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Infect Ecol Epidemiol

High seroprevalence of SARS-CoV-2 in elderly care employees in Sweden.

The COVID-19 pandemic is growing and spread in the Swedish elderly care system during April 2020. The increasing number of employees on sick-leave due to COVID-19 created severe logistic problems. Some elderly care homes therefore started to screen their personnel to secure the safety of the elderly and to avoid unnecessary quarantine of potentially immune employees. Secondary data from a screening with a COVID-19 rapid test for detection of SARS-CoV-2-specific IgM and IgG of 1,005 employees in 22 elderly care homes in Stockholm, Sweden, were analyzed. Seropositive employees were found in 21 out of the 22 care homes. In total, 23% (231/1,005) of the employees tested positive for antibodies against SARS-CoV-2, and 14.3% (144/1,005) were found positive for IgM (either alone or combined with IgG), indicating recent or present infection. Of those that tested seropositive, 46.5% did not report any clinical symptoms, indicating pre- or asymptomatic infections. Reported symptoms with the highest correlation with seropositivity were fever and loss of smell and taste. These results suggest that antibody testing of employees in elderly care homes is valuable for surveillance of disease development and a crucial screening tool in the effort to decrease the death toll in this pandemic.

covid-19;igg;igm;sars-cov-2;elderly care homes;employees;rapid test

Journal Article

Lindahl, Johanna F;Hoffman, Tove;Esmaeilzadeh, Mouna;Olsen, Bjorn;Winter, Reidar;Amer, Stefan;Molnar, Christian;Svalberg, Ann;Lundkvist, Ake

10.1080/20008686.2020.1789036

[Title]: High seroprevalence of SARS-CoV-2 in elderly care employees in Sweden. [Abstract]: The COVID-19 pandemic is growing and spread in the Swedish elderly care system during April 2020. The increasing number of employees on sick-leave due to COVID-19 created severe logistic problems. Some elderly care homes therefore started to screen their personnel to secure the safety of the elderly and to avoid unnecessary quarantine of potentially immune employees. Secondary data from a screening with a COVID-19 rapid test for detection of SARS-CoV-2-specific IgM and IgG of 1,005 employees in 22 elderly care homes in Stockholm, Sweden, were analyzed. Seropositive employees were found in 21 out of the 22 care homes. In total, 23% (231/1,005) of the employees tested positive for antibodies against SARS-CoV-2, and 14.3% (144/1,005) were found positive for IgM (either alone or combined with IgG), indicating recent or present infection. Of those that tested seropositive, 46.5% did not report any clinical symptoms, indicating pre- or asymptomatic infections. Reported symptoms with the highest correlation with seropositivity were fever and loss of smell and taste. These results suggest that antibody testing of employees in elderly care homes is valuable for surveillance of disease development and a crucial screening tool in the effort to decrease the death toll in this pandemic. [Keywords]: covid-19;igg;igm;sars-cov-2;elderly care homes;employees;rapid test

Int J Infect Dis

Asymptomatic SARS Coronavirus 2 infection: Invisible yet invincible.

While successful containment measures of COVID-19 in China and many European countries have led to flattened curves, case numbers are rising dramatically in other countries, with the emergence of a second wave expected. Asymptomatic individuals carrying SARS-CoV-2 are hidden drivers of the pandemic, and infectivity studies confirm the existence of transmission by asymptomatic individuals. The data addressed here show that characteristics of asymptomatic and presymptomatic infection are not identical. Younger age correlates strongly with asymptomatic and mild infections and children as hidden drivers. The estimated proportion of asymptomatic infections ranges from 18% to 81%. The current perception of asymptomatic infections does not provide clear guidance for public-health measures. Asymptomatic infections will be a key contributor in the spread of COVID-19. Asymptomatic cases should be reported in official COVID-19 statistics.

asymptomatic;covid-19;case definition;herd immunity;presymptomatic;sars-cov-2

Journal Article;Review

Nikolai, Lea A;Meyer, Christian G;Kremsner, Peter G;Velavan, Thirumalaisamy P

10.1016/j.ijid.2020.08.076

[Title]: Asymptomatic SARS Coronavirus 2 infection: Invisible yet invincible. [Abstract]: While successful containment measures of COVID-19 in China and many European countries have led to flattened curves, case numbers are rising dramatically in other countries, with the emergence of a second wave expected. Asymptomatic individuals carrying SARS-CoV-2 are hidden drivers of the pandemic, and infectivity studies confirm the existence of transmission by asymptomatic individuals. The data addressed here show that characteristics of asymptomatic and presymptomatic infection are not identical. Younger age correlates strongly with asymptomatic and mild infections and children as hidden drivers. The estimated proportion of asymptomatic infections ranges from 18% to 81%. The current perception of asymptomatic infections does not provide clear guidance for public-health measures. Asymptomatic infections will be a key contributor in the spread of COVID-19. Asymptomatic cases should be reported in official COVID-19 statistics. [Keywords]: asymptomatic;covid-19;case definition;herd immunity;presymptomatic;sars-cov-2

Cardiovasc Drugs Ther

Lopinavir-Ritonavir in SARS-CoV-2 Infection and Drug-Drug Interactions with Cardioactive Medications.

Lopinavir-ritonavir combination is being used for the treatment of SARS-CoV-2 infection. A low dose of ritonavir is added to other protease inhibitors to take advantage of potent inhibition of cytochrome (CYP) P450 3A4, thereby significantly increasing the plasma concentration of coadministered lopinavir. Ritonavir also inhibits CYP2D6 and induces CYP2B6, CYP2C19, CYP2C9, and CYP1A2. This potent, time-dependent interference of major hepatic drug-metabolizing enzymes by ritonavir leads to several clinically important drug-drug interactions. A number of patients presenting with acute coronary syndrome and acute heart failure may have SARS-CoV-2 infection simultaneously. Lopinavir-ritonavir is added to their prescription of multiple cardiac medications leading to potential drug-drug interactions. Many cardiology, pulmonology, and intensivist physicians have never been exposed to clinical scenarios requiring co-prescription of cardiac and antiviral therapies. Therefore, it is essential to enumerate these drug-drug interactions, to avoid any serious drug toxicity, to consider alternate and safer drugs, and to ensure better patient care.

covid-19;cardiovascular therapy;drug interactions;lopinavir-ritonavir;sars-cov-2

Journal Article;Review

Agarwal, Shubham;Agarwal, Sanjeev Kumar

10.1007/s10557-020-07070-1

[Title]: Lopinavir-Ritonavir in SARS-CoV-2 Infection and Drug-Drug Interactions with Cardioactive Medications. [Abstract]: Lopinavir-ritonavir combination is being used for the treatment of SARS-CoV-2 infection. A low dose of ritonavir is added to other protease inhibitors to take advantage of potent inhibition of cytochrome (CYP) P450 3A4, thereby significantly increasing the plasma concentration of coadministered lopinavir. Ritonavir also inhibits CYP2D6 and induces CYP2B6, CYP2C19, CYP2C9, and CYP1A2. This potent, time-dependent interference of major hepatic drug-metabolizing enzymes by ritonavir leads to several clinically important drug-drug interactions. A number of patients presenting with acute coronary syndrome and acute heart failure may have SARS-CoV-2 infection simultaneously. Lopinavir-ritonavir is added to their prescription of multiple cardiac medications leading to potential drug-drug interactions. Many cardiology, pulmonology, and intensivist physicians have never been exposed to clinical scenarios requiring co-prescription of cardiac and antiviral therapies. Therefore, it is essential to enumerate these drug-drug interactions, to avoid any serious drug toxicity, to consider alternate and safer drugs, and to ensure better patient care. [Keywords]: covid-19;cardiovascular therapy;drug interactions;lopinavir-ritonavir;sars-cov-2

Assist Inferm Ric

[The covid-19 emergency in the words of the nurses].

. The covid-19 emergency in the words of the nurses . This special issue of AIR is dedicated to the direct professional experiences and personal testimonies of a sample of the nursing personnel during the most dramatic phase of the covid-19 pandemia in the most severely affected regions of Northern Italy (Lombardy, Piedmont, Veneto, Friuli, Trentino, Emilia Romagna Regions). The decision to adopt a research strategy aimed to give visibility and voice to colleagues representing some of the key hospitals of the regions obliged to a radical reorganisation of their structures and organisation of care, was adopted to catch from inside the crisis scenarios the expected mix of intense emotions (from anxiety, to fatigue, to personal and professional uncertainty, to the burden of impotence), and of needed technical creativity and efficiency which were requested to face a totally unexpected situation where guidelines could hardly be of help. The interview/diaries/focus groups were carefully planned not so much in terms of the contents, but with attention to the acceptance of the interviewed to enter in a free dialogue, with no Q&A, to be recorded, and to last for the time felt to be by both sides appropriate. The texts which are reported in this dossier are fragments of the recordings (overall more then 30 hours), without adjustments. It has been agreed that while all the names of the participants are provided as 'authors', the individual contributions are anonymous (not out of privacy consideration!) as they are part of a collective narrative, which reflects the great variability of the languages and of the perceived-expressed experiences and memories. The material has been organised in sections which are conceived as 'verbal snapshots' taken from the networks of care settings, but at the same time of the places and houses where the colleagues were literally full-time living, to assure unaccountable overtime working hours, and the requested 'safety distances' and lockdowns. The titles of the 8 sections coincide somehow with the principal components of the chain of activities and challenges which had to be faced: The changes in everyday's care, How to be prepared to the emergency, The teamwork, The loneliness and the isolation of the patients, The loneliness of the nurses, The difficult choices, The organization of the work and of the wards, change after covid-19. The core of the dossier is framed by boxes which provide also a minimum background of the administrative and epidemiological data on the pandemia in the regions of interest (it is interesting to remind that the central-southern areas of Italy have been far less affected), and a brief concluding reflection on reflection on the post-pandemia from the nursing point of view.

Journal Article

Ambrosi, Elisa;Canzan, Federica;Di Giulio, Paola;Mortari, Luigina;Palese, Alvisa;Tognoni, Gianni;Saiani, Luisa

10.1702/3409.33934

[Title]: [The covid-19 emergency in the words of the nurses]. [Abstract]: . The covid-19 emergency in the words of the nurses . This special issue of AIR is dedicated to the direct professional experiences and personal testimonies of a sample of the nursing personnel during the most dramatic phase of the covid-19 pandemia in the most severely affected regions of Northern Italy (Lombardy, Piedmont, Veneto, Friuli, Trentino, Emilia Romagna Regions). The decision to adopt a research strategy aimed to give visibility and voice to colleagues representing some of the key hospitals of the regions obliged to a radical reorganisation of their structures and organisation of care, was adopted to catch from inside the crisis scenarios the expected mix of intense emotions (from anxiety, to fatigue, to personal and professional uncertainty, to the burden of impotence), and of needed technical creativity and efficiency which were requested to face a totally unexpected situation where guidelines could hardly be of help. The interview/diaries/focus groups were carefully planned not so much in terms of the contents, but with attention to the acceptance of the interviewed to enter in a free dialogue, with no Q&A, to be recorded, and to last for the time felt to be by both sides appropriate. The texts which are reported in this dossier are fragments of the recordings (overall more then 30 hours), without adjustments. It has been agreed that while all the names of the participants are provided as 'authors', the individual contributions are anonymous (not out of privacy consideration!) as they are part of a collective narrative, which reflects the great variability of the languages and of the perceived-expressed experiences and memories. The material has been organised in sections which are conceived as 'verbal snapshots' taken from the networks of care settings, but at the same time of the places and houses where the colleagues were literally full-time living, to assure unaccountable overtime working hours, and the requested 'safety distances' and lockdowns. The titles of the 8 sections coincide somehow with the principal components of the chain of activities and challenges which had to be faced: The changes in everyday's care, How to be prepared to the emergency, The teamwork, The loneliness and the isolation of the patients, The loneliness of the nurses, The difficult choices, The organization of the work and of the wards, change after covid-19. The core of the dossier is framed by boxes which provide also a minimum background of the administrative and epidemiological data on the pandemia in the regions of interest (it is interesting to remind that the central-southern areas of Italy have been far less affected), and a brief concluding reflection on reflection on the post-pandemia from the nursing point of view. [Keywords]:

Indian J Ophthalmol

Demographics and clinical presentation of patients with ocular disorders during the COVID-19 lockdown in India: A report.

Purpose: The aim of this study is to describe the demographics and clinical profile of patients with ocular disorders presenting during the novel coronavirus (COVID-19) lockdown in India. Methods: This cross-sectional hospital-based study included patients presenting between March 23, 2020 and April 19, 2020. All patients who presented to the emergency department were included as cases. The data were collected using an electronic medical record system. Results: Overall, 1,192 patients (mean 42.57 per day) presented to the ocular emergency department and were included for analysis. The median age of the patients was 35 (Interquartile range, IQR: 20-52) years and they were mostly adults (77.85%). The majority of patients were male (62.16%) and presented from the local metropolitan region (56.21%). On triaging based on the ocular disorders at presentation, the majority of the patients were emergency related (65.02%), followed by urgent (8.14%) and routine (26.85%) in nature. The most common emergencies were microbial keratitis (23.74%), followed by corneal trauma (16.39%). There was an increasing trend seen in emergency patients (46.11%; week 1 to 71.78%; week 4) and a decreasing trend seen in routine patients (45%; week1 to 21.20%; week 4). A subset of patients (23.49%) underwent surgery where indicated and the most commonly performed procedures were vitreo-retinal procedures (32.86%) followed by trauma related (31.43%). Conclusion: The enforcement of the nationwide lockdown due to COVID-19 resulted in a fewer patients presenting to the hospital. The majority of them presented from the local metropolitan region and the common emergencies were microbial keratitis and corneal trauma. About one fourth required a surgical intervention which was most commonly a vitreo-retinal procedure.

covid-19;india;sars-cov-2;electronic medical records;eye care

Journal Article;Observational Study

Das, Anthony Vipin;Narayanan, Raja

10.4103/ijo.IJO_1171_20

[Title]: Demographics and clinical presentation of patients with ocular disorders during the COVID-19 lockdown in India: A report. [Abstract]: Purpose: The aim of this study is to describe the demographics and clinical profile of patients with ocular disorders presenting during the novel coronavirus (COVID-19) lockdown in India. Methods: This cross-sectional hospital-based study included patients presenting between March 23, 2020 and April 19, 2020. All patients who presented to the emergency department were included as cases. The data were collected using an electronic medical record system. Results: Overall, 1,192 patients (mean 42.57 per day) presented to the ocular emergency department and were included for analysis. The median age of the patients was 35 (Interquartile range, IQR: 20-52) years and they were mostly adults (77.85%). The majority of patients were male (62.16%) and presented from the local metropolitan region (56.21%). On triaging based on the ocular disorders at presentation, the majority of the patients were emergency related (65.02%), followed by urgent (8.14%) and routine (26.85%) in nature. The most common emergencies were microbial keratitis (23.74%), followed by corneal trauma (16.39%). There was an increasing trend seen in emergency patients (46.11%; week 1 to 71.78%; week 4) and a decreasing trend seen in routine patients (45%; week1 to 21.20%; week 4). A subset of patients (23.49%) underwent surgery where indicated and the most commonly performed procedures were vitreo-retinal procedures (32.86%) followed by trauma related (31.43%). Conclusion: The enforcement of the nationwide lockdown due to COVID-19 resulted in a fewer patients presenting to the hospital. The majority of them presented from the local metropolitan region and the common emergencies were microbial keratitis and corneal trauma. About one fourth required a surgical intervention which was most commonly a vitreo-retinal procedure. [Keywords]: covid-19;india;sars-cov-2;electronic medical records;eye care

J Am Coll Emerg Physicians Open

Rates of coinfection with other respiratory pathogens in patients positive for coronavirus disease 2019 (COVID-19).

Objectives: The purpose of this study was to assess coinfection rates of coronavirus disease 2019 (COVID-19) with other respiratory infections on presentation. Methods: This is a retrospective analysis of data from a 2 hospital academic medical centers and 2 urgent care centers during the initial 2 weeks of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) , March 10, 2020 to March 23, 2020. Testing was targeted toward high-risk patients following US Centers for Disease Control and Prevention guidelines. Demographics include age group and sex. Laboratory test results included SARS-CoV-2, rapid influenza A/B, and upper respiratory pathogen nucleic acid detection. Patient demographics and coinfections are presented overall and by test results with descriptive statistics. Results: Complete laboratory results from the first 2 weeks of testing were available for 471 emergency department patients and 117 urgent care center patients who were tested for SARS-CoV. A total of 51 (8.7%) patients tested positive for COVID-19 with only 1 of these patients also testing positive for another respiratory infection. One of the patients positive for COVID-19 also tested positive for influenza A. Among the 537 patients who were screened and tested negative for COVID-19, there were 33 (6.1%) patients who tested positive in the upper respiratory pathogen nucleic acid detection test. Conclusion: In our study investigating coinfections among 51 patients testing positive for COVID-19, 1 patient also tested positive for influenza A. Although we found limited coinfections in our emergency department and urgent care center patient populations, further research is needed to assess potential coinfection in patients with COVID-19.

covid-19;coinfection;emergency department;epidemic;pandemic;virus

Journal Article

Castillo, Edward M;Coyne, Christopher J;Brennan, Jesse J;Tomaszewski, Christian A

10.1002/emp2.12172

[Title]: Rates of coinfection with other respiratory pathogens in patients positive for coronavirus disease 2019 (COVID-19). [Abstract]: Objectives: The purpose of this study was to assess coinfection rates of coronavirus disease 2019 (COVID-19) with other respiratory infections on presentation. Methods: This is a retrospective analysis of data from a 2 hospital academic medical centers and 2 urgent care centers during the initial 2 weeks of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) , March 10, 2020 to March 23, 2020. Testing was targeted toward high-risk patients following US Centers for Disease Control and Prevention guidelines. Demographics include age group and sex. Laboratory test results included SARS-CoV-2, rapid influenza A/B, and upper respiratory pathogen nucleic acid detection. Patient demographics and coinfections are presented overall and by test results with descriptive statistics. Results: Complete laboratory results from the first 2 weeks of testing were available for 471 emergency department patients and 117 urgent care center patients who were tested for SARS-CoV. A total of 51 (8.7%) patients tested positive for COVID-19 with only 1 of these patients also testing positive for another respiratory infection. One of the patients positive for COVID-19 also tested positive for influenza A. Among the 537 patients who were screened and tested negative for COVID-19, there were 33 (6.1%) patients who tested positive in the upper respiratory pathogen nucleic acid detection test. Conclusion: In our study investigating coinfections among 51 patients testing positive for COVID-19, 1 patient also tested positive for influenza A. Although we found limited coinfections in our emergency department and urgent care center patient populations, further research is needed to assess potential coinfection in patients with COVID-19. [Keywords]: covid-19;coinfection;emergency department;epidemic;pandemic;virus

Tuberk Toraks

[Management of obstructive sleep apnea during COVID-19 pandemic].

Coronavirus disease 2019 (COVID-19) is an infectious disease that causes important mortality and morbidity all over the world caused by SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2), which started in China at the end of 2019. It spreads rapidly, mainly through droplets, and especially for all healthcare workers involved in aerosol producing procedures are at high risk. During COVID-19 pandemic , the health systems worldwide, along with the practice of chest diseases daily were affected. In our article, we aimed to give some clinical suggestions related to sleep practices according to current data.

Journal Article

Gulbay, Banu;Azap, Alpay;Kaya, Akin;Acican, Turan

10.5578/tt.69745

[Title]: [Management of obstructive sleep apnea during COVID-19 pandemic]. [Abstract]: Coronavirus disease 2019 (COVID-19) is an infectious disease that causes important mortality and morbidity all over the world caused by SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2), which started in China at the end of 2019. It spreads rapidly, mainly through droplets, and especially for all healthcare workers involved in aerosol producing procedures are at high risk. During COVID-19 pandemic , the health systems worldwide, along with the practice of chest diseases daily were affected. In our article, we aimed to give some clinical suggestions related to sleep practices according to current data. [Keywords]:

Curr Nutr Rep

A Rapid Advice Guideline for the Prevention of Novel Coronavirus Through Nutritional Intervention.

PURPOSE OF REVIEW: An unexpected and sudden outbreak of a novel infection known as a coronavirus (COVID-19) has imposed important problems to global well-being and economy. Based upon current researches, this virus is spreading from one human to another through respiratory droplets, i.e. cough and sneeze. Till now, there has not been any specific treatment found for this virus. Hence, there is a critical need to discover alternative techniques to cope with the current scenario. RECENT FINDINGS: This review conducted an online search for prevention of coronavirus infection with the help of nutritional interventions. It has been observed that the effect of the virus is mostly on the individual with low immunity, individual affected with diseases like diabetes, and individual using any immune-suppressed drug or having past history of major surgeries or severe medical conditions. Therefore, consuming foods which boost immunity helps in preventing respiratory-related disorder or suppressing diseases-related problems, which could be helpful in controlling the spread of this virus. In conclusion, it has been suggested that before the beginning of generalised treatments and interventions in each infected patient, nutritional status should be evaluated, as it can help in creating a specific nutrition intervention for the infected individual.

coronavirus;immunity;nutrition;prevention;respiratory-related disorders

Journal Article;Review

Budhwar, Savita;Sethi, Kashika;Chakraborty, Manali

10.1007/s13668-020-00325-1

[Title]: A Rapid Advice Guideline for the Prevention of Novel Coronavirus Through Nutritional Intervention. [Abstract]: PURPOSE OF REVIEW: An unexpected and sudden outbreak of a novel infection known as a coronavirus (COVID-19) has imposed important problems to global well-being and economy. Based upon current researches, this virus is spreading from one human to another through respiratory droplets, i.e. cough and sneeze. Till now, there has not been any specific treatment found for this virus. Hence, there is a critical need to discover alternative techniques to cope with the current scenario. RECENT FINDINGS: This review conducted an online search for prevention of coronavirus infection with the help of nutritional interventions. It has been observed that the effect of the virus is mostly on the individual with low immunity, individual affected with diseases like diabetes, and individual using any immune-suppressed drug or having past history of major surgeries or severe medical conditions. Therefore, consuming foods which boost immunity helps in preventing respiratory-related disorder or suppressing diseases-related problems, which could be helpful in controlling the spread of this virus. In conclusion, it has been suggested that before the beginning of generalised treatments and interventions in each infected patient, nutritional status should be evaluated, as it can help in creating a specific nutrition intervention for the infected individual. [Keywords]: coronavirus;immunity;nutrition;prevention;respiratory-related disorders

Engineering (Beijing)

Efficacy and Safety of Triazavirin Therapy for Coronavirus Disease 2019: A Pilot Randomized Controlled Trial.

No therapeutics have been proven effective yet for the treatment of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To assess the efficacy and safety of Triazavirin therapy for COVID-19, we conducted a randomized, double-blinded controlled trial involving hospitalized adult patients with COVID-19. Participants were enrolled from ten sites, and were randomized into two arms of the study with a ratio of 1:1. Patients were treated with Triazavirin 250 mg versus a placebo three or four times a day for 7d. The primary outcome was set as the time to clinical improvement, defined as normalization of body temperature, respiratory rate, oxygen saturation, cough, and absorption of pulmonary infection by chest computed tomography (CT) until 28d after randomization. Secondary outcomes included individual components of the primary outcome, the mean time and proportion of inflammatory absorption in the lung, and the conversion rate to a repeated negative SARS-CoV-2 nucleic acid test of throat swab sampling. Concomitant therapeutic treatments, adverse events, and serious adverse events were recorded. Our study was halted after the recruitment of 52 patients, since the number of new infections in the participating hospitals decreased greatly. We randomized 52 patients for treatment with Triazavirin (n = 26) or a placebo (n = 26). We found no differences in the time to clinical improvement (median, 7d versus 12d; risk ratio (RR), 2.0; 95% confidence interval (CI), 0.7-5.6; p = 0.2), with clinical improvement occurring in ten patients in the Triazavirin group and six patients in the placebo group (38.5% versus 23.1%; RR, 2.1; 95% CI, 0.6-7.0; p = 0.2). All components of the primary outcome normalized within 28d, with the exception of absorption of pulmonary infection (Triazavirin 50.0%, placebo 26.1%). Patients in the Triazavirin group used less frequent concomitant therapies for respiratory, cardiac, renal, hepatic, or coagulation supports. Although no statistically significant evidence was found to indicate that Triazavirin benefits COVID-19 patients, our observations indicated possible benefits from its use to treat COVID-19 due to its antiviral effects. Further study is required for confirmation.

coronavirus disease 2019;efficacy;safety;triazavirin

Journal Article

Wu, Xiaoke;Yu, Kaijiang;Wang, Yongchen;Xu, Wanhai;Ma, Hongli;Hou, Yan;Li, Yue;Cai, Benzhi;Zhu, Liying;Zhang, Min;Hu, Xiaoli;Gao, Jingshu;Wang, Yu;Qin, Huichao;Wang, Wenjie;Zhao, Mingyan;Wu, Xia;Zhang, Yong;Li, Lu;Li, Kang;Du, Zhimin;Mol, Ben Willem J;Yang, Baofeng

10.1016/j.eng.2020.08.011

[Title]: Efficacy and Safety of Triazavirin Therapy for Coronavirus Disease 2019: A Pilot Randomized Controlled Trial. [Abstract]: No therapeutics have been proven effective yet for the treatment of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To assess the efficacy and safety of Triazavirin therapy for COVID-19, we conducted a randomized, double-blinded controlled trial involving hospitalized adult patients with COVID-19. Participants were enrolled from ten sites, and were randomized into two arms of the study with a ratio of 1:1. Patients were treated with Triazavirin 250 mg versus a placebo three or four times a day for 7d. The primary outcome was set as the time to clinical improvement, defined as normalization of body temperature, respiratory rate, oxygen saturation, cough, and absorption of pulmonary infection by chest computed tomography (CT) until 28d after randomization. Secondary outcomes included individual components of the primary outcome, the mean time and proportion of inflammatory absorption in the lung, and the conversion rate to a repeated negative SARS-CoV-2 nucleic acid test of throat swab sampling. Concomitant therapeutic treatments, adverse events, and serious adverse events were recorded. Our study was halted after the recruitment of 52 patients, since the number of new infections in the participating hospitals decreased greatly. We randomized 52 patients for treatment with Triazavirin (n = 26) or a placebo (n = 26). We found no differences in the time to clinical improvement (median, 7d versus 12d; risk ratio (RR), 2.0; 95% confidence interval (CI), 0.7-5.6; p = 0.2), with clinical improvement occurring in ten patients in the Triazavirin group and six patients in the placebo group (38.5% versus 23.1%; RR, 2.1; 95% CI, 0.6-7.0; p = 0.2). All components of the primary outcome normalized within 28d, with the exception of absorption of pulmonary infection (Triazavirin 50.0%, placebo 26.1%). Patients in the Triazavirin group used less frequent concomitant therapies for respiratory, cardiac, renal, hepatic, or coagulation supports. Although no statistically significant evidence was found to indicate that Triazavirin benefits COVID-19 patients, our observations indicated possible benefits from its use to treat COVID-19 due to its antiviral effects. Further study is required for confirmation. [Keywords]: coronavirus disease 2019;efficacy;safety;triazavirin

Acta Paediatr

Delayed diagnosis of paediatric appendicitis during the COVID-19 pandemic.

AIM: To present seven paediatric patients with appendicitis, all with late diagnosis resulting from different aspects of the fear from the current global COVID-19 pandemic. METHODS: Cases were collected from three paediatric surgical wards. Comparison between complicated appendicitis rates in the COVID-19 era and similar period in previous year was performed. RESULTS: All seven children presented with complicated appendicitis. Main reasons for the delayed diagnosis during the COVID-19 era were parental concern, telemedicine use and insufficient evaluation. Higher complication rates were found during the COVID-19 era compared to similar period in previous year (22% vs 11%, P-value .06). CONCLUSION: The fear from COVID-19 pandemic may result in delayed diagnosis and higher complication rates in common paediatric medical conditions. We believe caregivers and healthcare providers should not withhold necessary medical care since delay in diagnosis and treatment in these routinely seen medical emergencies may become as big of a threat as COVID-19 itself.

covid-19;appendicitis;children;coronavirus;paediatric

Case Reports;Journal Article

Snapiri, Ori;Rosenberg Danziger, Chen;Krause, Irit;Kravarusic, Dragan;Yulevich, Alon;Balla, Uri;Bilavsky, Efraim

10.1111/apa.15376

[Title]: Delayed diagnosis of paediatric appendicitis during the COVID-19 pandemic. [Abstract]: AIM: To present seven paediatric patients with appendicitis, all with late diagnosis resulting from different aspects of the fear from the current global COVID-19 pandemic. METHODS: Cases were collected from three paediatric surgical wards. Comparison between complicated appendicitis rates in the COVID-19 era and similar period in previous year was performed. RESULTS: All seven children presented with complicated appendicitis. Main reasons for the delayed diagnosis during the COVID-19 era were parental concern, telemedicine use and insufficient evaluation. Higher complication rates were found during the COVID-19 era compared to similar period in previous year (22% vs 11%, P-value .06). CONCLUSION: The fear from COVID-19 pandemic may result in delayed diagnosis and higher complication rates in common paediatric medical conditions. We believe caregivers and healthcare providers should not withhold necessary medical care since delay in diagnosis and treatment in these routinely seen medical emergencies may become as big of a threat as COVID-19 itself. [Keywords]: covid-19;appendicitis;children;coronavirus;paediatric

Clin Transl Med

COVID-19 critical illness pathophysiology driven by diffuse pulmonary thrombi and pulmonary endothelial dysfunction responsive to thrombolysis.

Patients with severe COVID-19 disease have been characterized as having the acute respiratory distress syndrome (ARDS). Critically ill COVID-19 patients have relatively well-preserved lung mechanics despite severe gas exchange abnormalities, a feature not consistent with classical ARDS but more consistent with pulmonary vascular disease. Many patients with severe COVID-19 also demonstrate markedly abnormal coagulation, with elevated d-dimers and higher rates of venous thromboembolism. We present four cases of patients with severe COVID-19 pneumonia with severe respiratory failure and shock, with evidence of markedly elevated dead-space ventilation who received tPA. All showed post treatment immediate improvements in gas exchange and/or hemodynamics. We suspect that severe COVID-19 pneumonia causes respiratory failure via pulmonary microthrombi and endothelial dysfunction. Treatment for COVID-19 pneumonia may warrant anticoagulation for milder cases and thrombolysis for more severe disease.

covid-19;tpa;thrombolysis;tissue plasminogen activator

Journal Article

Poor, Hooman D;Ventetuolo, Corey E;Tolbert, Thomas;Chun, Glen;Serrao, Gregory;Zeidman, Amanda;Dangayach, Neha S;Olin, Jeffrey;Kohli-Seth, Roopa;Powell, Charles A

10.1002/ctm2.44

[Title]: COVID-19 critical illness pathophysiology driven by diffuse pulmonary thrombi and pulmonary endothelial dysfunction responsive to thrombolysis. [Abstract]: Patients with severe COVID-19 disease have been characterized as having the acute respiratory distress syndrome (ARDS). Critically ill COVID-19 patients have relatively well-preserved lung mechanics despite severe gas exchange abnormalities, a feature not consistent with classical ARDS but more consistent with pulmonary vascular disease. Many patients with severe COVID-19 also demonstrate markedly abnormal coagulation, with elevated d-dimers and higher rates of venous thromboembolism. We present four cases of patients with severe COVID-19 pneumonia with severe respiratory failure and shock, with evidence of markedly elevated dead-space ventilation who received tPA. All showed post treatment immediate improvements in gas exchange and/or hemodynamics. We suspect that severe COVID-19 pneumonia causes respiratory failure via pulmonary microthrombi and endothelial dysfunction. Treatment for COVID-19 pneumonia may warrant anticoagulation for milder cases and thrombolysis for more severe disease. [Keywords]: covid-19;tpa;thrombolysis;tissue plasminogen activator

Int J Infect Dis

Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis.

OBJECTIVES: Existing findings regarding the relationship between comorbidities and the severity of coronavirus disease 2019 (COVID-19) are inconsistent and insufficient. The aim of this study was to evaluate the association between different comorbidities and the severity of COVID-19. METHODS: The PubMed, Embase, and Cochrane Library databases were searched to identify studies reporting the rates of comorbidities in COVID-19 patients with severe/fatal outcomes. Subgroup analyses were conducted according to disease severity and the country of residence. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using random-effects models. RESULTS: A total of 34 eligible studies were identified. In patients with severe/fatal COVID-19, the most prevalent chronic comorbidities were obesity (42%, 95% CI 34-49%) and hypertension (40%, 95% CI 35-45%), followed by diabetes (17%, 95% CI 15-20%), cardiovascular disease (13%, 95% CI 11-15%), respiratory disease (8%, 95% CI 6-10%), cerebrovascular disease (6%, 95% CI 4-8%), malignancy (4%, 95% CI 3-6%), kidney disease (3%, 95% CI 2-4%), and liver disease (2%, 95% CI 1-3%). In order of the prediction, the pooled ORs of the comorbidities in patients with severe or fatal COVID-19 when compared to patients with non-severe/fatal COVID-19 were as follows: chronic respiratory disease, OR 3.56 (95% CI 2.87-4.41); hypertension, OR 3.17 (95% CI 2.46-4.08); cardiovascular disease, OR 3.13 (95% CI 2.65-3.70); kidney disease, OR 3.02 (95% CI 2.23-4.08); cerebrovascular disease, OR 2.74 (95% CI 1.59-4.74); malignancy, OR 2.73 (95% CI 1.73-4.21); diabetes, OR 2.63 (95% CI 2.08-3.33); and obesity, OR 1.72 (95% CI 1.04-2.85). No correlation was observed between liver disease and COVID-19 aggravation (OR 1.54, 95% CI 0.95-2.49). CONCLUSIONS: Chronic comorbidities, including obesity, hypertension, diabetes, cardiovascular disease, cerebrovascular disease, respiratory disease, kidney disease, and malignancy are clinical risk factors for a severe or fatal outcome associated with COVID-19, with obesity being the most prevalent and respiratory disease being the most strongly predictive. Knowledge of these risk factors could help clinicians better identify and manage the high-risk populations.

covid-19;comorbidity;fatality;icu admission;severe

Journal Article;Meta-Analysis;Systematic Review

Zhou, Yue;Yang, Qing;Chi, Jingwei;Dong, Bingzi;Lv, Wenshan;Shen, Liyan;Wang, Yangang

10.1016/j.ijid.2020.07.029

[Title]: Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis. [Abstract]: OBJECTIVES: Existing findings regarding the relationship between comorbidities and the severity of coronavirus disease 2019 (COVID-19) are inconsistent and insufficient. The aim of this study was to evaluate the association between different comorbidities and the severity of COVID-19. METHODS: The PubMed, Embase, and Cochrane Library databases were searched to identify studies reporting the rates of comorbidities in COVID-19 patients with severe/fatal outcomes. Subgroup analyses were conducted according to disease severity and the country of residence. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using random-effects models. RESULTS: A total of 34 eligible studies were identified. In patients with severe/fatal COVID-19, the most prevalent chronic comorbidities were obesity (42%, 95% CI 34-49%) and hypertension (40%, 95% CI 35-45%), followed by diabetes (17%, 95% CI 15-20%), cardiovascular disease (13%, 95% CI 11-15%), respiratory disease (8%, 95% CI 6-10%), cerebrovascular disease (6%, 95% CI 4-8%), malignancy (4%, 95% CI 3-6%), kidney disease (3%, 95% CI 2-4%), and liver disease (2%, 95% CI 1-3%). In order of the prediction, the pooled ORs of the comorbidities in patients with severe or fatal COVID-19 when compared to patients with non-severe/fatal COVID-19 were as follows: chronic respiratory disease, OR 3.56 (95% CI 2.87-4.41); hypertension, OR 3.17 (95% CI 2.46-4.08); cardiovascular disease, OR 3.13 (95% CI 2.65-3.70); kidney disease, OR 3.02 (95% CI 2.23-4.08); cerebrovascular disease, OR 2.74 (95% CI 1.59-4.74); malignancy, OR 2.73 (95% CI 1.73-4.21); diabetes, OR 2.63 (95% CI 2.08-3.33); and obesity, OR 1.72 (95% CI 1.04-2.85). No correlation was observed between liver disease and COVID-19 aggravation (OR 1.54, 95% CI 0.95-2.49). CONCLUSIONS: Chronic comorbidities, including obesity, hypertension, diabetes, cardiovascular disease, cerebrovascular disease, respiratory disease, kidney disease, and malignancy are clinical risk factors for a severe or fatal outcome associated with COVID-19, with obesity being the most prevalent and respiratory disease being the most strongly predictive. Knowledge of these risk factors could help clinicians better identify and manage the high-risk populations. [Keywords]: covid-19;comorbidity;fatality;icu admission;severe

Proc Int Symp Hum Factors Ergon Healthc

SCHEDULING DELAYED TREATMENT AND SURGERIES POST-PANDEMIC: A STAKEHOLDER ANALYSIS.

Many are interested in how to safely ramp up elective surgeries after national, state, and voluntary shutdowns of operating rooms to minimize the spread of COVID-19 infections to patients and providers. We conducted an analysis of diverse perspectives from stakeholders regarding how to trade off risks and benefits to patients, healthcare providers, and the local community. Our findings indicate that there are a large number of different categories of stakeholders impacted by the post-pandemic decisions to reschedule delayed treatments and surgeries. For a delayed surgery, the primary stakeholders are the surgeon with expertise about the clinical benefits of undergoing an operation and the patient's willingness to tolerate uncertainty and the increased risk of infection. For decisions about how much capacity in the operating rooms and in the inpatient setting after the surgery, the primary considerations are minimizing staff infections, preventing patients from getting COVID-19 during operations and during post-surgical recovery at the hospital, conserving critical resources such as PPE, and meeting the needs of hospital staff for quality of life, such as child care needs and avoiding infecting members of their household. The timing and selection of elective surgery cases has an impact on the ability of hospitals to steward finances, which in turns affects decisions about maintaining employment of staff when operating rooms and inpatient rooms are not being used.

Journal Article

Patterson, Emily S;Papautsky, Elizabeth Lerner;Krok-Schoen, Jessica L;Lee, Clara;Park, Ko Un;White, Julia R;Moffatt-Bruce, Susan;Chirumamilla, Varshita;Lustberg, Maryam

10.1177/2327857920091066

[Title]: SCHEDULING DELAYED TREATMENT AND SURGERIES POST-PANDEMIC: A STAKEHOLDER ANALYSIS. [Abstract]: Many are interested in how to safely ramp up elective surgeries after national, state, and voluntary shutdowns of operating rooms to minimize the spread of COVID-19 infections to patients and providers. We conducted an analysis of diverse perspectives from stakeholders regarding how to trade off risks and benefits to patients, healthcare providers, and the local community. Our findings indicate that there are a large number of different categories of stakeholders impacted by the post-pandemic decisions to reschedule delayed treatments and surgeries. For a delayed surgery, the primary stakeholders are the surgeon with expertise about the clinical benefits of undergoing an operation and the patient's willingness to tolerate uncertainty and the increased risk of infection. For decisions about how much capacity in the operating rooms and in the inpatient setting after the surgery, the primary considerations are minimizing staff infections, preventing patients from getting COVID-19 during operations and during post-surgical recovery at the hospital, conserving critical resources such as PPE, and meeting the needs of hospital staff for quality of life, such as child care needs and avoiding infecting members of their household. The timing and selection of elective surgery cases has an impact on the ability of hospitals to steward finances, which in turns affects decisions about maintaining employment of staff when operating rooms and inpatient rooms are not being used. [Keywords]:

Epilepsy Curr

The Impact of COVID-19 on Epilepsy Care: A Survey of the American Epilepsy Society Membership.

The COVID-19 pandemic has impacted the delivery of care to people with epilepsy (PWE) in multiple ways including limitations on in-person contact and restrictions on neurophysiological procedures. To better study the effect of the pandemic on PWE, members of the American Epilepsy Society were surveyed between April 30 and June 14, 2020. There were 366 initial responses (9% response rate) and 337 respondents remained for analysis after screening out noncompleters and those not directly involved with clinical care; the majority were physicians from the United States. About a third (30%) of respondents stated that they had patients with COVID-19 and reported no significant change in seizure frequency. Conversely, one-third of respondents reported new onset seizures in patients with COVID-19 who had no prior history of seizures. The majority of respondents felt that there were at least some barriers for PWE in receiving appropriate clinical care, neurophysiologic procedures, and elective surgery. Medication shortages were noted by approximately 30% of respondents, with no clear pattern in types of medication involved. Telehealth was overwhelmingly found to have value. Among the limitation of the survey was that it was administered at a single point in time in a rapidly changing pandemic. The survey showed that almost all respondents were affected by the pandemic in a variety of ways.

covid-19;eeg;sars-cov-2;epilepsy care;people with epilepsy (pwe);seizures;survey;telehealth

Journal Article

Albert, Dara V F;Das, Rohit R;Acharya, Jayant N;Lee, Jong Woo;Pollard, John R;Punia, Vineet;Keller, Joy A;Husain, Aatif M

10.1177/1535759720956994

[Title]: The Impact of COVID-19 on Epilepsy Care: A Survey of the American Epilepsy Society Membership. [Abstract]: The COVID-19 pandemic has impacted the delivery of care to people with epilepsy (PWE) in multiple ways including limitations on in-person contact and restrictions on neurophysiological procedures. To better study the effect of the pandemic on PWE, members of the American Epilepsy Society were surveyed between April 30 and June 14, 2020. There were 366 initial responses (9% response rate) and 337 respondents remained for analysis after screening out noncompleters and those not directly involved with clinical care; the majority were physicians from the United States. About a third (30%) of respondents stated that they had patients with COVID-19 and reported no significant change in seizure frequency. Conversely, one-third of respondents reported new onset seizures in patients with COVID-19 who had no prior history of seizures. The majority of respondents felt that there were at least some barriers for PWE in receiving appropriate clinical care, neurophysiologic procedures, and elective surgery. Medication shortages were noted by approximately 30% of respondents, with no clear pattern in types of medication involved. Telehealth was overwhelmingly found to have value. Among the limitation of the survey was that it was administered at a single point in time in a rapidly changing pandemic. The survey showed that almost all respondents were affected by the pandemic in a variety of ways. [Keywords]: covid-19;eeg;sars-cov-2;epilepsy care;people with epilepsy (pwe);seizures;survey;telehealth

J Am Acad Dermatol

Navigating immunosuppression in a pandemic: A guide for the dermatologist from the COVID Task Force of the Medical Dermatology Society and Society of Dermatology Hospitalists.

Dermatologists treating immune-mediated skin disease must now contend with the uncertainties associated with immunosuppressive use in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Although the risk of infection with many commonly used immunosuppressive agents remains low, direct data evaluating the safety of such agents in coronavirus disease 2019 (COVID-19) are scarce. This article reviews and offers guidance based on currently available safety data and the most recent COVID-19 outcome data in patients with immune-mediated dermatologic disease. The interdisciplinary panel of experts emphasizes a stepwise, shared decision-making approach in the management of immunosuppressive therapy. The goal of this article is to help providers minimize the risk of disease flares while simultaneously minimizing the risk of iatrogenic harm during an evolving pandemic.

covid-19;sars-cov-2;autoimmune disease;dermatology-rheumatology;immunosuppression;immunosuppressive therapy;medical dermatology

Journal Article;Review

Zahedi Niaki, Omid;Anadkat, Milan J;Chen, Steven T;Fox, Lindy P;Harp, Joanna;Micheletti, Robert G;Nambudiri, Vinod E;Pasieka, Helena B;Shinohara, Michi M;Rosenbach, Misha;Merola, Joseph F

10.1016/j.jaad.2020.06.051

[Title]: Navigating immunosuppression in a pandemic: A guide for the dermatologist from the COVID Task Force of the Medical Dermatology Society and Society of Dermatology Hospitalists. [Abstract]: Dermatologists treating immune-mediated skin disease must now contend with the uncertainties associated with immunosuppressive use in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Although the risk of infection with many commonly used immunosuppressive agents remains low, direct data evaluating the safety of such agents in coronavirus disease 2019 (COVID-19) are scarce. This article reviews and offers guidance based on currently available safety data and the most recent COVID-19 outcome data in patients with immune-mediated dermatologic disease. The interdisciplinary panel of experts emphasizes a stepwise, shared decision-making approach in the management of immunosuppressive therapy. The goal of this article is to help providers minimize the risk of disease flares while simultaneously minimizing the risk of iatrogenic harm during an evolving pandemic. [Keywords]: covid-19;sars-cov-2;autoimmune disease;dermatology-rheumatology;immunosuppression;immunosuppressive therapy;medical dermatology

J Racial Ethn Health Disparities

Survey of the Health of Urban Residents: a Community-Driven Assessment of Conditions Salient to the Health of Historically Excluded Populations in the USA.

BACKGROUND: Data from the Survey of the Health of Urban Residents (SHUR) identified connections between police brutality and medical mistrust, generating significant media, policy, and research attention. Amidst intersecting crises of COVID-19, racism, and police brutality, this report describes survey development and data collection procedures for the SHUR. BASIC PROCEDURES: We conducted focus groups with Black men, Latinxs, and immigrants in Allentown, Pennsylvania. Findings were used to develop and refine measures of conditions salient to the health of urban residents across the country. Quota sampling was employed; oversampling people of color and persons whose usual source of care was not a doctor's office. MAIN FINDINGS: Non-Hispanic Whites made up just under two thirds of the sample (63.65%, n = 2793). Black/African American respondents accounted for 14.2% of the sample (n = 623), while 11.62% (n = 510) were Latinx. Only 43.46% of respondents reported a doctor's office as their usual source of care. Novel measures of population-specific stressors include a range of negative encounters with the police, frequency of these encounters, and respondents' assessments of whether the encounters were necessary. SHUR assessed the likelihood of calling the police if there is a problem, worries about incarceration, and cause-specific stressors such as race-related impression management. PRINCIPAL CONCLUSIONS: SHUR (n = 4389) is a useful resource for researchers seeking to address the health implications of experiences not frequently measured by national health surveillance surveys. It includes respondents' zip codes, presenting the opportunity to connect these data with zip code-level health system, social and economic characteristics that shape health beyond individual factors.

community-engaged health survey;police brutality;shur data;social conditions and health;urban health

Journal Article

Alang, Sirry;Pando, Cynthia;McClain, Malcolm;Batts, Hasshan;Letcher, Abby;Hager, Janelle;Person, Taylor;Shaw, Adama;Blake, Kwamaine;Matthews-Alvarado, Kevelis

10.1007/s40615-020-00852-1

[Title]: Survey of the Health of Urban Residents: a Community-Driven Assessment of Conditions Salient to the Health of Historically Excluded Populations in the USA. [Abstract]: BACKGROUND: Data from the Survey of the Health of Urban Residents (SHUR) identified connections between police brutality and medical mistrust, generating significant media, policy, and research attention. Amidst intersecting crises of COVID-19, racism, and police brutality, this report describes survey development and data collection procedures for the SHUR. BASIC PROCEDURES: We conducted focus groups with Black men, Latinxs, and immigrants in Allentown, Pennsylvania. Findings were used to develop and refine measures of conditions salient to the health of urban residents across the country. Quota sampling was employed; oversampling people of color and persons whose usual source of care was not a doctor's office. MAIN FINDINGS: Non-Hispanic Whites made up just under two thirds of the sample (63.65%, n = 2793). Black/African American respondents accounted for 14.2% of the sample (n = 623), while 11.62% (n = 510) were Latinx. Only 43.46% of respondents reported a doctor's office as their usual source of care. Novel measures of population-specific stressors include a range of negative encounters with the police, frequency of these encounters, and respondents' assessments of whether the encounters were necessary. SHUR assessed the likelihood of calling the police if there is a problem, worries about incarceration, and cause-specific stressors such as race-related impression management. PRINCIPAL CONCLUSIONS: SHUR (n = 4389) is a useful resource for researchers seeking to address the health implications of experiences not frequently measured by national health surveillance surveys. It includes respondents' zip codes, presenting the opportunity to connect these data with zip code-level health system, social and economic characteristics that shape health beyond individual factors. [Keywords]: community-engaged health survey;police brutality;shur data;social conditions and health;urban health

PLoS One

Association between COVID-19 prognosis and disease presentation, comorbidities and chronic treatment of hospitalized patients.

IMPORTANCE: The rapid pandemic expansion of the disease caused by the new SARS-CoV-2 virus has compromised health systems worldwide. Knowledge of prognostic factors in affected patients can help optimize care. OBJECTIVE: The objective of this study was to analyze the relationship between the prognosis of COVID-19 and the form of presentation of the disease, the previous pathologies of patients and their chronic treatments. DESIGN, PARTICIPANTS AND LOCATIONS: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia (Spain). As primary outcomes, severe disease (need for oxygen therapy via nonrebreather mask or mechanical ventilation) and death were studied. Multivariate binary logistic regression models were performed to study the association between the different factors and the results. RESULTS: Advanced age, male sex and obesity were independent markers of poor prognosis. The most frequent presenting symptom was fever, while dyspnea was associated with severe disease and the presence of cough with greater survival. Low oxygen saturation in the emergency room, elevated CRP in the emergency room and initial radiological involvement were all related to worse prognosis. The presence of eosinophilia (% of eosinophils) was an independent marker of less severe disease. CONCLUSIONS: This study identified the most robust markers of poor prognosis for COVID-19. These results can help to correctly stratify patients at the beginning of hospitalization based on the risk of developing severe disease.

Journal Article;Observational Study

Rodriguez-Molinero, Alejandro;Galvez-Barron, Cesar;Minarro, Antonio;Macho, Oscar;Lopez, Gabriela F;Robles, Maria Teresa;Dapena, Maria Dolores;Martinez, Sergi;Mila Rafols, Nuria;Monaco, Ernesto E;Hidalgo Garcia, Antonio

10.1371/journal.pone.0239571

[Title]: Association between COVID-19 prognosis and disease presentation, comorbidities and chronic treatment of hospitalized patients. [Abstract]: IMPORTANCE: The rapid pandemic expansion of the disease caused by the new SARS-CoV-2 virus has compromised health systems worldwide. Knowledge of prognostic factors in affected patients can help optimize care. OBJECTIVE: The objective of this study was to analyze the relationship between the prognosis of COVID-19 and the form of presentation of the disease, the previous pathologies of patients and their chronic treatments. DESIGN, PARTICIPANTS AND LOCATIONS: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia (Spain). As primary outcomes, severe disease (need for oxygen therapy via nonrebreather mask or mechanical ventilation) and death were studied. Multivariate binary logistic regression models were performed to study the association between the different factors and the results. RESULTS: Advanced age, male sex and obesity were independent markers of poor prognosis. The most frequent presenting symptom was fever, while dyspnea was associated with severe disease and the presence of cough with greater survival. Low oxygen saturation in the emergency room, elevated CRP in the emergency room and initial radiological involvement were all related to worse prognosis. The presence of eosinophilia (% of eosinophils) was an independent marker of less severe disease. CONCLUSIONS: This study identified the most robust markers of poor prognosis for COVID-19. These results can help to correctly stratify patients at the beginning of hospitalization based on the risk of developing severe disease. [Keywords]:

Morphologie

Cadaverless anatomy: Darkness in the times of pandemic Covid-19.

The pandemic Covid-19 is responsible for a major education crisis globally and has a drastic impact on medical training as well. The objective of the present study was to envision the present and future impact of Covid-19 on anatomy learning and research. The virtual education is the only mode of teaching in current scenario. Every anatomist is unlocking technology to deliver best education however understanding of the subject without dissections or other practical teaching aids like bones, specimens, embryology models, microscopic slides etc. is challenging. This approach misses the feel and human visual impacts. Potential educational disruption is felt currently and will be experienced even after the pandemic is over due to scarcity of cadavers. As the body donor may be carrier or died of Covid-19 and there is no proven screening to rule out this infection in donor, so the acceptance of body donations is not advisable for the safety of medical students and health care workers. To conclude, anatomy education is cadaverless currently due to Covid-19 lockdown and it is prophesied that after the pandemic, real cadavers will be replaced by virtual cadavers because of paucity of cadavers. Research in the field of anatomy will also be adversely affected.

anatomy education;body donation;covid-19;pandemic;virtual classes

Editorial

Singal, A;Bansal, A;Chaudhary, P

10.1016/j.morpho.2020.05.003

[Title]: Cadaverless anatomy: Darkness in the times of pandemic Covid-19. [Abstract]: The pandemic Covid-19 is responsible for a major education crisis globally and has a drastic impact on medical training as well. The objective of the present study was to envision the present and future impact of Covid-19 on anatomy learning and research. The virtual education is the only mode of teaching in current scenario. Every anatomist is unlocking technology to deliver best education however understanding of the subject without dissections or other practical teaching aids like bones, specimens, embryology models, microscopic slides etc. is challenging. This approach misses the feel and human visual impacts. Potential educational disruption is felt currently and will be experienced even after the pandemic is over due to scarcity of cadavers. As the body donor may be carrier or died of Covid-19 and there is no proven screening to rule out this infection in donor, so the acceptance of body donations is not advisable for the safety of medical students and health care workers. To conclude, anatomy education is cadaverless currently due to Covid-19 lockdown and it is prophesied that after the pandemic, real cadavers will be replaced by virtual cadavers because of paucity of cadavers. Research in the field of anatomy will also be adversely affected. [Keywords]: anatomy education;body donation;covid-19;pandemic;virtual classes

Clin Infect Dis

Remdesivir failure with SARS-CoV-2 RNA-dependent RNA-polymerase mutation in a B-cell immunodeficient patient with protracted Covid-19.

SARS-CoV-2 is a new pandemic virus for which Remdesivir is the only antiviral available. We report the occurrence of a mutation in the RdRP (D484Y) following failure of remdesivir in a 76-year-old woman with a post-rituximab B-cell immunodeficiency and persistent SARS-CoV-2 viremia. Cure was reached after supplementation with convalescent plasma.

covid-19;covid-19 convalescent plasma;remdesivir;sars-cov-2;sars-cov-2 rna-dependent rna-polymerase mutation

Journal Article

Martinot, Martin;Jary, Aude;Fafi-Kremer, Samira;Leducq, Valentin;Delagreverie, Heloise;Garnier, Marc;Pacanowski, Jerome;Mekinian, Arsene;Pirenne, France;Tiberghien, Pierre;Calvez, Vincent;Humbrecht, Catherine;Marcelin, Anne-Genevieve;Lacombe, Karine

10.1093/cid/ciaa1474

[Title]: Remdesivir failure with SARS-CoV-2 RNA-dependent RNA-polymerase mutation in a B-cell immunodeficient patient with protracted Covid-19. [Abstract]: SARS-CoV-2 is a new pandemic virus for which Remdesivir is the only antiviral available. We report the occurrence of a mutation in the RdRP (D484Y) following failure of remdesivir in a 76-year-old woman with a post-rituximab B-cell immunodeficiency and persistent SARS-CoV-2 viremia. Cure was reached after supplementation with convalescent plasma. [Keywords]: covid-19;covid-19 convalescent plasma;remdesivir;sars-cov-2;sars-cov-2 rna-dependent rna-polymerase mutation

Epidemiol Serv Saude

Suspected COVID-19 case definition: a narrative review of the most frequent signs and symptoms among confirmed cases.

OBJECTIVE: to describe the most frequent signs and symptoms of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: this is a narrative literature review carried out in April 2020; the search was performed on electronic databases and complemented with a manual review of the references of the selected papers and Brazilian Ministry of Health publications. RESULTS: the spectrum of clinical disease was wide; fever, coughing and dyspnea were the most frequent signs/symptoms, however, they may not be present, thus hindering case definition; gastrointestinal symptoms and loss of taste or smell have been reported among mild cases; dyspnea was frequent among severe and fatal cases. CONCLUSION: considering the scarcity of diagnostic tests and the diversity of symptoms, health services should use a sensitive case definition, in order to adopt appropriate surveillance, prevention and treatment actions.

Journal Article;Review

Iser, Betine Pinto Moehlecke;Sliva, Isabella;Raymundo, Vitoria Timmen;Poleto, Marcos Bottega;Schuelter-Trevisol, Fabiana;Bobinski, Franciane

10.5123/S1679-49742020000300018

[Title]: Suspected COVID-19 case definition: a narrative review of the most frequent signs and symptoms among confirmed cases. [Abstract]: OBJECTIVE: to describe the most frequent signs and symptoms of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: this is a narrative literature review carried out in April 2020; the search was performed on electronic databases and complemented with a manual review of the references of the selected papers and Brazilian Ministry of Health publications. RESULTS: the spectrum of clinical disease was wide; fever, coughing and dyspnea were the most frequent signs/symptoms, however, they may not be present, thus hindering case definition; gastrointestinal symptoms and loss of taste or smell have been reported among mild cases; dyspnea was frequent among severe and fatal cases. CONCLUSION: considering the scarcity of diagnostic tests and the diversity of symptoms, health services should use a sensitive case definition, in order to adopt appropriate surveillance, prevention and treatment actions. [Keywords]:

Diabetes Metab Syndr

A short questionnaire to assess changes in lifestyle-related behaviour during COVID 19 pandemic.

BACKGROUND AND AIMS: The lasting impact of COVID 19 pandemic and associated restrictions are bound to be significant on lifestyle-related behaviour including diet, physical activity and sleep which is one of the important components in the management of diabetes mellitus and metabolic syndrome. This study was conducted to develop and validate a questionnaire to assess changes in individual's lifestyle-related behaviour during COVID 19 pandemic. MATERIALS AND METHODS: The questionnaire was developed through a standardised methodology including literature review, focus group discussion, expert evaluation, pre-testing and validation. The face validity and content validity of the questionnaire were analysed. A cross-sectional survey was carried out on 103 participants to validate the questionnaire that used a 5-point Likert scale for the response option. Exploratory factor analysis was performed to establish construct validity. Cronbach's alpha was calculated to test the internal consistency of the whole questionnaire. RESULTS: A questionnaire with 20 items to assess the lifestyle-related behaviour of people was developed. The questionnaire shows a satisfactory validity and a good internal consistency with the Cronbach's alpha value of 0.72. CONCLUSION: The developed tool is valid and reliable to assess the changes in lifestyle-related behaviour of individuals during COVID 19 pandemic.

covid 19;diabetes;diet;exercise;lifestyle;metabolic syndrome;questionnaire;sleep

Journal Article

Kumari, Archana;Ranjan, Piyush;Vikram, Naval K;Kaur, Divjyot;Sahu, Anamika;Dwivedi, Sada Nand;Baitha, Upendra;Goel, Aastha

10.1016/j.dsx.2020.08.020

[Title]: A short questionnaire to assess changes in lifestyle-related behaviour during COVID 19 pandemic. [Abstract]: BACKGROUND AND AIMS: The lasting impact of COVID 19 pandemic and associated restrictions are bound to be significant on lifestyle-related behaviour including diet, physical activity and sleep which is one of the important components in the management of diabetes mellitus and metabolic syndrome. This study was conducted to develop and validate a questionnaire to assess changes in individual's lifestyle-related behaviour during COVID 19 pandemic. MATERIALS AND METHODS: The questionnaire was developed through a standardised methodology including literature review, focus group discussion, expert evaluation, pre-testing and validation. The face validity and content validity of the questionnaire were analysed. A cross-sectional survey was carried out on 103 participants to validate the questionnaire that used a 5-point Likert scale for the response option. Exploratory factor analysis was performed to establish construct validity. Cronbach's alpha was calculated to test the internal consistency of the whole questionnaire. RESULTS: A questionnaire with 20 items to assess the lifestyle-related behaviour of people was developed. The questionnaire shows a satisfactory validity and a good internal consistency with the Cronbach's alpha value of 0.72. CONCLUSION: The developed tool is valid and reliable to assess the changes in lifestyle-related behaviour of individuals during COVID 19 pandemic. [Keywords]: covid 19;diabetes;diet;exercise;lifestyle;metabolic syndrome;questionnaire;sleep

Gut

Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in the context of the COVID-19 pandemic: a RAND appropriateness panel.

OBJECTIVE: Management of acute severe UC (ASUC) during the novel COVID-19 pandemic presents significant dilemmas. We aimed to provide COVID-19-specific guidance using current British Society of Gastroenterology (BSG) guidelines as a reference point. DESIGN: We convened a RAND appropriateness panel comprising 14 gastroenterologists and an IBD nurse consultant supplemented by surgical and COVID-19 experts. Panellists rated the appropriateness of interventions for ASUC in the context of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Median scores and disagreement index (DI) were calculated. Results were discussed at a moderated meeting prior to a second survey. RESULTS: Panellists recommended that patients with ASUC should be isolated throughout their hospital stay and should have a SARS-CoV-2 swab performed on admission. Patients with a positive swab should be discussed with COVID-19 specialists. As per BSG guidance, intravenous hydrocortisone was considered appropriate as initial management; only in patients with COVID-19 pneumonia was its use deemed uncertain. In patients requiring rescue therapy, infliximab with continuing steroids was recommended. Delaying colectomy because of COVID-19 was deemed inappropriate. Steroid tapering as per BSG guidance was deemed appropriate for all patients apart from those with COVID-19 pneumonia in whom a 4-6 week taper was preferred. Post-ASUC maintenance therapy was dependent on SARS-CoV-2 status but, in general, biologics were more likely to be deemed appropriate than azathioprine or tofacitinib. Panellists deemed prophylactic anticoagulation postdischarge to be appropriate in patients with a positive SARS-CoV-2 swab. CONCLUSION: We have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel.

ibd clinical;clinical decision making;ulcerative colitis

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

Din, Shahida;Kent, Alexandra;Pollok, Richard C;Meade, Susanna;Kennedy, Nicholas A;Arnott, Ian;Beattie, R Mark;Chua, Felix;Cooney, Rachel;Dart, Robin J;Galloway, James;Gaya, Daniel R;Ghosh, Subrata;Griffiths, Mark;Hancock, Laura;Hansen, Richard;Hart, Ailsa;Lamb, Christopher Andrew;Lees, Charlie W;Limdi, Jimmy K;Lindsay, James O;Patel, Kamal;Powell, Nick;Murray, Charles D;Probert, Chris;Raine, Tim;Selinger, Christian;Sebastian, Shaji;Smith, Philip J;Tozer, Phil;Ustianowski, Andrew;Younge, Lisa;Samaan, Mark A;Irving, Peter M

10.1136/gutjnl-2020-321927

[Title]: Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in the context of the COVID-19 pandemic: a RAND appropriateness panel. [Abstract]: OBJECTIVE: Management of acute severe UC (ASUC) during the novel COVID-19 pandemic presents significant dilemmas. We aimed to provide COVID-19-specific guidance using current British Society of Gastroenterology (BSG) guidelines as a reference point. DESIGN: We convened a RAND appropriateness panel comprising 14 gastroenterologists and an IBD nurse consultant supplemented by surgical and COVID-19 experts. Panellists rated the appropriateness of interventions for ASUC in the context of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Median scores and disagreement index (DI) were calculated. Results were discussed at a moderated meeting prior to a second survey. RESULTS: Panellists recommended that patients with ASUC should be isolated throughout their hospital stay and should have a SARS-CoV-2 swab performed on admission. Patients with a positive swab should be discussed with COVID-19 specialists. As per BSG guidance, intravenous hydrocortisone was considered appropriate as initial management; only in patients with COVID-19 pneumonia was its use deemed uncertain. In patients requiring rescue therapy, infliximab with continuing steroids was recommended. Delaying colectomy because of COVID-19 was deemed inappropriate. Steroid tapering as per BSG guidance was deemed appropriate for all patients apart from those with COVID-19 pneumonia in whom a 4-6 week taper was preferred. Post-ASUC maintenance therapy was dependent on SARS-CoV-2 status but, in general, biologics were more likely to be deemed appropriate than azathioprine or tofacitinib. Panellists deemed prophylactic anticoagulation postdischarge to be appropriate in patients with a positive SARS-CoV-2 swab. CONCLUSION: We have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel. [Keywords]: ibd clinical;clinical decision making;ulcerative colitis

Otolaryngol Head Neck Surg

Telemedicine and the Interdisciplinary Clinic Model: During the COVID-19 Pandemic and Beyond.

The emergence of the novel coronavirus disease 2019 (COVID-19) and the subsequent need for physical distancing have necessitated a swift change in health care delivery. Prior to the COVID-19 outbreak, many institutions utilized an interdisciplinary clinic model including both a laryngologist and a speech-language pathologist for the evaluation of patients with voice, swallowing, and upper airway disorders. To improve access, many providers are pursuing the use of interdisciplinary telemedicine to provide individualized patient-centered care while allowing for physical distancing. The purpose of this commentary is to review the current literature regarding telemedicine in laryngology and speech-language pathology as well as the current and future states of practice for interdisciplinary tele-evaluations.

covid-19;interdisciplinary;laryngology;speech-language pathology;telemedicine;telepractice

Journal Article;Review

Zughni, Lisa A;Gillespie, Amanda I;Hatcher, Jeanne L;Rubin, Adam D;Giliberto, John Paul

10.1177/0194599820932167

[Title]: Telemedicine and the Interdisciplinary Clinic Model: During the COVID-19 Pandemic and Beyond. [Abstract]: The emergence of the novel coronavirus disease 2019 (COVID-19) and the subsequent need for physical distancing have necessitated a swift change in health care delivery. Prior to the COVID-19 outbreak, many institutions utilized an interdisciplinary clinic model including both a laryngologist and a speech-language pathologist for the evaluation of patients with voice, swallowing, and upper airway disorders. To improve access, many providers are pursuing the use of interdisciplinary telemedicine to provide individualized patient-centered care while allowing for physical distancing. The purpose of this commentary is to review the current literature regarding telemedicine in laryngology and speech-language pathology as well as the current and future states of practice for interdisciplinary tele-evaluations. [Keywords]: covid-19;interdisciplinary;laryngology;speech-language pathology;telemedicine;telepractice

Expert Rev Anti Infect Ther

Can nanotechnology help in the fight against COVID-19?

INTRODUCTION: The current COVID-19 pandemic caused by the SARS-CoV-2 virus demands the development of strategies not only to detect or inactivate the virus, but to treat it (therapeutically and prophylactically). COVID-19 is not only a critical threat for the population with risk factors, but also generates a dramatic economic impact in terms of morbidity and the overall interruption of economic activities. AREAS COVERED: Advanced materials are the basis of several technologies that could diminish the impact of COVID-19: biosensors might allow early virus detection, nanosized vaccines are powerful agents that could prevent viral infections, and nanosystems with antiviral activity could bind the virus for inactivation or destruction upon application of an external stimulus. Herein all these methods are discussed under the light of cutting-edge technologies and the previously reported prototypes targeting enveloped viruses similar to SARS-CoV-2. This analysis was derived from an extensive scientific literature search (including pubmed) performed on April 2020. EXPERT OPINION: Perspectives on how biosensors, vaccines, and antiviral nanosystems can be implemented to fight COVID-19 are envisioned; identifying the approaches that can be implemented in the short term and those that deserve long term research to cope with respiratory viruses-related pandemics in the future.

sars-cov-2;biosensors;graphene oxide;nanoclays;quantum dots;silica nanoparticles;silver nanoparticles;virus-like particles

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

Palestino, Gabriela;Garcia-Silva, Ileana;Gonzalez-Ortega, Omar;Rosales-Mendoza, Sergio

10.1080/14787210.2020.1776115

[Title]: Can nanotechnology help in the fight against COVID-19? [Abstract]: INTRODUCTION: The current COVID-19 pandemic caused by the SARS-CoV-2 virus demands the development of strategies not only to detect or inactivate the virus, but to treat it (therapeutically and prophylactically). COVID-19 is not only a critical threat for the population with risk factors, but also generates a dramatic economic impact in terms of morbidity and the overall interruption of economic activities. AREAS COVERED: Advanced materials are the basis of several technologies that could diminish the impact of COVID-19: biosensors might allow early virus detection, nanosized vaccines are powerful agents that could prevent viral infections, and nanosystems with antiviral activity could bind the virus for inactivation or destruction upon application of an external stimulus. Herein all these methods are discussed under the light of cutting-edge technologies and the previously reported prototypes targeting enveloped viruses similar to SARS-CoV-2. This analysis was derived from an extensive scientific literature search (including pubmed) performed on April 2020. EXPERT OPINION: Perspectives on how biosensors, vaccines, and antiviral nanosystems can be implemented to fight COVID-19 are envisioned; identifying the approaches that can be implemented in the short term and those that deserve long term research to cope with respiratory viruses-related pandemics in the future. [Keywords]: sars-cov-2;biosensors;graphene oxide;nanoclays;quantum dots;silica nanoparticles;silver nanoparticles;virus-like particles

Adv Radiat Oncol

Radiation Therapy Department Reorganization during the Coronavirus Disease 2019 (COVID-19) Outbreak: Keys to Securing Staff and Patients During the First Weeks of the Crisis and Impact on Radiation Therapy Practice from a Single Institution Experience.

Purpose: During the first weeks of the coronavirus disease 2019 (COVID-19) outbreak in France, it was necessary to clearly define organizational priorities in the radiation therapy (RT) departments. In this report, we focus on the urgent measures taken to reduce risk for both our staff and patients by reducing the number of patients receiving treatment. Methods and Materials: We reviewed the fractionation schemes for all patients in our department, including those receiving treatment and those soon to start treatment. Our goals were to (1) decrease the number of patients coming daily to the hospital for RT, (2) adapt our human resources to continue patients' care in the department, and (3) help to cover understaffed COVID-19 sectors of the hospital. Results: We identified 50 patients who were receiving treatment (n = 6), were going to start radiation after CT scan simulation (n = 41), or for whom the CT scan was pending (n = 3). The majority were women (64%) treated for breast cancer (54%). RT was delayed for 22 (44%) patients. The majority were offered hormone therapy as "waiting therapy." Hypofractionation was considered in 21 (42%) patients mainly with breast cancer (18 of 21, 86%). The number of courses initially planned and replanned as a result of the COVID-19 outbreak during the period of March 15 to May 31, 2020, were 1383 and 683, respectively, which represented a reduction of 50% (including delayed sessions) that allowed our reorganization process. Conclusions: To conserve resources during the pandemic, we successfully reduced the number of patients receiving treatment in a proactive fashion and adapted our organization to minimize the risk of COVID-19 contamination. Departments across the world may benefit from this same approach.

Journal Article;Review

Belkacemi, Yazid;Loaganadane, Gokoulakrichenane;Grellier, Noemie;Fonteneau, Gloria;Zaoui, Gael;Coraggio, Gabriele;Hadhri, Asma;Adou, Marie;Bendavid, Jerome;Boros, Angela;Ghith, Sahar;Debbi, Kamel;Cadot, Pauline;Bak, Adeline;Le Bret, Cindy;Hassani, Wissal;Mahe, Mathilde;Herve, Marie-Laure;Colson-Durand, Laurianne;Hanh To, Nhu;Luo, Deng Feng;Cherif, Aziz

10.1016/j.adro.2020.04.039

[Title]: Radiation Therapy Department Reorganization during the Coronavirus Disease 2019 (COVID-19) Outbreak: Keys to Securing Staff and Patients During the First Weeks of the Crisis and Impact on Radiation Therapy Practice from a Single Institution Experience. [Abstract]: Purpose: During the first weeks of the coronavirus disease 2019 (COVID-19) outbreak in France, it was necessary to clearly define organizational priorities in the radiation therapy (RT) departments. In this report, we focus on the urgent measures taken to reduce risk for both our staff and patients by reducing the number of patients receiving treatment. Methods and Materials: We reviewed the fractionation schemes for all patients in our department, including those receiving treatment and those soon to start treatment. Our goals were to (1) decrease the number of patients coming daily to the hospital for RT, (2) adapt our human resources to continue patients' care in the department, and (3) help to cover understaffed COVID-19 sectors of the hospital. Results: We identified 50 patients who were receiving treatment (n = 6), were going to start radiation after CT scan simulation (n = 41), or for whom the CT scan was pending (n = 3). The majority were women (64%) treated for breast cancer (54%). RT was delayed for 22 (44%) patients. The majority were offered hormone therapy as "waiting therapy." Hypofractionation was considered in 21 (42%) patients mainly with breast cancer (18 of 21, 86%). The number of courses initially planned and replanned as a result of the COVID-19 outbreak during the period of March 15 to May 31, 2020, were 1383 and 683, respectively, which represented a reduction of 50% (including delayed sessions) that allowed our reorganization process. Conclusions: To conserve resources during the pandemic, we successfully reduced the number of patients receiving treatment in a proactive fashion and adapted our organization to minimize the risk of COVID-19 contamination. Departments across the world may benefit from this same approach. [Keywords]:

J Cardiovasc Electrophysiol

Inpatient cardiac monitoring using a patch-based mobile cardiac telemetry system during the COVID-19 pandemic.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a worldwide pandemic, and cardiovascular complications and arrhythmias in these patients are common. Cardiac monitoring is recommended for at risk patients; however, the availability of telemetry capable hospital beds is limited. We sought to evaluate a patch-based mobile telemetry system for inpatient cardiac monitoring during the pandemic. METHODS: A prospective cohort study was performed of inpatients hospitalized during the pandemic who had mobile telemetry devices placed; patients were studied up until the time of discharge or death. The primary outcome was a composite of management changes based on data obtained from the system and detection of new arrhythmias. Other clinical outcomes and performance characteristics of the mobile telemetry system were studied. RESULTS: Eighty-two patients underwent mobile telemetry device placement, of which 31 (37.8%) met the primary outcome, which consisted of 24 (29.3%) with new arrhythmias detected and 18 (22.2%) with management changes. Twenty-one patients (25.6%) died during the study, but none from primary arrhythmias. In analyses, age and heart failure were associated with the primary outcome. Monitoring occurred for an average of 5.3 +/- 3.4 days, with 432 total patient-days of monitoring performed; of these, QT-interval measurements were feasible in 400 (92.6%). CONCLUSION: A mobile telemetry system was successfully implemented for inpatient use during the COVID-19 pandemic and was shown to be useful to inform patient management, detect occult arrhythmias, and monitor the QT-interval. Patients with advanced age and structural heart disease may be more likely to benefit from this system.

covid-19;arrhythmia;cardiac monitoring;mobile telemetry;telemetry

Journal Article

Braunstein, Eric D;Reynbakh, Olga;Krumerman, Andrew;Di Biase, Luigi;Ferrick, Kevin J

10.1111/jce.14727

[Title]: Inpatient cardiac monitoring using a patch-based mobile cardiac telemetry system during the COVID-19 pandemic. [Abstract]: INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a worldwide pandemic, and cardiovascular complications and arrhythmias in these patients are common. Cardiac monitoring is recommended for at risk patients; however, the availability of telemetry capable hospital beds is limited. We sought to evaluate a patch-based mobile telemetry system for inpatient cardiac monitoring during the pandemic. METHODS: A prospective cohort study was performed of inpatients hospitalized during the pandemic who had mobile telemetry devices placed; patients were studied up until the time of discharge or death. The primary outcome was a composite of management changes based on data obtained from the system and detection of new arrhythmias. Other clinical outcomes and performance characteristics of the mobile telemetry system were studied. RESULTS: Eighty-two patients underwent mobile telemetry device placement, of which 31 (37.8%) met the primary outcome, which consisted of 24 (29.3%) with new arrhythmias detected and 18 (22.2%) with management changes. Twenty-one patients (25.6%) died during the study, but none from primary arrhythmias. In analyses, age and heart failure were associated with the primary outcome. Monitoring occurred for an average of 5.3 +/- 3.4 days, with 432 total patient-days of monitoring performed; of these, QT-interval measurements were feasible in 400 (92.6%). CONCLUSION: A mobile telemetry system was successfully implemented for inpatient use during the COVID-19 pandemic and was shown to be useful to inform patient management, detect occult arrhythmias, and monitor the QT-interval. Patients with advanced age and structural heart disease may be more likely to benefit from this system. [Keywords]: covid-19;arrhythmia;cardiac monitoring;mobile telemetry;telemetry

Dermatol Ther

Psoriatic arthritis and COVID-19 pandemic: Consequences in medical treatment?

The COVID-19 pandemic has a strong negative impact on human society worldwide. Patients with immune-mediated disease may be prone to an increased risk of infection and/or more severe course. We review the available data for patients with psoriatic arthritis (PSA) and systemic treatments. Current treatment options are summarized. Based upon the experience with COVID-19, the following problems are addressed: (a) Can systemic treatment reduce comorbidities of PsA that are also comorbidities for COVID-19? Does systemic medical treatment pose an increased risk of infection with SARS-CoV-2? Does systemic drug therapy have an impact on the risk of pulmonary fibrosis-a factor with strong negative impact on COVID-19 outcome? Small molecules, inhibitors of tumor necrosis factor alfa, interleukin, and JAK inhibitors are considered. The data are inhomogeneous for the multiple drugs used in PsA. Although the risk for severe upper airway tract infections during clinical controlled trials was mostly in the range of placebo, these data have been obtained before the COVID-19 pandemic and should be interpreted with caution. Some biologics demonstrated an antifibrotic activity in vitro and in animal disease models. None of the biologics is indicated during an active infection with fever. In nonsymptomatic PsA patients, systemic drug therapy can be continued.

covid-19;biologics;psoriatic arthritis;small molecules;systemic medical treatment

Journal Article;Review

Wollina, Uwe;Fioranelli, Massimo;Goldust, Mohamad;Lotti, Torello

10.1111/dth.13743

[Title]: Psoriatic arthritis and COVID-19 pandemic: Consequences in medical treatment? [Abstract]: The COVID-19 pandemic has a strong negative impact on human society worldwide. Patients with immune-mediated disease may be prone to an increased risk of infection and/or more severe course. We review the available data for patients with psoriatic arthritis (PSA) and systemic treatments. Current treatment options are summarized. Based upon the experience with COVID-19, the following problems are addressed: (a) Can systemic treatment reduce comorbidities of PsA that are also comorbidities for COVID-19? Does systemic medical treatment pose an increased risk of infection with SARS-CoV-2? Does systemic drug therapy have an impact on the risk of pulmonary fibrosis-a factor with strong negative impact on COVID-19 outcome? Small molecules, inhibitors of tumor necrosis factor alfa, interleukin, and JAK inhibitors are considered. The data are inhomogeneous for the multiple drugs used in PsA. Although the risk for severe upper airway tract infections during clinical controlled trials was mostly in the range of placebo, these data have been obtained before the COVID-19 pandemic and should be interpreted with caution. Some biologics demonstrated an antifibrotic activity in vitro and in animal disease models. None of the biologics is indicated during an active infection with fever. In nonsymptomatic PsA patients, systemic drug therapy can be continued. [Keywords]: covid-19;biologics;psoriatic arthritis;small molecules;systemic medical treatment

Theranostics

Optimizing use of theranostic nanoparticles as a life-saving strategy for treating COVID-19 patients.

On the 30(th) of January 2020, the World Health Organization fired up the sirens against a fast spreading infectious disease caused by a newly discovered Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and gave this disease the name COVID-19. While there is currently no specific treatment for COVID-19, several off label drugs approved for other indications are being investigated in clinical trials across the globe. In the last decade, theranostic nanoparticles were reported as promising tool for efficiently and selectively deliver therapeutic moieties (i.e. drugs, vaccines, siRNA, peptide) to target sites of infection. In addition, they allow monitoring infectious sides and treatment responses using noninvasive imaging modalities. While intranasal delivery was proposed as the preferred administration route for therapeutic agents against viral pulmonary diseases, NP-based delivery systems offer numerous benefits to overcome challenges associated with mucosal administration, and ensure that these agents achieve a concentration that is many times higher than expected in the targeted sites of infection while limiting side effects on normal cells. In this article, we have shed light on the promising role of nanoparticles as effective carriers for therapeutics or immune modulators to help in fighting against COVID-19.

covid-19;drug delivery systems;nanomedicine;theranostic nanoparticles

Journal Article;Review

Itani, Rasha;Tobaiqy, Mansour;Al Faraj, Achraf

10.7150/thno.46691

[Title]: Optimizing use of theranostic nanoparticles as a life-saving strategy for treating COVID-19 patients. [Abstract]: On the 30(th) of January 2020, the World Health Organization fired up the sirens against a fast spreading infectious disease caused by a newly discovered Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and gave this disease the name COVID-19. While there is currently no specific treatment for COVID-19, several off label drugs approved for other indications are being investigated in clinical trials across the globe. In the last decade, theranostic nanoparticles were reported as promising tool for efficiently and selectively deliver therapeutic moieties (i.e. drugs, vaccines, siRNA, peptide) to target sites of infection. In addition, they allow monitoring infectious sides and treatment responses using noninvasive imaging modalities. While intranasal delivery was proposed as the preferred administration route for therapeutic agents against viral pulmonary diseases, NP-based delivery systems offer numerous benefits to overcome challenges associated with mucosal administration, and ensure that these agents achieve a concentration that is many times higher than expected in the targeted sites of infection while limiting side effects on normal cells. In this article, we have shed light on the promising role of nanoparticles as effective carriers for therapeutics or immune modulators to help in fighting against COVID-19. [Keywords]: covid-19;drug delivery systems;nanomedicine;theranostic nanoparticles

JMIR Public Health Surveill

COVIDApp as an Innovative Strategy for the Management and Follow-Up of COVID-19 Cases in Long-Term Care Facilities in Catalonia: Implementation Study.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused an unprecedented worldwide public health crisis that requires new management approaches. COVIDApp is a mobile app that was adapted for the management of institutionalized individuals in long-term care facilities. OBJECTIVE: The aim of this paper is to report the implementation of this innovative tool for the management of long-term care facility residents as a high-risk population, specifically for early identification and self-isolation of suspected cases, remote monitoring of mild cases, and real-time monitoring of the progression of the infection. METHODS: COVIDApp was implemented in 196 care centers in collaboration with 64 primary care teams. The following parameters of COVID-19 were reported daily: signs/symptoms; diagnosis by reverse transcriptase-polymerase chain reaction; absence of symptoms for >/=14 days; total deaths; and number of health care workers isolated with suspected COVID-19. The number of at-risk centers was also described. RESULTS: Data were recorded from 10,347 institutionalized individuals and up to 4000 health care workers between April 1 and 30, 2020. A rapid increase in suspected cases was seen until day 6 but decreased during the last two weeks (from 1084 to 282 cases). The number of confirmed cases increased from 419 (day 6) to 1293 (day 22) and remained stable during the last week. Of the 10,347 institutionalized individuals, 5,090 (49,2%) remained asymptomatic for >/=14 days. A total of 854/10,347 deaths (8.3%) were reported; 383 of these deaths (44.8%) were suspected/confirmed cases. The number of isolated health care workers remained high over the 30 days, while the number of suspected cases decreased during the last 2 weeks. The number of high-risk long-term care facilities decreased from 19/196 (9.5%) to 3/196 (1.5%). CONCLUSIONS: COVIDApp can help clinicians rapidly detect and remotely monitor suspected and confirmed cases of COVID-19 among institutionalized individuals, thus limiting the risk of spreading the virus. The platform shows the progression of infection in real time and can aid in designing new monitoring strategies.

covid-19;covidapp;app;care;elderly;institutionalized individuals;long-term;long-term care facilities;mhealth;management;mobile health;public health;surveillance

Journal Article

Echeverria, Patricia;Mas Bergas, Miquel Angel;Puig, Jordi;Isnard, Mar;Massot, Mireia;Vedia, Cristina;Peiro, Ricardo;Ordorica, Yolanda;Pablo, Sara;Ulldemolins, Maria;Iruela, Merce;Balart, Dolors;Ruiz, Jose Maria;Herms, Jordi;Clotet Sala, Bonaventura;Negredo, Eugenia

10.2196/21163

[Title]: COVIDApp as an Innovative Strategy for the Management and Follow-Up of COVID-19 Cases in Long-Term Care Facilities in Catalonia: Implementation Study. [Abstract]: BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused an unprecedented worldwide public health crisis that requires new management approaches. COVIDApp is a mobile app that was adapted for the management of institutionalized individuals in long-term care facilities. OBJECTIVE: The aim of this paper is to report the implementation of this innovative tool for the management of long-term care facility residents as a high-risk population, specifically for early identification and self-isolation of suspected cases, remote monitoring of mild cases, and real-time monitoring of the progression of the infection. METHODS: COVIDApp was implemented in 196 care centers in collaboration with 64 primary care teams. The following parameters of COVID-19 were reported daily: signs/symptoms; diagnosis by reverse transcriptase-polymerase chain reaction; absence of symptoms for >/=14 days; total deaths; and number of health care workers isolated with suspected COVID-19. The number of at-risk centers was also described. RESULTS: Data were recorded from 10,347 institutionalized individuals and up to 4000 health care workers between April 1 and 30, 2020. A rapid increase in suspected cases was seen until day 6 but decreased during the last two weeks (from 1084 to 282 cases). The number of confirmed cases increased from 419 (day 6) to 1293 (day 22) and remained stable during the last week. Of the 10,347 institutionalized individuals, 5,090 (49,2%) remained asymptomatic for >/=14 days. A total of 854/10,347 deaths (8.3%) were reported; 383 of these deaths (44.8%) were suspected/confirmed cases. The number of isolated health care workers remained high over the 30 days, while the number of suspected cases decreased during the last 2 weeks. The number of high-risk long-term care facilities decreased from 19/196 (9.5%) to 3/196 (1.5%). CONCLUSIONS: COVIDApp can help clinicians rapidly detect and remotely monitor suspected and confirmed cases of COVID-19 among institutionalized individuals, thus limiting the risk of spreading the virus. The platform shows the progression of infection in real time and can aid in designing new monitoring strategies. [Keywords]: covid-19;covidapp;app;care;elderly;institutionalized individuals;long-term;long-term care facilities;mhealth;management;mobile health;public health;surveillance

Diabetes Res Clin Pract

Association of diabetes mellitus with disease severity and prognosis in COVID-19: A retrospective cohort study.

AIMS: The 2019 novel coronavirus disease (COVID-19) emerged in Wuhan, China, and was characterized as a pandemic by the World Health Organization. Diabetes is an established risk associated with poor clinical outcomes, but the association of diabetes with COVID-19 has not been reported yet. METHODS: In this cohort study, we retrospectively reviewed 258 consecutive hospitalized COVID-19 patients with or without diabetes at the West Court of Union Hospital in Wuhan, China, recruited from January 29 to February 12, 2020. The clinical features, treatment strategies and prognosis data were collected and analyzed. Prognosis was followed up until March 12, 2020. RESULTS: Of the 258 hospitalized patients (63 with diabetes) with COVID-19, the median age was 64 years (range 23-91), and 138 (53.5%) were male. Common symptoms included fever (82.2%), dry cough (67.1%), polypnea (48.1%), and fatigue (38%). Patients with diabetes had significantly higher leucocyte and neutrophil counts, and higher levels of fasting blood glucose, serum creatinine, urea nitrogen and creatine kinase isoenzyme MB at admission compared with those without diabetes. COVID-19 patients with diabetes were more likely to develop severe or critical disease conditions with more complications, and had higher incidence rates of antibiotic therapy, non-invasive and invasive mechanical ventilation, and death (11.1% vs. 4.1%). Cox proportional hazard model showed that diabetes (adjusted hazard ratio [aHR] = 3.64; 95% confidence interval [CI]: 1.09, 12.21) and fasting blood glucose (aHR = 1.19; 95% CI: 1.08, 1.31) were associated with the fatality due to COVID-19, adjusting for potential confounders. CONCLUSIONS: Diabetes mellitus is associated with increased disease severity and a higher risk of mortality in patients with COVID-19.

covid-19;diabetes mellitus;prognosis;sars-cov-2

Journal Article

Zhang, Yan;Cui, Yanhui;Shen, Minxue;Zhang, Jianchu;Liu, Ben;Dai, Minhui;Chen, Lingli;Han, Duoduo;Fan, Yifei;Zeng, Yanjun;Li, Wen;Lin, Fengyu;Li, Sha;Chen, Xiang;Pan, Pinhua

10.1016/j.diabres.2020.108227

[Title]: Association of diabetes mellitus with disease severity and prognosis in COVID-19: A retrospective cohort study. [Abstract]: AIMS: The 2019 novel coronavirus disease (COVID-19) emerged in Wuhan, China, and was characterized as a pandemic by the World Health Organization. Diabetes is an established risk associated with poor clinical outcomes, but the association of diabetes with COVID-19 has not been reported yet. METHODS: In this cohort study, we retrospectively reviewed 258 consecutive hospitalized COVID-19 patients with or without diabetes at the West Court of Union Hospital in Wuhan, China, recruited from January 29 to February 12, 2020. The clinical features, treatment strategies and prognosis data were collected and analyzed. Prognosis was followed up until March 12, 2020. RESULTS: Of the 258 hospitalized patients (63 with diabetes) with COVID-19, the median age was 64 years (range 23-91), and 138 (53.5%) were male. Common symptoms included fever (82.2%), dry cough (67.1%), polypnea (48.1%), and fatigue (38%). Patients with diabetes had significantly higher leucocyte and neutrophil counts, and higher levels of fasting blood glucose, serum creatinine, urea nitrogen and creatine kinase isoenzyme MB at admission compared with those without diabetes. COVID-19 patients with diabetes were more likely to develop severe or critical disease conditions with more complications, and had higher incidence rates of antibiotic therapy, non-invasive and invasive mechanical ventilation, and death (11.1% vs. 4.1%). Cox proportional hazard model showed that diabetes (adjusted hazard ratio [aHR] = 3.64; 95% confidence interval [CI]: 1.09, 12.21) and fasting blood glucose (aHR = 1.19; 95% CI: 1.08, 1.31) were associated with the fatality due to COVID-19, adjusting for potential confounders. CONCLUSIONS: Diabetes mellitus is associated with increased disease severity and a higher risk of mortality in patients with COVID-19. [Keywords]: covid-19;diabetes mellitus;prognosis;sars-cov-2

Prog Urol

[Recommendations of the Urolithiasis Committee of the French Urology Association for the management and the treatment of the stone formers patients during the COVID-19 pandemic crisis].

For the first time, faced with a crisis with an exceptional magnitude due to the COVID-19 pandemic responsible for saturation of emergency services and intensive care units, the urolithiasis committee of the French Urology Association designed the recommendations for care and treatment of stone-forming patients and their treatment during crisis.

calcul;coronavirus;covid-19;crise sanitaire;heath crisis;lithiase;pandemic;pandemie;recommandations;recommendations;stone;traitement;treatment;urinaire;urinary;urolithiasis

Journal Article;Review

Almeras, C;Denis, E;Meria, P;Estrade, V;Raynal, G;Hoznek, A;Malval, B;Dominique, S;Bart, S;Gautier, J R;Abid, N

10.1016/j.purol.2020.04.021

[Title]: [Recommendations of the Urolithiasis Committee of the French Urology Association for the management and the treatment of the stone formers patients during the COVID-19 pandemic crisis]. [Abstract]: For the first time, faced with a crisis with an exceptional magnitude due to the COVID-19 pandemic responsible for saturation of emergency services and intensive care units, the urolithiasis committee of the French Urology Association designed the recommendations for care and treatment of stone-forming patients and their treatment during crisis. [Keywords]: calcul;coronavirus;covid-19;crise sanitaire;heath crisis;lithiase;pandemic;pandemie;recommandations;recommendations;stone;traitement;treatment;urinaire;urinary;urolithiasis

Pediatr Radiol

A primer for pediatric radiologists on infection control in an era of COVID-19.

Pediatric radiology departments across the globe face unique challenges in the midst of the current COVID-19 pandemic that have not been addressed in professional guidelines. Providing a safe environment for personnel while continuing to deliver optimal care to patients is feasible when abiding by fundamental recommendations. In this article, we review current infection control practices across the multiple pediatric institutions represented on the Society for Pediatric Radiology (SPR) Quality and Safety committee. We discuss the routes of infectious transmission and appropriate transmission-based precautions, in addition to exploring strategies to optimize personal protective equipment (PPE) supplies. This work serves as a summary of current evidence-based recommendations for infection control, and current best practices specific to pediatric radiologists.

covid-19;children;infection control;pediatric radiology;personal protective equipment;safety

Journal Article;Review

Miranda-Schaeubinger, Monica;Blumfield, Einat;Chavhan, Govind B;Farkas, Amy B;Joshi, Aparna;Kamps, Shawn E;Kaplan, Summer L;Sammer, Marla B K;Silvestro, Elizabeth;Stanescu, A Luana;Sze, Raymond W;Zerr, Danielle M;Chandra, Tushar;Edwards, Emily A;Khan, Naeem;Rubio, Eva I;Vera, Chido D;Iyer, Ramesh S

10.1007/s00247-020-04713-1

[Title]: A primer for pediatric radiologists on infection control in an era of COVID-19. [Abstract]: Pediatric radiology departments across the globe face unique challenges in the midst of the current COVID-19 pandemic that have not been addressed in professional guidelines. Providing a safe environment for personnel while continuing to deliver optimal care to patients is feasible when abiding by fundamental recommendations. In this article, we review current infection control practices across the multiple pediatric institutions represented on the Society for Pediatric Radiology (SPR) Quality and Safety committee. We discuss the routes of infectious transmission and appropriate transmission-based precautions, in addition to exploring strategies to optimize personal protective equipment (PPE) supplies. This work serves as a summary of current evidence-based recommendations for infection control, and current best practices specific to pediatric radiologists. [Keywords]: covid-19;children;infection control;pediatric radiology;personal protective equipment;safety

J Biomed Sci

The origin and underlying driving forces of the SARS-CoV-2 outbreak.

BACKGROUND: SARS-CoV-2 began spreading in December 2019 and has since become a pandemic that has impacted many aspects of human society. Several issues concerning the origin, time of introduction to humans, evolutionary patterns, and underlying force driving the SARS-CoV-2 outbreak remain unclear. METHOD: Genetic variation in 137 SARS-CoV-2 genomes and related coronaviruses as of 2/23/2020 was analyzed. RESULT: After correcting for mutational bias, the excess of low frequency mutations on both synonymous and nonsynonymous sites was revealed which is consistent with the recent outbreak of the virus. In contrast to adaptive evolution previously reported for SARS-CoV during its brief epidemic in 2003, our analysis of SARS-CoV-2 genomes shows signs of relaxation. The sequence similarity in the spike receptor binding domain between SARS-CoV-2 and a sequence from pangolin is probably due to an ancient intergenomic introgression that occurred approximately 40 years ago. The current outbreak of SARS-CoV-2 was estimated to have originated on 12/11/2019 (95% HPD 11/13/2019-12/23/2019). The effective population size of the virus showed an approximately 20-fold increase from the onset of the outbreak to the lockdown of Wuhan (1/23/2020) and ceased to increase afterwards, demonstrating the effectiveness of social distancing in preventing its spread. Two mutations, 84S in orf8 protein and 251 V in orf3 protein, occurred coincidentally with human intervention. The former first appeared on 1/5/2020 and plateaued around 1/23/2020. The latter rapidly increased in frequency after 1/23/2020. Thus, the roles of these mutations on infectivity need to be elucidated. Genetic diversity of SARS-CoV-2 collected from China is two times higher than those derived from the rest of the world. A network analysis found that haplotypes collected from Wuhan were interior and had more mutational connections, both of which are consistent with the observation that the SARS-CoV-2 outbreak originated in China. CONCLUSION: SARS-CoV-2 might have cryptically circulated within humans for years before being discovered. Data from the early outbreak and hospital archives are needed to trace its evolutionary path and determine the critical steps required for effective spreading.

coronavirus;mutational bias;population genetics;positive selection

Journal Article

Chaw, Shu-Miaw;Tai, Jui-Hung;Chen, Shi-Lun;Hsieh, Chia-Hung;Chang, Sui-Yuan;Yeh, Shiou-Hwei;Yang, Wei-Shiung;Chen, Pei-Jer;Wang, Hurng-Yi

10.1186/s12929-020-00665-8

[Title]: The origin and underlying driving forces of the SARS-CoV-2 outbreak. [Abstract]: BACKGROUND: SARS-CoV-2 began spreading in December 2019 and has since become a pandemic that has impacted many aspects of human society. Several issues concerning the origin, time of introduction to humans, evolutionary patterns, and underlying force driving the SARS-CoV-2 outbreak remain unclear. METHOD: Genetic variation in 137 SARS-CoV-2 genomes and related coronaviruses as of 2/23/2020 was analyzed. RESULT: After correcting for mutational bias, the excess of low frequency mutations on both synonymous and nonsynonymous sites was revealed which is consistent with the recent outbreak of the virus. In contrast to adaptive evolution previously reported for SARS-CoV during its brief epidemic in 2003, our analysis of SARS-CoV-2 genomes shows signs of relaxation. The sequence similarity in the spike receptor binding domain between SARS-CoV-2 and a sequence from pangolin is probably due to an ancient intergenomic introgression that occurred approximately 40 years ago. The current outbreak of SARS-CoV-2 was estimated to have originated on 12/11/2019 (95% HPD 11/13/2019-12/23/2019). The effective population size of the virus showed an approximately 20-fold increase from the onset of the outbreak to the lockdown of Wuhan (1/23/2020) and ceased to increase afterwards, demonstrating the effectiveness of social distancing in preventing its spread. Two mutations, 84S in orf8 protein and 251 V in orf3 protein, occurred coincidentally with human intervention. The former first appeared on 1/5/2020 and plateaued around 1/23/2020. The latter rapidly increased in frequency after 1/23/2020. Thus, the roles of these mutations on infectivity need to be elucidated. Genetic diversity of SARS-CoV-2 collected from China is two times higher than those derived from the rest of the world. A network analysis found that haplotypes collected from Wuhan were interior and had more mutational connections, both of which are consistent with the observation that the SARS-CoV-2 outbreak originated in China. CONCLUSION: SARS-CoV-2 might have cryptically circulated within humans for years before being discovered. Data from the early outbreak and hospital archives are needed to trace its evolutionary path and determine the critical steps required for effective spreading. [Keywords]: coronavirus;mutational bias;population genetics;positive selection

J Am Coll Surg

Ethical Rationing of Personal Protective Equipment to Minimize Moral Residue During the COVID-19 Pandemic.

This article proposes systems for the fair distribution of scarce resources to healthcare providers. It builds on classic ethical structures and adapts them to the equitable distribution of personal protective equipment (PPE) to clinicians at risk of contracting novel corona virus-19 (COVID-19). The article also defines systems of allocation that are generally considered unethical and are to be avoided. We emphasize that policies must be transparent, collaborative, applied equally, and have a system of accountability. It is recognized that unless the supply of PPE is quickly replenished, or viable alternatives to traditional equipment are devised in the coming days to weeks, hospitals and healthcare systems will face the difficult task of rationing PPE to at-risk clinicians. This paper suggests an ethical framework for that process.

Journal Article

Binkley, Charles E;Kemp, David S

10.1016/j.jamcollsurg.2020.03.031

[Title]: Ethical Rationing of Personal Protective Equipment to Minimize Moral Residue During the COVID-19 Pandemic. [Abstract]: This article proposes systems for the fair distribution of scarce resources to healthcare providers. It builds on classic ethical structures and adapts them to the equitable distribution of personal protective equipment (PPE) to clinicians at risk of contracting novel corona virus-19 (COVID-19). The article also defines systems of allocation that are generally considered unethical and are to be avoided. We emphasize that policies must be transparent, collaborative, applied equally, and have a system of accountability. It is recognized that unless the supply of PPE is quickly replenished, or viable alternatives to traditional equipment are devised in the coming days to weeks, hospitals and healthcare systems will face the difficult task of rationing PPE to at-risk clinicians. This paper suggests an ethical framework for that process. [Keywords]:

Chest

Risk Factors of Fatal Outcome in Hospitalized Subjects With Coronavirus Disease 2019 From a Nationwide Analysis in China.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has become a global health emergency. The cumulative number of new confirmed cases and deaths are still increasing out of China. Independent predicted factors associated with fatal outcomes remain uncertain. RESEARCH QUESTION: The goal of the current study was to investigate the potential risk factors associated with fatal outcomes from COVID-19 through a multivariate Cox regression analysis and a nomogram model. STUDY DESIGN AND METHODS: A retrospective cohort of 1,590 hospitalized patients with COVID-19 throughout China was established. The prognostic effects of variables, including clinical features and laboratory findings, were analyzed by using Kaplan-Meier methods and a Cox proportional hazards model. A prognostic nomogram was formulated to predict the survival of patients with COVID-19. RESULTS: In this nationwide cohort, nonsurvivors included a higher incidence of elderly people and subjects with coexisting chronic illness, dyspnea, and laboratory abnormalities on admission compared with survivors. Multivariate Cox regression analysis showed that age >/= 75 years (hazard ratio [HR], 7.86; 95% CI, 2.44-25.35), age between 65 and 74 years (HR, 3.43; 95% CI, 1.24-9.5), coronary heart disease (HR, 4.28; 95% CI, 1.14-16.13), cerebrovascular disease (HR, 3.1; 95% CI, 1.07-8.94), dyspnea (HR, 3.96; 95% CI, 1.42-11), procalcitonin level > 0.5 ng/mL (HR, 8.72; 95% CI, 3.42-22.28), and aspartate aminotransferase level > 40 U/L (HR, 2.2; 95% CI, 1.1-6.73) were independent risk factors associated with fatal outcome. A nomogram was established based on the results of multivariate analysis. The internal bootstrap resampling approach suggested the nomogram has sufficient discriminatory power with a C-index of 0.91 (95% CI, 0.85-0.97). The calibration plots also showed good consistency between the prediction and the observation. INTERPRETATION: The proposed nomogram accurately predicted clinical outcomes of patients with COVID-19 based on individual characteristics. Earlier identification, more intensive surveillance, and appropriate therapy should be considered in patients at high risk.

covid-19;fatal outcome;nomogram;risk factors

Journal Article

Chen, Ruchong;Liang, Wenhua;Jiang, Mei;Guan, Weijie;Zhan, Chen;Wang, Tao;Tang, Chunli;Sang, Ling;Liu, Jiaxing;Ni, Zhengyi;Hu, Yu;Liu, Lei;Shan, Hong;Lei, Chunliang;Peng, Yixiang;Wei, Li;Liu, Yong;Hu, Yahua;Peng, Peng;Wang, Jianming;Liu, Jiyang;Chen, Zhong;Li, Gang;Zheng, Zhijian;Qiu, Shaoqin;Luo, Jie;Ye, Changjiang;Zhu, Shaoyong;Liu, Xiaoqing;Cheng, Linling;Ye, Feng;Zheng, Jinping;Zhang, Nuofu;Li, Yimin;He, Jianxing;Li, Shiyue;Zhong, Nanshan

10.1016/j.chest.2020.04.010

[Title]: Risk Factors of Fatal Outcome in Hospitalized Subjects With Coronavirus Disease 2019 From a Nationwide Analysis in China. [Abstract]: BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has become a global health emergency. The cumulative number of new confirmed cases and deaths are still increasing out of China. Independent predicted factors associated with fatal outcomes remain uncertain. RESEARCH QUESTION: The goal of the current study was to investigate the potential risk factors associated with fatal outcomes from COVID-19 through a multivariate Cox regression analysis and a nomogram model. STUDY DESIGN AND METHODS: A retrospective cohort of 1,590 hospitalized patients with COVID-19 throughout China was established. The prognostic effects of variables, including clinical features and laboratory findings, were analyzed by using Kaplan-Meier methods and a Cox proportional hazards model. A prognostic nomogram was formulated to predict the survival of patients with COVID-19. RESULTS: In this nationwide cohort, nonsurvivors included a higher incidence of elderly people and subjects with coexisting chronic illness, dyspnea, and laboratory abnormalities on admission compared with survivors. Multivariate Cox regression analysis showed that age >/= 75 years (hazard ratio [HR], 7.86; 95% CI, 2.44-25.35), age between 65 and 74 years (HR, 3.43; 95% CI, 1.24-9.5), coronary heart disease (HR, 4.28; 95% CI, 1.14-16.13), cerebrovascular disease (HR, 3.1; 95% CI, 1.07-8.94), dyspnea (HR, 3.96; 95% CI, 1.42-11), procalcitonin level > 0.5 ng/mL (HR, 8.72; 95% CI, 3.42-22.28), and aspartate aminotransferase level > 40 U/L (HR, 2.2; 95% CI, 1.1-6.73) were independent risk factors associated with fatal outcome. A nomogram was established based on the results of multivariate analysis. The internal bootstrap resampling approach suggested the nomogram has sufficient discriminatory power with a C-index of 0.91 (95% CI, 0.85-0.97). The calibration plots also showed good consistency between the prediction and the observation. INTERPRETATION: The proposed nomogram accurately predicted clinical outcomes of patients with COVID-19 based on individual characteristics. Earlier identification, more intensive surveillance, and appropriate therapy should be considered in patients at high risk. [Keywords]: covid-19;fatal outcome;nomogram;risk factors

Emerg Microbes Infect

Susceptibility of swine cells and domestic pigs to SARS-CoV-2.

The emergence of SARS-CoV-2 has resulted in an ongoing global pandemic with significant morbidity, mortality, and economic consequences. The susceptibility of different animal species to SARS-CoV-2 is of concern due to the potential for interspecies transmission, and the requirement for pre-clinical animal models to develop effective countermeasures. In the current study, we determined the ability of SARS-CoV-2 to (i) replicate in porcine cell lines, (ii) establish infection in domestic pigs via experimental oral/intranasal/intratracheal inoculation, and (iii) transmit to co-housed naive sentinel pigs. SARS-CoV-2 was able to replicate in two different porcine cell lines with cytopathic effects. Interestingly, none of the SARS-CoV-2-inoculated pigs showed evidence of clinical signs, viral replication or SARS-CoV-2-specific antibody responses. Moreover, none of the sentinel pigs displayed markers of SARS-CoV-2 infection. These data indicate that although different porcine cell lines are permissive to SARS-CoV-2, five-week old pigs are not susceptible to infection via oral/intranasal/intratracheal challenge. Pigs are therefore unlikely to be significant carriers of SARS-CoV-2 and are not a suitable pre-clinical animal model to study SARS-CoV-2 pathogenesis or efficacy of respective vaccines or therapeutics.

covid-19;sars-cov-2;coronavirus;infection models;pigs;swine;zoonotic disease

Journal Article

Meekins, David A;Morozov, Igor;Trujillo, Jessie D;Gaudreault, Natasha N;Bold, Dashzeveg;Carossino, Mariano;Artiaga, Bianca L;Indran, Sabarish V;Kwon, Taeyong;Balaraman, Velmurugan;Madden, Daniel W;Feldmann, Heinz;Henningson, Jamie;Ma, Wenjun;Balasuriya, Udeni B R;Richt, Juergen A

10.1080/22221751.2020.1831405

[Title]: Susceptibility of swine cells and domestic pigs to SARS-CoV-2. [Abstract]: The emergence of SARS-CoV-2 has resulted in an ongoing global pandemic with significant morbidity, mortality, and economic consequences. The susceptibility of different animal species to SARS-CoV-2 is of concern due to the potential for interspecies transmission, and the requirement for pre-clinical animal models to develop effective countermeasures. In the current study, we determined the ability of SARS-CoV-2 to (i) replicate in porcine cell lines, (ii) establish infection in domestic pigs via experimental oral/intranasal/intratracheal inoculation, and (iii) transmit to co-housed naive sentinel pigs. SARS-CoV-2 was able to replicate in two different porcine cell lines with cytopathic effects. Interestingly, none of the SARS-CoV-2-inoculated pigs showed evidence of clinical signs, viral replication or SARS-CoV-2-specific antibody responses. Moreover, none of the sentinel pigs displayed markers of SARS-CoV-2 infection. These data indicate that although different porcine cell lines are permissive to SARS-CoV-2, five-week old pigs are not susceptible to infection via oral/intranasal/intratracheal challenge. Pigs are therefore unlikely to be significant carriers of SARS-CoV-2 and are not a suitable pre-clinical animal model to study SARS-CoV-2 pathogenesis or efficacy of respective vaccines or therapeutics. [Keywords]: covid-19;sars-cov-2;coronavirus;infection models;pigs;swine;zoonotic disease

Zhonghua Jie He He Hu Xi Za Zhi

[Respiratory support for severe 2019-nCoV pneumonia suffering from acute respiratory failure: time and strategy].

Respiratory support is a very important technique for saving severe 2019-nCoV pneumonia patients who suffering respiratory failure, which can improve oxygenation, reduce mortality. Therefore, how to reasonable using respiratory support technique is the key point that relating success or failure. In this paper, the authors introduce their experience on treating severe 2019-nCoV pneumonia, it is hopeful for current fighting against 2019-nCoV in China.

2019-ncov;oxygenation;respiratory failure;respiratory support

Journal Article

Yuan, X;Mu, J S;Mo, G X;Hu, X S;Yan, P;Xie, L X

10.3760/cma.j.issn.1001-0939.2020.03.006

[Title]: [Respiratory support for severe 2019-nCoV pneumonia suffering from acute respiratory failure: time and strategy]. [Abstract]: Respiratory support is a very important technique for saving severe 2019-nCoV pneumonia patients who suffering respiratory failure, which can improve oxygenation, reduce mortality. Therefore, how to reasonable using respiratory support technique is the key point that relating success or failure. In this paper, the authors introduce their experience on treating severe 2019-nCoV pneumonia, it is hopeful for current fighting against 2019-nCoV in China. [Keywords]: 2019-ncov;oxygenation;respiratory failure;respiratory support

Front Immunol

Contriving Multi-Epitope Subunit of Vaccine for COVID-19: Immunoinformatics Approaches.

COVID-19 has recently become the most serious threat to public health, and its prevalence has been increasing at an alarming rate. The incubation period for the virus is ~1-14 days and all age groups may be susceptible to a fatality rate of about 5.9%. COVID-19 is caused by a novel single-stranded, positive (+) sense RNA beta coronavirus. The development of a vaccine for SARS-CoV-2 is an urgent need worldwide. Immunoinformatics approaches are both cost-effective and convenient, as in silico predictions can reduce the number of experiments needed. In this study, with the aid of immunoinformatics tools, we tried to design a multi-epitope vaccine that can be used for the prevention and treatment of COVID-19. The epitopes were computed by using B cells, cytotoxic T lymphocytes (CTL), and helper T lymphocytes (HTL) base on the proteins of SARS-CoV-2. A vaccine was devised by fusing together the B cell, HTL, and CTL epitopes with linkers. To enhance the immunogenicity, the beta-defensin (45 mer) amino acid sequence, and pan-HLA DR binding epitopes (13aa) were adjoined to the N-terminal of the vaccine with the help of the EAAAK linker. To enable the intracellular delivery of the modeled vaccine, a TAT sequence (11aa) was appended to C-terminal. Linkers play vital roles in producing an extended conformation (flexibility), protein folding, and separation of functional domains, and therefore, make the protein structure more stable. The secondary and three-dimensional (3D) structure of the final vaccine was then predicted. Furthermore, the complex between the final vaccine and immune receptors (toll-like receptor-3 (TLR-3), major histocompatibility complex (MHC-I), and MHC-II) were evaluated by molecular docking. Lastly, to confirm the expression of the designed vaccine, the mRNA of the vaccine was enhanced with the aid of the Java Codon Adaptation Tool, and the secondary structure was generated from Mfold. Then we performed in silico cloning. The final vaccine requires experimental validation to determine its safety and efficacy in controlling SARS-CoV-2 infections.

covid-19;sars-cov-2;epitope prediction;immunoinformatics;vaccine

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

Dong, Rong;Chu, Zhugang;Yu, Fuxun;Zha, Yan

10.3389/fimmu.2020.01784

[Title]: Contriving Multi-Epitope Subunit of Vaccine for COVID-19: Immunoinformatics Approaches. [Abstract]: COVID-19 has recently become the most serious threat to public health, and its prevalence has been increasing at an alarming rate. The incubation period for the virus is ~1-14 days and all age groups may be susceptible to a fatality rate of about 5.9%. COVID-19 is caused by a novel single-stranded, positive (+) sense RNA beta coronavirus. The development of a vaccine for SARS-CoV-2 is an urgent need worldwide. Immunoinformatics approaches are both cost-effective and convenient, as in silico predictions can reduce the number of experiments needed. In this study, with the aid of immunoinformatics tools, we tried to design a multi-epitope vaccine that can be used for the prevention and treatment of COVID-19. The epitopes were computed by using B cells, cytotoxic T lymphocytes (CTL), and helper T lymphocytes (HTL) base on the proteins of SARS-CoV-2. A vaccine was devised by fusing together the B cell, HTL, and CTL epitopes with linkers. To enhance the immunogenicity, the beta-defensin (45 mer) amino acid sequence, and pan-HLA DR binding epitopes (13aa) were adjoined to the N-terminal of the vaccine with the help of the EAAAK linker. To enable the intracellular delivery of the modeled vaccine, a TAT sequence (11aa) was appended to C-terminal. Linkers play vital roles in producing an extended conformation (flexibility), protein folding, and separation of functional domains, and therefore, make the protein structure more stable. The secondary and three-dimensional (3D) structure of the final vaccine was then predicted. Furthermore, the complex between the final vaccine and immune receptors (toll-like receptor-3 (TLR-3), major histocompatibility complex (MHC-I), and MHC-II) were evaluated by molecular docking. Lastly, to confirm the expression of the designed vaccine, the mRNA of the vaccine was enhanced with the aid of the Java Codon Adaptation Tool, and the secondary structure was generated from Mfold. Then we performed in silico cloning. The final vaccine requires experimental validation to determine its safety and efficacy in controlling SARS-CoV-2 infections. [Keywords]: covid-19;sars-cov-2;epitope prediction;immunoinformatics;vaccine

Polym Degrad Stab

Opinion to address the personal protective equipment shortage in the global community during the COVID-19 outbreak.

The current COVID-19 pandemic is stretching both the global supply for face masks and personal protective equipment (PPE). Production capacity is severely limited in many countries. This is a call for the R&D community, particularly to those in the polymer degradation and stability field. We have not only an opportunity but an obligation to engage and collaborate with virology and bio-medical experts. We require comparative R&D for extended, reuse and recyclability options. There is urgent need for large scale institutional approaches and methods that can be quickly applied locally by non-experts with limited resources.

Journal Article

Dargaville, Tim;Spann, Kirsten;Celina, Mathew

10.1016/j.polymdegradstab.2020.109162

[Title]: Opinion to address the personal protective equipment shortage in the global community during the COVID-19 outbreak. [Abstract]: The current COVID-19 pandemic is stretching both the global supply for face masks and personal protective equipment (PPE). Production capacity is severely limited in many countries. This is a call for the R&D community, particularly to those in the polymer degradation and stability field. We have not only an opportunity but an obligation to engage and collaborate with virology and bio-medical experts. We require comparative R&D for extended, reuse and recyclability options. There is urgent need for large scale institutional approaches and methods that can be quickly applied locally by non-experts with limited resources. [Keywords]:

J Matern Fetal Neonatal Med

Near-term pregnant women's attitude toward, concern about and knowledge of the COVID-19 pandemic.

Background: COVID-19 is a novel type of the coronavirus family with an incompletely described clinical course. Little is known about the psychological aspects, particularly for vulnerable populations including pregnant women.Objectives: To understand the attitude, concerns, and knowledge of the non-infected pregnant women toward the COVID-19 outbreak in order to constitute base data for detailed counseling and to develop targeted messages.Patients and methods: This cross-sectional survey research presented analysis of prospectively collected data yielded at a single tertiary "Coronavirus Pandemic Hospital" referral center for a ten days period following the first confirmed death due to the COVID-19 pandemic in Turkey. Non-infected women with a confirmed pregnancy over 30th gestational week were consecutively included. A patient-reported non-validated questionnaire formed by the expert committee that includes 15 specific questions was used. Non-infected, pregnant women over 30th gestational week who applied to the outpatient clinic were consecutively included. A total of 213 women were enrolled, 37 were excluded: 7 for being in the first trimester, 3 were illiterate, and 27 were Syrian refugees having difficulties in translation.Results: A total of 172 pregnant women were included. Overall, four women refused to participate to the survey (1.9%). The mean age was 27.5 +/- 5.3 years. Median gestational week and parity were 35 +/- 11 weeks and 1 +/- 2, respectively. Pregnant women were observed to trust the authorities (65%) and the healthcare staff (92.4%), and their respect was increased (82.5%) during the outbreak. Majority of the women (87.2%) comply with the self-quarantine rules. Half of the women (52%) reported that they felt vulnerable and predominantly were concerned (80%). Approximately one-third of the women constantly keep thinking that they may get infected (35.5%) or they might get infected during/following the delivery or their baby might get infected after being born (42%). Half of the women (50%) were reported that they either had no idea about or think the breastfeeding is not safe during the outbreak. About 45% of the women were confused or had doubts about if the mode of delivery may be affected by the pandemic. Greater part of the participants does not know if COVID-19 might cause birth defects (76%) or preterm birth (64.5%). Counseling flow keys helping pregnant women to overcome misleads, regarding the COVID-19 outbreak is proposed.Conclusions: Non-infected pregnant women with a viable pregnancy at near term were observed to have positive attitude and compliance toward the COVID-19 outbreak and frontline healthcare staff; increased concern and vulnerability; and restricted knowledge about the pregnancy-related outcomes. While the clinical evidence was growing rapidly, this data may guide obstetricians and midwives to perceive what accurate information should be provided to the pregnant women.

attitude;covid-19;coronavirus;knowledge;pregnancy

Journal Article

Yassa, Murat;Birol, Pinar;Yirmibes, Cihangir;Usta, Canberk;Haydar, Ahmad;Yassa, Ahmet;Sandal, Kemal;Tekin, Arzu Bilge;Tug, Niyazi

10.1080/14767058.2020.1763947

[Title]: Near-term pregnant women's attitude toward, concern about and knowledge of the COVID-19 pandemic. [Abstract]: Background: COVID-19 is a novel type of the coronavirus family with an incompletely described clinical course. Little is known about the psychological aspects, particularly for vulnerable populations including pregnant women.Objectives: To understand the attitude, concerns, and knowledge of the non-infected pregnant women toward the COVID-19 outbreak in order to constitute base data for detailed counseling and to develop targeted messages.Patients and methods: This cross-sectional survey research presented analysis of prospectively collected data yielded at a single tertiary "Coronavirus Pandemic Hospital" referral center for a ten days period following the first confirmed death due to the COVID-19 pandemic in Turkey. Non-infected women with a confirmed pregnancy over 30th gestational week were consecutively included. A patient-reported non-validated questionnaire formed by the expert committee that includes 15 specific questions was used. Non-infected, pregnant women over 30th gestational week who applied to the outpatient clinic were consecutively included. A total of 213 women were enrolled, 37 were excluded: 7 for being in the first trimester, 3 were illiterate, and 27 were Syrian refugees having difficulties in translation.Results: A total of 172 pregnant women were included. Overall, four women refused to participate to the survey (1.9%). The mean age was 27.5 +/- 5.3 years. Median gestational week and parity were 35 +/- 11 weeks and 1 +/- 2, respectively. Pregnant women were observed to trust the authorities (65%) and the healthcare staff (92.4%), and their respect was increased (82.5%) during the outbreak. Majority of the women (87.2%) comply with the self-quarantine rules. Half of the women (52%) reported that they felt vulnerable and predominantly were concerned (80%). Approximately one-third of the women constantly keep thinking that they may get infected (35.5%) or they might get infected during/following the delivery or their baby might get infected after being born (42%). Half of the women (50%) were reported that they either had no idea about or think the breastfeeding is not safe during the outbreak. About 45% of the women were confused or had doubts about if the mode of delivery may be affected by the pandemic. Greater part of the participants does not know if COVID-19 might cause birth defects (76%) or preterm birth (64.5%). Counseling flow keys helping pregnant women to overcome misleads, regarding the COVID-19 outbreak is proposed.Conclusions: Non-infected pregnant women with a viable pregnancy at near term were observed to have positive attitude and compliance toward the COVID-19 outbreak and frontline healthcare staff; increased concern and vulnerability; and restricted knowledge about the pregnancy-related outcomes. While the clinical evidence was growing rapidly, this data may guide obstetricians and midwives to perceive what accurate information should be provided to the pregnant women. [Keywords]: attitude;covid-19;coronavirus;knowledge;pregnancy

Int J Infect Dis

Mortality in COVID-19 disease patients: Correlating the association of major histocompatibility complex (MHC) with severe acute respiratory syndrome 2 (SARS-CoV-2) variants.

Genetic factors such as the HLA type of patients may play a role in regard to disease severity and clinical outcome of patients with COVID-19. Taking the data deposited in the GISAID database, we made predictions using the IEDB analysis resource (TepiTool) to gauge how variants in the SARS-CoV-2 genome may change peptide binding to the most frequent MHC-class I and -II alleles in Africa, Asia and Europe. We caracterized how a single mutation in the wildtype sequence of of SARS-CoV-2 could influence the peptide binding of SARS-CoV-2 variants to MHC class II, but not to MHC class I alleles. Assuming the ORF8 (L84S) mutation is biologically significant, selective pressure from MHC class II alleles may select for viral varients and subsequently shape the quality and quantity of cellular immune responses aginast SARS-CoV-2. MHC 4-digit typing along with viral sequence analysis should be considered in studies examining clinical outcomes in patients with COVID-19.

autoimmunity;covid-19;cross-reactivity;cytokines;disease association;epitope;hla;mhc;mhc binding;peptides;sars;sars-cov-2;t-cells;viral variants

Journal Article

de Sousa, Eric;Ligeiro, Dario;Lerias, Joana R;Zhang, Chao;Agrati, Chiara;Osman, Mohamed;El-Kafrawy, Sherif A;Azhar, Esam I;Ippolito, Giuseppe;Wang, Fu-Sheng;Zumla, Alimuddin;Maeurer, Markus

10.1016/j.ijid.2020.07.016

[Title]: Mortality in COVID-19 disease patients: Correlating the association of major histocompatibility complex (MHC) with severe acute respiratory syndrome 2 (SARS-CoV-2) variants. [Abstract]: Genetic factors such as the HLA type of patients may play a role in regard to disease severity and clinical outcome of patients with COVID-19. Taking the data deposited in the GISAID database, we made predictions using the IEDB analysis resource (TepiTool) to gauge how variants in the SARS-CoV-2 genome may change peptide binding to the most frequent MHC-class I and -II alleles in Africa, Asia and Europe. We caracterized how a single mutation in the wildtype sequence of of SARS-CoV-2 could influence the peptide binding of SARS-CoV-2 variants to MHC class II, but not to MHC class I alleles. Assuming the ORF8 (L84S) mutation is biologically significant, selective pressure from MHC class II alleles may select for viral varients and subsequently shape the quality and quantity of cellular immune responses aginast SARS-CoV-2. MHC 4-digit typing along with viral sequence analysis should be considered in studies examining clinical outcomes in patients with COVID-19. [Keywords]: autoimmunity;covid-19;cross-reactivity;cytokines;disease association;epitope;hla;mhc;mhc binding;peptides;sars;sars-cov-2;t-cells;viral variants

Int J Environ Res Public Health

The Impact and Consequences of SARS-CoV-2 Pandemic on a Single University Dermatology Outpatient Clinic in Germany.

The pandemic outbreak of coronavirus disease 2019 (COVID-19) affects health care systems globally and leads to other challenges besides infection and its direct medical consequences. The aim of this study was to investigate the impact of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic on the university dermatology outpatient clinic (UDOC) of the Technical University of Munich, Germany. We analyzed datasets from 2015 until 2020 extracted from the hospital information system database and our documented outpatient files regarding patient numbers, gender, age, and diagnoses. In 2020, case numbers of outpatient care declined significantly (p = 0.021) compared to previous years and was related to the timing of political announcements answering SARS-CoV-2 pandemic. Additionally, during calendar week 10 to 15-the peak time of the spread of COVID-19 in Germany-the proportion of patients missing their consultation was significantly higher in 2020 than in 2019 (22.4% vs. 12.4%; p < 0.001). Gender-associated differences regarding absences were not detected, but patients aged 85 years or older were significantly more likely to miss their consultation compared to all other age groups (p = 0.002). Regarding different disease clusters, patients with chronic inflammatory skin diseases and infectious and malignant diseases were more likely to miss their consultation (p = 0.006). Noticeably, less patients with malignant diseases, and particularly malignant melanoma, were registered during this pandemic. Our data support the hypothesis that medically constructive prioritization might not be implemented properly by patients themselves. Identifying missed patients and catching up on their medical care apart from COVID-19 will pose an enormous challenge for health care systems globally.

covid-19 (coronavirus disease 2019);sars-cov-2 (severe acute respiratory syndrome coronavirus 2);outpatient care;public health

Journal Article

Wang, Rosi;Helf, Charlotte;Tizek, Linda;Neuhauser, Ruth;Eyerich, Kilian;Zink, Alexander;Eberlein, Bernadette;Biedermann, Tilo;Brockow, Knut;Boehner, Alexander

10.3390/ijerph17176182

[Title]: The Impact and Consequences of SARS-CoV-2 Pandemic on a Single University Dermatology Outpatient Clinic in Germany. [Abstract]: The pandemic outbreak of coronavirus disease 2019 (COVID-19) affects health care systems globally and leads to other challenges besides infection and its direct medical consequences. The aim of this study was to investigate the impact of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic on the university dermatology outpatient clinic (UDOC) of the Technical University of Munich, Germany. We analyzed datasets from 2015 until 2020 extracted from the hospital information system database and our documented outpatient files regarding patient numbers, gender, age, and diagnoses. In 2020, case numbers of outpatient care declined significantly (p = 0.021) compared to previous years and was related to the timing of political announcements answering SARS-CoV-2 pandemic. Additionally, during calendar week 10 to 15-the peak time of the spread of COVID-19 in Germany-the proportion of patients missing their consultation was significantly higher in 2020 than in 2019 (22.4% vs. 12.4%; p < 0.001). Gender-associated differences regarding absences were not detected, but patients aged 85 years or older were significantly more likely to miss their consultation compared to all other age groups (p = 0.002). Regarding different disease clusters, patients with chronic inflammatory skin diseases and infectious and malignant diseases were more likely to miss their consultation (p = 0.006). Noticeably, less patients with malignant diseases, and particularly malignant melanoma, were registered during this pandemic. Our data support the hypothesis that medically constructive prioritization might not be implemented properly by patients themselves. Identifying missed patients and catching up on their medical care apart from COVID-19 will pose an enormous challenge for health care systems globally. [Keywords]: covid-19 (coronavirus disease 2019);sars-cov-2 (severe acute respiratory syndrome coronavirus 2);outpatient care;public health

Epidemiol Serv Saude

Internet searches for measures to address COVID-19 in Brazil: a description of searches in the first 100 days of 2020.

OBJECTIVE: to describe profiles of interest of web search queries related to the Covid-19 epidemic in Brazil. METHODS: this was a quantitative and exploratory study using Google Health Trends. We analyzed daily data of interest, defined as search probability (Pr), in 23 terms in searches performed by users connected in Brazil from January 1 to April 9, 2020. RESULTS: the peak in interest (Pr=0.0651) on the theme of coronavirus occurred on March 21. Interest in use of face masks (Pr=0.0041), social distancing (Pr=0.0043) and hand hygiene with alcohol gel (Pr=0.0037) was greater than interest in respiratory etiquette (Pr=0.0010) and hand hygiene with soap and water (Pr=0.0005). CONCLUSION: the difference in interest in issues related to combating Covid-19 was substantial and can guide new strategies for disseminating health information.

Journal Article

Garcia Filho, Carlos;Vieira, Luiza Jane Eyre de Souza;Silva, Raimunda Magalhaes da

10.5123/S1679-49742020000300011

[Title]: Internet searches for measures to address COVID-19 in Brazil: a description of searches in the first 100 days of 2020. [Abstract]: OBJECTIVE: to describe profiles of interest of web search queries related to the Covid-19 epidemic in Brazil. METHODS: this was a quantitative and exploratory study using Google Health Trends. We analyzed daily data of interest, defined as search probability (Pr), in 23 terms in searches performed by users connected in Brazil from January 1 to April 9, 2020. RESULTS: the peak in interest (Pr=0.0651) on the theme of coronavirus occurred on March 21. Interest in use of face masks (Pr=0.0041), social distancing (Pr=0.0043) and hand hygiene with alcohol gel (Pr=0.0037) was greater than interest in respiratory etiquette (Pr=0.0010) and hand hygiene with soap and water (Pr=0.0005). CONCLUSION: the difference in interest in issues related to combating Covid-19 was substantial and can guide new strategies for disseminating health information. [Keywords]:

Infect Control Hosp Epidemiol

The difference in the incubation period of 2019 novel coronavirus (SARS-CoV-2) infection between travelers to Hubei and nontravelers: The need for a longer quarantine period.

Data collected from the individual cases reported by the media were used to estimate the distribution of the incubation period of travelers to Hubei versus that of nontravelers. Because a longer and more volatile incubation period has been observed in travelers, the duration of quarantine should be extended to 3 weeks.

Journal Article

Leung, Char

10.1017/ice.2020.81

[Title]: The difference in the incubation period of 2019 novel coronavirus (SARS-CoV-2) infection between travelers to Hubei and nontravelers: The need for a longer quarantine period. [Abstract]: Data collected from the individual cases reported by the media were used to estimate the distribution of the incubation period of travelers to Hubei versus that of nontravelers. Because a longer and more volatile incubation period has been observed in travelers, the duration of quarantine should be extended to 3 weeks. [Keywords]:

Acta Clin Belg

Procalcitonin and secondary bacterial infections in COVID-19: association with disease severity and outcomes.

Introduction: Procalcitonin (PCT) is an emerging prognostic marker in coronavirus disease 2019 (COVID-19). Whether PCT can detect secondary bacterial infections or reflect target tissue injury in this setting is still unclear. Here we performed a meta-analysis to review the prognostic value of PCT for severe disease and adverse outcome events in COVID-19.Methods: We searched relevant publications in online databases. Studies were included if they reported categorical data according to disease severity and/or outcomes. We analysed extracted data using fixed or random-effects meta-analysis models, as appropriate, depending on the presence of significant heterogeneity. Results: Data from 14 studies (3492 patients) were included in the analysis. Overall, 163 of 256 patients with elevated PCT had severe disease (63.7%) compared with 553 of 2047 with negative PCT (27.0%) (OR: 5.92; 95% CI: 3.20 to 10.94). Elevated PCT was also associated with adverse outcomes (OR: 13.1; 95% CI: 7.37 to 23.1). PCT was increased in 22.8% and 30.6% of patients with the severe course and adverse outcome, respectively. Rates of secondary bacterial infections ranged from 4.7% to 19.5% and were associated with increased risk of severe course or fatal outcomes (OR: 20.8; 95% CI: 11.6 to 37.4). Conclusions: Elevated PCT levels could identify a subset of COVID-19 patients at increased risk of severe disease and adverse outcome. Its limitations include low sensitivity and undefined cost-utility ratio. Whether PCT may be used for detecting secondary bacterial infections and guiding antibiotic therapy in COVID-19 is still undefined.

covid-19;infections;procalcitonin;severe disease

Journal Article

Vazzana, Natale;Dipaola, Francesco;Ognibene, Silvia

10.1080/17843286.2020.1824749

[Title]: Procalcitonin and secondary bacterial infections in COVID-19: association with disease severity and outcomes. [Abstract]: Introduction: Procalcitonin (PCT) is an emerging prognostic marker in coronavirus disease 2019 (COVID-19). Whether PCT can detect secondary bacterial infections or reflect target tissue injury in this setting is still unclear. Here we performed a meta-analysis to review the prognostic value of PCT for severe disease and adverse outcome events in COVID-19.Methods: We searched relevant publications in online databases. Studies were included if they reported categorical data according to disease severity and/or outcomes. We analysed extracted data using fixed or random-effects meta-analysis models, as appropriate, depending on the presence of significant heterogeneity. Results: Data from 14 studies (3492 patients) were included in the analysis. Overall, 163 of 256 patients with elevated PCT had severe disease (63.7%) compared with 553 of 2047 with negative PCT (27.0%) (OR: 5.92; 95% CI: 3.20 to 10.94). Elevated PCT was also associated with adverse outcomes (OR: 13.1; 95% CI: 7.37 to 23.1). PCT was increased in 22.8% and 30.6% of patients with the severe course and adverse outcome, respectively. Rates of secondary bacterial infections ranged from 4.7% to 19.5% and were associated with increased risk of severe course or fatal outcomes (OR: 20.8; 95% CI: 11.6 to 37.4). Conclusions: Elevated PCT levels could identify a subset of COVID-19 patients at increased risk of severe disease and adverse outcome. Its limitations include low sensitivity and undefined cost-utility ratio. Whether PCT may be used for detecting secondary bacterial infections and guiding antibiotic therapy in COVID-19 is still undefined. [Keywords]: covid-19;infections;procalcitonin;severe disease

Trauma Surg Acute Care Open

Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees.

This document provides guidance for trauma and acute care surgeons surrounding the placement, management and removal of chest tubes during the COVID-19 pandemic.

hemothorax;guideline;hemopneumothorax;pneumothorax

Journal Article

Pieracci, Fredric M;Burlew, Clay Cothren;Spain, David;Livingston, David H;Bulger, Eileen M;Davis, Kimberly A;Michetti, Christopher

10.1136/tsaco-2020-000498

[Title]: Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees. [Abstract]: This document provides guidance for trauma and acute care surgeons surrounding the placement, management and removal of chest tubes during the COVID-19 pandemic. [Keywords]: hemothorax;guideline;hemopneumothorax;pneumothorax

J Clin Endocrinol Metab

Impacts of Type 2 Diabetes on Disease Severity, Therapeutic Effect, and Mortality of Patients With COVID-19.

PURPOSE: Coronavirus disease 2019 (COVID-19) has become a topic of concern worldwide; however, the impacts of type 2 diabetes mellitus (T2DM) on disease severity, therapeutic effect, and mortality of patients with COVID-19 are unclear. METHODS: All consecutive patients with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 11 to February 6, 2020, were included in this study. RESULTS: A total of 663 patients with COVID-19 were included, while 67 patients with T2DM accounted for 10.1% of the total. Compared with patients with COVID-19 without T2DM, those with T2DM were older (aged 66 years vs 57 years; P < 0.001) and had a male predominance (62.7% vs 37.3%; P = 0.019) and higher prevalence of cardiovascular diseases (61.2% vs 20.6%; P < 0.001) and urinary diseases (9% vs 2.5%; P = 0.014). Patients with T2DM were prone to developing severe (58.2% vs 46.3%; P = 0.002) and critical COVID-19 (20.9% vs 13.4%; P = 0.002) and having poor therapeutic effect (76.1% vs 60.4%; P = 0.017). But there was no obvious difference in the mortality between patients with COVID-19 with and without T2DM (4.5% vs 3.7%; P = 0.732). Multivariate logistic regression analysis identified that T2DM was associated with poor therapeutic effect in patients with COVID-19 (odd ratio [OR] 2.99; 95% confidence interval [CI], 1.07-8.66; P = 0.04). Moreover, having a severe and critical COVID-19 condition (OR 3.27; 95% CI, 1.02-9.00; P = 0.029) and decreased lymphocytes (OR 1.59; 95% CI, 1.10-2.34; P = 0.016) were independent risk factors associated with poor therapeutic effect in patients with COVID-19 with T2DM. CONCLUSIONS: T2DM influenced the disease severity and therapeutic effect and was one of the independent risk factors for poor therapeutic effect in patients with COVID-19.

coronavirus disease 2019;disease severity;risk factors;therapeutic effect;type 2 diabetes mellitus

Journal Article

Wang, Xiaoli;Liu, Zhengru;Li, Jiao;Zhang, Jixiang;Tian, Shan;Lu, Shimin;Qi, Mingming;Ma, Jingjing;Qiu, Bo;Dong, Weiguo;Xu, Yu

10.1210/clinem/dgaa535

[Title]: Impacts of Type 2 Diabetes on Disease Severity, Therapeutic Effect, and Mortality of Patients With COVID-19. [Abstract]: PURPOSE: Coronavirus disease 2019 (COVID-19) has become a topic of concern worldwide; however, the impacts of type 2 diabetes mellitus (T2DM) on disease severity, therapeutic effect, and mortality of patients with COVID-19 are unclear. METHODS: All consecutive patients with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 11 to February 6, 2020, were included in this study. RESULTS: A total of 663 patients with COVID-19 were included, while 67 patients with T2DM accounted for 10.1% of the total. Compared with patients with COVID-19 without T2DM, those with T2DM were older (aged 66 years vs 57 years; P < 0.001) and had a male predominance (62.7% vs 37.3%; P = 0.019) and higher prevalence of cardiovascular diseases (61.2% vs 20.6%; P < 0.001) and urinary diseases (9% vs 2.5%; P = 0.014). Patients with T2DM were prone to developing severe (58.2% vs 46.3%; P = 0.002) and critical COVID-19 (20.9% vs 13.4%; P = 0.002) and having poor therapeutic effect (76.1% vs 60.4%; P = 0.017). But there was no obvious difference in the mortality between patients with COVID-19 with and without T2DM (4.5% vs 3.7%; P = 0.732). Multivariate logistic regression analysis identified that T2DM was associated with poor therapeutic effect in patients with COVID-19 (odd ratio [OR] 2.99; 95% confidence interval [CI], 1.07-8.66; P = 0.04). Moreover, having a severe and critical COVID-19 condition (OR 3.27; 95% CI, 1.02-9.00; P = 0.029) and decreased lymphocytes (OR 1.59; 95% CI, 1.10-2.34; P = 0.016) were independent risk factors associated with poor therapeutic effect in patients with COVID-19 with T2DM. CONCLUSIONS: T2DM influenced the disease severity and therapeutic effect and was one of the independent risk factors for poor therapeutic effect in patients with COVID-19. [Keywords]: coronavirus disease 2019;disease severity;risk factors;therapeutic effect;type 2 diabetes mellitus

Eur J Radiol

Imaging of coronavirus disease 2019: A Chinese expert consensus statement.

Coronavirus disease 2019 (COVID-19) is highly contagious, mainly causing inflammatory lesions in the lungs, and can also cause damage to the intestine and liver. The rapid spread of the virus that causes coronavirus disease 2019 (COVID-19) pneumonia has posed complex challenges to global public health. Early detection, isolation, diagnosis, and treatment are the most effective means of prevention and control. At present, the epidemic situation of new coronavirus infection has tended to be controlled in China, and it is still in a period of rapid rise in much of the world. The current gold standard for the diagnosis of COVID-19 is the detection of coronavirus nucleic acids, but imaging has an important role in the detection of lung lesions, stratification, evaluation of treatment strategies, and differentiation of mixed infections. This Chinese expert consensus statement summarizes the imaging features of COVID-19 pneumonia and may help radiologists across the world to understand this disease better.

covid-19 pneumonia;computed tomography;imaging features

Journal Article;Review

Yang, Qi;Liu, Qiang;Xu, Haibo;Lu, Hong;Liu, Shiyuan;Li, Hongjun

10.1016/j.ejrad.2020.109008

[Title]: Imaging of coronavirus disease 2019: A Chinese expert consensus statement. [Abstract]: Coronavirus disease 2019 (COVID-19) is highly contagious, mainly causing inflammatory lesions in the lungs, and can also cause damage to the intestine and liver. The rapid spread of the virus that causes coronavirus disease 2019 (COVID-19) pneumonia has posed complex challenges to global public health. Early detection, isolation, diagnosis, and treatment are the most effective means of prevention and control. At present, the epidemic situation of new coronavirus infection has tended to be controlled in China, and it is still in a period of rapid rise in much of the world. The current gold standard for the diagnosis of COVID-19 is the detection of coronavirus nucleic acids, but imaging has an important role in the detection of lung lesions, stratification, evaluation of treatment strategies, and differentiation of mixed infections. This Chinese expert consensus statement summarizes the imaging features of COVID-19 pneumonia and may help radiologists across the world to understand this disease better. [Keywords]: covid-19 pneumonia;computed tomography;imaging features

J Hosp Infect

Aerosol-generating procedures and infective risk to healthcare workers from SARS-CoV-2: the limits of the evidence.

The transmission behaviour of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is still being defined. It is likely that it is transmitted predominantly by droplets and direct contact and it is possible that there is at least opportunistic airborne transmission. In order to protect healthcare staff adequately it is necessary that we establish whether aerosol-generating procedures (AGPs) increase the risk of transmission of SARS-CoV-2. Where we do not have evidence relating to SARS-CoV-2, guidelines for safely conducting these procedures should consider the risk of transmitting related pathogens. Currently there is very little evidence detailing the transmission of SARS-CoV-2 associated with any specific procedures. Regarding AGPs and respiratory pathogens in general, there is still a large knowledge gap that will leave clinicians unsure of the risk to themselves when offering these procedures. This review aimed to summarize the evidence (and gaps in evidence) around AGPs and SARS-CoV-2.

aerosol-generating procedures;infectivity;nosocomial infection;sars-cov-2;transmission

Journal Article;Review

Harding, H;Broom, A;Broom, J

10.1016/j.jhin.2020.05.037

[Title]: Aerosol-generating procedures and infective risk to healthcare workers from SARS-CoV-2: the limits of the evidence. [Abstract]: The transmission behaviour of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is still being defined. It is likely that it is transmitted predominantly by droplets and direct contact and it is possible that there is at least opportunistic airborne transmission. In order to protect healthcare staff adequately it is necessary that we establish whether aerosol-generating procedures (AGPs) increase the risk of transmission of SARS-CoV-2. Where we do not have evidence relating to SARS-CoV-2, guidelines for safely conducting these procedures should consider the risk of transmitting related pathogens. Currently there is very little evidence detailing the transmission of SARS-CoV-2 associated with any specific procedures. Regarding AGPs and respiratory pathogens in general, there is still a large knowledge gap that will leave clinicians unsure of the risk to themselves when offering these procedures. This review aimed to summarize the evidence (and gaps in evidence) around AGPs and SARS-CoV-2. [Keywords]: aerosol-generating procedures;infectivity;nosocomial infection;sars-cov-2;transmission

Clin Immunol

COVID-19 - Considerations for the paediatric rheumatologist.

The novel coronavirus SARS-CoV2 is a threat to the health and well-being of millions of lifes across the globe. A significant proportion of adult patients require hospitalisation and may develop severe life-threatening complications. Children, on the other hand, can carry and transmit the virus, but usually do not develop severe disease. Mortality in the paediatric age-group is relatively low. Differences in virus containment and clearance, as well as reduced inflammation-related tissue and organ damage may be caused by age-specific environmental and host factors. Since severe complications in adults are frequently caused by uncontrolled immune responses and a resulting "cytokine storm" that may be controlled by targeted blockade of cytokines, previously established treatment with immunosuppressive treatments may indeed protect children from complications.

ards;covid;cytokine storm;inflammation;paediatric;rheumatology;sars;sars-cov2

Journal Article;Review

Hedrich, Christian M

10.1016/j.clim.2020.108420

[Title]: COVID-19 - Considerations for the paediatric rheumatologist. [Abstract]: The novel coronavirus SARS-CoV2 is a threat to the health and well-being of millions of lifes across the globe. A significant proportion of adult patients require hospitalisation and may develop severe life-threatening complications. Children, on the other hand, can carry and transmit the virus, but usually do not develop severe disease. Mortality in the paediatric age-group is relatively low. Differences in virus containment and clearance, as well as reduced inflammation-related tissue and organ damage may be caused by age-specific environmental and host factors. Since severe complications in adults are frequently caused by uncontrolled immune responses and a resulting "cytokine storm" that may be controlled by targeted blockade of cytokines, previously established treatment with immunosuppressive treatments may indeed protect children from complications. [Keywords]: ards;covid;cytokine storm;inflammation;paediatric;rheumatology;sars;sars-cov2

Graefes Arch Clin Exp Ophthalmol

Impact of COVID-19 on outpatient visits and intravitreal treatments in a referral retina unit: let's be ready for a plausible "rebound effect".

PURPOSE: To quantify the shrinking in outpatient and intravitreal injections' volumes in a tertiary referral retina unit secondary to virus causing coronavirus disease 2019 (COVID-19). METHODS: In this retrospective cross-sectional study, we reviewed the charts of all patients who had a visit at a medical retina referral center during the Italian quarantine (from 9th of March 2020 to 3rd of May 2020). Number and characteristics of these data were compared with data from the same period in 2019 (from 9th of March 2019 to 3rd of May 2019). RESULTS: In the 2019 study period, there were 303 patients attending clinic (150 males, 153 females). In the 2020 study period, patients decreased to 75 (48 males, 27 females; P = 0.022 comparing gender prevalence between the two periods) with an overall reduction of 75.2%. Mean +/- SD age was 71.4 +/- 14.3 years (range 25-93 years) in the 2019 study period and 66.7 +/- 13.1 years (range 32-91 years) in the 2020 study period (P = 0.005). The largest drop in outpatient volume was recorded in AMD patients (- 79.9%). Regarding the intravitreal treatments, there were 1252 injections in the 2019 period and 583 injections in the 2020 period (- 53.6% in injections). The drop in intravitreal treatments was larger in patients with posterior uveitis, retinal vein occlusion, and diabetes (- 85.7%, - 61.9%, and - 59.6%, respectively). CONCLUSION: The volume of outpatient visits and intravitreal injections declined during the COVID-19 quarantine. The short- and long-term impacts are that routine in-person visits and intravitreal injections are expected to increase after the quarantine and, even more, after the pandemic.

covid-19;intravitreal injections;outpatient visits;retina

Journal Article

Borrelli, Enrico;Grosso, Domenico;Vella, Giovanna;Sacconi, Riccardo;Querques, Lea;Zucchiatti, Ilaria;Prascina, Francesco;Bandello, Francesco;Querques, Giuseppe

10.1007/s00417-020-04858-7

[Title]: Impact of COVID-19 on outpatient visits and intravitreal treatments in a referral retina unit: let's be ready for a plausible "rebound effect". [Abstract]: PURPOSE: To quantify the shrinking in outpatient and intravitreal injections' volumes in a tertiary referral retina unit secondary to virus causing coronavirus disease 2019 (COVID-19). METHODS: In this retrospective cross-sectional study, we reviewed the charts of all patients who had a visit at a medical retina referral center during the Italian quarantine (from 9th of March 2020 to 3rd of May 2020). Number and characteristics of these data were compared with data from the same period in 2019 (from 9th of March 2019 to 3rd of May 2019). RESULTS: In the 2019 study period, there were 303 patients attending clinic (150 males, 153 females). In the 2020 study period, patients decreased to 75 (48 males, 27 females; P = 0.022 comparing gender prevalence between the two periods) with an overall reduction of 75.2%. Mean +/- SD age was 71.4 +/- 14.3 years (range 25-93 years) in the 2019 study period and 66.7 +/- 13.1 years (range 32-91 years) in the 2020 study period (P = 0.005). The largest drop in outpatient volume was recorded in AMD patients (- 79.9%). Regarding the intravitreal treatments, there were 1252 injections in the 2019 period and 583 injections in the 2020 period (- 53.6% in injections). The drop in intravitreal treatments was larger in patients with posterior uveitis, retinal vein occlusion, and diabetes (- 85.7%, - 61.9%, and - 59.6%, respectively). CONCLUSION: The volume of outpatient visits and intravitreal injections declined during the COVID-19 quarantine. The short- and long-term impacts are that routine in-person visits and intravitreal injections are expected to increase after the quarantine and, even more, after the pandemic. [Keywords]: covid-19;intravitreal injections;outpatient visits;retina

J Clin Orthop Trauma

Out Patient Department practices in orthopaedics amidst COVID-19: The evolving model.

Severe Acute Respiratory Syndrome COVID-19 was declared as a pandemic on 11(th) March 2020 by the World Health Organization and consequent lockdown imposed in several areas resulted in a marked reduction in orthopaedic practices. Although some guidelines for patient care in orthopaedic practice have been published, overall, publications focusing exclusively on guidelines on starting orthopaedic outpatient departments (OPD) after the COVID-19 lockdown amidst the on-going pandemic are lacking. We hereby propose the evolving knowledge in changes in OPD management practices for orthopaedic surgeons in the COVID- 19 era. The emphasis on online registration (e-registration) should be given impetus and become the new norm supplemented by telephonic and spot registration for the uneducated patients. The review highlights the safety of patient and orthopaedic surgeons in OPD by screening and maintaining hygiene at various levels. The article also mentions the duties of the help desk, OPD hall supervisor and the new norms of air conditioning, ventilation, safe use of elevators, sanitization of OPD premises and biomedical waste disposal. The optimum and safe utilization of human & material resources, DO's and DON'Ts for patients & health staff have also been proposed. The reorganization of plaster room, the precaution during plastering, fracture clinic, dressing and injection room services are discussed as per evolving guidelines. This article will also give deep insight into the OPD plan & telemedicine graphically. The authors suggest updating and downward permeation of existing e-infrastructure of government health services that is up-gradation of existing tertiary level online registration services, a paperless model of OPD consultation & dispensation. The future updating of Aarogya Setu App (https://mygov.in/aarogya-setu-app/) for convenient online OPD registration and dispensation has been discussed and proposed. This review will help in containing the spread of COVID 19 and build upon the health gains achieved after lockdown. The easy concept of CCCATTT has been introduced, and the OPD Plan has also been suggested. We have endeavoured to holistically detail an orthopaedic OPD setup and its upkeep in COVID-19 pandemic, but since the knowledge of COVID 19 is ever-evolving it needs replenishment by regular education for health staff.

covid 19;coronavirus;opd;orthopaedics;outpatient

Journal Article;Review

Lal, Hitesh;Sharma, Deepak Kumar;Patralekh, Mohit Kumar;Jain, Vijay Kumar;Maini, Lalit

10.1016/j.jcot.2020.05.009

[Title]: Out Patient Department practices in orthopaedics amidst COVID-19: The evolving model. [Abstract]: Severe Acute Respiratory Syndrome COVID-19 was declared as a pandemic on 11(th) March 2020 by the World Health Organization and consequent lockdown imposed in several areas resulted in a marked reduction in orthopaedic practices. Although some guidelines for patient care in orthopaedic practice have been published, overall, publications focusing exclusively on guidelines on starting orthopaedic outpatient departments (OPD) after the COVID-19 lockdown amidst the on-going pandemic are lacking. We hereby propose the evolving knowledge in changes in OPD management practices for orthopaedic surgeons in the COVID- 19 era. The emphasis on online registration (e-registration) should be given impetus and become the new norm supplemented by telephonic and spot registration for the uneducated patients. The review highlights the safety of patient and orthopaedic surgeons in OPD by screening and maintaining hygiene at various levels. The article also mentions the duties of the help desk, OPD hall supervisor and the new norms of air conditioning, ventilation, safe use of elevators, sanitization of OPD premises and biomedical waste disposal. The optimum and safe utilization of human & material resources, DO's and DON'Ts for patients & health staff have also been proposed. The reorganization of plaster room, the precaution during plastering, fracture clinic, dressing and injection room services are discussed as per evolving guidelines. This article will also give deep insight into the OPD plan & telemedicine graphically. The authors suggest updating and downward permeation of existing e-infrastructure of government health services that is up-gradation of existing tertiary level online registration services, a paperless model of OPD consultation & dispensation. The future updating of Aarogya Setu App (https://mygov.in/aarogya-setu-app/) for convenient online OPD registration and dispensation has been discussed and proposed. This review will help in containing the spread of COVID 19 and build upon the health gains achieved after lockdown. The easy concept of CCCATTT has been introduced, and the OPD Plan has also been suggested. We have endeavoured to holistically detail an orthopaedic OPD setup and its upkeep in COVID-19 pandemic, but since the knowledge of COVID 19 is ever-evolving it needs replenishment by regular education for health staff. [Keywords]: covid 19;coronavirus;opd;orthopaedics;outpatient

J Clin Virol

Predictive factors for disease progression in hospitalized patients with coronavirus disease 2019 in Wuhan, China.

BACKGROUND: A few studies have revealed the clinical characteristics of hospitalized patients with COVID-19. However, predictive factors for the outcomes remain unclear. OBJECTIVE: Attempted to determine the predictive factors for the poor outcomes of patients with COVID-19. STUDY DESIGN: This is a single-center, retrospective study. Clinical, laboratory, and treatment data were collected and analyzed from 111 hospitalized patients with laboratory-confirmed COVID-19 in Union Hospital. The gathered data of discharged and deteriorated patients were compared. RESULTS: Among these 111 patients, 93 patients were discharged and 18 patients were deteriorated. The lymphocyte count (0.56 G/L [0.47-0.63] vs 1.30 G/L [0.95-1.65]) was lower in the deteriorated group than those in the discharged group. The numbers of pulmonary lobe involved (5.00 [5.00-5.00] vs 4.00 [2.00-5.00]), serum C-reactive protein (CRP, 79.52 mg/L [61.25-102.98] vs 7.93 mg/L [3.14-22.50]), IL-6 (35.72 pg/mL [9.24-85.19] vs 5.09 pg/mL [3.16-9.72]), and IL-10 (5.35 pg/mL [4.48-7.84] vs 3.97 pg/mL [3.34-4.79]) concentrations in deteriorated patients were elevated compared with discharged patients. Multivariate logistic regression analysis showed that male gender (OR, 24.8 [1.8-342.1]), comorbidity (OR, 52.6 [3.6-776.4]), lymphopenia (OR, 17.3 [1.1-261.8]), and elevated CRP (OR, 96.5 [4.6-2017.6]) were the independent risk factors for the poor prognosis in COVID-19 patients. CONCLUSIONS: This finding would facilitate the early identification of high-risk COVID-19 patients.

coronavirus disease 2019;predictive factors;prognosis

Journal Article

Zhang, Jun;Yu, Miao;Tong, Song;Liu, Lu-Yu;Tang, Liang-V

10.1016/j.jcv.2020.104392

[Title]: Predictive factors for disease progression in hospitalized patients with coronavirus disease 2019 in Wuhan, China. [Abstract]: BACKGROUND: A few studies have revealed the clinical characteristics of hospitalized patients with COVID-19. However, predictive factors for the outcomes remain unclear. OBJECTIVE: Attempted to determine the predictive factors for the poor outcomes of patients with COVID-19. STUDY DESIGN: This is a single-center, retrospective study. Clinical, laboratory, and treatment data were collected and analyzed from 111 hospitalized patients with laboratory-confirmed COVID-19 in Union Hospital. The gathered data of discharged and deteriorated patients were compared. RESULTS: Among these 111 patients, 93 patients were discharged and 18 patients were deteriorated. The lymphocyte count (0.56 G/L [0.47-0.63] vs 1.30 G/L [0.95-1.65]) was lower in the deteriorated group than those in the discharged group. The numbers of pulmonary lobe involved (5.00 [5.00-5.00] vs 4.00 [2.00-5.00]), serum C-reactive protein (CRP, 79.52 mg/L [61.25-102.98] vs 7.93 mg/L [3.14-22.50]), IL-6 (35.72 pg/mL [9.24-85.19] vs 5.09 pg/mL [3.16-9.72]), and IL-10 (5.35 pg/mL [4.48-7.84] vs 3.97 pg/mL [3.34-4.79]) concentrations in deteriorated patients were elevated compared with discharged patients. Multivariate logistic regression analysis showed that male gender (OR, 24.8 [1.8-342.1]), comorbidity (OR, 52.6 [3.6-776.4]), lymphopenia (OR, 17.3 [1.1-261.8]), and elevated CRP (OR, 96.5 [4.6-2017.6]) were the independent risk factors for the poor prognosis in COVID-19 patients. CONCLUSIONS: This finding would facilitate the early identification of high-risk COVID-19 patients. [Keywords]: coronavirus disease 2019;predictive factors;prognosis

J Infect Chemother

COVID-19 outbreak in Italy: Clinical-radiological presentation and outcome in three oncologic patients.

We present three patients affected by pulmonary squamous cell carcinoma, metastatic esophageal cancer and advanced non-Hodgkin lymphoma, who incurred in coronavirus 2019 (COVID-19) infection during the early phase of epidemic wave in Italy. All patients presented with fever. Social contact with subject positive for COVID-19 was declared in only one of the three cases. In all cases, laboratory findings showed lymphopenia and elevated C-reactive protein (CRP). Chest x-ray and computed tomography showed bilateral ground-glass opacities, shadowing, interstitial abnormalities, and "crazy paving" pattern which evolved with superimposition of consolidations in one patient. All patients received antiviral therapy based on ritonavir and lopinavir, associated with hydroxychloroquine. Despite treatment, two patients with advanced cancers died after 39 and 17 days of hospitalization, while the patient with lung cancer was dismissed at home, in good conditions.

2019 novel coronavirus disease;antineoplastic chemotherapy protocols;computed tomography

Case Reports

Colombi, Davide;Bodini, Flavio Cesare;Morelli, Nicola;Silva, Mario;Milanese, Gianluca;Cavanna, Luigi;Michieletti, Emanuele

10.1016/j.jiac.2020.09.008

[Title]: COVID-19 outbreak in Italy: Clinical-radiological presentation and outcome in three oncologic patients. [Abstract]: We present three patients affected by pulmonary squamous cell carcinoma, metastatic esophageal cancer and advanced non-Hodgkin lymphoma, who incurred in coronavirus 2019 (COVID-19) infection during the early phase of epidemic wave in Italy. All patients presented with fever. Social contact with subject positive for COVID-19 was declared in only one of the three cases. In all cases, laboratory findings showed lymphopenia and elevated C-reactive protein (CRP). Chest x-ray and computed tomography showed bilateral ground-glass opacities, shadowing, interstitial abnormalities, and "crazy paving" pattern which evolved with superimposition of consolidations in one patient. All patients received antiviral therapy based on ritonavir and lopinavir, associated with hydroxychloroquine. Despite treatment, two patients with advanced cancers died after 39 and 17 days of hospitalization, while the patient with lung cancer was dismissed at home, in good conditions. [Keywords]: 2019 novel coronavirus disease;antineoplastic chemotherapy protocols;computed tomography

Rev Assoc Med Bras (1992)

Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID-19 infection.

BACKGROUND: Coronavirus Disease 2019 is an acute inflammatory respiratory disease. It causes many changes in hemogram parameters. Low albumin levels are associated with mortality risk in hospitalized patients. The aim of the present study is to reveal the place of neutrophil count to albumin ratio in predicting mortality in patients with COVID-19. METHODS: 144 patients, 65 females and 79 males, were included in the study. Patients were divided into 2 groups. Group 1 was the non-severe group (n:85), and Group 2 was severe (n:59). Demographic data, neutrophil, lymphocyte and platelet counts, albumin and C-reactive protein (CRP) levels were recorded. Neutrophil count to albumin ratio (NAR) was calculated by dividing the absolute neutrophil counts by the albumin levels. The NAR and levels of the two groups were then compared. RESULTS: There were no significant differences in gender and platelet count (201 vs. 211 K/mL) between the groups (p>0,05). Ages (62.0 +/- 14.3 vs 68.6 +/- 12.2 years), albumin (33.1 vs 29.9 gr/L), CRP (33 vs 113 mg/l), neutrophil count (4 vs 7.24 K/mL), WBC counts (6.70 vs 8.50 K/mL), NAR values (113.5 vs 267.2) and number of Death (5 vs 33) were found to be statistically higher (p <0.001) in Group 2 than in Group 1. The NAR value of 201.5 showed mortality in all patients with COVID-19 to have 71.1% sensitivity and 71.7% specificity (AUC:0.736, 95% CI: 0.641-0.832, p<0.001). CONCLUSION: The present study showed that NAR levels can be a cheap and simple marker for predicting mortality in patients with COVID-19.

Journal Article

Varim, Ceyhun;Yaylaci, Selcuk;Demirci, Taner;Kaya, Tezcan;Nalbant, Ahmet;Dheir, Hamad;Senocak, Didar;Kurt, Rumeysa;Cengiz, Hasret;Karacaer, Cengiz

10.1590/1806-9282.66.S2.77

[Title]: Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID-19 infection. [Abstract]: BACKGROUND: Coronavirus Disease 2019 is an acute inflammatory respiratory disease. It causes many changes in hemogram parameters. Low albumin levels are associated with mortality risk in hospitalized patients. The aim of the present study is to reveal the place of neutrophil count to albumin ratio in predicting mortality in patients with COVID-19. METHODS: 144 patients, 65 females and 79 males, were included in the study. Patients were divided into 2 groups. Group 1 was the non-severe group (n:85), and Group 2 was severe (n:59). Demographic data, neutrophil, lymphocyte and platelet counts, albumin and C-reactive protein (CRP) levels were recorded. Neutrophil count to albumin ratio (NAR) was calculated by dividing the absolute neutrophil counts by the albumin levels. The NAR and levels of the two groups were then compared. RESULTS: There were no significant differences in gender and platelet count (201 vs. 211 K/mL) between the groups (p>0,05). Ages (62.0 +/- 14.3 vs 68.6 +/- 12.2 years), albumin (33.1 vs 29.9 gr/L), CRP (33 vs 113 mg/l), neutrophil count (4 vs 7.24 K/mL), WBC counts (6.70 vs 8.50 K/mL), NAR values (113.5 vs 267.2) and number of Death (5 vs 33) were found to be statistically higher (p <0.001) in Group 2 than in Group 1. The NAR value of 201.5 showed mortality in all patients with COVID-19 to have 71.1% sensitivity and 71.7% specificity (AUC:0.736, 95% CI: 0.641-0.832, p<0.001). CONCLUSION: The present study showed that NAR levels can be a cheap and simple marker for predicting mortality in patients with COVID-19. [Keywords]:

Biol Sport

Medical recommendations for home-confined footballers' training during the COVID-19 pandemic: from evidence to practical application.

In early 2020, the world is facing a global emergency called COVID-19. Many professional footballers around the world are home confined. The maintenance of physical capacity is a fundamental requirement for the athlete, so the training sessions must be adapted to this unique situation. Specific recommendations must be followed concerning the type of training, its intensity, the precautions that have to be followed to avoid the possibility of contagion, and the restrictions in accordance with the presence of any symptoms. This article analyses the available scientific evidence in order to recommend a practical approach.

coronavirus;football;illness;soccer;training

Journal Article;Review

Eirale, Cristiano;Bisciotti, Giannicola;Corsini, Alessandro;Baudot, Christophe;Saillant, Gerard;Chalabi, Hakim

10.5114/biolsport.2020.94348

[Title]: Medical recommendations for home-confined footballers' training during the COVID-19 pandemic: from evidence to practical application. [Abstract]: In early 2020, the world is facing a global emergency called COVID-19. Many professional footballers around the world are home confined. The maintenance of physical capacity is a fundamental requirement for the athlete, so the training sessions must be adapted to this unique situation. Specific recommendations must be followed concerning the type of training, its intensity, the precautions that have to be followed to avoid the possibility of contagion, and the restrictions in accordance with the presence of any symptoms. This article analyses the available scientific evidence in order to recommend a practical approach. [Keywords]: coronavirus;football;illness;soccer;training

Diagn Interv Radiol

Determination of disease severity in COVID-19 patients using deep learning in chest X-ray images.

PURPOSE: Chest X-ray plays a key role in diagnosis and management of COVID-19 patients and imaging features associated with clinical elements may assist with the development or validation of automated image analysis tools. We aimed to identify associations between clinical and radiographic features as well as to assess the feasibility of deep learning applied to chest X-rays in the setting of an acute COVID-19 outbreak. METHODS: A retrospective study of X-rays, clinical, and laboratory data was performed from 48 SARS-CoV-2 RT-PCR positive patients (age 60+/-17 years, 15 women) between February 22 and March 6, 2020 from a tertiary care hospital in Milan, Italy. Sixty-five chest X-rays were reviewed by two radiologists for alveolar and interstitial opacities and classified by severity on a scale from 0 to 3. Clinical factors (age, symptoms, comorbidities) were investigated for association with opacity severity and also with placement of central line or endotracheal tube. Deep learning models were then trained for two tasks: lung segmentation and opacity detection. Imaging characteristics were compared to clinical datapoints using the unpaired student's t-test or Mann-Whitney U test. Cohen's kappa analysis was used to evaluate the concordance of deep learning to conventional radiologist interpretation. RESULTS: Fifty-six percent of patients presented with alveolar opacities, 73% had interstitial opacities, and 23% had normal X-rays. The presence of alveolar or interstitial opacities was statistically correlated with age (P = 0.008) and comorbidities (P = 0.005). The extent of alveolar or interstitial opacities on baseline X-ray was significantly associated with the presence of endotracheal tube (P = 0.0008 and P = 0.049) or central line (P = 0.003 and P = 0.007). In comparison to human interpretation, the deep learning model achieved a kappa concordance of 0.51 for alveolar opacities and 0.71 for interstitial opacities. CONCLUSION: Chest X-ray analysis in an acute COVID-19 outbreak showed that the severity of opacities was associated with advanced age, comorbidities, as well as acuity of care. Artificial intelligence tools based upon deep learning of COVID-19 chest X-rays are feasible in the acute outbreak setting.

Journal Article

Blain, Maxime;T Kassin, Michael;Varble, Nicole;Wang, Xiaosong;Xu, Ziyue;Xu, Daguang;Carrafiello, Gianpaolo;Vespro, Valentina;Stellato, Elvira;Ierardi, Anna Maria;Di Meglio, Letizia;D Suh, Robert;A Walker, Stephanie;Xu, Sheng;H Sanford, Thomas;B Turkbey, Evrim;Harmon, Stephanie;Turkbey, Baris;J Wood, Bradford

10.5152/dir.2020.20205

[Title]: Determination of disease severity in COVID-19 patients using deep learning in chest X-ray images. [Abstract]: PURPOSE: Chest X-ray plays a key role in diagnosis and management of COVID-19 patients and imaging features associated with clinical elements may assist with the development or validation of automated image analysis tools. We aimed to identify associations between clinical and radiographic features as well as to assess the feasibility of deep learning applied to chest X-rays in the setting of an acute COVID-19 outbreak. METHODS: A retrospective study of X-rays, clinical, and laboratory data was performed from 48 SARS-CoV-2 RT-PCR positive patients (age 60+/-17 years, 15 women) between February 22 and March 6, 2020 from a tertiary care hospital in Milan, Italy. Sixty-five chest X-rays were reviewed by two radiologists for alveolar and interstitial opacities and classified by severity on a scale from 0 to 3. Clinical factors (age, symptoms, comorbidities) were investigated for association with opacity severity and also with placement of central line or endotracheal tube. Deep learning models were then trained for two tasks: lung segmentation and opacity detection. Imaging characteristics were compared to clinical datapoints using the unpaired student's t-test or Mann-Whitney U test. Cohen's kappa analysis was used to evaluate the concordance of deep learning to conventional radiologist interpretation. RESULTS: Fifty-six percent of patients presented with alveolar opacities, 73% had interstitial opacities, and 23% had normal X-rays. The presence of alveolar or interstitial opacities was statistically correlated with age (P = 0.008) and comorbidities (P = 0.005). The extent of alveolar or interstitial opacities on baseline X-ray was significantly associated with the presence of endotracheal tube (P = 0.0008 and P = 0.049) or central line (P = 0.003 and P = 0.007). In comparison to human interpretation, the deep learning model achieved a kappa concordance of 0.51 for alveolar opacities and 0.71 for interstitial opacities. CONCLUSION: Chest X-ray analysis in an acute COVID-19 outbreak showed that the severity of opacities was associated with advanced age, comorbidities, as well as acuity of care. Artificial intelligence tools based upon deep learning of COVID-19 chest X-rays are feasible in the acute outbreak setting. [Keywords]:

New Microbes New Infect

Baseline electrolyte abnormalities would be related to poor prognosis in hospitalized coronavirus disease 2019 patients.

Electrolyte abnormalities are not uncommon in coronavirus disease 2019 (COVID-19). Several studies have suggested that various electrolyte imbalances seem to have an impact on disease prognosis. However, no study has primarily focused on the effect of baseline electrolyte abnormalities on disease outcome. In this study, we assessed the validity of the hypothesis that baseline electrolyte imbalances may be related to unfavourable outcomes in hospitalized COVID-19 patients. Design of the study was retrospective and observational. We included 408 hospitalized individuals with COVID-19 over 18 years old. Baseline levels of sodium, potassium, calcium and chloride were assessed and the effects of abnormalities in these electrolytes on requirement for intensive care unit and mechanical ventilation, hospitalization duration and treatment outcome were evaluated. Patients were clustered based on electrolyte levels and clusters were compared according to outcome variables. Frequency of other severe disease indices was compared between the clusters. Lastly, we evaluated the independent factors related to COVID-19-associated deaths with multivariate analyses. In all, 228 (55.8%) of the patients had at least one electrolyte imbalance at baseline. Hyponatraemia was the most frequent electrolyte abnormality. Patients with hyponatraemia, hypochloraemia or hypocalcaemia had, respectively, more frequent requirement for intensive care unit and mechanical ventilation, higher mortality rate and longer hospitalization. The clusters associated with electrolyte abnormalities had unfavourable outcomes. Also, Clinical and laboratory features associated with severe disease were detected more often in those clusters. Hyponatraemia was an independent factor related to death from COVID-19 (OR 10.33; 95% CI 1.62-65.62; p 0.01). Furthermore, baseline electrolyte imbalances, primarily hyponatraemia, were related to poor prognosis in COVID-19 and baseline electrolyte assessment would be beneficial for evaluating the risk of severe COVID-19.

coronavirus disease 2019;disease outcome;electrolyte abnormalities;intensive care unit;mechanical ventilation

Journal Article

Tezcan, M E;Dogan Gokce, G;Sen, N;Zorlutuna Kaymak, N;Ozer, R S

10.1016/j.nmni.2020.100753

[Title]: Baseline electrolyte abnormalities would be related to poor prognosis in hospitalized coronavirus disease 2019 patients. [Abstract]: Electrolyte abnormalities are not uncommon in coronavirus disease 2019 (COVID-19). Several studies have suggested that various electrolyte imbalances seem to have an impact on disease prognosis. However, no study has primarily focused on the effect of baseline electrolyte abnormalities on disease outcome. In this study, we assessed the validity of the hypothesis that baseline electrolyte imbalances may be related to unfavourable outcomes in hospitalized COVID-19 patients. Design of the study was retrospective and observational. We included 408 hospitalized individuals with COVID-19 over 18 years old. Baseline levels of sodium, potassium, calcium and chloride were assessed and the effects of abnormalities in these electrolytes on requirement for intensive care unit and mechanical ventilation, hospitalization duration and treatment outcome were evaluated. Patients were clustered based on electrolyte levels and clusters were compared according to outcome variables. Frequency of other severe disease indices was compared between the clusters. Lastly, we evaluated the independent factors related to COVID-19-associated deaths with multivariate analyses. In all, 228 (55.8%) of the patients had at least one electrolyte imbalance at baseline. Hyponatraemia was the most frequent electrolyte abnormality. Patients with hyponatraemia, hypochloraemia or hypocalcaemia had, respectively, more frequent requirement for intensive care unit and mechanical ventilation, higher mortality rate and longer hospitalization. The clusters associated with electrolyte abnormalities had unfavourable outcomes. Also, Clinical and laboratory features associated with severe disease were detected more often in those clusters. Hyponatraemia was an independent factor related to death from COVID-19 (OR 10.33; 95% CI 1.62-65.62; p 0.01). Furthermore, baseline electrolyte imbalances, primarily hyponatraemia, were related to poor prognosis in COVID-19 and baseline electrolyte assessment would be beneficial for evaluating the risk of severe COVID-19. [Keywords]: coronavirus disease 2019;disease outcome;electrolyte abnormalities;intensive care unit;mechanical ventilation

J Perinat Med

COVID-19 in obstetrics 2020: the experience at a New York City medical center.

The global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.

covid-19;sars-cov-2;health system resources;obstetrics;pregnancy

Journal Article;Review

Dayal, Ashlesha K;Razavi, Armin S;Jaffer, Amir K;Prasad, Nishant;Skupski, Daniel W

10.1515/jpm-2020-0365

[Title]: COVID-19 in obstetrics 2020: the experience at a New York City medical center. [Abstract]: The global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand. [Keywords]: covid-19;sars-cov-2;health system resources;obstetrics;pregnancy

Disaster Med Public Health Prep

Public Health Communication in Time of Crisis: Readability of On-Line COVID-19 Information.

OBJECTIVE: The purpose of this study was to assess the readability of information on the Internet posted about coronavirus disease 2019 (COVID-19) to determine how closely these materials are written to the recommended reading levels. METHODS: Using the search term "coronavirus," information posted on the first 100 English language websites was identified. Using an online readability calculator, multiple readability tests were conducted to ensure a comprehensive representation would result. RESULTS: The mean readability scores ranged between grade levels 6.2 and 17.8 (graduate school level). Four of the 5 measures (GFI, CLI, SMOG, FRE) found that readability exceeded the 10th grade reading level indicating that the text of these websites would be difficult for the average American to read. The mean reading level for nearly all noncommercial and commercial websites was at or above the 10th grade reading level. CONCLUSIONS: Messages about COVID-19 must be readable at an "easy" level, and must contain clear guidelines for behavior. The degree to which individuals seek information in response to risk messages is positively related to the expectation that the information will resolve uncertainty. However, if the information is too complex to interpret and it fails to lead to disambiguation, this can contribute to feelings of panic.

covid-19;on-line information;readability

Journal Article;Review

Basch, Corey H;Mohlman, Jan;Hillyer, Grace C;Garcia, Philip

10.1017/dmp.2020.151

[Title]: Public Health Communication in Time of Crisis: Readability of On-Line COVID-19 Information. [Abstract]: OBJECTIVE: The purpose of this study was to assess the readability of information on the Internet posted about coronavirus disease 2019 (COVID-19) to determine how closely these materials are written to the recommended reading levels. METHODS: Using the search term "coronavirus," information posted on the first 100 English language websites was identified. Using an online readability calculator, multiple readability tests were conducted to ensure a comprehensive representation would result. RESULTS: The mean readability scores ranged between grade levels 6.2 and 17.8 (graduate school level). Four of the 5 measures (GFI, CLI, SMOG, FRE) found that readability exceeded the 10th grade reading level indicating that the text of these websites would be difficult for the average American to read. The mean reading level for nearly all noncommercial and commercial websites was at or above the 10th grade reading level. CONCLUSIONS: Messages about COVID-19 must be readable at an "easy" level, and must contain clear guidelines for behavior. The degree to which individuals seek information in response to risk messages is positively related to the expectation that the information will resolve uncertainty. However, if the information is too complex to interpret and it fails to lead to disambiguation, this can contribute to feelings of panic. [Keywords]: covid-19;on-line information;readability