tyrosine hydroxylase

Gene Context Sentence

Table 2. Analysis of context sentence of TH gene in 202 abstracts.

PMID Gene Context Sentence
32036774 Coronaviruses are the well-known cause of severe respiratory, enteric and systemic infections in a wide range of hosts including man, mammals, fish, and avian. […] The scientific interest on coronaviruses increased after the emergence of Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) outbreaks in 2002-2003 followed by Middle East Respiratory Syndrome CoV (MERS-CoV). […] This decade’s first CoV, named 2019-nCoV, emerged from Wuhan, China, and declared as ‘Public Health Emergency of International Concern’ on January 30th, 2020 by the World Health Organization (WHO). […] As on February 4, 2020, 425 deaths reported in China only and one death outside China (Philippines). […] In a short span of time, the virus spread has been noted in 24 countries. […] The zoonotic transmission (animal-to-human) is suspected as the route of disease origin. […] The genetic analyses predict bats as the most probable source of 2019-nCoV though further investigations needed to confirm the origin of the novel virus. […] The ongoing nCoV outbreak highlights the hidden wild animal reservoir of the deadly viruses and possible threat of spillover zoonoses as well. […] The successful virus isolation attempts have made doors open for developing better diagnostics and effective vaccines helping in combating the spread of the virus to newer areas.
32048560 The global spread of the 2019-nCoV is continuing and is fast moving, as indicated by the WHO raising the risk assessment to high. […] In this article, we provide a preliminary phylodynamic and phylogeographic analysis of this new virus. […] A Maximum Clade Credibility tree has been built using the 29 available whole genome sequences of 2019-nCoV and two whole genome sequences that are highly similar sequences from Bat SARS-like Coronavirus available in GeneBank. […] We are able to clarify the mechanism of transmission among the countries which have provided the 2019-nCoV sequence isolates from their patients. […] The Bayesian phylogeographic reconstruction shows that the 2019-2020 nCoV most probably originated from the Bat SARS-like Coronavirus circulating in the Rhinolophus bat family. […] In agreement with epidemiological observations, the most likely geographic origin of the new outbreak was the city of Wuhan, China, where 2019-nCoV time of the most recent common ancestor emerged, according to molecular clock analysis, around November 25th, 2019. […] These results, together with previously recorded epidemics, suggest a recurring pattern of periodical epizootic outbreaks due to Betacoronavirus. […] Moreover, our study describes the same population genetic dynamic underlying the SARS 2003 epidemic, and suggests the urgent need for the development of effective molecular surveillance strategies of Betacoronavirus among animals and Rhinolophus of the bat family.
32057209 The New Coronavirus Pneumonia (NCP, also named as COVID-19 by WHO on Feb 11 2020, is now causing a severe public health emergency in China since. […] The number of diagnosed cases is more than 40,000 until the submission of this manuscript. […] Coronavirus has caused several epidemic situations world widely, but the present contagious disease caused by 2019 new Coronavirus is unprecedentedly fulminating. […] The published cohorts of 2019 new Coronavirus (n-Cov) are single-center studies, or retrospective studies. […] We here share the therapeutic experiences of NCP treatment with literature review. […] Combination of Ribavirin and Interferon-α is recommended by the 5(th) edition National Health Commission’s Regimen (Revised Edition) because of the effect on MERS (Middle East Respiratory Syndrome), and the effectiveness of Lopinavir/Ritonavir and Remdisivir needs to be confirmed by randomized controlled trial (RCT), given the situation of no specific antivirus drug on NCP is unavailable. […] Systemic glucocorticosteroid is recommended as a short term use (1~2, 3~5d ) by the 5(th) edition National Health Commission’s Regimen (Revised Edition) yet RCTs are expected to confirm the effectiveness. […] Inappropriate application of antibiotics should be avoided, especially the combination of broad-spectrum antibiotics, for the NCP is not often complicated with bacterial infection.
32107909 Objective: To explorethe proper protective measures for pancreaticdiseases treatment during theoutbreak of 2019 coronavirus disease(COVID-19). Method: Clinical data of four cases of patients that suffered COVID-19from February 2(nd), 2020 to February 9(th), 2020 in pancreatic surgery were reviewed.After the first patientscuffednosocomial infection of COVID-19, the general protective measures in our department wereupdated.Only one patient was admitted to each room alone, with no more than one caregiver.The body temperature of care givers was measuredtwice a day.Primary protections were applied to all staff.The floor was sterilized using disinfectant with an effective chlorine concentration of 1000 mg/L.The protective measures for interventional procedures were as follow.Primary protection was applied to the operators ofcentral venipuncture catheter, percutaneous abdominal/pleural drainage, percutaneous retroperitoneal drainage, percutaneous transhepatic cholangial drainage and other surgical procedures with local anesthesiaand epidural anesthesia.Secondary protection was applied to the operators of endoscopic retrograde cholangiopancreatography and surgical procedures with general anesthesia. Results: During Feb 2(nd), 2020 to Feb 9(th), 2020, four patients in our department were diagnosed with COVID-19, of which one was died of COVID-19, two were cured, and one is still in hospital for COVID-19. […] After the update ofprotective measures in our department, no more nosocomial infection of COVID-19occurred.Two central venipuncture catheter, three percutaneous abdominal/pleural drainage, one percutaneous retroperitoneal drainage, one percuteneous transhepatic cholecyst drainage and one open surgery with general anesthesia were performed with no infection of operators. Conclusions: The caregivers of patients are potential infection source of COVID-19. […] Enhanced protective measures including the management measures of caregivers can decrease the risk of nosocomial infection of COVID-19. 目的: 探讨新型冠状病毒肺炎疫情下胰腺外科诊疗活动的开展方式及感染防控方法。
32111114 2019 novel coronavirus (2019-nCoV) is one of the beta coronaviruses and was identified as the pathogen of the severe “coronavirus disease 2019 (COVID-19)” in 2019. […] China has formally included the 2019-nCoV in the statutory notification and control system for infectious diseases according to the Law of the People’s Republic of China on the Prevention and Treatment of Infectious Diseases. […] Currently, the national defending actions on the 2019-nCoV in China is in a critical period. […] Burn Department is also confronted with risk of infection by the 2019-nCoV. […] According to the guidelines on the diagnosis and treatment of COVID-19 (6(th) trial edition), the latest relative literature at home and abroad, the features of the COVID-19, recommendations for the COVID-19 prevention and control issued by the National Health Commission of China, and management experience of diagnosis and treatment in the related disciplines, we put forward recommendations for the medical practices of burn treatment during the outbreak of the COVID-19 in outpatient and emergency treatment, inpatient treatment, operation and ward management, etc. […] We hope these recommendations could benefit the professionals of the same occupation as us and related hospital managers, improve the treatment of burn during the outbreak of the COVID-19, and avoid or reduce the risk of infection of medical staff .
32149037 The first confirmed case of coronavirus disease 2019 (COVID-19) in South Korea was reported in January 2020, with 28 confirmed cases reported as of February 14th, 2020. […] The epidemiological and clinical characteristics of all 28 cases were analyzed in response to this disease. […] The epidemiological characteristics and early clinical features of the 28 patients from Korea with confirmed COVID-19 were analyzed using COVID-19 reporting and surveillance data and the epidemiological investigation reports prepared by the rapid response team. […] There were 16 patients that entered Korea from foreign countries: Wuhan, China (11 patients), Zhuhai, China, (1 patient), Singapore (2 patients), Japan (1 patient), and Thailand (1 patient). […] The early symptoms were fever, sore throat, cough or sputum production, chills, and muscle ache. […] Three patients were asymptomatic, however, 18 developed pneumonia. […] Of the 28 cases, 16 were index cases imported from abroad, with 10 cases of secondary infection originating in Korea, and the route of transmission still under investigation for 2 patients. […] The 10 patients with secondary infection were infected from contact with family members or acquaintances of primary patients, and the suspected sites of transmission were mostly at home. […] COVID-19 in Korea was spread by 16 infected individuals traveling from other countries, leading to second-generation cases. […] The initial symptoms were mostly minor, but the disease was infectious at this stage, resulting from close contact, particularly at home. […] Establishing an early detection strategy for COVID-19 is crucial for managing the transmission of the disease.
32164081 The new coronavirus pneumonia (NCP), also named as COVID-19 by WHO on Feb 11 2020, is now causing a severe public health emergency in China since. […] The number of diagnosed cases is more than 40,000 until the submission of this manuscript. […] Coronavirus has caused several epidemic situations world widely, but the present contagious disease caused by 2019 new coronavirus is unprecedentedly fulminating. […] The published cohorts of 2019 new coronavirus (n-Cov) are single-center studies, or retrospective studies. […] We here share the therapeutic experiences of NCP treatment with literature review. […] Combination of Ribavirin and interferon-α is recommended by the 5(th) edition National Health Commission’s Regimen (Revised Edition) because of the effect on Middle East respiratory syndrome (MERS), and the effectiveness of Lopinavir/Ritonavir and Remdisivir needs to be confirmed by randomized controlled trial (RCT), given the situation of no specific antivirus drug on NCP is unavailable. […] Systemic glucocorticosteroid is recommended as a short term use (1~2 mg·kg(-1)·d(-1), 3~5 d) by the 5(th) edition National Health Commission’s Regimen (Revised Edition) yet RCTs are expected to confirm the effectiveness. […] Inappropriate application of antibiotics should be avoided, especially the combination of broad-spectrum antibiotics, for the NCP is not often complicated with bacterial infection.
32193831 No information on severe pediatric patients with COVID-19 has been reported. […] We aimed to describe the clinical features of severe pediatric patients with COVID-19. […] We included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU), Wuhan Children’s Hospital from January 24 to February 24. […] We collected information including demographic data, symptoms, imaging data, laboratory findings, treatments and clinical outcomes of the patients with severe COVID-19. […] The onset age of the eight patients ranged from 2 months to 15 years; six were boys. […] The most common symptoms were polypnea (8/8), followed by fever (6/8) and cough (6/8). […] Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8), increased CD3 (2/8), CD4 (4/8) and CD8 (1/8), IL-6 (2/8), IL-10 (5/8) and IFN-γ (2/8). […] Up to February 24, 2020, three patients remained under treatment in ICU, the other five recovered and were discharged home. […] In this series of severe pediatric patients in Wuhan, polypnea was the most common symptom, followed by fever and cough. […] Common imaging changes included multiple patch-like shadows and ground-glass opacity; and a cytokine storm was found in these patients, which appeared more serious in critically ill patients.
32201449 The 2019-novel coronavirus (nCoV) is a major source of disaster in the 21th century. […] However, the lack of specific drugs to prevent/treat an attack is a major need at this current point of time. […] In this regard, we conducted a systematic review to identify major druggable targets in coronavirus (CoV). […] We searched PubMed and RCSB database with keywords HCoV, NCoV, corona virus, SERS-CoV, MERS-CoV, 2019-nCoV, crystal structure, X-ray crystallography structure, NMR structure, target, and drug target till Feb 3, 2020. […] The search identified seven major targets (spike protein, envelop protein, membrane protein, protease, nucleocapsid protein, hemagglutinin esterase, and helicase) for which drug design can be considered. […] There are other 16 nonstructural proteins (NSPs), which can also be considered from the drug design perspective. […] The major structural proteins and NSPs may serve an important role from drug design perspectives. […] However, the occurrence of frequent recombination events is a major deterrent factor toward the development of CoV-specific vaccines/drugs.
32205204 We evaluate the role of hydroxychloroquine on respiratory viral loads. […] French Confirmed COVID-19 patients were included in a single arm protocol from early March to March 16th, to receive 600mg of hydroxychloroquine daily and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. […] Depending on their clinical presentation, azithromycin was added to the treatment. […] Untreated patients from another center and cases refusing the protocol were included as negative controls. […] Presence and absence of virus at Day6-post inclusion was considered the end point. […] Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. […] Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination. […] Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin.
32217650 The coronavirus disease 2019 (Covid-19) outbreak is evolving rapidly worldwide. […] To evaluate the risk of serious adverse outcomes in patients with coronavirus disease 2019 (Covid-19) by stratifying the comorbidity status. […] We analysed the data from 1590 laboratory-confirmed hospitalised patients 575 hospitals in 31 province/autonomous regions/provincial municipalities across mainland China between December 11th, 2019 and January 31st, 2020. […] We analyse the composite endpoints, which consisted of admission to intensive care unit, or invasive ventilation, or death. […] The risk of reaching to the composite endpoints was compared according to the presence and number of comorbidities. […] The mean age was 48.9 years. 686 patients (42.7%) were females. […] Severe cases accounted for 16.0% of the study population. […] 131 (8.2%) patients reached to the composite endpoints. […] The most prevalent comorbidity was hypertension (16.9%), followed by diabetes (8.2%). […] After adjusting for age and smoking status, COPD [hazards ratio (HR) 2.681, 95% confidence interval (95%CI) 1.424-5.048], diabetes (HR 1.59, 95%CI 1.03-2.45), hypertension (HR 1.58, 95%CI 1.07-2.32) and malignancy (HR 3.50, 95%CI 1.60-7.64) were risk factors of reaching to the composite endpoints. […] The HR was 1.79 (95%CI 1.16-2.77) among patients with at least one comorbidity and 2.59 (95%CI 1.61-4.17) among patients with two or more comorbidities. […] Among laboratory-confirmed cases of Covid-19, patients with any comorbidity yielded poorer clinical outcomes than those without. […] A greater number of comorbidities also correlated with poorer clinical outcomes.
32219871 Coronavirus disease 2019 (COVID-19) is a novel type of highly contagious pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). […] Despite the strong efforts taken to control the epidemic, hundreds of thousands of people were infected worldwide by Mar. 11th , and was characterized as a pandemic by World Health Organization. […] Pregnant women are more susceptible to the virus due to immune and anatomic alteration, though hospital visits may increase the chance of infection, the lack of medical care during pregnancy may do more harm. […] Hence, a well-managed system that allows pregnant women to access maternal health care with minimum exposure risk is desired during the outbreak. […] Here, we present the managing processes of three pregnant women that had a fever during hospitalization at gynecology or obstetrics department, then further summarize and demonstrate our maternal health care management strategies including antenatal care planning, patient triage based on risk level, admission control, and measures counteracting emergencies and newly discovered high risk cases at in-patient department. […] In the meantime, we will explain the alterations we have done throughout different stages of the epidemic, and also review relative articles in both Chinese and English to compare our strategies with those of other areas. […] Although tens of COVID-19 cases were confirmed in our hospital, no nosocomial infection has occurred and none of the pregnant woman registered in our hospital was reported to be infected. […] This article is protected by copyright.
32223840 Objective: To collect the current status and healthcare needs of people living with HIV (PLHIV) in China during the COVID-19 outbreak to inform quick response from government and communities. Methods: During February 5(th) to 10(th) , 2020, a national anonymous survey was conducted using an online questionnaire among PLHIV at least 18 years of age and had started antiretroviral treatment (ART) to collect the information on COVID-19 prevention, HIV-related health services and the needs on psychosocial support. […] Current status and needs of people living with HIV were analyzed in Hubei and other regions. Results: A total of 1 014 valid questionnaires were collected, with PLHIV respondents cross the country. […] The survey revealed that 93.79% of the respondents could obtain information regarding the prevention of COVID-19 from their communities or villages. […] Respondents were concerned with HIV-specific protective measures and personal protective equipment shortage. […] 32.64% of all respondents were not carrying sufficient antiretroviral medicines (ARVs) to meet the needs under traffic and travel restrictions, and some could face stock-outs in the coming month. […] In Hubei province where 53 respondents needed ARV refill, 64.15% reported difficulty accessing ARV due to the “blockage”. […] 28.93% respondents were in need of sociopsychological support, and 85.31% anticipated further improvement of the out-of-town ARV refill process from the government. Conclusion: PLHIV wants to know HIV-specific protective measures against COVID-19 outbreak. […] PLHIV who returned to their home-towns and affected by the lock-downs reported challenges with refills. […] We should undertake a more systematic study on impacts of the COVID-19 on PLHIV to develop preparedness capacity for future public health emergency. 目的: 了解新型冠状病毒肺炎暴发流行对HIV感染者卫生需求影响,为政府和感染者社区快速制定应对措施提供参考依据。
32232214 SARS-CoV-2 is a newly emerging human infectious coronavirus that causes COVID-19, which has been recognized as a pandemic by the World Health Organization (WHO) on March 11th. […] There is still no vaccine or definitive treatment for this virus because its pathogenesis and proliferation pathways are still unknown. […] Therefore, in this article, new potential COVID-19 therapies are briefly reviewed.
32240770 The novel coronavirus (COVID-19) was first diagnosed in Wuhan, China in December 2019 and has now spread throughout the world, being verified by the World Health Organization as a Pandemic on March 11th. […] This had led to the calling of a national emergency on March 13th in the United States. […] Many hospitals, healthcare networks, and specifically Departments of Surgery are asking the same questions of how to cope and plan for surge capacity, personnel attrition, novel infrastructure utilization, and resource exhaustion. […] This includes Acute Care Surgeon deployment (given their critical care training and vertically integrated position in the hospital), recommended infrastructure and transfer utilization, triage principles, and faculty, resident and advanced care practitioner deployment.
32246890 Respiratory protective devices are critical in protecting against infection in health care workers at high risk of novel 2019 coronavirus disease (COVID-19); however, recommendations are conflicting and epidemiological data on their relative effectiveness against COVID-19 are limited. […] To compare medical masks to N95 respirators in preventing laboratory confirmed viral infection and respiratory illness including coronavirus specifically in health care workers. […] MEDLINE, Embase and CENTRAL from January 1st 2014 to March 9th 2020. […] Update of published search conducted from January 1st 1990 to December 9th 2014. […] Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in health care workers. […] Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence. […] Compared to N95 respirators; the use of medical masks did not increase laboratory confirmed viral (including coronaviruses) respiratory infection (OR 1.06; 95% CI 0.90-1.25; I2 =0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95%CI 0.98-2.28; I2 =78%; very low certainty in the evidence). […] Only one trial evaluated coronaviruses separately and found no difference between the two groups (p=0.49). […] Low certainty evidence suggests that medical masks and N95 respirators offer similar protection against viral respiratory infection including coronavirus in health care workers during non-aerosol generating care. […] Preservation of N95 respirators for high-risk, aerosol generating procedures in this pandemic should be considered when in short supply.
32251790 Hong Kong has been recently attacked by the coronavirus disease-2019 (COVID-19). […] There is a 257 in total infected cases confirmed including 4 deaths until 20th of March 2020. […] To prevent further outbreak of COVID-19, this article discusses the current understanding of COVID-19 and compares with the outbreak of SARS-CoV-2 in 2003 of Hong Kong from the causes, transmission, symptoms, diagnosis, treatments and preventions to study for an applicable measurement to control COVID-19.
32257771 This study aims to evaluate the risk assessments of coronavirus 2019 (COVID-19) in the Korea Centers for Disease Control and Prevention (KCDC), from the point of detection to the provision of basic information to the relevant public health authorities. […] To estimate the overall risk of specific public health events, probability, and impact at the country-level were evaluated using available information. […] To determine the probability of particular public health events, the risk of importation and risk of transmission were taken into consideration. […] A total of 8 risk assessments were performed on 8 separate occasions between January 8th to February 28th, 2020, depending on the detection and report of COVID-19 cases in other countries. […] The overall risk of the situation in each assessment increased in severity over this period: “low” (first), “moderate” (second), “high” (third), “high” (fourth), “high” (fifth), “high” (sixth), “high” (seventh), and “very high” (eighth). […] The KCDC’s 8 risk assessments were utilized to activate national emergency response mechanisms and eventually prepare for the pandemic to ensure the containment and mitigation of COVID-19 with non-pharmaceutical public health measures.
32257772 In this article, an international analysis was performed on the ongoing coronavirus disease 2019 (COVID-19) pandemic. […] Data were retrieved from accurate databases according to the user’s guide of data sources for patient registries, CFR and recovery rates were calculated for each country. […] A comparison of CFR between countries with total cases ≥ 1,000 was observed for 12th and 23rd March. […] Italy’s CFR was the highest of all countries studied for both time points (12th March, 6.22% versus 23rd March, 9.26%). […] The data showed that even though Italy was the only European country reported on 12rd March, Spain and France had the highest CFR of 6.16 and 4.21%, respectively, on 23rd March, which was strikingly higher than the overall CFR of 3.61%. […] Obtaining detailed and accurate medical history from COVID-19 patients, and analyzing CFR alongside the recovery rate, may enable the identification of the highest risk areas so that efficient medical care may be provided. […] This may lead to the development of point-of-care tools to help clinicians in stratifying patients based on possible requirements in the level of care, to increase the probabilities of survival from COVID-19 disease.
32257773 Between January 24th and March 10th, a total of 2,370 individuals had contact with the first 30 cases of COVID-19. […] There were 13 individuals who contracted COVID-19 resulting in a secondary attack rate of 0.55% (95% CI 0.31-0.96). […] There were 119 household contacts, of which 9 individuals developed COVID-19 resulting in a secondary attack rate of 7.56% (95% CI 3.7-14.26).
32257774 We report the first 7,755 patients with confirmed COVID-19 in Korea as of March 12th, 2020. […] A total of 66 deaths have been recorded, giving a case fatality proportion of 0.9%. […] Older people, and those with comorbidities were at a higher risk of a fatal outcome. […] The highest number of cases of COVID-19 were in Daegu, followed by Gyeongbuk. […] This summary may help to understand the disease dynamics in the early phase of the COVID-19 outbreaks, and may therefore, guide future public health measures.
32278670 Community transmission of SARS-CoV-2 was detected in Spain in February 2020, with 216% intensive care unit (ICU) capacity expanded in Vitoria by March 18th, 2020. […] We identified patients from the two public hospitals in Vitoria who were admitted to ICU with confirmed infection by SARS-CoV-2. […] Data reported here were available in March 31th, 2020. […] Mortality was assessed in those who completed 7-days of ICU stay. […] We identified 48 patients (27 males) with confirmed SARS-CoV-2. […] The most common comorbidities identified were obesity (n = 48%), arterial hypertension (n = 44%) and chronic lung disease (n = 37%). […] After 15 days, 14/45 (31%) intubated patients died (13% within one week), 10 (22%) were extubated, and 21/45 (47%) underwent mechanical ventilation. […] Procalcitonin plasma above 0.5 µg/L was associated with 16% vs. 19% (p = 0.78) risk of death after 7 days. […] This early experience with SARS-CoV-2 in Spain suggests that a strategy of right oxygenation avoiding non-invasive mechanical ventilation was life-saving. […] Seven-day mortality in SARS-CoV-2 requiring intubation was lower than 15%, with 80% of patients still requiring mechanical ventilation. […] After 15 days of ICU admission, half of patients remained intubated, whereas one third died.
32302280 As of March 30th, 2020 there were 161,807 total cases and 2,953 total deaths of SARS-CoV-2 in the United States, with the number of cases expected to rise. […] Other than supportive care, there are no SARS-CoV-2 specific treatments available for patients discharged from the emergency department (ED) or those admitted to the hospital. […] In addition, there are no vaccines available to protect our at-risk healthcare workers. […] The National Institutes of Health is conducting a Phase 1 clinical trial to evaluate for a potential vaccine and the recipients have started to receive the investigational vaccine.2 We present a brief overview of the potential prophylactic and treatment agents under investigation, some which could be initiated in the ED if proven effective.
32302419 Since the novel Coronavirus 2019, also known as COVID-19 or SARS CoV-2, crossed the Chinese borders and became pandemic, Italy has rapidly become the country with the highest number of patient deaths as well as confirmed and/or hospitalized patients, after China [1-2]. […] On March 12th Italy was declared a red-zone and special protocols were enacted to limit the spread of the virus. […] Although COVID-19 does not have epidermotropism, cutaneous manifestations in Cov-19 positive patients have been reported [3] and departments of dermatology are considered at high risk [4] and were ordered to admit only patients needing urgent treatments or undergoing chronic immunosuppressive therapy in order to minimize nosocomial virus spread.
32305269 Zimbabwe is among the countries that have been identified to be at risk of the COVID-19 pandemic. […] As of the 15th of March 2020, there was no confirmed case of the virus. […] Official reports of suspected cases were used to appraise the general screening, case management, and the emergency preparedness and response of the country towards the COVID-19 pandemic. […] In terms of the surveillance and capacity to screen at the ports of entry, the country seems to be faring well. […] The country might not be screening optimally, considering the number of COVID-19 tests conducted to date and the suspected cases who missed testing. […] Three of the suspected cases faced mental, social, and psychological consequences due to them being suspected cases of COVID-19. […] There is a need to enhance the screening process and infrastructure at all the ports of entry. […] More COVID-19 diagnostic tests should be procured to increase the testing capacity. […] Training and awareness on mental, social, and psychological consequences of COVID-19 should be offered to the health care workers and the general public. […] More financial resources should be sourced to enable the country control the pandemic.
32321874 The present study provides an overview of the coronavirus disease 2019 (COVID-19) outbreak which has rapidly extended globally within a short period. […] It is crucial to understand the impact and outcome of this pandemic. […] We therefore overview the changes in the curves of COVID-19 confirmed cases and fatality rate in China and outside of China from 31st of December 2019 to 25th of March 2020. […] We also aimed to assess the temporal developments and death rate of COVID-19 in China and worldwide. […] More than 414,179 confirmed cases of COVID-19 have been reported in 197 countries, including 81,848 cases in China and 332,331 outside of China. […] Furthermore, 18,440 infected patients died from COVID-19 infection; 3,287 cases were from China and 15,153 fatalities were reported worldwide. […] Among the worldwide infected cases, 113,802 patients have been recovered and discharged from different hospitals. […] Effective prevention and control measures should be taken to control the disease. […] The presented Chinese model (protocol) of disease prevention and control could be utilized in order to curb the pandemic situation.
32335962 On March 11th 2020 the World Health Organisation (WHO) declared COVID-19 pandemic, leading to a subsequent impact on the entire world and health care system. […] Since the causing Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) houses in the aerodigestive tract, activities in the gastrointestinal outpatient clinic and endoscopy unit should be limited to emergencies only. […] Health care professionals are faced with the need to perform endoscopic or endoluminal emergency procedures in patients with a confirmed positive or unknown COVID-19 status. […] With this report we aim to provide recommendations and practical relevant information for gastroenterologists based on the limited amount of available data and local experience, to guarantee a high-quality patient care and adequate infection prevention in the gastroenterology clinic.
32339344 Coronavirus 19 (COVID-19) was declared as a pandemic viral infection by the World Health organization on March 11th 2020. […] Usual clinical manifestations of COVID-19 infection include fever, fatigue, myalgia, headache, diarrhea, dry cough, dyspnea that may lead to acute respiratory distress syndrome and death (1). […] Skin symptoms of COVID-19 have been poorly described but may include erythematous rash, urticaria and chicken pox like lesions (2-7).
32341229 The World Health Organization (WHO), on March 11th 2020, upgraded the status of the novel coronavirus disease (COVID-19) from epidemic to pandemic. […] Over two million individuals have been infected with SARS-CoV-2, the virus causing COVID-19, and as of April, 14th 2020, there were over 5000 confirmed cases in Saudi Arabia (SA). […] Many countries, including SA, have imposed major restrictions on travel, and everyday life, and the implications of these necessary changes are being felt in liver transplant (LT) centers in SA. […] Concerns remain that there is an increased risk for individuals over 65 years of age, with underlying medical conditions, or for those who are immunocompromised. […] Therefore, the Saudi Association for the Study of Liver Diseases and Transplantation (SASLT) established an urgent task force to launch a statement that can be utilized by LT centers as a guidance in the management of patients with advanced liver disease from the time of LT listing to the post-operative care of transplanted patients.
32358994 When I first read the manuscript that accompanies this editorial, upon its online publication on February 19th 2020(1), COVID-19 had already killed 2118 people in China, but only one person in Europe - an 80-year-old tourist from China, who died in France on the 15th February. […] I read the manuscript with grim fascination, as it was clear that SARS-CoV-2 had spread very rapidly in China which already had 74,576 cases and in South Korea which already had 58 cases, and that it was then invading Europe also, as France already had 12 cases, Germany 16, the UK 9, Italy 3, Spain 2 and other countries too.
32360420 Clinical intervention in patients with corona virus disease 2019 (COVID-19) has demonstrated a strong upregulation of cytokine production in patients who are critically ill with SARS-CoV2-induced pneumonia. […] In a retrospective study of 41 patients with COVID-19, most patients with SARS-CoV-2 infection developed mild symptoms, whereas some patients later developed aggravated disease symptoms, and eventually passed away because of multiple organ dysfunction syndrome (MODS), as a consequence of a severe cytokine storm. […] Guidelines for the diagnosis and treatment of SARS-CoV-2 infected pneumonia were first published January 30th, 2020; these guidelines recommended for the first time that cytokine monitoring should be applied in severely ill patients to reduce pneumonia related mortality. […] The cytokine storm observed in COVID-19 illness is also an important component of mortality in other viral diseases, including SARS, MERS and influenza. […] In view of the severe morbidity and mortality of COVID-19 pneumonia, we review the current understanding of treatment of human coronavirus infections from the perspective of a dysregulated cytokine and immune response.
32361715 “…but why think? […] Why not try the experiment?…” John Hunter (1728-1793), in a letter to Edward Jenner. […] A.D.), physician, philosopher and experimentalist, sought to ascertain the therapeutic properties of Theriac, an antidote of repute against poisons, he resorted to an experiment. […] Theriac or Theriaca was a compound drug, containing in some versions used in antiquity numerous components; Galen’s own composition included over 70 ingredients! […] One of its uses was as an antidote against snakebites, a frequent peril for the Roman armies marching on in sandals. […] Galen spent most of his life in Rome and was elevated to Imperial Physician at the court of Marcus Aurelius, who apparently took daily doses of Theriac, which among other components included opium. […] Describing the experiment to his friend Pison, Galen wrote, “as I could not possibly conduct a trial on humans, I experimented on roosters” For his experiment, Galen, studied two groups of roosters, but he doesn’t tell us how many animals he included in each category. […] Both groups were exposed to poisonous snakebites. […] All roosters who were fed with theriac prior to exposure to viper bites survived, whereas in the second group that had not received prophylactic Theriac, all roosters died. […] Not only is Galen’s methodology remarkable, preceding the modern randomised trial by eighteen centuries, but more importantly, it is notable for his ethical stance at a time when sensitivities about human rights, prevalent in our times, were largely absent in societies of widespread slavery. […] For example, Mithridates VI (132-63 BC), the King of Pontus who is credited with the first use of Theriac, tested its efficacy on criminals and slaves. […] For his experiment Galen used the random allocation of treatment, today’s prospective randomised clinical trial, implemented in the evaluation of novel therapies, widely used internationally, particularly in cancer research! […] This experimental method used for ascertaining the efficacy of new drugs became established after the second half of the 20th century and is now firmly entrenched as a research tool. […] On the other hand, the retrieval of information from observational studies or non-randomised series is considered scientifically inferior and is often dismissed or ignored as irrelevant or anecdotal. […] Such is the compulsion for the randomised study that in the midst of the COVID-19 pandemic, respected physicians and scientists appeared in the media hesitant to recommend the use of protective facial masks, as there was no evidence of benefit for their use from prospective randomised studies in the general population! […] Logic had no place in the argument! […] COVID-19, caused by the SARS-CoV-2 new corona virus, brought to the fore the randomised trial, as well as, the ethical dilemmas that surround the allocation of treatment at random, in the face of a devastating pandemic. […] Anthony Fauci, distinguished infectious diseases expert and an adviser to the President of the USA, at a recent briefing from the Situation Room of the White House, endorsed categorically and unreservedly the randomised trial for the evaluation of drugs potentially effective against SARS-CoV-2, in patients afflicted with COVID-19. […] A few days later on April 8th, 2020, Professor Sotiris Tsiodras, scientific advisor to the Greek Government for COVID-19 and an expert on infectious diseases, when asked by a journalist about chloroquine, he responded, “Antony Fauci is correct. […] Nevertheless, we give the drug to everyone, that is, not half of the patients will receive it, and the other half will not”. […] If we accept that the randomised trial represents the unique, impregnable method of evaluating new treatments-several clinicians dispute this dogma. -the question arises how will treatments be allocated to patients? […] According to the Declaration of Helsinki participation of a subject in a clinical trial requires their explicit written consent. […] Will, a potentially hypoxic patient rapidly deteriorating, be able to understand what is being asked of them, and will that patient be in a position to provide consent? […] And if that patient refuses to be randomised, what are the options? […] Is it his/her right to request the active treatment that a fellow patient is receiving in the next bed? […] Although the Declaration of Helsinki allows the option of no treatment or even placebo, where no known treatment is available for a certain condition, such as COVID-19, it also emphasizes that “while the primary purpose of medical research is to generate new knowledge, this goal can never take precedence over the rights and interests of individual research subjects”. […] Consider now the physicians and nurses on the first line of the battle against the pandemic; to the enormous pressures and risks that they experience daily, they may have to endure the added psychological burden of the randomised trial, knowing that half of their patients are receiving the promising drug, whilst the other half are denied the chance of potential benefit. […] When during the Medical Research Council’s randomized trial of streptomycin, one senior physician contracted tuberculosis, the Medical Research Council obtained supplies for him outside the trial. […] In this brief instance of medical history, the equipoise, the scientific imperative, all arguments and other justifications for providing treatment at random, were thrown out of the window in favour of the human factor! […] Because-it is presumed-the process of randomising subjects, protects the study from the selective inclusion of patients with favourable characteristics, thus inadvertently allowing or facilitating a falsely favourable result for the drug or treatment under investigation. […] However, the process of randomising patients does not necessarily result in the randomisation of the characteristics of their disease. […] Exactly because of this, at the end of a randomised study, even if the prognostic variables are evenly represented and balanced in the strata, further confirmation of the result is sought with a statistical multifactorial analysis. […] Such multifactorial analyses can also be applied to a non-randomised group of patients engaged in the trial of a new drug. […] Since the middle of the 20th century a generation of physicians have been trained to dismiss, or are incapable of evaluating the validity of a treatment beyond the established etiquette of the randomised study. […] This, some have argued, constitutes intellectual indolence, it is not scientific robustness. […] Pandits foresee that the world will be different after the end of this pandemic. […] Perhaps human ingenuity will seek new investigative methods that will render the randomised clinical trial obsolete, both, on methodological and ethical grounds. […] Until then and even if we have to accept the scientific supremacy of the randomised study in the evaluation of novel therapies, the ethical considerations in the unprecedented circumstances of a relentless pandemic demand a more humane approach, befitting the beneficent precepts of the Hippocratic tradition.
32362682 World Health Organization (WHO) declared novel coronavirus outbreak a “pandemic” on March 11th, 2020. […] India has already reached Stage 2 (local transmission) and the Indian Government, in collaboration with the Indian Council of Medical Research (ICMR), is taking all necessary steps to halt the community transmission(Stage 3). […] Anaesthesiologists and intensivists around the globe are making untiring efforts akin to soldiers at the final frontier during war. […] In this article, all outbreak response measures including triaging, preparation of isolation rooms, decontamination and disinfection protocols as well as fundamental principles of critical care and anaesthetic management in Covid-19 cases is being discussed. […] All the recommendations have been derived from the past experiences of SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) outbreak as well as upcoming guidelines from the international health fraternity and Indian Health Services.
32373339 The outbreak of coronavirus disease 2019 (COVID-19) has posed stress on the health and well-being of both Chinese people and the public worldwide. […] Global public interest in this new issue largely reflects people’s attention to COVID-19 and their willingness to take precautionary actions. […] This study aimed to examine global public awareness of COVID-19 using Google Trends. […] Using Google Trends, we retrieved public query data for terms of “2019-nCoV + SARS-CoV-2 + novel coronavirus + new coronavirus + COVID-19 + Corona Virus Disease 2019” between the 31st December 2019 and the 24th February 2020 in six major English-speaking countries, including the USA, the UK, Canada, Ireland, Australia, and New Zealand. […] Dynamic series analysis demonstrates the overall change trend of relative search volume (RSV) for the topic on COVID-19. […] We compared the top-ranking related queries and sub-regions distribution of RSV about COVID-19 across different countries. […] The correlation between daily search volumes on the topic related to COVID-19 and the daily number of people infected with SARS-CoV-2 was analyzed. […] The overall search trend of RSV regarding COVID-19 increased during the early period of observing time and reached the first apex on 31st January 2020. […] A shorter response time and a longer duration of public attention to COVID-19 was observed in public from the USA, the UK, Australia, and Canada, than that in Ireland and New Zealand. […] A slightly positive correlation between daily RSV about COVID-19 and the daily number of confirmed cases was observed (P < 0.05). […] People across countries presented a various interest to the RSV on COVID-19, and public awareness of COVID-19 was different in various sub-regions within countries. […] The results suggest that public response time to COVID-19 was different across countries, and the overall duration of public attention was short. […] The current study reminds us that governments should strengthen the publicity of COVID-19 nationally, strengthen the public’s vigilance and sensitivity to COVID-19, inform public the importance of protecting themselves with enough precautionary measures, and finally control the spread of COVID-19 globally.
32375787 On February 19th 2020, the Iranian Ministry of Health and Medical Education (MoHME) has announced the first 2 cases of SARS-CoV-2, a novel emerging coronavirus which causes an infection termed as COVID-19, in Qom city. […] As such, the Iranian government, through the establishment of the “National Headquarters for the management and control of the novel Coronavirus”, has started implementing policies and programs for the prevention and control of the virus. […] These measures include schools and universities closure, reduced working hours, and increased production and delivery of equipment such as masks, gloves and hygienic materials for sterile environments. […] The government has also made efforts to divulge high-quality information concerning the COVID-19 and to provide laboratories and hospitals with diagnostic kits and adequate resources to treat patients. […] However, despite such efforts, the number of cases and deaths has progressively increased with rising trends in total confirmed cases and deaths, as well as in new daily cases and deaths associated with the COVID-19. […] While developed countries have allocated appropriate funding and are responding adequately to the COVID-19 pandemics, Iran has experienced a serious surge of cases and deaths and should strive to provide additional resources to the health system to make healthcare services more accessible and to increase the fairness of that access. […] All relevant actors and stakeholders should work together to fight this disease.
32376317 COVID-19 can severely affect pregnant women and the issue of vertical transmission of sars-cov-2 has also emerged. […] Sars-cov-2 could be recovered by real-time (RT) PCR from nasal and throat swabs, sputum and feces of symptomatic patients including neonates but not from vaginal swabs, amniotic fluid, placenta, cord blood, neonatal blood or breast milk. […] We identified 12 articles published between February 10th and April 4th 2020 reporting on 68 deliveries and 71 neonates with maternal infection in the third trimester of pregnancy. […] Perinatal exposure, including mode of delivery and time interval from delivery to the diagnosis of neonatal infection are crucial in differentiating congenital from perinatal infection. […] Neonatal infection was diagnosed within 48 hours of life in 4 cases. […] Detection rates of real-time PCR and the interpretation of IgM and IgG antibodies levels in cord and neonatal blood are discussed in relation with the immaturity of the fetal and neonatal immune system.
32390285 We aimed to present early data on children tested for SARS-CoV-2 at a large Australian tertiary children’s hospital according to the state health department guidelines, which varied over time. […] We conducted a retrospective cohort study at The Royal Children’s Hospital, Melbourne, Australia. […] It included all paediatric patients (aged 0-18 years) who presented to the Emergency Department (ED) or the Respiratory Infection Clinic (RIC) and were tested for SARS-CoV-2. […] The 30-day study period commenced after the first confirmed positive case was detected at the hospital on 21st March 2020, until 19th April 2020. […] There were 433 patients in whom SARS-CoV-2 testing was performed in ED (331 (76%)) or RIC (102 (24%)). […] There were 4 (0.9%) who had positive SARS-CoV-2 detected, none of whom were admitted to hospital or developed severe disease. […] Of these SARS-CoV-2 positive patients, 1/4 (25%) had a comorbidity, which was asthma. […] Of the SARS-CoV-2 negative patients, 196/429 (46%) had comorbidities.
32390691 On March 11 th 2020, World Health Organization (WHO) declared the 2019 novel corona virus as global pandemic. […] Corona virus, also known as COVID-19 was first originated in Wuhan, Hubei province in China around December 2019 and spread out all over the world within few weeks. […] Based on the public datasets provided by John Hopkins university and Canadian health authority, we have developed a forecasting model of COVID-19 outbreak in Canada using state-of-the-art Deep Learning (DL) models. […] In this novel research, we evaluated the key features to predict the trends and possible stopping time of the current COVID-19 outbreak in Canada and around the world. […] In this paper we presented the Long short-term memory (LSTM) networks, a deep learning approach to forecast the future COVID-19 cases. […] Based on the results of our Long short-term memory (LSTM) network, we predicted the possible ending point of this outbreak will be around June 2020. […] In addition to that, we compared transmission rates of Canada with Italy and USA. […] Here we also presented the 2, 4, 6, 8, 10, 12 and 14 th day predictions for 2 successive days. […] Our forecasts in this paper is based on the available data until March 31, 2020. […] To the best of our knowledge, this of the few studies to use LSTM networks to forecast the infectious diseases.
32392948 Objective: To investigate the application of pulmonary ultrasound in the diagnosis of neonatal COVID-19. Methods: In this retrospective study, the clinical data of 5 infants, who were admitted to the Department of Neonatology in Wuhan Children’s Hospital from 31(st) January to 25(th) February 2020, were collected. […] Bedsides pulmondary ultrasound was conducted on admission, during the hospitalization, and before discharge, the result were compared with the chest X-ray or CT done at the same time. Results: Among the 5 cases who aged 1-18 days, 3 were male. […] The main clinical manifestations were respiratory and gastrointestinal symptoms. […] The pulmonary ultrasonography on admission showed abnormal pleural line and pulmonary edema of different severity in all 5 cases, presented as increase and fusion of B-line, and pulmonary interstitial syndrome; among them, one case also had a small-range consolidation. […] The chest CT on admission showed no obvious parenchymal infiltration in 2 cases, small strip or patchy high-density shadow in 2 cases, and ground glass change in one case. […] The re-examination of ultrosound during the hospitalization and at discharge showed improvement in all cases and were consistent with the chest X-ray taken at the same time. Conclusions: The main changes on the pulmonary ultrasonography in neonates with COVID-19 pneumonia are increase and fusion of B-line, abnormal pleural line, and alveolar interstitial syndrome, and may coexist with small range of pulmonary consolidation. […] The sensitivity of pulmonary ultrasound is higher than that of chest X-ray and CT in the diagnosis of pulmonary edema, and could be used in monitoring and evaluation of the disease. 目的: 探讨肺部超声在新生儿新型冠状病毒肺炎(COVID-19)诊断中的应用。
32396239 Studies have demonstrated that comorbidities, especially cardiovascular and endocrine diseases, correlated with poorer clinical outcomes. […] However, the impact of digestive system diseases have not been issued. […] The aim of this study is to determine the impact of laryngopharyngeal reflux disease (LPRD) on hospitalized patients with COVID-19. […] We extracted clinical data regarding 95 patients in Jin-yin tan hospital, Wuhan, China between January 26th , 2020 and February 21st . […] The Reflux Symptom Index (RSI) was used to assess the presence and severity of LPRD. […] A total of 95 patients with COVID-19 were enrolled, with 61.1% (58/95), 32.6% (31/95), and 6.3% (6/95) being moderately ill, severely ill, and critically ill, respectively. […] In this study, 38.9% (37/95) of the patient had a RSI score over 13, which was indicative of LPRD. […] In a univariable analysis, the age and RSI scores of severely or critically ill patients were statistically significantly higher than patients with moderate disease (p=0.026 and p=0.005, respectively). […] After controlling for age difference in a multivariable model, the RSI>13, compared with RSI=0, was associated with significantly higher risk of severe infection (p<0.001; OR = 11.411, 95% CI 2.95-42.09) and critical infection (p=0.028; OR = 19.61, 95% CI 1.38-277.99). […] Among hospitalized patients with COVID-19, RSI score greater than 13, indicative of LPRD, correlated with poorer clinical outcomes. […] The prevalence of LPRD may be higher than the general population, which indicated that COVID-19 can impair the upper esophageal sphincter and aggravate reflux. […] This article is protected by copyright.
32398918 In the fight against COVID 19, the government of India announced a 3 weeks lockdown of the entire country of 1.3 billion people on 24th March 2020. […] One week after the lockdown was announced, we conducted an anonymous online survey of the orthopaedic surgeons in India through social media platforms to assess the impact of the lockdown during COVID 19. […] The survey had a total of 13 questions with (3-5) options and was designed with an aim to understand the perception and the state of mind of the Orthopaedic surgeons in the lockdown situation. […] The survey was completed by 611 orthopaedic surgeons from 140 cities in India. […] There were 22.5% orthopaedic surgeons who said that they were definitely stressed out, and 40.5% who said they were mildly stressed out. […] As the age decreased, the percentage of orthopaedic surgeons feeling “definitely stressed out” increased. […] Disruption of life-work balance and uncertainties regarding return to work were other strongly associated factors with the “definitely stressed out” group. […] The psychological impact of the lockdown during COVID 19 on orthopaedic surgeons may become a potential concern that will require addressal through open discussion. diagnostic level 4.
32399515 Since its emergence in Wuhan, China in December 2019, novel Coronavirus disease - 2019 (COVID-19) has rapidly spread worldwide, achieving pandemic status on 11 th March, 2020. […] As of 1 st April 2020, COVID-19, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had infected over 800,000 people and caused over 40,000 deaths in 205 countries and territories. […] As of 1 st of April 2020, the number of confirmed COVID-19 cases in Africa was relatively low, with the highest number registered by South Africa, which had reported 1,380 confirmed cases. […] On the same date (also the date of this review), Africa had reported 5,999 confirmed cases, of which 3,838 (almost 65%) occurred in South Africa, Algeria, Egypt, Morocco and Tunisia, with the remaining 2,071 cases distributed unevenly across the other African countries. […] We speculate that while African nations are currently experiencing much lower rates of COVID-19 relative to other continents, their significantly lower testing rates may grossly underestimate incidence rates. […] Failure to grasp the true picture may mean crucial windows of opportunity shut unutilized, while limited resources are not deployed to maximum effect. […] In the absence of extensive testing data, an overestimation of spread may lead to disproportionate measures being taken, causing avoidable strain on livelihoods and economies. […] Here, based on the African situation, we discuss COVID-19 diagnostic challenges and how they may blunt responses.
32400099 COVID 19 pandemic is spreading worldwide and the impact of the disease in transplant patients is evolving. […] In this case report, we presented a 63 years old female kidney transplant recipient who presented with dyspnea and cough and diagnosed with COVID 19 pneumonia. […] On the 4th day of admission, the patient’s condition worsened. […] Therefore, the immunosuppressive medications were discontinued, and hydrocortisone started. […] The patient died on the 5th day.
32405111 : When COVID-19 emerged in China in late 2019, most citizens were home-quarantined to prevent the spread of the virus. […] This study explored the prevalence of post-traumatic stress disorder (PTSD) and depression in a sample of home-quarantined college students to identify the psychological distress risk factors. : The PTSD and depressive symptoms in the 2485 participants from 6 universities were investigated using online survey versions of the PTSD Checklist Civilian Version and the 9-question Patient Health Questionnaires (PHQ-9), and data on sleep durations, exposure, home-quarantine time and socio-demographic variables were also collected. : The PTSD and depression prevalence were found to be 2.7% and 9.0%. […] Subjectively, feeling extreme fear was the most significant risk factor for psychological distress, followed by short sleep durations, being in their graduating year (4th year) and living in severely afflicted areas. […] Sleep durations was a mediator between exposures and mental health problems. : The results suggested that the psychological consequences of the COVID-19 could be serious. […] Psychological interventions that reduce fear and improve sleep durations need to be made available to the home-quarantined university students, and graduating students and those in the worst-hit areas should be given priority focus.
32408995 The spread of the SARS-CoV-2 infection (COVID-19) has required adaptation by hospitals affected by the pandemic, which has caused a reduction in elective surgical activity. […] Retrospective study of patients operated on in the previous month and during the peak of the pandemic. […] We analysed the COVID-19 infection rate, the severity of respiratory infection according to the Brescia respiratory COVID-19 severity scale, the adopted therapeutic measures and the overall postoperative complications. […] From 17th February to 31st March 2020, there was a progressive decrease in surgical activity, with only 213 patients operated on. […] This comprised 59 (27.8%) elective operations for oncological diseases, 97 (45.5%) elective operations for benign diseases and 57 (26.7%) as urgent procedures. […] There was a progressive increase in the rate of infection by COVID-19, with a total of 15 cases (7%). […] This included 10 patients (16.9%) in the elective group for oncological disease, 1 (1%) in the elective surgery group for benign disease and 4 (7%) in the urgent surgery group (P<.001). […] Five patients presented with a severe respiratory infection, of which 4 were affected by oncological disease. […] There were 3 deaths (1.4%), which were all due to the worsening of a respiratory infection. […] The patients undergoing the surgical procedures showed high rates of COVID-19 infection and postoperative complications, especially the patients with oncological diseases. […] Local resumption of surgical activity must be based on the prioritisation of the cases to be operated on, respecting certain premises of security and optimisation of the available resources.
32416028 Infections with coronaviruses are not always confined to the respiratory tract and various neurological manifestations have been reported. […] The aim of this study was to perform a review to describe neurological manifestations in patients with COVID-19 and possible neuro-invasive mechanisms of Sars-CoV-2. […] Pubmed, WebOfScience and Covid-dedicated databases were searched for the combination of COVID-19 terminology and neurology terminology up to May 10th 2020. […] Social media channels were followed-up between March 15th and May 10th 2020 for postings with the same scope. […] Neurological manifestations were extracted from the identified manuscripts and combined to provide a useful summary for the neurologist in clinical practice. […] Neurological manifestations potentially related to COVID-19 have been reported in large studies, case series and case reports and include acute cerebrovascular diseases, impaired consciousness, cranial nerve manifestations and auto-immune disorders such as Guillain-Barré Syndrome often present in patients with more severe COVID-19. […] Cranial nerve symptoms such as olfactory and gustatory dysfunctions are highly prevalent in patients with mild-to-moderate COVID-19 even without associated nasal symptoms and often present in an early stage of the disease. […] Physicians should be aware of the neurological manifestations in patients with COVID-19, especially when rapid clinical deterioration occurs. […] The neurological symptoms in COVID-19 patients may be due to direct viral neurological injury or indirect neuroinflammatory and autoimmune mechanisms. […] No antiviral treatments against the virus or vaccines for its prevention are available and the long-term consequences of the infection on human health remain uncertain especially with regards to the neurological system.
32416146 Hubei province in China has completed cycle of quarantine-resumption in 23rd Janauary and 8th April 2020, providing a unique opportunity as for now to assess its intervention impact and the pattern of SARS-COV-2 transmission during the quarantine period. […] In this study, we evaluate the impact of the metropolitan-wide quarantine on the trend and transmission route of the COVID-19 epidemic in Hubei, China. […] The intervention reduces more than 70% of new infections in both households and the public space, as well as the deaths caused by COVID-19 pneumonia. […] Household transmission is the dominant route of disease spread regardless of quarantine. […] This will provide important evidence and scientific insights to other worldwide countries that are currently under quarantine.
32417117 The COVID19-Tracker web application systematically produces daily updated data visualization and analysis of SARS-CoV-2 epidemic in Spain. […] It collects automatically daily data on COVID-19 diagnosed cases and mortality, from February 24th, 2020 onwards. […] Three applications have already been developed: 1) to analyze data trends and estimating short-term projections; 2) to estimate the case fatality rate; and 3) to assess the effect of the lockdowns on the data trends. […] The application may help for a better understanding of the SARS-CoV-2 epidemic data in Spain.
32417304 Thought to be of zoonotic origin, it has been named SARS-CoV-2 (COVID-19) and has spread rapidly. […] As of April 20th, 2020, there have been more than 2.4 million cases recorded worldwide. […] The inflammatory process, cytokine storm, and lung injury that are associated with COVID-19 can put patients at an increased risk of thrombosis. […] It is uncertain what the total incidences of thrombotic events in COVID-19 patients is currently at. […] Those with more severe disease and with other risk factors, including increasing age, male sex, obesity, cancer, comorbidities, and intensive care unit admission, are at higher risk of these events. […] However, there is little international guidance on managing these risks in COVID-19 patients. […] In this paper, we explore the current evidence and theories surrounding thrombosis in these unique patients and reflect on experience from our center.
32417398 The ongoing enigmatic COVID-19 outbreak, first reported from Wuhan, China, on last day of the year 2019, which has spread to 213 countries, territories/areas till 28th April 2020, threatens hundreds of thousands human souls. […] This devastating viral infection has stimulated the urgent development of viable vaccine against COVID-19 across the research institutes around the globe. […] The World Health Organization (WHO) has also confirmed that the recent pandemic is causing Public Health Emergency of International apprehension. […] Moreover, the earlier two pathogenic SARS-CoV and MERS-CoV and many others yet to be identified pose a universal menace. […] Here, in this piece of work, we have utilized an in silico structural biology and advanced immunoinformatic strategies to devise a multi-epitope subunit vaccine against ongoing COVID-19 infection. […] The engineered vaccine sequence is adjuvanted with ß-3 defensin and comprised of B-cell epitopes, HTL epitopes and CTL epitopes. […] This is very likely that the vaccine will be able to elicit the strong immune response. […] Further, specific binding of the engineered vaccine and immune cell receptor TLR3 was estimated by molecular interaction studies. […] Strong interaction in the binding groove as well as good docking scores affirmed the stringency of engineered vaccine. […] The interaction is stable with minimal deviation in root-mean square deviation and root-mean-square fluctuation was confirmed by the molecular dynamics simulation experiment. […] The immune-simulation by C-ImmSim server, which mimics the natural immune environment, yielded more potent immune response data of B-cells, Th cells, Tc cells and IgG for vaccine. […] The encouraging data obtained from the various in-silico works indicated this vaccine as an effective therapeutic against COVID-19.
32417802 The COVID-19 pandemic represents the greatest challenge to date faced by the medical community in the 21st century. […] The rate of rapid dissemination, magnitude of viral contagiousness, person to person transmission at an asymptomatic phase of illness pose a unique and dangerous challenge for all patients, including neonatal and obstetric patients. […] Although scientific understanding of the pathophysiology of the disease, nature of transmission, and efficacy of mitigation strategies grow, neither a cure or vaccine have been developed. […] While COVID-19 is primarily a disease of older patients, infection is now seen across all age demographics with reports of illness in pregnant patients and infants. […] Altered hormone status and predominance of Th-2 immune helper cells may result in increased predisposition to SARS-CoV-2. […] Case reports of pregnant patients demonstrate a clinical presentation comparable to non-pregnant adults, but evidence of vertical transmission to the fetus is controversial. […] Neonatal reports demonstrate an inconsistent and non-specific phenotype, and it is often difficult to separate COVID-19 from the underlying conditions of prematurity or bacterial infection. […] The development of international registries to enable risk profiling of COVID-19 positive pregnant mothers and/or their offspring may facilitate the development of enhanced mitigation strategies, medical treatments and effective vaccinations.
32419713 We aimed to describe the variability and identify gaps in preparedness and response to the COVID-19 pandemic in European EDs caring for children. […] A cross-sectional point prevalence survey, was developed and disseminated through the pediatric emergency medicine research networks for Europe (REPEM) and the United Kingdom and Ireland (PERUKI). […] We aimed to include ten EDs for countries with > 20 million inhabitants and five EDs for less populated countries, unless the number of eligible EDs was below five. […] ED directors or their delegates completed the survey between March 20th and 21st to report practice at that time. […] Overall 102 centers from 18 countries (86% response rate) completed the survey: 34% did not have an ED contingency plan for pandemics and 36% had never had simulations for such events. […] Wide variation on PPE items was shown for recommended PPE use at pre-triage and for patient assessment, with 62% of centers experiencing shortage in one or more PPE items, most frequently FFP2/N95 masks. […] We found variation and identified gaps in preparedness and response to the COVID-19 epidemic across European referral EDs for children. […] A lack in early availability of a documented contingency plan, provision of simulation training, appropriate use of PPE, and appropriate isolation facilities emerged as gaps that should be optimized to improve preparedness and inform responses to future pandemics.
32420609 Since being identified in China in December 2019, coronavirus disease 2019 (Covid-19) has rapidly evolved into a global pandemic with over 4 million cases and more than 270,000 deaths.( […] 1) Following the first reported cases in the United Kingdom (UK) in late January 2020, numbers have continued to rise with 223,060 cases and 32,065 deaths reported as of 11th May 2020.( […] 2) Initial reports from China have indicated that Covid-19 has an overall mortality rate of 1.4%. […] However, the prognosis varies widely between groups, with age over 60 years and underlying conditions including hypertension, diabetes, cardiovascular disease and cancer identified as risk factors for severe disease and death.( […] 3) The initial reports from China show that patients with cancer are over-represented among individuals who develop severe Covid-19 after contracting the virus.( […] 4) Patients with haematological malignancies are expected to be at increased risk of adverse outcomes from this viral infection, due being immunosuppressed as a consequence of the underlying cancer, and from the effects of therapy.
32422693 In the context of COVID-19 pandemic, teledermatology is being favored over in-person consultation in order to avoid the possibility of virus transmission1 . […] In France, COVID-19 wasn’t known to cause cutaneous manifestations before April 6th 2020, when an alert about possible associated skin symptoms was raised to the general public and the professional social network2-4 . […] We aimed to assess the impact of alerting about COVID-associated lesions on the activity of urgent teledermatology (TD) and the activity of dermatologic emergencies unit (DEU) of two university hospitals during this pandemic.
32425269 COVID-19 can manifest as a viral induced hyperinflammation with multi-organ involvement. […] We aimed to identify and prospectively validate biomarkers that allow the identification of patients in need of impending mechanical ventilation. […] Patients with COVID-19 hospitalized from February 29th to April 09th, 2020 were analyzed for baseline clinical and laboratory findings at admission and during the disease. […] Data from 89 evaluable patients were available for the purpose of analysis comprising an initial evaluation cohort (n=40) followed by a temporally separated validation cohort (n=49). […] We identified markers of inflammation, LDH and creatinine as most predictive variables of respiratory failure in the evaluation cohort. […] Maximal interleukin-6 (IL-6) levels before intubation showed the strongest association with the need of mechanical ventilation followed by maximal CRP. […] Respective AUC values for IL-6 and CRP in the evaluation cohort were 0.97 and 0.86 and similar in the validation cohort 0.90 and 0.83. […] The calculated optimal cutoff values in the course of disease from the evaluation cohort (IL-6> 80 pg/ml and CRP> 97 mg/l) both correctly classified 80% of patients in the validation cohort regarding their risk of respiratory failure. […] Maximal levels of IL-6 followed by CRP were highly predictive of the need for mechanical ventilation. […] This suggests the possibility of using IL-6 or CRP levels to guide escalation of treatment in patients with COVID-19 related hyperinflammatory syndrome.
32425430 Severe Acute Respiratory Syndrome COVID-19 was declared as a pandemic on 11th March 2020 by the World Health Organization and consequent lockdown imposed in several areas resulted in a marked reduction in orthopaedic practice. […] 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 give deep insight into the OPD plan &telemedicine graphically also. […] 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 ( 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.
32425638 As of May 11th 2020, the coronavirus disease 2019 (COVID-19) pandemic, caused by the novel, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused 274,361 deaths out of 3,917,366 (7% case fatality rate). […] As with the two other novel coronavirus zoonotic diseases of humans, SARS and MERS, no specific treatments for reducing mortality or morbidity are yet available. […] Deaths from COVID-19 will continue to rise globally until effective and appropriate treatments and vaccines are found. […] With no specific treatments being available for treating COVID-19 patients, the global medical, scientific, pharma and funding communities have rapidly initiated over 500 COVID-19 clinical on a range of antiviral drug regimens, biologics, repurposed drugs in various combinations. […] We focus this editorial specifically on the background to, and the rationale for, the use and evaluation of mesenchymal stromal (Stem) cells (MSCs) in treatment trials of patients with severe COVID-19 disease. […] This is an area which has been eclipsed by the current emphasis the huge number of trials evaluating new anti-viral drugs, repurposed drugs and combinations thereof. […] MSCs should also be trialed for treatment of severe cases of MERS where mortality rates are upto 34% and MERS-CoV remains a WHO priority Blueprint pathogen. […] It’s about time funding agencies now invest more into development MSCs per se and other host-directed therapies in combination with other therapeutic interventions. […] MSC therapy could turn out to be an important contribution to bringing an end to the high COVID-19 and MERS death rates.
32426864 Our hospital diagnosed the two first non-imported COVID-19 cases in Spain on 26th February. […] Eight of them were referred for dermatological examination. […] Due to the overwhelming situation, the incidence of cutaneous manifestations in our hospitalized COVID-19 patients is probably greater than this 0.7%1, 2 .
32428303 As of the 11th of March, the world health organization (WHO) declared Coronavirus disease-2019 (COVID-19) as a pandemic disease caused by SARS-CoV-2 (previously known as 2019-nCOV) (1,2). […] By the 19th of April, 2,241,778 confirmed patients were reported worldwide with 152,552 COVID-19 related deaths (3). […] The COVID-19 pandemic represents the most serious health crisis facing the modern world resulting in unprecedented efforts to contain this pandemic and its consequences (1).
32428372 On March 11th 2020, the World Health Organization (WHO) declared the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) as a pandemic. […] Until an effective treatment or a vaccine is developed, the current recommendations are to contain the disease, and control its transmission. […] It is now clear that the primary mode of SARS-CoV-2 transmission is aerosol/droplet spread, and by contacting virus contaminated surfaces acting as fomites (inanimate vectors). […] Furthermore, recent data indicate that the live virus particles are present in saliva, and, more alarmingly, asymptomatic individuals may transmit the infection. […] By virtue of the nature of the practice of dentistry where intrinsically, a high volume of aerosols are produced, as well as the close proximity of dentists and patients during treatment, dentists and allied health staff are considered the highest risk health professional group for acquiring SARS-CoV-2 during patient management. […] Therefore, several organizations and specialty associations have proposed guidelines and recommendations for limiting the transmission of SARS-COV-2 from carriers to dentists and vice versa. […] This paper aims to provide a review of these guidelines, and concludes with a brief look at how the practice of dentistry may be impacted by COVID-19, in the post-pandemic era.
32428957 Up to February 24th 2020 occasionally occuring SARS-CoV-2 infections in Germany without severe course. […] Emergency presentation of a couple in the emergency room. […] For seven days now, the man has fever, dry cough und physical weakness and the wife has similar symptoms of a milder form. […] The clinical examination shows fine crackles over both lungs and a respiratory failure of the husband. […] Further on diagnosis of a SARS-CoV-2-infection of both patients with a severe course of the male. […] Intubation and mechanical ventilation of the male patient with prolonged intenive care treatment. […] Recovery of the female patient under conventional oxygen therapy. […] These two cases show the starting point of an endemic spread of SARS-CoV-2 in the district of Heinsberg (North Rhine-Westphalia) and up to this point the first case of a life-threatenning course in Germany. […] Genesung der weiblichen Patientin unter Sauerstofftherapie.
32429004 Organ donation has been suspended for almost 3 months in Wuhan due to COVID-19 outbreak. […] Donation and transplantation were performed on 8th April, the very day Wuhan lifted its lockdown. […] Two weeks after donation, COVID-19 screenings of the liver recipient and medical staffs present negative.
32436994 Current evidence suggests an important role of interleukin-6 (IL-6) pathway in SARS-CoV-2-related cytokine release storm in severely ill COVID-19 patients. […] Inhibition of the IL-6 pathway with tocilizumab has been employed successfully in some of these patients but the data is mostly consistent of case reports and series. […] We performed a systematic search of PubMed, Embase, and Medline from 22nd April 2020 and again on 27th April 2020 using the following search terms alone or in combination: “COVID-19”, “coronavirus”, “SARS-CoV-2”, “COVID”, “anti-interleukin 6 receptor antibodies”, “anti-IL-6”, “tocilizumab”, “sarilumab”, “siltuximab”. […] Secondary endpoints included in-hospital complications, recovery rates, effect of patient characteristics on the primary outcome and changes in levels of inflammatory markers. 352 records were identified through the systematic search of which 10 studies met the inclusion criteria. […] Eleven observational studies encompassing 29 patients were included in the present review. […] There were more males (24 [82.8%]) and hypertension was the most common comorbidity (16 [48.3 %]). […] Over an average of 5.4 hospital days, the primary endpoint occurred in 6 (20.7%) patients. […] The most common complication was acute respiratory distress syndrome (8[27.6%]). […] IL-6 level was significantly higher after the initiation of tocilizumab with median (IQR) of 376.6 (148-900.6) pg/mL compared to the baseline of 71.1 (31.9-122.8) pg/mL (p=0.002). […] In COVID-19 patients treated with tocilizumab, IL-6 levels are significantly elevated which are supportive of cytokine storm. […] Following initiation of tocilizumab, there is elevation in the IL-6 levels and CRP levels dramatically decrease suggesting an improvement in this hyper-inflammatory state. […] Ongoing randomized control trials will allow for further evaluation of this promising therapy. […] Recent data indicate that severe COVID 19 causes cytokine release storm and is associated with worse clinical outcomes and IL-6 plays an important role. […] It is suggestive that anti-IL6 results in the improvement of this hyperinflammatory state. […] However, to our knowledge, there is no individual patient data systematic review performed to summarize baseline characteristics and clinical outcomes of COVID 19 patients who received tocilizumab. […] This article is protected by copyright.
32436998 On 11 February 2020, the World Health Organization officially names the disease as COVID-19.1 The new coronavirus is highly contagious. […] The rapid spread of SARS-CoV-2 lead to declare the pandemic on the 11th March 2020. […] On 10 May 2020 the number of infected people is 4,132,373 worldwide.2 This article is protected by copyright.
32437052 The new coronavirus (COVID-19) infection reported by China in December 2019 has become a pandemic affecting the entire world in a few weeks. […] In this respect, it is crucial to determine case increase and case fatality and case recovery rates in order to control COVID-19. […] In this study, case increase, case fatality and case recovery rates of COVID-19 in 36 European countries were analyzed with meta-analysis method using data released by the health organizations and WHO. […] The data were obtained from the website of health organizations of 36 European countries and the website of WHO until the date of May 11, 2020. […] The analyses were carried out on 1,744,704 COVID-19 diagnosed cases in 36 European countries. […] The case increase and case fatality and case recovery rates of COVID-19 were calculated using 95% confidence intervals (95% CI), single-arm meta-analysis, cross-temporal meta-analysis and meta-regression random effects model. […] The standardized case increase rate of COVID-19 is 5% (95% CI [0.040, 0.063]) and the average case increase rate in European countries has started to decline by around 3% (95% CI [0.047, 0.083]) weekly. […] The countries with the highest rate of case increase are Belgium, Sweden, Russia, the Netherlands and the UK. […] Although the case fatality rate of COVID-19 patients was 4.5% as of May 11 (95% CI [0.037-0.055]), this rate is 6.3% (95% CI [0.047, 0.083]) in standardized time (6th week). […] This research presents important results regarding the COVID-19 pandemic in Europe. […] Although the rate of increase in new COVID-19 cases has dropped, there is not much decline in case fatality rates and no increase in case recovery rates. […] The case fatality rate of COVID-19 in Europe was estimated to be in the range of 4-4.5% and minimum 4 weeks (As of May 11) are expected in order to have the figure below 1% in the country with an average case increase rate. […] Monitoring case fatality in Belgium, the Netherlands and Sweden, and treatment successes in Germany and Austria play an utmost importance. […] This article is protected by copyright.
32437770 Unfortunately, there is lack of evidence about the optimal management of novel coronavirus disease 2019 (COVID-19), even less in patients on maintenance hemodialysis (MHD) therapy than in the general population. […] In this retrospective observational single-center study we analyzed the clinical course and outcomes of all MHD patients hospitalized with COVID-19 from March 12th to April 10th, 2020 as confirmed by real time polymerase chain reaction. […] Baseline features, clinical course, laboratory data, and different therapies were compared between survivors and non-survivors to identify risk factors associated with mortality. […] Among the 36 patients, 11 (30.5%) died and 7 could be discharged within the observation period. […] Clinical and radiological evolution during the first week of admission were predictive of mortality. […] Among the 36 patients, 18 had worsening of their clinical status, as defined by severe hypoxia with oxygen therapy requirements greater than 4 Liters/minute and radiological worsening. […] Significantly 11 out of those 18 patients (61.1%) died. […] None of the classical cardiovascular risk factors in the general population were associated with higher mortality. […] However, a longer time on hemodialysis (hazard ratio 1.008(95% confidence interval 1.001-1.015) per year), increased LDH levels (1.006(1.001-1.011), and lower lymphocyte count (0.996 (0.992-1.000) one week after clinical onset were all significantly associated with higher mortality risk. […] Thus, the mortality among hospitalized hemodialysis patients diagnosed with COVID-19 is high. […] Lymphopenia and increased LDH levels were associated with poor prognosis.
32437915 COVID-19 pandemic has the potential to significantly affect the mental health of healthcare workers (HCWs), who stand in the frontline of this crisis. […] It is, therefore, an immediate priority to monitor rates of mood, sleep and other mental health issues in order to understand mediating factors and inform tailored interventions. […] The aim of this review is to synthesize and analyze existing evidence on the prevalence of depression, anxiety and insomnia among HCWs during the Covid-19 outbreak. […] A systematic search of literature databases was conducted up to April 17th, 2020. […] Risk of bias for each individual study was assessed and data pooled using random-effects meta-analyses to estimate the prevalence of specific mental health problems. […] The review protocol is registered in PROSPERO and is available online. […] Findings Thirteen studies were included in the analysis with a combined total of 33062 participants. […] Anxiety was assessed in 12 studies, with a pooled prevalence of 23·2% and depression in 10 studies, with a prevalence rate of 22·8%. […] A subgroup analysis revealed gender and occupational differences with female HCPs and nurses exhibiting higher rates of affective symptoms compared to male and medical staff respectively. […] Interpretation Early evidence suggests that a considerable proportion of HCWs experience mood and sleep disturbances during this outbreak, stressing the need to establish ways to mitigate mental health risks and adjust interventions under pandemic conditions.
32441332 The aim of this study is to report our clinical experience in the management of pregnant women infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) during the first thirty days of the Coronavirus disease (COVID-19) pandemic. […] We reviewed clinical data from the first 60 pregnant women with COVID-19 whose care was managed at Puerta de Hierro University Hospital, Madrid, Spain from March 14th to April 14th , 2020. […] An analysis of variance (Kruskal-Wallis test) was performed to compare the medians of laboratory parameters. […] A total of 60 pregnant women were diagnosed with COVID-19. […] The most common symptoms were fever and cough (75.5%, each) followed by dyspnea (37.8%). […] No renal or cardiac failures or maternal deaths were reported. […] Lymphopenia (50%), thrombocytopenia (25%), and elevated C-reactive protein (CRP) (59%) were observed in the early stages of the disease. […] Median CRP, D-dimer and the neutrophil/lymphocyte ratio were elevated. […] High CRP and D-dimer levels were the parameters most frequently associated with severe pneumonia. […] The Neutrophil/lymphocyte ratio was found to be the most sensitive marker for disease improvement (relative risk: 6.65; 95% CI: 4.1-5.9). […] During the study period, 18 of the women (78%) delivered vaginally. […] All newborns tested negative for SARS-CoV-2 and none of them were infected during breastfeeding. […] Most of the pregnant COVID-19 positive patients had a favorable clinical course. […] However, one-third of them developed pneumonia, of whom 5% presented a critical clinical status. […] CRP and D-dimer levels positively correlated with severe pneumonia and the neutrophil/lymphocyte ratio decreased as the patients improved clinically. […] No vertical or horizontal transmissions were diagnosed in the neonates during labor or breastfeeding.
32441830 The outbreak of COVID-19 has stricken more than 203,000 people in Italy up to 30th of April 2020, with over 27,000 died according to official estimates1 . […] While Italy was one of the most affected countries in Europe, the impact of the disease in the southern part of the state was less dramatic than in the north, due to some still not understood reasons. […] Particularly in Sicily, ‘only’ 3,140 cases have been recorded, of whom 533 encountered in the province of Messina.
32445608 On 21st December 2019 the first cluster of patients with ‘pneumonia of an unknown cause’, which was subsequently identified as a coronavirus or ‘Covid-19’, were identified in Wuhan, China. […] As we now know the virus spread rapidly around the globe and on March 11th the World Health Organization (WHO) declared the virus a pandemic (BFPG, 2020). […] As we write, 201,315 deaths have been attributed to the virus internationally and there have been 2,844,712 confirmed cases (ECDC, 2020).
32447059 In Ontario, on March 16th, 2020, a directive was issued to all acute care hospitals to halt non-essential procedures in anticipation for a potential surge in COVID-19 patients. […] This included scheduled outpatient cardiac surgical and interventional procedures that required the use of intensive care units, ventilators, and skilled critical care personnel, given that these procedures would draw from the same pool of resources required for critically ill COVID-19 patients. […] We adapted the COVID-19 Resource Estimator (CORE) decision analytic model by adding a cardiac component to determine the impact of various policy decisions on the incremental waitlist growth and estimated waitlist mortality for three key groups of cardiovascular disease patients; coronary artery disease, valvular heart disease, and arrhythmias. […] First, in the initial crisis phase, in a worst case scenario, we showed that the potential number of waitlist related cardiac deaths would be orders of magnitude less than those who would die of COVID-19 if critical cardiac care resources were diverted to the care of COVID-19 patients. […] Second, with better local epidemiology data, we predicted that across five regions of Ontario, there may be insufficient resources to resume all elective outpatient cardiac procedures. […] Finally in the recovery phase, we showed that the estimated incremental growth in waitlist for all cardiac procedures is likely substantial. […] These outputs informed timely, data-driven decisions during the COVID-19 pandemic regarding the provision of cardiovascular care.
32448345 Coronavirus disease 2019 (COVID-19), caused by a novel corinavirus (later named SARS-CoV-2 virus), was fistly reported in Wuhan, Hubei Province, China towards the end of 2019. […] Large-scale spread within China and internationally led the World Health Organization to declare a Public Health Emergency of International Concern on 30th January 2020. […] The clinical manifestations of COVID-19 virus infection include asymptomatic infection, mild upper respiratory symptoms, severe viral pneumonia with respiratory failure, and even death. […] There are no antivirals of proven clinical efficacy in coronavirus infections. […] Remdesivir (GS-5734), a nucleoside analogue, has inhibitory effects on animal and human highly pathogenic coronaviruses, including MERS-CoV and SARS-CoV, in in vitro and in vivo experiments. […] It is also inhibitory against the COVID-19 virus in vitro. […] The aim of this study is to assess the efficacy and safety of remdesivir in adult patients with severe COVID-19. […] The protocol is prepared in accordance with the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. […] This is a phase 3, randomized, double-blind, placebo-controlled, multicentre trial. […] Adults (≥ 18 years) with laboratory-confirmed COVID-19 virus infection, severe pneumonia signs or symptoms, and radiologically confirmed severe pneumonia are randomly assigned in a 2:1 ratio to intravenously administered remdesivir or placebo for 10 days. […] The primary endpoint is time to clinical improvement (censored at day 28), defined as the time (in days) from randomization of study treatment (remdesivir or placebo) until a decline of two categories on a six-category ordinal scale of clinical status (1 = discharged; 6 = death) or live discharge from hospital. […] One interim analysis for efficacy and futility will be conducted once half of the total number of events required has been observed. […] This is the first randomized, placebo-controlled trial in COVID-19. […] Enrolment began in sites in Wuhan, Hubei Province, China on 6th February 2020.
32449272 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is rapidly spreading worldwide, and the WHO declared its pandemic nature on 11th March 20201 . […] The outbreak has hit Europe and, as of April 19, 2020, Italy has the third largest number of confirmed cases, namely a total of 175,925 cases and 23,227 deaths according to the John Hopkins University2 . […] This is the largest health and economic emergency of our country since the post-war period, and many hospitals are now dedicated exclusively to COVID-19 assistance. […] Our University Hub Stroke Unit of Cattinara Hospital is in the northeaster Italian region of Friuli Venezia Giulia which enlisted 2,731 cases and 222 deaths at the time of writing3 .
32454187 Currently, numerous trials testing potential treatment and preventative options are undertaken all over the world. […] Additionally, we evaluated the quality of the retrieved studies. […], the Chinese Clinical Trial Registry and the European Union Clinical Trials Register were systematically searched. […] We excluded withdrawn or cancelled studies and trials not reporting therapeutic or preventative strategies for COVID-19. and interventions: No restrictions in terms of participants’ age and medical background or type of intervention were enforced. […] The registries were searched using the term “coronavirus” or “COVID-19” from their inception until 26th March 2020. […] Additional manual search of the registries was also performed. […] Interventional trials were methodologically analysed, excluding expanded access studies and trials testing Traditional Chinese Medicine. […] In total, 309 trials evaluating therapeutic management options, 23 studies assessing preventive strategies and 3 studies examining both were retrieved. […] Finally, 214 studies were methodologically reviewed. […] Interventional treatment studies were mostly randomised (n=150, 76%) and open-label (n=73, 37%) with a median number of planned inclusions of 90 (IQR 40-200). […] Major categories of interventions that are currently being investigated are discussed. […] Numerous clinical trials have been registered since the onset of the COVID-19 pandemic. […] Summarised data on these trials will assist physicians and researchers to promote patient care and guide future research efforts for COVID-19 pandemic containment.
32455471 The COVID-19 pandemic is impacting all urological cancer services. […] On March 19th the British Association of Urological Surgeons (BAUS) provided pragmatic guidance for prostate cancer diagnostic services (Table 1).(
32458760 The recently emerged novel coronavirus, “severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)”, caused a highly contagious disease called coronavirus disease 2019 (COVID-19). […] The virus was first reported from Wuhan city in China in December, 2019, which in less than three months spread throughout the globe and was declared a global pandemic by the World Health Organization (WHO) on 11th of March, 2020. […] So far, the ongoing pandemic severely damaged the world’s most developed countries and is becoming a major threat for low- and middle-income countries. […] The poorest continent, Africa with the most vulnerable populations to infectious diseases, is predicted to be significantly affected by the ongoing COVID-19 outbreak. […] Therefore, in this review we collected and summarised the currently available literature on the epidemiology, etiology, vulnerability, preparedness and economic impact of COVID-19 in Africa, which could be useful and provide necessary information on ongoing COVID-19 pandemics in the continent. […] We also briefly summarised the concomitance of the COVID-19 pandemic and global warming.
32460378 Coronavirus disease 19 (Covid-19) was declared a pandemic by the World Health Organization on March 11th , 2020 ( […] As of May 19th , 2020, approximately 4,731,458 cases of contamination and 316,169 deaths from Covid-19 were recorded (
32460385 An exponential diffusion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prompted Italian Institutions to take extraordinary healthcare restrictive measures since 8th March 2020, declaring quarantine for COVID-19 (1).
32461415 To describe the experience of tele-consultations addressed at the centre of excellence of a multi-tier ophthalmology hospital network in India during the ongoing novel coronavirus (COVID-19) lockdown. […] This cross-sectional hospital-based study included 7,008 tele-consultations presenting between March 23rd and April 19th 2020. […] A three-level protocol was implemented to triage the calls. […] The data of patient queries were collected using a Google Form/Sheets and the tele-calls were returned using the patient information retrieved from the electronic medical record system. […] The most common queries were related to redness/pain/watering/blurring of vision (31.52%), closely followed by usage of medications (31.05%). […] The majority of the queries were directed to the department of cornea (34.15%), followed by retina (24.74%). […] Less than one-fifth of the patients were from the lower socio-economic class (16.08%) and one-fourth were new patients (23.96%). […] The most common advice given to the patient was related to management of medications (54.15%) followed by appointment related (17.79%). […] Emergency requests requiring further evaluation by an ophthalmologist accounted for a small percentage (16.36%) of patients. […] Tracking of tele-consultations and access to patient information from the electronic medical records enabled a timely response in an ongoing lockdown due to the COVID-19 pandemic. […] The current experience provided valuable insights to the possibility of managing patient follow-up visits remotely in the future.
32463935 What a better time to address nurses as heroes and political activists than on this, the 200th birthday of Florence Nightingale and in the year of the nurse and midwife? […] Who better to serve as the model for what nurses must be - guardians and advocates of patients’ welfare? […] Nurses’ experiences during COVID-19, visibly documented during nightly news broadcasts, have raised the public’s awareness of what nurses do on a daily basis. […] Such awareness has resulted in the public labelling nurses as heroes. […] In other words, the public recognizes nurses for their courage, bravery, commitment, knowledge, resilience, advocacy, and persistence in the face of incredible adversity. […] Consequently, the public now has a better idea of nurses’ work. […] However, it is important to acknowledge nurses’ work has not changed; rather it is public perception that has changed.
32467007 Because treatment options for coronavirus disease 2019 (COVID-19) are very limited, the use of convalescent plasma has bee explored. […] A male centenarian with cough and dyspnea for 2 months was diagnosed with COVID-19. […] Without effective treatments and with the increased risks of antiviral therapy for the elderly, this patient was given convalescent plasma. […] The viral load, complete blood count, inflammatory indicators, vital signs, and clinical symptoms were observed before and after COVID-19 convalescent plasma transfusion. […] After convalescent plasma transfusion, significant improvement was observed on laboratory indicators and clinical symptoms of the patient. […] Concurrently, SARS-CoV-2 viral load decreased sharply after the first transfusion (from 2.55 × 104 to 1.39 × 103 copies/mL) and became undetectable after the second transfusion. […] With the substantial increase of COVID-19 in recent months,treatment for elderly patients has become restricted in some countries. […] The successful treatment of this 100-year-old patient using convalescent plasma suggests that we should consider adding convalescent plasma in th management of the elderly.
32470186 Mortality is high among severe patients with 2019 novel coronavirus-infected disease (COVID-19). […] We retrospectively collected patients with COVID-19 in two hospital of Chongqing from January 1st to February 29th , 2020. […] At admission, we collected the demographics and laboratory tests to predict whether the patient would progress to severe cases in hospitalization. […] Severe case was confirmed when one of the following criteria occurred: 1) dyspnea, respiratory rate ≥30 breaths/min, 2) blood oxygen saturation ≤93%, and 3) PaO2 /FiO2 ≤300 mmHg. […] At admission, 348 mild cases were enrolled in this study. […] Of them, 20 (5.7%) patients progressed to severe cases after median 4.0 days (IQR: 2.3-6.0). […] In addition, higher C-reactive protein was associated with shorter time to progress to severe cases (r =-0.62). […] Several easily obtained variables at admission are associated with progression to severe cases during hospitalization. […] These variables provide a reference for the medical staffs when they manage the COVID-19 patients. […] This article is protected by copyright.
32471001 The SARS-Cov-2 infection disease (COVID-19) pandemic has posed at risk the kidney transplant (KT) population, particularly the elderly recipients. […] From March-12th until April-4th 2020, we diagnosed COVID-19 in 16 of our 324 KT patients aged ≥65 years old (4.9%). […] Many of them had had contact with healthcare facilities in the month prior to infection. […] All presented with fever and all but one with pneumonia. […] At infection diagnosis, mTOR inhibitors or mycophenolate were withdrawn. […] Tacrolimus was withdrawn in 70%. […] The main treatment combination was hydroxychloroquine and azithromycin. […] A subset of patients was treated with anti-retroviral and tocilizumab. […] Those who died were more frequently obese, frail and had underlying heart disease. […] Although a higher respiratory rate was observed at admission in nonsurvivors, symptoms at presentation were similar between both groups. […] Patients who died were more anemic, lymphopenic and showed higher D-dimer, C-reactive protein, and IL-6 at their first tests. […] COVID-19 is frequent among the elderly KT population and associates a very early and high mortality rate.
32473074 Since January 11th , when the first 40 cases of infection by SARS-Cov-2 (COVID-19 disease) were communicated from Wuhan, in the Chinese province of Hubei, about 4.5 million confirmed cases have been reported worldwide. […] During this three-month period, 80,000 new cases and 11,000 deaths were registered daily. […] Spain holds the sad privilege of leading the European raking of confirmed cases (>228,000) and deaths (>27,000) with no consensus on the actual figures.
32473182 We assessed the economic impact of such policies on dental practices in Germany using a modelling approach. […] A provider’s perspective within German healthcare was taken, with two provider scenarios (low/high volume practice, low/high proportion of non-statutory insurance revenue, low/high staff pool and costs; S1 and S2 scenarios) being modelled. […] Providers’ costs were estimated in different blocks (staff, material, laboratory, others). […] A telephone-based survey was conducted on 24th March to 2nd April 2020 on a random sample of 300 German dentists (response: n = 146) to determine the experienced dental services utilization changes in these service blocks. […] Mitigation/suppression reduced utilization of all services, the most severe for prevention (-80% in mean), periodontics (-76%) and prosthetics (-70%). […] Within the base-case, mean revenue reductions were 18.7%/15.7% from the public insurance, 18.7/18.6% from private insurers and 19%/19% for out-of-pocket expenses in S1/S2, respectively. […] If the mitigation/suppression was upheld for 135 days, overall revenue decreased by 31%/30% in S1/S2, respectively. […] In this case, 29%/12% S1/S2 would have a negative net profit over the course of one year. […] Policy makers will want to consider this when designing governmental subsidy and safety nets with immediate and midterm economic relieve effects.
32473197 The COVID-19 pandemic forced surgeons to reconsider concepts of “elective” surgery. […] Perceptions regarding the time-sensitivity and medical necessity of a procedure have taken on greater significance during the pandemic. […] The evolving ethical and clinical environment requires reappraisal of perioperative factors such as personal protective equipment conservation; limiting the risk of exposure to COVID-19 for patients, families, and health care workers; preservation of hospital beds and intensive care unit resources; and minimizing COVID-19 related perioperative risk to patients. […] A scaffold for the complex decision-making required for prioritization of Medically Necessary, Time Sensitive (MeNTS) surgeries was developed for adult patients by colleagues at The University of Chicagoi. […] Although adult MeNTS scoring can be applied across adult surgical specialties, some variables were irrelevant in a pediatric population. […] In order to account for the unique challenges children face, we modified the adult MeNTS system for use across pediatric subspecialties. […] This Pediatric MeNTS (pMeNTS) scoring system was applied to 101 cases both performed and deferred between March 23rd and April 19th, 2020, at The University of Chicago Comer Children’s Hospital. […] The pMeNTS scores provides a safe, equitable, transparent, and ethical strategy to prioritize children’s surgical procedures. […] This process is adaptable to individual institutions, and we project it will be useful during the acute phase of the pandemic (maximal limitations) as well as the anticipated recovery phase.
32478500 Pandemics such as influenza, smallpox, and plague have caused the loss of hundreds of millions of lives and have occurred for many centuries. […] Fortunately, they have been largely eliminated by the use of vaccinations and drugs. […] More recently, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and now Coronavirus Disease 2019 (COVID-19) have arisen, and given the current absence of highly effective approved vaccines or drugs, brute-force approaches involving physical barriers are being used to counter virus spread. […] A major basis for physical protection from respiratory infections is eye, nose, and mouth protection. […] However, eye protection with goggles is problematic due to “fogging”, while nose/mouth protection is complicated by the breathing difficulties associated with non-valved respirators. […] Here, we give a brief review of the origins and development of face masks and eye protection to counter respiratory infections on the basis of experiments conducted 100 years ago, work that was presaged by the first use of personal protective equipment, “PPE”, by the plague doctors of the 17th Century. […] The results of the review lead to two conclusions: first, that eye protection using filtered eye masks be used to prevent ocular transmission; second, that new, pre-filtered, valved respirators be used to even more effectively block viral transmission.
32478951 To examine the impact of COVID-19 on acute heart failure (AHF) hospitalization rates, clinical characteristics and management of patients admitted to a tertiary Heart Failure Unit in London during the peak of the pandemic. […] Data from King’s College Hospital, London, reported to the National Heart Failure Audit for England and Wales, between 2nd March - 19th April 2020 were compared both to a pre-COVID cohort and the corresponding time periods in 2017-2019 with respect to absolute hospitalization rates. […] Furthermore, we performed detailed comparison of patients hospitalized during the COVID-19 pandemic and patients presenting in the same period in 2019 with respect to clinical characteristics and management during the index admission. […] A significantly lower admission rate for AHF was observed during the study period compared to all other included time periods. […] Patients admitted during the COVID-19 pandemic had higher rates of NYHA III or IV symptoms (96% vs. 77%, p=0.03) and severe peripheral oedema (39% vs. 14%, p=0.01). […] We did not observe any differences in inpatient management, including place of care and pharmacological management of heart failure with reduced ejection fraction (HFrEF) CONCLUSION: Incident AHF hospitalization significantly declined in our centre during the COVID-19 pandemic, but hospitalized patients had more severe symptoms at admission. […] Further studies are needed to investigate whether the incidence of AHF declined or patients did not present to hospital while the national lockdown and social distancing restrictions were in place. […] From a public health perspective, it is imperative to ascertain whether this will be associated with worse long-term outcomes. […] This article is protected by copyright.
32483428 On the 30th 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.
32489022 In the previous research, our laboratory established a mouse model combining disease with syndrome of human coronavi-rus pneumonia with pestilence attacking the lung syndrome, based on the national traditional Chinese medicine clinical classification of Novel Coronavirus Infected Pneumonia Diagnosis and Treatment Plan. […] In this study, a mouse model combining disease with syndrome of human coronavirus pneumonia with pestilence attacking the lung syndrome was used to evaluate the effectiveness of Reyanning Mixture to provide animal experimental support for clinical application. […] Mice were divided into normal group, 229 E infection group, cold-dampness group, cold-dampness+229 E infection group(the model group), Reyanning high and low dose groups. […] The cold-dampness group, cold-dampness+229 E infection group, two Reyanning groups were given cold and damp stimulation for 7 days. […] On the 5 th day, the 229 E infection group, cold-dampness+229 E infection group, and two Reyanning groups were infected with HCoV-229 E virus. […] Reyanning was administered for 3 days, starting from the day of infection. […] Blood was collected on the 4 th day and the lung tissue was dissected to calculate the lung index and inhibition rate; flow cytometry was used to detect the percentage of T and B lymphocytes in peripheral blood; RT-PCR was used to detect the nucleic acid virus load in lung tissue; ELISA was used to detect motilin and gastrin in serum, and inflammatory factors TNF-α, IFN-γ, IL-6, IL-10 in lung tissue proteins. […] Reyanning Mixture could reduce the lung index(P<0.01) of coronavirus pneumonia mice with pestilence attacking the lung; it could significantly increase the percentage of CD8~+ T lymphocytes and CD4~+ T lymphocytes in peripheral blood of model mice(P<0.05, P<0.01). […] The low dose of Reyanning could effectively increase the percentage of total B lymphocytes(P<0.05), reduce virus load in lung tissue of model mice(P<0.01), reduce the levels of TNF-α, IFN-γ, IL-6, IL-10 in the lung tissue of model mice(P<0.01), reduce the content of motilin in the serum of model mice(P<0.01). […] Reyanning Mixture convey a better effect in treating coronavirus pneumonia mice with pestilence attacking the lung. […] It manifested obvious effects in improving lung lesions, enhancing the gastrointestinal function of mice, improving the autoimmune function of mice, and reducing the expression of inflammatory factors in vivo, which could provide evidences for clinical research.
32490552 The Editor in chief and Deputy Editors of the JAMA recently shared their concern regarding possible reporting of patients in more than one manuscript, while this has not been clearly indicated in the submission [1]. […] Although the unprecedented context of the COVID-19 outbreak justifies efforts for rapid dissemination of knowledge, such practice may be responsible for inaccurate interpretation and overestimation of published data [1]. […] In Spain, the national COVID Piel study have reported 372 patients with skin manifestations related with COVID-19, including 71 patients with pseudo-chilblains, from April 3rd to April 16th [2].
32492533 The outbreak of Coronavirus Disease 2019 (COVID-19) has become a global public health emergency. 204 elderly patients (≥60 years old) diagnosed with COVID-19 in Renmin Hospital of Wuhan University from January 31st to February 20th, 2020 were included in this study. […] Clinical endpoint was in-hospital death. […] Of the 204 patients, hypertension, diabetes, cardiovascular disease, and chronic obstructive pulmonary disease (COPD) were the most common coexisting conditions. 76 patients died in the hospital. […] Multivariate analysis showed that dyspnea (hazards ratio (HR) 2.2, 95% confidence interval (CI) 1.414 to 3.517;p < 0.001), older age (HR 1.1, 95% CI 1.070 to 1.123; p < 0.001), neutrophilia (HR 4.4, 95% CI 1.310 to 15.061; p = 0.017) and elevated ultrasensitive cardiac troponin I (HR 3.9, 95% CI 1.471 to 10.433; p = 0.006) were independently associated with death. […] Although so far the overall mortality of COVID-19 is relatively low, the mortality of elderly patients is much higher. […] Early diagnosis and supportive care are of great importance for the elderly patients of COVID-19.
32493174 Our personal views about the challenges of continuing to deliver peer teaching during a pandemic. […] We are a group of 4th year medical students who are part of a student society which has delivered structured, highly formulaic peer-led teaching sessions for the past three years. […] During the COVID-19 pandemic, the reduced access to our normal clinical teaching highlighted the importance of peer-led teaching sessions. […] We wanted to continue with our peer-taught sessions but knew we would have to devise a new format to make our teaching accessible to our peers wherever they were. […] Here, we describe the challenges of online peer teaching during the COVID-19 pandemic and our reflections of the future implications to our group.
32493441 The purpose of this study is to test the safety and effectiveness of individually or simultaneously blocking IL-6, IL-6 receptor and IL-1 versus standard of care on blood oxygenation and systemic cytokine release syndrome in patients with COVID-19 coronavirus infection and acute hypoxic respiratory failure and systemic cytokine release syndrome. […] Subjects will be recruited at the specialized COVID-19 wards and/or ICUs at 16 Belgian participating hospitals. […] Only adult (≥18y old) patients will be recruited with recent (≤16 days) COVID-19 infection and acute hypoxia (defined as PaO2/FiO2 below 350mmHg or PaO2/FiO2 below 280 on supplemental oxygen and immediately requiring high flow oxygen device or mechanical ventilation) and signs of systemic cytokine release syndrome characterized by high serum ferritin, or high D-dimers, or high LDH or deep lymphopenia or a combination of those, who have not been on mechanical ventilation for more than 24 hours before randomisation. […] Patients should have had a chest X-ray and/or CT scan showing bilateral infiltrates within the last 2 days before randomisation. […] Patients with active bacterial or fungal infection will be excluded. […] The experimental arms consist of Anakinra alone (anti-IL-1 binding the IL-1 receptor), Siltuximab alone (anti-IL-6 chimeric antibody), a combination of Siltuximab and Anakinra, Tocilizumab alone (humanised anti-IL-6 receptor antibody) or a combination of Anakinra with Tocilizumab in addition to standard care. […] Patients treated with Anakinra will receive a daily subcutaneous injection of 100mg for a maximum of 28 days or until hospital discharge, whichever comes first. […] Siltuximab (11mg/kg) or Tocilizumab (8mg/kg, with a maximum dose of 800mg) are administered as a single intravenous injection immediately after randomization. […] The primary end point is the time to clinical improvement defined as the time from randomization to either an improvement of two points on a six-category ordinal scale measured daily till day 28 or discharge from the hospital or death. […] This ordinal scale is composed of (1) Death; (2) Hospitalized, on invasive mechanical ventilation or ECMO; (3) Hospitalized, on non-invasive ventilation or high flow oxygen devices; (4) Hospitalized, requiring supplemental oxygen; (5) Hospitalized, not requiring supplemental oxygen; (6) Not hospitalized. […] A 2x2 factorial design was selected with a 2:1 randomization regarding the IL-1 blockade (Anakinra) and a 1:2 randomization regarding the IL-6 blockade (Siltuximab and Tocilizumab). […] In this open-label trial neither participants, caregivers, nor those assessing the outcomes are blinded to group assignment. […] Participant recruitment is ongoing and started on April 4th 2020. […] Given the current decline of the COVID-19 pandemic in Belgium, it is difficult to anticipate the rate of participant recruitment. […] The trial was registered on Clinical on April 1st, 2020 ( Identifier: NCT04330638) and on EudraCT on April 3rd 2020 (Identifier: 2020-001500-41). […] The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
32493460 Entertainment-education (E-E) media can improve behavioral intent toward health-related practices. […] In the era of COVID-19, millions of people can be reached by E-E media without requiring any physical contact. […] We have designed a short, wordless, animated video about COVID-19 hygiene practices-such as social distancing and frequent hand washing-that can be rapidly distributed through social media channels to a global audience. […] The E-E video’s effectiveness, however, remains unclear. […] The study aims to achieve the following objectives. […] Establish the CoVideo’s effectiveness in increasing behavioural intent toward COVID-19 hygiene.3. […] Establish the CoVideo’s effectiveness in improving COVID-19 hygiene knowledge. […] The present study is a multi-site, parallel group, randomized controlled trial (RCT) comparing the effectiveness of the CoVideo against an attention placebo control (APC) video or no video. […] The trial has an intervention arm (CoVideo), placebo arm (APC), and control arm (no video). […] Nested in each trial arm is a list experiment and questionnaire survey, with the following ordering. […] Arm 1: the CoVideo, list experiment, and questionnaire survey. […] Arm 2: the APC video, list experiment, questionnaire survey, and CoVideo. […] Arm 3: the list experiment, questionnaire survey, and CoVideo. […] The control group will receive a list of five items and the treatment group will receive the same five items plus one item about COVID-19 hygiene. […] We will use the list experiment to reduce response bias associated with socially desirable answers to COVID-19 questions. […] The questionnaire survey will include items about the participant’s age, sex, country of residence, highest education, and knowledge of COVID-19 spread. […] After completing the list experiment and questionnaire survey, participants in Arms 2 and 3 will receive the CoVideo to ensure post-trial access to treatment. […] This will be an online study setting. […] We will use Prolific Academic (ProA: to recruit participants and host our study on the Gorilla™ platform ( […] To be eligible, participants must be between the age of 18 and 59 years (male, female, or other) and have current residence in the United States, the United Kingdom, Germany, Spain, Mexico, or France. […] Participants will be excluded from the study if they cannot speak English, German, French, or Spanish (since the instructions and survey questions will be available in these 4 languages only). […] The intervention is an E-E video about COVID-19 hygiene (CoVideo). […] Developed by our co-author (MA) for Stanford Medicine, the CoVideo is animated with sound effects, and has no words, speech, or text. […] The CoVideo shows how the novel coronavirus is spread (airborne, physical contact) and summarizes the public’s response to the COVID-19 outbreak. […] Key components of the CoVideo are the promotion of five hygiene practices: i) social distancing and avoiding group gatherings, ii) frequently washing hands with soap and water or sanitizer, iii) cleaning surfaces at home (e.g., kitchen counters), iv) not sharing eating utensils, and v) avoidance of stockpiling essential goods (such as toilet paper and face masks). […] The CoVideo, which was designed for universal reach and optimized for release on social media channels, can be viewed at […] The comparators are an APC video (Arm 2) or no video (Arm 3). […] The APC video is similar in style to the CoVideo; it is also animated with a duration of 2.30 minutes, has sound effects but no words, speech, or text. […] The video message is about how small choices become actions, which become habits, which become a way of life. […] Each list experiment will have a control list as the comparator. […] The control list is needed to measure the prevalence of behavioral intent toward COVID-19 hygiene. […] This study will measure primary and secondary outcomes related to COVID-19 hygiene. […] By hygiene, we mean the adoption of behaviors or practices that reduce the chances of being infected or spreading COVID-19. […] As a secondary outcome, we will measure knowledge about behaviors that can prevent the spread of COVID-19. […] Using a web-based randomization algorithm, Gorilla will randomly allocate participants to the intervention (CoVideo), placebo (APC), or control (no video) arm (sequence generation) at a 1:1:1 ratio. […] Within each trial arm, Gorilla will randomly allocate participants at a 1:1 ratio to the control or treatment group. […] Items in the lists will be randomly ordered to avoid order effects. […] The presentation order of the list experiments will also be randomized. […] Because ProA handles the interaction between the study investigators and participants, the participants will be completely anonymous to the study investigators. […] The outcome measures will be self-reported and submitted anonymously. […] All persons in the study team will be blinded to the group allocation. […] The Gorilla algorithm will randomize 6,700 participants to each trial arm, giving a total sample size of 20,100. […] The protocol version number is 1.0 and the date is 18 May 2020. […] Thus far, the study investigators have recruited 2,500 participants on ProA. […] Of these participants, 800 have completed the study on the Gorilla platform. […] The study and its outcomes were registered at the German Clinical Trials Register ( on May 12th, 2020, protocol number: #DRKS00021582. […] The study was registered before any data was collected. […] The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
32493468 We will investigate the effectiveness of Interferon Beta 1a, compared to Interferon Beta 1b and the usual therapeutic regimen in COVID-19 in patients that have tested positive and are moderately to severely ill. […] This is a single center, open label, randomized, controlled, parallel group, clinical trial that will be conducted at Loghman Hakim Medical Education Center in conjunction with Shahid Beheshti University of Medical Sciences. […] Sixty COVID-19 confirmed cases (using the RT-PCR test) will be enrolled in the trial between April 9th to April 14th 2020. […] Patients will be randomly assigned to the intervention groups or the control group with the following eligibility criteria: ≥ 18 years of age AND (oxygen saturation (SPO2) ≤ 93% OR respiratory rate ≥ 24) AND at least one of the following: Contactless infrared forehead thermometer temperature of ≥37.8, cough, sputum production, nasal discharge, myalgia, headache or fatigue on admission, and time of onset of the symptoms should be acute (Days ≤ 14). […] Although Hydroxychloroquine will be administered in a single dose, patients with heart problems (prolonged QT or PR intervals, second- or third-degree heart block, and arrhythmias including torsade de pointes) will be excluded. […] Other exclusion criteria include using drugs with potential interaction with Hydroxychloroquine + Lopinavir/Ritonavir, Interferon-β 1a, Interferon-β 1b, pregnant or lactating women, history of alcohol or drug addiction in the past 5 years, blood ALT/AST levels > 5 times the upper limit of normal on laboratory results and refusal to participate. […] This study will be undertaken at the Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences and Health Services. […] COVID-19 confirmed patients will be randomly assigned to one of three groups, with 20 patients in each. […] The first group (Arm 1) will receive Hydroxychloroquine + Lopinavir / Ritonavir (Kaletra) + Interferon-β 1a (Recigen), the second group (Arm 2) will be administered Hydroxychloroquine + Lopinavir / Ritonavir (Kaletra) + Interferon-β 1b (Ziferon), and the control group (Arm 3) will be treated by Hydroxychloroquine + Lopinavir / Ritonavir (Kaletra). […] This is an improvement of two points on a seven-category ordinal scale (recommended by the World Health Organization: Coronavirus disease (COVID-2019) R&D. […] Geneva: World Health Organization) or discharge from the hospital, whichever comes first. […] Secondary outcomes include mortality from the date of randomization until the last day of the study which will be the day all of the patients have had at least one of the following outcomes: 1) Improvement of two points on a seven-category ordinal scale. […] 2) Discharge from the hospital 3) Death. […] SpO2 Improvement between the last and first day of hospitalization, using pulse-oximetry. […] Duration of hospitalization from date of randomization until the date of hospital discharge or date of death from any cause, whichever comes first. […] Incidence of new mechanical ventilation uses from date of randomization until the last day of the study. […] Please note that we are trying to add further secondary outcomes and this section of the protocol is still evolving. […] We will use Kaplan-Meier to analyze the time to clinical improvement (compared with a log-rank test). […] Hazard ratios with 95% confidence intervals will be calculated using the Cox proportional-hazards model in crude and adjusted analysis. […] Eligible patients will be randomly assigned in a 1:1:1 ratio to receive either Interferon Beta 1a, Interferon Beta 1b or standard care only. […] Patients will be randomly allocated to three therapeutic arms using permuted, block-randomization to balance the number of patients allocated to each group. […] The permuted block (three or six patients per block) randomization sequence will be generated, using Package ‘randomizeR’ in R software version 3.6.1. and placed in individual sealed and opaque envelopes by the statistician. […] The investigator will enroll the patients and only then open envelopes to assign patients to the different treatment groups. […] This method of allocation concealment will result in minimum selection and confounding biases. […] The present research is open-label (no masking) of patients and health care professionals who are undertaking outcome assessment of the primary outcome - time to clinical improvement. […] Of the 60 patients who underwent randomization, 20 patients were assigned to receive Interferon beta-1a, 20 patients were assigned to receive Interferon beta 1b plus standard care and the rest of patients were assigned to receive the standard care alone. […] Recruitment is finished, the start date of recruitment was on 9th April 2020 and the end date was on 14th April 2020. […] Last point of data collection will be the last day on which all of the 60 participants have had an outcome of clinical improvement or death, completing the study’s follow-up time window. […] This study was registered with National Institutes of Health Clinical trials (; identification number NCT04343768, registered April 8, 2020 and first available online April 13, 2020). […] The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
32493473 The primary objective of the study is to assess the safety of a single intravenous infusion of Mesenchymal Stromal Cells (MSCs) in patients with Acute Respiratory Distress Syndrome (ARDS) due to COVID-19. […] Secondary objectives are to determine the effects of MSCs on important clinical outcomes, as described below. […] The study will be conducted in Intensive Care Units in hospitals across the United Kingdom. […] Patients with moderate to severe ARDS as defined by the Berlin definition, receiving invasive mechanical ventilation and with a diagnosis of COVID-19 based on clinical diagnosis or PCR test will be eligible. […] Patients will be excluded for the following reasons: more than 72 hours from the onset of ARDS; age < 16 years; patient known to be pregnant; major trauma in previous 5 days; presence of any active malignancy (other than non-melanoma skin cancer); WHO Class III or IV pulmonary hypertension; venous thromboembolism currently receiving anti-coagulation or within the past 3 months; patient receiving extracorporeal life support; severe chronic liver disease (Child-Pugh > 12); Do Not Attempt Resuscitation order in place; treatment withdrawal imminent within 24 hours; prisoners; declined consent; non-English speaking patients or those who do not adequately understand verbal or written information unless an interpreter is available; previously enrolled in the REALIST trial. […] The cellular product (REALIST ORBCEL-C) was developed and patented by Orbsen Therapeutics. […] The primary safety outcome is the incidence of serious adverse events. […] The primary efficacy outcome is Oxygenation Index (OI) at day 7. […] Secondary outcomes include: OI at days 4 and 14; respiratory compliance, driving pressure and PaO2/FiO2 ratio (PF ratio) at days 4, 7 and 14; Sequential Organ Failure Assessment (SOFA) score at days 4, 7 and 14; extubation and reintubation; ventilation free days at day 28; duration of mechanical ventilation; length of ICU and hospital stay; 28-day and 90-day mortality. […] After obtaining informed consent, patients will be randomised via a centralised automated 24-hour telephone or web-based randomisation system (CHaRT, Centre for Healthcare Randomised Trials, University of Aberdeen). […] The investigator, treating physician, other members of the site research team and participants will be blinded. […] The cell therapy facility and clinical trials pharmacist will be unblinded to facilitate intervention and placebo preparation. […] The unblinded individuals will keep the treatment information confidential. […] The infusion bag will be masked at the time of preparation and will be administered via a masked infusion set. […] A sample size of 60 patients with 30 patients randomised to the intervention and 30 to the control group. […] The total number of patients recruited will depend on the pandemic and be guided by the data monitoring and ethics committee (DMEC). […] REALIST Phase 1 completed in January 2020 prior to the COVID-19 pandemic. […] This was an open label dose escalation study of REALIST ORBCEL-C in patients with ARDS. […] The COVID-19 pandemic emerged as REALIST Phase 2 was planned to commence and the investigator team decided to repurpose the Phase 2 trial as a COVID-19 specific trial. […] This decision was discussed and approved by the Trial Steering Committee (TSC) and DMEC. […] Submissions were made to the Research Ethics Committee (REC) and MHRA to amend the protocol to a COVID-19 specific patient population and the protocol amendment was accepted by the REC on 27th March 2020 and MHRA on 30th March 2020 respectively. […] Other protocol changes in this amendment included an increase in the time of onset of ARDS from 48 to 72 hours, inclusion of clinical outcomes as secondary outcomes, the provision of an option for telephone consent, an indicative sample size and provision to continue recruitment beyond this indicative sample size. […] The current protocol in use is version 4.0 23.03.2020 (Additional file 1). […] Urgent Public Health status was awarded by the NIHR on 2 April 2020 and the trial opened to recruitment and recruited the first participant the same day. […] At the time of publication the trial was open to recruitment at 5 sites across the UK (Belfast Health and Social Care Trust, King’s College London, Guys and St Thomas’ Hospital London, Birmingham Heartlands Hospital and the Queen Elizabeth Hospital Birmingham) and 12 patients have been recruited across these sites. […] Additional sites are planned to open and appropriate approvals for these are being obtained. […] It is estimated recruitment will continue for 6 months. […] The full protocol (version 4.0 23.03.2020) is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. […] The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
32494567 In 2020 a significant threat to public health emerged. […] The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic outbreak emerged in December 2019 from Wuhan City, Hubei Province, China and spread to the rest of the world. […] This disease was named COVID-19 by World Health Organization. […] To date (17th April 2020) a total of 2,230,439 cases of COVID-19; 150,810 cases of deaths and 564,210 recovered cases have been reported worldwide. […] In this review the SARS-CoV-2 morphology, pathogenic mechanism, similarities and differences between SARS-CoV and Middle East Respiratory Syndrome and severe acute respiratory syndrome, transmission mode, diagnosis, treatment, and preventive measures were investigated. […] The outbreak of COVID-19 from a Malaysian perspective was explored and mental health care during the COVID-19 outbreak was explored. […] To date, there is no vaccine or no specific treatment for COVID-19. […] Therefore, preventive measures are very important to prevent and control the rapid spread of the SARS-CoV-2 virus.
32495574 In this paper, we analyzed medical records of 40 patients with coronavirus disease 2019(COVID-19), in order to explore the clinical efficacy of Matrine and Sodium Chloride Injection in the treatment of COVID-19. […] The investigation was based on the results of a previous animal test, which was aimed to investigate and confirme the clinical efficacy of Matrine and Sodium Chloride Injection in the treatment of COVID-19. […] The animal test demonstrated that Matrine and Sodium Chloride Injection has a significant therapeutic effect on the human coronavirus pneumonia for the model mice. […] The lung inhibition index reached up to 86.86%. […] The evaluation was conducted on 40 confirmed cases of COVID-19 treated at Jingzhou Hospital of Infectious Disease(Chest Hospital) of Hubei Pro-vince from January 30~(th) to March 21~(th), 2020. […] In these cases, patients were treated with other integrated Chinese and Western medicines regimens in the recommended Matrine and Sodium Chloride Injection diagnosis and treatment regimen. […] The clinical manifestations, laboratory data, nucleic acid clearance time, and imaging data were compared and analyzed before and after treatment. […] After administration with Matrine and Sodium Chloride Injection, the clinical symptoms of 40 cases were alleviated markedly, and their blood analysis and biochemical indexes returned to normal. […] The lung CT showed more than 50% of lesion absorption rate, and the viral nucleic acid test showed the average clearance time of patients was 16.6 days, and the average length of hospital stay was 25.9 days. […] After administration with Matrine and Sodium Chloride Injection, the symptoms of cough and fatigue were alleviated significantly, and the appetite was significantly improved compared with before, especially for patients with gastrointestinal symptoms. […] According to the chest CT for short-term review, the absorption of lung lesions was faster than before, especially for grid-like and fibrotic lesions. […] Compared with antiviral drugs, such as Abidol and Kriging, the nucleic acid clearance time was significantly shorter than the cases treated with Matrine and Sodium Chloride Injection. […] The clinical effective rate of 40 cases was 100.0%. […] We believed that Matrine and Sodium Chloride Injection have a good clinical effect in the treatment of COVID-19, and suggested increasing the clinical application and further conducting large-sample-size cli-nical verification.
32496247 The origin of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is still a debatable topic. […] The association of the virus spread from the market is supported by the close relation of genome sequences of environmental surface samples with virus samples from earliest patients by phylogenetic analysis. […] To have an insight into the SARS-CoV-2 genome sequences reported from India for better understanding on their epidemiology and virulence. […] Genome sequences of Indian isolates of SARS-CoV-2 were analyzed to understand their phylogeny and divergence with respect to other isolates reported from other countries. […] Amino acid sequences of individual open reading frames (ORFs) from SARS-CoV-2 Indian isolates were aligned with sequences of isolates reported from other countries to identify the mutations occurred in Indian isolates. […] Our analysis suggests that Indian SARS-CoV-2 isolates are closely related to isolates reported from other parts of the world. […] We found that most isolates reported from India have key mutations at 614th position of the S protein and 84th position of the ORF 8, which has been reported to be associated with high virulence and high transmission rate. […] An attempt was made to understand the SARS-CoV-2 virus reported from India. […] SARS-CoV-2 reported from India was closely similar to other SARS-CoV-2 reported from other parts of the world, which suggests that vaccines and other therapeutic methods generated from other countries might work well in India. […] In addition, available sequence data suggest that majority of Indian isolates are capable of high transmission and virulence.
32496252 India has reported more than 70,000 cases and 2000 deaths. […] Pune is the second city in the Maharashtra state after Mumbai to breach the 1000 cases. […] Total deaths reported from Pune were 158 with a mortality of 5.7%. […] To plan health services, it is important to learn lessons from early stage of the outbreak on course of the disease in a hospital setting. […] To describe the epidemiological characteristics of the outbreak of COVID-19 in India from a tertiary care hospital. […] This was a hospital-based cross-sectional study which included all admitted laboratory confirmed COVID19 cases from March 31, to April 24, 2020. […] The information was collected in a predesigned pro forma which included sociodemographic data, duration of stay, family background, outcome, etc., by trained staff after ethics approval. […] Out of the total 197 cases, majority cases were between the ages of 31-60 years with slight male preponderance. […] Majority of these cases were from the slums. […] Breathlessness was the main presenting symptom followed by fever and cough. […] More than 1/5th of patients were asymptomatic from exposure to admission. […] The case fatality rate among the admitted cases was 29.4%. […] Comorbidity was one of the significant risk factors for the progression of disease and death (odds ratio [OR] = 16.8, 95% confidence interval [CI] = 7.0 - 40.1, P < 0.0001). […] Mortality was higher than the national average of 3.2%; comorbidity was associated with bad prognosis.
32497451 Aim: To identify the psychological change process of the registered nurses who worked in the epicenter of the COVID-19 outbreak.Background: The pandemic of COVID-19 has continued to pose an unprecedented threat and challenge to people’s health around the world. […] Nurses are at high risk because they work within the closest proximity to patients. […] Understanding nurses’ psychological change process during the care for patients with COVID-19 is imperative for healthcare leaders.Methods: This was a qualitative descriptive study that took place in a hospital in Wuhan, China, the epicenter of the COVID-19 epidemic, from February 9th to March 15th, 2020. […] Data were analyzed using Colaizzi’s method of data analysis to find, understand, and describe nurses’ experiences.Results: The psychological change process of frontline nurses included three stages, early, middle, and later stages. […] The psychological characteristics of each period were ambivalence, emotional exhaustion, and energy renewal, respectively. […] Nurse leaders were anchors in facilitating frontline nurses’ psychological adaptation.Conclusions: In the past month, the psychological characteristics of nurses changed over time. […] The study indicated the necessity for nurse leaders to implement intervention programs based on nurses’ psychological characteristics in different periods to promote nurses’ health during this critical time period.
32501372 In this report, we analyze historical and forecast infections for COVID-19 death based on Reduced-Space Gaussian Process Regression associated to chaotic Dynamical Systems with information obtained in 82 days with continuous learning, day by day, from January 21 th , 2020 to April 12 th . […] According last results, COVID-19 could be predicted with Gaussian models mean-field models can be meaning- fully used to gather a quantitative picture of the epidemic spreading, with infections, fatality and recovery rate. […] The forecast places the peak in USA around July 14 th 2020, with a peak number of 132,074 death with infected individuals of about 1,157,796 and a number of deaths at the end of the epidemics of about 132,800. […] Late on January, USA confirmed the first patient with COVID-19, who had recently traveled to China, however, an evaluation of states in USA have demonstrated a fatality rate in China (4%) is lower than New York (4.56%), but lower than Michigan (5.69%). […] Mean estimates and uncertainty bounds for both USA and his cities and other provinces have increased in the last three months, with focus on New York, New Jersey, Michigan, California, Massachusetts, … […] (January e April 12 th ). […] Besides, we propose a Reduced-Space Gaussian Process Regression model predicts that the epidemic will reach saturation in USA on July 2020. […] Our findings suggest, new quarantine actions with more restrictions for containment strategies implemented in USA could be successfully, but in a late period, it could generate critical rate infections and death for the next 2 month.
32502662 The largely resolved first wave of the COVID-19 epidemic in China provides a unique opportunity to investigate how the early characteristics of the COVID-19 outbreak predicts its subsequent size. […] We collected publicly available COVID-19 epidemiological data from 436 Chinese cities during 16th January-15th March 2020. […] Based on 45 cities which reported >100 confirmed cases, we examined the correlation between early-stage epidemic characteristics and subsequent epidemic size. […] We identified a transition point from a slow- to a fast-growing phase for COVID-19 at 5.5 (95% CI, 4.6-6.4) days after the first report, and 30 confirmed cases marked a critical threshold for this transition. […] The average time for the number of confirmed cases to increase from 30 to 100 (time from 30-to-100) was 6.6 (5.3-7.9) days, and the average case-fatality rate in the first 100 confirmed cases (CFR-100) was 0.8% (0.2-1.4%). […] The subsequent epidemic size per million population was significantly associated with both of these indicators. […] We predict a ranking of epidemic size in the cities based on these two indicators and found it highly correlated with the actual ranking of epidemic size. […] Early epidemic characteristics are important indicators for the size of the entire epidemic.
32502664 Although the COVID-19 is known to cause by human-to-human transmission, it remains largely unclear whether ambient air pollutants and meteorological parameters could promote its transmission. […] A retrospective study is conducted to study whether air quality index (AQI), four ambient air pollutants (PM2.5, PM10, NO2 and CO) and five meteorological variables (daily temperature, highest temperature, lowest temperature, temperature difference and sunshine duration) could increase COVID-19 incidence in Wuhan and XiaoGan between Jan 26th to Feb 29th in 2020. […] First, a significant correlation was found between COVID-19 incidence and AQI in both Wuhan (R2 = 0.13, p < 0.05) and XiaoGan (R2 = 0.223, p < 0.01). […] Specifically, among four pollutants, COVID-19 incidence was prominently correlated with PM2.5 and NO2 in both cities. […] In Wuhan, the tightest correlation was observed between NO2 and COVID-19 incidence (R2 = 0.329, p < 0.01). […] In XiaoGan, in addition to the PM2.5 (R2 = 0.117, p < 0.01) and NO2 (R2 = 0.015, p < 0.05), a notable correlation was also observed between the PM10 and COVID-19 incidence (R2 = 0.105, p < 0.05). […] Moreover, temperature is the only meteorological parameter that constantly correlated well with COVID-19 incidence in both Wuhan and XiaoGan, but in an inverse correlation (p < 0.05). […] AQI, PM2.5, NO2, and temperature are four variables that could promote the sustained transmission of COVID-19.
32503088 We systematically reviewed available evidence for reports of neurological signs and symptoms in Coronavirus disease (COVID)-19 patients to identify cases with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection or immune-mediated reaction in the nervous system. […] We followed PRISMA guidelines and used the MEDLINE, EMBASE, Google Scholar, MedRxiv and ChinaXiv databases to search for papers on COVID-19 and nervous system involvement which were published from January 1st to April 24th 2020. […] Biases were assessed with the Newcastle-Ottawa scale. […] The reports focused on smell and taste (n=5) and evaluation of neurological symptoms and signs in cohorts (n=5). […] There were cases of Guillain-Barré syndrome/Miller-Fisher syndrome/cranial neuropathy (7 cases), meningitis/encephalitis (9 cases) and various other conditions (5 cases). […] Patients with cerebrospinal fluid (CSF) examination and in particular SARS-CoV-2 PCR was negligible. […] The study of potential parenchymal involvement with magnetic resonance imaging was rare. […] Only 4 reports received a rating for the highest quality standards. […] This systematic review failed to establish comprehensive insights to nervous system manifestations of COVID-19 beyond immune-mediated complications as aftermath of respiratory symptoms. […] The authors therefore provide guidance for more careful clinical, diagnostic and epidemiological studies to characterize the manifestations and burden of neurological disease caused by SARS-CoV-2 on behalf of the Infectious Disease Panel of the European Academy of Neurology.
32503657 A variety of possible mechanisms can make the nucleic acid test of patients who meet the discharge conditions positive again, including reinfection, reactivation of the original virus, lack of strict discharge criteria, new infection, and so on. […] We will enroll patients who are discharged after treatment, whose nucleic acid test has changed from negative to positive during the screening visit, regardless of the severity of the symptoms, to investigate the mechanism, clinical outcome and therapeutic efficacy with Favipiravir patients with Corona virus Disease 2019. […] Favipiravir is an anti-viral agent that selectively and potently inhibits the RNA-dependent RNA polymerase, it has been used for treatment of some life-threatening infections such as Ebola virus, Lassa virus and rabies. […] Its therapeutic efficacy has been proven in these diseases. […] This is a multi-center, two arm, open label, parallel group, randomized controlled trial. […] After the first diagnosis and treatment of COVID-19, the nucleic acid test of respiratory specimens such as sputum or nasopharyngeal swabs, has been negative for two consecutive times (sampling time interval of at least 24 hours), in accordance with the COVID-19’s diagnosis and treatment Plan (7th Edition), discharged.3. […] During screening visit (follow-up after discharge), The nucleic acid test of COVID-19 is positive in any one of the following samples: sputum, throat swabs, blood, feces or other specimens. […] Regardless of whether or not they had symptoms and the severity of symptoms.4. […] Volunteer to participate in the research and sign the Informed Consent Form. […] Uncontrolled diseases of the blood and cardiovascular system, liver or kidney.4. […] Participating in other clinical studies. […] Loss to Follow up: Cases that do not complete the clinical trial program will be regarded as lost to follow up. […] Including the withdrawal of patients by themselves (such as poor compliance, etc.), or the withdrawal of patients ordered by the researcher (those who need other drugs which affect the judgment of the curative effect, and those who need to stop taking drugs for severe adverse events) Study setting: The participating hospitals are some of the designated hospitals that have been or may be admitting patients who meet the eligibility criteria, mainly in Hubei, Shenzhen, Anhui and Beijing. […] Participants will be recruited from these 15 hospitals: Wuhan Pulmonary Hospital, Hubei; Jinyintan Hospital of Wuhan, Hubei; Ezhou Central Hospital, Hubei; The Second People’s Hospital of Fuyang, Anhui; The First Affiliated Hospital of USTC, Anhui; Beijing Youan Hospital, Beijing; Capital Medical University Beijing Institute of Hepatology, Beijing; Ezhou Hospital of Traditional Chinese Medicine, Hubei; Zhongnan Hospital of Wuhan University, Hubei; The Fifth Hospital of ShiJiazhuang, Hebei; Jinan Infectious Diseases Hospital, Shandong; Public Health Clinical Center of Chengdu, Sichuan; Wuxi No.5 People’s Hospital, Jiangsu; The Third People’s Hospital of Shenzhen, Guangdong; The First Affiliated Hospital of Bengfu Medical College, AnHui. […] Favipiravir group (experimental): Favipiravir 1600mg each dose, twice a day on the 1st day; 600mg each dose, twice a day from the 2nd to the 7th day, Oral administration, the maximum number of days taken will be no more than 14 days plus routine treatment for COVID-19. […] Regular treatment group (control): Treatments other than Antiviral drugs can be given. […] Routine treatment for patients with the corona virus will be administered, this includes oxygen therapy, drugs that reduced phlegm and relieve cough, including thymosin, proprietary Chinese medicine, etc. […] MAIN OUTCOMES: Primary Outcome Measures: Viral nucleic acid test negative [Time Frame: 5 months]: Subjects who tested negative for nucleic acid from sputum or nasopharyngeal swabs for two consecutive times (sampling time interval of at least 24 hours). […] Clinical cure [Time Frame: 5 months]: 1. […] Body temperature returned to normal for more than 3 days;2. […] The viral nucleic acid test of respiratory specimens was negative for two consecutive times (sampling time interval of at least 24 hours). […] The central randomization system (Interactive Web Response Management System), will be used to randomly divide the subjects into the experimental group and the control group according to the ratio of 2:1. […] In this study, block randomization will be used, in blocks of 6. […] This is an open label trial. […] Trial participants, investigators, care givers, outcome assessors, and date analysts are not blinded to group assignment. 210 patients are expected to be enrolled and allocated according to the ratio of 2 (Favipiravir group, n=140): 1(regular treatment group, n=70). […] Protocol version number 3.0, 10th April 2020 First Patient, first visit 17th March 2020; recruitment end date anticipated June 1, 2020. […] The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
32503663 The hypothesis of the proposed intervention is that Granulocyte-macrophage colony-stimulating factor (GM-CSF) has profound effects on antiviral immunity, and can provide the stimulus to restore immune homeostasis in the lung with acute lung injury post COVID-19, and can promote lung repair mechanisms, that lead to a 25% improvement in lung oxygenation parameters. […] Sargramostim is a man-made form of the naturally-occurring protein GM-CSF. […] Patients aged 18-80 years admitted to specialized COVID-19 wards in 5 Belgian hospitals with recent (< 2 weeks prior to randomization) confirmed COVID-19 infection and acute respiratory failure defined as a PaO2/FiO2 below 350 mmHg or SpO2 below 93% on minimal 2 L/min supplemental oxygen. […] Patients were excluded from the trial in case of (1) known serious allergic reactions to yeast-derived products, (2) lithium carbonate therapy, (3) mechanical ventilation prior to randomization, (4) peripheral white blood cell count above 25.000/μL and/or active myeloid malignancy, (5) high dose systemic steroid therapy (> 20 mg methylprednisolone or equivalent), (6) enrolment in another investigational study, (7) pregnant or breastfeeding or (8) ferritin levels > 2000 μg/mL. […] Upon progression of disease requiring mechanical ventilation or to acute respiratory distress syndrome (ARDS) and initiation of mechanical ventilator support within the 5 day period, inhaled sargramostim will be replaced by intravenous sargramostim 125 μg/m2 body surface area once daily until the 5 day period is reached. […] From day 6 onwards, progressive patients in the active group will have the option to receive an additional 5 days of IV sargramostim, based on the treating physician’s assessment. […] Subjects progressing to ARDS and requiring invasive mechanical ventilatory support, from day 6 onwards in the standard of care group will have the option (clinician’s decision) to initiate IV sargramostim 125m μg/m2 body surface area once daily for 5 days. […] The primary endpoint of this intervention is measuring oxygenation after 5 days of inhaled (and intravenous) treatment through assessment of a change in pretreatment and post-treatment ratio of PaO2/FiO2 and through measurement of the P(A-a)O2 gradient (PAO2= Partial alveolar pressure of oxygen, PaO2=Partial arterial pressure of oxygen; FiO2= Fraction of inspired oxygen). […] In this open-label trial neither participants, caregivers, nor those assessing the outcomes will be blinded to group assignment. […] A total of 80 patients with confirmed COVID-19 and acute hypoxic respiratory failure will be enrolled, 40 in the active and 40 in the control group. […] Participant recruitment started on March 26th 2020. […] Given the current decline of the COVID-19 pandemic in Belgium, it is difficult to anticipate the rate of participant recruitment. […] The trial was registered on Clinical on March 30th, 2020 ( Identifier: NCT04326920) - retrospectively registered; […] term=sarpac&recrs=ab&draw=2&rank=1 and on EudraCT on March 24th, 2020 (Identifier: 2020-001254-22). […] The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
32504360 The clinical characteristics and outcome of COVID-19 in children are different from those in adults. […] We aimed to describe the characteristics of infants under 1 year of age (excluding newborns) with COVID-19. […] We retrospectively retrieved data of 36 infants with SARS-CoV-2 infection in Wuhan Children’s Hospital from January 26 to March 22, 2020. […] The mean age of the infected infants was 6.43 months, with a range of 2-12 months. […] 61.11% of the patients were males and 38.89% females. […] 86.11% of the infants were infected due to family clustering. […] Cough (77.78%) and fever (47.22%) were the most common clinical manifestations. […] 47.22% of the infants developed complications. […] Increased leucocytes, neutrophils, lymphocytes, and thrombocytes were observed in 11.11, 8.33, 36.11 and 44.44% of infants, respectively. […] Decreased leucocytes, neutrophils, thrombocyte and hemoglobin were observed in 8.33, 19.44, 2.78 and 36.11% of infants, respectively. […] Co-infections with other respiratory pathogens were observed in 62.86% of infants. […] CD3 (20.69%), CD4 (68.97%), CD19 (31.03%) and Th/Ts (44.83%) were elevated; CD8 (6.9%) and CD16+CD56 (48.28%) was reduced. […] When the infant’s condition deteriorates rapidly, lymphocytopenia was discovered. […] In the cohort, we discovered that lymphocytosis, elevated CD4 and IL-10, and co-infections were common in infants with COVID-19, which were different from adults with COVID-19. […] Most infants with COVID-19 have mild clinical symptoms and good prognosis.
32504745 The seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was examined among 105 healthcare workers (HCWs) exposed to four patients who were laboratory confirmed with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2 infection. […] These HCWs were immediately under quarantine for 14 days as soon as they were identified as close contacts. […] The nasopharyngeal swab samples were collected on the first and 14th day of the quarantine, while the serum samples were obtained on the 14th day of the quarantine. […] With the assay of enzyme immunoassay (EIA) and microneutralization assay, 17.14% (18/105) of HCWs were seropositive, while their swab samples were found to be SARS-CoV-2 RNA negative. […] Risk analysis revealed that wearing face mask could reduce the infection risk (odds ratio [OR], 0.127, 95% confidence interval [CI] 0.017, 0.968), while when exposed to COVID-19 patients, doctors might have higher risk of seroconversion (OR, 346.837, 95% CI 8.924, 13479.434), compared with HCWs exposed to colleagues as well as nurses and general service assistants who exposed to patients. […] Our study revealed that the serological testing is useful for the identification of asymptomatic or subclinical infection of SARS-CoV-2 among close contacts with COVID-19 patients.
32506699 To describe the incidence and severity of coronavirus disease 2019 (COVID-19) in rheumatic patients treated with targeted synthetic or biological anti-rheumatic drugs (ts/bDMARDs) compared with the general population living in the same Italian region. […] Patients followed at two referral rheumatology centres in Lombardy from 25th February to 10th April 2020 were invited to participate in a survey to detect patients with confirmed COVID-19, close contacts with known COVID-19 cases, symptoms of infection, working, behavioural and disease management changes applied to prevent the contagion. […] The incidence of COVID-19 in the Lombardy population was obtained from the National Institute of Statistics. […] The survey was circulated amongst 955 patients (531 rheumatoid arthritis, 203 psoriatic arthritis, 181 spondyloarthritis, and 40 of connective tissue diseases/vasculitides/autoinflammatory diseases; mean age 53.7 years; female: 67.4%). […] The rate of responders was 98.05%. […] The incidence of confirmed COVID-19 is consistent with the general population (0.62% vs 0.66%; p=0.92). […] None of the patients had severe complications or required intensive care treatment, and all of them temporarily discontinued ongoing ts/bDMARDs therapy. […] Almost all patients adopted precautions to prevent the contagion (90.6%) and maintained the ongoing treatment with ts/bDMARDs (93.2%). […] The disease activity remained stable in 89.5% of patients. […] Our results highlight the attitude from rheumatic patients to prevent the contagion while maintaining their chronic treatments. […] The incidence and severity of COVID-19 in patients treated with ts/bDMARDs was not significantly different from that of the general population in the same region.
32506779 The Coronavirus disease-2019 (COVID-19) pandemic, due to the Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) was declared a public health emergency of international concern by the World Health Organization on 30th of January 2020 (World Health Organization, 2020). […] The first case of COVID-19 was reported in India on the same day, and at the time of writing, on 20th May 2020, India has reported over 106,000 patients, with over 3,300 related deaths. […] The country is under a state of lockdown since 25th March, 2020, and over 600 health care providers have been infected.
32512579 Following the emergence of a novel coronavirus1 (SARS-CoV-2) and its spread outside of China, Europe has experienced large epidemics. […] We study the impact of major interventions across 11 European countries for the period from the start of COVID-19 until the 4th of May 2020 when lockdowns started to be lifted. […] Our model calculates backwards from observed deaths to estimate transmission that occurred several weeks prior, allowing for the time lag between infection and death. […] We use partial pooling of information between countries with both individual and shared effects on the reproduction number. […] Our model relies on fixed estimates of some epidemiological parameters such as the infection fatality rate, does not include importation or subnational variation and assumes that changes in the reproduction number are an immediate response to interventions rather than gradual changes in behavior. […] Amidst the ongoing pandemic, we rely on death data that is incomplete, with systematic biases in reporting, and subject to future consolidation. […] We estimate that, for all the countries we consider, current interventions have been sufficient to drive the reproduction number [Formula: see text] below 1 (probability [Formula: see text]< 1.0 is 99.9%) and achieve epidemic control. […] We estimate that, across all 11 countries, between 12 and 15 million individuals have been infected with SARS-CoV-2 up to 4th May, representing between 3.2% and 4.0% of the population. […] Our results show that major non-pharmaceutical interventions and lockdown in particular have had a large effect on reducing transmission.
32524732 The novel Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) disease 2019 (COVID-19) seems to have a worse clinical course among infected men compared to women, thus, highlighting concerns about gender predisposition to serious prognosis. […] Therefore, androgens, particularly testosterone (T), could be suspected as playing a critical role in driving this excess of risk. […] However, gonadal function in critically ill men is actually unknown, mainly because serum T concentration is not routinely measured in clinical practice, even more in this clinical context. […] To overview on possible mechanisms by which serum T levels could affect the progression of COVID-19 in men. […] Authors searched PubMed/Medline, Web of Science, EMBASE, Cochrane Library, Google, and Institutional websites for medical subheading terms and free text words referred to “SARS-CoV-2”, “COVID-19”, “testosterone”, “male hypogonadism”, “gender” “immune system”, “obesity”, “thrombosis” until May 19th 2020. […] T, co-regulating the expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2 in host cells, may facilitate SARS-CoV-2 internalization. […] Instead, low serum T levels may predispose to endothelial dysfunction, thrombosis and defective immune response, leading to both impaired viral clearance and systemic inflammation. […] Obesity, one of the leading causes of severe prognosis in infected patients, is strictly associated with functional hypogonadism, and may consistently strengthen the aforementioned alterations, ultimately predisposing to serious respiratory and systemic consequences. […] Low serum levels of T, which should be supposed to characterize the hormonal milieu in seriously ill individuals, may predispose men, especially aged men, to poor prognosis or death. […] Further studies are needed to confirm these pathophysiological assumptions and to promptly identify adequate therapeutic strategies.
32525251 The novel coronavirus, otherwise known as COVID-19 has fast become a major health concern.1 2 It has been reported that in addition to the conventional respiratory symptoms, patients also display skin manifestations such as Urticaria and angioedema.3 Here we present a case study of an elderly man who first presented with generalised pruritic hives ranging from 1.5 to 8.0 cm in diameter on the 5th of March 2020. […] The patient was investigated for another differential diagnosis of Urticaria such as parasitic and bacterial infection, for which negative results were found. […] On the 5th of March 2020 the patient-reported these symptoms plus general malaise, fatigue, 37.9⁰C temperature and sore throat. […] Initial biochemical tests showed that the patient presented with low numbers of white blood cells (WBC) (WBC=2.75x103 ).
32526252 Coronavirus disease (COVID-19) is a major worldwide threat for healthy individuals as well as for patients with comorbidities, but its impact on patients with cirrhosis is currently unknown. […] This study aimed at evaluating the impact of COVID-19 on the clinical outcome of these patients. […] In this multicenter retrospective study, cirrhotic patients with confirmed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. […] Clinical and biochemical data at COVID-19 and at the last outpatient visit were obtained through review of medical records. […] Fifty cirrhotic patients with confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virus-related, 52% previously compensated cirrhosis). […] At diagnosis, 64% of patients presented fever, 42% shortness of breath/polypnea, 22% encephalopathy, 96% needed hospitalization or prolonged an ongoing one. […] Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. […] The proportion of patients with MELD≥15 increased from 13% to 26% (p=0.037), acute-on-chronic liver failure and and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. […] Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. […] Mortality was significantly higher in hospitalized cirrhotics with COVID-19 than in those hospitalized for bacterial infections. […] COVID-19 is associated with liver function deterioration and elevated mortality in cirrhotic patients.
32528234 The reports and information on coronavirus are not conspicuously emphasising the possible impact of population density on the explanation of difference in rapid spread and fatality due to the disease and not much has been done on bicountry comparisons. […] The study examined the impact of population density on the spread of COVID-19 pandemic in two sociodemographic divergent countries. […] The study conducted a scoping review of published and unpublished articles including blogs on incidences and fatalities of COVID-19. […] The analysis followed qualitative description and quantitative presentation of the findings using only frequency distribution, percentages, and graphs. […] The two countries shared similar experience of “importation” of COVID-19, but while different states ordered partial lockdown in Nigeria, it was an immediate total lockdown in Italy. […] The physician/patient ratio is high in Italy (1 : 328) but low in Nigeria (1 : 2500), while population density is 221 in Nigeria and 206 in Italy. […] Fatality rate has plummeted to below 10% after the 66th day in Italy but has not been stabilised in Nigeria. […] The authors upheld both governments’ recommending measures that tilted towards personal hand-hygienic practices and social distancing. […] Authors suggested that if Italy with its high physician/patient ratio and lower population density compared to Nigeria could suffer high fatality from COVID-19 pandemic under four weeks, then Nigeria with its low physician/patient ratio and higher population density should prepare to face harder time if the pandemic persists.
32528819 South Korea is operating a flexible quarantine management system which is based on the results of epidemiological investigations of patients arriving from overseas with coronavirus disease-19 (COVID-19), and closely monitoring COVID-19 outbreaks. […] South Korea has designated countries with a localized, high prevalence of infection as “quarantine inspection required areas” and has reinforced quarantine measures by applying special immigration procedures for people entering South Korea. […] Furthermore, South Korea also provides information on international travel history of entrants (who are South Korean citizens and foreign nationals) to all medical institutions, through the smart quarantine information system. […] On March 11th 2020, the World Health Organization characterized COVID-19 as a pandemic. […] Inevitably, the number of patients from overseas with COVID-19 (based on 10,000 people entering South Korea), increased to 10 cases in the second week of March, 37 cases in the third week, and 67.7 cases in the fourth week. […] However, after enforcing quarantine strengthening measures, and with a decrease in the number of people entering the country, the number of cases decreased to 52.0 in the first week of April.
32528820 This study aimed to observe the initial trend of imported COVID-19 cases in South Korea since the beginning of the outbreak. […] All imported cases were classified into 5 regions (China, Asia, Europe, Africa, and America) according to travel history and potential exposure to the COVID-19. […] The list of countries for which confirmed cases had a travel history (single visit, multiple visits) and presented, were used to estimate the potential “exposure countries” of confirmed cases. […] For better understanding of the overall imported cases, time differences (day) among 3 major steps (symptom onset, entry to South Korea, laboratory confirmation) were measured based on available data. […] From the first importation of a COVID-19 case on January 20th, a total of 171 imported cases have been officially reported in South Korea as of March 23rd 2020. […] The overall trend of importation has significantly changed during this period. […] Importation of confirmed cases were initially from China, and subsequently from other Asian countries. […] After that, importation from Europe rapidly increased, with importation from America also increasing. […] One hundred fifteen (81%) were confirmed within 7 days of symptom onset. […] One Hundred forty three (84.1%) imported cases were confirmed within a week after entry into South Korea. […] One hundred seven imported cases (75.9%) developed symptoms within 5 days before or after, entry to South Korea. […] Streamlined processes of detection, subsequent testing, isolation, and treatment by public health authority, was key in minimizing the risk of secondary transmission.
32529737 Minimization of immunosuppression and administration of antiretrovirals have been recommended for kidney transplant recipients (KTRs) with COVID-19. […] Given the likely benefit of cyclosporine due to its antiviral and immunomodulatory effect, we have been using it as a strategy in KTRs diagnosed with SARS-CoV-2. […] We studied 29 kidney transplant recipients (KTRs) who were admitted to our institution with COVID-19 between March,15- April, 24th , 2020. […] Two therapeutic strategies were compared: Group 1) minimization of calcineurin inhibitors (N=6); Group 2) cyclosporine-based therapy (N=23), with 15 patients switched from tacrolimus. […] Hydroxychloroquine was considered in both strategies but antivirals in none. […] Five required mechanical ventilation (17.2 %), and three could be weaned. […] In group 2, three patients died 3/23 (12.5%). […] Renal function did not deteriorate and signs of rejection were not observed in any patient on the second treatment regime. […] In conclusion, immunosuppressant treatment based on cyclosporine could be safe and effective for KTRs diagnosed with COVID-19.
32532356 To assess the safety and therapeutic effects of allogeneic human dental pulp stem cells (DPSCs) in treating severe pneumonia caused by COVID-19. […] This is a single centre, two arm ratio 1:1, triple blinded, randomized, placebo-controlled, parallel group, clinical trial. […] Twenty serious COVID-19 cases will be enrolled in the trial from April 6th to December 31st 2020. hospitalised patients at Renmin Hospital of Wuhan University satisfy all criteria as below: 1)Adults aged 18-65 years;2)Voluntarily participate in this clinical trial and sign the “informed consent form” or have consent from a legal representative.3)Diagnosed with severe pneumonia of COVID-19: nucleic acid test SARS-CoV-2 positive; respiratory distress (respiratory rate > 30 times / min); hypoxia (resting oxygen saturation < 93% or arterial partial pressure of oxygen / oxygen concentration < 300 mmHg).4)COVID-19 featured lung lesions in chest X-ray image. […] Patients will be excluded from the study if they meet any of the following criteria. […] Patients have received other experimental treatment for COVID-19 within the last 30 days;2. […] Patients have severe liver condition (e.g., Child Pugh score >=C or AST> 5 times of the upper limit);3. […] Patients with severe renal insufficiency (estimated glomerular filtration rate <=30mL / min/1.73 m2) or patients receiving continuous renal replacement therapy, hemodialysis, peritoneal dialysis;4. […] Patients who are co-infected with HIV, hepatitis B, tuberculosis, influenza virus, adenovirus or other respiratory infection viruses;5. […] Female patients who have no sexual protection in the last 30 days prior to the screening assessment;6. […] Patients who are planning to become pregnant during the study period or within 6 months after the end of the study period;8. […] Other conditions that the researchers consider not suitable for participating in this clinical trial. […] There will be two study groups: experimental and control. […] Both will receive all necessary routine treatment for COVID-19. […] The experimental group will receive an intravenous injection of dental pulp stem cells suspension (3.0x107 human DPSCs in 30ml saline solution) on day 1, 4 and 7; The control group will receive an equal amount of saline (placebo) on the same days. […] Clinical and laboratory observations will be performed for analysis during a period of 28 days for each case since the commencement of the study. […] Primary outcome The primary outcome is Time To Clinical Improvement (TTCI). […] By definition, TTCI is the time (days) it takes to downgrade two levels from the following six ordered grades [(grade 1) discharge to (grade 6) death] in the clinical state of admission to the start of study treatments (hDPSCs or placebo). […] Six grades of ordered variables: GradeDescriptionGrade 1:Discharged of patient;Grade 2:Hospitalized without oxygen supplement;Grade 3:Hospitalized, oxygen supplement is required, but NIV / HFNC is not required;Grade 4:Hospitalized in intensive care unit, and NIV / HFNC treatment is required;Grade 5:Hospitalized in intensive care unit, requiring ECMO and/or IMV;Grade 6:Death. […] NIV, non-invasive mechanical ventilation; HFNC, high-flow nasal catheter; IMV, invasive mechanical ventilation. […] During the screening period, hospitalization every day (additional time points of D1, D4, D7 30min before injection, 2h ± 30min, 24h ± 30min after the injection) and follow-up period D90 ± 3 days. […] 2.2 Laboratory examinations: during the screening period, 30 minutes before D1, D4, D7 infusion, 2h ± 30min, 24h ± 30min after the end of infusion, D10, D14, D28 during hospitalization or discharge day and follow-up period D90 ± 3 days. […] 2.3 Blood routine: white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils, neutrophils, lymphocytes, monocytes, eosinophils Acidic granulocyte count, basophil count, red blood cell, hemoglobin, hematocrit, average volume of red blood cells, average red blood cell Hb content, average red blood cell Hb concentration, RDW standard deviation, RDW coefficient of variation, platelet count, platelet specific platelet average Volume, platelet distribution width,% of large platelets; 2.4 Liver and kidney function tests: alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase, prealbumin, total protein, albumin, globulin, white / globule ratio , Total bilirubin, direct bilirubin, cholinesterase, urea, creatinine, total carbon dioxide, uric acid glucose, potassium, sodium, chlorine, calcium, corrected calcium, magnesium, phosphorus, calcium and phosphorus product, anion gap, penetration Pressure, total cholesterol, triacylglycerol, high density lipoprotein cholesterol, Low density lipoprotein cholesterol, lipoprotein a, creatine kinase, lactate dehydrogenase, estimated glomerular filtration rate. […] 2.5 Inflammation indicators: hypersensitive C-reactive protein, serum amyloid (SAA); 2.6 Infectious disease testing: Hepatitis B (HBsAg, HBsAb, HBeAg, HBeAb, HBcAb), Hepatitis C (Anti-HCV), AIDS (HIVcombin), syphilis (Anti-TP), cytomegalovirus CMV-IgM, cytomegalovirus CMV-IgG; only during the screening period and follow-up period D90 ± 3. […] 2.7 Immunological testing: Collect peripheral blood to detect the phenotype of T lymphocyte, B lymphocyte, natural killer cell, Macrophage and neutrophil by using flow cytometry. […] Collect peripheral blood to detect the gene profile of mononuclear cells by using single-cell analyses. […] Collect peripheral blood serum to detect various immunoglobulin changes: IgA, IgG, IgM, total IgE; Collect peripheral blood serum to explore the changes of cytokines, Th1 cytokines (IL-1 β, IL-2, TNF-a, ITN-γ), Th2 cytokines (IL-4, IL-6, IL -10). […] 2.8 Pregnancy test: blood β-HCG, female subjects before menopause are examined during the screening period and follow-up period D90 ± 3. […] 2.9 Urine routine: color, clarity, urine sugar, bilirubin, ketone bodies, specific gravity, pH, urobilinogen, nitrite, protein, occult blood, leukocyte enzymes, red blood cells, white blood cells, epithelial cells, non-squamous epithelial cells , Transparent cast, pathological cast, crystal, fungus; 2.10 Stool Routine: color, traits, white blood cells, red blood cells, fat globules, eggs of parasites, fungi, occult blood (chemical method), occult blood (immune method), transferrin (2h ± 30min after the injection and not detected after discharge). […] Block randomization method will be applied by computer to allocate the participants into experimental and control groups. […] The random ratio is 1:1. […] Participants, outcomes assessors and investigators (including personnel in laboratory and imaging department who issue the sample report or image observations) will be blinded. […] Injections of cell suspension and saline will be coded in accordance with the patient’s randomisation group. […] The blind strategy is kept by an investigator who does not deliver the medical care or assess primary outcome results. […] Twenty participants will be randomized to the experimental and control groups (10 per group). […] Patients screening commenced on 16th April and an estimated date of the recruitment of the final participants will be around end of July. . […] Registration: World Health Organization Trial Registry: ChiCTR2000031319; March 27,2020. […] Identifier: NCT04336254; April 7, 2020 Other Study ID Numbers: hDPSC-CoVID-2019-02-2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
32535885 SARS-CoV-2 has infected 189,000 people in Italy, with more than 25,000 deaths. […] Several predictive factors of mortality have been identified; however, none has been validated in patients presenting with mild disease. […] Patients with a diagnosis of interstitial pneumonia caused by SARS-CoV-2, presenting with mild symptoms, and requiring hospitalization in a non-intensive care unit with known discharge status were prospectively collected and retrospectively analyzed. […] Univariate and multivariate logistic regression were used to identify independent predictors of death. […] Between 28th February and 10th April 2020, 229 consecutive patients were included in the study cohort; the majority were males with a mean age of 60 years. 54% of patients had at least one comorbidity, with hypertension being the most commonly represented, followed by diabetes mellitus. 196 patients were discharged after a mean of 9 days, while 14.4% died during hospitalization because of respiratory failure. […] Age higher than 75 years, low platelet count (<150 x10^3/mm3) and higher ferritin levels (>750 ng/mL) were independent predictors of death. […] Comorbidities were not independently associated with in-hospital mortality. […] In-hospital mortality of patients with COVID-19 presenting with mild symptoms is high and is associated with older age, platelet count and ferritin levels. […] Identifying early predictors of outcome can be useful in the clinical practice to better stratify and manage patients with COVID-19.
32540814 The SARS-CoV-2 virus is responsible for an epidemic disease called COVID-19, which was initially evidenced in Wuhan, China, and spread very rapidly in China and around the world. […] In France, the first isolated case seems now to be reported in December 2019, stage 3 of the COVID-19 epidemic was triggered on March 14th, the start of the planned containment exit from May 11th. […] Healthcare services have faced a large influx of patients who may be beyond their capacity to receive and care, particularly in the Large-East and Ile-de-France regions. […] Some patients show an evolution of the disease never observed before with other coronaviruses and develop in a few days a very important inflammatory reaction, which can lead to death of patients. […] A working group of the French Society of Clinical Biology (SFBC) was set up with the objective of providing updated information on the current status of the biological prescriptions (focusing on biochemistry ones) and their evolution during the epidemic, and of analyzing the biological parameters associated with comorbidities and patient evolution in order to link biological results with medical events. […] The expanded working group covers all sectors of medical biology in France and extends to the French-speaking world: hospital sectors (CHU and CH, Army Training Hospitals) and the private sector opening a field of view on the biological situation in establishments for dependent elderly, social establishments and clinical medical institutions. […] The purpose of this article is the presentation of this working group and its immediate and future actions.
32542706 We would like to report the clinical characteristics of 3 people living with HIV (PLWH) in the United Kingdom within the context of coronavirus disease 2019 (COVID-19). […] Our institution serves a population of 500,000 with a prevalence of HIV at 0.34%. […] At of the time of writing, 5th June 2020, only 3 PLWH tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on nasopharyngeal swab specimen using Real-Time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) have required admission to hospital. […] This article is protected by copyright.
32546368 On January 7th, 2020, a new coronavirus, SARS-CoV-2, was identified, as responsible for a new human disease: COVID-19. […] Given its recent appearance, our current knowledge about the possible influence that this disease can exert on pregnancy is very limited. […] One of the unknowns to be solved is whether there is a vertical transmission of the infection during pregnancy. […] Using the Real-time Polymerase Chain Reaction techniques for SARS-CoV-2 nucleic acids, the possible presence of this germ in vaginal discharge and amniotic fluid was investigated in four pregnant Caucasian patients affected by mild acute symptoms of COVID-19 during the second trimester of pregnancy. […] There is no laboratory evidence to suggest a possible passage of SARS-CoV-2 from the infected mother to the amniotic fluid. […] It is necessary to expand the investigation of COVID-19 cases diagnosed during pregnancy to clarify the real influence that SARS-CoV-2 has on pregnant women and their offspring, as well as those factors that modulate the disease.
32548163 What are the clinical features of this disease? […] What is the clinical diagnosis and how should such patients be treated? […] As a clinician, mastery of the clinical characteristics, basic diagnosis, and treatment methods of COVID-19 are required to provide help to patients. […] A 42-year-old male patient with a cough lasting 6 d without obvious cause, as well as fever and fatigue for 1 d, was admitted to Hankou Hospital on January 22, 2020 and transferred to Huoshenshan Hospital on February 4. […] The main clinical symptoms were dry cough, fatigue, and fever. […] He was diagnosed with COVID-19. […] From the 4th d of admission, the patient’s condition gradually worsened, with increased respiratory rate and body temperature. […] On the 8th d of admission, the patient’s highest temperature was 40.7 °C, and oxygen saturation was 83% despite high-flow oxygen inhalation. […] Chest computed tomography results showed that the virus progressed rapidly. […] The number of lesions significantly increased with expanded scope and increased density. […] The distribution of lesions advanced from peripheral to central. […] In addition to nasal catheter oxygen inhalation and symptomatic support, antiviral drugs were used throughout the treatment. […] On January 24, three tablets of lopinavir and ritonavir were added orally (twice daily). […] After 6 d, this was changed to 0.2 g (two tablets) arbidol, taken orally (three times daily) for 5 d. […] During the severe stage, methylprednisolone was given (40 mg) once every 12 h, immunoglobulin (20 g) was administered by intravenous drip infusion once daily, and thymosin (1.6 mg) was injected subcutaneously once daily combined with immunotherapy. […] Throat swabs on February 4 and 9 were negative for novel coronavirus nucleic acid. […] After 19 d in the hospital, the patient was successfully treated and discharged. […] COVID-19 in young adults can be successfully treated with active treatment.
32554953 COVID-19 pandemic has accounted for ~ 4.3 million confirmed cases and ~ 292,000 deaths (till 12th May, 2020) across the globe since its outbreak. […] Several anti-viral drugs such as RNA dependent RNA polymerase inhibitors (remdesivir, favipiravir, ribavirin), protease inhibitors (lopinavir, ritonavir) and drugs targeting endocytic pathway (hydroxychloroquine) are being evaluated for COVID-19 but standard therapeutics yet not available. […] Severe health deterioration in critically ill patients is characterized by pulmonary edema, severe respiratory distress, cytokine storm and septic shock. […] To combat cytokine storm, immune-therapy targeting IL-1, IL-2, IL-6 and TNFα are being evaluated and one of the promising immune-modulator is the mesenchymal stem cells (MSCs) that can surmount the severity of COVID-19 infections. […] Recent studies have shown that MSC-therapy significantly dampens the cytokine storm in critically ill COVID-19 patients. […] This communication endows with the insight of stem cell therapy and summarizes the recent studies on COVID-19 patients.
32557999 Our objective was to quantify trends in Emergency Medical Services (EMS) incidents as the effects of the COVID-19 pandemic spread across the United States, and to determine if there was an increase in EMS attended deaths. […] We conducted a three-year comparative retrospective cohort analysis of data from the National EMS Information System. […] Data were included if care was provided between the 40th and 21st week of the next year and compared over three-years. […] We included incidents identified through 9-1-1 where patient contact was made. […] The total number of EMS incidents per week was used as the denominator to calculate the rate of patient deaths and possible injury. […] Starting in the 10th week of 2020 there was a decrease in the number of EMS activations in the United States compared to the prior weeks and the same time period in previous years. […] The number of activations between week 10 and 16 decreased by 140,292 or 26.1%. […] The portion of EMS activations reporting a patient disposition of death nearly doubled between the 11th and 15th week of 2020 (1.49% to 2.77% of all activations). […] The number of EMS activations documenting a possible injury decreased from 18.43% to 15.27% between weeks 10 and 13. […] We found that early in the COVID-19 outbreak there was a significant decrease in the number of EMS responses across the United States. […] Simultaneously the rate of EMS attended death doubled, while the rate of injuries decreased.
32558002 Although the main clinical features of COVID-19 infection are pulmonary, several associated neurological signs, symptoms and diseases are emerging. […] For this reason, the European Academy of Neurology (EAN) core COVID-19 Task Force initiated a survey on neurological symptoms observed in patients with COVID-19 infection. […] A 17-question on-line survey was made available on the EAN website and distributed to EAN members and other worldwide physicians starting on April 9th , 2020. […] By April 27th, 2020, proper data were collected from 2,343 responders (out of 4,199), of whom 82.0% were neurologists, mostly from Europe. […] Most responders (74.7%) consulted patients with COVID-19 mainly in emergency rooms and in COVID-19 units. […] The majority (67.0%) had evaluated fewer than 10 patients with neurological manifestations of COVID-19 (neuro COVID-19). […] The most frequently reported neurological findings were headache (61.9%), myalgia (50.4%), anosmia (49.2%), ageusia (39.8%), impaired consciousness (29.3%), and psychomotor agitation (26.7%). […] Encephalopathy and acute cerebrovascular disorders were reported at 21.0%. […] Neurological manifestations were generally interpreted as being possibly related to COVID-19, they were most commonly recognized in patients with multiple general symptoms, and occurred at any time during infection. […] Neurologists are currently and actively involved in the management of neurological issues related to the COVID-19 pandemic. […] This survey justifies setting up a prospective registry to better capture the prevalence of patients with neuro COVID-19, neurological disease characteristics and the contribution of neurological manifestations to outcome.
32558210 On April 17th 2020 the US Food and Drug Administration granted Coronavirus Disease 2019 (COVID-19) emergency use authorizations for the Seraph® 100 Microbind® Affinity Blood Filter. […] The medical device is aimed to treat critically ill COVID-19 patients with confirmed or imminent respiratory failure. […] The aim of this life size in vitro pharmacokinetic study was to investigate the in-vitro adsorption of chloroquine and hydroxychloroquine from human plasma using equipment that is also used at the bedside. […] After start of the hemoperfusion Pre (Cpre ) Seraph® plasma levels were obtained at 5 (C5 ), 10 (C10 ), 15 (C15 ), 30 (C30 ), 60 (C60 ) and 120 (C120 ) minutes into the procedure. […] At two timepoints (5 min and 120 min) post (Cpost ) Seraph® plasma levels were determined that were used to calculate the plasma clearance. […] Both drugs were determined using a validated HPLC method Median [IQR] plasma clearance of the Seraph for chloroquine / hydroxychloroquine was 1.71 [0.51-4.38] ml/min / 1.79 [0.21-3.68] ml/min respectively. […] The lack of elimination was also confirmed by the fact that plasma levels did not change over the 120 min treatment. […] As neither chloroquine nor hydroxychloroquine were removed by the treatment with the Seraph dose adjustments in COVID-19 patients undergoing this treatment are not necessary. […] This article is protected by copyright.
32558644 Previously we showed that 31/1,032 (3%) asymptomatic healthcare workers (HCW) from a large teaching hospital in Cambridge UK tested positive for SARS-CoV-2 in April 2020. […] 26/169 (15%) HCWs with symptoms of coronavirus disease 2019 (COVID-19) also tested positive (Rivett et al., 2020). […] Here we show that the proportion of both asymptomatic and symptomatic HCWs testing positive rapidly declined to near-zero between 25th April and 24th May 2020, corresponding with a decline in patient admissions with COVID-19 during the ongoing UK ‘lockdown’. […] These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent ‘hubs’ of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organisations in other sectors may be able to resume on-site work safely.
32560744 Phase I - To determine the optimal dose of each candidate (or combination of candidates) entered into the platform. […] Phase II - To determine the efficacy and safety of each candidate entered into the platform, compared to the current Standard of Care (SoC), and recommend whether it should be evaluated further in a later phase II & III platforms. […] AGILE-ACCORD is a Bayesian multicentre, multi-arm, multi-dose, multi-stage open-label, adaptive, seamless phase I/II randomised platform trial to determine the optimal dose, activity and safety of multiple candidate agents for the treatment of COVID-19. […] Designed as a master protocol with each candidate being evaluated within its own sub-protocol (Candidate Specific Trial (CST) protocol), randomising between candidate and SoC with 2:1 allocation in favour of the candidate (N.B the first candidate has gone through regulatory approval and is expected to open to recruitment early summer 2020). […] Patient populations can vary between CSTs, but the main eligibility criteria include adult patients (≥18 years) who have laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). […] We will include both severe and mild-moderate patients defined as follows: Group A (severe disease) - patients with WHO Working Group on the Clinical Characteristics of COVID-19 infection 9-point ordinal scale of Grades 4 (hospitalised, oxygen by mask or nasal prongs), 5 (hospitalised, non-invasive ventilation or high flow oxygen), 6 (hospitalised, intubation and mechanical ventilation) or 7 (hospitalised, ventilation and additional organ support); Group B (mild-moderate disease) - ambulant or hospitalised patients with peripheral capillary oxygen saturation (SpO2) >94% RA. […] If any CSTs are included in the community setting, the CST protocol will clarify whether patients with suspected SARS-CoV-2 infection are also eligible. […] Participants will be recruited from England, North Ireland, Wales and Scotland. […] Comparator is the current standard of care (SoC), in some CSTs plus placebo. […] Candidates that prevent uncontrolled cytokine release, prevention of viral replication, and other anti-viral treatment strategies are at various stages of development for inclusion into AGILE-ACCORD. […] Other CSTs will be added over time. […] There is not a set limit on the number of CSTs we can include within the AGILE-ACCORD Master protocol and we will upload each CST into this publication as each opens to recruitment. […] Phase II: Agreed on a CST basis depending on mechanism of action of the candidate and patient population. […] But may include; time to clinical improvement of at least 2 points on the WHO 9-point category ordinal scale [measured up to 29 days from randomisation], progression of disease (oxygen saturation (SaO2) <92%) or hospitalization or death, or change in time-weighted viral load [measured up to 29 days from randomisation]. […] Varies with CST, but default is 2:1 allocation in favour of the candidate to maximise early safety data. […] For the safety phase open-label although for some CSTs may include placebo or SoC for the efficacy phase. […] However simulations have shown that around 16 participants are necessary to determine futility or promise of a candidate at a given dose (in efficacy evaluation alone) and between 32 and 40 participants are required across the dose-finding and efficacy evaluation when capping the maximum number of participants contributing to the evaluation of a treatment at 40. […] Master protocol version number v5 07 May 2020, trial is in setup with full regulatory approval and utilises several digital technology solutions, including Medidata’s Rave EDC [electronic data capture], RTSM for randomisation and patient eConsent on iPads via Rave Patient Cloud. […] The recruitment dates will vary between CSTs but at the time of writing no CSTs are yet open for recruitment. […] EudraCT 2020-001860-27 14th March 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
32560746 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may trigger severe pneumonia in coronavirus disease of 2019 (COVID-19) patients through release of damage-associated molecular patterns (DAMPs) and recruitment of neutrophils in the lungs. […] The backbones of many DAMPs and NETs are made of extracellular, cell-free DNA decorated with highly toxic compounds such as elastase, myeloperoxidase and citrullinated histones. […] Dornase alfa is a FDA-approved recombinant human DNAse 1 for the treatment of cystic fibrosis, which cleaves extracellular DNA and may break up cell-free DNA, loosening sticky mucus in the distal airways and reducing NETs-induced toxicity on alveolar pneumocytes. […] The COVIDornase trial intends to define the impact of aerosolized intra-tracheal dornase alfa administration on the severity and progression of acute respiratory distress syndrome (ARDS) in COVID-19 patients. […] This drug might make lung mucus thinner and looser, promoting improved clearance of secretions and reduce extracellular double-stranded DNA-induced hyperinflammation in alveoli, preventing further damage to the lungs. […] The study will recruit mechanically ventilated patients hospitalized in the intensive care unit (ICU) in the recruiting centres (at the time of writing: The Rothschild foundation hospital in Paris, the Strasbourg university hospitals, and Metz-Thionville hospital) who have been diagnosed with COVID-19 and meet ARDS criteria. - Adult patient (age ≥ 18 years old); - Hospitalized in ICU; - With severe COVID-19 pneumonia and ARDS according to Berlin criteria (PaO2/FiO2 < 300 and PEEP > 5 cmH2O); - Intubated for less than 8 days; - With an anticipated duration of mechanical ventilation > 48 hours; - Carrier of an arterial catheter; - For whom 4 PaO2/FiO2 values over the preceding 24 hours are available; NON-INCLUSION CRITERIA: - Known hypersensitivity to dornase alfa or any of its excipients; - Pregnant or breastfeeding status; - Patient under legal protection. […] The remainder of the management will be performed in accordance with good clinical practice, including mechanical ventilation (protective ventilation, PEEP > 5 cmH2O, tracheal balloon pressure check every 4 hours or automatic device, 30° head of the bed elevation, tidal volume 6-8mL/kg, plateau pressure < 30 cmH2O), neuromuscular blockers if necessary, prone position if PaO2/FiO2 < 150, early enteral nutrition, glycemic control and a sedation protocol based on the RASS score. […] Intervention 2, Comparator Patients will receive usual care in accordance with good practice (as detailed above), without aerosols. […] The primary outcome is the occurrence of at least one grade improvement between D0 (inclusion) and D7 in the ARDS scale severity (Berlin criteria). […] All consecutive patients meeting the inclusion criteria will be randomised 1:1 using an eCRF-based, computer-generated randomisation table, either to the dornase alfa arm or to the control arm. […] Inclusions may be stopped at the interim analysis per data safety and monitoring board (DSMB) advice, if statistical analyses conclude on the futility or efficacy of the intervention or by other DSMB decision. […] The participants and caregivers will not be blinded to study group assignment. […] Those assessing the outcomes will be blinded to study group assignment. […] Protocol version number 2, April 29th, 2020. […] The trial started recruitment on the 21st April 2020. […] The trial was registered in on 21 April 2020, updated on 8 May 2020. […] The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest in expediting dissemination of this material, the familiar formatting has been eliminated. […] This Letter serves as a summary of the key elements of the full protocol.
32560915 The first case of COVID-19 detected in Mexico was on the 27th of February 2020. […] On the 30th of April, 64 days after this first diagnosis, the number of patients had increased exponentially, reaching 19 224 confirmed cases and 1859 (9.67%) deaths. […] In response to this global outbreak, we summarize the current state of our understanding regarding COVID-19 in Mexico. […] We obtained the data from the official website of the Ministry of Health in Mexico. […] The study period was between the 27th of February and the 30th of April 2020. […] The cases were confirmed using real-time reverse transcription-polymerase chain reaction, and we analysed epidemiological, demographic and clinical data. […] The mean age of the patients was 46 years. […] Of the 12 656 confirmed cases, most infected individuals were between the ages of 30 and 59 years (65.85%), and there was a higher incidence rate in men (58.18%) than in women (41.82%). […] The patients who died had one or more comorbidities, mainly hypertension (45.53%), diabetes (39.39%) and obesity (30.4%). […] In the first 64 days of the epidemic, China had reported 80 304 cases with a mortality rate of 3.66%. […] The descriptive epidemiology shows similarities between the cases of COVID-19 in Mexico and those in China. […] In the same period of the epidemic curve, we observed a reduction in the number of confirmed cases of COVID-19 in Mexico and a higher mortality rate compared with that of China.
32561221 While certain infectious diseases have been linked to socioeconomic disadvantage, mental health problems, and lower cognitive function, relationships with COVID-19 are either uncertain or untested. […] Our objective was to examine the association of a range of psychosocial factors with hospitalisation for COVID-19. […] Hospitalisation for COVID-19 were ascertained between 16th March and 26th April 2020. […] There were 908 hospitalisations for COVID-19 in an analytical sample of 431,051 England-based study members. […] In age- and sex-adjusted analyses, an elevated risk of COVID-19 was related to disadvantaged levels of education (odds ratio; 95% confidence interval: 2.05; 1.70, 2.47), income (2.00; 1.63, 2,47), area deprivation (2.20; 1.86, 2.59), occupation (1.39; 1.14, 1.69), psychological distress (1.58; 1.32, 1.89), mental health (1.50; 1.25, 1.79), neuroticism (1.19; 1.00, 1.42), and performance on two tests of cognitive function - verbal and numerical reasoning (2.66; 2.06, 3.34) and reaction speed (1.27; 1.08, 1.51). […] These associations were graded (p-value for trend ≤0.038) such that effects were apparent across the full psychosocial continua. […] After mutual adjustment for these characteristics plus ethnicity, comorbidity, and lifestyle factors, only the relationship between lower cognitive function as measured using the reasoning test and a doubling in the risk of the infection remained (1.98; 1.38, 2.85). […] A range of psychosocial factors revealed associations with hospitalisations for COVID-19 of which the relation with cognitive function, a marker of health literacy, was most robust.
32561425 OBJETIVE: to analyze the trends of COVID-19 in Brazil in 2020 by Federal Units (FU). ecological time-series based on cumulative confirmed cases of COVID-19 from March 11 to May 12. […] Joinpoint regression models were applied to identify points of inflection in COVID-19 trends, considering the days since the 50th confirmed case as time unit. […] Brazil reached the 50th confirmed case of COVID-19 in 11 March 2020 and, 63 days after that, on May 12, 177,589 cases had been confirmed. […] The trends for all regions and FU are upward. […] In the last segment, from the 31st to the 63rd day, Brazil presented a DPC of 7.3% (95%CI= 7.2;7.5). […] For the country the ADPC was 14.2% (95%CI: 13.8;14.5). […] The highest ADPC values were found in the North, Northeast and Southeast regions. […] In summary, our results show that all FUs in Brazil present upward trends of COVID-19. […] In some FUs, the slowdown in DPC in the last segment must be considered carefully. […] Each FUs is at a different stage of the pandemic and, therefore, non-pharmacological measures must be applied accordingly.
32565626 The world is now immobilized by this infectious RNA virus. […] As of June 15, already more than 7.9 million people have been infected and 432k people died. […] This RNA virus has the ability to do the mutation in the human body. […] Accurate determination of mutation rates is essential to comprehend the evolution of this virus and to determine the risk of emergent infectious disease. […] This study explores the mutation rate of the whole genomic sequence gathered from the patient’s dataset of different countries. […] The collected dataset is processed to determine the nucleotide mutation and codon mutation separately. […] Furthermore, based on the size of the dataset, the determined mutation rate is categorized for four different regions: China, Australia, the United States, and the rest of the World. […] It has been found that a huge amount of Thymine (T) and Adenine (A) are mutated to other nucleotides for all regions, but codons are not frequently mutating like nucleotides. […] A recurrent neural network-based Long Short Term Memory (LSTM) model has been applied to predict the future mutation rate of this virus. […] The LSTM model gives Root Mean Square Error (RMSE) of 0.06 in testing and 0.04 in training, which is an optimized value. […] Using this train and testing process, the nucleotide mutation rate of 400th patient in future time has been predicted. […] It is found that this model can be used to predict day basis mutation rates if more patient data is available in updated time.
32566795 In this paper, we are studying the response of the Serbian government and health authorities to the SARS-CoV-2 pandemic in the early stage of the local outbreak between Mar. 15th and Apr. 15th, 2020 by predictive numerical models. […] Such a study should be helpful to access the effectiveness of measures conducted to suppress the pandemic at a local scale. […] We have performed extrapolation of the number of SARS-CoV-2 infections with the first stable set of data exploiting exponential growth (linear in logarithmic scale). […] Based on obtained coefficients it is performed prediction of a number of cases until the end of March. […] After initial exponential growth, we have changed predictive model to the generalized gamma function. […] Obtained results are compared with the number of infections and the prediction for the remainder of the outbreak is given. […] We have found that the daily growth rate was above 21.5% at the beginning of the period, increased slightly after the introduction of the State of Emergency and the first set of strict epidemical control measures. […] It took about 13 days after the first set of strict measures to smooth daily growth. […] It seems that early government measures had an only moderate impact to reduce growth due to the social behavior of citizens and influx of diaspora returning to Serbia from highly affected areas, i.e., the exponential growth of infected persons is kept but with a reduced slope of about 14-15%. […] Anyway, it is demonstrated that period required that any measure has effect is up to 15 days after introduction, firstly to exponential growth with a smaller rate and after to smooth function representing the number of infected persons below exponential growth rate. […] Obtained results are consistent with findings from other countries, i.e., initial exponential growth slows down within the presumed incubation period of 2 weeks after adopting lockdown and other non-pharmaceutical epidemiological measures. […] However, it is also shown that the exponential growth can continue after this period with a smaller slope. […] Therefore, quarantine and other social distancing measures should be adopted as soon as possible in a case of any similar outbreak since alternatives mean prolonged epidemical situation and growing costs in human life, pressure on the health system, economy, etc. […] For modeling the remainder of the outbreak generalized gamma function is used showing accurate results but requiring more samples and pre-processing (data filtering) concerning exponential part of the outbreak. […] We have estimated the number of infected persons for the remaining part of the outbreak until the end of June.
32567972 The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak resulted in 5,993,317 confirmed cases worldwide with 365,394 confirmed deaths (as of May 29th, 2020, WHO). […] The molecular mechanism of virus infection and spread in the body is not yet disclosed, but studies on other betacoronaviruses show that, upon cell infection, these viruses inhibit macroautophagy/autophagy flux and cause the accumulation of autophagosomes. […] No drug has yet been approved for the treatment of SARS-CoV-2 infection; however, preclinical investigations suggested repurposing of several FDA-approved drugs for clinical trials. […] Half of these drugs are modulators of the autophagy pathway. […] Unexpectedly, instead of acting by directly antagonizing the effects of viruses, these drugs appear to function by suppressing autophagy flux. […] Based on the established cross-talk between autophagy and apoptosis, we speculate that over-accumulation of autophagosomes activates an apoptotic pathway that results in apoptotic death of the infected cells and disrupts the virus replication cycle. […] However, administration of the suggested drugs are associated with severe adverse effects due to their off-target accumulation. […] Nanoparticle targeting of autophagy at the sites of interest could be a powerful tool to efficiently overcome SARS-CoV-2 infection while avoiding the common adverse effects of these drugs.
32569839 Amid the global COVID-19 crisis, South Korea has been touted for successfully preventing the spread of the infectious disease, which may be due to the aggressive implementation of preventive policies. […] We evaluated the spread pattern of COVID-19 in South Korea considering the potential impact of policy interventions on transmission rates. […] The SIR (Susceptible-Infected-Removed) model with a breakpoint that allows a change in transmission rate at an unknown point was proposed. […] Estimated trajectories of COVID-19 from SIR models with and without a breakpoint were compared. […] The proposed model with a break fitted the actual series of infection case much better than the classic model. […] The estimated breakpoint was March 7th and the transmission rate dropped by 0.23 after the breakpoint. […] A counterfactual study based on our estimate indicated that the number of the infected could reach 2,500,000 compared to the peak of 8,000 in the observed series. […] It is critical to consider a change in the transmission rate to evaluate the spread trajectory of COVID-19 in South Korea. […] Our estimation and counterfactual experiments indicate that public health interventions may play a role in determining the spread pattern of infectious diseases.
32573350 Background: The COVID-19 pandemic represents an unprecedented global challenge. […] While drastic measures within the German healthcare system and extensive restrictions of public life up to now have prevented a healthcare collapse, the current situation implicates a wide range of burden on medical professionals. […] We evaluated the perception and impact of the COVID-19 pandemic among medical professionals in Germany. Methods: A total of n=2827 medical professionals in Germany participated in an online survey between March 18th and April 11th. Results: While most participants stated that Germany was well prepared and rated the measures taken by their employer as positive, subgroup analyses revealed decisive differences. […] The preventive measures were rated significantly worse by nurses compared to doctors (p<0.001) and by participants from ambulatory healthcare centers compared to participants from maximum-care hospitals (p<0.001). […] Importantly, shortage of protective medical equipment was reported more commonly in the ambulatory sector (p<0.001) and in East German federal states (p=0.004). […] Moreover, the majority of health care professionals (72.4%) reported significant restrictions of daily work routine. […] Finally, most participants reported a negative influence on their mood (48.3%) and over 60% of medical professionals had concerns regarding their own health, which were more pronounced among female participants (p=0.024). Conclusion: This survey is the first to analyze the impact of the COVID-19 pandemic on medical professionals of both the hospital and ambulatory healthcare sector in Germany and may indicate starting points on how medical professionals could be supported in carrying out their important activities during the ongoing and future healthcare challenges.
32574334 The outbreak of COVID-19 has attracted the attention of the whole world. […] Our study aimed to describe illness progression and risk profiles for mortality in non-survivors. Methods. […] We retrospectively analyzed 155 patients with COVID-19 in Wuhan and focused on 18 non-survivors among them. […] Briefly, we compared the dynamic profile of biochemical and immune parameters and drew an epidemiological and clinical picture of disease progression from disease onset to death in non-survivors. […] The survival status of the cohort was indicated by a Kaplan-Meier curve. Results. […] Of the non-survivors, the median age was 73.5 years, and the proportion of males was 72.2%. […] The interval between disease onset and diagnosis was 8.5 days (IQR, [4-11]). […] With the deterioration of disease, most patients experienced consecutive changes in biochemical parameters, including lymphopenia, leukocytosis, thrombocytopenia, hypoproteinemia, as well as elevated D-dimer and procalcitonin. […] Regarding the immune dysregulation, patients exhibited significantly decreased T lymphocytes in the peripheral blood, including CD3+T, CD3+CD4+Th, and CD3+CD8+Tc cells. […] By the end of the disease, most patients suffered from severe complications, including ARDS (17/18; 94.4%), acute cardiac injury (10/18; 55.6%), acute kidney injury (7/18; 38.9%), shock (6/18; 33.3%), gastrointestinal bleeding (1/18; 5.6%), as well as perforation of intestine (1/18; 5.6%). […] All patients died within 45 days after the initial hospital admission with a median survivor time of 13.5 days (IQR, 8-17). Conclusions. […] Our data show that patients experienced consecutive changes in biochemical and immune parameters with the deterioration of the disease, indicating the necessity of early intervention.
32574693 Coronavirus disease 2019 (COVID-19) represents a major pandemic threat that has spread to more than 212 countries and 2 international conveyance with more than 432,902 recorded deaths and 7,898,442 confirmed global worldwide so far (on June 14, 2020). […] It is crucial to investigate the spatial drivers to prevent and control the epidemic of COVID-19. […] This is the first comprehensive study of COVID-19 in Iran and it undertakes spatial modeling, risk mapping, change detection, and outbreak trend analysis of the disease spread. […] Four main steps were taken: comparison of Iranian coronavirus data with the global trends; prediction of mortality trends using regression modelling; spatial modelling, risk mapping, and change detection using the random forest (RF) machine learning technique (MLT); and validation of the modelled risk map. […] The results show that from February 19 to June 14, 2020 the average growth rates (GR) of COVID-19 deaths and the total number of COVID-19 cases in Iran were 1.08 and 1.10, respectively. […] Based on World Health Organisation (WHO) data, Iran’s fatality (deaths/0.1 M pop) is 10.53. […] Other countries’ fatality rates were, for comparison, Belgium - 83.32, UK - 61.39, Spain - 58.04, Italy - 56.73, Sweden - 48.28, France - 45.04, USA - 35.52, Canada - 21.49, Brazil - 20.10, Peru - 19.70, Chile - 16.20, Mexico- 12.80, and Germany - 10.58. […] This fatality rate for China is 0.32 (deaths/0.1 M pop). […] The heatmap of the infected areas over time identified two critical time intervals for the COVID-19 outbreak in Iran. […] The provinces were classified in terms of disease and death rates into a large primary group and three provinces that had critical outbreaks that were separate from others. […] The heatmap of countries of the world show that China and Italy were distinguished from other countries in terms of nine viral infection-related parameters. […] The regression models for death cases showed an increasing trend but with some evidences of turning. […] In addition, a third-degree polynomial regression model for deaths showed an increasing trend recently, indicating that subsequent measures taken to cope with the outbreak have been insufficient and ineffective. […] The general trend of deaths in Iran is similar to the worlds, but it shows lower volatility. […] Change detection of COVID-19 risk maps with a random forest model for the period from March 11th to March 18th showed an increasing trend in COVID-19 in Iran’s provinces. […] It is worth noting that using the LASSO MLT to evaluate variables’ importance indicated that the most important variables were distance from bus stations, bakeries, hospitals, mosques, ATMs (automated teller machines), banks, and the minimum temperature of the coldest month. […] We believe that the risk maps provided by this study is the primary, fundamental step for managing and controlling COVID-19 in Iran and its provinces.
32574702 Globally, there have been many cases of COVID-2019 cases among medical staff, however, the main factors associated with the infection are not well understood. […] To identify the super-factors causing COVID-19 infection in medical staff in China. […] A cross-sectional study was conducted between Jan. 1st, and Feb. 30th, 2020, where front line members of medical staff that took part in the care and treatment of patients with COVID-19 were enrolled. […] In all participant groups, the super-factor identified by the network was wearing a medical protective mask or surgical mask correctly (degree = 572; closeness =25; betweenness centrality = 3·23). […] Touching the cheek, nose, and mouth while working was the super-factor in the infected group. […] This was the biggest node in the network and had the strongest influence (degree = 370; closeness = 29; betweenness centrality = 0·37). […] Self-protection score was the super-factor in the uninfected group but was the isolated factor in the infected group (degree = 201; closeness = 28; betweenness centrality = 5·64). […] For family members, the exposure history to Huanan Seafood Wholesale Market and the contact history to wild animals were two isolated nodes. […] High self-protection score was the main factor that prevented medical staff from contracting COVID-19 infection. […] The main factor that contributed to COVID-19 infections among medical staff was touching the cheek, nose and mouth while working.
32579076 BACKGROUND With the rapid global spread of the acute respiratory syndrome coronavirus 2, urgent health-care measures have been implemented. […] We describe the organizational process in setting up a coronavirus disease 2019 triage unit in a Swiss tertiary care hospital. […] METHODS Our triage unit was set-up outside of the main hospital building and consists of three areas: 1. […] The Pre-triage check-points identify any potential COVID-19-infected patients and re-direct them to the main Triage area where trained medical staff screen which patients undergo diagnostic testing. […] If patients require further investigations, they are referred to Triage plus. […] At this stage, patients are then discharged home after additional testing or admitted to the hospital for management. […] OBSERVATIONS A total of 1,265 patients were screened between March 10th 2020 and April 12th 2020 at our Triage unit. […] Of these, 112 (8.9%) tested positive. 73 (65%) of the positively-tested patients were female and 39 (35%) were male. […] The mean age for all patients was 43.8 years (SD 16.3 years). […] Distinguishing between genders, mean age for females was 41.1 (SD 16.5) and mean age for males was 48.6 (SD 14.9), with females being significantly younger than males (p<0.001). […] We hope that our experience will help other health care institutions develop similar triage systems.
32582309 To analyze Chest X-ray findings in COVID 19 positive patients, presented at corona filtration center, Benazir Bhutto Hospital Rawalpindi, based on CXR classification of British Society of Thoracic Imaging (BSTI). […] In this study, all RT-PCR COVID-19 positive patients screened at corona filtration center, Benazir Bhutto hospital Rawalpindi from 20th March 2020 to 10th April 2020 were included. […] Mean age of the cohort with age range was calculated. […] Mean age of the patients was 44 years. […] Presenting complaints were cough 20 (67%), fever 18 (60%), shortness of breath 11 (37%), sore throat six (20%), loss of sense of taste and smell four(13%). […] Two (7%) patients had normal and seven (23%) had classical COVID CXRs. 21 (70%) patients were in indeterminate group with only one (3%) having unilateral lung disease. […] Three (10%) patients had diffuse lung involvement and 18(60%) had peripheral lung involvement. […] In this study, COVID-19 CXRs generally manifested a spectrum of pure ground glass, mixed ground glass opacities to consolidation in bilateral peripheral middle and lower lung zones. […] BSTI CXR reporting classification of COVID-19 is valid in our patients with addition of middle zonal involvement in classical COVID-19 criteria as opposed to just lower zone involvement.
32585074 On March 11th , 2020, the World Health Organization (WHO) has declared the novel coronavirus disease (COVID-19) a global pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). […] A consistent number of case reports and clinical series have been already published describing a complex spectrum of skin manifestations associated with the SARS-CoV-2 infection. […] We carried out a review of the English-language literature up to May 20th 2020, reporting original cases or case series of the cutaneous manifestations of SARS-CoV-2 virus infection. […] The following databases were consulted PubMed, Embase, Google Scholar, ResearchGate. […] The search of papers was conducted by using the key term ‘COVID-19’ or ‘SARS-CoV-2’ or ‘coronavirus’ combined with each of the following: ‘skin’, ‘cutaneous’, ‘dermatologic’ or ‘dermatology’, ‘manifestation’, ‘lesions,’ or ‘rash.’ […] The patterns of dermatological manifestations associated with SARS-CoV-2 infection could be classified into four categories: exanthema (varicella-like, papulo-vesicular and morbilliform rash), vascular (chilblain-like, purpuric/petechial and livedoid lesions), urticarial and acro-papular eruption. […] Lastly, other skin manifestations to be considered are the cutaneous adverse reactions to the drugs prescribed for the treatment of COVID-19. […] Whether SARS-CoV-2 infection can directly cause a worsening of chronic inflammatory diseases such as psoriasis or atopic dermatitis remains to be determined. […] Dermatology’s outlook in the COVID-19 pandemic is multidimensional.
32585284 To evaluate the therapeutic use of plasma exchange in COVID-19 patients compared to controls. […] Case series of critically ill adult men and non-pregnant women, ≥18 years of age, with laboratory confirmed COVID-19, was conducted at the Royal Hospital, Oman, from April 17th to May 11th, 2020. […] Therapeutic plasma exchange (TPE) was performed on patients admitted to intensive care unit (ICU) with confirmed or imminent acute respiratory distress syndrome (ARDS) or severe pneumonia. […] A total of 31 COVID-19 patients were included with an overall mean age of 51 ± 15 years (range: 27-76 years), 90% (n = 28) were males, and 35% (n = 11) of the patients had TPE as a mode of treatment. […] The TPE group was associated with higher extubation rates than the non-TPE cohort (73% versus 20%; p = 0.018). […] However, all-cause mortality was only marginally lower in the TPE group compared to the non-TPE group (9.1% versus 45%; p = 0.055; power = 66%). […] Laboratory and ventilatory parameters also improved with the TPE. […] The use of TPE in severe COVID-19 patients has been associated with improved outcomes, however, randomized controlled clinical trials are warranted to draw final conclusive findings.
32585767 A 35-year-old woman with no significant previous medical history presented at the Emergency Department of Fundación Jiménez Díaz Hospital (Madrid, Spain) on April 14th with acral purpuric lesions of three weeks duration. […] These had started as oedematous, erythematous areas and had appeared coincidentally with fever and coughing, which lasted only two days. […] There was no history of diarrhoea, ageusia, hyposmia or dyspnea. […] The patient stated that the skin of her feet acquired a bluish discoloration after standing for some time.
32586395 Primary Objective: The primary objective is to reduce initiation of mechanical ventilator dependency in patients with moderate to severe CoViD- 19. […] This will be measured as the difference between the control group and active group for subjects admitted to the hospital for CoViD-19. […] Secondary Objectives: • To evaluate cytokine trends / Prevent cytokine storms • To evaluate supplemental oxygen requirements • To decrease mortality of CoViD-19 patients • Delay onset of ventilation TRIAL DESIGN: The study is a single centre, 2-arm, prospective, randomized (ratio 1:1), controlled trial with parallel groups design to compare the reduction of respiratory distress in a CoViD-19 population, using the intervention of the gammaCore®-Sapphire device plus standard of care (active) vs. standard of care alone (SoC) - the control group. […] The gammaCore® treatments will be used acutely and prophylactically. […] The active and control groups will be matched for disease and severity. i. […] Inclusion Criteria The subjects have to meet all of the following criteria to be eligible to enter the trial: 1. […] Patient older than 18 years2. […] Been tested positive or suspected/presumed positive for CoViD-19 Has a cough, shortness of breath or respiratory O2 Saturation less than or equal to 92% without need for mechanical ventilation or acute respiratory failure 3. […] Agree to use the gammaCore®-Sapphire device as intended and to follow all of the requirements of the study including recording required study data4. […] Exclusion Criteria Subjects meeting any of the following criteria cannot be included in this research study: 1. […] On home/therapy oxygen (i.e. for patients with Chronic Obstructive Pulmonary Disease) at baseline prior to development of CoViD-193. […] Patient already enrolled in a clinical trial using immunotherapeutic regimen for CoViD-194. […] Known or suspected severe atherosclerotic cardiovascular disease, severe carotid artery disease (eg, bruits or history of transient ischemic attack or cerebrovascular accident), congestive heart failure, known severe coronary artery disease, or recent myocardial infarction6. […] Current implantation of an electrical and/or neurostimulator device, including but not limited to a cardiac pacemaker or defibrillator, vagal neurostimulator, deep brain stimulator, spinal stimulator, bone growth stimulator, or cochlear implant8. […] Current implantation of metal cervical spine hardware or a metallic implant near the gammaCore stimulation site9. […] Belongs to a vulnerable population or has any condition such that his or her ability to provide informed consent, comply with the follow-up requirements, or provide self-assessments is compromised (e.g. homeless, developmentally disabled and prisoner) Participants will be recruited from Hospital Clínico Universitario de Valencia in Spain. […] Intervention: Prophylactic: Administer 2 doses (at 2 minutes each) of gammaCore®-Sapphire, one dose on each side of the neck scheduled three times a day (morning, mid-day and 1 hour before bed at night). […] Acute respiratory failure or shortness of breath: Administer 2 doses (at 2 minutes each) of gammaCore®-Sapphire, one on each side of the neck. […] If shortness of breath (SOB) persists 20 minutes after the start of the first treatment, a second dose will be administered. […] Max doses per day is 9 or 18 stimulations.Plus standard of care Control: Standard of care: oxygen therapy, antibiotics and ventilatory support if necessary depending on the clinic MAIN OUTCOMES: Primary Endpoint: Initiation of mechanical ventilation, from randomization until ICU admission or hospital discharge, whatever occurs first Secondary Endpoints: Safety; ascertainment of Adverse Effects/Serious Adverse Events, from randomisation to ICU admission or hospital discharge, whatever occurs firstCytokine Storm measured by: Tumor necrosis factor α, Interleukin 6, Interleukin 1β. […] Days 1,3,5,10,15 and/or at hospital dischargeMortality and/or need for Critical Care admission, from randomisation until ICU admission or hospital discharge, whatever occurs first,O2 saturation levels , from randomization until ICU admission or hospital discharge, whatever occurs firstNeed for supplemental oxygen, from randomisation until ICU admission or hospital discharge, whatever occurs first RANDOMISATION: The patients are classified according to their oxygen levels as mild, moderate and severe and randomized according to their classification to the intervention and control in a ratio of 1:1. […] The randomization will be stratified for gender and age. […] This is an open label study, it is not possible to blind the participants and healthcare providers to the intervention. […] The total number of patients to be included in the study is 90, with 45 in each study group TRIAL STATUS: The protocol version is 8.0 from 07th April 2020. […] The recruitment began 20th April 2020 and is expected to be complete 31st July 2020. […] The study is registered in on 29th April 2020 with the identification number: NCT04368156 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
32586399 Tissue hypoxia is the main cause of multi-organ dysfunction in sepsis. […] Emerging experimental and clinical evidence reveals an evolutionary conserved action of thyroid hormone (TH) to adapt injured tissue to hypoxic conditions via its action on p38 MAPK, Akt signaling pathways. […] In addition, TH has favorable effects on the immune system and viral load in infected tissue. […] Non-Thyroid Illness Syndrome is common in sepsis, acute myocardial infarction and trauma and is associated with increased mortality. […] Thus, TH may be a novel treatment in the setting of critical illness due to viral infection in which hypoxia prevails. […] The present study aims to address the efficacy and safety of acute administration of triiodothyronine (T3) in critically ill COVID-19 infected patients requiring mechanical respiratory support or Extra Corporeal Membrane Oxygenation (ECMO). […] This study is a phase II, parallel, 2-arm (1:1 ratio), multi-centre, prospective, randomized, double-blind, placebo controlled trial. […] Male and female patients aged over 18 years old who are diagnosed with pulmonary infection due to COVID-19, admitted to Intensive Care Unit and requiring mechanical ventilation or ECMO will be enrolled in this trial. […] Patients will be excluded in cases of pregnancy, severe systemic disease with life expectancy less than 6 months, participation in another trial of an investigational drug or device, corticosteroid and/or sympathomimetic use before initiation of treatment. […] Participants will start to be recruited from the ICU center of “ATTIKO” University Hospital in Greece. […] We aim to include two more clinical sites in the trial one from Greece and one from Germany INTERVENTION AND COMPARATOR: Intervention: T3 Solution for injection 10 μg/ml. […] The dose administered will be 0.8g/kg i.v. bolus and will be followed by an infusion of 0.113g. kg-1.h-1 i.v. for 48 hours (therapeutic dose). […] After the first 48h, a maintenance dose will be administered corresponding to 50% of the therapeutic dose (0.057g. kg-1.h-1 i.v.). […] Comparator: Placebo with composition and dosage identical apart from the active substance. […] The primary outcome assessed in the present study will be the percentage of patients successfully weaned after 30 days of follow-up. […] An allocation sequence to one of the groups will be prepared by the Sponsor of the study. […] The representative of the sponsor will get a copy of randomization codes. […] The information of the randomization codes will then be locked in the database until the time at which an interim analysis or final analysis is performed. […] Participants, caregivers, and all investigators assessing the outcomes will be blinded to group assignment. […] The sample size of 60 patients (that indicates 30 subjects for each group) will have 84% power to detect the estimated difference between the two study groups. […] The criterion for significance (alpha) has been set at 0.05 and the test is 2-tailed. […] Protocol number T3inj-02/ThySupport, version 03, May 11, 2020. […] The trial is not recruiting yet. […] The trial will start recruitment June 18th 2020. […] Estimated recruitment will finish June 18th, 2021. […] Triiodothyronine for the Treatment of Critically Ill Patients With COVID-19 Infection (Thy-Support), Identifier: NCT04348513, date of trial registration: April 16, 2020, EudraCT Identifier: 2020-001623-13, date of trial registration: April 22, 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). […] In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
32587176 To assess the perspectives of physicians in general and ophthalmologists in particular about restarting elective out-patient (OP) and operating (OT) services after relaxation of lockdown for COVID-19. […] The survey was open for 48 hours from 16th-18th April 2020. […] Responses were received from 556 physicians (including 266 ophthalmologists). […] About a third (n = 205) wanted to start OP immediately after lockdown. […] Ophthalmologists were more likely to start immediately after lockdown compared to other specialists (P = 0.004). […] 40.5% felt additional personal protective equipment (PPE) is not required and 33.1% felt that full PPE is required for everyone in OT. […] Ophthalmic surgeons preferred 3-ply masks and were less inclined to use full PPE (P < 0.001). […] Perspectives of doctors vary, especially with regarding to timing of restarting services and precautions to be taken in the OT. […] Ophthalmologists may tend to err on the side of taking lesser stringent precautions when restarting services post lockdown.
32587902 Background: This systematic review had three aims: i) to determine the frequency of anosmia (or other smell disorders) and dysgeusia (or other taste disorders) in COVID-19 patients; ii) to determine whether anosmia or dysgeusia are independently associated with COVID-19 diagnosis; and iii) to determine whether anosmia or dysgeusia are prognostic factors for impaired outcomes among COVID-19 patients. Methods: On April 20 th, 2020, we search MEDLINE, Embase, Global Health, Scopus, Web of Science and MedXriv. […] We included studies with COVID-19 patients describing their symptoms; studies that compared smell and taste disorders between COVID-19 patients and otherwise healthy subjects; and studies comparing smell and taste disorders between COVID-19 severe and mild/moderate cases. […] Because of methodological heterogeneity and the limited number of results, a qualitative synthesis is presented. Results: From 31 reports, we selected six (n=2,757). […] Six studies reported the proportion of smell and taste disorders among COVID-19 patients. […] Two reports studied whether smell and taste disorders were independently associated with COVID-19 diagnosis. […] No reports studied the association with impaired outcomes among COVID-19 patients. […] The frequency of anosmia ranged between 22%-68%. […] The definition of taste disorders varied greatly, with dysgeusia present in 33% and ageusia in 20%. […] People who reported loss of smell and taste had six-fold higher odds of being COVID-19 positive; similarly, anosmia and ageusia were associated with 10-fold higher odds of COVID-19 diagnosis. Conclusions: The frequency of smell and taste disorders is as high as other symptoms, thus, at least anosmia for which the definition was more consistent, could be included in lists of COVID-19 symptoms. […] Although there is promising evidence, it is premature to conclude that smell and taste disorders are strongly associated with COVID-19 diagnosis. Registration: PROSPERO CRD42020181308.
32588427 Association between Hydroxychloroquine (HCQ) and Azithromycin (AZT) is under evaluation for patients with lower respiratory tract infection (LRTI) caused by the Severe Acute Respiratory Syndrome (SARS-CoV-2). […] Both drugs have a known torsadogenic potential, but sparse data are available concerning QT prolongation induced by this association. […] Before therapy initiation, a baseline 12 lead-ECG was electronically sent to our cardiology department for automated and manual QT analysis (Bazett and Fridericia’s correction), repeated 2 days after initiation. […] From March 24th to April 20th 2020, 73 patients were included (mean age 62 ± 14 y, male 67 %). […] Baseline average automated QTc was 415 ± 29 ms and lengthened to 438 ± 40 ms after 48 hours of combined therapy. […] The treatment had to be stopped because of significant QTc prolongation in 2 out of 71 patients (2.8 %). […] No drug-induced life-threatening arrhythmia, nor death was observed. […] Automated QTc measurements revealed accurate in comparison with manual QTc measurements. […] In this specific population of inpatients with COVID-19 LRTI, HCQ/AZT could not be initiated or had to be interrupted in less than 6% of the cases.
32589293 Skin manifestations have been increasingly reported in the setting of COVID-19. […] However, their incidence and presentation are debated, and the role, direct or undirect, of SARS-CoV-2 in their pathogenesis has yet to be determined. […] In this work, we aimed to analyze our experience in a French referral center and to perform a systematic review of the literature to evaluate the incidence and prognosis of cutaneous lesions observed in COVID-19 patients. […] Cutaneous manifestations were assessed in COVID-19 patients admitted to Cochin Hospital (Paris, France) between March 16th and April 27th 2020. 759 confirmed moderate-to-severe COVID-19 cases were diagnosed in our institution. […] Eight patients (1%, 6 males, 2 females, mean age 55.6) presented with skin lesions, mainly disseminated maculo-papular exanthema, but also digitate papulo-squamous rash (reported in1 ), herpes recurrence, papulo-vesicular rash and Grover’s disease. […] The mean delay between respiratory/systemic and dermatological signs was 13 days.
32592080 The COVID-19 pandemic has had an unprecedented effect upon the National Health Service (NHS). […] Like other specialties, Interventional Radiology (IR) rapidly adapted to the evolving situation. […] Members of BSIR were surveyed to obtain a snapshot of the experiences of UK IRs in response to COVID-19. […] An electronic survey was compiled using Google Forms, approved by the BSIR Council Officers and distributed to BSIR members by email on 18 th April 2020. […] The survey was open for a 14-day period and the data analysed in Microsoft Excel 365. […] The response rate was 29% (228/800). […] Two thirds of respondents work in a Tertiary unit and 33% deliver IR in a District Hospital. 84% have a day-case facility. […] After the COVID-19 crisis, 81% of respondents were able to maintain 24-7 On-call service. 59% of respondents had been required change their day to day practice to allow the on-call service to continue. 55% of respondents were involved in providing a central line service. […] Of those questioned, 91% continued to offer endovascular services, 98% genitourinary and 92% hepatobiliary services, although a degree of service reduction was described. 38% have provided IR trainees with additional training material during this pandemic. […] This survey has confirmed that the responses of UK IR departments to the COVID-19 crisis have ensured vital on-call and urgent services have continued, including ongoing availability of most IR sub-specialties. […] Availability of a day case facility has possibly influenced the positive response.
32593224 Coronavirus Disease 2019 (COVID-19) pandemic has overwhelmed and disrupted healthcare systems including dermatology services. […] National directives were issued to reduce patient footfall within hospitals in anticipation of a deluge of COVID-19 admissions. […] We conducted a survey focusing on the impact of the pandemic upon Mohs micrographic surgery (MMS) practices and invited all British Society for Dermatological Surgery (BSDS) members undertaking MMS to complete over three weeks commencing 27th April 2020.
32611651 A few weeks after the peak of the global 2019 novel coronavirus disease pandemic, cases of shock, multisystem inflammation and severe myocarditis have occurred in children and adolescents, generating some concerns and above all many questions. […] An almost immediate association raised with shock syndrome related to Kawasaki disease (KD). […] However, in light of bo/th experience and literature have taught us about severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, and what already known on the epidemiology of KD, we suggest here the hypothesis of a new ‘post-viral’ systemic inflammatory disease related to excessive adaptive immune response rather than a form of KD caused by SARS-COV-2. […] We discuss analogies and differences between the two forms.
32679620 Biotinylated peptide amphiphile (Biotin-PA) nanofibers, are designed as a noncovalent binding location for antigens, which are adjuvants to enhance, accelerate, and prolong the immune response triggered by antigens. […] Presenting antigens on synthetic Biotin-PA nanofibers generated a higher immune response than the free antigens delivered with a cytosine-phosphate-guanine oligodeoxynucleotides (CpG ODN) (TLR9 agonist) adjuvant. […] Antigen attached Biotin-PA nanofibers trigger splenocytes to produce high levels of cytokines (IFN-γ, IL-12, TNF-α, and IL-6) and to exhibit a superior cross-presentation of the antigen. […] Both Biotin-PA nanofibers and CpG ODN induce a Th-1-biased IgG subclass response; however, delivering the antigen with Biotin-PA nanofibers induce significantly greater production of total IgG and subclasses of IgG compared to delivering the antigen with CpG ODN. […] Contrary to CpG ODN, Biotin-PA nanofibers also enhance antigen-specific splenocyte proliferation and increase the proportion of the antigen-specific CD8(+) T cells. […] Given their biodegradability and biocompatibility, Biotin-PA nanofibers have a significant potential in immunoengineering applications as a biomaterial for the delivery of a diverse set of antigens derived from intracellular pathogens, emerging viral diseases such as COVID-19, or cancer cells to induce humoral and cellular immune responses against the antigens.
32699972 Children with Coronavirus Disease 2019 (COVID-19) were reported to show milder symptoms and better prognosis than their adult counterparts, but the difference of immune response against SARS-CoV-2 between children and adults hasn’t been reported. […] Therefore we initiated this study to figure out the features of immune response in children with COVID-19. […] Sera and whole blood cells from 19 children with COVID-19 during different phases after disease onset were collected. […] The cytokine concentrations, SARS-CoV-2 S-RBD or N-specific antibodies and T cell immune responses were detected respectively. […] In children with COVID-19, only 3 of 12 cytokines were increased in acute sera, including interferon (IFN)-γ-induced protein 10 (IP10), interleukin (IL)-10 and IL-16. […] We observed an increase in T helper (Th)-2 cells and a suppression in regulatory T cells (Treg) in patients during acute phase, but no significant response was found in the IFN-γ-producing or tumor necrosis factor (TNF)-α-producing CD8+ T cells in patients. […] Children with COVID-19 displayed an immunophenotype that is less inflammatory than adults, including unremarkable cytokine elevation, moderate CD4+ T cell response and inactive CD8+ T cell response, but their humoral immunity against SARS-CoV-2 were as strong as adults. […] Our finding presented immunological characteristics of children with COVID-19 and might give some clues as to why children develop less severe disease than adults.
32753362 Discontinuation of IVF cycles has been part of the radical transformation of healthcare provision to enable reallocation of staff and resources to deal with the COVID-19 pandemic. […] This study sought to estimate the impact of cessation of treatment on individual prognosis and US population live birth rates. […] Data from 271,438 ovarian stimulation UK IVF cycles was used to model the effect of age as a continuous, yet non-linear, function on cumulative live birth rate. […] This model was recalibrated to cumulative live birth rates reported for the 135,673 stimulation cycles undertaken in the USA in 2016, with live birth follow-up to October 2018. […] The effect of a 1-month, 3-month and 6-month shutdown in IVF treatment was calculated as the effect of the equivalent increase in a woman’s age, stratified by age group. […] The average reduction in cumulative live birth rate would be 0.3% (95% confidence interval [CI] 0.3-0.3), 0.8% (95% CI 0.8-0.8) and 1.6% (95% CI 1.6-1.6) for 1-month, 3-month and 6-month shutdowns. […] This corresponds to a reduction of 369 (95% CI 360-378), 1098 (95% CI 1071-1123) and 2166 (95% CI 2116-2216) live births in the cohort, respectively. […] Th e greatest contribution to this reduction was from older mothers. […] The study demonstrated that the discontinuation of fertility treatment for even 1 month in the USA could result in 369 fewer women having a live birth, due to the increase in patients’ age during the shutdown. […] As a result of reductions in cumulative live birth rate, more cycles may be required to overcome infertility at individual and population levels.
32794180 Interleukin (IL)-18 is a pro-inflammatory cytokine belonging to the IL-1 family, first identified for its interferon-γ-inducing properties. […] IL-18 regulates both T helper (Th) 1 and Th2 responses. […] It acts synergistically with IL-12 in the Th1 paradigm, whereas with IL-2 and without IL-12 it can induce Th2 cytokine production from cluster of differentation (CD)4+ T cells, natural killer (NK cells, NKT cells, as well as from Th1 cells. […] IL-18 also plays a role in the hemophagocytic lymphohistiocytosis, a life-threatening condition characterized by a cytokine storm that can be secondary to infections. […] These studies highlight the contribution of either IL-18 overproduction by the host or overresponsiveness of the host to IL-18 causing an exaggerated inflammatory burden and leading to tissue injury. […] Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19). […] The damage in the later phase of the disease appears to be driven by a cytokine storm, including interleukin IL-1 family members and secondary cytokines like IL-6. […] IL-18 may participate in this hyperinflammation, as it was previously found to be able to cause injury in the lung tissue of infected animals. […] IL-18 blockade has become an appealing therapeutic target and has been tested in some IL-18-mediated rheumatic diseases and infantile-onset macrophage activation syndrome. […] Given its role in regulating the immune response to infections, IL-18 blockade might represent a therapeutic option for COVID-19, although further studies are warranted to investigate more in detail the exact role of IL-18 in SARS-CoV-2 infection.
32832851 Public interest in this disease has led to the publication of thousands of articles in the medical literature in a very short timeframe. […] It is imperative that medical research into COVID-19 is conducted quickly and safely, and that due reference is given to the ethical considerations enshrined in the ICH GCP guidelines, according to the Declaration of Helsinki. […] In order to review the reporting of ethical considerations in these papers, we hereby propose a protocol for a systematic review of COVID-19 papers up to April 14 th 2020. […] The search criteria proposed for the review are based upon what would be a reasonable search conducted by a lay member of the public with access to […] Institutional Research Ethics Committees (RECs) face significant challenges in providing thorough and timely ethical review during the COVID-19 pandemic. […] It is proposed to publish the findings of this rapid review along with a summary of an institutional REC response to the challenges of reviewing and approving clinical research proposals in the time of a pandemic.
32838091 Coronavirus (COVID-19) has continued to be a global threat to public health. […] As the matter of fact, it needs unreserved effort to monitor the prevalence of the virus. […] However, applying an effective prediction of the prevalence is thought to be the fundamental requirement to effectively control the spreading rate. […] Time series models have extensively been considered as the convenient methods to predict the prevalence or spreading rate of the disease. […] This study, therefore, aimed to apply the Autoregressive Integrated Moving Average (ARIMA) modeling approach for projecting coronavirus (COVID-19) prevalence patterns in East Africa Countries, mainly Ethiopia, Djibouti, Sudan and Somalia. […] The data for the study were obtained from the reports of confirmed COVID-19 cases by the official website of Johns Hopkins University from 13th March, 2020 to 30th June, 2020. […] The results of the study, then, showed that in the coming four month, the number of COVID-19 positive people in Ethiopia may reach up to 56,610 from 5,846 on June 30, 2020 in average-rate scenario. […] However, in worst case scenario forecast, the model showed that the cases will be around 84,497. […] The analysis further depicted that with average interventions and control scenario, cumulative number of infected persons in Djibouti, Somalia and Sudan will increase from 4,656, 2,904 and 9,258 respectively at the end of June to 8,336, 3,961 and 21,388, which is by the end of October, 2020, after four-months. […] But, with insufficient intervention, the number of infected persons may grow quickly and reach up to 14,072, 10,037 and 38,174 in Djibouti, Somalia and Sudan respectively. […] Generally, the extent of the coronavirus spreading was increased from time to time in the past four month, until 30 th June, 2020, and it is expected to continue quicker than before for the coming 4-month, until the end of October, 2020, in Ethiopia, Djibouti, Somalia, and Sudan and more rapidly than before in Sudan and Ethiopia, while the peak will remain unknown yet. […] Therefore, an effective implementation of the preventive measures and a rigorous compliance by avoiding negligence with the rules such as prohibiting public gatherings, travel restrictions, personal protection measures, and social distancing may alleviate the spreading rates of the virus, particularly, Sudan and Ethiopia. […] Moreover, more efforts should be exerted on Ethiopian side to control the population movement across all the border areas and to strengthen border quarantining. […] Further, through updating more new data with continuous reconsideration of predictive model, provide useful and more precise prediction.
32843150 To compare the activity the Urology Department of a Portuguese Academic Hospital during the state of emergency and the equivalent period at the previous year. […] We compared the number of elective consultations and diagnostic urologic examinations, number and type of elective surgeries, as well as patients’ demographic characteristics and main causes of presentation to Urology Emergency Department (ED) during the two mentioned periods MATERIALS AND METHODS: Data from 691 patients coming to emergency department were collected from institutional clinical software from March 18 th 2020 to May 2 nd 2020 - and from the same period the previous year. […] Data collected were age, sex, day of the presentation to Emergency Department, referral from other hospitals, triage color, reason of admission, diagnosis of discharge, and the need for emergency surgery or hospitalization. […] In order to identify associations between demographic and clinical variables with having been submitted to an emergency surgery (outcome), logistic regression models were applied. […] Multivariable analysis showed an association of sex with being submitted to surgery, 65.6% decrease in the odds for the male gender. […] The period (COVID versus non-COVID) did not show a significant association with surgery. […] We also observe a reduction in urgent causes to attend the ED considered less serious. […] The percentage of cases requiring emergency surgery and hospitalization was higher during COVID-period.
32870735 VDD among African-Americans, diabetics, hypertensive, and aged populations possibly explain the higher death rate, aggravated by cocooning. […] Vitamin D is pleiotropic, mediating bone metabolism, calcium homeostasis, and immune functions, whereas VDD is associated with inflammatory reactions and immune dysfunction, predisposing individuals to severe infections. […] Vitamin D modulates innate and adaptive immunity via the expression of genes that code antimicrobial peptides (AMPs). […] And the expression of cluster of differentiation (CD)14, the co-receptor for epidermal toll-like receptor (TLR)4. […] AMPs stimulate TLR2 in macrophages, increasing the conversion of vitamin D into its active form by cytochrome P450 27B1. […] Antiviral properties of vitamin D-induced AMPs can shift the polarization of the adaptive immune response from helper T cells (Th)1 to the more regulatory Th2 responses that suppress immune over-reactivity by preventing cytokine storm, which is already demonstrated during the Spanish flu episode. […] Vitamin D induces antiviral effects by both direct and indirect mechanisms via AMPs, immunomodulation, the interplay between major cellular and viral elements, induction of autophagy and apoptosis, variation of genetic and epigenetic factors. […] The crosstalk between vitamin D and intracellular signaling pathways may operate as a primary regulatory action on viral gene transcription. […] VDD may increase the likelihood of infection with enveloped viruses, including retrovirus, hepatitis, and dengue. […] Global data correlates severe VDD with COVID-19 associated coagulopathy, disrupted immune response and mortality, reduced platelet count, and prolonged prothrombin time, suggesting benefits from supplementation. […] Global data correlates severe VDD with COVID-19 associated coagulopathy, disrupted immune response and mortality, reduced platelet count, and prolonged prothrombin time, together suggesting benefits from supplementation. […] Many clinical trials are underway globally to delineate the role of vitamin D in both prevention and treatment of COVID-19.
32904944 Regulation of immune function continues to be one of the most well recognised extra-skeletal actions of vitamin D. […] This stemmed initially from the discovery that antigen presenting cells such as macrophages could actively metabolise precursor 25-hydroxyvitamin D (25D) to active 1,25-dihydroxyvitamin D (1,25D). […] Parallel observation that activated cells from the immune system expressed the intracellular vitamin D receptor (VDR) for 1,25D suggested a potential role for vitamin D as a localised endogenous modulator of immune function. […] Subsequent studies have expanded our understanding of how vitamin D exerts effects on both the innate and adaptive arms of the immune system. […] At an innate level, intracrine synthesis of 1,25D by macrophages and dendritic cells (DC) stimulates expression of antimicrobial proteins such as cathelicidin, as well as lowering intracellular iron concentrations via suppression of hepcidin. […] By potently enhancing autophagy, 1,25D may also play an important role in combatting intracellular pathogens such as M. tuberculosis and viral infections. […] Local synthesis of 1,25D by macrophages and DC also appears to play a pivotal role in mediating T cell responses to vitamin D, leading to suppression of inflammatory T helper (Th)1 and Th17 cells, and concomitant induction of immunotolerogenic T regulatory (Treg) responses. […] The aim of this review is to provide an update on our current understanding of these prominent immune actions of vitamin D, as well as highlighting new, less well-recognised immune effects of vitamin D. […] The review also aims to place this mechanistic basis for the link between vitamin D and immunity with studies in vivo that have explored a role for vitamin D supplementation as a strategy for improved immune health. […] This has gained prominence in recent months with the global COVID-19 health crisis and highlights important new objectives for future studies of vitamin D and immune function. […] This article is protected by copyright.
32921216 Coronavirus disease 2019 (COVID-19) has the characteristics of high transmission, diverse clinical manifestations, and a long incubation period. […] In addition to infecting the respiratory system, COVID-19 also has adverse effects on the cardiovascular system. […] COVID-19 causes acute myocardial injuries, as well as chronic damage to the cardiovascular system. […] The present review is aimed at providing current information on COVID-19 and the cardiovascular system. […] It is suggested that heart injury caused by COVID-19 infection might be an important cause of severe clinical phenotypes or adverse events in affected patients. […] Myocardial damage is closely related to the severity of the disease and even the prognosis in patients with COVID-19. […] In addition to disorders that are caused by COVID-19 on the cardiovascular system, more protection should be employed for patients with preexisting cardiovascular disease (CVD). […] Hence, it is very important that once relevant symptoms appear, patients with COVID-19 be rapidly treated to reduce mortality. […] Thus, early measurements of cardiac damage via biomarkers following hospitalization for COVID-19 infections in a patient with preexisting CVD are recommended, together with careful monitoring of any myocardial injury that might be caused by the infection. […] Abbreviations: ICU: An intensive care unit; 2019-nCoV: 2019 novel coronavirus; ACEI: ACE inhibitor; ACS: Acute coronary syndrome; ARDS: Acute respiratory distress syndrome; AT1R: Ang II type 1 receptor; ATP: Adenosine triphosphate; ACC: American College of Cardiology; ACE: Angiotensin converting enzyme; Ang II: Angiotensin II; ARB: Angiotensin II receptor blocker; AV block: Atrioventricular block; CAD: Coronary artery disease; CVD: Cardiovascular disease; CT: Computerized tomography; CHF: Congestive heart failure; CHD: Coronary heart disease; CK-MB: Creatine kinase isoenzyme-MB; CRP: C-reactive protein; cTnI: Cardiac troponin I; EAT: Epicardial adipose tissue; ECMO: Extracorporeal membrane oxygenation; FDA: Food and Drug Administration; G-CSF: Granulocyte colony-stimulating factor; HFrEF: HF with a reduced ejection fraction; synhACE2: Human isoform of ACE2; IL: Interleukin; IABP: Intra-aortic balloon counterpulsation; IP10: Interferon γ-induced protein 10 kDa; LPC: Lysophosphatidylcholine; Mas: Mitochondrial assembly receptor; MCP1: Monocyte chemoattractant protein-1; MERS: Middle East respiratory syndrome; MIP1a: macrophage inflammatory protein 1a: MOF: Multiple organ failure; MI: Myocardial infarction; MRI: Magnetic resonance imaging; MYO: Myohe-moglobin; NT-proBNP: N-terminal pro-brain natriuretic peptide; PCPS: Percutaneous cardiopulmonary assistance; rhACE2: Recombinant human ACE2; SARS: Severe acute respiratory syndrome; Th: T helper; RAS: Renin-angiotensin system; TNF-α: Tumor necrosis factor-α; WHO: World Health Organization.
32942077 During the lockdown period, the fear about the risk of infection in hospital has reduced the admission to Emergency Services (ES) with possible negative health effects. […] We have investigated the changes in the emergency flow occurred during SARS-CoV-2 pandemic in an obstetrics and gynecological ES and the short-term adverse outcomes on women’s and reproductive health. […] The study was conducted in the OBGYN ES of the Clinica Mangiagalli, the largest maternity clinic of Milan, Lombardy, Northern Italy. […] We analyzed retrospectively the records of all women consecutively admitted at the ES from February 23rd to June 24th 2019, and compared them with the admissions during the lockdown executive order from February 23rd to June 23rd, 2020. […] Patients were assessed in terms of demographic features, presentation times, triage classification (urgent/not urgent), reason for admission and outcome of the visit (discharge/admission to the ward). […] Categorical variables were compared by the chi-square test calculating the p value and computed were percentage changes (with 95 % Confidence interval, CI). […] During the period February 24 th - May 31 th 2020 the admissions at the ES decreased by 35.4 % (95 % CI-34.1-36.6) compared with the corresponding period in 2019. […] The reduction was more marked for gynecological complaints (-63.5 %, 95 %CI -60.5 to -66.5): in particular we observed a reduction of admissions for genital infection/cystitis of 75.7 % (95 %CI -71.4 to -80.1). […] The admission for complaints associated with pregnancy decreased by 28.5 % (95 %CI -27.2 to-29.9). […] In the index period, five fetal deaths were diagnosed compared with one observed in the reference period in 2019 (chi square computed using as denominator all observed pregnancies = 4.29, p = 0.04). […] The frequency of admission for elective caesarean section/labor induction increased from 47.5 % in 2019 to 53.6 % in 2020: this difference was statistically significant. […] The lockdown negatively influenced ES admissions and consequently the women’s/reproductive health. […] As possible short-term consequences, we observed an increase of intrauterine deaths and a decrease of natural births.
32970753 Wuhan, China was the epicenter of the 2019 coronavirus outbreak. […] With the COVID-19 becoming a pandemic all over the world, we aim to share our epidemiological and clinical findings with the global community. […] We studied 340 confirmed COVID-19 patients with clear clinical outcomes from Wuhan Pulmonary Hospital, including 310 discharged cases and 30 death cases. […] We analyzed their demographic, epidemiological, clinical and laboratory data and implemented our findings into an interactive, free access web application to evaluate COVID-19 patient’s severity level. […] Our results show that baseline T cell subsets results differed significantly between the discharged cases and the death cases in Mann Whitney U test: Total T cells (p < 0.001), Helper T cells (p <0.001), Suppressor T cells (p <0.001), and TH/TSC (Helper/Suppressor ratio, p<0.001). […] Multivariate logistic regression model with death or discharge as the outcome resulted in the following significant predictors: age (OR 1.05, 95% CI, 1.00 to 1.10), underlying disease status (OR 3.42, 95% CI, 1.30 to 9.95), Helper T cells on the log scale (OR 0.22, 95% CI, 0.12 to 0.40), and TH/TSC on the log scale (OR 4.80, 95% CI, 2.12 to 11.86). […] The AUC for the logistic regression model is 0.90 (95% CI, 0.84 to 0.95), suggesting the model has a very good predictive power. […] Our findings suggest that while age and underlying diseases are known risk factors for poor prognosis, patients with a less damaged immune system at the time of hospitalization had higher chance of recovery. […] Close monitoring of the T cell subsets might provide valuable information of the patient’s condition change during the treatment process. […] Our web visualization application can be used as a supplementary tool for the evaluation.
32974109 The outbreak of coronavirus disease 2019 (COVID-19) that occurred in Wuhan, China, has become a global public health threat. […] It is necessary to identify indicators that can be used as optimal predictors for clinical outcomes of COVID-19 patients. […] The clinical information from 126 patients diagnosed with COVID-19 were collected from Wuhan Fourth Hospital. […] A random forest (RF) algorithm was used to predict the prognoses of COVID-19 patients and identify the optimal diagnostic predictors for patients’ clinical prognoses. […] Seven of the 126 patients were excluded for losing endpoints, 103 of the remaining 119 patients were discharged (alive) and 16 died in the hospital. […] A synthetic minority over-sampling technique (SMOTE) was used to correct the imbalanced distribution of clinical patients. […] Recursive feature elimination (RFE) was used to select the optimal subset for analysis. […] Eleven clinical parameters, Myo, CD8, age, LDH, LMR, CD45, Th/Ts, dyspnea, NLR, D-Dimer and CK were chosen with AUC approximately 0.9905. […] The RF algorithm was built to predict the prognoses of COVID-19 patients based on the best subset, and the area under the ROC curve (AUC) of the test data was 100%. […] Moreover, two optimal clinical risk predictors, lactate dehydrogenase (LDH) and Myoglobin (Myo), were selected based on the Gini index. […] The univariable logistic analysis revealed a substantial increase in the risk for in-hospital mortality when Myo was higher than 80 ng/ml (OR = 7.54, 95% CI [3.42-16.63]) and LDH was higher than 500 U/L (OR = 4.90, 95% CI [2.13-11.25]). […] We applied an RF algorithm to predict the mortality of COVID-19 patients with high accuracy and identified LDH higher than 500 U/L and Myo higher than 80 ng/ml to be potential risk factors for the prognoses of COVID-19 patients in the early stage of the disease.
32984549 Emerging highly transmissible viral infections such as SARS-CoV-2 pose a significant global threat to human health and the economy. […] Since its first appearance in December 2019 in the city of Wuhan, Hubei province, China, SARS-CoV-2 infection has quickly spread across the globe, with the first case reported on the African continent, in Egypt on February 14 th, 2020. […] Although the global number of COVID-19 infections has increased exponentially since the beginning of the pandemic, the number of new infections and deaths recorded in African countries have been relatively modest, suggesting slower transmission dynamics of the virus on the continent, a lower case fatality rate, or simply a lack of testing or reliable data. […] Notably, there is no significant increase in unexplained pneumonias or deaths on the continent which could possibly indicate the effectiveness of interventions introduced by several African governments. […] However, there has not yet been a comprehensive assessment of sub-Saharan Africa’s (SSA) preparedness and response to the COVID-19 pandemic that may have contributed to prevent an uncontrolled outbreak so far. […] As a group of early career scientists and the next generation of African scientific leaders with experience of working in medical and diverse health research fields in both SSA and resource-rich countries, we present a unique perspective on the current public health interventions to fight COVID-19 in Africa. […] Our perspective is based on extensive review of the available scientific publications, official technical reports and announcements released by governmental and non-governmental health organizations as well as from our personal experiences as workers on the COVID-19 battlefield in SSA. […] We documented public health interventions implemented in seven SSA countries including Uganda, Kenya, Rwanda, Cameroon, Zambia, South Africa and Botswana, the existing gaps and the important components of disease control that may strengthen SSA response to future outbreaks.
32984666 COVID-19 is still a major pandemic threatening all the world. […] In Palestine, there were 26,764 COVID-19 cumulative confirmed cases as of 27th August 2020. […] In this paper, two statistical approaches, autoregressive integrated moving average (ARIMA) and k-th moving averages - ARIMA models are used for modeling the COVID-19 cumulative confirmed cases in Palestine. […] The data was taken from World Health Organization (WHO) website for one hundred seventy-six (176) days, from March 5, 2020 through August 27, 2020. […] We identified the best models for the above mentioned approaches that are ARIMA (1,2,4) and 5-th Exponential Weighted Moving Average - ARIMA (2,2,3). […] Consequently, we recommended to use the 5-th Exponential Weighted Moving Average - ARIMA (2,2,3) model in order to forecast new values of the daily cumulative confirmed cases in Palestine. […] The forecast values are alarming, and giving the Palestinian government a good picture about the next number of COVID-19 cumulative confirmed cases to review her activities and interventions and to provide some robust structures and measures to avoid these challenges.
32986819 Health-care workers (HCWs) could be at increased occupational risk for SARS-CoV-2 infection. […] Here, we aimed to explore prevalence of SARS-CoV-2, symptoms, and risk factors associated with adverse outcomes in HCWs in Mexico City. […] We explored data collected by the National Epidemiological Surveillance System in Mexico City. […] We explored outcomes related to severe COVID-19 in HCWs and the diagnostic performance of symptoms to detect SARS-CoV-2 infection in HCWs. […] As of July 5 th, 2020, 35,095 HCWs were tested for SARS-CoV-2 and 11,226 were confirmed (31.9%). […] Overall, 4,322 were nurses (38.5%), 3,324 physicians (29.6%), 131 dentists (1.16%) and 3,449 laboratory personnel and other HCWs (30.8%). […] Lethality was recorded in 226 (2.01%) cases. […] Symptoms associated with SARS-CoV-2 positivity were fever, cough, malaise, shivering, myalgias at evaluation but neither had significant predictive value. […] Older HCWs with chronic non-communicable diseases, pregnancy, and severe respiratory symptoms were associated with higher risk for adverse outcomes. […] Physicians had higher risk for hospitalization and for severe outcomes compared with nurses and other HCWs. […] No symptomatology can accurately discern HCWs with SARS-CoV-2 infection. […] Particular attention should focus on HCWs with risk factors to prevent adverse outcomes and reduce infection risk.
32995559 The Avon Longitudinal Study of Parents and Children (ALSPAC) is a prospective population-based cohort study which recruited pregnant women in 1990-1992 and has followed these women, their partners and their offspring ever since. […] The study reacted rapidly to the coronavirus disease 2019 (COVID-19) pandemic, deploying an online questionnaire early on during lockdown (from 9 th April to 15 th May). […] In late May 2020, a second questionnaire was developed asking about physical and mental health, lifestyle and behaviours, employment and finances. […] The online questionnaire was deployed across the parent and offspring generations between the 26th May and 5 th July 2020. 6482 participants completed the questionnaire (2639 original mothers, 1039 original fathers/partners, 2711 offspring (mean age ~28 years) and 93 partners of offspring). 1039 new participants who did not respond to the first questionnaire deployed in April completed the second questionnaire. […] A positive COVID-19 test was reported by 36 (0.6%) participants (12 G0 and 24 G1), 91 (1.4%; 35 G0 and 56 G1) reported that they had been told by a doctor they likely had COVID-19 and 838 (13%; 422 G0 and 416 G1) suspected that they have had COVID-19. […] The observational data from both COVID questionnaires will be complemented with linkage to health records and results of biological testing as they become available. […] In combination, these data may help us identify true cases. […] Data has been released as an update to the original dataset released in May 2020. […] It comprises: 1) a standard dataset containing all participant responses to both questionnaires with key sociodemographic factors and 2) as a composite release coordinating data from the existing resource, thus enabling bespoke research across all areas supported by the study. […] This data note describes the second questionnaire and the data obtained from it.
32997739 Severe coronavirus disease 2019 (COVID-19) frequently entails complications that bear similarities to autoimmune diseases. […] To date, there is little data on possible IgA-mediated autoimmune responses. […] Here, we aim to determine whether COVID-19 is associated with a vigorous total IgA response and if IgA antibodies are associated with complications of severe illness. […] Since thrombotic events are frequent in severe COVID-19 and resemble hypercoagulation of antiphospholipid syndrome (APS), our approach focused on antiphospholipid antibodies (aPL). […] In this retrospective cohort study clinical data and aPL from 64 patients with COVID-19 were compared from three independent tertiary hospitals (one in Liechtenstein, two in Switzerland). […] Samples were collected from April 9 th to May 1 st, 2020. […] Clinical records of 64 patients with COVID-19 were reviewed and divided into a cohort with mild illness (mCOVID) (41%), a discovery cohort with severe illness (sdCOVID) (22%) and a confirmation cohort with severe illness (scCOVID) (38%). […] Total IgA, IgG and aPL were measured with clinical diagnostic kits. […] Severe illness was significantly associated with increased total IgA (sdCOVID, P=0.01; scCOVID, p-value<0.001), but not total IgG. […] Among aPL, both cohorts with severe illness significantly correlated with elevated anti-Cardiolipin IgA (sdCOVID and scCOVID, p-value<0.001), anti-Cardiolipin IgM (sdCOVID, P=0.003; scCOVID, P<0.001), and anti-Beta2 Glycoprotein-1 IgA (sdCOVID and scCOVID, P<0.001). […] Systemic lupus erythematosus was excluded from all patients as a potential confounder. […] Higher total IgA and IgA-aPL were consistently associated with severe illness. […] These novel data strongly suggest that a vigorous antiviral IgA-response, possibly triggered in the bronchial mucosa, induces systemic autoimmunity.
33015540 The virus subsequently spread to most countries worldwide and the World Health Organisation characterised the outbreak a pandemic on March 11 th 2020 (WHO, 2020a). […] Older age is associated with an increased risk of mortality in patients with COVID-19 (Chen et al., 2020). […] In March 2020, the Irish Government introduced ‘cocooning’ as a measure for those over 70 years of age to minimise interactions with others by not leaving their homes (Dept. of Health, 2020). […] The COVID-19 pandemic presents unique threats to the health and well-being of older adults. […] This study aims to explore the longitudinal experiences and beliefs of older adults during the COVID-19 pandemic. […] Findings will be important for tailoring supports, interventions and public health information for this population. […] Methods: A longitudinal exploratory qualitative study will be conducted using repeated semi-structured telephone interviews with a convenient sample of older adults recruited from participants of an older adult and family carer stakeholder panel for health services research established by the Ageing Research Centre (ARC) at the University of Limerick and through known older adult contacts of ARC academic members. […] Interviews will be audio recorded, transcribed and analysed using a reflexive approach to thematic analysis. […] Participants will have the opportunity to review and discuss preliminary analysis of the interview data and to co-write / design dissemination materials. […] Ethics and Dissemination: Ethical approval has been granted by the Faculty of Education and Health Sciences University of Limerick, Research Ethics Committee (2020_03_51_EHS (ER)). […] Findings will be disseminated through open access journal publications and distribution of lay summaries, a press release and an infographic to organisations of and for older people in Ireland, broadcast and print media.
33023916 COVID-19 raised tension both within China and internationally. […] Here, we used mathematical modeling to predict the trend of patient diagnosis outside China in future, with the aim of easing anxiety regarding the emergent situation. […] According to all diagnosis number from WHO website and combining with the transmission mode of infectious diseases, the mathematical model was fitted to predict future trend of outbreak. […] The data used for this analysis were collected from January 21, 2020 and currently end at February 28, 2020. […] A simple regression model was developed based on these numbers, as follows: [Formula: see text], where [Formula: see text] is the total diagnosed patient till the i-th day and t=1 at February 1, 2020. […] Based on this model, we estimate that there were approximately 34 undetected founder patients at the beginning of the spread of COVID-19 outside China. […] The global trend was approximately exponential, with an increase rate of 10-fold every 19 days. […] Through establishment of this model, we call for worldwide strong public health actions, with reference to the experiences learned from China and Singapore.
33043110 Stimulation and generation of T and B cell-mediated long-term immune response are essential for the curbing of a deadly virus such as SAR-CoV-2 (Severe Acute Respiratory Corona Virus 2). […] Immunoinformatics approach in vaccine design takes advantage of antigenic and non-allergenic epitopes present on the spike glycoprotein of SARS-CoV-2 to elicit immune responses. […] T cells and B cells epitopes were predicted, and the selected residues were subjected to allergenicity, antigenicity and toxicity screening which were linked by appropriate linkers to form a multi-epitope subunit vaccine. […] The physiochemical properties of the vaccine construct were analyzed, and the molecular weight, molecular formula, theoretical isoelectric point value, half-life, solubility score, instability index, aliphatic index and GRAVY were predicted. […] The vaccine structure was constructed, refined, validated, and disulfide engineered to get the best model. […] Molecular binding simulation and molecular dynamics simulation were carried out to predict the stability and binding affinity of the vaccine construct with TLRs. […] Codon acclimatization and in silico cloning were performed to confirm the vaccine expression and potency. […] Results obtained indicated that this novel vaccine candidate is non-toxic, capable of initiating the immunogenic response and will not induce an allergic reaction. […] The highest binding energy was observed in TLR4 (Toll-like Receptor 4) (-1398.1), and the least is TLR 2 (-1479.6). […] The steady rise in Th (T-helper) cell population with memory development was noticed, and IFN-g (Interferon gamma) was provoked after simulation. […] At this point, the vaccine candidate awaits animal trial to validate its efficacy and safety for use in the prevention of the novel COVID-19 (Coronavirus Disease 2019) infections.
33062720 Furthermore, CQ blocks the production of prostaglandins (PGs) in the intact cell by inhibiting substrate accessibility of arachidonic acid necessary for the production of PGs. […] Moreover, CQ affects the stability between T-helper cell (Th) 1 and Th2 cytokine secretion by augmenting IL-10 production in peripheral blood mononuclear cells (PBMCs). […] Also, HCQ inhibits cytokine generation from all the B-cell subsets. […] IgM memory B-cells exhibits the utmost cytokine production. […] Nevertheless, CQ triggers the production of reactive oxygen species. […] Thus, in critically ill patients, CQ and HCQ are most likely to deplete all the energy stores of the body leaving the patient very weak and sicker. […] We advocate that, during clinical usage of CQ and HCQ in critically ill patients, it is very essential to strengthen the CQ or HCQ with glucose infusion. […] CQ and HCQ are thus potential inhibitors of the COVID-19 cytokine storm.
33068090 There is a global crisis which has been led by COVID-19. […] The patients undergoingdental procedures and dental professionals are at higher risk of contracting this disease owing toaerosols generated and a lot of face to face contact during the procedures. […] The aim of this study was to know the perceptions of dental students of COMS-TH regarding future of dentistry in Nepal amidCOVID-19 pandemic. […] The present cross-sectional descriptive study was conducted at COMS-TH, Bharatpur by sending an online e-survey questionnaire to 146 dental students out of which 99 responded. […] The e-survey questionnaire consisted of three parts which consisted of questions about demographics, knowledge about COVID-19 and their perceptions about future of dentistry. […] The results of the study depicted that most of the students thought dentistry is good and noble profession and will recommend it to young medical aspirants. […] Most of them wanted to pursue post graduation courses in future giving preference to Oral and Maxillofacial Surgery. […] The study concluded that most of the dental students were satisfied with dentistry as their profession and wanted National Dental Association to fix the minimum charges of each dental procedure. […] Also there is a need to start more post graduation courses in existing institutions providing dental education as most of the students want to pursue it in future.
33072093 Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2) induced Coronavirus Disease - 19 (COVID-19) cases have been increasing at an alarming rate (7.4 million positive cases as on June 11 2020), causing high mortality (4,17,956 deaths as on June 11 2020) and economic loss (a 3.2% shrink in global economy in 2020) across 212 countries globally. […] The clinical manifestations of this disease are pneumonia, lung injury, inflammation, and severe acute respiratory syndrome (SARS). […] Currently, there is no vaccine or effective pharmacological agents available for the prevention/treatment of SARS-CoV2 infections. […] Moreover, development of a suitable vaccine is a challenging task due to antibody-dependent enhancement (ADE) and Th-2 immunopathology, which aggravates infection with SARS-CoV-2. […] Furthermore, the emerging SARS-CoV-2 strain exhibits several distinct genomic and structural patterns compared to other coronavirus strains, making the development of a suitable vaccine even more difficult. […] Therefore, the identification of novel small molecule inhibitors (NSMIs) that can interfere with viral entry or viral propagation is of special interest and is vital in managing already infected cases. […] SARS-CoV-2 infection is mediated by the binding of viral Spike proteins (S-protein) to human cells through a 2-step process, which involves Angiotensin Converting Enzyme-2 (ACE2) and Transmembrane Serine Protease (TMPRSS)-2. […] Therefore, the development of novel inhibitors of ACE2/TMPRSS2 is likely to be beneficial in combating SARS-CoV-2 infections. […] However, the usage of ACE-2 inhibitors to block the SARS-CoV-2 viral entry requires additional studies as there are conflicting findings and severe health complications reported for these inhibitors in patients. […] Hence, the current interest is shifted toward the development of NSMIs, which includes natural antiviral phytochemicals and Nrf-2 activators to manage a SARS-CoV-2 infection. […] It is imperative to investigate the efficacy of existing antiviral phytochemicals and Nrf-2 activators to mitigate the SARS-CoV-2-mediated oxidative stress. […] Therefore, in this review, we have reviewed structural features of SARS-CoV-2 with special emphasis on key molecular targets and their known modulators that can be considered for the development of NSMIs.
33107280 COVID-19 has quickly become a worldwide threat to health, travel, and commerce. […] Studies adressing the clinical-functional presentation of viral infection and physiotherapy management in children are scarce. […] The purpose statement was to provide current perspectives on the physiotherapy interventions for managing children based on COVID-19 evidences. […] In this review, databases were searched between 1th January and 26 th March 2020. […] The following descriptors were considered: (novel coronavirus); (novel corona virus); Coronavirus; (corona vírus); 2019-nCoV; nCovor; COVID-19; SARSCoV-2; in the electronic databases National Library of Medicine (PubMed/Medline), Scientific Electronic Library Online (SciELO) and Physiotherapy Evidence Database (PEDro). […] The results were described through the International Classification of Functioning, Disability and Health. 16 papers were included in this review. […] Effective oxygen therapy should be given immediately in presence of hypoxia. […] Nasal high-flow oxygen therapy, non-invasive ventilation, lung-protective ventilation strategies and prone position, should be undertaken when necessary under appropriate conditions. […] Potential physiotherapy interventions for children with COVID-19/SARS-CoV-2 consist on ventilatory management, airway clearance techniques and early activities and mobilization.
33119065 An outbreak of COVID-19 in a nursing home in the Netherlands, following an on-site church service held on March 8 th, 2020, triggered an investigation to unravel sources and chain(s) of transmission. […] Epidemiological data were collected from registries and through a questionnaire among church attendees. […] Symptomatic residents and healthcare workers (HCWs) were tested for SARS-CoV-2 by RT-PCR and subjected to whole genome sequencing (WGS). […] Sequences from a selection of people from the same area were included as community reference. […] After the church service, 30 of 39 attendees (77%) developed symptoms; 14 were tested and were positive for COVID-19 (11 residents and 3 non-residents). […] In the following five weeks, 62 of 300 residents (21%) and 30 of 640 HCWs (5%) tested positive for COVID-19; 21 of 62 residents (34%) died. […] The outbreak was controlled through a cascade of measures. […] Seven resident church attendees all were infected with distinct viruses, four of which belonged to two larger clusters in the nursing home. […] Although initial investigation suggested the church service as source of the outbreak, detailed analysis showed a more complex picture, most consistent with widespread regional circulation of the virus in the weeks before the outbreak, and multiple introductions into the nursing home before the visitor ban. […] The findings underscore the importance of careful outbreak investigations to understand SARS-CoV-2 transmission to develop evidence-based mitigation measures.
33129694 The prediction of COVID-19 disease behavior in the early phase of infection is challenging but urgently needed. […] MuLBSTA score is a scoring system that predicts the mortality of viral pneumonia induced by a variety of viruses, including coronavirus, but the scoring system has not been verified in novel coronavirus pneumonia. […] The aim of this study was to validate this scoring system for estimating the risk of disease worsening in patients with COVID-19. […] This study included the patients who were treated between April 1 st and March 13 th , 2020. […] The patients were classified into mild, moderate, and severe groups according to the extent of respiratory failure. […] MuLBSTA score was applied to estimate the risk of disease worsening in each severity group and we validated the utility of the scoring system. […] Among the 46 patients with mild disease, 17 showed disease progression to moderate or severe disease after admission. […] The model showed a sensitivity of 100% and a specificity of only 34.5% with a cut-off value of 5 points. […] Among the 55 patients with mild or moderate disease, 6 deteriorated to severe disease, and the model showed a sensitivity of 83.3% and a specificity of 71.4% with a cut-off value of 11 points. […] This study showed that MuLBSTA score is a potentially useful tool for predicting COVID-19 disease behavior. […] This scoring system may be used as one of the criteria to identify high-risk patients worsening to life-threatening status.
33179020 As COVID-19 unprecedented situation significantly increased the time families spend indoors, the awareness of unhealthy living conditions negatively impacting immune system and early neurodevelopment of children is of crucial importance. […] We retrospectively reviewed unrelated cases of the children with confirmed multiple indoor allergen sensitization due to prolonged exposure to unhealthy indoor environment with infestation and water damage, who, in addition to multiple health problems related to allergy and asthma, also developed neuroimmune complications and growth delay. molds were found in all homes and sensitization was confirmed in all cases. […] Significant similarities in the symptoms recorded in all three families led us to a hypothesis that, likely, a significant level of the immune response to external immunogenic pathological stimulus such as mold spore protein, mycotoxin protein, dust mite protein, decay-related volatile particles (VOC) skewed a balance of the neuroimmune interactions, and further affected neuronal network establishment. […] As all children exhibited significant spectrum of the systemic inflammatory conditions early in life, coupled with inability to follow normal neurodevelopment, we hypothesize that an overwhelming activation of the aggressive immune mechanisms by the epigenetic factors led to glia activation, cytokine storm and break of tolerance. […] We hypothesize that developing immune system exhibited aggressive responses due to environmental danger signals, subsequently TH-1 or TH-2 switch enables multiple clinical syndromes development with atypical presentation due to the described novel mechanism. […] An increased due to the COVID-19 lock-down may increase an amount of exposure of vulnerable people to indoor biological particles and volatile organic compounds present in unhealthy buildings. […] It is of crucial importance to identify and remediate indoor exposure factors that can decrease immune protection, especially against infectious pathogens such as novel coronavirus.
33196843 Telehealth (TH) practices among pediatric infectious disease specialists prior to the coronavirus disease 2019 (COVID-19) pandemic are largely unknown. […] In 2019, the Pediatric Infectious Diseases Society (PIDS) Telehealth Working Group surveyed PIDS members to collect data on the use of TH modalities, adoption barriers, interest, extent of curbside consultations (CC), and reimbursement. […] Of 1,213 PIDS members, 161 (13.3%) completed the survey, and the responses of 154 (12.7%) from the US were included in our report. […] Medical school (63.6%) and hospital (44.8%) were the commonest work settings with 16.9% practicing in both of them. […] The most common TH modalities used were synchronous provider-patient virtual visits (20.8%) and synchronous provider-provider consultations (13.6%). […] TH services included outpatient consultations (48.1%), vaccine recommendations (43.5%), inpatient consultations (39.6%) and travel advice (39.6%). […] Barriers perceived by respondents included reimbursement (55.8%), lack of experience with TH (55.2%), lack of institutional support (52.6%), lack of administrative support (50%), and cost of implementation (48.7%). […] Most respondents (144, 93.5%) were interested in implementing a wide range of TH modalities. […] Most of the PIDS survey respondents reported low utilization of TH and several perceived barriers to TH adoption before the COVID-19 pandemic. […] Nonetheless, they expressed a strong interest in adopting different TH modalities. […] They also reported spending considerable time on non-reimbursed CCs from within and outside their institutions. […] Results of this survey provide baseline information that will allow comparisons with post-COVID-19 changes in the adoption of TH in PID.
33242703 Covid-19 pandemic, starting from Wuhan, China spread all over the world and Italy was one of the most affected countries, especially in Lombardy, where, on February 20, the first confirmed case was detected. […] Italian Government ordered a national lockdown on the 9 th March 2020, forcing the population to severe restrictive isolation measures. […] The burden on mental health of the medical emergency related to COVID19 is progressively been revealed. […] Takotsubo syndrome (TTS), is estimated to represent 1-3% of patients admitted with suspected STEMI, mostly affecting elderly women with emotional stress and/or acute illness preceding the presentation. […] Comparing patients hospitalised from February to May 2020 with those of the corresponding period in 2019 we observed a significantly increased number of TTS diagnosis in 2020 (11 patients vs 3 in 2019), especially during the first period of lockdown. […] The only two males were patients with COVID-19 and were the only two who died in hospital. […] At psychological examination all patients enrolled report to have lived a particularly stressful experience at IES-R in the last year, without presenting the symptoms of a post-traumatic stress disorder. […] Most patients were positive to the allostatic overload. […] Only one patient showed a clinical cut-off for HADS and no one for the Fear COVID-19 scale. […] We finally concluded that subjects with pre-pandemic psychological distress may have experienced additional psychological overload, opening the door to TTS by a series of physiological alterations as the secretion of cortisol and catecholamines, making the subject more vulnerable to the onset of TTS.
33249484 While risk of outdoor transmission of respiratory viral infections is hypothesized to be low, there is limited data of SARS-CoV-2 transmission in outdoor compared to indoor settings. […] We conducted a systematic review of peer-reviewed papers indexed in PubMed, EMBASE and Web of Science and pre-prints in Europe PMC through August 12 th, 2020 that described cases of human transmission of SARS-CoV-2. […] Reports of other respiratory virus transmission were included for reference. […] Five identified studies found that a low proportion of reported global SARS-CoV-2 infections have occurred outdoors (<10%) and the odds of indoor transmission was very high compared to outdoors (18.7 times; 95% CI 6.0, 57.9). […] There was high heterogeneity in study quality and individual definitions of outdoor settings which limited our ability to draw conclusions about outdoor transmission risks. […] In general, factors such as duration and frequency of personal contact, lack of personal protective equipment and occasional indoor gathering during a largely outdoor experience were associated with outdoor reports of infection. […] Existing evidence supports the wide-held belief that the the risk of SARS-CoV-2 transmission is lower outdoors but there are significant gaps in our understanding of specific pathways.
33252665 In this longitudinal study we present symptoms registered during the acute phase as well as long COVID, i.e. long-lasting COVID-19 symptoms, in patients from the Faroe Islands. […] All consecutive patients with confirmed RT-PCR testing from April to June 2020 were invited to participate in this study for the assessment of long COVID. […] Demographic and clinical characteristics and self-reported acute and persistent symptoms were assessed using a standardized detailed questionnaire administered at enrollment and at repeated phone interviews in the period 22 th April to Aug 16 th. […] Of the 180 participants (96.3% of the 187 eligible COVID-19 patients), 53.1% reported persistence of at least one symptom after a mean of 125 days after symptoms onset, 33.3% reported one or two symptoms and 19.4% three or more symptoms. […] At the last follow-up, 46.7% were asymptomatic compared with 4.4 % during the acute phase. […] The most prevalent persistent symptoms were fatigue, loss of smell and taste, and arthralgias. […] Our results show that it might take months for symptoms to resolve, even among non-hospitalized persons with mild illness course in the acute phase.
33301216 Psoriasis is a chronic immune-mediated disease characterized by inflammation of skin (psoriasis) or joints (psoriatic arthritis) or both, resulting from a dysregulation in particular of the T helper (Th)17 functions. […] There is no available cure for psoriasis, and a life-long treatment is needed to control signs and symptoms. […] Research interest is high around the newest biological drugs approved for the treatment of moderate to severe psoriasis and psoriatic arthritis, and especially drugs blocking the IL-23/IL-17 axis. […] Our aim is to review the new biological drugs for the treatment of psoriasis and their adverse effects, focusing on the risk of infections.
33324414 The severity of SARS-CoV-2 infection has been related to uncontrolled inflammatory innate responses and impaired adaptive immune responses mostly due to exhausted T lymphocytes and lymphopenia. […] In this work we have characterized the nature of the lymphopenia and demonstrate a set of factors that hinder the effective control of virus infection and the activation and arming of effector cytotoxic T CD8 cells and showing signatures defining a high-risk population. […] We performed immune profiling of the T helper (Th) CD4+ and T CD8+ cell compartments in peripheral blood of 144 COVID-19 patients using multiparametric flow cytometry analysis. […] On the one hand, there was a consistent lymphopenia with an overrepresentation of non-functional T cells, with an increased percentage of naive Th cells (CD45RA+, CXCR3-, CCR4-, CCR6-, CCR10-) and persistently low frequency of markers associated with Th1, Th17, and Th1/Th17 memory-effector T cells compared to healthy donors. […] On the other hand, the most profound alteration affected the Th1 subset, which may explain the poor T cells responses and the persistent blood virus load. […] Finally, the decrease in Th1 cells may also explain the low frequency of CD4+ and CD8+ T cells that express the HLA-DR and CD38 activation markers observed in numerous patients who showed minimal or no lymphocyte activation response. […] We also identified the percentage of HLA-DR+CD4+ T cells, PD-1+CD+4/CD8+ T cells in blood, and the neutrophil/lymphocyte ratio as useful factors for predicting critical illness and fatal outcome in patients with confirmed COVID-19.
33354152 Since the beginning of the coronavirus disease (COVID-19) pandemic, the responses of countries to emerging infectious diseases have altered dramatically, increasing the demand for health-care practitioners. […] Telehealth (TH) applications could have an important role in supporting public health precautions and the control of the spread of the COVID-19 pandemic. […] This review summarizes the existing literature on the current status of TH applications used during COVID-19 in Saudi Arabia and discusses the extent to which TH can support public health measures. […] TH mobile applications (e.g., Seha, Mawid, Tawakklna, Tabaud, and Tetamman) have found effective tools to facilitate delivering healthcare to persons with COVID-19, and tracking of COVID-19 patients. […] TH has been essential in the control of the spread of COVID-19 and has helped to flatten the growth curve in Saudi Arabia. […] Further research is needed to explore the impact of TH applications on the progression of COVID-19 in Saudi Arabia.
33367625 The COVID-19 pandemic has brought with it many challenges in the field of healthcare around the world. […] Managing burn patients has its own challenges as they require a long duration of care and are more susceptible to infection. […] We conducted a retrospective observational study from 30 th January to 15 th July 2020 at our centre to study the epidemiology of burns treated & patients and healthcare workers affected by COVID-19 during this period. […] The number of burn admissions showed a 42.6% reduction as compared to last year. […] A total of 17 patients (3.67%) and 29 health care workers (8.68%) tested positive for COVID-19 in the burns department. […] Our strategy underwent changes based on the changing dynamics of COVID-19 and changes in government and institutional policies. […] We have described the various challenges we faced in managing burns during this time. […] We found that effective screening of patients and healthcare workers, proper segregation of negative and positive/ suspect population and a low threshold for COVID-19 testing were essential to mitigate transmission of infection.
33372280 In novel coronavirus disease 2019 (COVID-19), the increased frequency and overactivation of T helper (Th) 17 cells and subsequent production of large amounts of proinflammatory cytokines result in hyperinflammation and disease progression. […] The current study aimed to investigate the therapeutic effects of nanocurcumin on the frequency and responses of Th17 cells in mild and severe COVID-19 patients. […] In this study, 40 severe COVID-19 intensive care unit-admitted patients and 40 patients in mild condition were included. […] The frequency of Th17 cells, the messenger RNA expression of Th17 cell-related factors (RAR-related orphan receptor γt, interleukin [IL]-17, IL-21, IL-23, and granulocyte-macrophage colony-stimulating factor), and the serum levels of cytokines were measured in both nanocurcumin and placebo-treated groups before and after treatment. […] A significant decrease in the number of Th17 cells, downregulation of Th17 cell-related factors, and decreased levels of Th17 cell-related cytokines were found in mild and severe COVID-19 patients treated by nanocurcumin compared to the placebo group. […] Moreover, the abovementioned parameters were significantly decreased in the nanocurcumin-treated group after treatment versus before treatment. […] Curcumin could reduce the frequency of Th17 cells and their related inflammatory factors in both mild and severe COVID-19 patients. […] Hence, it could be considered as a potential modulatory compound in improving the patient’s inflammatory condition.
33376956 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viruses spread unscrupulously virtually every corner on the planet in a very quick speed leading to an unprecedented world pandemic of COVID-19 claiming a great many of people’s life. […] Paramount importance has been given to the studies on the virus itself including genomic variation and viron structure, as well as cell entry pathway and tissue residence. […] Other than that, to learn the main characteristic of host immunity responding to SARS-CoV-2 infection is an eminent task for restraining virus and controlling disease progress. […] In this review, we summarized the recent knowledge regarding the aberrant regulation and dysfunction of multiple immune cells during SARS-CoV-2 infection. […] This includes the dysregulation of immune cell number, Th polarity, cytokine storm they implicated with, as well as cell function exhaustion after chronic virus stimulation. […] Notwithstanding that many obstacles remain to be overcome, studies on immunotherapy for COVID-19 treatment based on the known features of host immunity in response to SARS-CoV-2 infection offer us tangible benefits and hope for making this SARS-CoV-2 pandemic under control.
33388003 Previously it has been demonstrated that telehealth (TH) could help cover the gaps in health attention in remote locations. […] Today the expanded capabilities have transformed TH delivery, and from the beginning of the coronavirus pandemic, it has remained one of our biggest allies. […] Telehealth has become a central piece in patient healthcare delivery during COVID-19 pandemic era. […] Telehealth allows health care services to reach patients in their homes, keeping other patients safe through social distancing and maintaining self-quarantine. […] Within this administration of health, TH allows health care providers to focus more resources to pandemic usage and at the same time continue caring for the health of non COVID-19 patients. […] During this time, clinicians are expanding knowledge about TH capabilities, such as application of forward triage as a tool to avoid patient contact in emergency departments. […] While previously TH was mainly used for primary care needs, specialized and urgent care health is now being utilized more than ever before. […] These advantages comes with limitations, some of them include a limited physical exam, lack of access to diagnostic testing or imaging, and many other pitfalls and persistent unmet needs. […] The 2020 pandemic has led to significant improvements leading into the next generation of telemedicine.
33388748 With the pandemic of SARS-CoV-2 ongoing in Europe in June of 2020, day care centres were reopened in the state of Hesse, Germany, after the lockdown. […] The role young children play in the dynamics of the transmission was unknown. […] We conducted a longitudinal study over a period of 12 weeks and two days (18 th of June 2020 to 10 th of September, 2020) to screen attendees and staff from day care centres in the state of Hesse, Germany, for both respiratory and gastrointestinal shedding of SARS-CoV-2. 859 children (age range 3 months to 8 years) and 376 staff members from 50 day care centres, which were chosen representatively from throughout the state, participated in the study. […] Parents were asked to perform both a buccal mucosa and an anal swab on their children once a week. […] Staff were asked to self-administer the swabs. […] No respiratory or gastrointestinal shedding of SARS-CoV-2 was detected in any of the children. […] One was asymptomatic at the time of testing, and one was symptomatic and did not attend the facility on that day. […] Detection of either respiratory or gastrointestinal shedding of SARS-CoV-2 RNA in children and staff members attending day care centres was rare in the context of limited community activity and with infection prevention measures in the facilities in place.
33491049 As a priority group, healthcare personnel (HCP) will be key to success of COVID-19 vaccination programs. […] The purpose of this study was to assess HCP willingness to get vaccinated and identify specific concerns that would undermine vaccination efforts. […] We conducted a cross-sectional survey of HCP, including clinical and non-clinical staff, researchers, and trainees between November 23 rd ,2020 and December 5 th ,2020. […] The survey evaluated attitudes, beliefs and willingness to get vaccinated. […] 80.4% were physicians and scientists representing the largest group. […] 33.6% of registered nurses, 31.6% of allied health professionals, and 32% of master’s level clinicians were unsure they would take the vaccine (p<.001 respondents who were older males white or asian more likely to get vaccinated compared other groups. fewer providers of direct care vs. non-care and those had provided for covid-19 patients not indicated they would take the vaccine if offered we observed that self-reported willingness receive vaccination against differs by hospital roles with physicians research scientists showing highest acceptance. these findings highlight important heterogeneity in personal attitudes among hcps around vaccines a need tailored communication strategies.> </.001>
33492545 There is a current escalating need for telehealth (TH) options in family mental health services. […] In the absence of replicated evidence, TH guidelines from peak bodies are largely based on assumptions of the effectiveness of TH methods. […] New investments in TH would optimally be based in evidence of clinical efficacy. […] To this end, we conducted three studies in which we (1) systematically reviewed eight professional guidelines for TH family therapy, (2) examined replicated evidence for the efficacy of TH family therapy through systematic review of 20 studies and meta-analyses of 13 effects, and (3) synthesised clinical accommodations to TH methodology from a study of 12 experienced TH family therapists. […] The studies found (1) a predominant focus in existing TH guidelines on operational matters pertaining to TH and relative neglect of therapeutic process; (2) meta-analyses of efficacy for child behavioural problems (k = 8) and parental depression (k = 5) showed equivalent outcomes in TH and face-to-face therapy and enhanced outcomes in TH relative to treatment as usual, resource provision (i.e. written materials), or wait-list control. […] Narrative review of 20 studies for a range of relational and mental health outcomes aligned with these findings; and (3) therapists defined clear conditions for enhanced engagement and therapeutic process via TH and reflected on cautions and accommodations for purposes of rapport building and mitigating risk. […] Given moderate-strong evidence for the efficacy of TH methods of family therapy for a range of conditions, we offer recommendations for future implementation of TH for family therapy.
33542929 To compare the difference of inflammatory cytokines and lymphocyte subsets between deceased patients and survivors with COVID-19. […] This retrospective study included 254 confirmed patients from 10 January to 11 March, 2020, at Tongji Hospital of Wuhan, China. […] Laboratory and immunologic features were collected and analyzed, and the main outcomes focused on inflammatory cytokines and lymphocyte subsets. […] A trend of markedly higher levels of inflammatory cytokines as well as lower lymphocyte subset levels in deceased patients was observed compared with survivors. […] ROC curve analyses indicated that inflammatory cytokines and the decrease levels of T cell, Th (helper T cells) cell, Ts (suppressor T cells) cell, B cell, and NK cell along with Th/Ts ratio increase could be used to predict the death of COVID-19. […] Multivariate analyses showed that higher levels of IL-6, IL-8, and IL-10 remained significantly correlated with shorter survival time and that the amount of Ts cells was negatively associated with the possibility of death in COVID-19 patients. […] In conclusion, SARS-CoV-2 would cause lymphopenia and result in decreased lymphocyte subset cells, particularly in Ts cell counts, which further induces hyperinflammatory response and cytokine storm. […] IL-6, IL-8, IL-10, and Ts cell might be independent predictors for the poor outcome of COVID-19.
33592305 India has the second largest COVID-19 epidemic in the world as per current estimates. […] This letter is the first report of the spectrum of neurological disorders observed in patients with severe COVID-19 from a resource limited setting like India. […] Till October 30 th 2020, Noble hospital and research center, Pune, India has admitted 2631 patients of COVID-19. […] Out of these, 423 patients had severe COVID-19. […] NEUROLOGIC COMPLICATIONS IN SEVERE COVID-19 IN PUNE, INDIA: Of the 423 patients with severe COVID-19, 20 (4.7%) had pre-existing neurologic co-morbidities, with cerebrovascular disease (8 patients) being the most common. […] Poliomyelitis (4 patients) was also an important co-morbidity associated with severe COVID-19. […] Bodyache or myalgia (207/423, 49 %) and headache (59/423, 13.9 %) were the most common neurologic symptoms observed in patients. […] Encephalopathy (22/423, 5.2 %) and new onset large vessel ischemic stroke secondary to cerebral artery thrombosis (5/423, 1.1%) were the most common secondary neurologic complications noted in our cohort. […] CHALLENGES IN MANAGEMENT OF NEURO COVID-19 IN INDIA: Various challenges like an overwhelmed health care system, inadequate workforce, lack of exhaustive reporting of symptoms and poor availability of neuroimaging in ventilated COVID-19 patients leads to underestimation of Neuro COVID-19 in resource limited settings like India.