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Bibliography on: covid-19

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Robert J. Robbins is a biologist, an educator, a science administrator, a publisher, an information technologist, and an IT leader and manager who specializes in advancing biomedical knowledge and supporting education through the application of information technology. More About:  RJR | OUR TEAM | OUR SERVICES | THIS WEBSITE

RJR: Recommended Bibliography 29 Sep 2020 at 01:36 Created: 

covid-19

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS coronavirus 2, or SARS-CoV-2), a virus closely related to the SARS virus. The disease was discovered and named during the 2019-20 coronavirus outbreak. Those affected may develop a fever, dry cough, fatigue, and shortness of breath. A sore throat, runny nose or sneezing is less common. While the majority of cases result in mild symptoms, some can progress to pneumonia and multi-organ failure. The infection is spread from one person to others via respiratory droplets produced from the airways, often during coughing or sneezing. Time from exposure to onset of symptoms is generally between 2 and 14 days, with an average of 5 days. The standard method of diagnosis is by reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab or sputum sample, with results within a few hours to 2 days. Antibody assays can also be used, using a blood serum sample, with results within a few days. The infection can also be diagnosed from a combination of symptoms, risk factors and a chest CT scan showing features of pneumonia. Correct handwashing technique, maintaining distance from people who are coughing and not touching one's face with unwashed hands are measures recommended to prevent the disease. It is also recommended to cover one's nose and mouth with a tissue or a bent elbow when coughing. Those who suspect they carry the virus are recommended to wear a surgical face mask and seek medical advice by calling a doctor rather than visiting a clinic in person. Masks are also recommended for those who are taking care of someone with a suspected infection but not for the general public. There is no vaccine or specific antiviral treatment, with management involving treatment of symptoms, supportive care and experimental measures. The case fatality rate is estimated at between 1% and 3%. The World Health Organization (WHO) has declared the 2019-20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC). As of 29 February 2020, China, Hong Kong, Iran, Italy, Japan, Singapore, South Korea and the United States are areas having evidence of community transmission of the disease.

Created with PubMed® Query: "SARS-CoV-2" OR "COVID-19" OR (wuhan AND "coronavirus") NOT pmcbook NOT ispreviousversion

Citations The Papers (from PubMed®)

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RevDate: 2020-09-26

Worrall AP, Kelly C, O'Neill A, et al (2020)

Transfusion requirements in patients with COVID-19.

Since the emergence of COVID-19 in late 2019, our knowledge of the clinical implications of infection with SARS-CoV-2 has steadily grown. The clinical spectrum of COVID-19 is broad, ranging from asymptomatic infection to multi-organ failure. COVID-19 induces a proinflammatory state, activating systemic coagulation and resulting in markedly elevated D-Dimers, fibrinogen and a prolongation of the prothrombin time (PT) (Tang et al, 2020). Initial studies reported the development of Disseminated Intravascular Coagulation (DIC), associated with poorer outcomes (Tang et al, 2020). DIC results from perturbations in the normal haemostatic balance and may produce a clinical phenotype of thrombosis, bleeding or a combination thereof. Subsequently, the International Society on Thrombosis and Haemostasis (ISTH) issued guidance on the management of DIC in this setting (Thachil et al, 2020). This guidance was controversial, recommending admission based on coagulation parameters and more liberal transfusion thresholds (maintaining platelets >25 in non-bleeding patients). At this time, COVID-19 represented a particular challenge to transfusion services as concerns existed that transfusion requirements may be increased at a time of limited donor availability. Despite increasing data on thrombotic sequalae of COVID-19, there remains a paucity of information on transfusion requirements in this clinical setting. This is of importance, not only for physicians, but for clinical transfusion services in order to plan stock management during the pandemic. To address this deficit, we retrospectively analysed the transfusion records and outcomes of a large cohort of patients with COVID-19.

RevDate: 2020-09-26

Johnson J, Melvin E, Srinivas SK, et al (2020)

COVID-19 Testing, Personal Protective Equipment, and Staffing Strategies Vary at Obstetrics Centers across the Country.

American journal of perinatology [Epub ahead of print].

RevDate: 2020-09-28

Yang C, Li Y, SY Xiao (2020)

Differential expression of ACE2 in the respiratory tracts and its relationship to COVID-19 pathogenesis.

EBioMedicine, 60:103004 pii:S2352-3964(20)30380-7 [Epub ahead of print].

RevDate: 2020-09-28

Mirza MU, Ahmad S, Abdullah I, et al (2020)

Identification of novel human USP2 inhibitor and its putative role in treatment of COVID-19 by inhibiting SARS-CoV-2 papain-like (PLpro) protease.

Computational biology and chemistry, 89:107376 pii:S1476-9271(20)30608-3 [Epub ahead of print].

Human ubiquitin carboxyl-terminal hydrolase-2 (USP2) inhibitors, such as thiopurine analogs, have been reported to inhibit SARS-CoV papain-like proteases (PLpro). The PLpro have significant functional implications in the innate immune response during SARS-CoV-2 infection and considered an important antiviral target. Both proteases share strikingly similar USP fold with right-handed thumb-palm-fingers structural scaffold and conserved catalytic triad Cys-His-Asp/Asn. In this urgency situation of COVID-19 outbreak, there is a lack of in-vitro facilities readily available to test SARS-CoV-2 inhibitors in whole-cell assays. Therefore, we adopted an alternate route to identify potential USP2 inhibitor through integrated in-silico efforts. After an extensive virtual screening protocol, the best compounds were selected and tested. The compound Z93 showed significant IC50 value against Jurkat (9.67 μM) and MOTL-4 cells (11.8 μM). The binding mode of Z93 was extensively analyzed through molecular docking, followed by MD simulations, and molecular interactions were compared with SARS-CoV-2. The relative binding poses of Z93 fitted well in the binding site of both proteases and showed consensus π-π stacking and H-bond interactions with histidine and aspartate/asparagine residues of the catalytic triad. These results led us to speculate that compound Z93 might be the first potential chemical lead against SARS-CoV-2 PLpro, which warrants in-vitro evaluations.

RevDate: 2020-09-28

England E, Jordan S, Kanfi A, et al (2020)

Radiology residency program management post-pandemic-peak: looking down the curve and around the bend.

Clinical imaging, 69:243-245 pii:S0899-7071(20)30349-1 [Epub ahead of print].

The three stage model set forth by the ACGME, which provides a framework for pandemic residency program management, is insufficient and could best be expanded to 5 stages to include post-pandemic-peak residency program management. Stage 4, "Increased non-COVID clinical demands," present the challenge of an increased clinical workload in the setting of social distancing while reengaging the educational mission of the residency program. In Stage 5, "Business as usual, redefined," the residency program must learn to adapt to new challenges including uncertainty surrounding the American Board of Radiology (ABR) Core examination, uncertainty in the job market, and potential diminished medical student interest in radiology. Despite these challenges, this post-pandemic environment offers tremendous opportunity to build on and enhance the residency program now and into the future.

RevDate: 2020-09-26

Shanmugam C, Mohammed AR, Ravuri S, et al (2020)

COVID-2019 - A comprehensive pathology insight.

Pathology, research and practice, 216(10):153222 pii:S0344-0338(20)32077-X [Epub ahead of print].

Corona virus disease-2019 (COVID-19) caused by severe acute respiratory syndrome corona virus-2 (SARS CoV-2), a highly contagious single stranded RNA virus genetically related to SARS CoV. The lungs are the main organs affected leading to pneumonia and respiratory failure in severe cases that may need mechanical ventilation. Occasionally patient may present with gastro-intestinal, cardiac and neurologic symptoms with or without lung involvement. Pathologically, the lungs show either mild congestion and alveolar exudation or acute respiratory distress syndrome (ARDS) with hyaline membrane or histopathology of acute fibrinous organizing pneumonia (AFOP) that parallels disease severity. Other organs like liver and kidneys may be involved secondarily. Currently the treatment is principally symptomatic and prevention by proper use of personal protective equipment and other measures is crucial to limit the spread. In the midst of pandemic there is paucity of literature on pathological features including pathogenesis, hence in this review we provide the current pathology centered understanding of COVID-19. Furthermore, the pathogenetic pathway is pivotal in the development of therapeutic targets.

RevDate: 2020-09-26

Sadegh Beigee F, Pourabdollah Toutkaboni M, Khalili N, et al (2020)

Diffuse alveolar damage and thrombotic microangiopathy are the main histopathological findings in lung tissue biopsy samples of COVID-19 patients.

Pathology, research and practice, 216(10):153228 pii:S0344-0338(20)32083-5 [Epub ahead of print].

BACKGROUND: Since the outbreak of the novel coronavirus disease-2019 (COVID-19) in December 2019, limited studies have investigated the histopathologic findings of patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

MATERIAL AND METHODS: This study was conducted on 31 deceased patients who were hospitalized for COVID-19 in a tertiary hospital in Tehran, Iran. A total of 52 postmortem tissue biopsy samples were obtained from the lungs and liver of decedents. Clinical characteristics, laboratory data, and microscopic features were evaluated. Reverse transcription polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 was performed on specimens obtained from nasopharyngeal swabs and tissue biopsies.

RESULTS: The median age of deceased patients was 66 years (range, 30-87 years) and 25 decedents (81 %) were male. The average interval from symptom onset to death was 13 days (range, 6-34 days). On histopathologic examination of the lung specimens, diffuse alveolar damage and thrombotic microangiopathy were the most common findings (80 % and 60 %, respectively). Liver specimens mainly showed macrovesicular steatosis, portal lymphoplasmacytic inflammation and passive congestion. No definitive viral inclusions were observed in any of the specimens. In addition, 92 % of lung tissue samples tested positive for SARS-CoV-2 by RT-PCR.

CONCLUSIONS: Further studies are needed to investigate whether SARS-CoV-2 causes direct cytopathic changes in various organs of the human body.

RevDate: 2020-09-28

Cottler LB, Goldberger BA, Nixon SJ, et al (2020)

Introducing NIDA's New National Drug Early Warning System.

RevDate: 2020-09-26

Zhang Y, Wang S, Ding W, et al (2020)

Status and influential factors of anxiety depression and insomnia symptoms in the work resumption period of COVID-19 epidemic: A multicenter cross-sectional study.

Journal of psychosomatic research, 138:110253 pii:S0022-3999(20)30815-1 [Epub ahead of print].

OBJECTIVE: In this study, the authors analyzed the status of anxiety depression and insomnia symptoms and influential factors in the work resumption period of Coronavirus disease 2019 (COVID-19).

METHODS: A multicenter cross-sectional survey was conducted from March 2, 2020 to March 8, 2020 in Shandong Province, China, using quota sampling combined with snowball sampling. The Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Insomnia Severity Index (ISI) were used to assess the anxiety, depression, and insomnia symptoms. The multivariate logistic regression analysis was used to explore the influential factors.

RESULTS: A total of 4000 invitations were sent from three centers, 3237 valid questionnaires were received. Based on GAD-7, PHQ-9, and ISI scales, 19.5%-21.7% of the participants had anxiety, depression, or insomnia symptoms; 2.9%-5.6% had severe symptoms. Besides, 2.4%, 4.8%, and 4.5% of the participants had anxiety-depression, anxiety-insomnia, or depression-insomnia combined symptoms. The scores of anxiety and insomnia symptoms, along with scores of depression and insomnia symptoms were positively correlated in these samples. Aged 50-64 years and outside activities once in ≥30 days were risk factors of anxiety, depression, and insomnia symptoms in common. During the epidemic, 17.4% of the participants had received psychological interventions, and only 5.2% had received individual interventions.

CONCLUSIONS: The incidence of psychological distress increased during the outbreak of COVID-19 in the work resumption period than the normal period. Current psychological interventions were insufficient; target psychological interventions should be conducted in time.

RevDate: 2020-09-28

Mamun MA, Syed NK, MD Griffiths (2020)

Indian celebrity suicides before and during the COVID-19 pandemic and their associated risk factors: Evidence from media reports.

RevDate: 2020-09-26

Yu K, Micco AG, Ference E, et al (2020)

A survey of personal protective equipment use among US otolaryngologists during the COVID-19 pandemic.

American journal of otolaryngology, 41(6):102735 pii:S0196-0709(20)30429-4 [Epub ahead of print].

OBJECTIVE: Describe current practices and challenges in personal protective equipment (PPE) use among US otolaryngologists during the COVID-19 pandemic.

STUDY DESIGN: Online survey.

SETTING: Academic and non-academic healthcare institutions.

SUBJECTS AND METHODS: Subjects included US otolaryngology physicians. Emails were sent on April 17, 2020 to program coordinators at 121 residency programs, who were requested to forward the email to program directors for distribution. Further recruitment occurred through snowball recruitment. The survey was closed on June 15, 2020.

RESULTS: Sixty-one participants completed the survey. 95.1% reported routine access to full PPE (N95 ± powered air purifying respirator [PAPR], gown, gloves, eye protection) for aerosol-generating procedures (AGPs) in COVID-19 patients, while 68.9% had routine access to full PPE for AGPs in patients without confirmed COVID-19. 88.5% had routine access to full PPE for potential aerosol-generating procedures (pAGPs) in COVID patients, while 80.3% had routine access to full PPE for pAGPs in patients without confirmed COVID. All participants felt that they "always" or "usually" had necessary PPE to safely perform procedures and surgeries on COVID patients. 83.6% received N95 fitting in the past year, and 93.4% reported adequate PPE training.

CONCLUSION: The majority of participants reported routine access to full PPE for AGPs and pAGPs in all patients, regardless of COVID status. There was a high perception of security, as well as adequate N95 fitting and PPE training. Areas for improvement include: optimizing PPE availability for AGPs in patients without confirmed COVID and wider recognition of otolaryngologic procedures as high risk for aerosolization.

RevDate: 2020-09-26

Chorney SR, Rizzi MD, K Dedhia (2020)

Considerations for povidone-iodine antisepsis in pediatric nasal and pharyngeal surgery during the COVID-19 pandemic.

American journal of otolaryngology, 41(6):102737 pii:S0196-0709(20)30431-2 [Epub ahead of print].

PURPOSE: Surgeons resuming elective procedures during the COVID-19 pandemic should consider strategies to mitigate risk of exposure. For otolaryngologists performing surgery on children, unique vulnerability to SARS-CoV-2 results from a regular interface with the upper respiratory tract mucosa. A growing interest in perioperative application of povidone‑iodine (PVP-I) to the nasopharynx and oropharynx has emerged. The purpose of this review is to provide an evidence-based assessment of PVP-I in pediatric oral, nasal and pharyngeal surgery.

METHODS: A contemporary literature review with algorithmic approach to the potential use of PVP-I in pediatric mucosal surgery.

RESULTS: Several formulations of PVP-I have shown rapid in vitro virucidal activity against SARS-CoV-2. Antisepsis using 1.0% PVP-I mouthwash and 0.45% PVP-I throat spray can occur after 30 seconds of contact time. To date, in vivo effectiveness of PVP-I against SARS-CoV-2 has yet to be established and possible risks of its direct use on upper aerodigestive mucosa of children must be weighed.

CONCLUSION: Further research is required prior to strongly recommending PVP-I use in preparation for nasal, oral or pharyngeal surgery in children.

RevDate: 2020-09-26

Amer MA, Elsherif HS, Abdel-Hamid AS, et al (2020)

Early recovery patterns of olfactory disorders in COVID-19 patients; a clinical cohort study.

American journal of otolaryngology, 41(6):102725 pii:S0196-0709(20)30419-1 [Epub ahead of print].

INTRODUCTION: A rapidly evolving evidence suggests that smell dysfunction is a common symptom in COVID-19 infection with paucity of data on its duration and recovery rate.

OBJECTIVES: Delineate the different patterns of olfactory disorders recovery in patients with COVID-19.

METHODS: This cross-sectional cohort study included 96 patients with olfactory complaint confirmed to be COVID-19 positive with recent onset of anosmia. All patients were inquired for smell recovery patterns using self-assessment questionnaires.

RESULTS: Ninety six patients completed the study with mean age 34.26 ± 11.91 years. Most patients had sudden anosmia 83%. Loss of smell was accompanied by nonspecific inflammatory symptoms as low-grade fever (17%) and generalized body ache (25%). Nasal symptoms were reported by 33% of patients. Some patients reported comorbidities as D.M (16%), hypertension (8%) or associated allergic rhinitis (25%), different patterns of olfactory recovery showed 32 patients experiencing full recovery (33.3%) while, 40 patients showed partial recovery (41.7%) after a mean of 11 days while 24 patients (25%) showed no recovery within one month from onset of anosmia.

CONCLUSION: The sudden olfactory dysfunction is a common symptom in patients with COVID-19. Hyposmia patients recover more rapidly than anosmic ones while the middle age group carried the best prognosis in olfactory recovery. Females possess better potentiality in regaining smell after recovery and the association of comorbidities worsen the recovery rate of olfactory dysfunction in patients with COVID19.

LEVEL OF EVIDENCE: Level 2b a cross-sectional cohort study.

RevDate: 2020-09-26

Salari A, Jalaeefar A, M Shirkhoda (2020)

What is the best treatment option for head and neck cancers in COVID-19 pandemic? A rapid review.

American journal of otolaryngology, 41(6):102738 pii:S0196-0709(20)30432-4 [Epub ahead of print].

With the onset of the COVID-19 crisis in late 2019, the health care systems of different countries are experiencing stressful conditions. Many patients need care in hospital wards and intensive care units (ICU). Head & neck cancers (HNC) are in a special condition in this pandemic. The main treatment in these patients is surgery. Most of these patients need care in the ICU, which is reduced in capacity in pandemic conditions. It's important to note that delays in the surgery of these patients make them non-operable and on the other hand increase mortality and morbidity. Numerous non-surgical alternative therapies have been proposed in these conditions, but there are fundamental questions about these suggestions. 1 How long should we look for alternative therapies? Because many countries are facing a second wave of the disease. 2 What's the effect of these alternative therapies and the delay in starting standard treatments in patients' survival? Different countries have different financial resources; many countries, patients face restrictions on receiving alternative therapies to standard treatments, and in non-pandemic conditions, long queues are given for non-surgical treatments such as chemo-radiotherapy. There are numerous guidelines to guide head and neck surgeons to the best choice in this situation. It seems that different countries have to make individual decisions based on the prevalence of COVID-19 and the financial resources and facilities of the health care system. In this review article, we have collected the opinions of world-renowned guidelines and institutions on how to treat HNCs during the pandemic.

RevDate: 2020-09-28

Bonkowsky JL, deVeber G, Kosofsky BE, et al (2020)

Pediatric Neurology Research in the Twenty-First Century: Status, Challenges, and Future Directions Post-COVID-19.

Pediatric neurology, 113:2-12 pii:S0887-8994(20)30295-2 [Epub ahead of print].

BACKGROUND: The year 2020 marked a fundamental shift in the pediatric neurology field. An impressive positive trajectory of advances in patient care and research faced sudden global disruptions by the coronavirus disease 2019 pandemic and by an international movement protesting racial, socioeconomic, and health disparities. The disruptions revealed obstacles and fragility within the pediatric neurology research mission. However, renewed commitment offers unique opportunities for the pediatric neurology research community to enhance and prioritize research directions for the coming decades.

METHODS: The Research Committee of the Child Neurology Society evaluated the challenges and opportunities facing the pediatric neurology research field, including reviewing published literature, synthesizing publically available data, and conducting a survey of pediatric neurologists.

RESULTS: We identified three priority domains for the research mission: funding levels, active guidance, and reducing disparities. Funding levels: to increase funding to match the burden of pediatric neurological disease; to tailor funding mechanisms and strategies to support clinical trial efforts unique to pediatric neurology; and to support investigators across their career trajectory. Active guidance: to optimize infrastructure and strategies, to leverage novel therapeutics, enhance data collection, and improve inclusion of children in clinical trials. Reducing disparities: to reduce health disparities in children with neurological disease, to develop proactive measures to enhance workforce diversity and inclusion, and increase avenues to balance work-life obligations for investigators.

CONCLUSIONS: In this uniquely challenging epoch, the pediatric neurology research community has a timely and important mission to re-engage the public and government, advancing the health of children with neurological conditions.

RevDate: 2020-09-28

Guido-Estrada N, J Crawford (2020)

Embracing Telemedicine: The Silver Lining of a Pandemic.

RevDate: 2020-09-26

He F, Xia X, Nie D, et al (2020)

Respiratory bacterial pathogen spectrum among COVID-19 infected and non-COVID-19 virus infected pneumonia patients.

Diagnostic microbiology and infectious disease, 98(4):115199 pii:S0732-8893(20)30576-9 [Epub ahead of print].

COVID-19 positive (194) and negative (212) pneumonia patients were selected to analyze bacterial pathogens coinfection. Results showed that 50% of COVID-19 patients were coinfected or carried bacterial pathogens. Bordetella pertussis infection rate was significantly higher in positive patients. Consequently, preventions should be taken to control bacterial pathogens coinfection in COVID-19 patients.

RevDate: 2020-09-28

Strand NH, Maloney JA, Mariano ER, et al (2020)

Analysis of the gender distribution of industry- and society-sponsored webinar faculty during the COVID-19 pandemic.

RevDate: 2020-09-26

Cheli M, Dinoto A, Olivo S, et al (2020)

SARS-CoV-2 pandemic and epilepsy: The impact on emergency department attendances for seizures.

Seizure, 82:23-26 pii:S1059-1311(20)30247-8 [Epub ahead of print].

INTRODUCTION: The risk of acquiring SARS-CoV-2 in a hospital setting and the need of reorganizing the Emergency Departments (EDs) to cope with infected patients have led to a reduction of ED attendances for non-infectious acute conditions and to a different management of chronic disorders.

METHODS: We performed a retrospective study evaluating the frequency and features of ED attendances for seizures during the lockdown period (March 10th-April 30th 2020) in the University Hospital of Trieste, Italy. We studied the possible pandemic impact on the way patients with seizures sought for medical assistance by comparing the lockdown period to a matched period in 2019 and to a period of identical length preceding the lockdown (January 18th-March 9th 2020).

RESULTS: A striking decrease in total ED attendances was observed during lockdown (4664) compared to the matched control (10424) and to the pre-lockdown (9522) periods. A similar reduction, although to a lesser extent, was detected for seizure attendances to the ED: there were 37 during lockdown and 63 and 44 respectively during the two other periods. Intriguingly, during the lockdown a higher number of patients attended the ED with first seizures (p = 0.013), and more EEGs (p = 0.008) and CT brain scans (p = 0.018) were performed; there was a trend towards more frequent transport to the ED by ambulance (p = 0.061) in the lockdown period.

CONCLUSIONS: Our data suggest that the pandemic has affected the way patients with seizures access the Health Care System.

RevDate: 2020-09-28

Chen Y, Shi Y, Chen Y, et al (2020)

Contamination-free visual detection of SARS-CoV-2 with CRISPR/Cas12a: A promising method in the point-of-care detection.

Biosensors & bioelectronics, 169:112642 pii:S0956-5663(20)30632-1 [Epub ahead of print].

The outbreaks of the infectious disease COVID-19 caused by SARS-CoV-2 seriously threatened the life of humans. A rapid, reliable and specific detection method was urgently needed. Herein, we reported a contamination-free visual detection method for SARS-CoV-2 with LAMP and CRISPR/Cas12a technology. CRISPR/Cas12a reagents were pre-added on the inner wall of the tube lid. After LAMP reaction, CRISPR/Cas12a reagents were flowed into the tube and mixed with amplicon solution by hand shaking, which can effectively avoid possible amplicon formed aerosol contamination caused by re-opening the lid after amplification. CRISPR/Cas12a can highly specific recognize target sequence and discriminately cleave single strand DNA probes (5'-6FAM 3'-BHQ1). With smart phone and portable 3D printing instrument, the produced fluorescence can be seen by naked eyes without any dedicated instruments, which is promising in the point-of-care detection. The whole amplification and detection process could be completed within 40 min with high sensitivity of 20 copies RNA of SARS-CoV-2. This reaction had high specificity and could avoid cross-reactivity with other common viruses such as influenza virus. For 7 positive and 3 negative respiratory swab samples provided by Zhejiang Provincial Center for Disease Control and Prevention, our detection results had 100% positive agreement and 100% negative agreement, which demonstrated the accuracy and application prospect of this method.

RevDate: 2020-09-26

Mukwenha S, Dzinamarira T, Mugurungi O, et al (2020)

Maintaining robust HIV and TB services in the COVID-19 era: A public health dilemma in Zimbabwe.

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases pii:S1201-9712(20)32141-X [Epub ahead of print].

The coronavirus disease 2019 (COVID-19) has challenged health systems worldwide. In Zimbabwe, the COVID-19 response has seen diversion of human capital, equipment and other resources that were meant for the HIV and tuberculosis (TB) programs. In a country with one of the worst HIV and TB burdens globally, the authors discuss this public health dilemma of sustained HIV and TB services in the context of a new threat; COVID-19.

RevDate: 2020-09-26

Francis R, Le Bideau M, Jardot P, et al (2020)

High-speed large-scale automated isolation of SARS-CoV-2 from clinical samples using miniaturized co-culture coupled to high-content screening.

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases pii:S1198-743X(20)30570-X [Epub ahead of print].

OBJECTIVES: A novel coronavirus, SARS-CoV-2, is responsible for the current COVID-19 global pandemic. Only a few laboratories routinely isolate the virus, which is because the current co-culture strategy is highly time-consuming and requires working in a biosafety level 3 laboratory. This work aimed to develop a new high-throughput isolation strategy using novel technologies for rapid and automated isolation of SARS-CoV-2.

METHODS: We used an automated microscope based on high-content screening (HCS), and we applied specific image analysis algorithms targeting cytopathic effects of SARS-CoV-2 on Vero E6 cells. A randomized panel of 104 samples, including 72 that tested positive by RT-PCR and 32 that tested negative, were processed with our HCS strategy and were compared to the classical isolation procedure.

RESULTS: The isolation rate was 43% (31/72) with both strategies on RT-PCR-positive samples and was correlated with the initial RNA viral load in the samples, in which we obtained a positivity threshold of 27 Ct. Co-culture delays were shorter with the HCS strategy, where 80% (25/31) of the positive samples were recovered by the third day of co-culture, compared to only 26% (8/30) with the classic strategy. Moreover, only the HCS strategy allowed us to recover all the positive samples (31 with HCS versus 27 with classic strategy) after 1 week of co-culture.

CONCLUSIONS: This system allows the rapid and automated screening of clinical samples with minimal operator workload, which reduces the risk of contamination, thus paving the way for future applications in clinical microbiology, such as large-scale drug susceptibility testing.

RevDate: 2020-09-26

Ergönül Ö, Akyol M, Tanrıöver C, et al (2020)

National case fatality rates of the COVID-19 pandemic.

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases pii:S1198-743X(20)30576-0 [Epub ahead of print].

OBJECTIVES: The case fatality rate (CFR) of Coronavirus disease 2019 (COVID-19) varies significantly between countries. We aimed to describe the associations of health indicators with the national CFRs of COVID-19.

METHODS: We identified health indicators for each country potentially associated with the national CFRs of COVID-19. We extracted data for 18 variables from international administrative data sources for 34 member countries of the Organization for Economic Co-operation and Development (OECD). We excluded the collinear variables and examined the 16 variables in multivariable analysis. A dynamic web-based model was developed to analyse and display the associations for the CFRs of COVID-19. We followed the Guideline for Accurate and Transparent Health Estimates Reporting (GATHER).

RESULTS: In multivariable analysis, the variables significantly associated with the increased CFRs were percent of obesity in ages >18 years (β = 3.26, 95% CI = [1.20, 5.33], p = 0.003), tuberculosis incidence (β = 3.15, 95% CI = [1.09, 5.22], p = 0.004), duration (days) since first death due to COVID-19 (β = 2.89, 95% CI = [0.83, 4.96], p = 0.008), median age (β = 2.83, 95% CI = [0.76, 4.89], p = 0.009). The COVID-19 test rate (β = -3.54, 95% CI = [-5.60, -1.47], p = 0.002), hospital bed density (β = -2.47, 95% CI = [-4.54, -0.41], p = 0.021), and rural population ratio (β = -2.19, 95% CI = [-4.25, -0.13], p = 0.039) decreased the CFR.

CONCLUSIONS: The pandemic hits the population dense cities. Available hospital beds should be increased. Test capacity should be increased to enable more effective diagnostic tests. Older patients, and patients with obesity, and their caregivers should be warned about a potentially increased risk.

RevDate: 2020-09-26

Xiong Q, Xu M, Li J, et al (2020)

Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study.

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases pii:S1198-743X(20)30575-9 [Epub ahead of print].

OBJECTIVES: To describe the prevalence, nature, and risk factors for the main clinical sequelae in COVID-19 survivors who have been discharged from the hospital for more than 3 months.

METHODS: This longitudinal study was based on a telephone follow-up survey of COVID-19 patients hospitalized and discharged from Renmin Hospital of Wuhan University, Wuhan, China before March 1, 2020. Demographic and clinical characteristics and self-reported clinical sequelae of the survivors were described and analysed. A cohort of volunteers who were free of COVID-19 and lived in the urban area of Wuhan during the outbreak were also selected as the comparison group.

RESULTS: Among 538 survivors (293[54.5%] female), the median age was 52.0 years (IQR 41.0-62.0), and the median time from discharge from hospital to first follow-up was 97.0 days (IQR 95.0-102.0). Clinical sequelae were common, including general symptoms (n=267, 49.6%), respiratory symptoms (n=210, 39%), cardiovascular-related symptoms (n=70, 13%), psychosocial symptoms (n=122, 22.7%) and alopecia (n=154, 28.6%). We found that physical decline/fatigue (P<0.01), post-activity polypnea (P=0.04) and alopecia (P<0.01) were more common in females than in males. Dyspnoea during hospitalization was associated with subsequent physical decline/fatigue, post-activity polypnea and resting heart rate increases, but not specifically with alopecia. A history of asthma during hospitalization was associated with subsequent post-activity polypnea sequela. A history of pulse ≥90 beats per min during hospitalization was associated with resting heart rate increase in convalescence. The duration of viral shedding after COVID-19 onset and hospital length of stay were longer in survivors with physical decline/fatigue or post-activity polypnea than in those without.

CONCLUSION: Clinical sequelae during early COVID-19 convalescence were common, and some of these sequelae might be related to gender, age and clinical characteristics during hospitalization.

RevDate: 2020-09-26

Martínez-Sanz J, Muriel A, Ron R, et al (2020)

Effects of tocilizumab on mortality in hospitalized patients with COVID-19: A multicenter cohort study.

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases pii:S1198-743X(20)30573-5 [Epub ahead of print].

OBJECTIVES: Tocilizumab has been proposed as a candidate therapy for patients with severe coronavirus disease 2019 (COVID-19), especially among those with higher systemic inflammation. Here, we investigate the association between tocilizumab use and mortality in a large cohort of hospitalized patients.

METHODS: Cohort study of patients hospitalized with COVID-19 in Spain. The primary outcome was time to death and the secondary outcome time to intensive care unit admission (ICU) or death. We used inverse-probability weighting to fit marginal structural models adjusted for time-varying covariates to determine the causal relationship between tocilizumab use and the outcomes.

RESULTS: A total of 1,229 patients were analyzed, with 261 patients (61 deaths) in the tocilizumab group and 969 patients (120 deaths) in the control group. In the adjusted marginal structural models, a significant interaction between tocilizumab use and high C-reactive protein (CRP) levels was detected. Tocilizumab was associated with decreased risk of death (aHR 0.34, 95% CI 0.16-0.72, p=0.005) and ICU admission or death (aHR 0.38, 95% CI 0.19-0.81, p=0.011) among patients with baseline CRP >150 mg/L, but not among those with CRP ≤150 mg/L. Exploratory subgroup analyses yielded point estimates that were consistent with these findings.

CONCLUSIONS: In this large observational study, tocilizumab was associated with a lower risk of death or ICU or death in patients with higher CRP levels. While the results of ongoing clinical trials of tocilizumab in patients with COVID-19 will be important to establish its safety and efficacy, our findings have implications for the design of future clinical trials.

RevDate: 2020-09-26

Rawson TM, Wilson RC, A Holmes (2020)

Understanding the role of bacterial and fungal infection in COVID-19.

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases pii:S1198-743X(20)30577-2 [Epub ahead of print].

RevDate: 2020-09-26

Liotti FM, Menchinelli G, Lalle E, et al (2020)

Performance of a novel diagnostic assay for rapid SARS-CoV-2 antigen detection in nasopharynx samples.

RevDate: 2020-09-26

Rali P, O'Corragain O, Oresanya L, et al (2020)

Incidence of Venous Thromboembolism (VTE) in COVID-19: An Experience From A Single Large Academic Center.

Journal of vascular surgery. Venous and lymphatic disorders pii:S2213-333X(20)30524-2 [Epub ahead of print].

BACKGROUND: Novel severe acute respiratory coronavirus 2 (SARS-CoV2) has been associated with a hypercoagulable state. Emerging literature from China and Europe has consistently shown an increased incidence of venous thromboembolism (VTE). We aim to identify the VTE incidence and early predictors of VTE at our high-volume tertiary care center.

METHODS: We performed a retrospective cohort study of patients admitted to Temple University Hospital with COVID-19. We first identified VTE [pulmonary embolism (PE) and deep vein thrombosis (DVT)] incidence in our cohort. VTE and no VTE groups were compared in univariable analysis for demographics, co-morbidities, laboratory data, and treatment outcomes. Subsequently, multivariable logistic regression analysis was performed to identify early predictors of VTE.

RESULTS: 147 patients admitted to Temple University Hospital, between April 1st, 2020 to April 27th, 2020 to designated COVID 19 unit with a high clinical suspicion for acute VTE were tested with either CT pulmonary angiogram and/or extremity venous duplex, representing 20.9% of all admissions. The overall incidence of VTE was 17% (25/147). There were 16 cases of acute PE, 14 cases of acute DVT, and 5 patients with both PE and DVT. The need for invasive mechanical ventilation (adjusted OR 3.19, 95% CI:1.07-9.55), admission D-dimer level > 1,500 ng/mL (aOR 3.55, 95% CI:1.29-9.78) were independent markers associated with VTE occurence. All-cause mortality in the VTE group was higher (48% vs. 22%, p=0.007) than no VTE group.

CONCLUSION: Our data represents one of the earliest published US reports on the incidence rate of VTE in COVID-19. Patients with high clinical suspicion and identified risk factors (need for invasive mechanical ventilation, D-dimer on admission > 1,500 ng/mL can be considered for early VTE testing. We did not screen all patients admitted for VTE, therefore it is possible the true incidence of VTE was underestimated. Our findings should be confirmed prospectively in future studies.

RevDate: 2020-09-26

Epel ES (2020)

The geroscience agenda: What does stress have to do with it?.

Ageing research reviews pii:S1568-1637(20)30302-0 [Epub ahead of print].

Geroscience offers a counterpoint to the challenged pursuit of curing diseases of aging by focusing on slowing the biological aging process for extended healthspan earlier in life. Remarkable progress has led this field toward animal trials and the next challenge lies with translation to humans. There is an emerging number of small human trials that can take advantage of new models integrating behavioral and social factors. Understanding dynamic aging mechanisms, given the powerful social determinants of aging (Crimmins, 2019) and human variability and environmental contexts (Moffitt, 2019), will be critical. Behavioral and social factors are intrinsic to aging. Toxic stressors broadly defined can lead to stress-acceleration of aging, either directly impacting aging processes or by shaping poor behavioral health, and underlie the socioeconomic disparities of aging. In contrast, hormetic stressors, acute intermittent stressors of moderate intensity, can produce stress resilience, the ability for quick recovery and possibly rejuvenation of cells and tissues. Although health research usually examines static biomarkers, aging is reflected in ability to recover from challenges pointing to new interventions and targets for examining mechanisms. A fuller model incorporating stress resilience provides innovative biobehavioral interventions, both for bolstering response to challenges, such as COVID-19, and for improving healthspan.

RevDate: 2020-09-26

Ali SK (2020)

COVID-19: Searching for a Little Hope in Adversity - The sub-Saharan Experience.

Journal of pain and symptom management pii:S0885-3924(20)30763-6 [Epub ahead of print].

RevDate: 2020-09-26

Sheng-Kai Ma K, SY Tsai (2020)

Integrating Travel History via Big Data Analytics Under Universal Healthcare Framework for Disease Control and Prevention in the COVID-19 Pandemic.

RevDate: 2020-09-26

Knol WG, Thuijs DJFM, Odink AE, et al (2020)

Preoperative chest computed tomography screening for coronavirus disease 2019 in asymptomatic patients undergoing cardiac surgery.

Seminars in thoracic and cardiovascular surgery pii:S1043-0679(20)30300-2 [Epub ahead of print].

Due to the outbreak of SARS-Cov-2, an efficient COVID-19 screening strategy is required for patients undergoing cardiac surgery. The objective of this prospective observational study was to evaluate the role of preoperative CT-screening for COVID-19 in a population of COVID-19 asymptomatic patients scheduled for cardiac surgery. Between the 29th of March and the 26th of May 2020, patients asymptomatic for COVID-19 underwent a CT-scan the day before surgery, with RT-PCR reserved for abnormal scan results. The primary endpoint was the prevalence of abnormal scans, which was evaluated using the CO-RADS score, a COVID-19 specific grading system. In a secondary analysis, the rate of abnormal scans was compared between the screening cohort and matched historical controls who underwent routine preoperative CT-screening prior to the SARS-Cov-2 outbreak. Of the 109 patients that underwent CT-screening, an abnormal scan result was observed in 7.3% (95% CI: 3.2 - 14.0%). One patient, with a normal screening CT, was tested positive for COVID-19, with the first positive RT-PCR on the ninth day after surgery. A rate of preoperative CT-scan abnormalities of 8% (n=8) was found in the unexposed historical controls (p>0.999). In asymptomatic patients undergoing cardiac surgery, preoperative screening for COVID-19 using computed tomography will identify pulmonary abnormalities in a small percentage of patients that do not seem to have COVID-19. Depending on the prevalence of COVID-19, this results in an unfavorable positive predictive value of CT screening. Care should be taken when considering CT as a screening tool prior to cardiac surgery.

RevDate: 2020-09-26

Weber S, Ramirez C, W Doerfler (2020)

Signal hotspot mutations in SARS-CoV-2 genomes evolve as the virus spreads and actively replicates in different parts of the world.

Virus research pii:S0168-1702(20)31077-7 [Epub ahead of print].

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was first identified in Wuhan, China late in 2019. Nine months later (Sept. 18, 2020), the virus has infected > 30 million people world-wide and caused > 944.000 (3.15 %) fatalities in 220 countries and territories. Research on the genetics of the SARS-CoV-2 genome, its mutants and their penetrance can aid future defense strategies. By analyzing sequence data deposited between December 2019 and end of May 2020, we have compared nucleotide sequences of 570 SARS-CoV-2 genomes from China, Europe, the US, and India to the sequence of the Wuhan isolate. During world-wide spreading among human populations, at least 10 distinct hotspot mutations had been selected and found in up to > 80 % of viral genomes. Many of these mutations led to amino acid exchanges in replication-relevant viral proteins. Mutations in the SARS-CoV-2 genome would also impinge upon the secondary structure of the viral RNA molecule and its repertoire of interactions with essential cellular and viral proteins. The increasing frequency of SARS-CoV-2 mutation hotspots might select for dangerous viral pathogens. Alternatively, in a 29.900 nucleotide-genome, there might be a limit to the number of mutable and selectable sites which, when exhausted, could prove disadvantageous to viral survival. The speed, at which novel SARS-CoV-2 mutants are selected and dispersed around the world, could pose problems for the development of vaccines and therapeutics.

RevDate: 2020-09-26

Khare P, Sahu U, Pandey SC, et al (2020)

Current approaches for target-specific drug discovery using natural compounds against SARS-CoV-2 infection.

Virus research pii:S0168-1702(20)31076-5 [Epub ahead of print].

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) recently caused a pandemic outbreak called coronavirus disease 2019 (COVID-19). This disease has initially been reported in China and also now it is expeditiously spreading around the globe directly among individuals through coughing and sneezing. Since it is a newly emerging viral disease and obviously there is a lack of anti-SARS-CoV-2 therapeutic agents, it is urgently required to develop an effective anti-SARS-CoV-2-agent.Through recent advancements in computational biology and biological assays, several natural compounds and their derivatives have been reported to confirm their target specific antiviral potential against Middle East respiratory syndrome coronavirus (MERS-CoV) or Severe Acute Respiratory Syndrome(SARS-CoV).These targets including an important host cell receptor, i.e., angiotensin-converting enzyme ACE2 and several viral proteins e.g. spike glycoprotein (S) containing S1 and S2 domains, SARS CoV Chymotrypsin-like cysteine protease (3CLpro), papain-like cysteine protease (PLpro), helicases and RNA-dependent RNA polymerase (RdRp). Due to physical, chemical, and some genetic similarities of SARS CoV-2 with SARS-COV and MERS-COV, repurposing various anti-SARS-COV or anti-MERS-COV natural therapeutic agents could be helpful for the development of anti-COVID-19 herbal medicine. Here we have summarized various drug targets in SARS-COV and MERS-COV using several natural products and their derivatives, which could guide researchers to design and develop a safe and cost-effective anti-SARS-COV-2 drugs.

RevDate: 2020-09-26

Freire-Paspuel B, Vega-Mariño P, Velez A, et al (2020)

"Sample pooling of RNA extracts to speed up SARS-CoV-2 diagnosis using CDC FDA EUA RT-qPCR kit".

Virus research pii:S0168-1702(20)31080-7 [Epub ahead of print].

BACKGROUND: The CDC protocol for SARS-CoV2 RT-PCR diagnosis (2019-nCoV CDC kit) is considered a gold standard worldwide; based on three different FAM probes (N1 and N2 for viral detection; RP for RNA extraction quality control), three reactions per sample are needed for SARS-CoV-2 diagnosis.

RESULTS: We herein describe a sample pooling protocol: pooling 3 RNA extractions into a single PCR reaction; we tested this protocol with 114 specimens grouped in 38 pools and found no significant differences for N1 and N2 Ct values between pool and single sample PCR reaction.

CONCLUSION: This pool of three protocol has a sensitivity of 100 % compared to the standard single sample protocol. For a typical 96-well plate, this pool assay allows 96 samples processing, speeding up diagnosis and reducing cost while maintaining clinical performance, particularly useful for SARS-CoV-2 diagnosis at developing countries.

RevDate: 2020-09-26

Gadotti AC, de Castro Deus M, Telles JP, et al (2020)

IFN-γ is an independent risk factor associated with mortality in patients with moderate and severe COVID-19 infection.

Virus research pii:S0168-1702(20)31078-9 [Epub ahead of print].

BACKGROUND: Innate and adaptive immune responses have been evaluated in infected patients with COVID-19. The severity of the disease has been supposed to be associated with some profile not reported with other bacterial and viral pneumonia. We proposed a study in patients with moderate to severe COVID-19 infection to evaluate the interleukin patterns and its role as prognosis factors.

METHODS: A prospective cohort with moderate and severe cases of COVID-19 infection from June to July 2020. Blood samples from patients were collected regularly to evaluate IFN-γ, TNF-α, IL-4, IL-6, and IL-10. Clinical, laboratory, radiological data, and outcomes were recorded. The outcome variable was in-hospital death, survival, mechanical ventilation, and admission at the intensive care unit. Data are presented in median and interquartile range [IQR].

RESULTS: We evaluated the Th1 and Th2 responses according to evolution, distinguishing possible predictive markers. The IFN-γ median of 323 pg/mL [IQR 166-570] was found in patients who died and 208 pg/mL [IQR 155-392] in the survival group (p = 0.017). IFN-γ was also higher in the early stages of the disease (394 pg/mL [IQR 229-575] against 162 pg/mL [IQR 117-259], p < 0.001). IL-4 that was increased in late-stage (182 pg/mL [IQR 162-199] against 131 pg/mL [IQR 124-152], p < 0.001) but not associated with mortality. Also, death was also related to male gender (relative risk = 1.5 [95% confidence interval = 1.1-2.0]).

CONCLUSION: Our results suggest that the activation of the host immune response between Th1 or Th2 in COVID-19 infection may be related to the final result between discharge or death. This implies an attempt to control cytokines, such as IFN-γ, with combined therapies for clinical treatment.

RevDate: 2020-09-28

Nibali L, Ide M, Ng D, et al (2020)

The perceived impact of Covid-19 on periodontal practice in the United Kingdom: A questionnaire study.

Journal of dentistry, 102:103481 pii:S0300-5712(20)30228-1 [Epub ahead of print].

INTRODUCTION: COVID-19 has impacted dentistry in unprecedented ways.

OBJECTIVE: The following research aimed to investigate the impact of the COVID-19 pandemic on periodontal practice in the United Kingdom using the COM-B (Capability Opportunity Motivation-Behaviour) model as the basis for a questionnaire.

BASIC RESEARCH DESIGN: An online survey link was sent to all members of the British Society of Periodontology and Implant Dentistry. A total of 358 responses were received and analysed.

RESULTS: The great majority of participants thought that the pandemic had an impact on their profession, while only 4.7 % had no concerns. The main worries related to financial concerns and ability to provide appropriate levels of care. More than 80 % of respondents agreed that their establishment was compliant with infection control procedures. Some participants felt benefits mainly in terms of more time for CPD activities. It was felt that some of the changes needed will need to be sustained long-term.

CONCLUSIONS: Respondents were generally worried. However, they perceived they had the physical and psychological ability to effect changes to their practice, higher than the physical and social opportunities that they were afforded. Although the COVID-19 pandemic is causing profound changes and worries for the profession of Periodontology, clinicians are clear about their capability to control the situation and feel they have the motivation to make the required changes.

CLINICAL SIGNIFICANCE: COVID-19 has presented clinicians with novel challenges. Investigating the professional response to change and expected impact is of interest in the current climate as we navigate the 'new normal'. Assessing the results could be useful in informing support strategies moving forward.

RevDate: 2020-09-26

Jin W, Zhang W, Mitra D, et al (2020)

The structure-activity relationship of the interactions of SARS-CoV-2 spike glycoproteins with glucuronomannan and sulfated galactofucan from Saccharina japonica.

International journal of biological macromolecules pii:S0141-8130(20)34543-8 [Epub ahead of print].

The SARS-CoV-2 spike glycoproteins (SGPs) and human angiotensin converting enzyme 2 (ACE2) are the two key targets for the prevention and treatment of COVID-19. Host cell surface heparan sulfate (HS) is believed to interact with SARS-CoV-2 SGPs to facilitate host cell entry. In the current study, a series of polysaccharides from Saccharina japonica were prepared to investigate the structure-activity relationship on the binding abilities of polysaccharides (oligosaccharides) to pseudotype particles, including SARS-CoV-2 SGPs, and ACE2 using surface plasmon resonance. Sulfated galactofucan (SJ-D-S-H) and glucuronomannan (Gn) displayed strongly inhibited interaction between SARS-CoV-2 SGPs and heparin while showing negligible inhibition of the interaction between SARS-CoV-2 SGPs and ACE2. The IC50 values of SJ-D-S-H and Gn in blocking heparin SGP binding were 27 and 231 nM, respectively. NMR analysis showed that the structure of SJ-D-S-H featured with a backbone of 1, 3-linked α-L-Fucp residues sulfated at C4 and C2/C4 and 1, 3-linked α-L-Fucp residues sulfated at C4 and branched with 1, 6-linked β-D-galacto-biose; Gn had a backbone of alternating 1, 4-linked β-D-GlcAp residues and 1, 2-linked α-D-Manp residues. The sulfated galactofucan and glucuronomannan showed strong binding ability to SARS-CoV-2 SGPs, suggesting that these polysaccharides might be good candidates for preventing and/or treating SARS-CoV-2.

RevDate: 2020-09-26

YangMD C, LiuMD F, LiuMD W, et al (2020)

Myocardial injury and risk factors for mortality in patients with COVID-19 pneumonia.

International journal of cardiology pii:S0167-5273(20)33829-8 [Epub ahead of print].

BACKGROUND: Coronavirus disease 2019 (COVID-19) pneumonia tends to affect cardiovascular system and cause cardiovascular damage. This study aimed to explore the prevalence of myocardial injury and risk factors for mortality in patients with COVID-19 pneumonia.

METHODS: 224 consecutive patients with confirmed diagnosis of SARS-CoV-2 infection and definite outcomes (discharge or death) were retrospectively analyzed. Laboratory results including myocardial biomarkers, oxygen saturation, inflammatory indicators and coagulation function were compared between survivors and non-survivors. Univariate and multivariate logistic regression model were used to explore risk factors for in-hospital mortality, and a chart with different combinations of risk factors was constructed to predict mortality.

RESULTS: 203 patients were included in the final analysis, consisting of 145 patients who recovered and 58 patients who died. Compared with survivors, non-survivors were older, with more comorbidities, more severe inflammation and active coagulation function, higher levels of myocardial biomarkers and lower SaO2. 28 (50%) non-survivors and 9 (6%) survivors developed myocardial injury, which was associated with disease severity at admission. Elevated d-dimer (OR = 9.51, 95% CI [3.61-25.0], P < 0.001), creatinine kinase-myocardial band (OR = 6.93, 95% CI [1.83-26.2], P = 0.004), Troponin I (OR = 10.1, 95% CI [3.1-32.8], P < 0.001) and C-reactive protein (OR = 15.1, 95% CI [1.7-129.3], P = 0.013) were risk factors for mortality. Patients with abnormal levels of d-dimer, Troponin I and CRP were predicted to have significantly higher probability of death.

CONCLUSIONS: Our results suggest that SARS-CoV-2 infection may induce myocardial injury and consequently exacerbate the clinical course and worsen prognosis. Abnormal d-dimer, CK-MB, Troponin I and CRP are risk factors for short-term mortality.

RevDate: 2020-09-26

Akbariqomi M, Sadat Hosseini M, Rashidiani J, et al (2020)

Clinical characteristics and outcome of hospitalized COVID-19 patients with diabetes: A single-center, retrospective study in Iran.

Diabetes research and clinical practice pii:S0168-8227(20)30720-8 [Epub ahead of print].

AIM: To describe the epidemiological and clinical characteristics along with outcomes of hospitalized Coronavirus Disease 2019 (COVID-19) patients with and without diabetes.

METHODS: This retrospective, single-center study included 595 consecutive hospitalized patients with confirmed COVID-19 at Baqiyatallah Hospital in Tehran, Iran, from February 26, 2020 to March 26, 2020. Demographic data, clinical, laboratory, and radiological findings were collected and compared between patients based on diabetes status. Complications and clinical outcomes were followed up until April 4, 2020.

RESULTS: From among the 595 hospitalized patients with COVID-19, the median age was 55 years and 401 (67.4%) were male. The most common symptoms included fever (419 [70.4%]), dry cough (368 [61.8%]) and dyspnea (363 [61%]). A total of 148 patients (24.9%) had diabetes, and compared with patients without diabetes, these patients had more comorbidities (eg, hypertension [48.6% vs. 22.3%; P <.001]); had higher levels of white blood cell count, neutrophil count, C-reactive protein, erythrocyte sedimentation rate and blood urea nitrogen, and had a higher proportion of patchy ground-glass opacity in chest computed tomography findings (52.7% vs. 25.7%; P <.001). Significantly, patients with diabetes had more complications and needed more respiratory support than those without diabetes (P <.001). At the end of the follow-up, treatment failure and death was significantly higher in patients with diabetes compared to those without diabetes (17.8% vs. 8.7%; P = 0.003).

CONCLUSION: COVID-19 patients with diabetes are at a higher risk of complications and a higher in-hospital mortality during hospitalization. Diabetes status of COVID-19 patients and frequent monitoring of glycemia would be helpful to prevent deteriorating clinical conditions.

RevDate: 2020-09-26

Wang S, Fu L, Huang K, et al (2020)

Neutrophil-to-lymphocyte ratio at admission is an independent risk factors for the severity and mortality in patients with coronavirus disease 2019.

RevDate: 2020-09-26

Krüttgen A, Cornelissen CG, Dreher M, et al (2020)

Determination of SARS-CoV-2 antibodies with assays from Diasorin, Roche and IDvet.

Journal of virological methods pii:S0166-0934(20)30230-5 [Epub ahead of print].

There is an ongoing need for highly reliable serological assays to detect individuals with past SARS-CoV-2 infection. Using 75 sera from patients tested positive or negative by SARS-CoV-2 PCR, we investigated the sensitivity and specificity of the Liaison SARS-CoV-2 S1/S2 IgG assay (DiaSorin), the Elecsys Anti-SARS-CoV-2 assay (Roche), and the ID Screen SARS-CoV-2-N IgG indirect kit (IDVet). We determined a sensitivity of 95.5%, 95.5%, and 100% and a specificity of 90.5%, 96.2%, and 92,5% for the DiaSorin assay, the Roche assay, and the IDVet assay, respectively. We conclude that serologic assays combining very high sensitivity and specificity are still not commercially available for SARS-CoV-2. For maximizing sensitivity and specificity of SARS-CoV-2 serological diagnostics, the combination of two assays may be helpful.

RevDate: 2020-09-26

Alexander MR, Rootes CL, van Vuren PJ, et al (2020)

Concentration of infectious SARS-CoV-2 by polyethylene glycol precipitation.

Journal of virological methods pii:S0166-0934(20)30229-9 [Epub ahead of print].

The development of medical countermeasures against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires robust viral assays. Here we have adapted a protocol for polyethylene glycol (PEG)-mediated precipitation of SARS-CoV-2 stocks without the need for ultracentrifugation. Virus precipitation resulted in a ∼1.5 log10 increase in SARS-CoV-2 titres of virus prepared in VeroE6 cells and enabled the infection of several immortalized human cell lines (Caco-2 and Calu-3) at a high multiplicity of infection not practically achievable without virus concentration. This protocol underscores the utility of PEG-mediated precipitation for SARS-CoV-2 and provides a resource for a range of coronavirus research areas.

RevDate: 2020-09-26

Tsatsakis A, Calina D, Falzone L, et al (2020)

SARS-CoV-2 pathophysiology and its clinical implications: An integrative overview of the pharmacotherapeutic management of COVID-19.

Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association pii:S0278-6915(20)30659-1 [Epub ahead of print].

Common manifestations of COVID-19 are respiratory and can extend from mild symptoms to severe acute respiratory distress. The severity of the illness can also extend from mild disease to life-threatening acute respiratory distress syndrome (ARDS). SARS-CoV-2 infection can also affect the gastrointestinal tract, liver and pancreatic functions, leading to gastrointestinal symptoms. Moreover, SARS-CoV-2 can cause central and peripheral neurological manifestations, affect the cardiovascular system and promote renal dysfunction. Epidemiological data have indicated that cancer patients are at a higher risk of contracting the SARS-CoV-2 virus. Considering the multitude of clinical symptoms of COVID-19, the objective of the present review was to summarize their pathophysiology in previously healthy patients, as well as in those with comorbidities. The present review summarizes the current, though admittedly fluid knowledge on the pathophysiology and symptoms of COVID-19 infection. Although unclear issues still remain, the present study contributes to a more complete understanding of the disease, and may drive the direction of new research. The recognition of the severity of the clinical symptoms of COVID-19 is crucial for the specific therapeutic management of affected patients.

RevDate: 2020-09-26

Banday AZ, V Pandiarajan (2020)

Use of tocilizumab in multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2.

RevDate: 2020-09-26

Campi R, Tellini R, Grosso AA, et al (2020)

Deferring Elective Urologic Surgery During the COVID-19 Pandemic: the Patients' Perspective.

Urology pii:S0090-4295(20)31166-3 [Epub ahead of print].

OBJECTIVES: To explore the perspective of urological patients on the possibility to defer elective surgery due to the fear of contracting COVID-19.

METHODS: All patients scheduled for elective urological procedures for malignant or benign diseases at two high-volume Centres were administered a questionnaire, through structured telephone interviews, between 24th and 27th April 2020. The questionnaire included three questions: 1) In light of the COVID-19 pandemic, would you defer the planned surgical intervention? 2) If yes, when would you be willing to undergo surgery? 3) What do you consider potentially more harmful for your health: the risk of contracting COVID-19 during hospitalization or the potential consequences of delaying surgical treatment?

RESULTS: Overall, 332 patients were included (51.5% and 48.5% in the oncology and benign groups, respectively). Of these, 47.9% patients would have deferred the planned intervention (33.3% vs 63.4%; p<0.001), while the proportion of patients who would have preferred to delay surgery for more than six months was comparable between the groups (87% vs 80%). These answers were influenced by patient age and ASA score (in the Oncology group) and by the underlying urological condition (in the benign group). Finally, 182 (54.8%) patients considered the risk of COVID-19 potentially more harmful than the risk of delaying surgery (37% vs 73%; p<0.001). This answer was driven by patient age and the underlying disease in both groups.

CONCLUSIONS: Our findings reinforce the importance of shared decision-making before urological surgery, leveraging patients' values and expectations to refine the paradigm of evidence-based medicine during the COVID-19 pandemic and beyond.

RevDate: 2020-09-26

Jager KJ, Kramer A, Chesnaye NC, et al (2020)

Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe.

Kidney international pii:S0085-2538(20)31081-4 [Epub ahead of print].

The aim of this study was to investigate 28-day mortality after COVID-19 diagnosis in the European kidney replacement therapy population. In addition, we determined the role of patient characteristics, treatment factors, and country on mortality risk using ERA-EDTA Registry data on patients receiving kidney replacement therapy in Europe between February 1, 2020 and April 30, 2020. Additional data on all patients with a diagnosis of COVID-19 were collected from seven European countries encompassing 4298 patients. COVID-19 attributable mortality was calculated using propensity-score matched historic controls and after 28 days of follow-up was 20.0% (95% confidence interval 18.7%-21.4%) in 3285 patients receiving dialysis, and 19.9% (17.5%-22.5%) in 1013 recipients of a transplant. We identified differences in COVID-19 mortality across countries, and an increased mortality risk in older patients receiving kidney replacement therapy and male patients receiving dialysis. In recipients of kidney transplants older than 75 years of age 44.3% (35.7%-53.9%) did not survive COVID-19. Mortality risk was 1.28 (1.02-1.60) times higher in transplant recipients compared with matched dialysis patients. Thus, the pandemic has had a substantial effect on mortality in patients receiving kidney replacement therapy; a highly vulnerable population due to underlying chronic kidney disease and high prevalence of multimorbidity.

RevDate: 2020-09-26

Sadeghi S, Soudi S, Shafiee A, et al (2020)

Mesenchymal stem cell therapies for COVID-19: Current status and mechanism of action.

Life sciences pii:S0024-3205(20)31246-7 [Epub ahead of print].

The outbreak of COVID-19 in December 2019, has become an urgent and serious public health emergency. At present, there is no effective treatment or vaccine for COVID-19. Therefore, there is a crucial unmet need to develop a safe and effective treatment for COVID-19 patients. Mesenchymal stem cells (MSCs) are widely used in basic science and in a variety of clinical trials. MSCs are able to engraft to the damaged tissues after transplantation and promote tissue regeneration, besides MSCs able to secrete immunomodulatory factors that suppress the cytokine storms. Moreover, the contribution of MSCs to prevent cell death and inhibit tissue fibrosis is well established. In the current review article, the potential mechanisms by which MSCs contribute to the treatment of COVID-19 patients are highlighted. Also, current trials that evaluated the potential of MSC-based treatments for COVID-19 are briefly reviewed.

RevDate: 2020-09-26

Ronit A, Berg RMG, Bay JT, et al (2020)

Compartmental immunophenotyping in COVID-19 ARDS: a case series.

The Journal of allergy and clinical immunology pii:S0091-6749(20)31317-8 [Epub ahead of print].

BACKGROUND: Severe immunopathology may drive the deleterious manifestations observed in the advanced stages of coronavirus disease 2019 (COVID-19) but are poorly understood.

OBJECTIVE: To phenotype leukocyte subpopulations and the cytokine milieu in the lungs and blood of critically ill patients with COVID-19 acute respiratory distress syndrome (ARDS).

METHODS: We consecutively included patients <72 hours after intubation following informed consent from next of kin. Bronchoalveolar lavage fluid (BALF) was evaluated by microscopy and BALF and blood was assessed by 10-colored flow cytometry and a multiplex cytokine panel.

RESULTS: Four mechanically ventilated patients (40-75 yr.) with moderate to severe COVID-19 ARDS were included. Immature neutrophils dominated in both blood and lungs, while CD4 and CD8 T cell lymphopenia were observed in the two compartments. However, T regulatory cells and Th17 cells were found in higher fractions in the lung. Lung CD4 and CD8 T cells and macrophages expressed an even higher upregulation of activation markers than in blood. A wide range of cytokines were expressed at high levels both in blood and in the lungs, most notably IL-1RA, IL-6, IL-8, IP-10, and MCP-1, consistent with hyperinflammation.

CONCLUSION: COVID-19 ARDS exhibits a distinct immunologic profile in the lungs with a depleted and exhausted CD4 and CD8 T cell population that resides within a heavily hyperinflammatory milieu.

TRIAL REGISTRATION: clinicaltrials.gov/ct2/show/NCT04354584.

RevDate: 2020-09-28

Burki T (2020)

COVID-19 claims another victim.

The Lancet. Infectious diseases, 20(10):1129-1130.

RevDate: 2020-09-28

Makoni M (2020)

COVID-19 in Africa: half a year later.

The Lancet. Infectious diseases, 20(10):1127.

RevDate: 2020-09-26

Guitron S, Pianykh OS, Succi MD, et al (2020)

COVID-19: Recovery Models for Radiology Departments.

Journal of the American College of Radiology : JACR pii:S1546-1440(20)30963-7 [Epub ahead of print].

The coronavirus disease 2019 (COVID-19) pandemic has greatly affected demand for imaging services, with marked reductions in demand for elective imaging and image-guided interventional procedures. To guide radiology planning and recovery from this unprecedented impact, three recovery models were developed to predict imaging volume over the course of the COVID-19 pandemic: (1) a long-term volume model with three scenarios based on prior disease outbreaks and other historical analogues, to aid in long-term planning when the pandemic was just beginning; (2) a short-term volume model based on the supply-demand approach, leveraging increasingly available COVID-19 data points to predict examination volume on a week-to-week basis; and (3) a next-wave model to estimate the impact from future COVID-19 surges. The authors present these models as techniques that can be used at any stage in an unpredictable pandemic timeline.

RevDate: 2020-09-26

Lutz M, Hayney MS, Farraye FA, et al (2020)

Reducing the Risk of Vaccine Preventable Diseases During the COVID-19 Pandemic.

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association pii:S1542-3565(20)31120-4 [Epub ahead of print].

RevDate: 2020-09-26

Au L, Boos LA, Swerdlow A, et al (2020)

Cancer, COVID-19, and Antiviral Immunity: The CAPTURE Study.

Cell pii:S0092-8674(20)31146-6 [Epub ahead of print].

The SARS-CoV-2 pandemic has posed a significant challenge for risk evaluation and mitigation among cancer patients. Susceptibility to and severity of COVID-19 in cancer patients has not been studied in a prospective and broadly applicable manner. CAPTURE is a pan-cancer, longitudinal immune profiling study designed to address this knowledge gap.

RevDate: 2020-09-26

National SARS-CoV-2 Serology Assay Evaluation Group (2020)

Performance characteristics of five immunoassays for SARS-CoV-2: a head-to-head benchmark comparison.

The Lancet. Infectious diseases pii:S1473-3099(20)30634-4 [Epub ahead of print].

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic in 2020. Testing is crucial for mitigating public health and economic effects. Serology is considered key to population-level surveillance and potentially individual-level risk assessment. However, immunoassay performance has not been compared on large, identical sample sets. We aimed to investigate the performance of four high-throughput commercial SARS-CoV-2 antibody immunoassays and a novel 384-well ELISA.

METHODS: We did a head-to-head assessment of SARS-CoV-2 IgG assay (Abbott, Chicago, IL, USA), LIAISON SARS-CoV-2 S1/S2 IgG assay (DiaSorin, Saluggia, Italy), Elecsys Anti-SARS-CoV-2 assay (Roche, Basel, Switzerland), SARS-CoV-2 Total assay (Siemens, Munich, Germany), and a novel 384-well ELISA (the Oxford immunoassay). We derived sensitivity and specificity from 976 pre-pandemic blood samples (collected between Sept 4, 2014, and Oct 4, 2016) and 536 blood samples from patients with laboratory-confirmed SARS-CoV-2 infection, collected at least 20 days post symptom onset (collected between Feb 1, 2020, and May 31, 2020). Receiver operating characteristic (ROC) curves were used to assess assay thresholds.

FINDINGS: At the manufacturers' thresholds, for the Abbott assay sensitivity was 92·7% (95% CI 90·2-94·8) and specificity was 99·9% (99·4-100%); for the DiaSorin assay sensitivity was 95·0% (92·8-96·7) and specificity was 98·7% (97·7-99·3); for the Oxford immunoassay sensitivity was 99·1% (97·8-99·7) and specificity was 99·0% (98·1-99·5); for the Roche assay sensitivity was 97·2% (95·4-98·4) and specificity was 99·8% (99·3-100); and for the Siemens assay sensitivity was 98·1% (96·6-99·1) and specificity was 99·9% (99·4-100%). All assays achieved a sensitivity of at least 98% with thresholds optimised to achieve a specificity of at least 98% on samples taken 30 days or more post symptom onset.

INTERPRETATION: Four commercial, widely available assays and a scalable 384-well ELISA can be used for SARS-CoV-2 serological testing to achieve sensitivity and specificity of at least 98%. The Siemens assay and Oxford immunoassay achieved these metrics without further optimisation. This benchmark study in immunoassay assessment should enable refinements of testing strategies and the best use of serological testing resource to benefit individuals and population health.

FUNDING: Public Health England and UK National Institute for Health Research.

RevDate: 2020-09-26

Houlihan CF, R Beale (2020)

The complexities of SARS-CoV-2 serology.

The Lancet. Infectious diseases pii:S1473-3099(20)30699-X [Epub ahead of print].

RevDate: 2020-09-26

Huang J, Hume AJ, Abo KM, et al (2020)

SARS-CoV-2 Infection of Pluripotent Stem Cell-Derived Human Lung Alveolar Type 2 Cells Elicits a Rapid Epithelial-Intrinsic Inflammatory Response.

Cell stem cell pii:S1934-5909(20)30459-8 [Epub ahead of print].

A hallmark of severe COVID-19 pneumonia is SARS-CoV-2 infection of the facultative progenitors of lung alveoli, the alveolar epithelial type 2 cells (AT2s). However, inability to access these cells from patients, particularly at early stages of disease, limits an understanding of disease inception. Here, we present an in vitro human model that simulates the initial apical infection of alveolar epithelium with SARS-CoV-2 by using induced pluripotent stem cell-derived AT2s that have been adapted to air-liquid interface culture. We find a rapid transcriptomic change in infected cells, characterized by a shift to an inflammatory phenotype with upregulation of NF-κB signaling and loss of the mature alveolar program. Drug testing confirms the efficacy of remdesivir as well as TMPRSS2 protease inhibition, validating a putative mechanism used for viral entry in alveolar cells. Our model system reveals cell-intrinsic responses of a key lung target cell to SARS-CoV-2 infection and should facilitate drug development.

RevDate: 2020-09-26

Hallal PC, Hartwig FP, Horta BL, et al (2020)

SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys.

The Lancet. Global health pii:S2214-109X(20)30387-9 [Epub ahead of print].

BACKGROUND: Population-based data on COVID-19 are essential for guiding policies. There are few such studies, particularly from low or middle-income countries. Brazil is currently a hotspot for COVID-19 globally. We aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence by city and according to sex, age, ethnicity group, and socioeconomic status, and compare seroprevalence estimates with official statistics on deaths and cases.

METHODS: In this repeated cross-sectional study, we did two seroprevalence surveys in 133 sentinel cities in all Brazilian states. We randomly selected households and randomly selected one individual from all household members. We excluded children younger than 1 year. Presence of antibodies against SARS-CoV-2 was assessed using a lateral flow point-of-care test, the WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech, Guangzhou, China), using two drops of blood from finger prick samples. This lateral-flow assay detects IgG and IgM isotypes that are specific to the SARS-CoV-2 receptor binding domain of the spike protein. Participants also answered short questionnaires on sociodemographic information (sex, age, education, ethnicity, household size, and household assets) and compliance with physical distancing measures.

FINDINGS: We included 25 025 participants in the first survey (May 14-21) and 31 165 in the second (June 4-7). For the 83 (62%) cities with sample sizes of more than 200 participants in both surveys, the pooled seroprevalence increased from 1·9% (95% CI 1·7-2·1) to 3·1% (2·8-3·4). City-level prevalence ranged from 0% to 25·4% in both surveys. 11 (69%) of 16 cities with prevalence above 2·0% in the first survey were located in a stretch along a 2000 km of the Amazon river in the northern region. In the second survey, we found 34 cities with prevalence above 2·0%, which included the same 11 Amazon cities plus 14 from the northeast region, where prevalence was increasing rapidly. Prevalence levels were lower in the south and centre-west, and intermediate in the southeast, where the highest level was found in Rio de Janeiro (7·5% [4·2-12·2]). In the second survey, prevalence was similar in men and women, but an increased prevalence was observed in participants aged 20-59 years and those living in crowded conditions (4·4% [3·5-5·6] for those living with households with six or more people). Prevalence among Indigenous people was 6·4% (4·1-9·4) compared with 1·4% (1·2-1·7) among White people. Prevalence in the poorest socioeconomic quintile was 3·7% (3·2-4·3) compared with 1·7% (1·4-2·2) in the wealthiest quintile.

INTERPRETATION: Antibody prevalence was highly heterogeneous by country region, with rapid initial escalation in Brazil's north and northeast. Prevalence is strongly associated with Indigenous ancestry and low socioeconomic status. These population subgroups are unlikely to be protected if the policy response to the pandemic by the national government continues to downplay scientific evidence.

FUNDING: Brazilian Ministry of Health, Instituto Serrapilheira, Brazilian Collective Health Association, and the JBS Fazer o Bem Faz Bem.

RevDate: 2020-09-26

Lewer D, Braithwaite I, Bullock M, et al (2020)

COVID-19 among people experiencing homelessness in England: a modelling study.

The Lancet. Respiratory medicine pii:S2213-2600(20)30396-9 [Epub ahead of print].

BACKGROUND: People experiencing homelessness are vulnerable to COVID-19 due to the risk of transmission in shared accommodation and the high prevalence of comorbidities. In England, as in some other countries, preventive policies have been implemented to protect this population. We aimed to estimate the avoided deaths and health-care use among people experiencing homelessness during the so-called first wave of COVID-19 in England-ie, the peak of infections occurring between February and May, 2020-and the potential impact of COVID-19 on this population in the future.

METHODS: We used a discrete-time Markov chain model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that included compartments for susceptible, exposed, infectious, and removed individuals, to explore the impact of the pandemic on 46 565 individuals experiencing homelessness: 35 817 living in 1065 hostels for homeless people, 3616 sleeping in 143 night shelters, and 7132 sleeping outside. We ran the model under scenarios varying the incidence of infection in the general population and the availability of prevention measures: specialist hotel accommodation, infection control in homeless settings, and mixing with the general population. We divided our scenarios into first wave scenarios (covering Feb 1-May 31, 2020) and future scenarios (covering June 1, 2020-Jan 31, 2021). For each scenario, we ran the model 200 times and reported the median and 95% prediction interval (2·5% and 97·5% quantiles) of the total number of cases, the number of deaths, the number hospital admissions, and the number of intensive care unit (ICU) admissions.

FINDINGS: Up to May 31, 2020, we calibrated the model to 4% of the homeless population acquiring SARS-CoV-2, and estimated that 24 deaths (95% prediction interval 16-34) occurred. In this first wave of SARS-CoV-2 infections in England, we estimated that the preventive measures imposed might have avoided 21 092 infections (19 777-22 147), 266 deaths (226-301), 1164 hospital admissions (1079-1254), and 338 ICU admissions (305-374) among the homeless population. If preventive measures are continued, we projected a small number of additional cases between June 1, 2020, and Jan 31, 2021, with 1754 infections (1543-1960), 31 deaths (21-45), 122 hospital admissions (100-148), and 35 ICU admissions (23-47) with a second wave in the general population. However, if preventive measures are lifted, outbreaks in homeless settings might lead to larger numbers of infections and deaths, even with low incidence in the general population. In a scenario with no second wave and relaxed measures in homeless settings in England, we projected 12 151 infections (10 718-13 349), 184 deaths (151-217), 733 hospital admissions (635-822), and 213 ICU admissions (178-251) between June 1, 2020, and Jan 31, 2021.

INTERPRETATION: Outbreaks of SARS-CoV-2 in homeless settings can lead to a high attack rate among people experiencing homelessness, even if incidence remains low in the general population. Avoidance of deaths depends on prevention of transmission within settings such as hostels and night shelters.

FUNDING: National Institute for Health Research, Wellcome, and Medical Research Council.

RevDate: 2020-09-26

Flook M, Grohmann S, HR Stagg (2020)

Hard to reach: COVID-19 responses and the complexities of homelessness.

The Lancet. Respiratory medicine pii:S2213-2600(20)30446-X [Epub ahead of print].

RevDate: 2020-09-26

Glatter K, P Finkelman (2020)

History of the Plague: An Ancient Pandemic for the Age of Covid-19.

The American journal of medicine pii:S0002-9343(20)30792-0 [Epub ahead of print].

During the fourteenth century, the bubonic plague or Black Death killed over one-third of Europe or 25 million people. Afflicted subjects died quickly and horribly from an unseen menace, spiking high fevers with suppurative buboes (swellings). Its causative agent is Yersinia pestis, creating recurrent plague cycles from the Bronze Age into modern-day California and Mongolia. Plague remains endemic in Madagascar, Congo, and Peru. This history of medicine review highlights plague events across the centuries. Transmission is by fleas carried on rats, although new theories include via human body lice and infected grain. We discuss symptomatology and treatment options. Pneumonic plague can be weaponized for bioterrorism, highlighting the importance of understanding its clinical syndromes. Carriers of recessive familial Mediterranean fever (FMF) mutations have natural immunity against Yersinia pestis. During the Black Death, Jews were blamed for the bubonic plague, perhaps due to Jews carrying FMF mutations and dying at lower plague rates than Christians. Blaming minorities for epidemics echoes across history into our current coronavirus pandemic and provides insightful lessons for managing and improving its outcomes.

RevDate: 2020-09-26

Williams R, Jenkins DA, Ashcroft DM, et al (2020)

Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study.

The Lancet. Public health pii:S2468-2667(20)30201-2 [Epub ahead of print].

BACKGROUND: To date, research on the indirect impact of the COVID-19 pandemic on the health of the population and the health-care system is scarce. We aimed to investigate the indirect effect of the COVID-19 pandemic on general practice health-care usage, and the subsequent diagnoses of common physical and mental health conditions in a deprived UK population.

METHODS: We did a retrospective cohort study using routinely collected primary care data that was recorded in the Salford Integrated Record between Jan 1, 2010, and May 31, 2020. We extracted the weekly number of clinical codes entered into patient records overall, and for six high-level categories: symptoms and observations, diagnoses, prescriptions, operations and procedures, laboratory tests, and other diagnostic procedures. Negative binomial regression models were applied to monthly counts of first diagnoses of common conditions (common mental health problems, cardiovascular and cerebrovascular disease, type 2 diabetes, and cancer), and corresponding first prescriptions of medications indicative of these conditions. We used these models to predict the expected numbers of first diagnoses and first prescriptions between March 1 and May 31, 2020, which were then compared with the observed numbers for the same time period.

FINDINGS: Between March 1 and May 31, 2020, 1073 first diagnoses of common mental health problems were reported compared with 2147 expected cases (95% CI 1821 to 2489) based on preceding years, representing a 50·0% reduction (95% CI 41·1 to 56·9). Compared with expected numbers, 456 fewer diagnoses of circulatory system diseases (43·3% reduction, 95% CI 29·6 to 53·5), and 135 fewer type 2 diabetes diagnoses (49·0% reduction, 23·8 to 63·1) were observed. The number of first prescriptions of associated medications was also lower than expected for the same time period. However, the gap between observed and expected cancer diagnoses (31 fewer; 16·0% reduction, -18·1 to 36·6) during this time period was not statistically significant.

INTERPRETATION: In this deprived urban population, diagnoses of common conditions decreased substantially between March and May 2020, suggesting a large number of patients have undiagnosed conditions. A rebound in future workload could be imminent as COVID-19 restrictions ease and patients with undiagnosed conditions or delayed diagnosis present to primary and secondary health-care services. Such services should prioritise the diagnosis and treatment of these patients to mitigate potential indirect harms to protect public health.

FUNDING: National Institute of Health Research.

RevDate: 2020-09-26

Miller SL, Nazaroff WW, Jimenez JL, et al (2020)

Transmission of SARS-CoV-2 by inhalation of respiratory aerosol in the Skagit Valley Chorale superspreading event.

Indoor air [Epub ahead of print].

During the 2020 COVID-19 pandemic, an outbreak occurred following attendance of a symptomatic index case at a weekly rehearsal on 10 March of the Skagit Valley Chorale (SVC). After that rehearsal, 53 members of the SVC among 61 in attendance were confirmed or strongly suspected to have contracted COVID-19 and two died. Transmission by the aerosol route is likely; it appears unlikely that either fomite or ballistic droplet transmission could explain a substantial fraction of the cases. It is vital to identify features of cases such as this to better understand the factors that promote superspreading events. Based on a conditional assumption that transmission during this outbreak was dominated by inhalation of respiratory aerosol generated by one index case, we use the available evidence to infer the emission rate of aerosol infectious quanta. We explore how the risk of infection would vary with several influential factors: ventilation rate, duration of event, and deposition onto surfaces. The results indicate a best-estimate emission rate of 970 ± 390 quanta h-1 . Infection risk would be reduced by a factor of two by increasing the aerosol loss rate to 5 h-1 and shortening the event duration from 2.5 to 1 h.

RevDate: 2020-09-26

Kubo A, Kurtovich E, McGinnis M, et al (2020)

Pilot pragmatic randomized trial of mHealth mindfulness-based intervention for advanced cancer patients and their informal caregivers.

Psycho-oncology [Epub ahead of print].

OBJECTIVE: Assess the feasibility of conducting a cluster randomized trial (RCT) comparing technology-delivered mindfulness-based intervention (MBI) programs against a waitlist control arm targeting advanced cancer patients and their informal caregivers.

METHODS: Two-arm cluster RCT within Kaiser Permanente Northern California (KPNC). We recruited patients with metastatic solid malignancies or hematological cancers and their informal caregivers. Intervention-group participants chose to use either a commercially available mindfulness app (10-20 minutes/day) or a webinar-based mindfulness course for 6 weeks. The waitlist control group received usual care. We assessed feasibility measures and obtained participant-reported data on quality-of-life (primary outcome) and distress outcomes (secondary) pre- and post-intervention.

RESULTS: 103 patients (median age 67 years; 70% female; 81% White) and 39 caregivers (median age 66 years; 79% female; 69% White) were enrolled. Nearly all participants chose the mindfulness app over the webinar-based program. Among the participants in the intervention arm who chose the mobile-app program and completed the postintervention (6-week) survey, 21 (68%) patients and 7 (47%) caregivers practiced mindfulness at least 50% of the days during the 6-week study period. Seventy-four percent of intervention participants were "very" or "extremely" satisfied with the mindfulness program. We observed improvements in anxiety, quality of life, and mindfulness among patients in the intervention arm compared to those in the control group.

CONCLUSIONS: We demonstrated the feasibility of conducting a cluster RCT of mHealth MBI for advanced cancer patients and their caregivers. Such remote interventions can be helpful particularly during the COVID-19 pandemic. This article is protected by copyright. All rights reserved.

RevDate: 2020-09-26

Dib S, Rougeaux E, Vázquez-Vázquez A, et al (2020)

Maternal mental health and coping during the COVID-19 lockdown in the UK: Data from the COVID-19 New Mum Study.

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics [Epub ahead of print].

OBJECTIVE: To assess how mothers are feeling and coping during lockdown, and to identify the potential pathways that can assist them.

METHODS: A descriptive analysis of maternal mental health, coping, support, activities, lockdown consequences was conducted. Women living in the UK with an infant aged ≤12 months completed an online survey. Linear regression was used to identify predictors of maternal mental health and coping.

RESULTS: A majority of the 1329 participants reported feeling down (56%), lonely (59%), irritable (62%), and worried (71%) to some extent since lockdown began, but 70% felt able to cope. Support with her own health (95% confidence interval [CI] 0.004-0.235), contacting infant support groups (95% CI -0.003 to 0.252), and higher gestational age of the infant (95% CI 0.000-0.063) predicted better mental health. Travelling for work (95% CI -0.680 to -0.121), the impact of lockdown on the ability to afford food (95% CI -1.202 to -0.177), and having an income <£30,000 (95% CI -0.475 to -0.042) predicted poorer mental health. Support with her own health and more equal division of household chores were associated with better coping.

CONCLUSION: There is a need to assess maternal mental health and identify prevention strategies for mothers during lockdown.

RevDate: 2020-09-28

Wang X, Liu Z, Li J, et al (2020)

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

The Journal of clinical endocrinology and metabolism, 105(12):.

PURPOSE: Coronavirus disease 2019 (COVID-19) has become a topic of concern worldwide; however, the impacts of type 2 diabetes mellitus (T2DM) on disease severity, therapeutic effect, and mortality of patients with COVID-19 are unclear.

METHODS: All consecutive patients with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 11 to February 6, 2020, were included in this study.

RESULTS: A total of 663 patients with COVID-19 were included, while 67 patients with T2DM accounted for 10.1% of the total. Compared with patients with COVID-19 without T2DM, those with T2DM were older (aged 66 years vs 57 years; P < 0.001) and had a male predominance (62.7% vs 37.3%; P = 0.019) and higher prevalence of cardiovascular diseases (61.2% vs 20.6%; P < 0.001) and urinary diseases (9% vs 2.5%; P = 0.014). Patients with T2DM were prone to developing severe (58.2% vs 46.3%; P = 0.002) and critical COVID-19 (20.9% vs 13.4%; P = 0.002) and having poor therapeutic effect (76.1% vs 60.4%; P = 0.017). But there was no obvious difference in the mortality between patients with COVID-19 with and without T2DM (4.5% vs 3.7%; P = 0.732). Multivariate logistic regression analysis identified that T2DM was associated with poor therapeutic effect in patients with COVID-19 (odd ratio [OR] 2.99; 95% confidence interval [CI], 1.07-8.66; P = 0.04). Moreover, having a severe and critical COVID-19 condition (OR 3.27; 95% CI, 1.02-9.00; P = 0.029) and decreased lymphocytes (OR 1.59; 95% CI, 1.10-2.34; P = 0.016) were independent risk factors associated with poor therapeutic effect in patients with COVID-19 with T2DM.

CONCLUSIONS: T2DM influenced the disease severity and therapeutic effect and was one of the independent risk factors for poor therapeutic effect in patients with COVID-19.

RevDate: 2020-09-28

Kokoszka-Bargieł I, Cyprys P, Rutkowska K, et al (2020)

Intensive Care Unit Admissions During the First 3 Months of the COVID-19 Pandemic in Poland: A Single-Center, Cross-Sectional Study.

Medical science monitor : international medical journal of experimental and clinical research, 26:e926974 pii:926974.

BACKGROUND Data on the outcomes of patients with coronavirus disease 2019 (COVID-19) requiring Intensive Care Unit (ICU) care in Poland are limited. There are no data on critically ill patients with COVID-19 who did not meet criteria for ICU admission. MATERIAL AND METHODS We analyzed patients admitted to the ICU and those ineligible for ICU admission in a large COVID-19-dedicated hospital, during the first 3 months of the pandemic in Poland. Data from 67 patients considered for ICU admissions due to COVID-19 infection, treated between 10 March and 10 June 2020, were reviewed. Following exclusions, data on 32 patients admitted to the ICU and 21 patients ineligible for ICU admission were analyzed. RESULTS In 38% of analyzed patients, symptoms of COVID-19 infection occurred during a hospital stay for an unrelated medical issue. The mean age of ICU patients was 62.4 (10.4) years, and the majority of patients were male (69%), with at least one comorbidity (88%). The mean admission APACHE II and SAPS II scores were 20.1 (8.1) points and 51.2 (15.3) points, respectively. The Charlson Comorbidity Index and Clinical Frailty Scale were lower in ICU patients compared with those disqualified: 5.9 (4.3) vs. 9.1 (3.5) points, P=0.01, and 4.7 (1.7) vs. 6.9 (1.2) points, P<0.01, respectively. All ICU patients required intubation and mechanical ventilation. ICU mortality was 67%. Hospital mortality among patients admitted to the ICU and those who were disqualified was 70% and 79%, respectively. CONCLUSIONS Patients with COVID-19 requiring ICU admission in our studied population were frail and had significant comorbidities. The outcomes in this group were poor and did not seem to be influenced by ICU admission.

RevDate: 2020-09-28

DÖrschug A, Schwanbeck J, Hahn A, et al (2020)

Evaluation of the Xiamen AmonMed Biotechnology rapid diagnostic test COVID-19 IgM/IgG test kit (Colloidal gold).

European journal of microbiology & immunology pii:2020.00029 [Epub ahead of print].

Introduction: To efficiently monitor the COVID-19 pandemic for surveillance purposes, reliable serological rapid diagnostic tests (RDTs) are desirable for settings where well-established high-throughput bench-top solutions are not available. Here, we have evaluated such an RDT.

Methods: We have assessed the Xiamen AmonMed Biotechnology COVID-19 IgM/IgG test kit (Colloidal gold) and the EUROIMMUN benchtop assay with serum samples from patients with polymerase chain reaction (PCR)-confirmed COVID-19 disease. Samples from patients with Epstein-Barr-virus (EBV) infection and blood donors were used for specificity testing.

Results: For the colloid gold rapid test and the EUROIMMUN assay, the study indicated overall sensitivity of 15.2% and 67.4%, respectively, while specificity of 99.0% and 97.9% with the blood donor sera, as well as 100% and 96.8% with the EBV-patients, were observed, respectively. An association of the time period between positive PCR results and serum acquisition with serological test positivity could be observed for the immunologlobulin G subclass of the EUROIMMUN assay only.

Conclusions: In spite of acceptable specificity of the assessed RDT, the detected poor sensitivity leaves room for improvement. The test results remain difficult to interpret and therefore the RDT can currently not be recommended for routine diagnostic or surveillance use.

RevDate: 2020-09-26

Hyun M, Lee JY, Kwon YS, et al (2020)

COVID-19: Comparing the applicability of shared room and single room occupancy.

Transboundary and emerging diseases [Epub ahead of print].

To curb the COVID-19 pandemic, isolation measures are required. Shared room occupancy is recommended when isolation rooms are insufficient. However, there is little evidence of the applicability of shared and single room occupancy for patients with COVID-19 to determine whether shared room occupancy is feasible. COVID-19 patients admitted to the Daegu Dongsan Hospital of Keimyung University from 21st February 2020 to 20th April 2020 were enrolled in the study and randomly assigned to hospital rooms. Clinical symptoms, underlying diseases, and epidemiological data of patients were analyzed after dividing participants into a shared room occupancy group (group A) and a single room occupancy group (group B). Outcomes analyzed included microbiological cure rates, time to clinical symptom improvement, time to defervescence, and negative-to-positive conversion rates of polymerase chain reaction (PCR) results during hospitalization. A total of 666 patients were included in this study, 535 and 131 patients in groups A and B, respectively. Group B included more underlying conditions, such as pregnancy and solid organ transplantation, and was more closely associated with severe pneumonia during hospitalization. Besides, no statistically significant differences between the two groups in terms of negative PCR rates at HD 7 and 14, conversion rates of PCR results from negative-to-positive, as well as time to the improvement of clinical symptoms, and time to defervescence were observed. Our results suggest that the shared room occupancy of patients with mild symptoms could be an alternative to single room occupancy during the COVID-19 pandemic.

RevDate: 2020-09-26

Zhang N, Chan TLH, R Cowan (2020)

Reimagining Headache Fellowships.

Headache [Epub ahead of print].

In March of 2020, the COVID-19 pandemic led to drastic changes in clinical practice and teaching methods. This article relates the experience of developing an almost virtual headache fellowship in response to the pandemic.

RevDate: 2020-09-28

Erden Aki ŞÖ (2020)

Letter To The Editor - Covid-19 Pandemic And The Mental Health Of The Elderly.

Turk psikiyatri dergisi = Turkish journal of psychiatry, 31(3):221-223.

RevDate: 2020-09-26

Siniscalchi A, Vitale G, Morelli MC, et al (2020)

Liver transplantation in Italy in the era of COVID 19: reorganizing critical care of recipients.

Internal and emergency medicine pii:10.1007/s11739-020-02511-z [Epub ahead of print].

Transplant programs have been severely disrupted by the COVID-19 pandemic. Italy was one of the first countries with the highest number of deaths in the world due to SARS-CoV-2. Here we propose a management model for the reorganization of liver transplant (LT) activities and policies in a local intensive care unit (ICU) assigned to liver transplantation affected by restrictions on mobility and availability of donors and recipients as well as health personnel and beds. We describe the solutions implemented to continue transplantation activities throughout a given pandemic: management of donors and recipients' LT program, ICU rearrangement, healthcare personnel training and monitoring to minimize mortality rates of patients on the waiting list. Transplantation activities from February 22, 2020, the data of first known COVID-19 case in Italy's Emilia Romagna region to June 30, 2020, were compared with the corresponding period in 2019. During the 2020 study period, 38 LTs were performed, whereas 41 were performed in 2019. Patients transplanted during the COVID-19 pandemic had higher MELD and MELD-Na scores, cold ischaemia times, and hospitalization rates (p < 0.05); accordingly, they spent fewer days on the waitlist and had a lower prevalence of hepatocellular carcinoma (p < 0.05). No differences were found in the provenance area, additional MELD scores, age of donors and recipients, BMI, re-transplant rates, and post-transplant mortality. No transplanted patients contracted COVID-19, although five healthcare workers did. Ultimately, our policy allowed us to continue the ICU's operations by prioritizing patients hospitalized with higher MELD without any case of transplant infection due to COVID-19.

RevDate: 2020-09-26

Patra A, Ravi KS, P Chaudhary (2020)

COVID 19 reflection/experience on teaching-learning and assessment: story of anatomy teachers in India.

RevDate: 2020-09-26

Zintsmaster MP, DT Myers (2020)

Patients avoided important care during the early weeks of the coronavirus pandemic: diverticulitis patients were more likely to present with an abscess on CT.

Emergency radiology pii:10.1007/s10140-020-01854-6 [Epub ahead of print].

PURPOSE: To evaluate the frequency with which patients with an urgent health concern, specifically diverticulitis, avoided appropriate medical care during the early weeks of the coronavirus pandemic of 2020 and to study the consequences of the resultant delay in care, the incidence of an associated abscess.

METHODS: This study was institutional review board approved. Reports for CT studies with findings of newly diagnosed diverticulitis within Henry Ford Health System during the early weeks of the coronavirus pandemic of 2020 were reviewed and compared with the same time period in 2019. Total cases of diverticulitis on CT were compared, as well as the prevalence of an associated abscess. A chi-squared analysis was performed to determine the statistical significance of the percentage of patients presenting with an abscess in each year.

RESULTS: During the early weeks of the coronavirus pandemic, 120 patients were identified with CT findings of newly diagnosed diverticulitis with 11.7% of those patients (14 patients) presenting with an associated abscess. During the same time period in 2019, many more CT studies with newly diagnosed diverticulitis were obtained (339), and, compared to 2020, less than half the percentage of those patients had an associated abscess (4.4% or 15 patients).

CONCLUSION: Patients with urgent health concerns avoided appropriate and necessary care during the early weeks of the coronavirus pandemic. While non-COVID-19 emergency visits were diminished, patients who did present with diverticulitis were more likely to present with greater disease severity as manifested by an associated abscess. Patients must be encouraged to seek care when appropriate and need reassurance that hospitals and their emergency departments are safe to visit. Furthermore, emergency physicians and radiologists in particular should be vigilant during times when emergency volumes are low, such as a future surge in coronavirus patients, other pandemics, snow storms, and holidays as the patients who do present for care are more likely to present at later stages and with serious complications.

RevDate: 2020-09-26

Cifarelli CP, JP Sheehan (2020)

COVID-19 effects on neuro-oncology publishing: preliminary outcomes & future impacts.

RevDate: 2020-09-26

Bhat PS, Kaliavaradan S, Muruganidhi N, et al (2020)

Model for hands-on tonsillectomy surgical training of postgraduate residents during COVID-19 pandemic.

European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery pii:10.1007/s00405-020-06383-z [Epub ahead of print].

PURPOSE: Otorhinolaryngological surgeries being highly aerosol-generating carry the risk of transmission of SARS-CoV-2. Most centers have canceled elective surgeries. Surgical demonstration and hands-on training of postgraduate residents are challenging during the COVID-19 pandemic. Continued training of residents is of utmost importance in terms of time and skill development. Tonsillectomy is one of the most common and important surgeries in ENT. Resident training of tonsillectomy is essential. Here, we present a simple, inexpensive model for tonsillectomy hands-on training addressing critical steps of the surgery.

METHODS: An oropharynx and tonsil model is prepared using easily available materials, such as a small plastic tub, gauze pieces, ribbon gauze, and rubber strips. The junior residents are trained in all the critical steps of tonsillectomy using routine tonsillectomy instruments.

CONCLUSION: This model for tonsillectomy is a simple, inexpensive model for training postgraduate residents during and after the COVID-19 pandemic. We hope that this model can help young residents to get trained in critical steps of tonsillectomy, in a closely simulated environment and help them develop confidence and skills in managing live patients.

RevDate: 2020-09-26

Ciaffi J, Brusi V, Lisi L, et al (2020)

Living with arthritis: a "training camp" for coping with stressful events? A survey on resilience of arthritis patients following the COVID-19 pandemic.

Clinical rheumatology pii:10.1007/s10067-020-05411-x [Epub ahead of print].

Resilience is defined as "the capacity of individuals to cope successfully with significant change or adversity". The challenge posed by the COVID-19 pandemic may potentially represent an overwhelmingly stressful event for patients with chronic diseases. Aim of our study was to investigate the levels of resilience in individuals with inflammatory arthritis living in Emilia Romagna, the third hardest-hit Italian region during the ongoing COVID-19 pandemic. To this purpose, we developed a survey consisting of four different sections assessing demographic characteristics, the 14-item resilience scale (RS14) and questionnaires evaluating depression and anxiety. Consecutive patients with inflammatory arthritis were recruited over a short time frame immediately after the end of national lockdown and compared with control individuals from the general population. One hundred twenty-two patients and 173 controls were included. Levels of resilience, as measured by RS14 score, were significantly higher in patients with inflammatory arthritis (82.6 ± 14.0 vs 79.0 ± 12.8, p = 0.018). After stratification for gender, the difference in RS14 score was maintained in women (p = 0.045), but not in men (p = 0.252). High resilience, defined as having a RS14 score > 90, was significantly more prevalent in patients than in controls (30% vs 16%, p = 0.009). In arthritis patients, no significant differences in RS14 were observed after stratification for specific diagnosis, age, or disease duration and activity. Our findings suggest that patients with inflammatory arthritis may be more resilient than the general population towards unexpected stressful events such as the ongoing COVID-19 pandemic. Key Points • Living with inflammatory arthritis may foster resilience. • After COVID-19, patients with inflammatory arthritis were more resilient than the general population.

RevDate: 2020-09-26

Goss MB, Munoz FM, Ruan W, et al (2020)

Liver Transplant in a Recently COVID-19 Positive Child with Hepatoblastoma.

Pediatric transplantation [Epub ahead of print].

BACKGROUND: We describe the successful pediatric liver transplant for unresectable hepatoblastoma in a 4-year-old male with COVID-19 prior to transplant. The first negative nasopharyngeal (NP) swab was documented one month after initial diagnosis, when SARS-CoV-2 antibodies were also detected. The patient was actively listed for liver transplant after completing four blocks of a SIOPEL-4 based regimen due to his PRETEXT IV disease which remained unresectable. Following three additional negative NP swabs and resolution of symptoms for four weeks, he underwent a whole-organ pediatric liver transplant.

METHODS: COVID-19 positivity determined via NP swab SARS-CoV-2 real-time RT-PCR (Hologic Aptima SARS-CoV-2 RT-PCR assay). IgG and IgM total SARS- CoV-2 antibodies detected by Ortho Clinical Diagnostics VITROS® Immunodiagnostics Products Anti-SARS-CoV-2 Test.

RESULTS: Patient received standard prednisone and tacrolimus-based immunosuppression without induction therapy following transplant. Post-transplant course was remarkable for neutropenia and thrombocytopenia, with discharge home on post-transplant day #11. Surveillance tests have remained negative with persistent SARS-CoV-2 IgG antibodies at six weeks after transplant.

CONCLUSIONS: We describe one of the earliest, if not the first case of liver transplant following recent recovery from COVID-19 in a pediatric patient with a lethal malignant liver tumor. A better understanding of how to balance the risk profile of transplant in the setting of COVID-19 with disease progression if transplant is not performed is needed. We followed existing ASTS guidelines to document clearance of the viral infection and resolution of symptoms before transplant. This case highlights that pediatric liver transplantation can be safely performed upon clearance of COVID-19.

RevDate: 2020-09-26

Amor S, Fernández Blanco L, D Baker (2020)

Innate immunity during SARS-CoV-2: evasion strategies and activation trigger hypoxia and vascular damage.

Clinical and experimental immunology [Epub ahead of print].

Innate immune sensing of viral molecular patterns is essential for development of antiviral responses. Like many viruses, SARS-CoV-2 has evolved strategies to circumvent innate immune detection including low CpG levels in the genome, glycosylation to shield essential elements including the receptor binding domain, RNA shielding and generation of viral proteins that actively impede anti-viral interferon responses. Together these strategies allow widespread infection and increased viral load. Despite the efforts of immune subversion, SARS-CoV-2 infection activates innate immune pathways inducing a robust type I/III interferon response, production of proinflammatory cytokines, and recruitment of neutrophils and myeloid cells. This may induce hyperinflammation or alternatively, effectively recruit adaptive immune responses that help clear the infection and prevent reinfection. The dysregulation of the renin-angiotensin system due to downregulation of angiotensin converting enzyme 2, the receptor for SARS-CoV-2, together with the activation of type I/III interferon response, and inflammasome response converge to promote free radical production and oxidative stress. This exacerbates tissue damage in the respiratory system but also leads to widespread activation of coagulation pathways leading to thrombosis. Here, we review the current knowledge of the role of the innate immune response following SARS-CoV-2 infection, much of which is based on the knowledge from SARS-CoV and other coronaviruses. Understanding how the virus subverts the initial immune response and how an aberrant innate immune response contributes to the respiratory and vascular damage in COVID-19 may help explain factors that contribute to the variety of clinical manifestations and outcome of SARS-CoV-2 infection.

RevDate: 2020-09-26

Takagi H (2020)

Government's policy, citizens' behavior, and COVID-19 pandemic.

Government's policy responses and citizens' mobility behavior against coronavirus disease 2019 (COVID-19) may play an important role in avoidance of its pandemic. This article is protected by copyright. All rights reserved.

RevDate: 2020-09-26

Benkeser D, Díaz I, Luedtke A, et al (2020)

Improving precision and power in randomized trials for COVID-19 treatments using covariate adjustment, for binary, ordinal, and time-to-event outcomes.

Biometrics [Epub ahead of print].

Time is of the essence in evaluating potential drugs and biologics for the treatment and prevention of COVID-19. There are currently 876 randomized clinical trials (phase 2 and 3) of treatments for COVID-19 registered on clinicaltrials.gov. Covariate adjustment is a statistical analysis method with potential to improve precision and reduce the required sample size for a substantial number of these trials. Though covariate adjustment is recommended by the U.S. Food and Drug Administration and the European Medicines Agency, it is underutilized, especially for the types of outcomes (binary, ordinal and time-to-event) that are common in COVID-19 trials. To demonstrate the potential value added by covariate adjustment in this context, we simulated two-arm, randomized trials comparing a hypothetical COVID-19 treatment versus standard of care, where the primary outcome is binary, ordinal, or time-to-event. Our simulated distributions are derived from two sources: longitudinal data on over 500 patients hospitalized at Weill Cornell Medicine New York Presbyterian Hospital, and a Centers for Disease Control and Prevention (CDC) preliminary description of 2449 cases. In simulated trials with sample sizes ranging from 100 to 1000 participants, we found substantial precision gains from using covariate adjustment-equivalent to 4-18% reductions in the required sample size to achieve a desired power. This was the case for a variety of estimands (targets of inference). From these simulations, we conclude that covariate adjustment is a low-risk, high-reward approach to streamlining COVID-19 treatment trials. We provide an R package and practical recommendations for implementation. This article is protected by copyright. All rights reserved.

RevDate: 2020-09-26

Vilbrun SC, Mathurin L, Pape JW, et al (2020)

Case Report: Multidrug-Resistant Tuberculosis and COVID-19 Coinfection in Port-au-Prince, Haiti.

The American journal of tropical medicine and hygiene [Epub ahead of print].

The COVID-19 pandemic poses a unique threat to patients with multidrug-resistant tuberculosis (MDR-TB). We describe a case of a patient with pulmonary MDR-TB and COVID-19 in Port-au-Prince, Haiti, and highlight the challenges and approach to managing a patient with both diseases.

RevDate: 2020-09-28

Bansal P (2020)

Covid -19 Pandemic - Internal Medicine's Days of Glory!.

The Journal of the Association of Physicians of India, 68(10):82.

RevDate: 2020-09-28

Joshi S, Bhatia A, Singh P, et al (2020)

Pneumomediastinum as a Presenting Feature of COVID-19-an Observation.

The Journal of the Association of Physicians of India, 68(10):81-82.

RevDate: 2020-09-28

Joshi SR (2020)

COVID-19 Care in India: Evolving Paradigms from Public Health to Critical Care.

The Journal of the Association of Physicians of India, 68(10):56-58.

Covid-19 pandemic in India has rapidly grown though we have a low case fatality rate, high recovery rate and large population is asymptomatic or presymptomatic. Public health measures to close the tap across the country need hypervigilance and follow simple dictum of aggressive testing, tracing and isolation. The covid cases need an early diagnosis with treat and care model. Most can be managed with home isolation under telemedicine supervision with oxygen saturation screening by a simple six minute walk test. Hospitalised cases have emerging evidence in different therapies from antivirals, steroids, immunologic to heparins but high flow oxygen, prone position and supportive care remains the cornerstone in critical care with nursing and nutrition. Vaccine research is ongoing but currently only social vaccine can mitigate the pandemic. Covid appropriate behaviour of Masking, sanitisation and physical distancing with immune modulating behaviour like adequate sleep, digital detox for two hour and clean well ventilated environment is the key with breathing exercises including yoga and positive mental health and avoidance of crowds the only vaccine to live with covid -19 today.

RevDate: 2020-09-28

Jiandani MP, Salagre SB, Kazi S, et al (2020)

Preliminary Observations and Experiences of Physiotherapy Practice in Acute Care Setup of COVID 19: A Retrospective Observational Study.

The Journal of the Association of Physicians of India, 68(10):18-24.

Background: The rapid outbreak of coronavirus disease 2019 (COVID-19), a public health emergency of grave concern, warranted hospital admissions with almost 90,000 cases in June 2020 in city of Mumbai. 3-10% of the patients with moderate to severe involvement required intensive care unit (ICU) admission with respiratory support. Patients admitted in ICU with an acute COVID event present with respiratory dysfunction and are more likely to have critical illness myopathy and neuropathy (CIMN). Physiotherapy services being integral part of non-pharmacological management of any ICU was implemented for patients with COVID 19; a novel viral disease.

Objective: This retrospective study was undertaken to explore the physiotherapy practices that could be implemented in patients admitted with COVID 19 in the ICU and its effect on mobility and oxygen requirement as an outcome.

Methodology: Following ethical permission of institute, the data was extracted from electronic data record sheet in which daily parameters for physiotherapy intervention were recorded. Data from a single ICU and step down unit (SDU) from 5th June to 5th July 2020 was analysed. Records of patients diagnosed with COVID 19 and admitted in ICU or SDU were studied. Those in the age group of 18 to 90 years, of either gender were included. Demographic characteristics, disease severity, oxygen requirement, mobility status, physiotherapy intervention were studied.

Results: 278 record sheets (110 ICU and 168 SDU) were retrospectively analysed for demographics. 44.55% of patients improved with side lying position, 37.27% with prone position and 10.91% with quarter prone position. 4.55% of patient maintained oxygenation in propped up sitting. 2.73% could not be positioned. Chest physiotherapy techniques applied were deep breathing, ACBT, paced breathing and diaphragmatic breathing. Deep intercostal pressure on NIV along with vibrations was given to 12.72% of patients in the ICU. Group therapy sessions were conducted in SDU where 50.59% patients participated. ICU mobility score showed significant improvement on Wilcoxon Signed Ranks test status on day 7 in the ICU (z=-5.99, p=0.00) and SDU (z= 7.676, p=0.00) compared to day 1. Descriptive analysis showed a definitive reduction in oxygen support requirement.

Conclusion: Most common form of physiotherapy interventions in patients with Covid 19 were therapeutic positioning, early mobilization and breathing exercises. Physiotherapy intervention appears promising in facilitating early patient ambulation and discharge. This study shows that it is safe and feasible to provide early physiotherapy treatment techniques in patients with COVID-19 using appropriate measures of infection prevention and cross contamination.

RevDate: 2020-09-28

Deshpande R, Dash S, Bahadur MM, et al (2020)

Study of COVID-19 Pandemic in Representative Dialysis Population Across Mumbai, India: An Observational Multicentric Analysis.

The Journal of the Association of Physicians of India, 68(10):13-17.

COVID-19 has emerged as a pandemic of significance with potential to cause significant morbidity and mortality worldwide. Elderly with or without following comorbidities i.e Diabetes, hypertension, cardiac disease, chronic respiratory illnesses, chronic liver disease, CKD, malignancy and immunocompromised hosts are at increased risk of developing complicated course. Hemodialysis population hence are at increased risk for contracting the infection due to patient characteristics, environmental characteristics and procedural lapses. The current study was aimed at describing prevalence and characteristics of COVID19 in hemodialysis population across different HD centers across Mumbai. We found a prevalence rate of COVID19 in 6.4%, with 9 patients (12%) died during the study period. A fair proportion of Non covid HD patients (1.5%) also died due to lack of access to dialysis. At baseline, mean age of presentation was 54.5 years. On routine test 80% were asymptomatic at presentation. Patients with COPD, requiring ICU care and those on ventilation faired poorly. Contrary to assumption patients with underlying cardiovascular disease didn't show poor outcome. Total of 4.1% health care workers turned positive during the study period with mean age of 31 years and median of 28years. Out of them 5 (45.4%) were symptomatic. All recovered from the illness without any sequelae. Seventy two percent of healthcare workers were on Hydroxy-chloroquine chemoprophylaxis didn't reach statistical significance in preventing the infection. In our study elderly age with comorbidities had poor prognosis. We proposed extra healthcare measures to be taken in the dialysis unit presuming all as COVID suspect in the resource limited settings.

RevDate: 2020-09-28

Karnik ND, M Trivedi (2020)

COVID-19 and Kidney.

The Journal of the Association of Physicians of India, 68(10):11-12.

RevDate: 2020-09-26

de Siqueira Rotenberg L, Cohab Khafif T, Nascimento C, et al (2020)

Emotion Regulation and Bipolar Disorder: Strategies during the COVID-19 Pandemic.

Bipolar disorders [Epub ahead of print].

The COVID-19 pandemic, with necessary measures such as social distancing, has significantly affected people's habits, and psychological wellbeing. This directly impacts individuals suffering from Bipolar Disorder, since they depend on a well-balanced routine, regular sleeping hours, and sparse psychological stress, in order to prevent relapses. In this clinical care piece, we discuss Emotion Regulation strategies to help patients deal with the heightened psychological distress inflicted by the current pandemic.

RevDate: 2020-09-28

Leonard WR (2020)

Human Biologists confront the COVID-19 pandemic.

American journal of human biology : the official journal of the Human Biology Council, 32(5):e23511.

RevDate: 2020-09-28

Kim AW (2020)

Promoting mental health in community and research settings during COVID-19: Perspectives and experiences from Soweto, South Africa.

American journal of human biology : the official journal of the Human Biology Council, 32(5):e23509.

RevDate: 2020-09-26

Doneddu PE, De Sanctis P, Viganò L, et al (2020)

Response to: SARS-CoV-2 associated Guillain-Barré syndrome in 62 patients.

We thank Finsterer and colleagues for their useful comment and for their very useful update on the reported new cases of Guillain-Barré syndrome (GBS) in the context of SARS-Cov-2 infection. As shown by the authors and even more recently by others,1 the number of cases of GBS associated with coronavirus disease 2019 (COVID-19) is continuously increasing since the date of our review (May 17, 2020), but we are pleased to note that the clinical presentation and course does not seem to differ from what observed in our review of the first 18 published cases.

RevDate: 2020-09-26

Haynes K (2020)

Preparing for COVID-19 Vaccine Safety Surveillance: A United States Perspective.

Pharmacoepidemiology and drug safety [Epub ahead of print].

RevDate: 2020-09-26

Bsteh G, Bitschnau C, Hegen H, et al (2020)

Multiple sclerosis and COVID-19: how many are at risk?.

European journal of neurology [Epub ahead of print].

BACKGROUND: The COVID-19 pandemic challenges neurologists in counselling multiple sclerosis (MS) patients with respect to their risk for and by SARS-CoV-2 and in guiding disease-modifying treatment (DMT). The objective was to determine the frequency and distribution of currently known risk factors for COVID-19 mortality in a MS population.

METHODS: MS patients with at least one complete case report between January 1st , 2015 and December 31st , 2019 from the Innsbruck MS database (IMSD) were cross-sectionally included. Frequencies of currently estimated COVID-19 mortality risk factors were analyzed and the cumulative risk was calculated by a recently developed score. For every risk group, the proportions of patients under DMT and immunosuppressive treatment were determined.

RESULTS: Of 1931 MS patients, 63.4% had low risk of COVID-19 mortality, 26% had mild risk, 8.8% had a moderate risk, while a combined 0.9% had high or very high risk of COVID-19 mortality. Of the patients at high or very high risk, only one patient received DMT and none had an immunosuppressive therapy.

CONCLUSIONS: In a population-based MS cohort, the proportion of patients at high risk of COVID-19 mortality is below 1%. Importantly, the vast majority of these MS patients did not receive any DMT.

RevDate: 2020-09-26

Finsterer J, Scorza FA, AC Fiorini (2020)

SARS-CoV-2 associated Guillain-Barre syndrome in 62 patients.

With interest we read the review article by De Sanctis et al. about 18 patients with Guillain-Barre syndrome (GBS) associated with the SARS-CoV-2 infection (COVID-19) [1]. Acute, inflammatory, demyelinating polyneuropathy (AIDP) was the most frequent subtype of GBS. We have the following comments and concerns.

RevDate: 2020-09-26

Braegelmann C, Niebel D, Wenzel J, et al (2020)

Interferon beta as an enhancer of paraviral exanthema during influenza virus infection.

We herein describe the case of a 33-year-old male patient who presented at our emergency department with concomitant flu symptoms and a maculopapular rash. The evening prior to consultation he had first noticed erythematous macules on the trunk and arms, which had then rapidly progressed overnight. The rash was markedly pronounced at injection sites of interferon-beta (IFN-β) administered for relapsing remitting multiple sclerosis (RRMS) (see Fig. 1a). Pruritus was moderate (3/10 numeric rating scale). Fever up to 38°C, fatigue, hoarseness and muscle and joint pain had begun four days prior to consultation. Another four days earlier, the patient and his family had visited a private party. Some of the guests as well as the patient's wife and children experienced equivalent flu symptoms albeit no skin eruptions.

RevDate: 2020-09-26

Baptista AS, Prado IM, Perazzo MF, et al (2020)

Can children's oral hygiene and sleep routines be compromised during the COVID-19 pandemic?.

International journal of paediatric dentistry [Epub ahead of print].

BACKGROUND: During COVID-19 pandemic, children are confined at home, with changes in family routines.

AIM: Evaluate sleep disorders among Brazilian and Portuguese children during social distancing, and its association with parental perception of child's oral hygiene.

DESIGN: In this cross-sectional study, Portuguese and Brazilian parents/caregivers of 3-15-year-old children, practicing social distancing due to COVID-19 pandemic, answered an online questionnaire, from April 24th -26th 2020, evaluating sociodemographic characteristics, child's school activities online, child's sleep quality during social distancing. Two questions from the questionnaire, developed based on previous studies, evaluated the parental perception of child's oral hygiene quality and routine changes during social distancing. Parents/caregivers answered five domains of the Portuguese-language version of the Sleep Disturbances Scale for Children, evaluating sleep-breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence and sleep hyperhidrosis. Descriptive, Linear-by-linear association, Kruskal-Wallis and Post-Hoc analysis were performed (P≤0.05).

RESULTS: Participated in the study 253 parents/caregivers, 50.2% from Brazil. Most parents (72.2%) reported changes in child's routine during social distancing. Sleep-breathing disorders (P=0.019), sleep-wake transition disorders (P=0.022) and disorders of excessive somnolence (P<0.001) were associated with poor oral hygiene during social distancing.

CONCLUSION: Sleep disorders are associated with poor oral hygiene during social distancing.

RevDate: 2020-09-26

Ferrucci SM, Tavecchio S, Favale EM, et al (2020)

Effects of lockdown on health of patients with severe atopic dermatitis treated with dupilumab.

use of dupilumab as treatment for severe adult atopic dermatitis (AD) increased over time since its introduction in September 2018, due to its established efficacy. AD is one of the most common chronic inflammatory skin disease affecting up to 14.3% of adults, with 63,3% of these cases first appearing before 18 years of age. Patients' disease burden is important with high rate of discomfort, less confidence in daily life activities and psycho-social distress. The introduction of dupilumab changed the natural history of this disease, drastically improving AD manifestations and therefore quality of life.

RevDate: 2020-09-26

Sivaraman K, Chopra A, Narayana A, et al (2020)

A five-step risk management process for geriatric dental practice during SARS-CoV-2 pandemic.

Gerodontology [Epub ahead of print].

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus that causes coronavirus infection (COVID-19). COVID-19 is a highly contagious disease transmitted through respiratory droplets, saliva and other contact routes. Within 10 months of its outbreak, SARS-CoV-2 has infected more than 23 million people around the world. Evidence suggests that older adults are the most vulnerable to infection and have an increased risk of mortality. Reduced immunity and underlying medical conditions make them risk-prone and vulnerable to critical care. Older adults affected with the SARS-CoV-2 virus present with distinct clinical manifestations necessitating specific treatment needs and management protocols. While it is crucial to prevent the spread of novel coronavirus (2019-nCoV), the role of oral healthcare workers in addressing the specific needs of ageing adult patients by adopting specific guidelines and appropriate infection control protocols is timely. This paper aims to develop specific guidelines and protocols for the dental management of geriatric patients during the COVID-19 pandemic.

RevDate: 2020-09-26

Caporali C, Pisoni C, Naboni C, et al (2020)

Challenges and opportunities for early intervention and neurodevelopmental follow-up in preterm infants during COVID-19 Pandemic.

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RJR Experience and Expertise

Researcher

Robbins holds BS, MS, and PhD degrees in the life sciences. He served as a tenured faculty member in the Zoology and Biological Science departments at Michigan State University. He is currently exploring the intersection between genomics, microbial ecology, and biodiversity — an area that promises to transform our understanding of the biosphere.

Educator

Robbins has extensive experience in college-level education: At MSU he taught introductory biology, genetics, and population genetics. At JHU, he was an instructor for a special course on biological database design. At FHCRC, he team-taught a graduate-level course on the history of genetics. At Bellevue College he taught medical informatics.

Administrator

Robbins has been involved in science administration at both the federal and the institutional levels. At NSF he was a program officer for database activities in the life sciences, at DOE he was a program officer for information infrastructure in the human genome project. At the Fred Hutchinson Cancer Research Center, he served as a vice president for fifteen years.

Technologist

Robbins has been involved with information technology since writing his first Fortran program as a college student. At NSF he was the first program officer for database activities in the life sciences. At JHU he held an appointment in the CS department and served as director of the informatics core for the Genome Data Base. At the FHCRC he was VP for Information Technology.

Publisher

While still at Michigan State, Robbins started his first publishing venture, founding a small company that addressed the short-run publishing needs of instructors in very large undergraduate classes. For more than 20 years, Robbins has been operating The Electronic Scholarly Publishing Project, a web site dedicated to the digital publishing of critical works in science, especially classical genetics.

Speaker

Robbins is well-known for his speaking abilities and is often called upon to provide keynote or plenary addresses at international meetings. For example, in July, 2012, he gave a well-received keynote address at the Global Biodiversity Informatics Congress, sponsored by GBIF and held in Copenhagen. The slides from that talk can be seen HERE.

Facilitator

Robbins is a skilled meeting facilitator. He prefers a participatory approach, with part of the meeting involving dynamic breakout groups, created by the participants in real time: (1) individuals propose breakout groups; (2) everyone signs up for one (or more) groups; (3) the groups with the most interested parties then meet, with reports from each group presented and discussed in a subsequent plenary session.

Designer

Robbins has been engaged with photography and design since the 1960s, when he worked for a professional photography laboratory. He now prefers digital photography and tools for their precision and reproducibility. He designed his first web site more than 20 years ago and he personally designed and implemented this web site. He engages in graphic design as a hobby.

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Reprints and preprints of publications, slide presentations, instructional materials, and data compilations written or prepared by Robert Robbins. Most papers deal with computational biology, genome informatics, using information technology to support biomedical research, and related matters.

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