mitigate the impact and prioritise patients most in need of urgent care. Reorganisation and flexibility of healthcare delivery is paramount in these troubled times and will allow clinical activity without compromising patient safety.

covid-19;telemedicine;clinics;urgent;urology

Journal Article

Somani, Bhaskar K;Pietropaolo, Amelia;Coulter, Primrose;Smith, Julian

10.1177/0036933020951932

[Title]: Delivery of urological services (telemedicine and urgent surgery) during COVID-19 lockdown: experience and lessons learnt from a university hospital in United Kingdom. [Abstract]: BACKGROUND AND AIMS: Our departmental planning for COVID-19 was actioned a week before the lockdown (13th March 2020). We look at a 7- week lockdown activity for all scheduled outpatient clinics and urgent procedures. METHODS AND RESULTS: A total of 2361 outpatient clinic slots (52.6% oncology slots and 47.4% benign urology slots) were scheduled during this period. The oncology slots included 330 (26.5%) flexible cystoscopy, 555 (44.7%) prostate cancer and 357(28.8%) non-prostate cancer slots. The benign urology slots included 323 (28.8%) andrology, 193 (17.2%) stones and 603 (54%) lower urinary tract symptoms (LUTS) slots. Of the total oncology outpatient slots (n = 1242), 66.3% were virtual consultations, 20% were face-to-face and 13.6% were cancelled. Of the total benign outpatient slots (n = 1119), 81% were virtual consultations, 9.7% were face-to-face and 9.3% were cancelled. A total of 116 anaesthetic surgical procedures were carried out, of which 54 (46.5%) were oncological procedures, 18 (15.5%) were benign urological procedures, and 44 (38%) were diagnostic procedures. CONCLUSIONS: Hospitals and urologists can benefit from the model used by our hospital to mitigate the impact and prioritise patients most in need of urgent care. Reorganisation and flexibility of healthcare delivery is paramount in these troubled times and will allow clinical activity without compromising patient safety. [Keywords]: covid-19;telemedicine;clinics;urgent;urology

Cell Metab

Shining Light on the COVID-19 Pandemic: A Vitamin D Receptor Checkpoint in Defense of Unregulated Wound Healing.

SARS-CoV-2 pneumonitis can quickly strike to incapacitate the lung, leading to severe disease and sometimes death. In this perspective, we suggest that vitamin D deficiency and the failure to activate the vitamin D receptor (VDR) can aggravate this respiratory syndrome by igniting a wounding response in stellate cells of the lung. The FDA-approved injectable vitamin D analog, paricalcitol, suppresses stellate cell-derived murine hepatic and pancreatic pro-inflammatory and pro-fibrotic changes. Therefore, we suggest a possible parallel program in the pulmonary stellate cells of COVID-19 patients and propose repurposing paricalcitol infusion therapy to restrain the COVID-19 cytokine storm. This proposed therapy could prove important to people of color who have higher COVID-19 mortality rates and lower vitamin D levels.

Journal Article;Research Support, N.I.H., Extramural;Research Support, Non-U.S. Gov't

Evans, Ronald M;Lippman, Scott M

10.1016/j.cmet.2020.09.007

[Title]: Shining Light on the COVID-19 Pandemic: A Vitamin D Receptor Checkpoint in Defense of Unregulated Wound Healing. [Abstract]: SARS-CoV-2 pneumonitis can quickly strike to incapacitate the lung, leading to severe disease and sometimes death. In this perspective, we suggest that vitamin D deficiency and the failure to activate the vitamin D receptor (VDR) can aggravate this respiratory syndrome by igniting a wounding response in stellate cells of the lung. The FDA-approved injectable vitamin D analog, paricalcitol, suppresses stellate cell-derived murine hepatic and pancreatic pro-inflammatory and pro-fibrotic changes. Therefore, we suggest a possible parallel program in the pulmonary stellate cells of COVID-19 patients and propose repurposing paricalcitol infusion therapy to restrain the COVID-19 cytokine storm. This proposed therapy could prove important to people of color who have higher COVID-19 mortality rates and lower vitamin D levels. [Keywords]:

J Med Virol

Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Neurologic sequelae can be devastating complications of respiratory viral infections. We report the presence of virus in neural and capillary endothelial cells in frontal lobe tissue obtained at postmortem examination from a patient infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Our observations of virus in neural tissue, in conjunction with clinical correlates of worsening neurologic symptoms, pave the way to a closer understanding of the pathogenic mechanisms underlying central nervous system involvement by SARS-CoV-2.

cns infection;sars-cov-2;endothelium;neuroinvasion;neurotropism

Case Reports;Journal Article

Paniz-Mondolfi, Alberto;Bryce, Clare;Grimes, Zachary;Gordon, Ronald E;Reidy, Jason;Lednicky, John;Sordillo, Emilia Mia;Fowkes, Mary

10.1002/jmv.25915

[Title]: Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). [Abstract]: Neurologic sequelae can be devastating complications of respiratory viral infections. We report the presence of virus in neural and capillary endothelial cells in frontal lobe tissue obtained at postmortem examination from a patient infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Our observations of virus in neural tissue, in conjunction with clinical correlates of worsening neurologic symptoms, pave the way to a closer understanding of the pathogenic mechanisms underlying central nervous system involvement by SARS-CoV-2. [Keywords]: cns infection;sars-cov-2;endothelium;neuroinvasion;neurotropism

Auris Nasus Larynx

Society of swallowing and dysphagia of Japan: Position statement on dysphagia management during the COVID-19 outbreak.

On April 14, the Society of Swallowing and Dysphagia of Japan (SSDJ) proposed its position statement on dysphagia treatment considering the ongoing spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main routes of transmission of SARS-CoV-2 are physical contact with infected persons and exposure to respiratory droplets. In cases of infection, the nasal cavity and nasopharynx have the highest viral load in the body. Swallowing occurs in the oral cavity and pharynx, which correspond to the sites of viral proliferation. In addition, the possibility of infection by aerosol transmission is also concerning. Dysphagia treatment includes a broad range of clinical assessments and examinations, dysphagia rehabilitation, oral care, nursing care, and surgical treatments. Any of these can lead to the production of droplets and aerosols, as well as contact with viral particles. In terms of proper infection control measures, all healthcare professionals involved in dysphagia treatment must be fully briefed and must appropriately implement all measures. In addition, most patients with dysphagia should be considered to be at a higher risk for severe illness from COVID-19 because they are elderly and have complications including heart diseases, diabetes, respiratory diseases, and cerebrovascular diseases. This statement establishes three regional categories according to the status of SARS-CoV-2 infection. Accordingly, the SSDJ proposes specific infection countermeasures that should be implemented considering 1) the current status of SARS-CoV-2 infection in the region, 2) the patient status of SARS-CoV-2 infection, and 3) whether the examinations or procedures conducted correspond to aerosol-generating procedures, depending on the status of dysphagia treatment. This statement is arranged into separate sections providing information and advice in consideration of the COVID-19 outbreak, including "terminology", "clinical swallowing assessment and examination", "swallowing therapy", "oral care", "surgical procedure for dysphagia", "tracheotomy care", and "nursing care". In areas where SARS-CoV-2 infection is widespread, sufficient personal protective equipment should be used when performing aerosol generation procedures. The current set of statements on dysphagia management in the COVID-19 outbreak is not an evidence-based clinical practice guideline, but a guide for all healthcare workers involved in the treatment of dysphagia during the COVID-19 epidemic to prevent SARS-CoV-2 infection.

aerosol generating procedure;covid-19;dysphagia management;personal protective equipment;sars-cov-2

Journal Article;Practice Guideline

Kimura, Yurika;Ueha, Rumi;Furukawa, Tatsuya;Oshima, Fumiko;Fujitani, Junko;Nakajima, Junko;Kaneoka, Asako;Aoyama, Hisaaki;Fujimoto, Yasushi;Umezaki, Toshiro

10.1016/j.anl.2020.07.009

[Title]: Society of swallowing and dysphagia of Japan: Position statement on dysphagia management during the COVID-19 outbreak. [Abstract]: On April 14, the Society of Swallowing and Dysphagia of Japan (SSDJ) proposed its position statement on dysphagia treatment considering the ongoing spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main routes of transmission of SARS-CoV-2 are physical contact with infected persons and exposure to respiratory droplets. In cases of infection, the nasal cavity and nasopharynx have the highest viral load in the body. Swallowing occurs in the oral cavity and pharynx, which correspond to the sites of viral proliferation. In addition, the possibility of infection by aerosol transmission is also concerning. Dysphagia treatment includes a broad range of clinical assessments and examinations, dysphagia rehabilitation, oral care, nursing care, and surgical treatments. Any of these can lead to the production of droplets and aerosols, as well as contact with viral particles. In terms of proper infection control measures, all healthcare professionals involved in dysphagia treatment must be fully briefed and must appropriately implement all measures. In addition, most patients with dysphagia should be considered to be at a higher risk for severe illness from COVID-19 because they are elderly and have complications including heart diseases, diabetes, respiratory diseases, and cerebrovascular diseases. This statement establishes three regional categories according to the status of SARS-CoV-2 infection. Accordingly, the SSDJ proposes specific infection countermeasures that should be implemented considering 1) the current status of SARS-CoV-2 infection in the region, 2) the patient status of SARS-CoV-2 infection, and 3) whether the examinations or procedures conducted correspond to aerosol-generating procedures, depending on the status of dysphagia treatment. This statement is arranged into separate sections providing information and advice in consideration of the COVID-19 outbreak, including "terminology", "clinical swallowing assessment and examination", "swallowing therapy", "oral care", "surgical procedure for dysphagia", "tracheotomy care", and "nursing care". In areas where SARS-CoV-2 infection is widespread, sufficient personal protective equipment should be used when performing aerosol generation procedures. The current set of statements on dysphagia management in the COVID-19 outbreak is not an evidence-based clinical practice guideline, but a guide for all healthcare workers involved in the treatment of dysphagia during the COVID-19 epidemic to prevent SARS-CoV-2 infection. [Keywords]: aerosol generating procedure;covid-19;dysphagia management;personal protective equipment;sars-cov-2

J Endourol

Lessons Learnt (Clinical Outcomes and Cost Savings) from Virtual Stone Clinic and Their Application in the Era Post-COVID-19: Prospective Outcomes over a 6-Year Period from a University Teaching Hospital.

Introduction: We introduced a nurse-led telephone-based virtual stone clinic (VSC) follow-up for the surveillance of patients with asymptomatic renal calculi or those at a high risk of recurrent kidney stone disease (KSD). The aim of this study was to look at the outcomes of VSC and its role in the post-COVID era. Methods: Prospective outcomes audit was done for all patients referred to the VSC for a 6-year period (March 2014-April 2020). VSC is led by specialist stone nurses for on-going surveillance of KSD patients. Results: A total of 290 patients were seen (468 individual appointments; 1.6 +/- 1.0 per patient), with a mean age of 57.0 +/- 15.8 years (range: 17-92) and a men-women ratio of 3:2. The referral was for surveillance of asymptomatic small renal stones (230, 79.3%); history of recurrent stone disease (45, 15.5%); solitary kidneys (5, 1.7%); cystine stones; young age; and other conditions (10, 3.4%). The mean stone size was 5.0 +/- 2.7 mm, followed up with kidney, ureter, and bladder radiograph (225, 77.6%) and ultrasound scan (USS) (65, 22.4%), for median duration of 12 months (range: 3-24 months). At the end, 132 patients (45.6%) remained in VSC, 106 (36.6%) were discharged, 47 (16.2%) returned to face-to-face clinic or treatment, and 5 (1.7%) had emergency admissions. Of 47 patients who returned, 23 (48.9%) developed new symptoms, 21 (44.6%) had stone growth, and 3 defaulted to face-to-face appointment. Thirty-five patients needed surgical intervention (URS-21, SWL-13, and PCNL-1) and 10 were managed conservatively. VSC reduced the cost per clinic appointment from pound27.9 to pound2 per patient (93% reduction), equating to a total saving of pound12,006 for the study period. Conclusion: Nurse-led VSC not only provided a safe follow-up but also allowed to substantially reduce the cost of treatment by allowing patients to be either discharged or return to a face-to-face clinic or surgical intervention if needed. Post-COVID, this model using telemedicine will have a much wider uptake and further help to optimize health care resources.

clinic;stone;telemedicine;telephone;virtual

Journal Article

Hughes, Thomas;Pietropaolo, Amelia;Archer, Matthew;Davis, Tania;Tear, Loretta;Somani, Bhaskar K

10.1089/end.2020.0708

[Title]: Lessons Learnt (Clinical Outcomes and Cost Savings) from Virtual Stone Clinic and Their Application in the Era Post-COVID-19: Prospective Outcomes over a 6-Year Period from a University Teaching Hospital. [Abstract]: Introduction: We introduced a nurse-led telephone-based virtual stone clinic (VSC) follow-up for the surveillance of patients with asymptomatic renal calculi or those at a high risk of recurrent kidney stone disease (KSD). The aim of this study was to look at the outcomes of VSC and its role in the post-COVID era. Methods: Prospective outcomes audit was done for all patients referred to the VSC for a 6-year period (March 2014-April 2020). VSC is led by specialist stone nurses for on-going surveillance of KSD patients. Results: A total of 290 patients were seen (468 individual appointments; 1.6 +/- 1.0 per patient), with a mean age of 57.0 +/- 15.8 years (range: 17-92) and a men-women ratio of 3:2. The referral was for surveillance of asymptomatic small renal stones (230, 79.3%); history of recurrent stone disease (45, 15.5%); solitary kidneys (5, 1.7%); cystine stones; young age; and other conditions (10, 3.4%). The mean stone size was 5.0 +/- 2.7 mm, followed up with kidney, ureter, and bladder radiograph (225, 77.6%) and ultrasound scan (USS) (65, 22.4%), for median duration of 12 months (range: 3-24 months). At the end, 132 patients (45.6%) remained in VSC, 106 (36.6%) were discharged, 47 (16.2%) returned to face-to-face clinic or treatment, and 5 (1.7%) had emergency admissions. Of 47 patients who returned, 23 (48.9%) developed new symptoms, 21 (44.6%) had stone growth, and 3 defaulted to face-to-face appointment. Thirty-five patients needed surgical intervention (URS-21, SWL-13, and PCNL-1) and 10 were managed conservatively. VSC reduced the cost per clinic appointment from pound27.9 to pound2 per patient (93% reduction), equating to a total saving of pound12,006 for the study period. Conclusion: Nurse-led VSC not only provided a safe follow-up but also allowed to substantially reduce the cost of treatment by allowing patients to be either discharged or return to a face-to-face clinic or surgical intervention if needed. Post-COVID, this model using telemedicine will have a much wider uptake and further help to optimize health care resources. [Keywords]: clinic;stone;telemedicine;telephone;virtual

Leuk Lymphoma

Hematological manifestations of COVID-19.

The emergence of the Coronavirus Disease -19 (COVID-19) pandemic, has had a tremendous global impact, resulting in substantial morbidity and mortality worldwide and especially in the United States, where nearly one third of the cases are located. Although involvement of the lower respiratory track accounts for most of the morbidity and mortality seen, the virus involves several organ systems and the syndrome exhibits clinical diversity with a wide range of symptoms and manifestations. The involvement of elements of the hematopoietic system is prominent in severe cases and associated with poor outcomes and mortality. Lymphopenia, leukopenia, thrombocytopenia, disseminated intravascular coagulation, and a prothrombotic state are common manifestations of COVID-19 and have important treatment and prognostic implications. Better understanding of the mechanisms of the pathophysiology of COVID-19-induced hematological abnormalities may ultimately result in better ways to treat them and decrease the associated morbidity and mortality.

covid-19;coronavirus;lymphopenia;thrombocytopenia;thrombosis

Journal Article;Review

Mina, Alain;van Besien, Koen;Platanias, Leonidas C

10.1080/10428194.2020.1788017

[Title]: Hematological manifestations of COVID-19. [Abstract]: The emergence of the Coronavirus Disease -19 (COVID-19) pandemic, has had a tremendous global impact, resulting in substantial morbidity and mortality worldwide and especially in the United States, where nearly one third of the cases are located. Although involvement of the lower respiratory track accounts for most of the morbidity and mortality seen, the virus involves several organ systems and the syndrome exhibits clinical diversity with a wide range of symptoms and manifestations. The involvement of elements of the hematopoietic system is prominent in severe cases and associated with poor outcomes and mortality. Lymphopenia, leukopenia, thrombocytopenia, disseminated intravascular coagulation, and a prothrombotic state are common manifestations of COVID-19 and have important treatment and prognostic implications. Better understanding of the mechanisms of the pathophysiology of COVID-19-induced hematological abnormalities may ultimately result in better ways to treat them and decrease the associated morbidity and mortality. [Keywords]: covid-19;coronavirus;lymphopenia;thrombocytopenia;thrombosis

Transl Psychiatry

Emergency response strategy for containing COVID-19 within a psychiatric specialty hospital in the epicenter of the COVID-19 epidemic in China.

Coronavirus disease 2019 (COVID-19) has been recognized as a global pandemic, and psychiatric institutions located in the epicenter of the epidemic in China are facing severe challenges in fighting the epidemic. This article presents the accumulated experience of the authors during the process of combating COVID-19 in a psychiatric hospital. The aim of this article is to provide a reference for psychiatric specialty hospitals and institutions that treat large populations of chronically ill patients in other parts of the world.

Journal Article;Research Support, Non-U.S. Gov't;Review

Ma, Jun;Zhong, Hao;Jiang, Min;Zeng, Kuan;Zhong, Baoliang;Liu, Lianzhong;Liu, Xuebing

10.1038/s41398-020-00959-3

[Title]: Emergency response strategy for containing COVID-19 within a psychiatric specialty hospital in the epicenter of the COVID-19 epidemic in China. [Abstract]: Coronavirus disease 2019 (COVID-19) has been recognized as a global pandemic, and psychiatric institutions located in the epicenter of the epidemic in China are facing severe challenges in fighting the epidemic. This article presents the accumulated experience of the authors during the process of combating COVID-19 in a psychiatric hospital. The aim of this article is to provide a reference for psychiatric specialty hospitals and institutions that treat large populations of chronically ill patients in other parts of the world. [Keywords]:

Int J Ment Health Addict

Personality Traits, Risk Perception, and Protective Behaviors of Arab Residents of Qatar During the COVID-19 Pandemic.

During the 2020 COVID-19 pandemic, people in Qatar-similar to most countries globally-were instructed by health authorities to adopt protective behaviors to avoid infection. One of these behaviors is social distancing, which is influenced by diverse variables. Using data from an online survey with 405 responses, this study performed multiple regression analysis to explore effects of personality, risk perception, and personal hygiene practices on social distancing among residents of Qatar. The results showed that 87.3% of participants reported that they preferred to stay at home and not go outside unless necessary, 60.3% said that they maintain an adequate distance when communicating with others, 68.6% reported that they do not allow relatives and friends to visit them at home, 73.5% believed that COVID-19 is a dangerous disease, and 95.8% reported that they embrace personal hygiene practices and washing hands. Furthermore, multiple regression analysis showed that conscientiousness, neuroticism, risk perception, and personal hygiene practices predicted social distancing, with moderate effect sizes. Gender differences were also found in social distancing practices, indicating that women reported higher engagement in social distancing practices than men. These results highlighted the importance of individual differences in reacting to the COVID-19 pandemic and provide important information about the predictors of social distancing practices.

covid-19;personal hygiene;personality;risk perception;social distancing

Journal Article

Abdelrahman, Mohamed

10.1007/s11469-020-00352-7

[Title]: Personality Traits, Risk Perception, and Protective Behaviors of Arab Residents of Qatar During the COVID-19 Pandemic. [Abstract]: During the 2020 COVID-19 pandemic, people in Qatar-similar to most countries globally-were instructed by health authorities to adopt protective behaviors to avoid infection. One of these behaviors is social distancing, which is influenced by diverse variables. Using data from an online survey with 405 responses, this study performed multiple regression analysis to explore effects of personality, risk perception, and personal hygiene practices on social distancing among residents of Qatar. The results showed that 87.3% of participants reported that they preferred to stay at home and not go outside unless necessary, 60.3% said that they maintain an adequate distance when communicating with others, 68.6% reported that they do not allow relatives and friends to visit them at home, 73.5% believed that COVID-19 is a dangerous disease, and 95.8% reported that they embrace personal hygiene practices and washing hands. Furthermore, multiple regression analysis showed that conscientiousness, neuroticism, risk perception, and personal hygiene practices predicted social distancing, with moderate effect sizes. Gender differences were also found in social distancing practices, indicating that women reported higher engagement in social distancing practices than men. These results highlighted the importance of individual differences in reacting to the COVID-19 pandemic and provide important information about the predictors of social distancing practices. [Keywords]: covid-19;personal hygiene;personality;risk perception;social distancing

J Clin Endocrinol Metab

Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico.

BACKGROUND: The SARS-CoV-2 outbreak poses a challenge to health care systems due to its high complication rates in patients with cardiometabolic diseases. Here, we identify risk factors and propose a clinical score to predict COVID-19 lethality, including specific factors for diabetes and obesity, and its role in improving risk prediction. METHODS: We obtained data of confirmed and negative COVID-19 cases and their demographic and health characteristics from the General Directorate of Epidemiology of the Mexican Ministry of Health. We investigated specific risk factors associated to COVID-19 positivity and mortality and explored the impact of diabetes and obesity on modifying COVID-19-related lethality. Finally, we built a clinical score to predict COVID-19 lethality. RESULTS: Among the 177 133 subjects at the time of writing this report (May 18, 2020), we observed 51 633 subjects with SARS-CoV-2 and 5,332 deaths. Risk factors for lethality in COVID-19 include early-onset diabetes, obesity, chronic obstructive pulmonary disease, advanced age, hypertension, immunosuppression, and chronic kidney disease (CKD); we observed that obesity mediates 49.5% of the effect of diabetes on COVID-19 lethality. Early-onset diabetes conferred an increased risk of hospitalization and obesity conferred an increased risk for intensive care unit admission and intubation. Our predictive score for COVID-19 lethality included age >/= 65 years, diabetes, early-onset diabetes, obesity, age < 40 years, CKD, hypertension, and immunosuppression and significantly discriminates lethal from non-lethal COVID-19 cases (C-statistic = 0.823). CONCLUSIONS: Here, we propose a mechanistic approach to evaluate the risk for complications and lethality attributable to COVID-19, considering the effect of obesity and diabetes in Mexico. Our score offers a clinical tool for quick determination of high-risk susceptibility patients in a first-contact scenario.

covid-19;mexico;sars-cov-2;diabetes;lethality;obesity

Journal Article

Bello-Chavolla, Omar Yaxmehen;Bahena-Lopez, Jessica Paola;Antonio-Villa, Neftali Eduardo;Vargas-Vazquez, Arsenio;Gonzalez-Diaz, Armando;Marquez-Salinas, Alejandro;Fermin-Martinez, Carlos A;Naveja, J Jesus;Aguilar-Salinas, Carlos A

10.1210/clinem/dgaa346

[Title]: Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico. [Abstract]: BACKGROUND: The SARS-CoV-2 outbreak poses a challenge to health care systems due to its high complication rates in patients with cardiometabolic diseases. Here, we identify risk factors and propose a clinical score to predict COVID-19 lethality, including specific factors for diabetes and obesity, and its role in improving risk prediction. METHODS: We obtained data of confirmed and negative COVID-19 cases and their demographic and health characteristics from the General Directorate of Epidemiology of the Mexican Ministry of Health. We investigated specific risk factors associated to COVID-19 positivity and mortality and explored the impact of diabetes and obesity on modifying COVID-19-related lethality. Finally, we built a clinical score to predict COVID-19 lethality. RESULTS: Among the 177 133 subjects at the time of writing this report (May 18, 2020), we observed 51 633 subjects with SARS-CoV-2 and 5,332 deaths. Risk factors for lethality in COVID-19 include early-onset diabetes, obesity, chronic obstructive pulmonary disease, advanced age, hypertension, immunosuppression, and chronic kidney disease (CKD); we observed that obesity mediates 49.5% of the effect of diabetes on COVID-19 lethality. Early-onset diabetes conferred an increased risk of hospitalization and obesity conferred an increased risk for intensive care unit admission and intubation. Our predictive score for COVID-19 lethality included age >/= 65 years, diabetes, early-onset diabetes, obesity, age < 40 years, CKD, hypertension, and immunosuppression and significantly discriminates lethal from non-lethal COVID-19 cases (C-statistic = 0.823). CONCLUSIONS: Here, we propose a mechanistic approach to evaluate the risk for complications and lethality attributable to COVID-19, considering the effect of obesity and diabetes in Mexico. Our score offers a clinical tool for quick determination of high-risk susceptibility patients in a first-contact scenario. [Keywords]: covid-19;mexico;sars-cov-2;diabetes;lethality;obesity

Biosci Trends

Neuropsychiatric adverse events of chloroquine: a real-world pharmacovigilance study using the FDA Adverse Event Reporting System (FAERS) database.

In late March and early April 2020, the antimalarial drug, chloroquine, has been approved as an emergency treatment for the coronavirus disease 2019 (COVID-19) in the United States and in Europe. Although infrequent, neuropsychiatric symptoms have been reported in patients who received chloroquine for the treatment of malaria or autoimmune diseases. In this study, aiming to investigate these adverse events (AEs) using a large self-reporting database, we conducted a disproportionality analysis for the detection of neuropsychiatric AE signals associated with the use of chloroquine (or hydroxychloroquine), reported to FDA Adverse Event Reporting System (FAERS) database between the fourth quarter of 2012 and the fourth quarter of 2019. We included 2,389,474 AE cases, among which 520 cases developed neuropsychiatric AE following the use of chloroquine. Adjusted reporting odds ratio (ROR) for the development of each of the neuropsychiatric AEs following the use of chloroquine was calculated using a multilevel model: exposure to chloroquine was associated with a statistically significant high reporting of amnesia, delirium, hallucinations, depression, and loss of consciousness, (lower 95% confidence interval of the adjusted ROR > 1), although the degree of increase in their ROR was limited. There was no statistically significant high reporting of any other neuropsychiatric AE, including suicide, psychosis, confusion, and agitation. Current pharmacovigilance study results did not suggest any potential link between the use of chloroquine and an increased risk of suicide, psychosis, confusion, and agitation, which would be informative during the emergency use of chloroquine for the treatment of COVID-19.

covid-19;faers;adverse events;chloroquine;pharmacovigilance;real-world data

Journal Article

Sato, Kenichiro;Mano, Tatsuo;Iwata, Atsushi;Toda, Tatsushi

10.5582/bst.2020.03082

[Title]: Neuropsychiatric adverse events of chloroquine: a real-world pharmacovigilance study using the FDA Adverse Event Reporting System (FAERS) database. [Abstract]: In late March and early April 2020, the antimalarial drug, chloroquine, has been approved as an emergency treatment for the coronavirus disease 2019 (COVID-19) in the United States and in Europe. Although infrequent, neuropsychiatric symptoms have been reported in patients who received chloroquine for the treatment of malaria or autoimmune diseases. In this study, aiming to investigate these adverse events (AEs) using a large self-reporting database, we conducted a disproportionality analysis for the detection of neuropsychiatric AE signals associated with the use of chloroquine (or hydroxychloroquine), reported to FDA Adverse Event Reporting System (FAERS) database between the fourth quarter of 2012 and the fourth quarter of 2019. We included 2,389,474 AE cases, among which 520 cases developed neuropsychiatric AE following the use of chloroquine. Adjusted reporting odds ratio (ROR) for the development of each of the neuropsychiatric AEs following the use of chloroquine was calculated using a multilevel model: exposure to chloroquine was associated with a statistically significant high reporting of amnesia, delirium, hallucinations, depression, and loss of consciousness, (lower 95% confidence interval of the adjusted ROR > 1), although the degree of increase in their ROR was limited. There was no statistically significant high reporting of any other neuropsychiatric AE, including suicide, psychosis, confusion, and agitation. Current pharmacovigilance study results did not suggest any potential link between the use of chloroquine and an increased risk of suicide, psychosis, confusion, and agitation, which would be informative during the emergency use of chloroquine for the treatment of COVID-19. [Keywords]: covid-19;faers;adverse events;chloroquine;pharmacovigilance;real-world data

Osong Public Health Res Perspect

COVID-19 Outbreak in Malaysia.

In 2020 a significant threat to public health emerged. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic outbreak emerged in December 2019 from Wuhan City, Hubei Province, China and spread to the rest of the world. This disease was named COVID-19 by World Health Organization. To date (17(th) April 2020) a total of 2,230,439 cases of COVID-19; 150,810 cases of deaths and 564,210 recovered cases have been reported worldwide. In this review the SARS-CoV-2 morphology, pathogenic mechanism, similarities and differences between SARS-CoV and Middle East Respiratory Syndrome and severe acute respiratory syndrome, transmission mode, diagnosis, treatment, and preventive measures were investigated. The outbreak of COVID-19 from a Malaysian perspective was explored and mental health care during the COVID-19 outbreak was explored. To date, there is no vaccine or no specific treatment for COVID-19. Therefore, preventive measures are very important to prevent and control the rapid spread of the SARS-CoV-2 virus. Preparedness should be a priority for future pandemic outbreaks.

covid-19;malaysia;sars-cov-2

Journal Article;Review

Elengoe, Asita

10.24171/j.phrp.2020.11.3.08

[Title]: COVID-19 Outbreak in Malaysia. [Abstract]: In 2020 a significant threat to public health emerged. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic outbreak emerged in December 2019 from Wuhan City, Hubei Province, China and spread to the rest of the world. This disease was named COVID-19 by World Health Organization. To date (17(th) April 2020) a total of 2,230,439 cases of COVID-19; 150,810 cases of deaths and 564,210 recovered cases have been reported worldwide. In this review the SARS-CoV-2 morphology, pathogenic mechanism, similarities and differences between SARS-CoV and Middle East Respiratory Syndrome and severe acute respiratory syndrome, transmission mode, diagnosis, treatment, and preventive measures were investigated. The outbreak of COVID-19 from a Malaysian perspective was explored and mental health care during the COVID-19 outbreak was explored. To date, there is no vaccine or no specific treatment for COVID-19. Therefore, preventive measures are very important to prevent and control the rapid spread of the SARS-CoV-2 virus. Preparedness should be a priority for future pandemic outbreaks. [Keywords]: covid-19;malaysia;sars-cov-2

J Clin Exp Hepatol

Joint Guidance from SGEI, ISG and INASL for Gastroenterologists and Gastrointestinal Endoscopists on the Prevention, Care, and Management of Patients With COVID-19.

Coronavirus disease 2019 (COVID-19), which started in December 2019 in China, has resulted in a pandemic leading to significant morbidity and mortality across the globe. Although it mainly causes respiratory symptoms, respiratory failure and death due to multiorgan failure, there is evolving evidence to suggest gastrointestinal (GI) and liver involvement by this virus. Owing to this, health-care professionals taking care of GI and liver diseases are also at an increased risk of getting exposed. Hence, there is a need for protocols to be prepared to guide the handling of COVID-19 patients by the GI and liver specialists, as well as to manage the pre-existing GI and liver diseases during the ongoing pandemic. We present here the guidelines prepared jointly by the three Indian professional bodies in the field of GI diseases, namely the Society of Gastrointestinal Endoscopy of India, Indian Society of Gastroenterology, and Indian National Association for the Study of the Liver.

covid-19;india;endoscopy;guidance;liver

Journal Article;Review

Philip, Mathew;Lakhtakia, Sundeep;Aggarwal, Rakesh;Madan, Kaushal;Saraswat, Vivek;Makharia, Govind

10.1016/j.jceh.2020.04.001

[Title]: Joint Guidance from SGEI, ISG and INASL for Gastroenterologists and Gastrointestinal Endoscopists on the Prevention, Care, and Management of Patients With COVID-19. [Abstract]: Coronavirus disease 2019 (COVID-19), which started in December 2019 in China, has resulted in a pandemic leading to significant morbidity and mortality across the globe. Although it mainly causes respiratory symptoms, respiratory failure and death due to multiorgan failure, there is evolving evidence to suggest gastrointestinal (GI) and liver involvement by this virus. Owing to this, health-care professionals taking care of GI and liver diseases are also at an increased risk of getting exposed. Hence, there is a need for protocols to be prepared to guide the handling of COVID-19 patients by the GI and liver specialists, as well as to manage the pre-existing GI and liver diseases during the ongoing pandemic. We present here the guidelines prepared jointly by the three Indian professional bodies in the field of GI diseases, namely the Society of Gastrointestinal Endoscopy of India, Indian Society of Gastroenterology, and Indian National Association for the Study of the Liver. [Keywords]: covid-19;india;endoscopy;guidance;liver

Dermatol Res Pract

A Review of the Dermatological Manifestations of Coronavirus Disease 2019 (COVID-19).

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected 210 countries and territories around the world. The virus has spread rapidly, and the disease is still extending up to now. The pathophysiology for SARS-CoV-2 has not been well elucidated, and diverse hypotheses to date have been proposed. Initially, no skin manifestations were observed among patients with COVID-19, but recently a few cases have been described. In this review, we discuss these various cutaneous manifestations and skin problems related to personal protective equipment, as well as different cutaneous anti-COVID-19 drug-associated reactions. We also focus on the currently proposed managements of these rare manifestations.

Journal Article;Review

Marraha, Farah;Al Faker, Ibtissam;Gallouj, Salim

10.1155/2020/9360476

[Title]: A Review of the Dermatological Manifestations of Coronavirus Disease 2019 (COVID-19). [Abstract]: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected 210 countries and territories around the world. The virus has spread rapidly, and the disease is still extending up to now. The pathophysiology for SARS-CoV-2 has not been well elucidated, and diverse hypotheses to date have been proposed. Initially, no skin manifestations were observed among patients with COVID-19, but recently a few cases have been described. In this review, we discuss these various cutaneous manifestations and skin problems related to personal protective equipment, as well as different cutaneous anti-COVID-19 drug-associated reactions. We also focus on the currently proposed managements of these rare manifestations. [Keywords]:

Front Endocrinol (Lausanne)

Artificial Light at Night (ALAN): A Potential Anthropogenic Component for the COVID-19 and HCoVs Outbreak.

The origin of the coronavirus disease 2019 (COVID-19) pandemic is zoonotic. The circadian day-night is the rhythmic clue to organisms for their synchronized body functions. The "development for mankind" escalated the use of artificial light at night (ALAN). In this article, we tried to focus on the possible influence of this anthropogenic factor in human coronavirus (HCoV) outbreak. The relationship between the occurrences of coronavirus and the ascending curve of the night-light has also been delivered. The ALAN influences the physiology and behavior of bat, a known nocturnal natural reservoir of many Coronaviridae. The "threatened" and "endangered" status of the majority of bat species is mainly because of the destruction of their proper habit and habitat predominantly through artificial illumination. The stress exerted by ALAN leads to the impaired body functions, especially endocrine, immune, genomic integration, and overall rhythm features of different physiological variables and behaviors in nocturnal animals. Night-light disturbs "virus-host" synchronization and may lead to mutation in the genomic part of the virus and excessive virus shedding. We also proposed some future strategies to mitigate the repercussions of ALAN and for the protection of the living system in the earth as well.

alan;covid-19;hcovs;bat;melatonin;sustainability

Journal Article;Research Support, Non-U.S. Gov't;Review

Khan, Zeeshan Ahmad;Yumnamcha, Thangal;Mondal, Gopinath;Devi, Sijagurumayum Dharmajyoti;Rajiv, Chongtham;Labala, Rajendra Kumar;Sanjita Devi, Haobijam;Chattoraj, Asamanja

10.3389/fendo.2020.00622

[Title]: Artificial Light at Night (ALAN): A Potential Anthropogenic Component for the COVID-19 and HCoVs Outbreak. [Abstract]: The origin of the coronavirus disease 2019 (COVID-19) pandemic is zoonotic. The circadian day-night is the rhythmic clue to organisms for their synchronized body functions. The "development for mankind" escalated the use of artificial light at night (ALAN). In this article, we tried to focus on the possible influence of this anthropogenic factor in human coronavirus (HCoV) outbreak. The relationship between the occurrences of coronavirus and the ascending curve of the night-light has also been delivered. The ALAN influences the physiology and behavior of bat, a known nocturnal natural reservoir of many Coronaviridae. The "threatened" and "endangered" status of the majority of bat species is mainly because of the destruction of their proper habit and habitat predominantly through artificial illumination. The stress exerted by ALAN leads to the impaired body functions, especially endocrine, immune, genomic integration, and overall rhythm features of different physiological variables and behaviors in nocturnal animals. Night-light disturbs "virus-host" synchronization and may lead to mutation in the genomic part of the virus and excessive virus shedding. We also proposed some future strategies to mitigate the repercussions of ALAN and for the protection of the living system in the earth as well. [Keywords]: alan;covid-19;hcovs;bat;melatonin;sustainability

Comput Math Methods Med

A Mathematical Description of the Dynamics of Coronavirus Disease 2019 (COVID-19): A Case Study of Brazil.

This paper deals with the mathematical modeling and numerical simulations related to the coronavirus dynamics. A description is developed based on the framework of the susceptible-exposed-infectious-removed model. Initially, a model verification is carried out calibrating system parameters with data from China, Italy, Iran, and Brazil. Results show the model capability to predict infectious evolution. Afterward, numerical simulations are performed in order to analyze different scenarios of COVID-19 in Brazil. Results show the importance of the governmental and individual actions to control the number and the period of the critical situations related to the pandemic.

Journal Article

Savi, Pedro V;Savi, Marcelo A;Borges, Beatriz

10.1155/2020/9017157

[Title]: A Mathematical Description of the Dynamics of Coronavirus Disease 2019 (COVID-19): A Case Study of Brazil. [Abstract]: This paper deals with the mathematical modeling and numerical simulations related to the coronavirus dynamics. A description is developed based on the framework of the susceptible-exposed-infectious-removed model. Initially, a model verification is carried out calibrating system parameters with data from China, Italy, Iran, and Brazil. Results show the model capability to predict infectious evolution. Afterward, numerical simulations are performed in order to analyze different scenarios of COVID-19 in Brazil. Results show the importance of the governmental and individual actions to control the number and the period of the critical situations related to the pandemic. [Keywords]:

J Thorac Imaging

A Comparative Study of Chest Computed Tomography Features in Young and Older Adults With Corona Virus Disease (COVID-19).

OBJECTIVE: To analyze the most common computed tomography (CT) findings of pneumonia caused by new coronavirus in younger patients (60 and younger) and older adults (older than 60). MATERIALS AND METHODS: The chest CT images of 72 symptomatic patients with corona virus disease (COVID-19) were analyzed retrospectively, including 44 younger patients (47.5+/-8.7 y old) and 28 older patients (68.4+/-6.0 y old). CT findings including density (pure ground-glass opacities, ground-glass opacities with consolidation, consolidation), the number of lobes involved, lesion distribution, and the main accompanying signs were analyzed and compared. RESULTS: Characteristic CT findings included the lobes of bilateral lung extensively involved, ground-glass opacity and ground-glass opacity with consolidation in the peripheral area, sometimes accompanied by interlobular septal thickening, and subpleural line and pleural thickening. Compared with the younger group, the proportion of extensive involvement of lung lobes was higher in the elderly group (71.4% vs. 36.4%, P=0.009), and subpleural line and pleural thickening were more likely to occur (50.0% vs. 25.0%, and 71.4% vs. 40.9%, P=0.030 and 0.011, respectively). CONCLUSION: Elderly and younger patients with corona virus disease have some common CT features, but older patients are more likely to have extensive lung lobe involvement, and subpleural line and pleural thickening. These differentiated characteristics may be related to the progress and prognosis of the disease.

Comparative Study;Journal Article

Zhu, Tingting;Wang, Yujin;Zhou, Shuchang;Zhang, Na;Xia, Liming

10.1097/RTI.0000000000000513

[Title]: A Comparative Study of Chest Computed Tomography Features in Young and Older Adults With Corona Virus Disease (COVID-19). [Abstract]: OBJECTIVE: To analyze the most common computed tomography (CT) findings of pneumonia caused by new coronavirus in younger patients (60 and younger) and older adults (older than 60). MATERIALS AND METHODS: The chest CT images of 72 symptomatic patients with corona virus disease (COVID-19) were analyzed retrospectively, including 44 younger patients (47.5+/-8.7 y old) and 28 older patients (68.4+/-6.0 y old). CT findings including density (pure ground-glass opacities, ground-glass opacities with consolidation, consolidation), the number of lobes involved, lesion distribution, and the main accompanying signs were analyzed and compared. RESULTS: Characteristic CT findings included the lobes of bilateral lung extensively involved, ground-glass opacity and ground-glass opacity with consolidation in the peripheral area, sometimes accompanied by interlobular septal thickening, and subpleural line and pleural thickening. Compared with the younger group, the proportion of extensive involvement of lung lobes was higher in the elderly group (71.4% vs. 36.4%, P=0.009), and subpleural line and pleural thickening were more likely to occur (50.0% vs. 25.0%, and 71.4% vs. 40.9%, P=0.030 and 0.011, respectively). CONCLUSION: Elderly and younger patients with corona virus disease have some common CT features, but older patients are more likely to have extensive lung lobe involvement, and subpleural line and pleural thickening. These differentiated characteristics may be related to the progress and prognosis of the disease. [Keywords]:

J Clin Med

The COVID-19 Infection in Italy: A Statistical Study of an Abnormally Severe Disease.

We statistically investigate the Coronavirus Disease 19 (COVID-19) pandemic, which became particularly invasive in Italy in March 2020. We show that the high apparent lethality or case fatality ratio (CFR) observed in Italy, as compared with other countries, is likely biased by a strong underestimation of the number of infection cases. To give a more realistic estimate of the lethality of COVID-19, we use the actual (March 2020) estimates of the infection fatality ratio (IFR) of the pandemic based on the minimum observed CFR and analyze data obtained from the Diamond Princess cruise ship, a good representation of a "laboratory" case-study from an isolated system in which all the people have been tested. From such analyses, we derive more realistic estimates of the real extent of the infection as well as more accurate indicators of how fast the infection propagates. We then isolate the dominant factors causing the abnormal severity of the disease in Italy. Finally, we use the death count-the only data estimated to be reliable enough-to predict the total number of people infected and the interval of time when the infection in Italy could end.

covid-19;epidemic in italy;statistical forecast

Journal Article

De Natale, Giuseppe;Ricciardi, Valerio;De Luca, Gabriele;De Natale, Dario;Di Meglio, Giovanni;Ferragamo, Antonio;Marchitelli, Vito;Piccolo, Andrea;Scala, Antonio;Somma, Renato;Spina, Emanuele;Troise, Claudia

10.3390/jcm9051564

[Title]: The COVID-19 Infection in Italy: A Statistical Study of an Abnormally Severe Disease. [Abstract]: We statistically investigate the Coronavirus Disease 19 (COVID-19) pandemic, which became particularly invasive in Italy in March 2020. We show that the high apparent lethality or case fatality ratio (CFR) observed in Italy, as compared with other countries, is likely biased by a strong underestimation of the number of infection cases. To give a more realistic estimate of the lethality of COVID-19, we use the actual (March 2020) estimates of the infection fatality ratio (IFR) of the pandemic based on the minimum observed CFR and analyze data obtained from the Diamond Princess cruise ship, a good representation of a "laboratory" case-study from an isolated system in which all the people have been tested. From such analyses, we derive more realistic estimates of the real extent of the infection as well as more accurate indicators of how fast the infection propagates. We then isolate the dominant factors causing the abnormal severity of the disease in Italy. Finally, we use the death count-the only data estimated to be reliable enough-to predict the total number of people infected and the interval of time when the infection in Italy could end. [Keywords]: covid-19;epidemic in italy;statistical forecast

EClinicalMedicine

Socio-demographic heterogeneity in the prevalence of COVID-19 during lockdown is associated with ethnicity and household size: Results from an observational cohort study.

Background: Accumulating evidence indicates that COVID-19 causes adverse outcomes in ethnic minority groups. However, little is known about the impact of ethnicity and household size on acquiring infection with SARS-CoV-2. Methods: We undertook a retrospective cohort study, in Leicester (UK), of all individuals assessed for COVID-19 with polymerase chain reaction (PCR) testing at University Hospitals of Leicester NHS Trust between 1st March and 28th April 2020. We used logistic regression to identify sociodemographic, clinical and temporal factors associated with SARS-CoV-2 PCR positivity before/after lockdown. Findings: 971/4051 (24.0%) patients with suspected COVID-19 were found to be PCR positive for SARS-CoV-2. PCR positivity was more common amongst individuals from ethnic minortiy backgrounds than their White counterparts (White 20.0%, South Asian 37.5%, Black 36.1%, Other 32.2%; p<0.001 for all ethnic minority groups vs White). After adjustment, compared to White ethnicity, South Asian (aOR 2.44 95%CI 2.01, 2.97), Black (aOR 2.56 95%CI 1.71, 3.84) and Other (aOR 2.53 95%CI 1.74, 3.70) ethnicities were more likely to test positive, as were those with a larger estimated household size (aOR 1.06 95%CI 1.02, 1.11). We saw increasing proportions of positive tests in the three weeks post-lockdown amongst the ethnic minority , but not the White, cohort. Estimated household size was associated with PCR positivity after, but not before, lockdown (aOR 1.10 95%CI 1.03, 1.16). Interpretation: In individuals presenting with suspected COVID-19, those from ethnic minority communities and larger households had an increased likelihood of SARS-CoV-2 PCR positivity. Pandemic control measures may have more rapid impact on slowing viral transmission amongst those of White ethnicity compared to ethnic minority groups, Research is urgently required to understand the mechanisms underlying these disparities and whether public health interventions have differential effects on individuals from ethnic minority groups. Funding: 10.13039/100006662 NIHR.

bame;covid-19;ethnicity;lockdown;sars-cov-2

Journal Article

Martin, Christopher A;Jenkins, David R;Minhas, Jatinder S;Gray, Laura J;Tang, Julian;Williams, Caroline;Sze, Shirley;Pan, Daniel;Jones, William;Verma, Raman;Knapp, Scott;Major, Rupert;Davies, Melanie;Brunskill, Nigel;Wiselka, Martin;Brightling, Chris;Khunti, Kamlesh;Haldar, Pranab;Pareek, Manish

10.1016/j.eclinm.2020.100466

[Title]: Socio-demographic heterogeneity in the prevalence of COVID-19 during lockdown is associated with ethnicity and household size: Results from an observational cohort study. [Abstract]: Background: Accumulating evidence indicates that COVID-19 causes adverse outcomes in ethnic minority groups. However, little is known about the impact of ethnicity and household size on acquiring infection with SARS-CoV-2. Methods: We undertook a retrospective cohort study, in Leicester (UK), of all individuals assessed for COVID-19 with polymerase chain reaction (PCR) testing at University Hospitals of Leicester NHS Trust between 1st March and 28th April 2020. We used logistic regression to identify sociodemographic, clinical and temporal factors associated with SARS-CoV-2 PCR positivity before/after lockdown. Findings: 971/4051 (24.0%) patients with suspected COVID-19 were found to be PCR positive for SARS-CoV-2. PCR positivity was more common amongst individuals from ethnic minortiy backgrounds than their White counterparts (White 20.0%, South Asian 37.5%, Black 36.1%, Other 32.2%; p<0.001 for all ethnic minority groups vs White). After adjustment, compared to White ethnicity, South Asian (aOR 2.44 95%CI 2.01, 2.97), Black (aOR 2.56 95%CI 1.71, 3.84) and Other (aOR 2.53 95%CI 1.74, 3.70) ethnicities were more likely to test positive, as were those with a larger estimated household size (aOR 1.06 95%CI 1.02, 1.11). We saw increasing proportions of positive tests in the three weeks post-lockdown amongst the ethnic minority , but not the White, cohort. Estimated household size was associated with PCR positivity after, but not before, lockdown (aOR 1.10 95%CI 1.03, 1.16). Interpretation: In individuals presenting with suspected COVID-19, those from ethnic minority communities and larger households had an increased likelihood of SARS-CoV-2 PCR positivity. Pandemic control measures may have more rapid impact on slowing viral transmission amongst those of White ethnicity compared to ethnic minority groups, Research is urgently required to understand the mechanisms underlying these disparities and whether public health interventions have differential effects on individuals from ethnic minority groups. Funding: 10.13039/100006662 NIHR. [Keywords]: bame;covid-19;ethnicity;lockdown;sars-cov-2

Turk J Biol

An insight into the epitope-based peptide vaccine design strategy and studies against COVID-19.

SARS-CoV-2 is a new member of the coronavirus family and caused the pandemic of coronavirus disease 2019 (COVID-19) in 2020. It is crucial to design and produce an effective vaccine for the prevention of rapid transmission and possible deaths wcaused by the disease. Although intensive work and research are being carried out all over the world to develop a vaccine, an effective and approved formulation that can prevent the infection and limit the outbreak has not been announced yet. Among all types of vaccines, epitope-based peptide vaccines outshine with their low-cost production, easy modification in the structure, and safety. In this review, vaccine studies against COVID-19 have been summarized and detailed information about the epitope-based peptide vaccines against COVID-19 has been provided. We have not only compared the peptide vaccine with other types of vaccines but also presented comprehensive literature information about development steps for an effective and protective formulation to give an insight into on-going peptide vaccine studies against SARS-CoV-2.

covid-19;sars-cov-2;adjuvant;epitope-based peptide vaccine design;immunoinformatics

Journal Article

TopuzoGullari, Murat;Acar, Tayfun;PelIt Arayici, Pelin;UCar, Burcu;UGurel, Erennur;Abamor, Emrah Sefik;ArasoGlu, Tulin;Turgut-Balik, Dilek;Derman, Serap

10.3906/biy-2006-1

[Title]: An insight into the epitope-based peptide vaccine design strategy and studies against COVID-19. [Abstract]: SARS-CoV-2 is a new member of the coronavirus family and caused the pandemic of coronavirus disease 2019 (COVID-19) in 2020. It is crucial to design and produce an effective vaccine for the prevention of rapid transmission and possible deaths wcaused by the disease. Although intensive work and research are being carried out all over the world to develop a vaccine, an effective and approved formulation that can prevent the infection and limit the outbreak has not been announced yet. Among all types of vaccines, epitope-based peptide vaccines outshine with their low-cost production, easy modification in the structure, and safety. In this review, vaccine studies against COVID-19 have been summarized and detailed information about the epitope-based peptide vaccines against COVID-19 has been provided. We have not only compared the peptide vaccine with other types of vaccines but also presented comprehensive literature information about development steps for an effective and protective formulation to give an insight into on-going peptide vaccine studies against SARS-CoV-2. [Keywords]: covid-19;sars-cov-2;adjuvant;epitope-based peptide vaccine design;immunoinformatics

Br J Sports Med

Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians.

SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competitive sport is being asked. Given the rapidly evolving knowledge base about the virus and changing governmental and public health recommendations, a precise answer to this question is fraught with complexity and nuance. Without robust data to inform policy, return-to-play (RTP) decisions are especially difficult for elite athletes on the suspicion that the COVID-19 virus could result in significant cardiorespiratory compromise in a minority of afflicted athletes. There are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia and extreme fatigue. To support safe RTP, we provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system. As new evidence emerges, guidance for a safe RTP should be updated.

cardiology;exercise;infection;respiratory

Journal Article;Review

Wilson, Mathew G;Hull, James H;Rogers, John;Pollock, Noel;Dodd, Miranda;Haines, Jemma;Harris, Sally;Loosemore, Mike;Malhotra, Aneil;Pieles, Guido;Shah, Anand;Taylor, Lesley;Vyas, Aashish;Haddad, Fares S;Sharma, Sanjay

10.1136/bjsports-2020-102710

[Title]: Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians. [Abstract]: SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competitive sport is being asked. Given the rapidly evolving knowledge base about the virus and changing governmental and public health recommendations, a precise answer to this question is fraught with complexity and nuance. Without robust data to inform policy, return-to-play (RTP) decisions are especially difficult for elite athletes on the suspicion that the COVID-19 virus could result in significant cardiorespiratory compromise in a minority of afflicted athletes. There are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia and extreme fatigue. To support safe RTP, we provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system. As new evidence emerges, guidance for a safe RTP should be updated. [Keywords]: cardiology;exercise;infection;respiratory

Am J Pathol

Eicosanoids: The Overlooked Storm in Coronavirus Disease 2019 (COVID-19)?

Severe coronavirus disease 2019 (COVID-19) symptoms, including systemic inflammatory response and multisystem organ failure, are now affecting thousands of infected patients and causing widespread mortality. Coronavirus infection causes tissue damage, which triggers the endoplasmic reticulum stress response and subsequent eicosanoid and cytokine storms. Although proinflammatory eicosanoids, including prostaglandins, thromboxanes, and leukotrienes, are critical mediators of physiological processes, such as inflammation, fever, allergy, and pain, their roles in COVID-19 are poorly characterized. Arachidonic acid-derived epoxyeicosatrienoic acids could alleviate the systemic hyperinflammatory response in COVID-19 infection by modulating endoplasmic reticulum stress and stimulating the resolution of inflammation. Soluble epoxide hydrolase (sEH) inhibitors, which increase endogenous epoxyeicosatrienoic acid levels, exhibit potent anti-inflammatory activity and inhibit various pathologic processes in preclinical disease models, including pulmonary fibrosis, thrombosis, and acute respiratory distress syndrome. Therefore, targeting eicosanoids and sEH could be a novel therapeutic approach in combating COVID-19. In this review, we discuss the predominant role of eicosanoids in regulating the inflammatory cascade and propose the potential application of sEH inhibitors in alleviating COVID-19 symptoms. The host-protective action of omega-3 fatty acid-derived epoxyeicosanoids and specialized proresolving mediators in regulating anti-inflammation and antiviral response is also discussed. Future studies determining the eicosanoid profile in COVID-19 patients or preclinical models are pivotal in providing novel insights into coronavirus-host interaction and inflammation modulation.

Journal Article;Research Support, N.I.H., Extramural;Research Support, Non-U.S. Gov't;Review

Hammock, Bruce D;Wang, Weicang;Gilligan, Molly M;Panigrahy, Dipak

10.1016/j.ajpath.2020.06.010

[Title]: Eicosanoids: The Overlooked Storm in Coronavirus Disease 2019 (COVID-19)? [Abstract]: Severe coronavirus disease 2019 (COVID-19) symptoms, including systemic inflammatory response and multisystem organ failure, are now affecting thousands of infected patients and causing widespread mortality. Coronavirus infection causes tissue damage, which triggers the endoplasmic reticulum stress response and subsequent eicosanoid and cytokine storms. Although proinflammatory eicosanoids, including prostaglandins, thromboxanes, and leukotrienes, are critical mediators of physiological processes, such as inflammation, fever, allergy, and pain, their roles in COVID-19 are poorly characterized. Arachidonic acid-derived epoxyeicosatrienoic acids could alleviate the systemic hyperinflammatory response in COVID-19 infection by modulating endoplasmic reticulum stress and stimulating the resolution of inflammation. Soluble epoxide hydrolase (sEH) inhibitors, which increase endogenous epoxyeicosatrienoic acid levels, exhibit potent anti-inflammatory activity and inhibit various pathologic processes in preclinical disease models, including pulmonary fibrosis, thrombosis, and acute respiratory distress syndrome. Therefore, targeting eicosanoids and sEH could be a novel therapeutic approach in combating COVID-19. In this review, we discuss the predominant role of eicosanoids in regulating the inflammatory cascade and propose the potential application of sEH inhibitors in alleviating COVID-19 symptoms. The host-protective action of omega-3 fatty acid-derived epoxyeicosanoids and specialized proresolving mediators in regulating anti-inflammation and antiviral response is also discussed. Future studies determining the eicosanoid profile in COVID-19 patients or preclinical models are pivotal in providing novel insights into coronavirus-host interaction and inflammation modulation. [Keywords]:

Eur Heart J Qual Care Clin Outcomes

Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic.

AIM: COVID-19 might have affected the care and outcomes of hospitalised acute myocardial infarction (AMI). We aimed to determine whether the COVID-19 pandemic changed patient response, hospital treatment and mortality from AMI. METHODS AND RESULTS: Admission were classified as non ST-elevation myocardial infarction (NSTEMI) or STEMI at 99 hospitals in England through live feeding from the Myocardial Ischaemia National Audit Project between 1st January, 2019 and 22nd May, 2020. Time series plots were estimated using a 7-day simple moving average, adjusted for seasonality. From 23rd March, 2020 (UK lockdown) median daily hospitalisations decreased more for NSTEMI (69 to 35; IRR 0.51, 95% CI 0.47-0.54) than STEMI (35 to 25; IRR 0.74, 95% CI 0.69-0.80) to a nadir on 19th April, 2020. During lockdown, patients were younger (mean age 68.7 years vs. 66.9 years), less frequently diabetic (24.6% vs. 28.1%) or had cerebrovascular disease (7.0% vs. 8.6%). STEMI more frequently received primary PCI (81.8% vs 78.8%%), thrombolysis was negligible (0.5% vs. 0.3%), median admission-to-coronary angiography duration for NSTEMI decreased (26.2 vs. 64.0 hours), median duration of hospitalisation decreased (4 to 2 days), secondary prevention pharmacotherapy prescription remained unchanged (each >94.7%). Mortality at 30 days increased for NSTEMI (from 5.4% to 7.5%; OR 1.41, 95% CI 1.08-1.80), but decreased for STEMI (from 10.2% to 7.7%; OR 0.73, 95% CI 0.54-0.97). CONCLUSIONS: During COVID-19, there was a substantial decline in admissions with AMI. Those who presented to hospital were younger, less co-morbid and, for NSTEMI, had higher 30-day mortality.

Journal Article

Wu, Jianhua;Mamas, Mamas;Rashid, Muhammad;Weston, Clive;Hains, Julian;Luescher, Tom;de Belder, Mark A;Deanfield, John E;Gale, Chris P

10.1093/ehjqcco/qcaa062

[Title]: Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic. [Abstract]: AIM: COVID-19 might have affected the care and outcomes of hospitalised acute myocardial infarction (AMI). We aimed to determine whether the COVID-19 pandemic changed patient response, hospital treatment and mortality from AMI. METHODS AND RESULTS: Admission were classified as non ST-elevation myocardial infarction (NSTEMI) or STEMI at 99 hospitals in England through live feeding from the Myocardial Ischaemia National Audit Project between 1st January, 2019 and 22nd May, 2020. Time series plots were estimated using a 7-day simple moving average, adjusted for seasonality. From 23rd March, 2020 (UK lockdown) median daily hospitalisations decreased more for NSTEMI (69 to 35; IRR 0.51, 95% CI 0.47-0.54) than STEMI (35 to 25; IRR 0.74, 95% CI 0.69-0.80) to a nadir on 19th April, 2020. During lockdown, patients were younger (mean age 68.7 years vs. 66.9 years), less frequently diabetic (24.6% vs. 28.1%) or had cerebrovascular disease (7.0% vs. 8.6%). STEMI more frequently received primary PCI (81.8% vs 78.8%%), thrombolysis was negligible (0.5% vs. 0.3%), median admission-to-coronary angiography duration for NSTEMI decreased (26.2 vs. 64.0 hours), median duration of hospitalisation decreased (4 to 2 days), secondary prevention pharmacotherapy prescription remained unchanged (each >94.7%). Mortality at 30 days increased for NSTEMI (from 5.4% to 7.5%; OR 1.41, 95% CI 1.08-1.80), but decreased for STEMI (from 10.2% to 7.7%; OR 0.73, 95% CI 0.54-0.97). CONCLUSIONS: During COVID-19, there was a substantial decline in admissions with AMI. Those who presented to hospital were younger, less co-morbid and, for NSTEMI, had higher 30-day mortality. [Keywords]:

Annu Int Conf IEEE Eng Med Biol Soc

DoMoMEA: a Home-Based Telerehabilitation System for Stroke Patients.

After a cerebral stroke, survivors need to follow a neurorehabilitation program including exercises to be executed under a therapist's supervision or autonomously. Technological solutions are needed to support the early discharge of the patients just after the primary hospital treatments, by still providing an adequate level of rehabilitation. The DoMoMEA Project proposes a fully-wearable m-health solution able to administer a neurorehabilitation therapy in the patient's home or every other place established by the patient for a rehabilitation session. The exploitation of magneto-inertial measurement units only, wirelessly connected to an Android-operated device, provides robustness to different operating conditions and immunity to optical occlusion problems, compared to RGB-D cameras. Patients' engagement is fostered by the exploitation of the exergame version of the ten rehabilitation exercises, implemented in Unity 3D. Store-and-forward telemonitoring features, supported by cloud-based storage and by a web application accessible from anywhere by medical personnel and patients, enable constant transparent monitoring of the rehabilitation progresses. The clinical trial of the DoMoMEA telerehabilitation system will involve 40 post-stroke patients with mild impairment and will start as soon as the restrictions due to the COVID-19 pandemic will allow to enroll patients.

Journal Article

Zedda, A;Gusai, E;Caruso, M;Bertuletti, S;Baldazzi, G;Spanu, S;Riboni, D;Pibiri, A;Monticone, M;Cereatti, A;Pani, D

10.1109/EMBC44109.2020.9175742

[Title]: DoMoMEA: a Home-Based Telerehabilitation System for Stroke Patients. [Abstract]: After a cerebral stroke, survivors need to follow a neurorehabilitation program including exercises to be executed under a therapist's supervision or autonomously. Technological solutions are needed to support the early discharge of the patients just after the primary hospital treatments, by still providing an adequate level of rehabilitation. The DoMoMEA Project proposes a fully-wearable m-health solution able to administer a neurorehabilitation therapy in the patient's home or every other place established by the patient for a rehabilitation session. The exploitation of magneto-inertial measurement units only, wirelessly connected to an Android-operated device, provides robustness to different operating conditions and immunity to optical occlusion problems, compared to RGB-D cameras. Patients' engagement is fostered by the exploitation of the exergame version of the ten rehabilitation exercises, implemented in Unity 3D. Store-and-forward telemonitoring features, supported by cloud-based storage and by a web application accessible from anywhere by medical personnel and patients, enable constant transparent monitoring of the rehabilitation progresses. The clinical trial of the DoMoMEA telerehabilitation system will involve 40 post-stroke patients with mild impairment and will start as soon as the restrictions due to the COVID-19 pandemic will allow to enroll patients. [Keywords]:

Eur Ann Allergy Clin Immunol

Urticaria and coronavirus infection: a lesson from SARS-CoV-2 pandemic.

Summary: Urticaria is a condition involving both skin and mucosal tissues characterized by the presence of wheals and/or angioedema. The acute form has been related to allergic reactions to drugs or foods, interaction with chemicals, or infections. We reviewed the association of urticaria with coronavirus infections. This review was carried out by the use of two search engines for published original articles, employing two key terms correlated to urticaria and viruses: "urticaria" and one term linked to each virus. The research of the relationships between SARS-CoV-2 and urticaria produced 18 papers (including a total of 114 cases). Surprisingly, the search for cases of urticaria in patients with SARS-CoV or MERS produced no results. We tried to interpret this discrepancy and attempted to analyze the possible pathogenesis of urticaria lesions in SARS-CoV-2.

covid19;mers-cov;sars-cov;sars-cov-2;allergy;urticaria

Journal Article;Review

Allegra, A;Asero, R;Giovannetti, A;Isola, S;Gangemi, S

10.23822/EurAnnACI.1764-1489.173

[Title]: Urticaria and coronavirus infection: a lesson from SARS-CoV-2 pandemic. [Abstract]: Summary: Urticaria is a condition involving both skin and mucosal tissues characterized by the presence of wheals and/or angioedema. The acute form has been related to allergic reactions to drugs or foods, interaction with chemicals, or infections. We reviewed the association of urticaria with coronavirus infections. This review was carried out by the use of two search engines for published original articles, employing two key terms correlated to urticaria and viruses: "urticaria" and one term linked to each virus. The research of the relationships between SARS-CoV-2 and urticaria produced 18 papers (including a total of 114 cases). Surprisingly, the search for cases of urticaria in patients with SARS-CoV or MERS produced no results. We tried to interpret this discrepancy and attempted to analyze the possible pathogenesis of urticaria lesions in SARS-CoV-2. [Keywords]: covid19;mers-cov;sars-cov;sars-cov-2;allergy;urticaria

J Stroke Cerebrovasc Dis

Clinician's Perception of Practice Changes for Stroke During the COVID-19 Pandemic.

BACKGROUND: Approach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey. METHODS: A 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication. RESULTS: Respondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P=0.047, 95% CI: 1.004-1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P=0.052, 95% CI: 0.988-10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P=0.023, 95% CI: 1.110-4.132). CONCLUSION: Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. There is also a reported reduction in stroke volume across hospitals. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients.

acute ischemic stroke;covid-19;quality and outcomes;stroke management

Journal Article;Observational Study

Kamdar, Hera A;Senay, Blake;Mainali, Shraddha;Lee, Vivien;Gulati, Deepak Kumar;Greene-Chandos, Diana;Hinduja, Archana;Strohm, Tamara

10.1016/j.jstrokecerebrovasdis.2020.105179

[Title]: Clinician's Perception of Practice Changes for Stroke During the COVID-19 Pandemic. [Abstract]: BACKGROUND: Approach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey. METHODS: A 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication. RESULTS: Respondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P=0.047, 95% CI: 1.004-1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P=0.052, 95% CI: 0.988-10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P=0.023, 95% CI: 1.110-4.132). CONCLUSION: Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. There is also a reported reduction in stroke volume across hospitals. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients. [Keywords]: acute ischemic stroke;covid-19;quality and outcomes;stroke management

Nat Commun

A panel of human neutralizing mAbs targeting SARS-CoV-2 spike at multiple epitopes.

The novel highly transmissible human coronavirus SARS-CoV-2 is the causative agent of the COVID-19 pandemic. Thus far, there is no approved therapeutic drug specifically targeting this emerging virus. Here we report the isolation and characterization of a panel of human neutralizing monoclonal antibodies targeting the SARS-CoV-2 receptor binding domain (RBD). These antibodies were selected from a phage display library constructed using peripheral circulatory lymphocytes collected from patients at the acute phase of the disease. These neutralizing antibodies are shown to recognize distinct epitopes on the viral spike RBD. A subset of the antibodies exert their inhibitory activity by abrogating binding of the RBD to the human ACE2 receptor. The human monoclonal antibodies described here represent a promising basis for the design of efficient combined post-exposure therapy for SARS-CoV-2 infection.

Journal Article

Noy-Porat, Tal;Makdasi, Efi;Alcalay, Ron;Mechaly, Adva;Levy, Yinon;Bercovich-Kinori, Adi;Zauberman, Ayelet;Tamir, Hadas;Yahalom-Ronen, Yfat;Israeli, Ma'ayan;Epstein, Eyal;Achdout, Hagit;Melamed, Sharon;Chitlaru, Theodor;Weiss, Shay;Peretz, Eldar;Rosen, Osnat;Paran, Nir;Yitzhaki, Shmuel;Shapira, Shmuel C;Israely, Tomer;Mazor, Ohad;Rosenfeld, Ronit

10.1038/s41467-020-18159-4

[Title]: A panel of human neutralizing mAbs targeting SARS-CoV-2 spike at multiple epitopes. [Abstract]: The novel highly transmissible human coronavirus SARS-CoV-2 is the causative agent of the COVID-19 pandemic. Thus far, there is no approved therapeutic drug specifically targeting this emerging virus. Here we report the isolation and characterization of a panel of human neutralizing monoclonal antibodies targeting the SARS-CoV-2 receptor binding domain (RBD). These antibodies were selected from a phage display library constructed using peripheral circulatory lymphocytes collected from patients at the acute phase of the disease. These neutralizing antibodies are shown to recognize distinct epitopes on the viral spike RBD. A subset of the antibodies exert their inhibitory activity by abrogating binding of the RBD to the human ACE2 receptor. The human monoclonal antibodies described here represent a promising basis for the design of efficient combined post-exposure therapy for SARS-CoV-2 infection. [Keywords]:

JAMA Netw Open

Comparison of Estimated Rates of Coronavirus Disease 2019 (COVID-19) in Border Counties in Iowa Without a Stay-at-Home Order and Border Counties in Illinois With a Stay-at-Home Order.

Importance: Iowa is 1 of 5 states in the US that have not issued a stay-at-home order during the coronavirus disease 2019 (COVID-19) pandemic. There is no empirical evidence on whether issuing a stay-at-home order in Iowa could have been associated with a reduced rate of COVID-19 infections in the state. Objective: To compare COVID-19 cases in border counties in Iowa, which did not issue a stay-at-home order, with cases in border counties in Illinois, which did issue a stay-at-home order. Design, Setting, and Participants: This cross-sectional study with a difference-in-differences design compared daily changes in COVID-19 cases per 10000 residents in 8 Iowa counties bordering Illinois with those in the 7 Illinois counties bordering Iowa before and after Illinois issued a stay-at-home order on March 21, 2020. Additional sensitivity analyses were conducted to account for differences in timing of closing schools and nonessential businesses between the 2 states and differential trends in COVID-19 cases by county population density and poverty rates. Exposures: Issuing a stay-at-home order. Main Outcomes and Measures: Comparison of cumulative cases of COVID-19 per 10000 residents in border counties in Iowa and Illinois. Results: The total populations were 462445 in the Iowa border counties and 272385 in the Illinois border counties. Population density was higher in the Iowa counties (114.2 people per square mile) than in the Illinois counties (78.2 people per square mile). Trends of cumulative COVID-19 cases per 10000 residents for the Iowa and Illinois border counties were comparable before the Illinois stay-at-home order, which went into effect at 5:00 pm on March 21 (March 15 to March 21: 0.024 per 10000 residents vs 0.026 per 10000 residents). After that, cases increased more quickly in Iowa and more slowly in Illinois. Within 10, 20, and 30 days after the enactment of the stay-at-home order in Illinois, the difference in cases was -0.51 per 10000 residents (SE, 0.09; 95% CI, -0.69 to -0.32; P < .001), -1.15 per 10000 residents (SE, 0.49; 95% CI, -2.12 to -0.18; P = .02), and -4.71 per 10000 residents (SE, 1.99; 95% CI, -8.64 to -0.78; P = .02), respectively. The estimates indicate excess cases in the border Iowa counties by as many as 217 cases after 1 month without a stay-at-home order. This estimate of excess cases represents 30.4% of the 716 total cases in those Iowa counties by that date. Sensitivity analyses addressing differences in timing of closing schools and nonessential businesses and differences in county population density and poverty rates between the 2 states supported these findings. Conclusions and Relevance: This cross-sectional study with a difference-in-differences design found an increase in estimated rates of COVID-19 cases per 10000 residents in the border counties in Iowa compared with the border counties in Illinois following a stay-at-home order that was implemented in Illinois but not in Iowa.

Comparative Study;Journal Article

Lyu, Wei;Wehby, George L

10.1001/jamanetworkopen.2020.11102

[Title]: Comparison of Estimated Rates of Coronavirus Disease 2019 (COVID-19) in Border Counties in Iowa Without a Stay-at-Home Order and Border Counties in Illinois With a Stay-at-Home Order. [Abstract]: Importance: Iowa is 1 of 5 states in the US that have not issued a stay-at-home order during the coronavirus disease 2019 (COVID-19) pandemic. There is no empirical evidence on whether issuing a stay-at-home order in Iowa could have been associated with a reduced rate of COVID-19 infections in the state. Objective: To compare COVID-19 cases in border counties in Iowa, which did not issue a stay-at-home order, with cases in border counties in Illinois, which did issue a stay-at-home order. Design, Setting, and Participants: This cross-sectional study with a difference-in-differences design compared daily changes in COVID-19 cases per 10000 residents in 8 Iowa counties bordering Illinois with those in the 7 Illinois counties bordering Iowa before and after Illinois issued a stay-at-home order on March 21, 2020. Additional sensitivity analyses were conducted to account for differences in timing of closing schools and nonessential businesses between the 2 states and differential trends in COVID-19 cases by county population density and poverty rates. Exposures: Issuing a stay-at-home order. Main Outcomes and Measures: Comparison of cumulative cases of COVID-19 per 10000 residents in border counties in Iowa and Illinois. Results: The total populations were 462445 in the Iowa border counties and 272385 in the Illinois border counties. Population density was higher in the Iowa counties (114.2 people per square mile) than in the Illinois counties (78.2 people per square mile). Trends of cumulative COVID-19 cases per 10000 residents for the Iowa and Illinois border counties were comparable before the Illinois stay-at-home order, which went into effect at 5:00 pm on March 21 (March 15 to March 21: 0.024 per 10000 residents vs 0.026 per 10000 residents). After that, cases increased more quickly in Iowa and more slowly in Illinois. Within 10, 20, and 30 days after the enactment of the stay-at-home order in Illinois, the difference in cases was -0.51 per 10000 residents (SE, 0.09; 95% CI, -0.69 to -0.32; P < .001), -1.15 per 10000 residents (SE, 0.49; 95% CI, -2.12 to -0.18; P = .02), and -4.71 per 10000 residents (SE, 1.99; 95% CI, -8.64 to -0.78; P = .02), respectively. The estimates indicate excess cases in the border Iowa counties by as many as 217 cases after 1 month without a stay-at-home order. This estimate of excess cases represents 30.4% of the 716 total cases in those Iowa counties by that date. Sensitivity analyses addressing differences in timing of closing schools and nonessential businesses and differences in county population density and poverty rates between the 2 states supported these findings. Conclusions and Relevance: This cross-sectional study with a difference-in-differences design found an increase in estimated rates of COVID-19 cases per 10000 residents in the border counties in Iowa compared with the border counties in Illinois following a stay-at-home order that was implemented in Illinois but not in Iowa. [Keywords]:

Virus Res

Anti-inflammatory drugs and the renin-angiotensin-aldosterone system: Current knowledge and potential effects on early SARS-CoV-2 infection.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of coronavirus disease 19 (COVID-19), and is genetically related to the 2003 SARS and Middle East respiratory syndrome (MERS-CoV) coronaviruses. Recent studies have reported that similar to SARS-CoV, this strain expresses a spike protein (S) with a receptor binding domain (RBD) that binds to angiotensin-converting enzyme 2 (ACE2) - an enzyme expressed mostly in the endothelium, kidneys, heart, gastrointestinal tract and lungs - to facilitate viral entry and intracellular replication. Incidentally, the renin-angiotensin-aldosterone system (RAAS) is integral to physiologic control of both ACE and ACE2 expression, and is an essential system utilized by SARS-CoV-2, albeit with varying schools of thought on how it can affect viral entry. In this paper, we will review current knowledge on the RAAS and how it can be affected by non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid use at the organ and cellular levels. We will then discuss the relevance of these interactions on organ-specific ACE2 expression, and provide scientific insights on how this mechanism can potentially affect SARS-CoV-2 infection in the early phases of disease. From the standpoint of other known viruses, we will then aim to discuss the potential uses or restrictions of these drugs in viral infection, and provide an update on relevant studies about COVID-19.

corticosteroids;nsaids;paracetamol;renin-angiotensin system;sars-cov-2;viral infection

Journal Article;Review

Cabbab, Iris Louise N;Manalo, Rafael Vincent M

10.1016/j.virusres.2020.198190

[Title]: Anti-inflammatory drugs and the renin-angiotensin-aldosterone system: Current knowledge and potential effects on early SARS-CoV-2 infection. [Abstract]: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of coronavirus disease 19 (COVID-19), and is genetically related to the 2003 SARS and Middle East respiratory syndrome (MERS-CoV) coronaviruses. Recent studies have reported that similar to SARS-CoV, this strain expresses a spike protein (S) with a receptor binding domain (RBD) that binds to angiotensin-converting enzyme 2 (ACE2) - an enzyme expressed mostly in the endothelium, kidneys, heart, gastrointestinal tract and lungs - to facilitate viral entry and intracellular replication. Incidentally, the renin-angiotensin-aldosterone system (RAAS) is integral to physiologic control of both ACE and ACE2 expression, and is an essential system utilized by SARS-CoV-2, albeit with varying schools of thought on how it can affect viral entry. In this paper, we will review current knowledge on the RAAS and how it can be affected by non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid use at the organ and cellular levels. We will then discuss the relevance of these interactions on organ-specific ACE2 expression, and provide scientific insights on how this mechanism can potentially affect SARS-CoV-2 infection in the early phases of disease. From the standpoint of other known viruses, we will then aim to discuss the potential uses or restrictions of these drugs in viral infection, and provide an update on relevant studies about COVID-19. [Keywords]: corticosteroids;nsaids;paracetamol;renin-angiotensin system;sars-cov-2;viral infection

World J Clin Cases

Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic.

The current corona virus disease 2019 outbreak caused by severe acute respiratory syndrome coronavirus 2 started in Wuhan, China in December 2019 and has put the world on alert. To safeguard Chinese citizens and to strengthen global health security, China has made great efforts to control the epidemic. Many in the global community have joined China to limit the epidemic. However, discrimination and prejudice driven by fear or misinformation have been flowing globally, superseding evidence and jeopardizing the anti-severe acute respiratory syndrome coronavirus 2 efforts. We analyze this phenomenon and its underlying causes and suggest practical solutions.

coronavirus;coronavirus disease 2019;discrimination;fear;outbreak;prejudice;severe acute respiratory syndrome;severe acute respiratory syndrome coronavirus 2

Journal Article;Review

Ren, Shi-Yan;Gao, Rong-Ding;Chen, Ye-Lin

10.12998/wjcc.v8.i4.652

[Title]: Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic. [Abstract]: The current corona virus disease 2019 outbreak caused by severe acute respiratory syndrome coronavirus 2 started in Wuhan, China in December 2019 and has put the world on alert. To safeguard Chinese citizens and to strengthen global health security, China has made great efforts to control the epidemic. Many in the global community have joined China to limit the epidemic. However, discrimination and prejudice driven by fear or misinformation have been flowing globally, superseding evidence and jeopardizing the anti-severe acute respiratory syndrome coronavirus 2 efforts. We analyze this phenomenon and its underlying causes and suggest practical solutions. [Keywords]: coronavirus;coronavirus disease 2019;discrimination;fear;outbreak;prejudice;severe acute respiratory syndrome;severe acute respiratory syndrome coronavirus 2

Daru

Classification of the present pharmaceutical agents based on the possible effective mechanism on the COVID-19 infection.

OBJECTIVES: There are several types of research on the COVID-19 disease which have been conducting. It seems that prevailing over the pandemic would be achieved only by mastering over the virus pathophysiology. We tried to categorize the massive amount of available information for useful interpretation. EVIDENCE ACQUISITION: We searched databases with different keywords and search strategies that focus on virulence and pathophysiology of COVID-19. The present review has aimed to gather and categorize all implemented drugs based on the susceptible virulence mechanisms, and the pathophysiological events in the host cells, discussing and suggesting treatments. RESULTS: As a result, the COVID-19 lifecycle were categorized as following steps: "Host Cell Attachment" which is mainly conducted with ACE2 receptors and TMPRSS2 from the host cell and Spike (S) protein, "Endocytosis Pathway" which is performed mainly by clathrin-mediated endocytosis, and "Viral Replication" which contains translation and replication of RNA viral genome. The virus pathogenicity is continued by "Inflammatory Reactions" which mainly caused moderate to severe COVID-19 disease. Besides, the possible effective therapeutics' mechanism and the pharmaceutical agents that had at least one experience as a preclinical or clinical study on COVID-19 were clearly defined. CONCLUSION: The treatment protocol would be occasional based on the stage of the infection and the patient situation. The cocktail of medicines, which could affect almost all mentioned stages of COVID-19 disease, might be vital for patients with severe phenomena. The classification of the possible mechanism of medicines based on COVID-19 pathogenicity.

covid-19;coronaviruses;drug classification;pandemic;pharmaceutical agents;possible treatments;sars-cov-2

Journal Article;Review

Amini Pouya, Maryam;Afshani, Seyyedeh Maryam;Maghsoudi, Armin Salek;Hassani, Shokoufeh;Mirnia, Kayvan

10.1007/s40199-020-00359-4

[Title]: Classification of the present pharmaceutical agents based on the possible effective mechanism on the COVID-19 infection. [Abstract]: OBJECTIVES: There are several types of research on the COVID-19 disease which have been conducting. It seems that prevailing over the pandemic would be achieved only by mastering over the virus pathophysiology. We tried to categorize the massive amount of available information for useful interpretation. EVIDENCE ACQUISITION: We searched databases with different keywords and search strategies that focus on virulence and pathophysiology of COVID-19. The present review has aimed to gather and categorize all implemented drugs based on the susceptible virulence mechanisms, and the pathophysiological events in the host cells, discussing and suggesting treatments. RESULTS: As a result, the COVID-19 lifecycle were categorized as following steps: "Host Cell Attachment" which is mainly conducted with ACE2 receptors and TMPRSS2 from the host cell and Spike (S) protein, "Endocytosis Pathway" which is performed mainly by clathrin-mediated endocytosis, and "Viral Replication" which contains translation and replication of RNA viral genome. The virus pathogenicity is continued by "Inflammatory Reactions" which mainly caused moderate to severe COVID-19 disease. Besides, the possible effective therapeutics' mechanism and the pharmaceutical agents that had at least one experience as a preclinical or clinical study on COVID-19 were clearly defined. CONCLUSION: The treatment protocol would be occasional based on the stage of the infection and the patient situation. The cocktail of medicines, which could affect almost all mentioned stages of COVID-19 disease, might be vital for patients with severe phenomena. The classification of the possible mechanism of medicines based on COVID-19 pathogenicity. [Keywords]: covid-19;coronaviruses;drug classification;pandemic;pharmaceutical agents;possible treatments;sars-cov-2

Exp Ther Med

IgY - turning the page toward passive immunization in COVID-19 infection (Review).

The world is facing one of the major outbreaks of viral infection of the modern history, however, as vaccine development workflow is still tedious and can not control the infection spreading, researchers are turning to passive immunization as a good and quick alternative to treat and contain the spreading. Within passive immunization domain, raising specific immunoglobulin (Ig)Y against acute respiratory tract infection has been developing for more than 20 years. Far from being an obsolete chapter we will revise the IgY-technology as a new frontier for research and clinic. A wide range of IgY applications has been effectively confirmed in both human and animal health. The molecular particularities of IgY give them functional advantages recommending them as good candidates in this endeavor. Obtaining specific IgY is sustained by reliable and nature friendly methodology as an alternative for mammalian antibodies. The aria of application is continuously enlarging from bacterial and viral infections to tumor biology. Specific anti-viral IgY were previously tested in several designs, thus its worth pointing out that in the actual COVID-19 pandemic context, respiratory infections need an enlarged arsenal of therapeutic approaches and clearly the roles of IgY should be exploited in depth.

covid-19;igy;acute respiratory infection;immunoglobulin

Journal Article;Review

Constantin, Carolina;Neagu, Monica;Diana Supeanu, Teodora;Chiurciu, Viorica;A Spandidos, Demetrios

10.3892/etm.2020.8704

[Title]: IgY - turning the page toward passive immunization in COVID-19 infection (Review). [Abstract]: The world is facing one of the major outbreaks of viral infection of the modern history, however, as vaccine development workflow is still tedious and can not control the infection spreading, researchers are turning to passive immunization as a good and quick alternative to treat and contain the spreading. Within passive immunization domain, raising specific immunoglobulin (Ig)Y against acute respiratory tract infection has been developing for more than 20 years. Far from being an obsolete chapter we will revise the IgY-technology as a new frontier for research and clinic. A wide range of IgY applications has been effectively confirmed in both human and animal health. The molecular particularities of IgY give them functional advantages recommending them as good candidates in this endeavor. Obtaining specific IgY is sustained by reliable and nature friendly methodology as an alternative for mammalian antibodies. The aria of application is continuously enlarging from bacterial and viral infections to tumor biology. Specific anti-viral IgY were previously tested in several designs, thus its worth pointing out that in the actual COVID-19 pandemic context, respiratory infections need an enlarged arsenal of therapeutic approaches and clearly the roles of IgY should be exploited in depth. [Keywords]: covid-19;igy;acute respiratory infection;immunoglobulin

Br J Oral Maxillofac Surg

Setting up and maximising the usage of an Urgent Dental Care Centre in Blackpool. Sharing our experiences.

An integrated Urgent Dental Care Centre with Tier 2 Oral Surgery support was set up in Blackpool starting 24(th) March 2020. This was in reaction to the COVID-19 pandemic. In the first month 1433 patients had telephone consultations and 713 extractions were performed. The challenges surrounding set up and continuity of care are discussed.

covid-19;exodontia;ppe;udcc;patient safety;staff protection

Journal Article

Hammond, D;Hughes, F;Stirrup, P;Barkworth, N

10.1016/j.bjoms.2020.05.008

[Title]: Setting up and maximising the usage of an Urgent Dental Care Centre in Blackpool. Sharing our experiences. [Abstract]: An integrated Urgent Dental Care Centre with Tier 2 Oral Surgery support was set up in Blackpool starting 24(th) March 2020. This was in reaction to the COVID-19 pandemic. In the first month 1433 patients had telephone consultations and 713 extractions were performed. The challenges surrounding set up and continuity of care are discussed. [Keywords]: covid-19;exodontia;ppe;udcc;patient safety;staff protection

J Infect Dev Ctries

Spatial-temporal distribution of COVID-19 in China and its prediction: A data-driven modeling analysis.

Currently, the outbreak of COVID-19 is rapidly spreading especially in Wuhan city, and threatens 14 million people in central China. In the present study we applied the Moran index, a strong statistical tool, to the spatial panel to show that COVID-19 infection is spatially dependent and mainly spread from Hubei Province in Central China to neighbouring areas. Logistic model was employed according to the trend of available data, which shows the difference between Hubei Province and outside of it. We also calculated the reproduction number R0 for the range of [2.23, 2.51] via SEIR model. The measures to reduce or prevent the virus spread should be implemented, and we expect our data-driven modeling analysis providing some insights to identify and prepare for the future virus control.

covid-19;logistic model;seir;spatial-temporal distribution

Journal Article

Huang, Rui;Liu, Miao;Ding, Yongmei

10.3855/jidc.12585

[Title]: Spatial-temporal distribution of COVID-19 in China and its prediction: A data-driven modeling analysis. [Abstract]: Currently, the outbreak of COVID-19 is rapidly spreading especially in Wuhan city, and threatens 14 million people in central China. In the present study we applied the Moran index, a strong statistical tool, to the spatial panel to show that COVID-19 infection is spatially dependent and mainly spread from Hubei Province in Central China to neighbouring areas. Logistic model was employed according to the trend of available data, which shows the difference between Hubei Province and outside of it. We also calculated the reproduction number R0 for the range of [2.23, 2.51] via SEIR model. The measures to reduce or prevent the virus spread should be implemented, and we expect our data-driven modeling analysis providing some insights to identify and prepare for the future virus control. [Keywords]: covid-19;logistic model;seir;spatial-temporal distribution

Cleve Clin J Med

Keeping lupus patients on hydroxychloroquine during the COVID-19 pandemic.

Hydroxychloroquine (HCQ) is in short supply as a result of the coronavirus disease 2019 (COVID-19) pandemic, presenting a challenge to rheumatologists to ensure their patients with systemic lupus erythematosus (SLE) continue to take this essential drug. HCQ is the only SLE treatment shown to increase survival and any change in the HCQ regimen is potentially dangerous. Changes in the HCQ regimen should be made jointly with the patient after a discussion of the available evidence and expert opinion and the patient's preferences. Providers need to make thoughtful, informed decisions in this time of medication shortage.

Journal Article

Littlejohn, Emily

10.3949/ccjm.87a.ccc023

[Title]: Keeping lupus patients on hydroxychloroquine during the COVID-19 pandemic. [Abstract]: Hydroxychloroquine (HCQ) is in short supply as a result of the coronavirus disease 2019 (COVID-19) pandemic, presenting a challenge to rheumatologists to ensure their patients with systemic lupus erythematosus (SLE) continue to take this essential drug. HCQ is the only SLE treatment shown to increase survival and any change in the HCQ regimen is potentially dangerous. Changes in the HCQ regimen should be made jointly with the patient after a discussion of the available evidence and expert opinion and the patient's preferences. Providers need to make thoughtful, informed decisions in this time of medication shortage. [Keywords]:

J Assist Reprod Genet

Installing oncofertility programs for common cancers in limited resource settings (Repro-Can-OPEN Study): An extrapolation during the global crisis of Coronavirus (COVID-19) pandemic.

PURPOSE: The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer. METHODS: As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. RESULTS: All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings. CONCLUSIONS: Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises.

covid-19;cancer;limited resource settings;oncofertility;pandemic

Journal Article

Salama, M;Ataman-Millhouse, L;Braham, M;Berjeb, K;Khrouf, M;Rodrigues, J K;Reis, F M;Silva, T Cury-;Sanchez, F;Romero, S;Smitz, J;Vasquez, L;Vega, M;Sobral, F;Terrado, G;Lombardi, M G;Scarella, A;Bourlon, M T;Verduzco-Aguirre, H;Sanchez, A M;Adiga, S K;Tholeti, P;Udupa, K S;Mahajan, N;Patil, M;Dalvi, R;Venter, C;Demetriou, G;Geel, J;Quintana, R;Rodriguez, G;Quintana, T;Viale, L;Fraguglia, M;Coirini, M;Remolina-Bonilla, Y A;Noguera, J A R;Velasquez, J C;Suarez, A;Arango, G D;Pineda, J I D;Aldecoa, M D C;Javed, M;Al Sufyan, H;Daniels, N;Oranye, B C;Ogunmokun, A A;Onwuzurigbo, K I;Okereke, C J;Whesu, T C;Woodruff, T K

10.1007/s10815-020-01821-7

[Title]: Installing oncofertility programs for common cancers in limited resource settings (Repro-Can-OPEN Study): An extrapolation during the global crisis of Coronavirus (COVID-19) pandemic. [Abstract]: PURPOSE: The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer. METHODS: As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. RESULTS: All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings. CONCLUSIONS: Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises. [Keywords]: covid-19;cancer;limited resource settings;oncofertility;pandemic

Rhinology

Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers - A systematic review of the literature, case series, and recommendations for clinical assessment and management.

BACKGROUND: Healthcare workers are at the forefront of the ongoing COVID-19 pandemic and are at high risk for both the contraction and subsequent spread of virus. Understanding the role of anosmia as an early symptom of infection may improve monitoring and management of SARS-CoV2 infection. METHODOLOGY: We conducted a systematic review of the literature of SARS-CoV2 infection/COVID-19 and anosmia to help inform management of anosmia in healthcare works. We report a case series of healthcare workers, who presented with a loss of sense of smell secondary to COVID-19 infection to demonstrate management principles. RT-PCR was used to confirm COVID-19 positivity and psychophysical testing of olfaction was performed using the British version of the University of Pennsylvania Smell Identification Test, UPSIT. RESULTS: The systematic literature search returned 31 articles eligible for inclusion in the study and informed our recommendations for clinical assessment and management. All three healthcare professionals who presented with loss of sense of smell subsequently tested positive for SARS-CoV-2. Psychophysical testing of olfaction using the UPSIT confirmed mild and moderate microsmia in two, respectively, and normosmia at day 17 in one. CONCLUSIONS: Olfactory (A+/- gustatory) dysfunction is indicative of COVID-19 infection and thus has important implications in the context of healthcare workers, or key workers in general, who work in close contact with others if not recognised as suffering from COVID. This leads to a potentially higher likelihood of spreading the virus. In conjunction with our literature review these findings have helped with creating recommendations on the assessment and management of olfactory dysfunction during the ongoing COVID-19 pandemic, both for healthcare workers and patients.

Journal Article;Systematic Review

Lechner, M;Chandrasekharan, D;Jumani, K;Liu, J;Gane, S;Lund, V J;Philpott, C;Jayaraj, S

10.4193/Rhin20.189

[Title]: Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers - A systematic review of the literature, case series, and recommendations for clinical assessment and management. [Abstract]: BACKGROUND: Healthcare workers are at the forefront of the ongoing COVID-19 pandemic and are at high risk for both the contraction and subsequent spread of virus. Understanding the role of anosmia as an early symptom of infection may improve monitoring and management of SARS-CoV2 infection. METHODOLOGY: We conducted a systematic review of the literature of SARS-CoV2 infection/COVID-19 and anosmia to help inform management of anosmia in healthcare works. We report a case series of healthcare workers, who presented with a loss of sense of smell secondary to COVID-19 infection to demonstrate management principles. RT-PCR was used to confirm COVID-19 positivity and psychophysical testing of olfaction was performed using the British version of the University of Pennsylvania Smell Identification Test, UPSIT. RESULTS: The systematic literature search returned 31 articles eligible for inclusion in the study and informed our recommendations for clinical assessment and management. All three healthcare professionals who presented with loss of sense of smell subsequently tested positive for SARS-CoV-2. Psychophysical testing of olfaction using the UPSIT confirmed mild and moderate microsmia in two, respectively, and normosmia at day 17 in one. CONCLUSIONS: Olfactory (A+/- gustatory) dysfunction is indicative of COVID-19 infection and thus has important implications in the context of healthcare workers, or key workers in general, who work in close contact with others if not recognised as suffering from COVID. This leads to a potentially higher likelihood of spreading the virus. In conjunction with our literature review these findings have helped with creating recommendations on the assessment and management of olfactory dysfunction during the ongoing COVID-19 pandemic, both for healthcare workers and patients. [Keywords]:

Clin J Oncol Nurs

Telegenetics: Remote Counseling During the COVID-19 Pandemic.

During the COVID-19 pandemic, in-person provision of cancer genetic counseling and education services was not possible for a prolonged period. This article outlines why such services can continue remotely, despite the disruption of a pandemic, as well as describes the strengths and limitations of remote counseling to individuals and families about their hereditary risk for developing cancer. Considerations for the provision of remote counseling and some of the challenges of telehealth, with potential solutions, are described.

covid-19;genetic counseling;genetics;remote delivery;telegenetics;telehealth

Journal Article

Mahon, Suzanne M

10.1188/20.CJON.244-248

[Title]: Telegenetics: Remote Counseling During the COVID-19 Pandemic. [Abstract]: During the COVID-19 pandemic, in-person provision of cancer genetic counseling and education services was not possible for a prolonged period. This article outlines why such services can continue remotely, despite the disruption of a pandemic, as well as describes the strengths and limitations of remote counseling to individuals and families about their hereditary risk for developing cancer. Considerations for the provision of remote counseling and some of the challenges of telehealth, with potential solutions, are described. [Keywords]: covid-19;genetic counseling;genetics;remote delivery;telegenetics;telehealth

J Med Internet Res

Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens.

BACKGROUND: Since its outbreak in January 2020, COVID-19 has quickly spread worldwide and has become a global pandemic. Social media platforms have been recognized as important tools for health-promoting practices in public health, and the use of social media is widespread among the public. However, little is known about the effects of social media use on health promotion during a pandemic such as COVID-19. OBJECTIVE: In this study, we aimed to explore the predictive role of social media use on public preventive behaviors in China during the COVID-19 pandemic and how disease knowledge and eHealth literacy moderated the relationship between social media use and preventive behaviors. METHODS: A national web-based cross-sectional survey was conducted by a proportionate probability sampling among 802 Chinese internet users ("netizens") in February 2020. Descriptive statistics, Pearson correlations, and hierarchical multiple regressions were employed to examine and explore the relationships among all the variables. RESULTS: Almost half the 802 study participants were male (416, 51.9%), and the average age of the participants was 32.65 years. Most of the 802 participants had high education levels (624, 77.7%), had high income > yen5000 (US $736.29) (525, 65.3%), were married (496, 61.8%), and were in good health (486, 60.6%). The average time of social media use was approximately 2 to 3 hours per day (mean 2.34 hours, SD 1.11), and the most frequently used media types were public social media (mean score 4.49/5, SD 0.78) and aggregated social media (mean score 4.07/5, SD 1.07). Social media use frequency (beta=.20, P<.001) rather than time significantly predicted preventive behaviors for COVID-19. Respondents were also equipped with high levels of disease knowledge (mean score 8.15/10, SD 1.43) and eHealth literacy (mean score 3.79/5, SD 0.59). Disease knowledge (beta=.11, P=.001) and eHealth literacy (beta=.27, P<.001) were also significant predictors of preventive behaviors. Furthermore, eHealth literacy (P=.038) and disease knowledge (P=.03) positively moderated the relationship between social media use frequency and preventive behaviors, while eHealth literacy (beta=.07) affected this relationship positively and disease knowledge (beta=-.07) affected it negatively. Different social media types differed in predicting an individual's preventive behaviors for COVID-19. Aggregated social media (beta=.22, P<.001) was the best predictor, followed by public social media (beta=.14, P<.001) and professional social media (beta=.11, P=.002). However, official social media (beta=.02, P=.597) was an insignificant predictor. CONCLUSIONS: Social media is an effective tool to promote behaviors to prevent COVID-19 among the public. Health literacy is essential for promotion of individual health and influences the extent to which the public engages in preventive behaviors during a pandemic. Our results not only enrich the theoretical paradigm of public health management and health communication but also have practical implications in pandemic control for China and other countries.

covid-19;disease knowledge;ehealth literacy;media use;pandemic;preventive behaviors;public health;social media

Journal Article

Li, Xiaojing;Liu, Qinliang

10.2196/19684

[Title]: Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens. [Abstract]: BACKGROUND: Since its outbreak in January 2020, COVID-19 has quickly spread worldwide and has become a global pandemic. Social media platforms have been recognized as important tools for health-promoting practices in public health, and the use of social media is widespread among the public. However, little is known about the effects of social media use on health promotion during a pandemic such as COVID-19. OBJECTIVE: In this study, we aimed to explore the predictive role of social media use on public preventive behaviors in China during the COVID-19 pandemic and how disease knowledge and eHealth literacy moderated the relationship between social media use and preventive behaviors. METHODS: A national web-based cross-sectional survey was conducted by a proportionate probability sampling among 802 Chinese internet users ("netizens") in February 2020. Descriptive statistics, Pearson correlations, and hierarchical multiple regressions were employed to examine and explore the relationships among all the variables. RESULTS: Almost half the 802 study participants were male (416, 51.9%), and the average age of the participants was 32.65 years. Most of the 802 participants had high education levels (624, 77.7%), had high income > yen5000 (US $736.29) (525, 65.3%), were married (496, 61.8%), and were in good health (486, 60.6%). The average time of social media use was approximately 2 to 3 hours per day (mean 2.34 hours, SD 1.11), and the most frequently used media types were public social media (mean score 4.49/5, SD 0.78) and aggregated social media (mean score 4.07/5, SD 1.07). Social media use frequency (beta=.20, P<.001) rather than time significantly predicted preventive behaviors for COVID-19. Respondents were also equipped with high levels of disease knowledge (mean score 8.15/10, SD 1.43) and eHealth literacy (mean score 3.79/5, SD 0.59). Disease knowledge (beta=.11, P=.001) and eHealth literacy (beta=.27, P<.001) were also significant predictors of preventive behaviors. Furthermore, eHealth literacy (P=.038) and disease knowledge (P=.03) positively moderated the relationship between social media use frequency and preventive behaviors, while eHealth literacy (beta=.07) affected this relationship positively and disease knowledge (beta=-.07) affected it negatively. Different social media types differed in predicting an individual's preventive behaviors for COVID-19. Aggregated social media (beta=.22, P<.001) was the best predictor, followed by public social media (beta=.14, P<.001) and professional social media (beta=.11, P=.002). However, official social media (beta=.02, P=.597) was an insignificant predictor. CONCLUSIONS: Social media is an effective tool to promote behaviors to prevent COVID-19 among the public. Health literacy is essential for promotion of individual health and influences the extent to which the public engages in preventive behaviors during a pandemic. Our results not only enrich the theoretical paradigm of public health management and health communication but also have practical implications in pandemic control for China and other countries. [Keywords]: covid-19;disease knowledge;ehealth literacy;media use;pandemic;preventive behaviors;public health;social media

Nature

SARS-CoV-2 vaccines in development.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in late 2019 in China and is the causative agent of the coronavirus disease 2019 (COVID-19) pandemic. To mitigate the effects of the virus on public health, the economy and society, a vaccine is urgently needed. Here I review the development of vaccines against SARS-CoV-2. Development was initiated when the genetic sequence of the virus became available in early January 2020, and has moved at an unprecedented speed: a phase I trial started in March 2020 and there are currently more than 180 vaccines at various stages of development. Data from phase I and phase II trials are already available for several vaccine candidates, and many have moved into phase III trials. The data available so far suggest that effective and safe vaccines might become available within months, rather than years.

Journal Article;Research Support, N.I.H., Extramural;Research Support, Non-U.S. Gov't;Review

Krammer, Florian

10.1038/s41586-020-2798-3

[Title]: SARS-CoV-2 vaccines in development. [Abstract]: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in late 2019 in China and is the causative agent of the coronavirus disease 2019 (COVID-19) pandemic. To mitigate the effects of the virus on public health, the economy and society, a vaccine is urgently needed. Here I review the development of vaccines against SARS-CoV-2. Development was initiated when the genetic sequence of the virus became available in early January 2020, and has moved at an unprecedented speed: a phase I trial started in March 2020 and there are currently more than 180 vaccines at various stages of development. Data from phase I and phase II trials are already available for several vaccine candidates, and many have moved into phase III trials. The data available so far suggest that effective and safe vaccines might become available within months, rather than years. [Keywords]:

Front Public Health

A Low Viral Dose in COVID-19 Patient: A Case Report.

SARS-CoV-2 outbreak has attracted global attention. Verifying the presence of viral RNA is the gold standard for the diagnosis of COVID-19. However, RT-qPCR diagnosis often fails to catch infected patients, because of inconsistent swab sample collection. Here we report a case that showed 5 consecutive negative and 1 low-viral- dose RT-qPCR results during illness spanning over 20 days. Clinical symptoms suggest SARS-CoV-2 infection with typical ground glass like a lung in computed tomography. SARS-CoV-2 infection was serologically confirmed by the presence of anti-SARS-CoV-2 specific antibodies in patients' serum. Finally, a high level of protective IgG was produced after the patient recovered. Surprisingly, as a barber and a housewife staying at home for the first 2 weeks after the onset of illness, none of the close contacts were infected, showing a case of low viral load and low infectivity in this patient.

covid-19 patient;iga;igg;igm;rt-qpcr

Case Reports

Li, Yajuan;Hu, Xianwei;Tu, Youhui;Wu, Tao;Wang, Bo;Ma, Huan;Zeng, Weihong;Zhao, Dan;Mengist, Hylemariam Mihiretie;Kombe, Arnaud John Kombe;Zheng, Meijuan;Xu, Yuanhong;Jin, Tengchuan

10.3389/fpubh.2020.00339

[Title]: A Low Viral Dose in COVID-19 Patient: A Case Report. [Abstract]: SARS-CoV-2 outbreak has attracted global attention. Verifying the presence of viral RNA is the gold standard for the diagnosis of COVID-19. However, RT-qPCR diagnosis often fails to catch infected patients, because of inconsistent swab sample collection. Here we report a case that showed 5 consecutive negative and 1 low-viral- dose RT-qPCR results during illness spanning over 20 days. Clinical symptoms suggest SARS-CoV-2 infection with typical ground glass like a lung in computed tomography. SARS-CoV-2 infection was serologically confirmed by the presence of anti-SARS-CoV-2 specific antibodies in patients' serum. Finally, a high level of protective IgG was produced after the patient recovered. Surprisingly, as a barber and a housewife staying at home for the first 2 weeks after the onset of illness, none of the close contacts were infected, showing a case of low viral load and low infectivity in this patient. [Keywords]: covid-19 patient;iga;igg;igm;rt-qpcr

Health Educ Res

The media and health education: Did Nigerian media provide sufficient warning messages on coronavirus disease?

Previous studies on media coverage of health issues hardly recognize the role of time in moderating media contents. Instead, scholars most often examine how news media report health issues. In this study, we recognized the role of time by taking into account how media report differs based on when a global outbreak is confirmed in a country and when it is not. We focused on coronavirus disease 2019 (COVID-19) and examined six media-two TV stations, two newspapers and two radio stations. We content-analysed 537 stories and found that there were few stories about the virus before it was confirmed in Nigeria. But as soon as Nigeria recorded a confirmed case, the number of stories tripled. We also noticed that story format and recommendation on health behaviour were also closely linked to the COVID-19 status of Nigeria. However, we did not find an association between Nigeria's COVID-19 status and policy recommendation among the media studied. Therefore, this study concludes that Nigerian media did not provide sufficient health warning messages on COVID-19 before its spread to the country.

Journal Article

Gever, Verlumun Celestine;Ezeah, Gregory

10.1093/her/cyaa020

[Title]: The media and health education: Did Nigerian media provide sufficient warning messages on coronavirus disease? [Abstract]: Previous studies on media coverage of health issues hardly recognize the role of time in moderating media contents. Instead, scholars most often examine how news media report health issues. In this study, we recognized the role of time by taking into account how media report differs based on when a global outbreak is confirmed in a country and when it is not. We focused on coronavirus disease 2019 (COVID-19) and examined six media-two TV stations, two newspapers and two radio stations. We content-analysed 537 stories and found that there were few stories about the virus before it was confirmed in Nigeria. But as soon as Nigeria recorded a confirmed case, the number of stories tripled. We also noticed that story format and recommendation on health behaviour were also closely linked to the COVID-19 status of Nigeria. However, we did not find an association between Nigeria's COVID-19 status and policy recommendation among the media studied. Therefore, this study concludes that Nigerian media did not provide sufficient health warning messages on COVID-19 before its spread to the country. [Keywords]:

Med J Armed Forces India

The infodemics of COVID-19 amongst healthcare professionals in India.

Background: There is a deluge of information and misinformation about COVID-19. The present survey was conducted to explore the sources of information /misinformation for healthcare professionals from India. Methods: A cross-sectional online survey using snowballing technique was conducted from 24 Mar to 10 Apr 2020. The questionnaire was pretested and developed using standard techniques. It was circulated among medical students and physicians. Data were analysed using the STATA software. Results: Data of 758 participants were analysed. A total of 255 (33.6%) medical students, 335 (44.2%) nonspecialists and 168 (22.1%) specialists participated. The most common source of formal and informal information was official government websites and online news, respectively. A total of 517 (68.2%) participants accepted receiving misinformation. Social media and family and friends were the most common sources of misinformation. Seventy-two percent of participants agreed that spread of information helped to contain COVID-19, but more than that 75% agreed to having received inaccurate information. Seventy-four percent of respondents felt the need for regulation of information during such times; 26% and 33% felt that information about COVID-19 made them feel uncomfortable and distracts routine decision-making, respectively, and 50% felt it was difficult to differentiate correct from incorrect information about COVID-19. Conclusion: The study explored the sources of information and misinformation and found a high prevalence of misinformation, especially from social media. We suggest the need to better manage the flow of information so that it can be an effective weapon against SARS-CoV2. There is a need for doctors to adapt to the changing times of infodemics accompanying pandemics.

covid-19;infodemic;misinformation;pandemic;sars-cov2

Journal Article

Datta, Rakesh;Yadav, A K;Singh, Anubhav;Datta, Karuna;Bansal, Ankur

10.1016/j.mjafi.2020.05.009

[Title]: The infodemics of COVID-19 amongst healthcare professionals in India. [Abstract]: Background: There is a deluge of information and misinformation about COVID-19. The present survey was conducted to explore the sources of information /misinformation for healthcare professionals from India. Methods: A cross-sectional online survey using snowballing technique was conducted from 24 Mar to 10 Apr 2020. The questionnaire was pretested and developed using standard techniques. It was circulated among medical students and physicians. Data were analysed using the STATA software. Results: Data of 758 participants were analysed. A total of 255 (33.6%) medical students, 335 (44.2%) nonspecialists and 168 (22.1%) specialists participated. The most common source of formal and informal information was official government websites and online news, respectively. A total of 517 (68.2%) participants accepted receiving misinformation. Social media and family and friends were the most common sources of misinformation. Seventy-two percent of participants agreed that spread of information helped to contain COVID-19, but more than that 75% agreed to having received inaccurate information. Seventy-four percent of respondents felt the need for regulation of information during such times; 26% and 33% felt that information about COVID-19 made them feel uncomfortable and distracts routine decision-making, respectively, and 50% felt it was difficult to differentiate correct from incorrect information about COVID-19. Conclusion: The study explored the sources of information and misinformation and found a high prevalence of misinformation, especially from social media. We suggest the need to better manage the flow of information so that it can be an effective weapon against SARS-CoV2. There is a need for doctors to adapt to the changing times of infodemics accompanying pandemics. [Keywords]: covid-19;infodemic;misinformation;pandemic;sars-cov2

Cont Lens Anterior Eye

Influence of the COVID-19 pandemic on contact lens wear in Spain.

PURPOSE: To investigate the behaviour of contact lens (CL) wearers in Spain during the COVID-19 pandemic. METHODS: An anonymized web-based questionnaire was used to assess demographics, CL history, and activity, CL wear habits and perceived risk of infection due to CL wear during the COVID-19 pandemic. RESULTS: A total of 737 participants with an average age of 27.4 (+/-9.3) years completed the online questionnaire. The vast majority of respondents were soft CL wearers and reported at least two years of CL wear. Patients concerns about the increased risk of SARS-CoV-2 infection due to CL wear (40.6 % of participants) were significantly related (chi(2)(1)=11.195, p<0.05) to CL discontinuation (46 % of participants) during the COVID-19 pandemic. This fact joins the significant changes in the frequency of CL wear during the COVID-19 pandemic (chi(2)(4)=31.982, p<0.05), with a tendency to increase occasional CL wear from 29.1 % to 61.8 %. Interestingly, the majority of respondent (87.9 %) indicated that no professional had offered them information related to CL wear and COVID-19, and that they had not sought it on their own (82.2 %). CONCLUSION: There is a relationship between the perceived risk of infection and CL dropout during the COVID-19 pandemic, and a tendency to change the CL frequency of wear, with an increase in occasional CL wear. During the ongoing pandemic, eye care practitioners should reinforce CL patient education to minimize the risk of SARS-CoV-2 infection and CL-related complications requiring clinical care.

covid-19;contact lens;pandemic;sars-cov-2;spain

Journal Article

Garcia-Ayuso, Diego;Escamez-Torrecilla, Miguel;Galindo-Romero, Caridad;Valiente-Soriano, Francisco J;Moya-Rodriguez, Esmeralda;Sobrado-Calvo, Paloma;Di Pierdomenico, Johnny

10.1016/j.clae.2020.07.002

[Title]: Influence of the COVID-19 pandemic on contact lens wear in Spain. [Abstract]: PURPOSE: To investigate the behaviour of contact lens (CL) wearers in Spain during the COVID-19 pandemic. METHODS: An anonymized web-based questionnaire was used to assess demographics, CL history, and activity, CL wear habits and perceived risk of infection due to CL wear during the COVID-19 pandemic. RESULTS: A total of 737 participants with an average age of 27.4 (+/-9.3) years completed the online questionnaire. The vast majority of respondents were soft CL wearers and reported at least two years of CL wear. Patients concerns about the increased risk of SARS-CoV-2 infection due to CL wear (40.6 % of participants) were significantly related (chi(2)(1)=11.195, p<0.05) to CL discontinuation (46 % of participants) during the COVID-19 pandemic. This fact joins the significant changes in the frequency of CL wear during the COVID-19 pandemic (chi(2)(4)=31.982, p<0.05), with a tendency to increase occasional CL wear from 29.1 % to 61.8 %. Interestingly, the majority of respondent (87.9 %) indicated that no professional had offered them information related to CL wear and COVID-19, and that they had not sought it on their own (82.2 %). CONCLUSION: There is a relationship between the perceived risk of infection and CL dropout during the COVID-19 pandemic, and a tendency to change the CL frequency of wear, with an increase in occasional CL wear. During the ongoing pandemic, eye care practitioners should reinforce CL patient education to minimize the risk of SARS-CoV-2 infection and CL-related complications requiring clinical care. [Keywords]: covid-19;contact lens;pandemic;sars-cov-2;spain

J Med Virol

Presenting the characteristics, smoking versus diabetes, and outcome among patients hospitalized with COVID-19.

METHODS: We designed a cross-sectional, observational follow-up for 284 COVID-19 patients involving healthy patients, smokers, diabetics, and diabetic plus smokers recruited from May 1, 2020 to June 25, 2020. The clinical features, severity, duration, and outcome of the disease were analyzed. RESULTS: Of 284 COVID-19 patients, the median age was 48 years (range, 18-80), and 33.80% were female. Common symptoms included fever (85.56%), shortness of breath (49.65%), cough (45.42%), and headache (40.86%). Patients with more than one comorbidity (diabetes and smoking) presented as severe-critical cases compared to healthy patients, diabetics, and smokers. Smokers presented with a lower rate of death in comparison to diabetic patients and diabetic + smoking, furthermore, smoking was less risky than diabetes. Although the mortality rate was high in patients with smokers compared to healthy patients (4.22%, the hazard ratio [HR], 1.358; 95% confidence interval [CI], 1.542-1.100; p = .014), it was less than in diabetics (7.04%, HR 1.531, 95% CI: 1.668-1.337, p = .000), and diabetic plus smoker (10.00%, HR, 1.659; 95% CI, 1.763-1.510; p = .000). CONCLUSION: Multiple comorbidities are closely related to the severity of COVID-19 disease progression and the higher mortality rate. Smokers presented as mild cases compared to diabetic and diabetic + smoking patients, who presented as severe to critical cases. Although a higher death rate in smokers was seen compared with healthy patients, this was smaller when compared to diabetic and diabetic + smoking patients.

covid-19;comorbidity;diabetic;mortality rate;smoking

Journal Article;Observational Study

Abbas, Hassan M;Nassir, Kawthar F;Al Khames Aga, Qutaiba A;Al-Gharawi, Ali A;Rasheed, Jawad I;Al-Obaidy, Muhammed W;Al Jubouri, Adnan M;Jaber, Ali S;Al Khames Aga, Luma A

10.1002/jmv.26487

[Title]: Presenting the characteristics, smoking versus diabetes, and outcome among patients hospitalized with COVID-19. [Abstract]: METHODS: We designed a cross-sectional, observational follow-up for 284 COVID-19 patients involving healthy patients, smokers, diabetics, and diabetic plus smokers recruited from May 1, 2020 to June 25, 2020. The clinical features, severity, duration, and outcome of the disease were analyzed. RESULTS: Of 284 COVID-19 patients, the median age was 48 years (range, 18-80), and 33.80% were female. Common symptoms included fever (85.56%), shortness of breath (49.65%), cough (45.42%), and headache (40.86%). Patients with more than one comorbidity (diabetes and smoking) presented as severe-critical cases compared to healthy patients, diabetics, and smokers. Smokers presented with a lower rate of death in comparison to diabetic patients and diabetic + smoking, furthermore, smoking was less risky than diabetes. Although the mortality rate was high in patients with smokers compared to healthy patients (4.22%, the hazard ratio [HR], 1.358; 95% confidence interval [CI], 1.542-1.100; p = .014), it was less than in diabetics (7.04%, HR 1.531, 95% CI: 1.668-1.337, p = .000), and diabetic plus smoker (10.00%, HR, 1.659; 95% CI, 1.763-1.510; p = .000). CONCLUSION: Multiple comorbidities are closely related to the severity of COVID-19 disease progression and the higher mortality rate. Smokers presented as mild cases compared to diabetic and diabetic + smoking patients, who presented as severe to critical cases. Although a higher death rate in smokers was seen compared with healthy patients, this was smaller when compared to diabetic and diabetic + smoking patients. [Keywords]: covid-19;comorbidity;diabetic;mortality rate;smoking

Pediatr Investig

Anal swab findings in an infant with COVID-19.

Introduction: The transmission pathways of coronavirus disease 2019 (COVID-19) remain not completely clear. In this case study the test for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pharyngeal swab and anal swab were compared. Case presentation: A 3-month-old girl was admitted to our hospital with COVID-19. Her parents had both been diagnosed with COVID-19. The results of pharyngeal swab and anal swab of the little girl were recorded and compared during the course of the disease. The oropharyngeal specimen showed negative result for SARS-CoV-2 on the 14th day after onset of the illness. However, the anal swab was still positive for SARS-CoV-2 on the 28th day after the onset of the illness. Conclusion: The possibility of fecal-oral transmission of COVID-19 should be assessed. Personal hygiene during home quarantine merits considerable attention.

anal swab;covid-19;fecal-oral transmission;sars-cov-2

Case Reports

Fan, Qihong;Pan, Yan;Wu, Qingcui;Liu, Shan;Song, Xu;Xie, Zhongguo;Liu, Yang;Zhao, Liang;Wang, Zhonghong;Zhang, Yifei;Wu, Zuchuang;Guan, Lei;Lv, Xiaolong

10.1002/ped4.12186

[Title]: Anal swab findings in an infant with COVID-19. [Abstract]: Introduction: The transmission pathways of coronavirus disease 2019 (COVID-19) remain not completely clear. In this case study the test for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pharyngeal swab and anal swab were compared. Case presentation: A 3-month-old girl was admitted to our hospital with COVID-19. Her parents had both been diagnosed with COVID-19. The results of pharyngeal swab and anal swab of the little girl were recorded and compared during the course of the disease. The oropharyngeal specimen showed negative result for SARS-CoV-2 on the 14th day after onset of the illness. However, the anal swab was still positive for SARS-CoV-2 on the 28th day after the onset of the illness. Conclusion: The possibility of fecal-oral transmission of COVID-19 should be assessed. Personal hygiene during home quarantine merits considerable attention. [Keywords]: anal swab;covid-19;fecal-oral transmission;sars-cov-2

Diagnostics (Basel)

Peptide Nucleic Acid (PNA)-Enhanced Specificity of a Dual-Target Real-Time Quantitative Polymerase Chain Reaction (RT-qPCR) Assay for the Detection and Differentiation of SARS-CoV-2 from Related Viruses.

The threat posed by coronaviruses to human health has necessitated the development of a highly specific and sensitive viral detection method that could differentiate between the currently circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other SARS-related coronaviruses (SARSr-CoVs). In this study, we developed a peptide nucleic acid (PNA)-based real-time quantitative polymerase chain reaction (RT-qPCR) assay targeting the N gene to efficiently discriminate SARS-CoV-2 from other SARSr-CoVs in human clinical samples. Without compromising the sensitivity, this method significantly enhanced the specificity of SARS-CoV-2 detection by 100-fold as compared to conventional RT-qPCR. In addition, we designed an RT-qPCR method for the sensitive and universal detection of ORF3ab-E genes of SARSr-CoV with a limit of detection (LOD) of 3.3 RNA copies per microliter. Thus, the developed assay serves as a confirmative dual-target detection method. Our PNA-mediated dual-target RT-qPCR assay can detect clinical SARS-CoV-2 samples in the range of 18.10-35.19 Ct values with an 82.6-100% detection rate. Furthermore, our assay showed no cross-reactions with other coronaviruses such as human coronaviruses (229E, NL63, and OC43) and Middle East respiratory syndrome coronavirus, influenza viruses (Type B, H1N1, H3N2, HPAI H5Nx, and H7N9), and other respiratory disease-causing viruses (MPV, RSV A, RSV B, PIV, AdV, and HRV). We, thus, developed a PNA-based RT-qPCR assay that differentiates emerging pathogens such as SARS-CoV-2 from closely related viruses such as SARSr-CoV and allows diagnosis of infections related to already identified or new coronavirus strains.

pna;rt-qpcr;sars related-cov;sars-cov-2;dual-target detection

Journal Article

Choi, Won-Suk;Jeong, Ju Hwan;Nicolas, Halcyon Dawn G;Oh, Sol;Antigua, Khristine Joy C;Park, Ji-Hyun;Kim, Beomkyu;Yoon, Sun-Woo;Shin, Kyeong Seob;Choi, Young Ki;Baek, Yun Hee;Song, Min-Suk

10.3390/diagnostics10100775

[Title]: Peptide Nucleic Acid (PNA)-Enhanced Specificity of a Dual-Target Real-Time Quantitative Polymerase Chain Reaction (RT-qPCR) Assay for the Detection and Differentiation of SARS-CoV-2 from Related Viruses. [Abstract]: The threat posed by coronaviruses to human health has necessitated the development of a highly specific and sensitive viral detection method that could differentiate between the currently circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other SARS-related coronaviruses (SARSr-CoVs). In this study, we developed a peptide nucleic acid (PNA)-based real-time quantitative polymerase chain reaction (RT-qPCR) assay targeting the N gene to efficiently discriminate SARS-CoV-2 from other SARSr-CoVs in human clinical samples. Without compromising the sensitivity, this method significantly enhanced the specificity of SARS-CoV-2 detection by 100-fold as compared to conventional RT-qPCR. In addition, we designed an RT-qPCR method for the sensitive and universal detection of ORF3ab-E genes of SARSr-CoV with a limit of detection (LOD) of 3.3 RNA copies per microliter. Thus, the developed assay serves as a confirmative dual-target detection method. Our PNA-mediated dual-target RT-qPCR assay can detect clinical SARS-CoV-2 samples in the range of 18.10-35.19 Ct values with an 82.6-100% detection rate. Furthermore, our assay showed no cross-reactions with other coronaviruses such as human coronaviruses (229E, NL63, and OC43) and Middle East respiratory syndrome coronavirus, influenza viruses (Type B, H1N1, H3N2, HPAI H5Nx, and H7N9), and other respiratory disease-causing viruses (MPV, RSV A, RSV B, PIV, AdV, and HRV). We, thus, developed a PNA-based RT-qPCR assay that differentiates emerging pathogens such as SARS-CoV-2 from closely related viruses such as SARSr-CoV and allows diagnosis of infections related to already identified or new coronavirus strains. [Keywords]: pna;rt-qpcr;sars related-cov;sars-cov-2;dual-target detection

West J Emerg Med

A Multidisciplinary Intubation Algorithm for Suspected COVID-19 Patients in the Emergency Department.

INTRODUCTION: Intubation of patients suspected of having coronavirus disease 2019 (COVID-19) is considered to be a high-risk procedure due to the aerosolization of viral particles. In an effort to minimize the risk of exposure and optimize patient care, we sought to develop, test, provide training, and implement a standardized algorithm for intubating these high-risk patients at our institution. METHODS: We developed an initial intubation algorithm, incorporating strategic use of equipment and incorporating emerging best practices. By combining simulation-based training sessions and rapid-cycle improvement methodology with physicians, nurses, and respiratory therapists, and incorporating their feedback into the development, we were able to optimize the process prior to implementation. Training sessions also enabled the participants to practice the algorithm as a team. Upon completion of each training session, participants were invited to complete a brief online survey about their overall experience. RESULTS: An algorithm and training system vetted by simulation and actual practice were developed. A training video and dissemination package were made available for other emergency departments to adopt. Survey results were overall positive, with 97.92% of participants feeling confident in their role in the intubation process, and many participants citing the usefulness of the multidisciplinary approach to the training. CONCLUSION: A multidisciplinary, team-based approach to the development and training of a standardized intubation algorithm combining simulation and rapid-cycle improvement methodology is a useful, effective process to respond to rapidly evolving clinical information and experiences during a global pandemic.

Journal Article

Trembley, Lauren L;Tobias, Adam Z;Schillo, Gwendolyn;von Foerster, Nicholas;Singer, Jordan;Pavelka, Samantha L;Phrampus, Paul

10.5811/westjem.2020.5.47835

[Title]: A Multidisciplinary Intubation Algorithm for Suspected COVID-19 Patients in the Emergency Department. [Abstract]: INTRODUCTION: Intubation of patients suspected of having coronavirus disease 2019 (COVID-19) is considered to be a high-risk procedure due to the aerosolization of viral particles. In an effort to minimize the risk of exposure and optimize patient care, we sought to develop, test, provide training, and implement a standardized algorithm for intubating these high-risk patients at our institution. METHODS: We developed an initial intubation algorithm, incorporating strategic use of equipment and incorporating emerging best practices. By combining simulation-based training sessions and rapid-cycle improvement methodology with physicians, nurses, and respiratory therapists, and incorporating their feedback into the development, we were able to optimize the process prior to implementation. Training sessions also enabled the participants to practice the algorithm as a team. Upon completion of each training session, participants were invited to complete a brief online survey about their overall experience. RESULTS: An algorithm and training system vetted by simulation and actual practice were developed. A training video and dissemination package were made available for other emergency departments to adopt. Survey results were overall positive, with 97.92% of participants feeling confident in their role in the intubation process, and many participants citing the usefulness of the multidisciplinary approach to the training. CONCLUSION: A multidisciplinary, team-based approach to the development and training of a standardized intubation algorithm combining simulation and rapid-cycle improvement methodology is a useful, effective process to respond to rapidly evolving clinical information and experiences during a global pandemic. [Keywords]:

Head Neck

Penn Medicine Head and Neck Cancer Service Line COVID-19 management guidelines.

INTRODUCTION: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS: Creation of consensus document. RESULTS: The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.

covid-19;sars-cov-2;coronavirus;head and neck cancer

Journal Article

Weinstein, Gregory S;Cohen, Roger;Lin, Alexander;O'Malley, Bert W Jr;Lukens, John;Swisher-McClure, Samuel;Shanti, Rabie M;Newman, Jason G;Parhar, Harman S;Tasche, Kendall;Brody, Robert M;Chalian, Ara;Cannady, Steven;Palmer, James N;Adappa, Nithin D;Kohanski, Michael A;Bauml, Joshua;Aggarwal, Charu;Montone, Kathleen;Livolsi, Virginia;Baloch, Zubair W;Jalaly, Jalal B;Cooper, Kumarasen;Rajasekaran, Karthik;Loevner, Laurie;Rassekh, Christopher

10.1002/hed.26318

[Title]: Penn Medicine Head and Neck Cancer Service Line COVID-19 management guidelines. [Abstract]: INTRODUCTION: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS: Creation of consensus document. RESULTS: The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature. [Keywords]: covid-19;sars-cov-2;coronavirus;head and neck cancer