RevDate: 2020-07-13

Maini A, Saravanan Y, Singh TA, et al (2020)

Coaching skills for medical education in a VUCA world.

Medical teacher [Epub ahead of print].

The world is in the midst of the COVID-19 pandemic. Healthcare professionals and students globally are experiencing an increasingly 'VUCA' (volatile, uncertain, complex and ambiguous) healthcare and educational climate. Our future medical workforce needs skillsets to manage the personal and emotional challenges of work, uncertainty and change. These include organization, time management, proactive and consistent clinical skill development, effective communication, person-centred approaches, self-reflection and self-care. This is critical for success during undergraduate medical education and ongoing clinical practice to build personal resilience, provide the best possible clinical care in a different healthcare ecosystem, innovate for better healthcare systems and advocate for more vulnerable communities. Our faculty and students have been eager to learn and apply solution-oriented coaching skills to help to mitigate against burnout, hold more rewarding, person-centred conversations in clinical practice and enable them personally to respond flexibly and adapt constructively to change. Coaching training should comprise an essential component of the undergraduate medical curriculum and continuing professional development, supporting our medical workforce to derive joy from the practice of humanistic healthcare and develop the leadership skills to help shape a way forward through the challenges we are experiencing in an increasingly VUCA healthcare climate.

RevDate: 2020-07-13

de Lima Menezes G, RA da Silva (2020)

Identification of potential drugs against SARS-CoV-2 non-structural protein 1 (nsp1).

Journal of biomolecular structure & dynamics [Epub ahead of print].

Non-structural protein 1 (nsp1) is found in all Betacoronavirus genus, an important viral group that causes severe respiratory human diseases. This protein has significant role in pathogenesis and it is considered a probably major virulence factor. As it is absent in humans, it becomes an interesting target of study, especially when it comes to the rational search for drugs, since it increases the specificity of the target and reduces possible adverse effects that may be caused to the patient. Using approaches in silico we seek to study the behavior of nsp1 in solution to obtain its most stable conformation and find possible drugs with affinity to all of them. For this purpose, complete model of nsp1 of SARS-CoV-2 were predicted and its stability analyzed by molecular dynamics simulations in five different replicas. After main pocket validation using two control drugs and the main conformations of nsp1, molecular docking based on virtual screening were performed to identify novel potential inhibitors from DrugBank database. It has been found 16 molecules in common to all five nsp1 replica conformations. Three of them was ranked as the best compounds among them and showed better energy score than control molecules that have in vitro activity against nsp1 from SARS-CoV-2. The results pointed out here suggest new potential drugs for therapy to aid the rational drug search against COVID-19. Communicated by Ramaswamy H. Sarma.

RevDate: 2020-07-13

Ulrich CM, Anderson EE, JK Walter (2020)

COVID-19: Advancing Empirical Bioethics Research.

AJOB empirical bioethics [Epub ahead of print].

RevDate: 2020-07-13

Fallon D, McGhee K, Davies J, et al (2020)

Capturing the Impact of the COVID-19 Pandemic on Children's Nursing.

Comprehensive child and adolescent nursing [Epub ahead of print].

RevDate: 2020-07-13

Mackman N, Antoniak S, Wolberg AS, et al (2020)

Coagulation Abnormalities and Thrombosis in Patients Infected With SARS-CoV-2 and Other Pandemic Viruses.

Arteriosclerosis, thrombosis, and vascular biology [Epub ahead of print].

The world is amid a pandemic caused by severe acute respiratory syndrome-coronavirus 2. Severe acute respiratory syndrome-coronavirus causes serious respiratory tract infections that can lead to viral pneumonia, acute respiratory distress syndrome, and death. Some patients with coronavirus disease 2019 (COVID-19) have an activated coagulation system characterized by elevated plasma levels of d-dimer-a biomarker of fibrin degradation. Importantly, high levels of D-dimer on hospital admission are associated with increased risk of mortality. Venous thromboembolism is more common than arterial thromboembolism in hospitalized COVID-19 patients. Pulmonary thrombosis and microvascular thrombosis are observed in autopsy studies, and this may contribute to the severe hypoxia observed in COVID-19 patients. It is likely that multiple systems contribute to thrombosis in COVID-19 patients, such as activation of coagulation, platelet activation, hypofibrinolysis, endothelial cell dysfunction, inflammation, neutrophil extracellular traps, and complement. Targeting these different pathways may reduce thrombosis and improve lung function in COVID-19 patients.

RevDate: 2020-07-13

Monfared A, Balou HA, Hamidi Madani A, et al (2020)

Management of COVID-19 Crisis in Guilan Province in Northern Iran.

Archives of Iranian medicine, 23(7):511-513.

RevDate: 2020-07-13

Naser Moghadasi A, Azadvari M, MA Sahraian (2020)

Rehabilitation Recommendations for Multiple Sclerosis Patients during the COVID-19 Pandemic.

Archives of Iranian medicine, 23(7):509-510.

RevDate: 2020-07-13

Dooghaie Moghadam A, Eslami P, Razavi-Khorasani N, et al (2020)

The Impacts of the COVID-19 Pandemic on Liver Transplant Patients; Time to Change the Priorities.

Archives of Iranian medicine, 23(7):507-508.

RevDate: 2020-07-13

Dooghaie Moghadam A, Eslami P, Razavi-Khorasani N, et al (2020)

Colorectal Cancer Surgery during COVID-19 Pandemic in Iran; Most Appropriate Approach.

Archives of Iranian medicine, 23(7):505-506.

RevDate: 2020-07-13

Ghadir MR, Ebrazeh A, Khodadadi J, et al (2020)

The COVID-19 Outbreak in Iran; The First Patient with a Definite Diagnosis.

Archives of Iranian medicine, 23(7):503-504.

The novel coronavirus, formerly named as 2019 novel coronavirus (2019-nCov) caused a rapidly spreading epidemic of severe acute respiratory syndrome (SARS) in Wuhan, China and thereafter, progressed globally to form a pandemic of coronavirus disease 2019 (COVID-19) in numerous countries; and now confirmed cases are reported from several provinces of Iran. Now various medical centers, clinicians and researchers around the world share their data and experiences about COVID-19 in order to participate in the global attempt of controlling the pandemic. The current report investigates the clinical presentations and paraclinical findings of the first confirmed cases and mortalities in the initiation of the outbreak of COVID-19 in Iran.

RevDate: 2020-07-13

Rajani HF, Alshaikh FA, A Anushiravani (2020)

SARS-CoV-2; What We Know so far.

Archives of Iranian medicine, 23(7):498-502.

A recent outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected more than 1100000 (April 5, 2020) individuals worldwide and is spreading rapidly. The virus is reported to be derived from bats and the infection was first reported in China. Similar to the severe acute respiratory syndrome and the Middle East respiratory syndrome coronaviruses, it is responsible for respiratory tract infection. Real time polymerase chain reaction and radiography are the two main diagnostic methods. Guidelines from the Center for Disease Control and Prevention and the World Health Organization (WHO) should be followed for diagnostic and precautionary measures. Treatment of the infection is still not available; however, antivirals are under clinical trials.

RevDate: 2020-07-13

Chaibakhsh S, Pourhoseingholi A, M Vahedi (2020)

Global Incidence and Mortality Rate of COVID-19; Special Focus on Iran, Italy and China.

Archives of Iranian medicine, 23(7):455-461.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus, was diagnosed in China in December 2019. Around the globe, a total of 71429 were infected up to February 17, 2020, with 98.9% of cases in China. On March 11, 2020, the World Health Organization (WHO) characterized the COVID-19 as 'pandemic'. Rapid positive worldwide incidence was the motivation behind this study to investigate the incidence and mortality globally.

METHODS: We used the data published by the WHO until March 9, 2020. Non-parametric tests and change point analysis were used for inferences.

RESULTS: Change point analysis for Iran and China and the world excluding China for the first 20 days revealed around 78, 195 and 2 further new cases per day, respectively. Italy had a big jump in incidence on the 36th day. Similarly, a sharp rise of positive cases was reported for the world on the 35th day. China successfully controlled the ascending reports of incidence on the 23rd day. Mortality in China and the world were almost similar for the first 20 days. There was an ascending incidence trend with two change points in Italy (30th and 36th days) and one change point in Iran on the 17th day. Mortality in the world jumped remarkably after day 42 with an estimation of almost more than 25 deaths per day.

CONCLUSION: The incidence of COVID-19 varied by regions; however, after March 11, it became 'pandemic'. It was observed that after about 6 days with an emergence of sharp increase in incidences, there would be a mutation in mortality rate. On the other hand, the importance of 'on-time' quarantine programs in controlling this virus was confirmed.

RevDate: 2020-07-13

Whetton AD, Preston GW, Abubeker S, et al (2020)

Proteomics and informatics for understanding phases and identifying biomarkers in COVID-19 disease.

Journal of proteome research [Epub ahead of print].

The emergence of novel coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 coronavirus, has necessitated the urgent development of new diagnostic and therapeutic strategies. Rapid research and development, on an international scale, has already generated assays for detecting SARS-CoV-2 RNA and host immunoglobulins. However, the complexities of COVID-19 are such that a fuller definition of patient status, trajectory, sequelae and responses to therapy is now required. There is accumulating evidence - from studies of both COVID-19 and the related disease SARS - that protein biomarkers could help to provide this definition. Proteins associated with blood coagulation (D-dimer), cell damage (lactate dehydrogenase) and the inflammatory response (e.g. C-reactive protein) have already been identified as possible predictors of COVID-19 severity or mortality. Proteomics technologies, with their ability to detect many proteins per analysis, have begun to extend these early findings. In order to be effective, proteomics strategies must include not only methods for comprehensive data acquisition (e.g. using mass spectrometry) but also informatics approaches via which to derive actionable information from large data-sets. Here we review applications of proteomics to COVID-19 and SARS, and outline how pipelines involving technologies such as artificial intelligence could be of value for research on these diseases.

RevDate: 2020-07-13

Behzadinasab S, Chin A, Hosseini M, et al (2020)

A Surface Coating that Rapidly Inactivates SARS-CoV-2.

ACS applied materials & interfaces [Epub ahead of print].

SARS-CoV-2, the virus that causes the disease COVID-19, remains viable on solids for periods of up to one week, so one potential route for human infection is via exposure to an infectious dose from a solid. We have fabricated and tested a coating that is designed to reduce the longevity of SARS-CoV-2 on solids. The coating consists of cuprous oxide (Cu2O) particles bound with polyurethane. After one hour on coated glass or stainless steel, the viral titer was reduced by about 99.9% on average compared to the uncoated sample. An advantage of a polyurethane-based coating is that polyurethane is already used to coat a large number of everyday objects. Our coating adheres well to glass and stainless steel, as well as everyday items that people may fear to touch during a pandemic, such as a doorknob, a pen, and a credit card keypad button. The coating performs well in the cross-hatch durability test and remains intact and active after 13 days immersed in water, or after exposure to multiple cycles of exposure to virus and disinfection.

RevDate: 2020-07-13

Dev N, Kumar V, J Sankar (2020)

COVID-19 infection outbreak among health care workers: perspective from a low-middle income country.

Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace, 90(3):.

To the Editor, The new pandemic COVID -19 caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) is a global threat. So far, more than 11 million infections and more than five hundred thousand deaths have been reported worldwide. In India the number of cases as of 5th July, 2020 is 6,73,165 with 19,268 deaths. Health care workers (HCWs) have been the backbone of this pandemic since the very beginning...

RevDate: 2020-07-13

Pascual Gómez NF, Monge Lobo I, Granero Cremades I, et al (2020)

[Potential biomarkers predictors of mortality in COVID-19 patients in the Emergency Department].

Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia [Epub ahead of print].

OBJECTIVE: Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk.

METHODS: Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score.

RESULTS: A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%).

CONCLUSIONS: Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.

RevDate: 2020-07-13

Kong D, Wang Y, Lu L, et al (2020)

Clusters of 2019 coronavirus disease (COVID-19) cases in Chinese tour groups.

Transboundary and emerging diseases [Epub ahead of print].

International travel may facilitate the spread of the novel coronavirus disease (COVID-19). The study describes clusters of COVID-19 cases within Chinese tour groups travelling in Europe January 16-28. We compared characteristics of cases and non-cases to determine transmission dynamics. The index case travelled from Wuhan, China, to Europe on January 16, 2020, and to Shanghai, China, on January 27, 2020, within a tour group (group A). Tour groups with the same outbound flight (group B) or the same tourism venue (group D), and all Chinese passengers on the inbound flight (group C) were investigated. The outbreak involved 11 confirmed cases, 10 suspected cases, and 6 tourists who remained healthy. Group A, involving 7 confirmed cases and 6 suspected cases, consisted of familial transmission followed by propagative transmission. There was less pathogenicity with propagative transmission than with familial transmission. Disease was transmitted in shared outbound flights, shopping venues within Europe, and inbound flight back to China. The novel coronavirus caused clustered cases of COVID-19 in tour groups. When tourism and travel opens up, governments will need to improve screening at airports and consider increased surveillance of tour groups - particularly those with older tour members.

RevDate: 2020-07-13

Demir E, Uyar M, Parmaksiz E, et al (2020)

COVID-19 in kidney transplant recipients: A multicenter experience in Istanbul.

Transplant infectious disease : an official journal of the Transplantation Society [Epub ahead of print].

INTRODUCTION: Management of COVID-19 in kidney transplant recipients should include treatment of the infection, regulation of immunosuppression, and supportive therapy. However, there is no consensus on this issue yet. This study aimed to our experiences with kidney transplant recipients diagnosed with COVID-19.

MATERIAL AND METHODS: Kidney transplant recipients diagnosed with COVID-19 from five major transplant centers in Istanbul, Turkey, were included in this retrospective cohort study. Patients were classified as having moderate or severe pneumonia for the analysis. The primary endpoint was all-cause mortality. The secondary endpoints were acute kidney injury, the average length of hospital stay, admission to intensive care, and mechanical ventilation.

RESULTS: Forty patients were reviewed retrospectively over a follow-up period of 32 days after being diagnosed with COVID-19. Cough, fever, and dyspnea were the most frequent symptoms in all patients. The frequency of previous induction and rejection therapy was significantly higher in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Five patients died during follow-up in the intensive care unit. None of the patients developed graft loss during follow-up.

DISCUSSION: COVID-19 has been seen to more commonly cause moderate or severe pneumonia in kidney transplant recipients. Immunosuppression should be carefully reduced in these patients. Induction therapy with lymphocyte-depleting agents should be carefully avoided in kidney transplant recipients during the pandemic period.

RevDate: 2020-07-13

Kong J, Wang T, Di Z, et al (2020)

Analysis of hematological indexes of COVID-19 patients from fever clinics in Suzhou, China.

RevDate: 2020-07-13

Pagliaro M, Albo Y, R Ciriminna (2020)

New antivirals and antibacterials based on silver nanoparticles.

ChemMedChem [Epub ahead of print].

Microencapsulated Ag nanoparticles, wee argument in this study, may shortly emerge as new generation antibacterials and antivirals of broad scope, low toxicity and affordable cost. The rediscovery of the medical uses of silver provides another noticeable example, this time at the interface of chemistry and medicine with implications concerning also COVID-19, of the real (and non-linear) progress of scientific research.

RevDate: 2020-07-13

Byrd KM, Beckwith CG, Garland JM, et al (2020)

SARS-CoV-2 and HIV coinfection: clinical experience from Rhode Island, United States.

Journal of the International AIDS Society, 23(7):e25573.

INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected >6 million people worldwide since December 2019. Global reports of HIV/SARS-CoV-2 coinfection are limited. To better understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons with HIV and improve their care, we present an outpatient and inpatient clinical experience of HIV/SARS-CoV-2 coinfection from Rhode Island, US.

METHODS: We describe outpatient and inpatient preparedness for the COVID-19 pandemic, and present a case series of all known patients with HIV/SARS-CoV-2 coinfection at The Miriam Hospital and Rhode Island Hospital, and The Miriam Hospital Infectious Diseases and Immunology Center, in Providence, Rhode Island, US.

RESULTS AND DISCUSSION: The Infectious Diseases and Immunology Center rapidly prepared for outpatient and inpatient care of persons with HIV and SARS-CoV-2. Between 30 March and 20 May 2020, 27 patients with HIV were diagnosed with SARS-CoV-2. Twenty were male, six female and one transgender female; average age was 49 years; 13/27 were Hispanic and 6/27 were African American. All had HIV viral load <200 copies/mL and were on antiretroviral therapy with CD4 count range 87 to 1441 cells/µL. Twenty-six of the 27 had common COVID-19 symptoms for one to twenty-eight days and most had other co-morbidities and/or risk factors. Nine of the 27 were hospitalized for one to thirteen days; of those, three lived in a nursing home, six received remdesivir through a clinical trial or emergency use authorization and tolerated it well; eight recovered and one died. Overall, 17% of known Center people had HIV/SARS-CoV-2 coinfection, whereas the comparable state-wide prevalence was 9%.

CONCLUSIONS: We highlight challenges of outpatient and inpatient HIV care in the setting of the COVID-19 pandemic and present the largest detailed case series to date from the United States on HIV/SARS-CoV-2 coinfection, adding to limited global reports. The aggregated clinical findings suggest that the clinical presentation and outcomes of COVID-19 appear consistent with those without HIV. Whether SARS-CoV-2 infection is more frequent among persons with HIV remains to be determined. More data are needed as we develop our understanding of how HIV and antiretroviral therapy are affected by or have an impact on this pandemic.

RevDate: 2020-07-13

Callinan S, S MacLean (2020)

COVID-19 makes a stronger research focus on home drinking more important than ever.

RevDate: 2020-07-13

Amano T (2020)

Angiotensin-Converting Enzyme 2 as a Versatile Player in the Management of Coronavirus Disease 2019.

Journal of diabetes investigation [Epub ahead of print].

In view of the global coronavirus disease 2019 (COVID-19) pandemic, there are ongoing efforts aimed at predicting potential factors causing clinical exacerbation of COVID-19 and at seeking effective therapies for COVID-19.Recent studies have indicated that severe acute respiratory coronavirus 2 (SARS-CoV-2) uses angiotensin-converting enzyme 2 (ACE2) as a receptor for cellular invasion and subsequent replication.

RevDate: 2020-07-13

Parlakpinar H, Polat S, HA Acet (2020)

Pharmacological agents under investigation in the treatment of coronavirus disease 2019 and the importance of melatonin.

Fundamental & clinical pharmacology [Epub ahead of print].

Coronavirus disease 2019 (COVID-19) is a life-threatening infectious respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 pandemic causing morbidities and even deaths worldwide revealed that there is urgent need to find pharmacological agents or vaccines. Although there are a lot of agents under investigation, there is no approved agent for the prevention or treatment of the COVID-19 yet. Treatment of patients remains mainly supportive as well as compassionate use of the agents under investigation. It is well established that excessive inflammatory and immune response as well as oxidative injury play a critical role in the pathogenesis of COVID-19. In this review, we aimed to update knowledge about pathogenesis, clinical features and pharmacological treatment of COVID-19 and review the potential beneficial effects of ancient antioxidant, anti-inflammatory and immunomodulatory molecule melatonin for prevention and treatment of COVID-19.

RevDate: 2020-07-13

Ji X, Tan W, Zhang C, et al (2020)

TWIRLS, a knowledge-mining technology, suggests a possible mechanism for the pathological changes in the human host after coronavirus infection via ACE2.

Drug development research [Epub ahead of print].

Faced with the current large-scale public health emergency, collecting, sorting, and analyzing biomedical information related to the "SARS-CoV-2" should be done as quickly as possible to gain a global perspective, which is a basic requirement for strengthening epidemic control capacity. However, for human researchers studying viruses and hosts, the vast amount of information available cannot be processed effectively and in a timely manner, particularly if our scientific understanding is also limited, which further lowers the information processing efficiency. We present TWIRLS (Topic-wise inference engine of massive biomedical literatures), a method that can deal with various scientific problems, such as liver cancer, acute myeloid leukemia, and so forth, which can automatically acquire, organize, and classify information. Additionally, this information can be combined with independent functional data sources to build an inference system via a machine-based approach, which can provide relevant knowledge to help human researchers quickly establish subject cognition and to make more effective decisions. Using TWIRLS, we automatically analyzed more than three million words in more than 14,000 literature articles in only 4 hr. We found that an important regulatory factor angiotensin-converting enzyme 2 (ACE2) may be involved in host pathological changes on binding to the coronavirus after infection. On triggering functional changes in ACE2/AT2R, the cytokine homeostasis regulation axis becomes imbalanced via the Renin-Angiotensin System and IP-10, leading to a cytokine storm. Through a preliminary analysis of blood indices of COVID-19 patients with a history of hypertension, we found that non-ARB (Angiotensin II receptor blockers) users had more symptoms of severe illness than ARB users. This suggests ARBs could potentially be used to treat acute lung injury caused by coronavirus infection.

RevDate: 2020-07-13

Mechili EA, Saliaj A, Kamberi F, et al (2020)

Is the mental health of young students and their family members affected during the quarantine period? Evidence from the COVID-19 pandemic in Albania.

Journal of psychiatric and mental health nursing [Epub ahead of print].

INTRODUCTION: The use of quarantine method has a significant impact on mental health status.

AIM: This study aimed to assess the levels of depression among bachelor and master university students (nurses/midwives) and their family members' during the quarantine period of COVID-19 pandemic.

METHOD: A cross-sectional study was conducted in Vlora University, Albania. Patient Health Questionnaire (PHQ-9) was used. Institutional e-mails of all active students were used for their recruitment.

RESULTS: In total, 863 students and 249 family members participated in the study. The mean PHQ-9 score was 6.220 (SD=5.803) and 6.280 (SD=5.857) for students and family members, respectively. Being unsatisfied with COVID-19 prevention measures, beliefs that COVID-19 infection and quarantine process can cause problems on their health status were the key factors for students to be screened positive for mental problems in multiple regression analysis. For parents, the last two factors were found to contribute significantly.

DISCUSSION: Our findings indicate that quarantine measures have a significant impact on the levels of depression among both university students and their family members. Broader population studies are necessary to safeguard these results.

IMPLICATIONS FOR PRACTICE: Provision of mental health services during the quarantine period is of paramount significance. Mental health first aid trainingand support could benefit both students and their parents significantly. Additionally, follow up services after the end of quarantine are recommended.

RevDate: 2020-07-13

Tan R, Yu T, Luo K, et al (2020)

Experiences of clinical first-line nurses treating patients with COVID-19: A qualitative study.

Journal of nursing management [Epub ahead of print].

AIM: To explore the work experience of clinical first-line nurses treating patients with coronavirus disease 2019 (COVID-19).

BACKGROUND: COVID-19 has been listed as an international public health emergency. Clinical first-line nurses are at a high risk of infection, and they face a lack of experience and inadequate preparation for COVID-19, leading to physical and psychological disorders.

METHODS: A qualitative study was conducted from January to February, 2020 at a COVID-19-designated hospital in Wuhan, China. Thirty nurses were selected for the study using a purposive sampling method. Data were collected by semi-structured interviews and analyzed using content analysis.

RESULTS: Two main categories were defined in the study from the perspective of nurses: negative experiences during clinical first-line work and positive impacts of clinical first-line work. Under the first category, two subcategories were included: psychological experiences of clinical first-line work and difficulties faced during clinical first-line work. The analysis further yielded two subcategories for the second category: the needs of clinical first-line work and the impact of clinical first-line work on professional attitudes.

CONCLUSIONS: The results demonstrate that success depends upon strengthening emergency training and knowledge of infectious diseases for nurses, providing adequate protective equipment, and improving the emergency response plans of hospitals for public health emergencies.

It is believed that our findings will guide hospital managers to make improvements in personal, administrative, and institutional areas, and that they will provide a reference and inspiration for nurses with regard to public health emergencies in the future.

RevDate: 2020-07-13

Baeck M, Herman A, Peeters C, et al (2020)

Are chilblains a skin expression of COVID-19 microangiopathy?.

The unexpected outbreak of chilblains during the current coronavirus disease 2019 (COVID-19) pandemic has been causally linked to severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection (1). The pathophysiology of these chilblains observed in otherwise healthy patients is widely discussed.

RevDate: 2020-07-13

Zhan Y, Liu Y, Liu H, et al (2020)

Factors associated with insomnia among Chinese frontline nurses Fighting against COVID-19 in Wuhan: A cross-sectional survey.

Journal of nursing management [Epub ahead of print].

AIM: To investigate the prevalence of insomnia among frontline nurses fighting against COVID-19 in Wuhan, China and analyze its influencing factors.

BACKGROUND: Insomnia is an important factor that can affect the health and work quality of nurses. However, There is a lack of big-sample studies exploring factors that affect the insomnia of nurses fighting against COVID-19.

METHOD: This cross-sectional study using the Ascension Insomnia Scale, Fatigue Scale-14, and Perceived Stress Scale took place in March 2020. Participants were 1,794 frontline nurses from four tertiary-level general hospitals.

RESULTS: The prevalence of insomnia among participants was 52.8%. Insomnia was predicted by gender, working experience, chronic diseases, midday nap duration, direct participation in rescue of patients with COVID-19, frequency of night shifts, professional psychological assistance during the pandemic, negative experiences (such as family, friends, or colleagues being seriously ill or dying due to COVID-19), the degree of fear of COVID-19, fatigue, and perceived stress.

CONCLUSION: The level of insomnia among participants was higher than the normal level. Interventions based on influencing factors should be implemented to ensure nurses' sleep quality.

An in-depth understanding of the influencing factors of insomnia among frontline nurses can help nurse managers develop solutions to improve frontline nurses' sleep quality, which will enhance the physical and mental conditions of nurses and promote the quality of care.

RevDate: 2020-07-13

Goldberg AB, Kyung S, Swearingen S, et al (2020)

Expecting the unexpected: Echo laboratory preparedness in the time of COVID-19.

Echocardiography (Mount Kisco, N.Y.) [Epub ahead of print].

COVID-19 poses a unique set of challenges to the healthcare system due to its rapid spread, intensive resource utilization, and relatively high morbidity and mortality. Healthcare workers are at especially high risk of exposure given the viruses spread through close contact. Reported cardiac complications of COVID-19 include myocarditis, acute coronary syndrome, cardiomyopathy, pericardial effusion, arrhythmia, and shock. Thus, echocardiography is integral in the timely diagnosis and clinical management of COVID-19 patients. Rush University Medical Center has been at the forefront of the COVID-19 response in Illinois with high numbers of cases reported in Chicago and surrounding areas. The echocardiography laboratory at Rush University Medical Center (RUMC) proactively took numerous steps to balance the imaging needs of a busy, nearly 700-bed academic medical center while maintaining safety.

RevDate: 2020-07-13

Hetland G, Johnson E, Bernardshaw SV, et al (2020)

Can medicinal mushrooms have prophylactic or therapeutic effect against COVID-19 and its pneumonic superinfection and complicating inflammation?.

Scandinavian journal of immunology [Epub ahead of print].

Medicinal mushrooms have documented effects against different diseases, including infections and inflammatory disorders. The related Basidiomycota Agaricus blazei Murill (AbM), Hericium erinaceus (HE) and Grifola frondosa (GF) have been shown to exert antimicrobial activity against viral agents, Gram positive and Gram negative bacteria, and parasites in vitro and in vivo. Since the mechanism is immunomodulatory and not antibiotical the mushrooms should be active against multi-drug resistant microbes as well. Moreover, since these Basidiomycota also have anti-inflammatory properties, they may be suited for treatment of the severe lung inflammation that often follows COVID-19 infection. An AbM-based mushroom extract (AndosanTM), also containing HE and GF, has been shown to significantly reduce bacteremia and increase survival in mice with pneumococcal sepsis, and to improve symptoms and quality of life in IBD patients via an anti-inflammatory effect. Hence, such mushroom extracts could have prophylactic or therapeutic effect against the pneumonic superinfection and severe lung inflammation that often complicates COVID-19 infection. Here, we review antimicrobial and anti-inflammatory properties of AbM, HE and GF mushrooms, which could be used for the battle against COVID-19.

RevDate: 2020-07-13

Dodesini AR, Galliani S, Ciriello E, et al (2020)

Pre-gestational diabetes during the COVID-19 pandemic in Bergamo, Italy.

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

The COVID-19 pandemic has caused the proliferation of a highly contagious and frequently fatal pneumonia around the world.[1] COVID-19 has severely affected Italy, and at the onset of this crisis, Bergamo, a city in northern Italy, regularly reported the highest number of cases in the country for many weeks. During outbreaks of infectious disease, pregnant women represent a high-risk population due to their increased susceptibility to infections, particularly when comorbidities such as pre-gestational diabetes (present in 0.5% of pregnant populations) are present.[2,3] Few data are available on pregnant women with pre-gestational diabetes during the COVID-19 pandemic.

RevDate: 2020-07-13

Smithgall MC, Dowlatshahi M, Spitalnik SL, et al (2020)

Types of Assays for SARS-CoV-2 Testing: A Review.

Laboratory medicine pii:5870605 [Epub ahead of print].

Clinical laboratory testing routinely provides actionable results, which help direct patient care in the inpatient and outpatient settings. Since December 2019, a novel coronavirus (SARS-CoV-2) has been causing disease (COVID-19 [coronavirus disease 2019]) in patients, beginning in China and now extending worldwide. In this context of a novel viral pandemic, clinical laboratories have developed multiple novel assays for SARS-CoV-2 diagnosis and for managing patients afflicted with this illness. These include molecular and serologic-based tests, some with point-of-care testing capabilities. Herein, we present an overview of the types of testing available for managing patients with COVID-19, as well as for screening of potential plasma donors who have recovered from COVID-19.

RevDate: 2020-07-13

Danielli S, Patria R, Donnelly P, et al (2020)

Economic interventions to ameliorate the impact of COVID-19 on the economy and health: an international comparison.

Journal of public health (Oxford, England) pii:5869897 [Epub ahead of print].

BACKGROUND: The COVID-19 pandemic continues to challenge governments and policymakers worldwide. They have rightfully prioritised reducing the spread of the virus through social distancing interventions. However, shuttered business and widespread restrictions on travel and mobility have led to an economic collapse with increasing uncertainty of how quickly recovery will be achieved.

METHODS: The authors carried out a review of publicly available information on the economic intervention's countries have put in place to ameliorate the impact of COVID-19.

RESULTS: The strategies and scale of economic interventions have been broad, ranging from 2.5% to a reported 50% of Gross Domestic Product.

CONCLUSIONS: Numerous countries are beginning to ease lockdown restrictions and restart economies in different ways. There is therefore evolving, real-world data that should be used dynamically by governments and policymakers. The strategies on restarting the economy must be balanced against the uncertainty of a possible second wave of COVID-19. A nuanced approach to easing restrictions needs to take into account not only immediate risk to life but longer-term risks of widening inequalities and falling life expectancy.

RevDate: 2020-07-13

Visser JT (2020)

Patterns of Illness and Injury on Antarctic Research Cruises, 2004-2019: a descriptive analysis.

Journal of travel medicine pii:5870448 [Epub ahead of print].

BACKGROUND: Prior to the impact of the Covid 19 pandemic, cruise travel had experienced exponential growth in the preceding decade. Travel medicine practitioners were increasingly called upon to provide pre-cruise travel advice and medical clearance. Demand for these services will return at some time in the future.

METHODS: The clinical conditions seen in those presenting for care on 6 small vessel scientific cruises to Antarctica were analyzed.

RESULTS: Personnel presented on 196 occasions resulting in 257 consultations (when initial plus all follow up consultations were included). Personnel presented with a clinical condition at a rate of 17.9 per 1000 person days at sea. The total consultation rate was 23.5 per 1000 person days at sea. Injury accounted for 24% of all presentations at a rate of 4.3 per 1000 person days at sea. Dermatological, soft tissue and musculoskeletal, general malaise and motion sickness were the four most common presentations.

CONCLUSIONS: Pre-cruise advice for travelers planning small vessel cruises to polar regions needs to include skin care, prevention and management of sea sickness and how to reduce the risk of injury. Those providing medical care on such cruises should be prepared to manage a wide range of clinical presentations.

RevDate: 2020-07-13

Epelboin L, Blondé R, Nacher M, et al (2020)

COVID-19 and dengue co-infection in a returning traveller.

Journal of travel medicine pii:5870449 [Epub ahead of print].

In march 2020, a pandemic of respiratory infection due to the SARS-CoV2 is underway, dengue fever epidemics are at the same time present in many regions of the inter-equatorial zone. We report the first cases of covid19-dengue co-infection, which occurred in Mayotte, a French island in the Indian Ocean.

RevDate: 2020-07-13

de Vroege L, A van den Broek (2020)

UpdatesMental support for health care professionals essential during the COVID-19 pandemic.

Journal of public health (Oxford, England) pii:5869898 [Epub ahead of print].

RevDate: 2020-07-13

Ronquillo JG, Lester WT, DM Zuckerman (2020)

Using informatics to guide public health policy during the COVID-19 pandemic in the USA.

Journal of public health (Oxford, England) pii:5869906 [Epub ahead of print].

BACKGROUND: Current and future pandemics will require informatics solutions to assess the risks, resources and policies to guide better public health decision-making.

METHODS: Cross-sectional study of all COVID-19 cases and deaths in the USA on a population- and resource-adjusted basis (as of 24 April 2020) by applying biomedical informatics and data visualization tools to several public and federal government datasets, including analysis of the impact of statewide stay-at-home orders.

RESULTS: There were 2753.2 cases and 158.0 deaths per million residents, respectively, in the USA with variable distributions throughout divisions, regions and states. Forty-two states and Washington, DC, (84.3%) had statewide stay-at-home orders, with the remaining states having population-adjusted characteristics in the highest risk quartile.

CONCLUSIONS: Effective national preparedness requires clearly understanding states' ability to predict, manage and balance public health needs through all stages of a pandemic. This will require leveraging data quickly, correctly and responsibly into sound public health policies.

RevDate: 2020-07-13

Chaurasia B, Deora H, El-Ghandour NMF, et al (2020)

In Memoriam: A Memoir for Our Fallen "Heroes".

Neurosurgery pii:5870597 [Epub ahead of print].

Even though neurosurgeons exercise these enormous and versatile skills, the COVID-19 pandemic has shaken the fabrics of the global neurosurgical family, jeopardizing human lives, and forcing the entire world to be locked down. We stand on the shoulders of the giants and will not forget their examples and their teachings. We will work to the best of our ability to honor their memory. Professor Harvey Cushing said: "When to take great risks; when to withdraw in the face of unexpected difficulties; whether to force an attempted enucleation of a pathologically favorable tumor to its completion with the prospect of an operative fatality, or to abandon the procedure short of completeness with the certainty that after months or years even greater risks may have to be faced at a subsequent session-all these require surgical judgment which is a matter of long experience." It is up to us, therefore, to keep on the noble path that we have decided to undertake, to accumulate the surgical experience that these icons have shown us, the fruit of sacrifice and obstinacy. Our tribute goes to them; we will always remember their excellent work and their brilliant careers that will continue to enlighten all of us.

RevDate: 2020-07-13

Bäuerle A, Teufel M, Musche V, et al (2020)

Increased generalized anxiety, depression and distress during the COVID-19 pandemic: a cross-sectional study in Germany.

Journal of public health (Oxford, England) pii:5869903 [Epub ahead of print].

BACKGROUND: Since the first cases of the novel coronavirus disease SARS-CoV-2 were reported in December 2019 in China, the virus has spread in most countries. The aim of the present study was to assess initial data on the mental health burden of the German public during the COVID-19 pandemic.

METHODS: A cross-sectional study was conducted in Germany and collected complete datasets from 15 704 German residents aged 18 years and over. Besides demographics, generalized anxiety (GAD-7), depression (PHQ-2) and psychological distress (DT) were assessed. Furthermore, COVID-19-related fear, trust in governmental actions to face COVID-19 and the subjective level of information regarding COVID-19 were covered.

RESULTS: Significantly increased symptoms were highly prevalent in all dimensions: generalized anxiety (44.9%), depression (14.3%), psychological distress (65.2%) and COVID-19-related fear (59%). Females and younger people reported higher mental burden. Trust in governmental actions to face COVID-19 and the subjective level of information regarding COVID-19 are negatively associated with mental health burden. However, the subjective level of information regarding COVID-19 is positively associated with increased COVID-19-related fear.

CONCLUSIONS: The provision of appropriate psychological interventions for those in need and the provision of transparency and comprehensible information are crucial during the current pandemic.

RevDate: 2020-07-13

Comité de Crise de la Sfv (2020)

Facing Covid-19: A doctor and veterinarian alliance.

Virologie (Montrouge, France), 24(3):165-175.

RevDate: 2020-07-13

Comité de Crise de la Société Française de Virologie (2020)

Covid-19 : after Ebola, towards a new emergence of SARS-CoV-2 in Africa?.

Virologie (Montrouge, France), 24(3):147-152.

RevDate: 2020-07-13

Shi Q, Dorling D, Cao G, et al (2020)

Changes in population movement make COVID-19 spread differently from SARS.

Social science & medicine (1982), 255:113036.

This comment discusses the contribution of population movement to the spread of COVID-19, with a reference to the spread of SARS 17 years ago. We argue that the changing geography of migration, the diversification of jobs taken by migrants, the rapid growth of tourism and business trips, and the longer distance taken by people for family reunion are what make the spread of COVID-19 so differently from that of SARS. These changes in population movement are expected to continue. Hence, new strategies in disease prevention and control should be taken accordingly, which are also proposed in the comment.

RevDate: 2020-07-13

Tonen-Wolyec S, Marini Djang'eing'a R, Kambale-Kombi P, et al (2020)

Vulnerability of sickle cell disease persons to the COVID-19 in sub-Saharan Africa.

Hematology (Amsterdam, Netherlands), 25(1):280-282.

RevDate: 2020-07-13

Çalışkan F, Mıdık Ö, Baykan Z, et al (2020)

The knowledge level and perceptions towards COVID-19 among Turkish final year medical students.

Postgraduate medicine [Epub ahead of print].

BACKGROUND: Coronavirus disease 2019 (COVID-19) has upended medical education as well as the lives of healthcare professionals. Higher education institutions have a crucial role in the solution of public health problems by training young doctor candidates, and it is also essential to increase the knowledge level of physician candidates about the epidemic. So, in this study, we aimed to examine Turkish final year medical students' knowledge level, and perceptions towards the COVID-19 pandemic.

METHODS: The present descriptive multicentered study was conducted with the medical students in the final year of six medical schools located in six geographic regions of Turkey. After ethical approval, data was gathered using an online questionnaire through Google forms between April 10, 2020, and April 20, 2020.

RESULTS: In this national survey study, 860 volunteers answered the questions thoroughly. The median age was 24 (22-38) years. 55.3% of the participants were female. The median knowledge level score was 69.0 (0-93.1). The knowledge level was moderate. 34.2% of the participants had a high level of knowledge. 48.7% of participants stated that they felt the most competent about performing CPR. Updates about COVID-19 were followed regularly by 84.5% of the participants.

CONCLUSION: We determined that final year medical students are knowledgeable and aware of this pandemic. We, medical educators, should inculcate relevant knowledge and educate the medical students to improve practices in the current pandemic, as well as for future epidemics. Different learning techniques should be added to the curriculum, especially at the time which widespread panic and uncertainty are prevalent.

RevDate: 2020-07-13

Schimmel J, AF Manini (2020)

Opioid Use Disorder and COVID-19: Biological Plausibility for Worsened Outcomes.

Substance use & misuse [Epub ahead of print].

BACKGROUND: Alarms have been raised that COVID-19 may disproportionately affect certain populations with substance use disorders, particularly Opioid Use Disorder (OUD), however warnings have largely focused on social risks such as reduced availability of services. Objectives: This commentary highlights three plausible biological mechanisms for potentially worsened outcomes in patients with OUD who contract COVID-19. Results: Opioid-related respiratory depression may amplify risks of hypoxemia from COVID-19 viral pneumonia. Complex opioid immune modulation may impact host response to COVID-19, though the effect direction and clinical significance are unclear. Drug-drug interactions may affect individuals with OUD who are co-administered medications for OUD and medications for COVID-19, particularly due to cardiac adverse effects. Conclusions/Importance: There are plausible biological mechanisms for potentially worsened outcomes in patients with OUD who contract COVID-19; these mechanisms require further study, and should be considered in individuals with OUD.

RevDate: 2020-07-13

Grégory J, Raynaud L, Galy A, et al (2020)

Extension of COVID-19 pulmonary parenchyma lesions based on real-life visual assessment on initial chest CT is an independent predictor of poor patient outcome.

RevDate: 2020-07-13

Oltean M, Søfteland JM, Bagge J, et al (2020)

Covid-19 in kidney transplant recipients: a systematic review of the case series available three months into the pandemic.

Infectious diseases (London, England) [Epub ahead of print].

BACKGROUND: Coronavirus disease 2019 (COVID-19) ranges from a mild illness to acute respiratory distress syndrome (ARDS), multiorgan dysfunction, and death. Transplant recipients are vulnerable due to comorbidities and immunosuppressants that render them susceptible to infections. The information on COVID-19 in kidney transplant recipients remains limited to small case series.

METHODS: A systematic literature search was conducted, and 12 case series totalling 204 kidney transplant recipients with COVID-19 were identified. Data were extracted, pooled and analysed.

RESULTS: Most patients (74%) were men. The most frequent symptoms were fever (76%), cough (64%) and dyspnoea (43%). At admission, over 70% of the patients had abnormal radiological findings. Leukocyte counts were in the lower normal range. C-reactive protein, ferritin, and D-dimer were consistently increased. Treatments included lowering immunosuppression, hydroxychloroquine, antivirals, tocilizumab and intravenous immunoglobulins. Thirty-one percent of the patients were admitted to intensive care units (ICUs), and 16% required intubation. The overall mortality was 21.2%. Patients who died were significantly older than those who survived (61 ± 12 vs. 51 ± 15, p < .01). Logistic regression revealed that the odds for death increased by 4.3% for each additional year of age (odds ratio [OR] 1.043, 95% confidence interval [CI] 1.005-1.083, p value = .0265).

CONCLUSIONS: No substantial conclusions could be drawn on the efficacy of any particular treatment. More rigorous patient stratification is needed when analysing and reporting data to facilitate future meta-analyses.

RevDate: 2020-07-13

Karloh M, Sousa Matias T, A Fleig Mayer (2020)

The COVID-19 Pandemic Confronts the Motivation Fallacy within Pulmonary Rehabilitation Programs.

COPD [Epub ahead of print].

Social distancing and quarantines have been implemented worldwide to reduce the spread of Coronavirus Disease (COVID-19). However, social distancing has had far-reaching health consequences, considering that the COVID-19 pandemic has exposed people to the hazard of physical inactivity and sedentary behavior. For patients with Chronic Obstructive Pulmonary Disease (COPD), which is one of the main diseases at risk for COVID-19, the impact is even greater since outpatient pulmonary rehabilitation (PR) programs are temporarily closed. More than ever, patients' behavior change to exercise calls for urgent debate. We propose a theoretical discussion in light of Self-Determination Theory, aiming to make PR a setting that supports autonomous forms of motivation. The scenario will not be changed in the short-term; but if other conditions hinder the development of PR in its most traditional form, the PR community will be better prepared to overcome the barriers to maintain physical exercise.

RevDate: 2020-07-13

Yeo-Teh NSL, BL Tang (2020)

Letter to the Editor: Response to An 'alarming' and 'exceptionally high' rate of COVID-19 retractions? by Oransky.

Accountability in research [Epub ahead of print].

RevDate: 2020-07-13

Flaherty C (2020)

Tracheostomy care: the role of the nurse before, during and after insertion.

Nursing standard (Royal College of Nursing (Great Britain) : 1987) pii:e11500 [Epub ahead of print].

A tracheostomy is a surgical procedure that involves creating an opening and inserting a tube in the trachea to enable air transit from the external atmosphere to the lungs. The insertion of a tracheostomy is a common procedure used to wean patients from mechanical ventilation and to manage patients with upper respiratory tract complications. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has resulted in many patients requiring a tracheostomy as part of respiratory management. The two most commonly used tracheostomy insertion procedures are the open surgical tracheostomy and the percutaneous dilatation tracheostomy, both of which are associated with a range of complications. This article outlines the indications, benefits and complications of tracheostomy insertion, as well as the various types of tracheostomy tube that may be used. It also explains the role of the nurse in caring for patients before, during and after tracheostomy insertion, including the management of tracheostomy-related complications and emergencies.

RevDate: 2020-07-13

Kim HN, Lee JH, Park HS, et al (2020)

A Case of COVID-19 with Acute Myocardial Infarction and Cardiogenic Shock.

Journal of Korean medical science, 35(27):e258 pii:35.e258.

A 60-year-old male patient with coronavirus disease-2019 showed new onset ST-segment elevation in V1-V2 leads on electrocardiogram and cardiac enzyme elevation in intensive care unit. He had a history of type 2 diabetes mellitus, hypertension, and dyslipidemia. He was receiving mechanical ventilation and veno-venous extracorporeal membrane oxygenation treatment for severe hypoxia. Two-D echocardiogram showed regional wall motion abnormalities. We performed primary percutaneous coronary intervention for acute myocardial infarction complicating cardiogenic shock under hemodynamic support. He expired on the 16th day of admission because of cardiogenic shock and multi-organ failure. Active surveillance and intensive treatment strategy are important for saving lives of COVID-19 patients with acute myocardial infarction.

RevDate: 2020-07-13

Gupta L, Gasparyan AY, Misra DP, et al (2020)

Information and Misinformation on COVID-19: a Cross-Sectional Survey Study.

Journal of Korean medical science, 35(27):e256 pii:35.e256.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a large volume of publications, a barrage of non-reviewed preprints on various professional repositories and a slew of retractions in a short amount of time.

METHODS: We conducted an e-survey using a cloud-based website to gauge the potential sources of trustworthy information and misinformation and analyzed researchers', clinicians', and academics' attitude toward unpublished items, and pre- and post-publication quality checks in this challenging time.

RESULTS: Among 128 respondents (mean age, 43.2 years; M:F, 1.1:1), 60 (46.9%) were scholarly journal editors and editorial board members. Social media channels were distinguished as the most important sources of information as well as misinformation (81 [63.3%] and 86 [67.2%]). Nearly two in five (62, 48.4%) respondents blamed reviewers, editors, and misinterpretation by readers as additional contributors alongside authors for misinformation. A higher risk of plagiarism was perceived by the majority (70, 58.6%), especially plagiarism of ideas (64.1%) followed by inappropriate paraphrasing (54.7%). Opinion was divided on the utility of preprints for changing practice and changing retraction rates during the pandemic period, and higher rejections were not supported by most (76.6%) while the importance of peer review was agreed upon by a majority (80, 62.5%). More stringent screening by journal editors (61.7%), and facilitating open access plagiarism software (59.4%), including Artificial Intelligence (AI)-based algorithms (43.8%) were among the suggested solutions. Most (74.2%) supported the need to launch a specialist bibliographic database for COVID-19, with information indexed (62.3%), available as open-access (82.8%), after expanding search terms (52.3%) and following due verification by academics (66.4%), and journal editors (52.3%).

CONCLUSION: While identifying social media as a potential source of misinformation on COVID-19, and a perceived high risk of plagiarism, more stringent peer review and skilled post-publication promotion are advisable. Journal editors should play a more active role in streamlining publication and promotion of trustworthy information on COVID-19.

RevDate: 2020-07-13

Mantero V, Basilico P, Costantino G, et al (2020)

Recurrent Transient Ischemic Attack in a Young Patient with COVID-19.

Journal of clinical neurology (Seoul, Korea), 16(3):513-514.

RevDate: 2020-07-13

Naeem SB, Bhatti R, A Khan (2020)

An exploration of how fake news is taking over social media and putting public health at risk.

Health information and libraries journal [Epub ahead of print].

Recent statistics show that almost 1/4 of a million people have died and four million people are affected either with mild or serious health problems caused by coronavirus (COVID-19). These numbers are rapidly increasing (World Health Organization, May 3, 2020c). There is much concern during this pandemic about the spread of misleading or inaccurate information. This article reports on a small study which attempted to identify the types and sources of COVID-19 misinformation. The authors identified and analysed 1225 pieces of COVID-19 fake news stories taken from fact-checkers, myth-busters and COVID-19 dashboards. The study is significant given the concern raised by the WHO Director-General that 'we are not just fighting the pandemic, we are also fighting infodemic'. The study concludes that the COVID-19 infodemic is full of false claims, half backed conspiracy theories and pseudoscientific therapies, regarding the diagnosis, treatment, prevention, origin and spread of the virus. Fake news is pervasive in social media, putting public health at risk. The scale of the crisis and ubiquity of the misleading information require that scientists, health information professionals and journalists exercise their professional responsibility to help the general public identify fake news stories. They should ensure that accurate information is published and disseminated.J.M.

RevDate: 2020-07-13

Aysha AA, Rentsch C, Prentice R, et al (2020)

Practical management of inflammatory bowel disease patients during the COVID-19 pandemic: expert commentary from the Gastroenterological Society of Australia Inflammatory Bowel Disease faculty.

Internal medicine journal, 50(7):798-804.

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has emerged as a public health emergency and challenged healthcare systems globally. In a minority of patients, SARS-CoV-2 manifests with a severe acute respiratory illness and currently there is insufficient data regarding the virulence of COVID-19 in inflammatory bowel disease patients taking immunosuppressive therapy. This review aims to summarise the current literature and provide guidance on the management of inflammatory bowel disease patients in the context of the COVID-19 pandemic in the Australasian setting.

RevDate: 2020-07-13

Bart NK, Kearney K, PS Macdonald (2020)

'Put on your own oxygen mask before helping others': mitigating health care worker risk from COVID-19.

Internal medicine journal, 50(7):891-892.

RevDate: 2020-07-13

Zimran A, Szer J, S Revel-Vilk (2020)

Impact of Gaucher disease on COVID-19.

Internal medicine journal, 50(7):894-895.

RevDate: 2020-07-13

Choy KW (2020)

Urgent call to clinicians and researchers: 2020 acuity required when assessing and reporting laboratory abnormalities in COVID-19.

Internal medicine journal, 50(7):892-893.

RevDate: 2020-07-13

Choy KW (2020)

Diagnostic testing for gestational diabetes mellitus during the COVID-19 pandemic: an opportunity to revisit Glucose-Based testing.

Internal medicine journal, 50(7):893-894.

RevDate: 2020-07-13

Shamdasani P, Trubiano JA, Smibert OC, et al (2020)

COVID-19: collaboration will keep us ahead of the curve.

Internal medicine journal, 50(7):784-786.

RevDate: 2020-07-13

Johnson DF, Steinfort DP, B Cowie (2020)

Navigating shifting waters: rapid response to change in the era of COVID-19.

Internal medicine journal, 50(7):786-790.

RevDate: 2020-07-13

Criado PR, Pagliari C, Carneiro FRO, et al (2020)

Lessons from dermatology about inflammatory responses in Covid-19.

Reviews in medical virology [Epub ahead of print].

The SARS-Cov-2 is a single-stranded RNA virus composed of 16 non-structural proteins (NSP 1-16) with specific roles in the replication of coronaviruses. NSP3 has the property to block host innate immune response and to promote cytokine expression. NSP5 can inhibit interferon (IFN) signalling and NSP16 prevents MAD5 recognition, depressing the innate immunity. Dendritic cells, monocytes, and macrophages are the first cell lineage against viruses' infections. The IFN type I is the danger signal for the human body during this clinical setting. Protective immune responses to viral infection are initiated by innate immune sensors that survey extracellular and intracellular space for foreign nucleic acids. In Covid-19 the pathogenesis is not yet fully understood, but viral and host factors seem to play a key role. Important points in severe Covid-19 are characterized by an upregulated innate immune response, hypercoagulopathy state, pulmonary tissue damage, neurological and/or gastrointestinal tract involvement, and fatal outcome in severe cases of macrophage activation syndrome, which produce a 'cytokine storm'. These systemic conditions share polymorphous cutaneous lesions where innate immune system is involved in the histopathological findings with acute respiratory distress syndrome, hypercoagulability, hyperferritinemia, increased serum levels of D-dimer, lactic dehydrogenase, reactive-C-protein and serum A amyloid. It is described that several polymorphous cutaneous lesions similar to erythema pernio, urticarial rashes, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicles lesions, and purpuric exanthema or exanthema with clinical aspects of symmetrical drug-related intertriginous and flexural exanthema. This review describes the complexity of Covid-19, its pathophysiological and clinical aspects.

RevDate: 2020-07-13

Horesh D, Kapel Lev-Ari R, I Hasson-Ohayon (2020)

Risk factors for psychological distress during the COVID-19 pandemic in Israel: Loneliness, age, gender, and health status play an important role.

British journal of health psychology [Epub ahead of print].

OBJECTIVE: Research on the psychological toll of the COVID-19 pandemic is being conducted in various countries. This study aimed to examine risk factors for mental health problems among Israeli adults during this crisis.

METHODS: A total of 204 participants took part in the study. They completed self-report questionnaires assessing perceived stress, anxiety, quality of life, and various questions related to quarantine, pre-existing health issues, and worries related to the virus. The study took place during the last two weeks of March 2020.

RESULTS: The majority of participants reported relatively high levels of perceived stress and corona-related worries, but low levels of anxiety. Female gender, younger age, corona-related loneliness, and pre-existing chronic illness were all related to higher levels of psychological distress and lower levels of quality of life.

CONCLUSIONS: While considering the preliminary nature of these results, the current study highlights risk factors for psychological distress in light of the corona pandemic. Attention should be given to sociodemographic variables that were identified as related to psychological distress, as well as to the important role of loneliness, when screening and treating people during this crisis. More research is needed in order to fully understand the scope and correlates of psychological difficulties during these challenging times.

RevDate: 2020-07-13

Chen X, Yan L, Fei Y, et al (2020)

Laboratory abnormalities and risk factors associated with in-hospital death in patients with severe COVID-19.

Journal of clinical laboratory analysis [Epub ahead of print].

BACKGROUND: In the context of the COVID-19 outbreak of worldwide, we aim to analyze the laboratory risk factors of in-hospital death in patients with severe COVID-19.

METHODS: All ≥18-year-old patients with confirmed severe COVID-19 admitted to Tongji Hospital (Wuhan, China) from February 3 to February 20, 2020, were retrospectively enrolled and followed up until March 20, 2020. Epidemiological, clinical, laboratory, and treatment data were collected and explored the risk factors associated with in-hospital death.

RESULTS: A total of 73 severe patients were enrolled in the study, of whom 20 (27%) patients died in hospital during the average 28 days of follow-up period. The median age of non-survivors was significantly older than survivors (69 [64-76.5] years vs 64 [56-71.3] years, P = .033) and 15 (75%) patients were males. The laboratory abnormalities of non-survivors mainly presented in serious inflammation response and multiple organ failure, with high levels of cytokines and deranged coagulation parameters. Multivariable regression showed that neutrophil count greater than 4.47 × 109 /L (OR, 58.35; 95%CI: 2.16-1571.69; P = .016), hypersensitivity C-reactive protein greater than 86.7 mg/L (OR, 14.90; 95%CI: 1.29-171.10; P = .030), creatine kinase greater than 101 U/L (OR, 161.62; 95%CI: 6.45-4045.20; P = .002), and blood urea nitrogen greater than 6.7 mmol/L (OR, 11.18; 95%CI: 1.36-91.62; P = .024) were risk factors for in-hospital death.

CONCLUSION: The risk factors of neutrophil count, hypersensitivity C-reactive protein, creatine kinase, and blood urea nitrogen could help clinicians to early identify COVID-19 severe patients with poor outcomes on admission. Virus direct attack and cytokine storm play a major role in the death of COVID-19.

RevDate: 2020-07-13

Elsner P, Fartasch M, S Schliemann (2020)

Dermatological recommendations on hand hygiene in schools during the COVID-19 pandemic.

RevDate: 2020-07-13

Bharati J, Ramachandran R, Kumar V, et al (2020)

COVID-19 pandemic in limited-resource countries: Strategies for challenges in a dialysis unit.

RevDate: 2020-07-13

Garrido I, Liberal R, G Macedo (2020)

Letter: liver disease and COVID-19-not the perfect storm. Authors' reply".

Alimentary pharmacology & therapeutics, 52(3):574-575.

RevDate: 2020-07-13

Nathwani R, Mukherjee S, Forlano R, et al (2020)

Letter: liver disease and COVID-19-not the perfect storm.

Alimentary pharmacology & therapeutics, 52(3):572-574.

RevDate: 2020-07-13

Bertoldi G, Gianesello L, LA Calò (2020)

Letter: ACE2, Rho kinase inhibition and the potential role of vitamin D against COVID-19.

Alimentary pharmacology & therapeutics, 52(3):577-578.

RevDate: 2020-07-13

Baker EH, Patel K, Ball J, et al (2020)

Insights from compassionate use of tocilizumab for COVID-19 to inform appropriate design of randomised controlled trials.

RevDate: 2020-07-13

Cheng CS (2020)

Consultant-delivered care in telehealth and phone consultations during the COVID-19 shutdown period.

RevDate: 2020-07-13

Craig S, Cubitt M, Jaison A, et al (2020)

Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine.

The Medical journal of Australia [Epub ahead of print].

INTRODUCTION: The global pandemic of coronavirus disease 2019 (COVID-19) has caused significant worldwide disruption. Although Australia and New Zealand have not been affected as much as some other countries, resuscitation may still pose a risk to health care workers and necessitates a change to our traditional approach. This consensus statement for adult cardiac arrest in the setting of COVID-19 has been produced by the Australasian College for Emergency Medicine (ACEM) and aligns with national and international recommendations.

MAIN RECOMMENDATIONS: In a setting of low community transmission, most cardiac arrests are not due to COVID-19. Early defibrillation saves lives and is not considered an aerosol generating procedure. Compression-only cardiopulmonary resuscitation is thought to be a low risk procedure and can be safely initiated with the patient's mouth and nose covered. All other resuscitative procedures are considered aerosol generating and require the use of airborne personal protective equipment (PPE). It is important to balance the appropriateness of resuscitation against the risk of infection. Methods to reduce nosocomial transmission of COVID-19 include a physical barrier such as a towel or mask over the patient's mouth and nose, appropriate use of PPE, minimising the staff involved in resuscitation, and use of mechanical chest compression devices when available. If COVID-19 significantly affects hospital resource availability, the ethics of resource allocation must be considered.

CHANGES IN MANAGEMENT: The changes outlined in this document require a significant adaptation for many doctors, nurses and paramedics. It is critically important that all health care workers have regular PPE and advanced life support training, are able to access in situ simulation sessions, and receive extensive debriefing after actual resuscitations. This will ensure safe, timely and effective management of the patients with cardiac arrest in the COVID-19 era.

RevDate: 2020-07-13

Kapuria D, Bollipo S, Rabiee A, et al (2020)

Roadmap to Resuming Care for Liver Diseases after COVID-19.

Journal of gastroenterology and hepatology [Epub ahead of print].

The global pandemic of coronavirus disease-2019 (COVID-19) has led to significant disruptions in care delivery. Patients with chronic liver diseases require a high level of care and are therefore particularly vulnerable to disruptions in medical services during COVID-19. Recent data has also identified chronic liver disease as an independent risk factor for COVID-19 related hospital mortality. In response to the pandemic, national and international societies have recommended interim changes to the management of patients with liver diseases. These modifications included the implementation of telehealth, postponement or cancellation of elective procedures and other non-urgent patient care-related activities. There is concern that reduced access to diagnosis and treatment can also lead to increased morbidity in patients with liver diseases and we may witness a delayed surge of hospitalizations related to decompensated liver disease after the COVID-19 pandemic has receded. Therefore, it is paramount that liver practices craft a comprehensive plan for safe resumption of clinical operations while minimizing the risk of exposure to patients and healthcare professionals. Here, we provide a broad roadmap for how to safely resume care for patients with chronic liver disease according to various phases of the pandemic with particular emphasis on outpatient care, liver transplantation, liver cancer care and endoscopy.

RevDate: 2020-07-13

Jalessi M, Barati M, Rohani M, et al (2020)

Frequency and outcome of olfactory impairment and sinonasal involvement in hospitalized patients with COVID-19.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology pii:10.1007/s10072-020-04590-4 [Epub ahead of print].

BACKGROUND: Olfactory dysfunction has shown to accompany COVID-19. There are varying data regarding the exact frequency in the various study population. The outcome of the olfactory impairment is also not clearly defined.

OBJECTIVE: To find the frequency of olfactory impairment and its outcome in hospitalized patients with positive swab test for COVID-19.

METHODS: This is a prospective descriptive study of 100 hospitalized COVID-19 patients, randomly sampled, from February to March 2020. Demographics, comorbidities, and laboratory findings were analyzed according to the olfactory loss or sinonasal symptoms. The olfactory impairment and sinonasal symptoms were evaluated by 9 Likert scale questions asked from the patients.

RESULTS: Ninety-two patients completed the follow-up (means 20.1 (± 7.42) days). Twenty-two (23.91%) patients complained of olfactory loss and in 6 (6.52%) patients olfactory loss was the first symptom of the disease. The olfactory loss was reported to be completely resolved in all but one patient. Thirty-nine (42.39%) patients had notable sinonasal symptoms while rhinorrhea was the first symptom in 3 (3.26%). Fifteen patients (16.3%) had a taste impairment. Patients with sinonasal symptoms had a lower age (p = 0.01). There was no significant relation between olfactory loss and sinonasal symptoms (p = 0.07).

CONCLUSIONS: Sudden olfactory dysfunction and sinonasal symptoms have a considerable prevalence in patients with COVID-19. No significant association was noted between the sinonasal symptoms and the olfactory loss, which may suggest that other mechanisms beyond upper respiratory tract involvement are responsible for the olfactory loss.

RevDate: 2020-07-13

Sangalli D, Polonia V, Colombo D, et al (2020)

A single-centre experience of intravenous thrombolysis for stroke in COVID-19 patients.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology pii:10.1007/s10072-020-04591-3 [Epub ahead of print].

The sudden worldwide outbreak of Coronavirus Disease 2019 (COVID-19) has certainly provided new challenges in the management of acute ischaemic stroke, and the risk-benefit ratio of intravenous thrombolysis in COVID-19 positive patients is not well known. We describe four COVID-19 patients treated with intravenous thrombolysis for acute ischaemic stroke. Although rt-PA administration is the main therapeutic strategy, our patients experienced unpredictable complications and showed atypical features: the overall mortality was very high. In conclusion, in this article, we provide information about these cases and discuss the possible explanation behind this trend.

RevDate: 2020-07-13

Maguire S, F O'Shea (2020)

Social isolation due to the COVID-19 pandemic has led to worse outcomes in females with inflammatory arthritis.

Irish journal of medical science pii:10.1007/s11845-020-02307-2 [Epub ahead of print].

BACKGROUND: Prolonged social isolation as a result of the COVID-19 global pandemic has been a source of considerable psychological distress for many people. This can manifest in many ways and if left undetected can impact negatively on general health. It is essential to understand the impact of these conditions on inflammatory arthritis (IA) patients, especially axial spondyloarthropathy (axSpA).

AIM: To capture the level of psychological distress for patients with IA following prolonged social isolation.

METHODS: A survey was sent out to patients with a confirmed diagnosis of IA. This captured changes in sleep, mood, disease activity, employment and general health since the beginning of the social isolation period. A PHQ-4 (Patient Health Questionnaire) was included to determine level of psychological distress.

RESULTS: Females with IA reported significantly higher rates of decline in general health (40% vs 16%, p = 0.01), mood disturbance (43.4% vs 26%, p = 0.03) and increased disease activity (50% vs 16%, p = 0.01) compared to males. Evaluating the mean PHQ-4 scores, no significant difference was noted between genders (4.80 vs 3.44, p = 0.10). However, females demonstrated a non-significant trend toward increased rates of moderate to severe psychological distress (40% vs 30%, p = 0.13). Subanalysis of patients with axSpA found high rates of moderate to severe distress in both genders.

CONCLUSIONS: Females with IA reported significantly higher rates of decline in general health, mood disturbance and increased disease activity during the period of social isolation. This was reflected in a trend towards greater levels of psychological distress.

RevDate: 2020-07-13

Oda Y (2020)

COVID-19: review of case reports.

Journal of anesthesia pii:10.1007/s00540-020-02825-4 [Epub ahead of print].

Recently published case reports relating to anesthesia in patients with coronavirus disease (COVID-19) were reviewed. The diagnosis of COVID-19 was confirmed by positive results of reverse transcriptase polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Numerous reports handled emergency cesarean delivery. Primary symptoms and laboratory data of pregnant women with COVID-19 were similar to those of non-pregnant patients. Although the mortality rate is reported to be high after surgery in patients with COVID-19, cesarean delivery was successfully performed under regional anesthesia in most cases and postoperative course was favorable both in the parents and newborns. There is no direct evidence of vertical mother-to-child transmission of SARS-CoV-2; however, a diagnosis of COVID-19 was made in a newborn two hours after delivery from a pregnant woman with COVID-19, based on the increased immunoglobulin levels and deranged liver function, suggesting that its possibility cannot be completely eliminated. Emergency cerebral shunt reconstruction was performed repeatedly in an eight-month-old boy with COVID-19. The tracheal tube was removed in the operating room after surgery and postoperative course was uneventful. All the procedures should be performed in isolated operating rooms with medical staff with level-3 personal protection to ensure the safety of patients and health care providers.

RevDate: 2020-07-13

Volo T, Stritoni P, Battel I, et al (2020)

Elective tracheostomy during COVID-19 outbreak: to whom, when, how? Early experience from Venice, Italy.

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/s00405-020-06190-6 [Epub ahead of print].

PURPOSE: The need for prolonged invasive mechanical ventilation in COVID-19 patients is placing the otorhinolaryngologist in front of an increasing request for tracheostomy. Nowadays, there is uncertainty regarding the timing of tracheostomy, the prognosis of these patients and the safety of healthcare workers. The aim of this study is to evaluate the efficacy and safety of tracheostomy placement in patients with COVID-19.

METHODS: A retrospective cohort study on 23 COVID 19 patients, to analyse the timing of tracheostomy, the risk factors associated with in-hospital death and the infection of the involved health care workers. Early tracheostomy was defined as ≤ 10 days and late ones > 10 days.

RESULTS: The mortality rate of COVID-19 patients admitted to ICU that underwent tracheostomy was 18%. The overall mortality of patients admitted to ICU was 53%. The univariate analysis revealed that early tracheostomy, SOFA score > 6, and D-dimer level > 4 were significantly associated with a greater risk of death. At the multivariate analysis SOFA score > 6 and D-dimer level > 4 resulted as significant factors for a higher risk of death. No health care workers associated with tracheostomy are confirmed to be infected by SARS-CoV2.

CONCLUSION: We suggest to wait at least 14 days to perform tracheostomy. In patients with SOFA score > 6 and D dimer > 4, tracheostomy should not be performed or should be postponed. Optimized procedures and enhanced personal protective equipment can make the tracheostomy safe and beneficial in COVID-19 patients.

RevDate: 2020-07-13

Oberemok VV, Laikova KV, Yurchenko KA, et al (2020)

SARS-CoV-2 will constantly sweep its tracks: a vaccine containing CpG motifs in 'lasso' for the multi-faced virus.

Inflammation research : official journal of the European Histamine Research Society ... [et al.] pii:10.1007/s00011-020-01377-3 [Epub ahead of print].

During the current COVID-19 pandemic, the global ratio between the dead and the survivors is approximately 1 to 10, which has put humanity on high alert and provided strong motivation for the intensive search for vaccines and drugs. It is already clear that if we follow the most likely scenario, which is similar to that used to create seasonal influenza vaccines, then we will need to develop improved vaccine formulas every year to control the spread of the new, highly mutable coronavirus SARS-CoV-2. In this article, using well-known RNA viruses (HIV, influenza viruses, HCV) as examples, we consider the main successes and failures in creating primarily highly effective vaccines. The experience accumulated dealing with the biology of zoonotic RNA viruses suggests that the fight against COVID-19 will be difficult and lengthy. The most effective vaccines against SARS-CoV-2 will be those able to form highly effective memory cells for both humoral (memory B cells) and cellular (cross-reactive antiviral memory T cells) immunity. Unfortunately, RNA viruses constantly sweep their tracks and perhaps one of the most promising solutions in the fight against the COVID-19 pandemic is the creation of 'universal' vaccines based on conservative SARS-CoV-2 genome sequences (antigen-presenting) and unmethylated CpG dinucleotides (adjuvant) in the composition of the phosphorothioate backbone of single-stranded DNA oligonucleotides (ODN), which can be effective for long periods of use. Here, we propose a SARS-CoV-2 vaccine based on a lasso-like phosphorothioate oligonucleotide construction containing CpG motifs and the antigen-presenting unique ACG-containing genome sequence of SARS-CoV-2. We found that CpG dinucleotides are the least rare dinucleotides in the genomes of SARS-CoV-2 and other known human coronaviruses, and hypothesized that their higher frequency could be responsible for the unwanted increased lethality to the host, causing a 'cytokine storm' in people who overexpress cytokines through the activation of specific Toll-like receptors in a manner similar to TLR9-CpG ODN interactions. Interestingly, the virus strains sequenced in China (Wuhan) in February 2020 contained on average one CpG dinucleotide more in their genome than the later strains from the USA (New York) sequenced in May 2020. Obviously, during the first steps of the microevolution of SARS-CoV-2 in the human population, natural selection tends to select viral genomes containing fewer CpG motifs that do not trigger a strong innate immune response, so the infected person has moderate symptoms and spreads SARS-CoV-2 more readily. However, in our opinion, unmethylated CpG dinucleotides are also capable of preparing the host immune system for the coronavirus infection and should be present in SARS-CoV-2 vaccines as strong adjuvants.

RevDate: 2020-07-13

Garganese G, Tagliaferri L, Fragomeni SM, et al (2020)

Personalizing vulvar cancer workflow in COVID-19 era: a proposal from Vul.Can MDT.

Journal of cancer research and clinical oncology pii:10.1007/s00432-020-03312-9 [Epub ahead of print].

INTRODUCTION: Since the community spread of Coronavirus disease 2019 (COVID-19), the practice of oncologic care at our comprehensive cancer center has changed. Postponing cancer treatment without consideration of its implications could cost more lives than can be saved. In this special situation, we must continue to provide our cancer patients with the highest quality of medical services assuring the safety. This article provides general guidance on supporting curative treatment strategies in vulvar cancer patients.

METHODS: At our institution, a vulvar cancer multidisciplinary team (Vul.Can MDT) of specialists is responsible for personalized treatment of this disease. The phase 2 period necessarily requires specific procedures for both outpatient and inpatient pathways and to provide strategies concerning the management of vulvar cancer patients even in case of an eventually concomitant SARS-CoV-2 infection. In brief, an accurate remote and in person triage must be provided routinely and patients submitted to specific diagnostic tests prior to every major treatment or procedure (surgery, RT, and CT) or in case of suspicion for COVID-19 syndrome. The decisional workflow for these women often old and frail, have been rapidly adjusted by our Vul.Can MDT to mitigate the potential risks of COVID-19.

RESULTS: The team produced two types of recommendations concerning: (1) safety regulations of care pathways, patients and health care providers, (2) personalized treatment strategies. We present a protocol that can be applied in clinical practice: the flowcharts provided, include the modulation of treatment intensity designed for surgical procedures and radiation, stratified for FIGO stage of disease and intention.

CONCLUSION: We suggest that our proposals are applicable in this setting of patients, considering anyway current international recommendations and guidelines.

RevDate: 2020-07-13

Yuan X, Huang W, Ye B, et al (2020)

Changes of hematological and immunological parameters in COVID-19 patients.

International journal of hematology pii:10.1007/s12185-020-02930-w [Epub ahead of print].

The aim of this study was to identify the changes of hematologic and immunological parameters in COVID-19 patients. We collected and analyzed the data of 117 patients who were laboratory confirmed as SARS-CoV-2 infection. The cases were divided into regular group, severe group and critically ill group according to the sixth edition scheme for COVID-19 diagnosis and treatment of China. The laboratory tests included blood routine, cellular and humoral immunity indices, biochemical detections and inflammatory biomarker. Compared with regular patients, severe and critically ill patients had significantly lower lymphocyte count (p < 0.01), decreased red blood cell and hemoglobin (p < 0.01), low levels of immunoglobulin G (p < 0.05) and significantly higher in D-dimer (p < 0.0001), fibrinogen (p < 0.01), white blood cell count (p < 0.01), neutrophil count (p < 0.0001), interleukin-6 (p < 0.05), C-reactive protein (p < 0.01), procalcitonin (p < 0.01), erythrocyte sedimentation rate (p < 0.05), ferritin (p < 0.01) and lactate dehydrogenase (p < 0.0001). The specific immunoglobulin G antibodies to the SARS-CoV-2 in severe and critically ill patients were significantly lower than that in regular patients (p < 0.05). Our findings suggest that the lymphocyte counts, red blood cell counts and the immunoglobulin G antibodies of COVID-19 patients were impaired to varying degrees and the blood was in a state of hypercoagulation, which were more obvious in critically ill patients.

RevDate: 2020-07-13

Siavashpour Z, Taghizadeh-Hesary F, A Rakhsha (2020)

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

Journal of gastrointestinal cancer pii:10.1007/s12029-020-00454-4 [Epub ahead of print].

PURPOSE: Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era.

METHODS: In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran.

RESULTS: We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19.

CONCLUSION: Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.

RevDate: 2020-07-13

Chowdhury D, Hope KD, Arthur LC, et al (2020)

Telehealth for Pediatric Cardiology Practitioners in the Time of COVID-19.

Pediatric cardiology pii:10.1007/s00246-020-02411-1 [Epub ahead of print].

Due to the COVID-19 pandemic, there has been an increased interest in telehealth as a means of providing care for children by a pediatric cardiologist. In this article, we provide an overview of telehealth utilization as an extension of current pediatric cardiology practices and provide some insight into the rapid shift made to quickly implement these telehealth services into our everyday practices due to COVID-19 personal distancing requirements. Our panel will review helpful tips into the selection of appropriate patient populations and specific cardiac diagnoses for telehealth that put patient and family safety concerns first. Numerous practical considerations in conducting a telehealth visit must be taken into account to ensure optimal use of this technology. The use of adapted staffing and billing models and expanded means of remote monitoring will aid in the incorporation of telehealth into more widespread pediatric cardiology practice. Future directions to sustain this platform include the refinement of telehealth care strategies, defining best practices, including telehealth in the fellowship curriculum and continuing advocacy for technology.

RevDate: 2020-07-13

Chowdhury R, Luhar S, Khan N, et al (2020)

Long-term strategies to control COVID-19 in low and middle-income countries: an options overview of community-based, non-pharmacological interventions.

European journal of epidemiology pii:10.1007/s10654-020-00660-1 [Epub ahead of print].

In low and middle-income countries (LMICs), strict social distancing measures (e.g., nationwide lockdown) in response to the COVID-19 pandemic are unsustainable in the long-term due to knock-on socioeconomic and psychological effects. However, an optimal epidemiology-focused strategy for 'safe-reopening' (i.e., balancing between the economic and health consequences) remain unclear, particularly given the suboptimal disease surveillance and diagnostic infrastructure in these settings. As the lockdown is now being relaxed in many LMICs, in this paper, we have (1) conducted an epidemiology-based "options appraisal" of various available non-pharmacological intervention options that can be employed to safely lift the lockdowns (namely, sustained mitigation, zonal lockdown and rolling lockdown strategies), and (2) propose suitable application, pre-requisites, and inherent limitations for each measure. Among these, a sustained mitigation-only approach (adopted in many high-income countries) may not be feasible in most LMIC settings given the absence of nationwide population surveillance, generalised testing, contact tracing and critical care infrastructure needed to tackle the likely resurgence of infections. By contrast, zonal or local lockdowns may be suitable for some countries where systematic identification of new outbreak clusters in real-time would be feasible. This requires a generalised testing and surveillance structure, and a well-thought out (and executed) zone management plan. Finally, an intermittent, rolling lockdown strategy has recently been suggested by the World Health Organization as a potential strategy to get the epidemic under control in some LMI settings, where generalised mitigation and zonal containment is unfeasible. This strategy, however, needs to be carefully considered for economic costs and necessary supply chain reforms. In conclusion, while we propose three community-based, non-pharmacological options for LMICs, a suitable measure should be context-specific and based on: (1) epidemiological considerations, (2) social and economic costs, (3) existing health systems capabilities and (4) future-proof plans to implement and sustain the strategy.

RevDate: 2020-07-13

Latz CA, DeCarlo C, Boitano L, et al (2020)

Blood type and outcomes in patients with COVID-19.

Annals of hematology pii:10.1007/s00277-020-04169-1 [Epub ahead of print].

This study aimed to determine if there is an association between ABO blood type and severity of COVID-19 defined by intubation or death as well as ascertain if there is variability in testing positive for COVID-19 between blood types. In a multi-institutional study, all adult patients who tested positive for COVID-19 across five hospitals were identified and included from March 6th to April 16th, 2020. Hospitalization, intubation, and death were evaluated for association with blood type. Univariate analysis was conducted using standard techniques and logistic regression was used to determine the independent effect of blood type on intubation and/or death and positive testing. During the study period, there were 7648 patients who received COVID-19 testing throughout the institutions. Of these, 1289 tested positive with a known blood type. A total of 484 (37.5%) were admitted to hospital, 123 (9.5%) were admitted to the ICU, 108 (8.4%) were intubated, 3 (0.2%) required ECMO, and 89 (6.9%) died. Of the 1289 patients who tested positive, 440 (34.2%) were blood type A, 201 (15.6%) were blood type B, 61 (4.7%) were blood type AB, and 587 (45.5%) were blood type O. On univariate analysis, there was no association between blood type and any of the peak inflammatory markers (peak WBC, p = 0.25; peak LDH, p = 0.40; peak ESR, p = 0.16; peak CRP, p = 0.14) nor between blood type and any of the clinical outcomes of severity (admission p = 0.20, ICU admission p = 0.94, intubation p = 0.93, proning while intubated p = 0.58, ECMO p = 0.09, and death p = 0.49). After multivariable analysis, blood type was not independently associated with risk of intubation or death (referent blood type A; blood type B: AOR: 0.72, 95% CI: 0.42-1.26, blood type AB: AOR: 0.78, CI: 0.33-1.87, blood type O: AOR: 0.77, CI: 0.51-1.16), rhesus factor positive (Rh+): AOR: 1.03, CI: 0.93-1.86. Blood type A had no correlation with positive testing (AOR: 1.00, CI: 0.88-1.13), blood type B was associated with higher odds of testing positive for disease (AOR: 1.28, CI: 1.08-1.52), AB was also associated with higher odds of testing positive (AOR: 1.37, CI: 1.02-1.83), and O was associated with a lower risk of testing positive (AOR: 0.84, CI: 0.75-0.95). Rh+ status was associated with higher odds of testing positive (AOR: 1.23, CI: 1.003-1.50). Blood type was not associated with risk of intubation or death in patients with COVID-19. Patients with blood types B and AB who received a test were more likely to test positive and blood type O was less likely to test positive. Rh+ patients were more likely to test positive.

RevDate: 2020-07-13

Papathanasiou A (2020)

COVID-19 screening during fertility treatment: how do guidelines compare against each other?.

Journal of assisted reproduction and genetics pii:10.1007/s10815-020-01885-5 [Epub ahead of print].

Various fertility scientific societies have published pathways and recommendations for COVID-19 screening during fertility treatments. As there is currently very limited research evidence on how to best deliver this screening, it is not surprising that there are noticeable differences between their recommendations. This paper compares the screening pathways recommended by these guidelines, in the light of the emerging evidence. It proposes the more liberal use of viral testing for improving detection of asymptomatic or mildly symptomatic fertility patients. It also argues that a negative test result on symptomatic individuals should not be over-relied upon for allowing the treatment to proceed. In these cases, a low threshold for cancellation may still need to be maintained.

RevDate: 2020-07-13

Fauvel C, Weizman O, Trimaille A, et al (2020)

Pulmonary embolism in COVID-19 patients: a French multicentre cohort study.

European heart journal pii:5870571 [Epub ahead of print].

AIMS: While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients.

METHODS AND RESULTS: In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14-0.91, P = 0.04; and OR 0.11, 95% CI 0.06-0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003-1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79-0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82-0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01-1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006-1.038, P = 0.002).

CONCLUSION: PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.

RevDate: 2020-07-13

Torbicki A (2020)

COVID-19 and pulmonary embolism: an unwanted alliance.

European heart journal pii:5870570 [Epub ahead of print].

RevDate: 2020-07-13

Gavrilova NS, LA Gavrilov (2020)

Patterns of mortality during pandemic: An example of Spanish flu pandemic of 1918.

Population and economics, 4(2):56-64.

Now the attention of the whole world is focused on the developing pandemic of the coronavirus infection COVID-19. This article discusses mortality patterns of the deadliest epidemic in the last 120 years - the Spanish flu pandemic of 1918. Statistical sources from Italy and the USA, published shortly after the pandemic, were analyzed. The analysis was carried out for mortality from all causes, since in this case inaccuracies associated with establishing the causes of death are minimized. Despite the fact that the first cases of the Spanish flu appeared in the United States as early as March 1918, this first wave of epidemic practically did not affect the total mortality rate. The main peak of mortality in 1918 occurred in October 1918 both in the USA and Italy, with a gradual decrease in mortality over several months. Analysis of age-specific mortality demonstrates a significant increase in mortality at middle ages (20-50 years) in 1918 compared with 1917. Analysis of mortality trends using the method of latent variables shows a significant increase in the background mortality factor in 1918, which turned out to be higher for Italy than the mortality losses during the Second World War. The Spanish flu pandemic differs from the current coronavirus pandemic, because of significant increase in mortality of middle-aged people, while the COVID-19 pandemic causes a more marked increase in mortality among the elderly. With this, the COVID-19 pandemic is more like the recent flu epidemics than the earlier Spanish flu pandemic.

RevDate: 2020-07-13

Daraï E, Mathelin C, J Gligorov (2020)

Breast Cancer Management during the COVID 19 Pandemic: French Guidelines.

European journal of breast health, 16(3):160-161 pii:ejbh-16-3-160.

RevDate: 2020-07-13

Hartman D, Heaton P, Cammack N, et al (2020)

Clinical trials in the pandemic age: What is fit for purpose?.

Gates open research, 4:58.

It is critical to ensure that COVID-19 studies provide clear and timely answers to the scientific questions that will guide us to scalable solutions for all global regions. Significant challenges in operationalizing trials include public policies for managing the pandemic, public health and clinical capacity, travel and migration, and availability of tests and infrastructure. These factors lead to spikes and troughs in patient count by location, disrupting the ability to predict when or if a trial will reach recruitment goals. The focus must also be on understanding how to provide equitable access to these interventions ensuring that interventions reach those who need them the most, be it patients in low resource settings or vulnerable groups. We introduce a website to be used by The Bill & Melinda Gates Foundation, Wellcome Trust, and other funders of the COVID Therapeutics Accelerator that accept proposals for future clinical research. The portal enables evaluations of clinical study applications that focus on study qualities most likely to lead to informative outcomes and completed studies.

RevDate: 2020-07-13

Thuy BTP, My TTA, Hai NTT, et al (2020)

Correction to Investigation into SARS-CoV-2 Resistance of Compounds in Garlic Essential Oil.

ACS omega, 5(26):16315.

[This corrects the article DOI: 10.1021/acsomega.0c00772.].

RevDate: 2020-07-13

Hati S, S Bhattacharyya (2020)

Impact of Thiol-Disulfide Balance on the Binding of Covid-19 Spike Protein with Angiotensin-Converting Enzyme 2 Receptor.

ACS omega, 5(26):16292-16298.

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to an ongoing pandemic of coronavirus disease (COVID-19), which started in 2019. This is a member of Coronaviridae family in the genus Betacoronavirus, which also includes SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). The angiotensin-converting enzyme 2 (ACE2) is the functional receptor for SARS-CoV and SARS-CoV-2 to enter the host cells. In particular, the interaction of viral spike proteins with ACE2 is a critical step in the viral replication cycle. The receptor-binding domain of the viral spike proteins and ACE2 have several cysteine residues. In this study, the role of thiol-disulfide balance on the interactions between SARS-CoV/CoV-2 spike proteins and ACE2 was investigated using molecular dynamics simulations. The study revealed that the binding affinity was significantly impaired when all of the disulfide bonds of both ACE2 and SARS-CoV/CoV-2 spike proteins were reduced to thiol groups. The impact on the binding affinity was less severe when the disulfide bridges of only one of the binding partners were reduced to thiols. This computational finding possibly provides a molecular basis for the differential COVID-19 cellular recognition due to the oxidative stress.

RevDate: 2020-07-13

Leclerc QJ, Fuller NM, Knight LE, et al (2020)

What settings have been linked to SARS-CoV-2 transmission clusters?.

Wellcome open research, 5:83.

Background: Concern about the health impact of novel coronavirus SARS-CoV-2 has resulted in widespread enforced reductions in people's movement ("lockdowns"). However, there are increasing concerns about the severe economic and wider societal consequences of these measures. Some countries have begun to lift some of the rules on physical distancing in a stepwise manner, with differences in what these "exit strategies" entail and their timeframes. The aim of this work was to inform such exit strategies by exploring the types of indoor and outdoor settings where transmission of SARS-CoV-2 has been reported to occur and result in clusters of cases. Identifying potential settings that result in transmission clusters allows these to be kept under close surveillance and/or to remain closed as part of strategies that aim to avoid a resurgence in transmission following the lifting of lockdown measures. Methods: We performed a systematic review of available literature and media reports to find settings reported in peer reviewed articles and media with these characteristics. These sources are curated and made available in an editable online database. Results: We found many examples of SARS-CoV-2 clusters linked to a wide range of mostly indoor settings. Few reports came from schools, many from households, and an increasing number were reported in hospitals and elderly care settings across Europe. Conclusions: We identified possible places that are linked to clusters of COVID-19 cases and could be closely monitored and/or remain closed in the first instance following the progressive removal of lockdown restrictions. However, in part due to the limits in surveillance capacities in many settings, the gathering of information such as cluster sizes and attack rates is limited in several ways: inherent recall bias, biased media reporting and missing data.

RevDate: 2020-07-13

Nguyen AX, Gervasio KA, AY Wu (2020)

Differences in SARS-CoV-2 recommendations from major ophthalmology societies worldwide.

BMJ open ophthalmology, 5(1):e000525 pii:bmjophth-2020-000525.

Objective: Since the WHO declared the COVID-19 outbreak as a public health emergency, medical societies around the world published COVID-19 recommendations to physicians to ensure patient care and physician safety. During this pandemic, ophthalmologists around the world adapted their clinical and surgical practice following such guidelines. This original research examines all publicly available COVID-19 recommendations from twelve major ophthalmology societies around the world.

Methods and analysis: Twelve ophthalmology societies recognised by the International Council of Ophthalmology were included in this study. One society per each WHO region was included: the society selected was the one who had the highest number of national COVID-19 confirmed cases on 11 May 2020. In addition to these countries, the major ophthalmology society in each G7 country was included.

Results: Ten out of 12 major international ophthalmology societies from countries covering all six WHO regions have given recommendations regarding urgent patient care, social distancing, telemedicine and personal protective equipment when caring for ophthalmic patients during the COVID-19 pandemic. While all guidelines emphasise the importance of postponing non-urgent care and taking necessary safety measures, specific recommendations differ between countries.

Conclusions: As there is no clear consensus on ophthalmology guidelines across countries, this paper highlights the differences in international ophthalmic care recommendations during the COVID-19 pandemic. Knowledge of the differences in ophthalmic management plans will allow ophthalmologists and all eye care providers to consider the variety of international approaches and apply best practices following evidence-based recommendations during pandemics.

RevDate: 2020-07-13

McMillan P, BD Uhal (2020)

COVID-19-A theory of autoimmunity to ACE-2.

MOJ immunology, 7(1):17-19.

RevDate: 2020-07-13

Muthusami R, K Saritha (2020)

Statistical analysis and visualization of the potential cases of pandemic coronavirus.

Virusdisease, 31(2):204-208.

A local outbreak of initially unknown cause pneumonia was detected in Wuhan (Hubei, China) in December 2019 and a novel coronavirus, the severe acute respiratory syndrome coronavirus 2, was quickly found to be causing it. Since then, the epidemic has spread to all of China's mainland provinces as well as 58 other countries and territories, with more than 87,137 confirmed cases around the globe, including 79,968 from China, 7169 from other countries as of 1 March 2020, as stated by the World Health Organization in the COVID-19 situation report-41. In response to this current public health emergency, this study done a statistical analysis and visualized reported cases of coronavirus disease 2019 (COVID-19) based on the open data collection provided by Johns Hopkins University. Where the location and number of confirmed infected cases have been shown, there have also been deaths, recovered cases and comparisons of the growth rates between the Globe countries. This was intended to provide researchers, public health officials and the general public with exposure to the epidemic.

RevDate: 2020-07-13

Maurya VK, Kumar S, Prasad AK, et al (2020)

Structure-based drug designing for potential antiviral activity of selected natural products from Ayurveda against SARS-CoV-2 spike glycoprotein and its cellular receptor.

Virusdisease, 31(2):179-193.

The recent outbreak of COVID-19 caused by SARS-CoV-2 brought a great global public health and economic concern. SARS-CoV-2 is an enveloped RNA virus, from the genus Betacoronavirus. Although few molecules have been tested and shown some efficacy against SARS-CoV-2 in humans but a safe and cost-effective attachment inhibitors are still required for the treatment of COVID-19. Natural products are gaining attention because of the large therapeutic window and potent antiviral, immunomodulatory, anti-inflammatory, and antioxidant properties. Therefore, this study was planned to screen natural products from Ayurveda that have the potential to modulate host immune system as well as block the virus entry in host cells by interfering its interaction with cellular receptor and may be used to develop an effective and broad-spectrum strategy for the management of COVID-19 as well as other coronavirus infections in coming future. To decipher the antiviral activity of the selected natural products, molecular docking was performed. Further, the drug-likeness, pharmacokinetics and toxicity parameters of the selected natural products were determined. Docking results suggest that curcumin and nimbin exhibits highest interaction with spike glycoprotein (MolDock score - 141.36 and - 148.621 kcal/mole) and ACE2 receptor (MolDock score - 142.647 and - 140.108 kcal/mole) as compared with other selected natural products/drugs and controls. Also, the pharmacokinetics data illustrated that all selected natural products have better pharmacological properties (low molecular weight; no violation of Lipinski rule of five, good absorption profiles, oral bioavailability, good blood-brain barrier penetration, and low toxicity risk). Our study exhibited that curcumin, nimbin, withaferin A, piperine, mangiferin, thebaine, berberine, and andrographolide have significant binding affinity towards spike glycoprotein of SARS-CoV-2 and ACE2 receptor and may be useful as a therapeutic and/or prophylactic agent for restricting viral attachment to the host cells. However, few other natural products like resveratrol, quercetin, luteolin, naringenin, zingiberene, and gallic acid has the significant binding affinity towards ACE2 receptor only and therefore may be used for ACE2-mediated attachment inhibition of SARS-CoV-2.

RevDate: 2020-07-13

Rajendran DK, Rajagopal V, Alagumanian S, et al (2020)

Systematic literature review on novel corona virus SARS-CoV-2: a threat to human era.

Virusdisease, 31(2):161-173.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the seventh-generation coronavirus family causing viral pandemic coronavirus disease (COVID-19) across globe affecting millions of people. The objectives of this study are to (1) identify the major research themes in COVID-19 literature, (2) determine the origin, symptoms and modes of transmission of COVID, (3) recommend the intervention and mitigation strategies adopted by the Governments globally against the spread of COVID-19 and the traumatization among the public? and (4) study the possible drugs/treatment plans against COVID-19. A systematic literature review and comprehensive analysis of 38 research articles on COVID-19 are conducted. An integrated Research focus parallel-ship network and keyword co-occurrence analysis are carried out to visualize the three research concepts in COVID-19 literature. Some of our observations include: (1) as SARS-CoV-2's RNA matches ~ 96% to SARS-CoV, it is assumed to be transmitted from the bats. (2) The common symptoms are high fever, dry cough, fatigue, sputum production, shortness of breath, diarrhoea etc. (3) A lockdown across 180 affected counties for more than a month with social-distancing and the precautions taken in SARS and MERS are recommended by the Governments. (4) Researchers' claim that nutrition and immunity enhancers and treatment plans such as arbidol, lopinavir/ritonavir, convalescent plasma and mesenchymal stem cells and drugs including remdesivir, hydroxychloroquine, azithromycin and favipiravir are effective against COVID-19. This complied report serves as guide to help the administrators, researchers and the medical officers to adopt recommended intervention strategies and the optimal treatment/drug against COVID-19.

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