RevDate: 2020-08-13

Tingle J (2020)

Patient safety reports analysis: post COVID-19.

British journal of nursing (Mark Allen Publishing), 29(15):906-907.

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham discusses the recently published Cumberlege report on medicines and medical devices safety.

RevDate: 2020-08-13

Bruni T, Lalvani A, L Richeldi (2020)

Reply to: An Expanded COVID-19 Telemedicine Intermediate Care Model Utilizing Repurposed Hotel Rooms.

American journal of respiratory and critical care medicine [Epub ahead of print].

RevDate: 2020-08-13

Luo L, Liu D, Liao X, et al (2020)

Contact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China: A Prospective Cohort Study.

Annals of internal medicine [Epub ahead of print].

BACKGROUND: Risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to close contacts of infected persons has not been well estimated.

OBJECTIVE: To evaluate the risk for transmission of SARS-CoV-2 to close contacts in different settings.

DESIGN: Prospective cohort study.

SETTING: Close contacts of persons infected with SARS-CoV-2 in Guangzhou, China.

PARTICIPANTS: 3410 close contacts of 391 index cases were traced between 13 January and 6 March 2020. Data on the setting of the exposure, reverse transcriptase polymerase chain reaction testing, and clinical characteristics of index and secondary cases were collected. Measurement: Coronavirus disease 2019 (COVID-19) cases were confirmed by guidelines issued by China. Secondary attack rates in different settings were calculated.

RESULTS: Among 3410 close contacts, 127 (3.7% [95% CI, 3.1% to 4.4%]) were secondarily infected. Of these 127 persons, 8 (6.3% [CI, 2.1% to 10.5%]) were asymptomatic. Of the 119 symptomatic cases, 20 (16.8%) were defined as mild, 87 (73.1%) as moderate, and 12 (10.1%) as severe or critical. Compared with the household setting (10.3%), the secondary attack rate was lower for exposures in healthcare settings (1.0%; odds ratio [OR], 0.09 [CI, 0.04 to 0.20]) and on public transportation (0.1%; OR, 0.01 [CI, 0.00 to 0.08]). The secondary attack rate increased with the severity of index cases, from 0.3% (CI, 0.0 to 1.0%) for asymptomatic to 3.3% (CI, 1.8% to 4.8%) for mild, 5.6% (CI, 4.4% to 6.8%) for moderate, and 6.2% (CI, 3.2% to 9.1%) for severe or critical cases. Index cases with expectoration were associated with higher risk for secondary infection (13.6% vs. 3.0% for index cases without expectoration; OR, 4.81 [CI, 3.35 to 6.93]).

LIMITATION: There was potential recall bias regarding symptom onset among patients with COVID-19, and the symptoms and severity of index cases were not assessed at the time of exposure to contacts.

CONCLUSION: Household contact was the main setting for transmission of SARS-CoV-2, and the risk for transmission of SARS-CoV-2 among close contacts increased with the severity of index cases.

PRIMARY FUNDING SOURCE: Guangdong Province Higher Vocational Colleges and Schools Pearl River Scholar Funded Scheme.

RevDate: 2020-08-13

Phillips G, Felt D, Ruprecht MM, et al (2020)

Addressing the Disproportionate Impacts of the COVID-19 Pandemic on Sexual and Gender Minority Populations in the United States: Actions Toward Equity.

LGBT health [Epub ahead of print].

Sexual and gender minority (SGM) populations may be affected disproportionately by health emergencies such as the coronavirus disease 2019 (COVID-19) pandemic. Health professionals must take immediate steps to ensure equitable treatment of SGM populations. These steps are to (1) maintain and increase cultural responsiveness training and preparedness for SGM populations, (2) increase use of sexual orientation and gender identity measures in surveillance, (3) conduct research on the impacts of COVID-19 on SGM populations, and (4) include equity-focused initiatives in disaster preparedness plans. These actions toward equity would begin to allow for our current health system to care more appropriately for SGM populations.

RevDate: 2020-08-13

Gioia LC, Poppe AY, Laroche R, et al (2020)

Streamlined Poststroke Treatment Order Sets During the SARS-CoV-2 Pandemic: Simplifying While Not Compromising Care.

Stroke [Epub ahead of print].

BACKGROUND AND PURPOSE: Standard poststroke treatment monitoring protocols are made problematic during the coronavirus disease 2019 (COVID-19) pandemic by the frequency of patient assessments, requiring repeated donning and doffing procedures in a short interval of time.

METHODS: A streamlined poststroke treatment protocol was developed to limit frequency of patient encounters while maximizing the yield of each encounter by grouping together different components of poststroke care into single bedside visits.

RESULTS: Streamlined order sets were developed late March 2020. During the first 6 weeks following implementation, 70 patients were admitted to a geographically defined designated warm COVID-19 unit with modified poststroke care order sets. Of these, 33 (47.1%) patients received acute reperfusion therapy. All but 3 patients evolved favorably with either stable or improving National Institutes of Health Stroke Scale at 24 hours. In the 3 patients who experienced early neurological deterioration, none were found to be attributable to insufficient patient monitoring.

CONCLUSIONS: Adapting preexisting poststroke care protocols may be necessary while the risk of COVID-19 infection remains high. We propose a streamlined approach to facilitate poststroke monitoring in patients with stroke with unknown COVID status.

RevDate: 2020-08-13

Dou Y, Fatemi S, Darvas M, et al (2020)

A Geroscience Approach to Preventing Pathologic Consequences of COVID-19.

Journal of interferon & cytokine research : the official journal of the International Society for Interferon and Cytokine Research [Epub ahead of print].

The essential scope of the coronavirus infectious disease 2019 (COVID-19) pandemic is focused on developing effective treatments and vaccines for acute SARS-CoV-2 infection. There is also a critical need to develop interventions to prevent the complications of COVID-19, which occur with an alarming frequency in older adults. Since severe pathologic effects of infection occur with increasing age, COVID-19 falls under the geroscience concept that all diseases in older adults have a common and major underlying cause of declining function and resilience. Geroscience posits that manipulation of aging will simultaneously delay the appearance or severity of major diseases because they share the same risk factor: aging and the multiple processes involved in aging. Drug combinations that target multiple aging processes and the cytokine networks associated with them would not necessarily limit SARS-CoV-2 infection rates but would prevent severe pathologic consequences of the disease in older adults by maintaining a more youthful-like resilience to infection-related complications. A drug cocktail aimed at controlling cytokine actions would complement current clinical treatments and vaccine effectiveness for COVID-19 and serve as a prototype for future age-related infectious disease pandemics wherein the elderly population is especially vulnerable.

RevDate: 2020-08-13

Fenton ME, Wasko K, Behl V, et al (2020)

An Expanded COVID-19 Telemedicine Intermediate Care Model Utilizing Repurposed Hotel Rooms.

American journal of respiratory and critical care medicine [Epub ahead of print].

RevDate: 2020-08-13

Hoerger M, Alonzi S, Perry LM, et al (2020)

Impact of the COVID-19 pandemic on mental health: Real-time surveillance using Google Trends.

Psychological trauma : theory, research, practice and policy pii:2020-59192-001 [Epub ahead of print].

In the wake of COVID-19, the capacity to track emerging trends in mental health symptoms and needs will guide public health responses at multiple ecological levels. Using Google Trends to track population-level mental health-related Google searches in the United States, this investigation identified pandemic-associated spikes in searches related to anxiety symptoms and remote treatments for anxiety, such as deep breathing and body scan meditation. As other discernable population-level changes in mental health have yet to emerge, continued surveillance is warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

RevDate: 2020-08-13

Nguyen HL, Lan PD, Thai NQ, et al (2020)

Does SARS-CoV-2 Bind to Human ACE2 Stronger Than SARS-CoV?.

The journal of physical chemistry. B [Epub ahead of print].

The 2019 novel coronavirus (SARS-CoV-2) epidemic, which was first reported in December 2019 in Wuhan, China, was declared a pandemic by the World Health Organization in March 2020. Genetically, SARS-CoV-2 is closely related to SARS-CoV, which caused a global epidemic with 8,096 confirmed cases in more than 25 countries in 2002-2003. Given the significant morbidity and mortality rate, the current pandemic poses a danger to all of humanity, prompting us to understand the activity of SARS-CoV-2 at the atomic level. Experimental studies have revealed that spike proteins of both SARS-CoV-2 and SARS-CoV bind to Angiotensin-converting enzyme 2 (ACE2) before entering the cell for replication. However, the binding affinities reported by different groups seem to contradict each other. Wrapp et al (Science 2020, 367, 1260-1263) showed that the spike protein of SARS-CoV-2 binds to the ACE2 peptidase domain (ACE2-PB) more strongly than SARS-CoV, and this fact may be associated with a greater severity of the new virus. However, Walls et al. (Cell 2020, 181, 281-292) reported that SARS-CoV-2 exhibits a higher binding affinity, but the difference between the two variants is relatively small. To understand the binding mechnism and experimental results, we investigated how the receptor binding domain (RBD) of the SARS-CoV (SARS-CoV-RBD) and of SARS-CoV-2 (SARS-CoV-2-RBD) interacts with a human ACE2 peptidase domain (ACE2-PB) using molecular modeling. We applied a coarse-grained model to calculate the dissociation constant and found that SARS-CoV-2 displays a 2-fold higher binding affinity. Using steered all-atom molecular dynamics simulations, we demonstrate that, like coarse-grained simulation, SARS-CoV-2-RBD was associated with ACE2-PD stronger than SARS-CoV-RBD, evidenced by a higher rupture force and larger pulling work. We show that the binding affinity of both viruses to ACE2 is driven by electrostatic interactions.

RevDate: 2020-08-13

Bergasa-Caceres F, HA Rabitz (2020)

Interdiction of Protein Folding for Therapeutic Drug Development in SARS CoV-2.

The journal of physical chemistry. B [Epub ahead of print].

In this article we predict the folding initiation events of the ribose phosphatase domain of protein Nsp3 and the receptor binding domain of the spike protein from the SARS Coronavirus-2. The calculations employ the Sequential Collapse Model (SCM), and the crystal structures to identify the segments involved in the initial contact formation events of both viral proteins. The initial contact locations may provide good targets for therapeutic drug development. The proposed strategy is based on a drug binding to the contact location thereby aiming to prevent protein folding. Peptides are suggested as a natural choice for such protein folding interdiction drugs.

RevDate: 2020-08-13

Goh GK, Dunker AK, Foster JA, et al (2020)

Shell disorder analysis suggests that pangolins offered a window for a silent spread of an attenuated SARS-CoV-2 precursor among humans.

Journal of proteome research [Epub ahead of print].

A model to predict the relative levels of respiratory and fecal-oral transmission potentials of coronaviruses (CoVs) by measuring the percentage of protein intrinsic disorder (PID) of the M (Membrane) and N (Nucleoprotein) proteins in their outer and inner shells, respectively, was built before the MERS-CoV outbreak. With MPID = 8.6% and NPID = 50.2%, the 2003 SARS-CoV falls into group B, which consists of CoVs with intermediate levels of both fecal-oral and respiratory transmission potentials. Further validation of the model came with MERS-CoV (MPID = 9%, NPID = 44%) and SARS-CoV-2 (MPID = 5.5%, NPID = 48%) falling into the groups C and B, respectively. Group C contains CoVs with higher fecal-oral but lower respiratory transmission potentials. Unlike SARS-CoV, SARS-CoV-2 with MPID = 5.5% has one of the hardest outer shells among CoVs. . Because the hard shell is able to resist the anti-microbial enzymes in body fluids, the infected person is able to shed large quantities of viral particles via saliva and mucus, which could account for the higher contagiousness of SARS-COV-2 . Further searches have found that high rigidity of outer shell is characteristic for the CoVs of burrowing animals, such as rabbits (MPID = 5.6%) and pangolins (MPID = 5-6%), which are in contact with the buried feces. A closer inspection of pangolin-CoVs from 2017-19 reveals that pangolins provided a unique window of opportunity for the entry of an attenuated SARS-CoV-2 precursor into the human population in 2017 or earlier, with the subsequent slow and silent spread as a mild cold that followed by its mutations into the current more virulent form. Evidence of this lies in both the genetic proximity of the pangolin-CoVs to SARS-CoV-2(~90%) and differences in N disorder. A 2017 pangolin-CoV strain shows evidence of higher levels of attenuation and higher fecal-oral transmission associated with lower human infectivity via having lower NPID (44.8%). Our shell disorder model predicts this to be a SARS-CoV-2 vaccine strain as lower inner shell disorder is associated with the lesser virulence in a variety of viruses.

RevDate: 2020-08-13

Saei AA, Sharifi S, M Mahmoudi (2020)

COVID-19: Nanomedicine Uncovers Blood-Clot Mystery.

Journal of proteome research [Epub ahead of print].

Further complications associated with infection by severe acute respiratory syndrome coronavirus 2 (a.k.a. SARS-CoV-2) continue to be reported. Very recent findings reveal that 20-30% of patients at high risk of mortality from COVID-19 infection experience blood clotting that leads to stroke and sudden death. Timely assessment of the severity of blood clotting will be of enormous help to clinicians in determining the right blood-thinning medications to prevent stroke or other life-threatening consequences. Therefore, rapid identification of blood clotting-related proteins in the plasma of COVID-19 patients would save many lives. Several nanotechnology-based approaches are being developed to diagnose patients at high risk of death due to the complications of COVID-19 infections, including blood clots. This perspective outlines the significant potential of nanomedicine i) in assessing the risk of blood clotting and its severity in SARS-CoV-2 infected patients, and ii) its synergistic roles with advanced mass spectrometry (MS)-based proteomics approaches in identifying the important protein patterns that are involved in the disease occurrence and progression. The combination of such powerful tools might help us understand the clotting phenomenon and pave the way for development of new diagnostics and therapeutics in the fight against COVID-19.

RevDate: 2020-08-13

Siddiqui R, Khamis M, Ibrahim T, et al (2020)

SARS-CoV-2: The Increasing Importance of Water Filtration against Highly Pathogenic Microbes.

ACS chemical neuroscience [Epub ahead of print].

The presence of SARS-CoV-2 in human wastewater together with poor quality of public drinking water supplies in developing countries is of concern. Additionally, the frequent use of contaminated water for bathing, nasal irrigation, swimming, and ablution can be a risk factor in contracting infectious agents such as the brain-eating amoebae and possibly SARS-CoV-2. The use of appropriate tap water filters should be encouraged to remove pathogenic microbes, together with restrained nasal irrigation (not forcing water inside nostrils vigorously) during ritual ablution or bathing to avoid dangerous consequences for populations residing in developing countries.

RevDate: 2020-08-13

Chen L, Zhao Y, J Qiao (2020)

More on Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China. Reply.

The New England journal of medicine, 383(7):697.

RevDate: 2020-08-13

Vouga M, Grobman WA, D Baud (2020)

More on Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China.

The New England journal of medicine, 383(7):696-697.

RevDate: 2020-08-13

Mofenson LM, Ciaranello A, N LaHood (2020)

More on Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China.

The New England journal of medicine, 383(7):696.

RevDate: 2020-08-13

Tutelyan VA, Nikityuk DB, Burlyaeva EA, et al (2020)

[COVID-19: new challenges for medical science and practical health].

Voprosy pitaniia, 89(3):6-13.

Currently, due to the wide spread of the new coronavirus infection COVID-19 and the need for anti-epidemic measures, medical science should integrate all efforts to ensure, on the one hand, at the global level - the fight against the spread of infection, on the other hand, at the individual level - increasing the adaptive capacity and immune response of the organism to protect against COVID-19. Nutrition is the most important factor determining human health and the functioning of all mechanisms to protect a person from negative environmental factors. For the prevention and treatment of new coronavirus infection COVID-19, a significant role is played by the correction of eating disorders, including vitamin and micronutrient deficiency. Federal Research Centre of Nutrition and Biotechnology, together with Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), prepared Recommendations on nutrition for children and adults, requiring a self-isolation regime or quarantine at home in connection with COVID-19. In order to promptly inform and advise the population on nutrition optimization in the early days of anti-epidemic measures, an information reference Contact Center was created and is continuously functioning on the basis of the Federal Research Centre of Nutrition and Biotechnology. Equally important is the implementation of measures aimed at the prevention of food contamination with COVID-19 agent. In this regard, the Federal Research Centre of Nutrition and Biotechnology, together with Rospotrebnadzor prepared guidelines on measures to prevent the transmission of a new coronavirus infection through foods. Another aspect that the medical community has faced in connection with the pandemic is the need to reorient specialized medical organizations that have not previously worked with patients with infectious diseases in order to create Clinical centers for the treatment of the new coronavirus infection COVID-19. Thus, in the context of the spread of the new coronavirus infection COVID-19, many areas of medicine are involved in the process of providing anti-epidemic measures. Successful completion of the tasks will significantly reduce the negative consequences of the COVID-19 pandemic for the state and citizens.

RevDate: 2020-08-13

Escosa-García L, Aguilera-Alonso D, Calvo C, et al (2020)

Ten key points about COVID-19 in children: the shadows on the wall.

Pediatric pulmonology [Epub ahead of print].

The pandemic of the new coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), initially described in China, is challenging the healthcare systems of all countries. Every emerging disease raises many questions with a scarcity of answers since all its characteristics are still being discovered. In the case of SARS-CoV-2, most of the literature comes from adult patients. Children seem to be less affected. Pediatric patients diagnosed with COVID-19 disease usually suffer a mild illness, with low risk of complications or mortality. Defining the role of children in the transmission of SARS-CoV-2 is critical as some national infection control decisions involving children, such as school closures or social distancing, will probably impact the dynamics of the virus. To aid in the knowledge on COVID-19 in children, this work presents an expert review of the literature published from January 1 to April 20, 2020, including peer-reviewed and pre-print non-peer-reviewed studies, along with some relevant articles afterwards, summarizing ten key points that characterize the disease in children. This article is protected by copyright. All rights reserved.

RevDate: 2020-08-13

Bartilotti-Matos F, P Davies (2020)

Pearls and Pitfalls: two contrasting HIV diagnoses in the COVID-19 era and the case for screening.

The risk of coronavirus disease 2019 (COVID-19) for people living with HIV (PLWH) is poorly understood. The vast majority of reported cases of COVID-19/HIV co-infection consists of those with an established HIV diagnosis who are on anti-retroviral therapy (ART). Better knowledge of the effects of COVID19 on HIV patients who are ART naïve is required. Two cases of previously undiagnosed HIV presenting to secondary care with respiratory symptoms are detailed in this series, with a view to extrapolate lessons on blood borne virus (BBV) screening in the COVID-19 era. This article is protected by copyright. All rights reserved.

RevDate: 2020-08-13

Kudsi OY, Chang K, N Bou-Ayash (2020)

Robotic Low Anterior Resection for a Distal Sigmoid Colon Cancer during the COVID-19 Pandemic - a Video Vignette.

The COVID-19 pandemic brings unprecedented challenges for both surgeons and patients. For patients who still require surgical management during this time, measures to decrease exposure risk during their hospitalization should be a priority. Minimally invasive approaches to low anterior resections (LAR) have been shown to result in early return of bowel function and a short length of stay.

RevDate: 2020-08-13

Singh S, A Arya (2020)

A hybrid flipped-classroom approach for online teaching of biochemistry in developing countries during Covid-19 crisis.

Biochemistry and molecular biology education : a bimonthly publication of the International Union of Biochemistry and Molecular Biology [Epub ahead of print].

RevDate: 2020-08-13

Toptan T, Aktan Ç, Başari A, et al (2020)

Case series of headache characteristics in COVID-19; Headache can be an isolated symptom.

Headache [Epub ahead of print].

Headache was described up to one third of the hospitalized patients, yet the clinical characteristics of headache associated with COVID-19 have not been defined. This observational case study included patients who were consulted to headache unit due to headache and had COVID-19 illness. Headache features in 13 PCR-confirmed COVID-19 patients with mild symptoms were reported. Headache was the isolated symptom of the COVID-19 in 3 patients, and emerged as an early symptom during the disease course in all patients. Patients specified severe, rapid onset, unrelenting headache with migraine-like features, as well as unusual sensory symptoms such as anosmia, and gastrointestinal symptoms such as diarrhea and loss of appetite and weight. Headache lasted up to 3 days in 70% of the patients and resolved in all patients within 2 weeks. Despite the fact that most of patients were female and headache characteristics were suggestive of migraine, majority of patients were not suffering from primary headaches. It was concluded that headache could be an isolated symptom of COVID-19, which might possibly be ignored in asymptomatic patients. Headaches associated with COVID-19 included features resembling migraine and/or atypical symptoms including anosmia and diarrhea.

RevDate: 2020-08-13

García-Azorín D, Trigo J, Talavera B, et al (2020)

Frequency and type of red flags in patients with Covid-19 and headache: a series of 104 hospitalized patients.

Headache [Epub ahead of print].

OBJECTIVE: In this study we aimed to evaluate the frequency of the main red flags in patients with headache who do have Covid-19.

BACKGROUND: Headache is one of the most frequent neurologic symptoms of Coronavirus disease 2019 (Covid-19). Diagnosis of secondary headache disorders is still based on the presence of red flags.

DESIGN AND METHODS: Cross-sectional study of hospitalized patients with confirmed Covid-19 disease. We interrogated every patient about the presence of headache and if so, a headache expert conducted a structured interview assessing the presence and type of the main red flags. We evaluated the presence of laboratory abnormalities on admission.

RESULTS: We screened 576 consecutive patients, 130/576 (22.6%) described headache, and 104 were included in the study. Mean age of patients was 56.7 (standard deviation: 11.2) and 66/104 (63.4%) were female. Red flags concerning prior medical history were present in 79/104 (76.0%) cases, and those related to the headache itself were observed in 99/104 (95.2%) patients. All patients 104/104 (100%) described systemic symptoms and 86/104 (82.7%) some neurologic symptoms. Laboratory results were abnormal in 98/104 (94.2%) cases. The most frequent red flags were fever, in 93/104 (89.4%) patients, cough, in 89/104 (85.6% cases), and increased C-reactive protein in 84/100 (84.0%) cases.

CONCLUSION: In patients with Covid-19 that described headache red flags were present in most cases. There was not any universal red flag, being necessary the comprehensive evaluation of all of them.

RevDate: 2020-08-13

Kow CS, SS Hasan (2020)

The use of pharmacological preventive therapy for migraine with weight gain potential amid COVID-19 pandemic.

Headache [Epub ahead of print].

We read with interest the narrative review by Arca et al. [1] on the use of headache medicines, specifically non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, amid novel coronavirus disease 2019 (COVID-19) pandemic. Arca et al. [1] have comprehensively summarized current understanding of the risks and benefits of NSAIDs and corticosteroids to facilitate decision-making by the clinicians. Nevertheless, we feel that headache medicines including the tricyclic antidepressant amitriptyline and the anticonvulsant valproate that possess the potential for weight gain are also worthy of discussion.

RevDate: 2020-08-13

Sam IC, Chong YM, Tan CW, et al (2020)

Low post-pandemic wave SARS-CoV-2 seroprevalence in Kuala Lumpur and Selangor, Malaysia.

Seroprevalence studies provide a more accurate picture of coronavirus disease 2019 (COVID-19) than PCR-confirmed cases as antibodies can be detected in mild or asymptomatic cases who otherwise remain undiagnosed. Seroprevalence can also be used as an indicator of population immunity. This article is protected by copyright. All rights reserved.

RevDate: 2020-08-13

Batiha O, Al-Deeb T, Al-Zoubi E, et al (2020)

Impact of COVID-19 and other viruses on reproductive health.

Andrologia [Epub ahead of print].

Male infertility is linked to some viral infections including human papillomavirus (HPV), herpes simplex viruses (HSV) and human immunodeficiency viruses (HIVs). Almost nothing is known about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) effect on fertility. The possible risk factors of coronavirus disease 2019 (COVID-19) infection on fertility comes from the abundance of angiotensin-Converting Enzyme-2 (ACE2), receptor entry of the virus, on testes, a reduction in important sex hormone ratios and COVID-19-associated fever. Recent studies have shown a gender difference for COVID-19 rates and comorbidity. In this review, we will discuss the potential effect of COVID-19 on male fertility and talk about what needs to be done by the scientific community to tackle our limited understanding of the disease. On the other side, we will focus on what is known so far about the risk of COVID-19 on pregnancy, neonatal health and the vertical transfer of the virus between mothers and their neonates. Finally, because reproduction is a human right and infertility is considered a health disease, we will discuss how assisted reproductive clinics can cope with the pandemic and what guidelines they should follow to minimise the risk of viral transmission.

RevDate: 2020-08-13

Takagi H (2020)

Risk and protective factors of SARS-CoV-2 infection.

It has been reported that coexistent chronic diseases are strongly associated with coronavirus disease 2019 (COVID-19) severity.1 Investigations of predictors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection itself, however, have been seldom performed. This article is protected by copyright. All rights reserved.

RevDate: 2020-08-13

Ferguson FJ, Street G, Cunningham L, et al (2020)

Occupational Dermatology in the time of the Covid-19 pandemic: A report of experience from London and Manchester, United Kingdom.

The Covid-19 pandemic has resulted in healthcare systems responding to rapidly rising demand. Simultaneously, increased infection prevention measures for staff, which includes additional personal protective equipment (PPE) and more rigorous hand hygiene procedures, has resulted in an increased incidence of occupational skin disease in frontline staff (1).

RevDate: 2020-08-13

Infantino M, Manfredi M, Grossi V, et al (2020)

Closing the Serological Gap in the Diagnostic Testing for COVID-19: The Value of Anti-SARS-CoV-2 IgA Antibodies.

Journal of medical virology [Epub ahead of print].

BACKGROUND: During COVID-19 pandemic, the early diagnosis of patients is a priority. Serological assays, in particular IgM and IgG anti-SARS-CoV-2, have today several applications but the interpretation of their results remain an open challenge. Given the emerging role of the IgA isotype in the COVID-19 diagnostics, we aimed to identify the SARS-CoV-2 IgA antibodies in a COVID-19 population seronegative for IgM.

METHODS: A total of 30 patients hospitalized in San Giovanni di Dio Hospital (Florence, Italy) for COVID-19, seronegative for IgM antibodies, have been studied for anti-SARS-CoV-2 antibodies. They all had a positive oro/nasopharyngeal swab reverse transcription polymerase chain reaction result. Assays used were a chemiluminescent assay measuring SARS-CoV-2 specific IgM and IgG (S+N) and an ELISA, measuring specific IgG (S1) and IgA antibodies against SARS-CoV-2.

RESULTS: Among the 30 patients, eight were positive for IgA, seven were positive for IgG (N+S) and two for IgG (S1), at first point (5-7 days from the onset of symptoms). The IgA antibodies mean values at the second (9-13 days) and third (21-25 days) time points were even more than twice as high as IgG assays. The agreement between the two IgG assays was moderate (Cohen's K = 0.59; SE = 0.13).

CONCLUSIONS: The inclusion of the IgA antibodies determination among serological tests of the COVID-19 diagnostic is recommended. IgA antibodies may help to close the serological gap of the COVID-19. Variations among anti-SARS-CoV-2 IgG assays should be considered in the interpretation of results. This article is protected by copyright. All rights reserved.

RevDate: 2020-08-13

Sampaio Rocha-Filho PA, L Voss (2020)

Persistent headache and persistent anosmia associated with COVID-19.

Headache [Epub ahead of print].

Respiratory symptoms are the predominant symptoms in COVID-19. However, 6.5 to 71% of patients with this disease have headaches (in most studies, between 11 and 14%).1 Despite this, little is known about the characteristics of this headache, its repercussions, or its temporal evolution.1 We describe here a case of persistent headache associated with COVID-19.

RevDate: 2020-08-13

Jarry Trujillo C, Achurra Tirado P, Escalona Vivas G, et al (2020)

Surgical training during COVID-19: a validated solution to keep on practicing.

RevDate: 2020-08-13

Brennan C, Morrissey B, Dubois-Marshall S, et al (2020)

COVID-19: No benefit of chest inclusion in acute abdomen CT.

RevDate: 2020-08-13

Huddy JR, Freeman Z, Crockett M, et al (2020)

Establishing a "cold" elective unit for robotic colorectal and urological cancer surgery and regional vascular surgery following the initial COVID-19 surge.

RevDate: 2020-08-13

Ogunkola IO, Adebisi YA, Imo UF, et al (2020)

Rural communities in Africa should not be forgotten in responses to COVID-19.

The International journal of health planning and management [Epub ahead of print].

Rural areas in Africa make up a large proportion of the continent. Since the emergence of COVID-19 on the continent, major attention and responses have been placed on urban areas. Rural areas are typified by certain challenges which may serve as limitations to the provision of resources and tools for COVID-19 responses in these areas. These major challenges include limited access to these areas due to poor road networks which may hamper the possibility of conveying resources and manpower. Shortage of healthcare workforce in these areas, poor health facilities/structures and limited access to COVID-19 diagnostics services may also make containment challenging. It is therefore important that investment should be made in these areas towards providing the necessary tools, resources, and manpower to ensure effective containment of COVID-19 and to alleviate the plight caused by the pandemic in rural Africa. Rural communities in Africa should not be left behind in COVID-19 responses.

RevDate: 2020-08-13

Li J, Huang DQ, Zou B, et al (2020)

Epidemiology of COVID-19: A Systematic Review and Meta-analysis of Clinical Characteristics, Risk factors and Outcomes.

Journal of medical virology [Epub ahead of print].

BACKGROUND: COVID-19 has become a pandemic, but its reported characteristics and outcomes vary greatly amongst studies.

OBJECTIVES: We determined pooled estimates for clinical characteristics and outcomes in COVID-19 patients including subgroups by disease severity (based on WHO Interim Guidance Report or IDSA/ATS criteria) and by country/region.

METHODS: We searched Pubmed, Embase, Scopus, Cochrane, Chinese Medical Journal, and preprint databases from January 1, 2020 to April 6, 2020. Studies of laboratory confirmed COVID-19 patients with relevant data were included. Two reviewers independently performed study selection and data extraction.

RESULTS: From 6,007 articles, 212 studies from 11 countries/regions involving 281,461 individuals were analyzed. Overall, mean age was 46.7 years, 51.8% were male, 22.9% had severe disease, and mortality was 5.6%. Underlying immunosuppression, diabetes, and malignancy were most strongly associated with severe COVID-19 (coefficient=53.9, 23.4, 23.4, respectively, all p<0.0007), while older age, male gender, diabetes, and hypertension were also associated with higher mortality (coefficient=0.05 per year, 5.1, 8.2, 6.99, respectively, p=0.006 to 0.0002). Gastrointestinal (nausea, vomiting, abdominal pain) and respiratory symptoms (shortness of breath, chest pain) were associated with severe COVID-19, while pneumonia and end organ failure were associated with mortality.

CONCLUSION: COVID-19 is associated with a severe disease course in about 23% and mortality in about 6% of infected persons. Individuals with comorbidities and clinical features associated with severity should be monitored closely, and preventive efforts should especially target those with diabetes, malignancy and immunosuppression. This article is protected by copyright. All rights reserved.

RevDate: 2020-08-13

Pellino G, Vaizey CJ, Maeda Y, et al (2020)

COVID-19 Pandemic: Considerations for resuming normalcy in colorectal service.

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Epub ahead of print].

The outbreak of COVID-19 is a global pandemic that has changed our health service operation drastically with reduction or no service of outpatient clinics and elective surgeries. It is difficult to predict the direction of pandemic with potential recurrence of outbreaks. Some restrictions in society are likely to continue to contain the spread of COVID-19 for the foreseeable future, so it is expected that a degree of alteration in hospital service will continue.

RevDate: 2020-08-13

Cahill D (2020)

How the Martini-Klinik handled prostate surgery during COVID-19.

In the August issue of BJUI, Würnschimmel et al. [1] describe the safety profile of radical prostatectomy at The Martini-Klinik (MK) during the early phase of COVID-19 using a retrospective review. They report no negative outcomes in the cohort when compared to a pre-COVID-19 cohort with short follow-up.

RevDate: 2020-08-13

Fiore JR, Centra M, De Carlo A, et al (2020)

Results from a survey in healthy blood donors in South Eastern Italy indicate that we are far away from herd immunity to SARS-CoV-2.

Journal of medical virology [Epub ahead of print].

Here we present results from a survey on anti-SARS-CoV-2 seroprevalence in healthy blood donors from a low incidence COVID-19 area (Apulia region, South Eastern Italy). Among 904 subjects tested, only in 9 cases (0.99%) antibodies against SARS-CoV-2 were demonstrated. All the 9 seropositive patients were negative for the research of viral RNA by RT-PCR in nasopharyngeal swabs. These data, along with those recently reported from other countries, clearly show that we are very far from herd immunity and that the containment measures are at the moment the only realistic instrument we have to slow the spread of the pandemic. This article is protected by copyright. All rights reserved.

RevDate: 2020-08-13

Pettit NN, Nguyen CT, Mutlu GM, et al (2020)

Late Onset Infectious Complications and Safety of Tocilizumab in the Management of COVID-19.

Journal of medical virology [Epub ahead of print].

BACKGROUND: Tocilizumab (TCZ) has been used in the management of COVID-19-related cytokine release syndrome (CRS). Concerns exist regarding the risk of infections and drug-related toxicities. We sought to evaluate the incidence of these TCZ complications among COVID-19 patients.

METHODS: All adult inpatients with COVID-19 between March 1st and April 25th , 2020 that received TCZ were included. We compared the rate of late-onset infections (>48 hours following admission) to a control group matched according to intensive care unit admission and mechanical ventilation requirement. Post-TCZ toxicities evaluated included: elevated liver function tests (LFTs), GI perforation, diverticulitis, neutropenia, hypertension, allergic reactions, and infusion-related reactions.

RESULTS: Seventy-four patients were included in each group. Seven-teen infections in the TCZ group (23%) and 6 (8%) infections in the control group occurred >48 hours after admission (p=0.013). Most infections were bacterial with pneumonia being the most common manifestation. Among patients receiving TCZ, LFT elevations were observed in 51%, neutropenia in 1.4%, and hypertension in 8%. The mortality rate among those that received TCZ was greater than the control (39% versus 23%, p=0.03).

CONCLUSION: Late onset infections were significantly more common among those receiving TCZ. Combining infections and TCZ-related toxicities, 61% of patients had a possible post-TCZ complication. While awaiting clinical trial results to establish the efficacy of TCZ for COVID-19 related CRS, the potential for infections and TCZ related toxicities should be carefully weighed when considering use. This article is protected by copyright. All rights reserved.

RevDate: 2020-08-13

Xu R, Zhou Y, Cai L, et al (2020)

Co-Reactivation of Human Herpesvirus alpha Subfamily (HSV Ⅰ and VZV) in Critically Ill Patient with COVID-19.

Coronavirus disease 2019 (COVID-19) is already well known globally1 . The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 infection) causes a spectrum of severe clinical manifestations, which leads to a high rate of intensive care unit (ICU) admissions and mortality. We report a first case of COVID-19 with reactivation of human herpesvirus (HHV) alpha subfamily (herpes simplex virus I [HSV Ⅰ] and varicella-zoster virus [VZV]). Due to the immunosuppressive state associated with COVID-19, infection of the HHV alpha subfamily (HSV Ⅰ and VZV) could be potentially life threatening.

RevDate: 2020-08-13

Battesti G, V Descamps Vincent (2020)

Negative tests for SARS-CoV-2 infection do not rule out its responsibility for chilblains.

We read with great interest the report of Le Cleach et al discussing chilblains as a manifestation of COVID-19 pandemic. They reported 311 patients with acral lesions occurring during the COVID-19 lockdown in France. The most frequent clinical presentation of these acral lesions was typical chilblains. Among the 150 patients with RT-PCR testing and/or serology, only 10 had confirmed COVID-19. They concluded that there is no evidence of SARS-CoV-2 infection in the large majority of patients with acral lesions. They hypothesized that the situation could be due to the media stating that chilblains were caused by SARS-CoV-2 infection and leading to a higher rate of consultation or the lockdown leading to more inactivity and long periods at home barefoot on a cold floor.

RevDate: 2020-08-13

Lambkin-Williams R, JP DeVincenzo (2020)

A COVID-19 human viral challenge model. Learning from experience.

Influenza and other respiratory viruses [Epub ahead of print].

The controlled human infection model and specifically the human viral challenge model are not dissimilar to standard clinical trials while adding another layer of complexity and safety considerations. The models deliberately infect volunteers, with an infectious challenge agent to determine the effect of the infection and the potential benefits of the experimental interventions. The human viral challenge model studies can shorten the time to assess the efficacy of a new vaccine or treatment by combining this with the assessment of safety. The newly emerging SARS-CoV-2 virus is highly contagious, and an urgent race is on to develop a new vaccine against this virus in a timeframe never attempted before. The use of the human viral challenge model has been proposed to accelerate the development of the vaccine. In the early 2000s, the authors successfully developed a pathogenic human viral challenge model for another virus for which there was no effective treatment and established it to evaluate potential therapies and vaccines against respiratory syncytial virus. Experience gained in the development of that model can help with the development of a COVID-19 HVCM and the authors describe it here.

RevDate: 2020-08-13

Mazurik L, Javidan AP, Higginson I, et al (2020)

Early lessons from COVID-19 that may reduce future emergency department crowding.

Emergency medicine Australasia : EMA [Epub ahead of print].

RevDate: 2020-08-13

Fujita K, Ito T, Saito Z, et al (2020)

Impact of COVID-19 pandemic on lung cancer treatment scheduling.

Thoracic cancer [Epub ahead of print].

The current coronavirus disease 2019 (COVID-19) pandemic is associated with a heavy burden on the mental and physical health of patients, regional healthcare resources, and global economic activity. Many patients with lung cancer are thought to be affected by this situation. Therefore, in this study, we aimed to evaluate the impact of COVID-19 pandemic on lung cancer treatment scheduling. We retrospectively reviewed the medical records of lung cancer patients who were undergoing anticancer treatment at the National Hospital Organization Kyoto Medical Center (600 beds) in Kyoto, Japan, between 1 March 2020 and 31 May 2020. After the medical records were reviewed, the patients were assigned to one of two groups, depending on whether their lung cancer treatment schedule was delayed. We assessed the characteristics, types of histopathology and treatment, and the reason for the delay. A total 15 (9.1%) patients experienced a delay in lung cancer treatment during the COVID-19 pandemic. Patients with a treatment delay received significantly more immune checkpoint inhibitor (ICI) monotherapy than patients without a treatment delay (P = 0.0057). On the contrary, no patients receiving molecular targeted agents experienced a treatment delay during the COVID-19 pandemic period (P = 0.0027). The treatments of most of the patients were delayed at their request. We determined that 9.1% lung cancer patients suffered anxiety and requested a treatment delay during the COVID-19 pandemic. Oncologists should bear in mind that patients with cancer have more anxiety than expected under unprecedented circumstances such as the COVID-19 pandemic.

RevDate: 2020-08-13

Gentile S, Strollo F, Mambro A, et al (2020)

COVID-19, ketoacidosis, and new-onset Diabetes: might we envisage any cause-effect relationships among them?.

RevDate: 2020-08-13

Hakmi H, Sohail A, Brathwaite C, et al (2020)

Cardiac tamponade in COVID-19 patients: Management and outcomes.

IMPORTANCE: Cardiac tamponade requiring emergent intervention is a possible complication of coronavirus disease 2019 (COVID-19) infection. Favorable clinical outcomes are possible if timely management and drainage are performed unless ventricular failure develops.

OBSERVATION: Cardiac tamponade in COVID-19, based on the limited reported cases, seems to be more common among middle-aged men with observed complications in black and ethnic minorities. Prognosis is worse amongst patients with concomitant ventricular failure.

DESIGN AND METHODS: This is a case series of three COVID-19 patients complicated by cardiac tamponade, requiring surgical intervention at a single institution in New York.

INTERVENTION: Pericardial window, Pericardiocentesis.

OUTCOME: One patient had recurrence of cardiac tamponade with hemorrhagic component but fully recovered and was discharged home. Two patients developed cardiac tamponade with concomitant biventricular failure, resulting in death.

CONCLUSION AND RELEVANCE: Cardiac tamponade with possible concomitant biventricular failure can develop in COVID-19 patients; incidence seems to be highest at the point of marked inflammatory response. Concomitant ventricular failure seems to be a predictor of poor prognosis.

RevDate: 2020-08-13

Leon-Abarca JA (2020)

Obesity and immunodeficiencies are the main pre-existing conditions associated with mild to moderate COVID-19 in children.

RevDate: 2020-08-13

Barkhordari K, Khajavi MR, Bagheri J, et al (2020)

Early respiratory outcomes following cardiac surgery in patients with COVID-19.

Journal of cardiac surgery [Epub ahead of print].

BACKGROUND: Both coronavirus disease (COVID-19) and cardiac surgery have a negative impact on pulmonary function. This study aimed to determine the postoperative respiratory outcomes of patients with COVID-19 who underwent cardiac surgery.

METHODS: In this retrospective study, we reviewed and analyzed the patient characteristics and clinical data of 25 asymptomatic patients with COVID-19 who underwent urgent or emergency cardiac surgery at Tehran Heart Center Hospital, Iran, between 29 February and 10 April 2020.

RESULTS: The mean age, EuroSCORE, and body mass index were 57.3 ± 15.1 years, 6.65 ± 1.29, and 25.7 ± 3.7 kg/m2 , respectively. Four patients underwent off-pump cardiac surgery and 21 underwent on-pump cardiac surgery with a median cardiopulmonary bypass time of 85 minutes (interquartile range (IQR, 50-147). The overall mortality rate and the length of stay in the intensive care unit (ICU) were higher compared to those of a propensity-matched group of patients who underwent cardiac surgery in the pre-COVID era. The median intubation time was 13 hours (IQR, 9.5-18), which was comparable to that of pre-COVID cardiac surgery patients. The readmission rate to the ICU was 16%. In this ICU readmitted group, the mean oxygen index, FiO2 , and mortality rate were higher and the PaO2 /FiO2 ratio was lower than those of the nonreadmitted patients.

CONCLUSIONS: Although early respiratory outcomes of asymptomatic COVID-19 patients who underwent early cardiac surgery appeared to be satisfactory, compared to the propensity-scored matched non-COVID group, the postoperative outcomes were worse, especially in the ICU readmitted patients. We suggest postponing cardiac operations unless the patient requires emergency surgery.

RevDate: 2020-08-13

Brochez L, Baurain JF, Del Marmol V, et al (2020)

Recommendations for skin cancer consultation and surgery during COVID-19 pandemic.

Journal of the European Academy of Dermatology and Venereology : JEADV [Epub ahead of print].

RevDate: 2020-08-13

Korun O, Yurdakök O, Arslan A, et al (2020)

The impact of COVID-19 pandemic on congenital heart surgery practice: An alarming change in demographics.

Journal of cardiac surgery [Epub ahead of print].

BACKGROUND: The aim of this study is to investigate the effect of COVID-19 outbreak on congenital cardiac surgery practice in a single center.

METHODS: The first case of COVID-19 in our country was seen on March 11th, 2020. The patients operated between March 11th, 2019-and March 10th, 2020 were taken as the pre-COVID group, and those operated between March 11th and May 11th, 2020 were taken as the COVID group. The data was retrospectively collected, and the two periods were compared.

RESULTS: Monthly average number of cases which was 52 patients/month (626 patients in 12 months) before COVID decreased to 35 patients/month (70 patients in 2 months) during COVID periods (P < .01). During the pre-COVID period the median postoperative length of hospital stay was 3 (IQR: 1-5) days. During the COVID period, this decreased to 1 (IQR: 1-3) day (P < .01). During the pre-COVID period, the hospital expenses of 17% (8/47) of the foreign nationals were covered by their homeland. The remaining 83% (39/47) were paid from the asylum seekers' fund. The proportion of foreign nationals operated significantly decreased during the COVID period ([7%; 47/632 vs 1%; 1/70]; P = .04). No significant difference was observed in terms of STAT mortality scores and categories and postoperative results of the operations performed between the two periods.

CONCLUSIONS: Congenital cardiac surgery practice can be safely maintained with restricted case volume during the pandemic period. It is alarming that patients in the deprived areas cannot access pediatric cardiac surgery and possibly other health services because of closure of the borders between countries.

RevDate: 2020-08-13

Mok VCT, Pendlebury S, Wong A, et al (2020)

Tackling challenges in care of Alzheimer's disease and other dementias amid the COVID-19 pandemic, now and in the future.

Alzheimer's & dementia : the journal of the Alzheimer's Association [Epub ahead of print].

We have provided an overview on the profound impact of COVID-19 upon older people with Alzheimer's disease and other dementias and the challenges encountered in our management of dementia in different health-care settings, including hospital, out-patient, care homes, and the community during the COVID-19 pandemic. We have also proposed a conceptual framework and practical suggestions for health-care providers in tackling these challenges, which can also apply to the care of older people in general, with or without other neurological diseases, such as stroke or parkinsonism. We believe this review will provide strategic directions and set standards for health-care leaders in dementia, including governmental bodies around the world in coordinating emergency response plans for protecting and caring for older people with dementia amid the COIVD-19 outbreak, which is likely to continue at varying severity in different regions around the world in the medium term.

RevDate: 2020-08-13

Mosheva M, Hertz-Palmor N, Dorman Ilan S, et al (2020)

Anxiety, pandemic-related stress and resilience among physicians during the COVID-19 pandemic.

Depression and anxiety [Epub ahead of print].

BACKGROUND: Physicians play a crucial frontline role in the COVID-19 pandemic, which may involve high levels of anxiety. We aimed to investigate the association between pandemic-related stress factors (PRSF) and anxiety and to evaluate the potential effect of resilience on anxiety among physicians.

METHODS: A self-report digital survey was completed by 1106 Israeli physicians (564 males and 542 females) during the COVID-19 outbreak. Anxiety was measured by the 8-item version of the Patient-Reported Outcomes Measurement Information System. Resilience was evaluated by the 10-item Connor-Davidson Resilience Scale. Stress was assessed using a PRSF inventory.

RESULTS: Physicians reported high levels of anxiety with a mean score of 59.20 ± 7.95. We found an inverse association between resilience and anxiety. Four salient PRSF (mental exhaustion, anxiety about being infected, anxiety infecting family members, and sleep difficulties) positively associated with anxiety scores.

CONCLUSIONS: Our study identified specific PRSF including workload burden and fear of infection that are associated with increased anxiety and resilience that is associated with reduced anxiety among physicians.

RevDate: 2020-08-13

Al-Taweel FB, Abdulkareem AA, Gul SS, et al (2020)

Evaluation of technology-based learning by dental students during the pandemic outbreak of Corona virus disease 2019.

European journal of dental education : official journal of the Association for Dental Education in Europe [Epub ahead of print].

INTRODUCTION: Although technology-based learning (TB-learning) has been accepted as an efficient educational tool in the field of dentistry, evaluation of TB-learning in non-prepared situations such as pandemics has not been fully investigated. This study aimed to evaluate different aspects of TB-learning among undergraduate dental students during the pandemic outbreak of COVID-19.

MATERIALS AND METHODS: Dental students in selected Iraqi universities (University of Baghdad, University of Sulaimani, and Dijlah University College) were invited to join the study. A questionnaire was created using a Google platform and answered by students. Satisfaction and attitude toward TB-learning plus total evaluation scores for lecturers were examined.

RESULTS: A total of 832 out of 1800 dental students participated in the study. The majority of participants have basic (40.7%) and intermediate (47.5%) computer skills and more than half of them lack any experience in TB-learning. The overall satisfaction and positive attitude toward TB-learning was less than 50%. Students at final grade, with advanced computer skills and TB-learning experience showed higher satisfaction (OR: 3.031, 2.876, 3.644, respectively) and a more positive attitude (OR: 3.172, 3.035, 3.477, respectively) toward TB-learning than those at earlier grades. Total evaluation scores for lecturers were higher among females (11.5± 5.8) than males (9.9± 7.2) as well as among participants at final grade (14.0± 6.2), with advanced computer skills (13.8± 6.1), and TB-learning experience (16.2± 6.0).

CONCLUSIONS: Dental students demonstrated low-moderate satisfaction and positive attitude toward TB-learning and the quality of material presented to them. Integrating TB-learning into the dental education curriculum is an essential step in enhancing the acceptance of TB-learning in the future.

RevDate: 2020-08-13

Villamizar N, DM Nguyen (2020)

Enhancement in virtual learning cannot substitute for hands-on training in cardiothoracic surgery.

Journal of cardiac surgery [Epub ahead of print].

This program director survey attempts to determine how coronavirus 2019 pandemic is impacting current training in cardiothoracic surgery. A transition to virtual didactic sessions may prove beneficial with increasing attendance. On the other hand, decreasing live simulation and case volumes may jeopardize achieving competency in surgical skills.

RevDate: 2020-08-13

Idhrees M, Bashir M, Mousavizadeh M, et al (2020)

International study on impact of COVID-19 on cardiac and thoracic aortic aneurysm surgery.

Journal of cardiac surgery [Epub ahead of print].

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic gripped every nation's health care system and provisions on all levels. In cardiac and aortic surgery, as it is with most specialities, elective surgeries were halted.

AIMS OF THE STUDY: We captured reflections, contingencies, and current practices across of high-volume centers in cardiac and aortic surgery globally. We also aimed this study to assess decision on prioritization of the surgical patients, the need for personal protection equipment, and the choice of preoperative investigations in current dynamic and fluid climate.

METHODS: A validated web-based questionnaire was constructed and was circulated to the international surgeons amongst high volume cardiac and aortic surgery centers. Their intrinsic feedback on decision making, the impact of the lockdown, and perspectives for the future ahead of us all were noted. A mixed-method approach was constructed. Qualitative data analysis was introduced to signify the impact globally.

RESULTS: Overall, 23 centers from 18 countries participated in this international study. About 91.7% of the respondents stopped operating on elective patients during the pandemic. The majority of the surgeons agreed that acute aortic dissection (87.1%) should be operated as an emergency procedure and stable triple vessel disease (87.1%) to be considered as an elective procedure. Three-fifth (60%) of the respondents relied on computerized tomography chest as a preoperative screening modality.

CONCLUSION: In the present climate where there is a paucity of evidence, this will give an interim consensus for the cardiac surgeons. With the increase in the cumulative number of patients with COVID-19, careful utilization of the resources regarding hospital beds and manpower is of paramount importance.

RevDate: 2020-08-13

Malherbe N (2020)

Community psychology and the crisis of care.

Journal of community psychology [Epub ahead of print].

In addition to the twinned crises of ecology and political economy, we face today a crisis of care. The crisis of care, I contend, is fundamentally a political and an ethical crisis. In this short commentary, I outline the structural (i.e., systemic) and reproductive (i.e., labour) character of this crisis, using the COVID-19 pandemic as an example. From here, I argue for the imperative to centre an expansive conception of care in critical community psychology work. Specifically, I posit that by working with and alongside activist care workers, community psychologists can assist in building socially just modalities of care. After reflecting on my work with collective caring initiatives, I offer five (tentative) guiding principles for a community psychology that is committed to addressing the crisis of care, namely: (1) commitment to building political coalitions; (2) commitment to refuting capitalist conceptions of care; (3) commitment to expanding conceptions of care; (4) commitment to embracing the psychological consequences of care work; and (5) a politicoethical commitment.

RevDate: 2020-08-13

Hodges K, Mubashir M, Insler J, et al (2020)

Successful management of COVID-19 and associated coagulopathy in a patient with durable left ventricular assist device.

Patients with durable left ventricular assist devices pose special problems for management in the setting of COVID-19 infection. We describe the successful management of a 44-year-old man with severe COVID-19 infection and HeartMate 3 left ventricular assist device. His course was complicated by cytokine storm and COVID-19-associated coagulopathy. We describe our institutional protocol for managing COVID-19 infection in patients on mechanical circulatory support, focusing on the need for a thoughtful, multidisciplinary approach.

RevDate: 2020-08-13

Vasudev R, Guragai N, Habib H, et al (2020)

The utility of bedside echocardiography in critically ill COVID-19 patients: Early observational findings from three Northern New Jersey hospitals.

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

INTRODUCTION: Cardiovascular complications related to coronavirus disease 2019 (COVID-19) have led to the need for echocardiographic services during the pandemic. The present study aimed to identify the echocardiographic findings in hospitalized COVID-19 patients and their utility in disease management.

METHODS: We included patients who were diagnosed with COVID-19 using polymerase chain reaction and those who underwent echocardiographic examination during their hospitalization.

RESULTS: Altogether, 45 patients were evaluated. The mean age was 61.4 ± 12.2 years. Hypertension (n = 29, 64%) and diabetes mellitus (n = 25, 55%) were the most common comorbidities followed by congestive heart failure (n = 11, 24%), coronary artery disease (n = 9, 20%), and valvular heart disease (n = 3, 7%). Eight patients (18%) showed evidence of myocardial injury, as suggested by elevated troponin levels. Brain natriuretic peptide was elevated in 14 patients (36%), and 14 patients had left ventricular dysfunction in the form of reduced ejection fraction (31%). Right ventricular (RV) dilatation was observed in six patients, and five patients had reduced RV ejection fraction. RV pressure and volume overload were observed in three patients. RV thrombus was observed in one patient. Pulmonary pressure was elevated in 10 patients (24%).

CONCLUSION: Two-dimensional echocardiography can be an important bedside tool for the assessment of cardiovascular abnormalities and hemodynamic status of COVID-19 patients.

RevDate: 2020-08-13

Baker MG, Kvalsvig A, AJ Verrall (2020)

New Zealand's COVID-19 elimination strategy.

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

RevDate: 2020-08-13

Li G, Saguner AM, An J, et al (2020)

Cardiovascular disease during the COVID-19 pandemic: Think ahead, protect hearts, reduce mortality.

Cardiology journal pii:VM/OJS/J/68726 [Epub ahead of print].

Coronavirus disease 2019 (COVID-19) is rapidly spreading globally. As of July 3, 2020, the number of confirmed cases has been nearly 11 million with 521,000 fatalities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is accountable for COVID-19. Newly diagnosed and worsening cardiovascular disease are common complications in COVID-19 patients, including acute cardiac injury, hypertension, arrhythmia, myocardial infarction, heart failure and sudden cardiac arrest. The mechanisms contributing to cardiac disease burden include hypoxemia, inflammatory factor storm, dysfunctional angiotensin converting enzyme 2 (ACE2), and drug-induced cardiac toxicity. Notably, the macrophages expressing ACE2 as direct host cells of SARS-CoV-2 secrete chemokine and inflammatory cytokines, as well as a decrease in cellular immune responses to SARS-CoV-2 infection due to elevated exhaustion levels and dysfunctional diversity of T cells, that may be accountable for the "hyperinflammation and cytokine storm syndrome" and subsequently acute cardiac injury and deteriorating cardiovascular disease in COVID-19 patients. However, no targeted medication or vaccines for COVID-19 are yet available. The management of cardiovascular disease in patients with COVID-19 include general supportive treatment, circulatory support, other symptomatic treatment, psychological assistance as well as online consultation. Further work should be concentrated on better understanding the pathogenesis of COVID-19 and accelerating the development of drugs and vaccines to reduce the cardiac disease burden and promote the management of COVID-19 patients, especially those with a severe disease course and cardiovascular complications.

RevDate: 2020-08-13

Proniewska K, Pręgowska A, Dołęga-Dołęgowski D, et al (2020)

Immersive technologies as a solution for general data protection regulation in Europe and impact on the COVID-19 pandemic.

Cardiology journal pii:VM/OJS/J/69625 [Epub ahead of print].

BACKGROUND: General data protection regulation (GDPR) provides rules according to which data should be managed and processed in a secure and appropriate way for patient requirements and security. Currently, everyone in Europe is covered by GDPR. Thus, the medical practice also requires access to patient data in a safe and secure way.

METHODS: Holographic technology allows users to see everything visible ona computer screen in a new and less restricted way, i. e. without the limitations of traditional computers and screens.

RESULTS: In this study, a three-dimensional holographic doctors' assistant is designed and implemented in a way that meets the GDPR requirements. The HoloView application, which is tailored to run on Microsoft HoloLens, is proposed toallow display and access to personal data and so-called sensitive information of all individual patients without the risk that it will be presented to unauthorized persons.

CONCLUSIONS: To enhance the user experience and remain consistent with GSPR, a holographic desk is proposed that allows displaying patient data and sensitive information only in front of the doctor's eyes using mixed reality glasses. Last but not least, it boasts of a reduction in infection risk for the staff during the COVID-19 pandemic, affording medical care to be carried out by as few doctors as possible.

RevDate: 2020-08-13

Cleveland Manchanda EC, Sanky C, JM Appel (2020)

Crisis Standards of Care in the USA: A Systematic Review and Implications for Equity Amidst COVID-19.

Journal of racial and ethnic health disparities pii:10.1007/s40615-020-00840-5 [Epub ahead of print].

BACKGROUND: Crisis Standards of Care (CSC) provide a framework for the fair allocation of scarce resources during emergencies. The novel coronavirus disease (COVID-19) has disproportionately affected Black and Latinx populations in the USA. No literature exists comparing state-level CSC. It is unknown how equitably CSC would allocate resources.

METHODS: The authors identified all publicly available state-level CSC through online searches and communication with state governments. Publicly available CSC were systematically reviewed for content including ethical framework and prioritization strategy.

RESULTS: CSC were identified for 29 states. Ethical principles were explicitly stated in 23 (79.3%). Equity was listed as a guiding ethical principle in 15 (51.7%); 19 (65.5%) said decisions should not factor in race, ethnicity, disability, and other identity-based factors. Ten states (34.4%) allowed for consideration of societal value, which could lead to prioritization of health care workers and other essential personnel. Twenty-one (72.4%) CSC provided a specific strategy for prioritizing patients for critical care resources, e.g., ventilators. All incorporated Sequential Organ Failure Assessment scores; 15 (71.4%) of these specific CSC considered comorbid conditions (e.g., cardiac disease, renal failure, malignancy) in resource allocation decisions.

CONCLUSION: There is wide variability in the existence and specificity of CSC across the USA. CSC may disproportionately impact disadvantaged populations due to inequities in comorbid condition prevalence, expected lifespan, and other effects of systemic racism.

RevDate: 2020-08-13

Tabatabaei SMH, Talari H, Gholamrezanezhad A, et al (2020)

A low-dose chest CT protocol for the diagnosis of COVID-19 pneumonia: a prospective study.

Emergency radiology pii:10.1007/s10140-020-01838-6 [Epub ahead of print].

PURPOSE: The increasing trend of chest CT utilization during the COVID-19 pandemic necessitates novel protocols with reduced dose and maintained diagnostic accuracy. We aimed to investigate the diagnostic accuracy of 30-mAs chest CT protocol in comparison with a 150-mAs standard-dose routine protocol for imaging of COVID-19 pneumonia.

METHODS: Upon IRB approval, consecutive laboratory-confirmed positive COVID-19 patients aged 50 years or older who were referred for chest CT scan and had same-day normal CXR were invited to participate in this prospective study. First, a standard-dose chest CT scan (150 mAs) was performed. Only if typical COVID-19 pneumonia features were identified, then a low-dose CT (30 mAs) was done immediately. Diagnostic accuracy of low-dose and standard-dose CT in the detection of typical COVID-19 pneumonia features were compared.

RESULTS: Twenty patients with a mean age of 64.20 ± 13.8 were enrolled in the study. There was excellent intrareader agreement in detecting typical findings of COVID-19 pneumonia between low-dose and standard-dose (intraclass correlation coefficient [ICC] = 0.98-0.99, P values < 0.001 all readers). The mean effective dose values in standard- and low-dose groups were 6.60 ± 1.47 and 1.80 ± 0.42 mSv, respectively. Also, absolute cancer risk per mean cumulative effective dose values obtained from the standard- and low-dose CT examinations were 2.71 × 10-4 and 0.74 × 10-4, respectively.

CONCLUSIONS: According to our study, it was found that proposed low-dose CT chest protocol is reliable in detecting COVID-19 pneumonia in daily practice with significant reduction in radiation dose and estimated cancer risk.

RevDate: 2020-08-13

Park YJ, Farooq J, Cho J, et al (2020)

Fighting the War Against COVID-19 via Cell-Based Regenerative Medicine: Lessons Learned from 1918 Spanish Flu and Other Previous Pandemics.

Stem cell reviews and reports pii:10.1007/s12015-020-10026-5 [Epub ahead of print].

The human population is in the midst of battling a rapidly-spreading virus- Severe Acute Respiratory Syndrome Coronavirus 2, responsible for Coronavirus disease 2019 or COVID-19. Despite the resurgences in positive cases after reopening businesses in May, the country is seeing a shift in mindset surrounding the pandemic as people have been eagerly trickling out from federally-mandated quarantine into restaurants, bars, and gyms across America. History can teach us about the past, and today's pandemic is no exception. Without a vaccine available, three lessons from the 1918 Spanish flu pandemic may arm us in our fight against COVID-19. First, those who survived the first wave developed immunity to the second wave, highlighting the potential of passive immunity-based treatments like convalescent plasma and cell-based therapy. Second, the long-term consequences of COVID-19 are unknown. Slow-progressive cases of the Spanish flu have been linked to bacterial pneumonia and neurological disorders later in life, emphasizing the need to reduce COVID-19 transmission. Third, the Spanish flu killed approximately 17 to 50 million people, and the lack of human response, overcrowding, and poor hygiene were key in promoting the spread and high mortality. Human behavior is the most important strategy for preventing the virus spread and we must adhere to proper precautions. This review will cover our current understanding of the pathology and treatment for COVID-19 and highlight similarities between past pandemics. By revisiting history, we hope to emphasize the importance of human behavior and innovative therapies as we wait for the development of a vaccine. Graphical Abstract.

RevDate: 2020-08-13

Pu J, Leader JK, Bandos A, et al (2020)

Automated quantification of COVID-19 severity and progression using chest CT images.

European radiology pii:10.1007/s00330-020-07156-2 [Epub ahead of print].

OBJECTIVE: To develop and test computer software to detect, quantify, and monitor progression of pneumonia associated with COVID-19 using chest CT scans.

METHODS: One hundred twenty chest CT scans from subjects with lung infiltrates were used for training deep learning algorithms to segment lung regions and vessels. Seventy-two serial scans from 24 COVID-19 subjects were used to develop and test algorithms to detect and quantify the presence and progression of infiltrates associated with COVID-19. The algorithm included (1) automated lung boundary and vessel segmentation, (2) registration of the lung boundary between serial scans, (3) computerized identification of the pneumonitis regions, and (4) assessment of disease progression. Agreement between radiologist manually delineated regions and computer-detected regions was assessed using the Dice coefficient. Serial scans were registered and used to generate a heatmap visualizing the change between scans. Two radiologists, using a five-point Likert scale, subjectively rated heatmap accuracy in representing progression.

RESULTS: There was strong agreement between computer detection and the manual delineation of pneumonic regions with a Dice coefficient of 81% (CI 76-86%). In detecting large pneumonia regions (> 200 mm3), the algorithm had a sensitivity of 95% (CI 94-97%) and specificity of 84% (CI 81-86%). Radiologists rated 95% (CI 72 to 99) of heatmaps at least "acceptable" for representing disease progression.

CONCLUSION: The preliminary results suggested the feasibility of using computer software to detect and quantify pneumonic regions associated with COVID-19 and to generate heatmaps that can be used to visualize and assess progression.

KEY POINTS: • Both computer vision and deep learning technology were used to develop computer software to quantify the presence and progression of pneumonia associated with COVID-19 depicted on CT images. • The computer software was tested using both quantitative experiments and subjective assessment. • The computer software has the potential to assist in the detection of the pneumonic regions, monitor disease progression, and assess treatment efficacy related to COVID-19.

RevDate: 2020-08-13

do Espírito Santo DA, Lemos ACB, CH Miranda (2020)

In vivo demonstration of microvascular thrombosis in severe COVID-19.

Journal of thrombosis and thrombolysis pii:10.1007/s11239-020-02245-x [Epub ahead of print].

Several autopsy studies showed microthrombi in pulmonary circulation of severe COVID-19 patients. The major limitation of these investigations is that the autopsy provided static information. Some of these alterations could be secondary to the disseminated intravascular coagulation (DIC) observed as the final standard route to the multisystem organ failure exhibited in critically ill patients. We report preliminary results of an in vivo evaluation of sublingual microcirculation in thirteen patients with severe COVID-19 requiring mechanical ventilation. We observed multiple filling defects moving within the microvessels indicative of thrombi in most of the cases 11/13 (85%). This is the first imaging documentation of microvascular thrombosis in living severe COVID-19 patients since the beginning of the hospitalization. The clinical relevance of microvascular thrombosis in this disease requires further research.

RevDate: 2020-08-13

Meletiadis J, Tsiodras S, P Tsirigotis (2020)

Interleukin-6 Blocking vs. JAK-STAT Inhibition for Prevention of Lung Injury in Patients with COVID-19.

Infectious diseases and therapy pii:10.1007/s40121-020-00326-1 [Epub ahead of print].

The severe respiratory insufficiency observed during COVID-19 infection may not be directly related to a cytopathogenic effect induced by the virus itself, but to an exaggerated and inappropriate immune response. In an effort to reduce the severity of organ dysfunction, including respiratory insufficiency, monoclonal antibodies (Mabs) that block the interleukin-6 receptor, such as tocilizumab, sarilumab, and siltuximab, are under investigation for the treatment of COVID-19. However, blocking of just one of the many cytokines involved in the inflammatory reaction may not slow down the magnitude of the process. Since timing is important, the immune deficiency induced by IL6 blockade at the late immunodeficiency phase of sepsis that follows the initial inflammatory response may be detrimental. Finally, monitoring the degree and duration of IL6 blockade may be challenging because of the long half-life of Mabs (2-3 weeks). Pro- and anti-inflammatory cytokines act through a common JAK-STAT signaling pathway, which can be inhibited by JAK-STAT inhibitors. Ruxolitinib, a tyrosine kinase inhibitor selective for JAK1, 2, blocks many pro- and anti-inflammatory cytokines including IL6. Ruxolitinib has favorable pharmacodynamics and an acceptable safety profile. The short half-life (4-6 h) of the drug offers the opportunity for ideal monitoring of the degree and duration of cytokine blocking, simply by the adjusting dose and duration of therapy. From a theoretical point of view, the balanced control of cytokine blockade throughout the course of the septic process should be the cornerstone of modern management. According to this hypothesis, maximization of blocking should be attempted at the phase of hyper-inflammation for preventing severe organ damage, while pro-inflammatory blockade should be minimized at the late phase of immunoparalysis for prevention of secondary infections. Based on the above considerations, we consider that the efficacy and safety of this drug deserves testing in the context of a controlled randomized trial.

RevDate: 2020-08-13

Bidar F, Hékimian G, Martin-Toutain I, et al (2020)

Heparin-induced thrombocytopenia in COVID-19 patients with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation: two case reports.

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs pii:10.1007/s10047-020-01203-x [Epub ahead of print].

Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is increasingly used in Coronavirus disease-19 (COVID-19) patients with the most severe forms of acute respiratory distress syndrome (ARDS). Its use is associated with a significant hemostatic challenge, especially in COVID- 19 patients who have been demonstrated to otherwise present a COVID-19-associated coagulopathy. The systematic use of unfractionated heparin therapy to prevent circuit thrombosis is warranted during ECMO support. The clinical presentation and management of heparin-induced thrombocytopenia, which is a rare but life-threatening complication of heparin therapy, has not been described in those patients yet. We report herein two cases of laboratory-confirmed HIT in COVID-19 patients with severe ARDS admitted to our intensive care unit for VV-ECMO support and the successful use of argatroban as an alternative therapy. We also provide a brief literature review of best evidence for managing such patients. The diagnosis and management of HIT is particularly challenging in COVID-19 patients receiving ECMO support. An increased awareness is warranted in those patients who already present a procoagulant state leading to higher rates of thrombotic events which can confuse the issues. Argatroban seems to be an appropriate and safe therapeutic option in COVID-19 patients with HIT while on VV-ECMO.

RevDate: 2020-08-13

Gonçalves B, Righy C, P Kurtz (2020)

Thrombotic and Hemorrhagic Neurological Complications in Critically Ill COVID-19 Patients.

Neurocritical care pii:10.1007/s12028-020-01078-z [Epub ahead of print].

RevDate: 2020-08-13

Devaurs D, Antunes DA, LE Kavraki (2020)

Computational analysis of complement inhibitor compstatin using molecular dynamics.

Journal of molecular modeling, 26(9):231 pii:10.1007/s00894-020-04472-8.

The complement system plays a major role in human immunity, but its abnormal activation can have severe pathological impacts. By mimicking a natural mechanism of complement regulation, the small peptide compstatin has proven to be a very promising complement inhibitor. Over the years, several compstatin analogs have been created, with improved inhibitory potency. A recent analog is being developed as a candidate drug against several pathological conditions, including COVID-19. However, the reasons behind its higher potency and increased binding affinity to complement proteins are not fully clear. This computational study highlights the mechanistic properties of several compstatin analogs, thus complementing previous experimental studies. We perform molecular dynamics simulations involving six analogs alone in solution and two complexes with compstatin bound to complement component 3. These simulations reveal that all the analogs we consider, except the original compstatin, naturally adopt a pre-bound conformation in solution. Interestingly, this set of analogs adopting a pre-bound conformation includes analogs that were not known to benefit from this behavior. We also show that the most recent compstatin analog (among those we consider) forms a stronger hydrogen bond network with its complement receptor than an earlier analog.

RevDate: 2020-08-13

Ahmed MH (2020)

Black and Minority Ethnic (BAME) Alliance Against COVID-19: One Step Forward.

Journal of racial and ethnic health disparities pii:10.1007/s40615-020-00837-0 [Epub ahead of print].

During the COVID-19 pandemic, the data of Department of Health in United Kingdom (UK) showed an increase mortality and morbidity among the Black and Minority Ethnic (BAME) population. This high mortality can be due to social factors, genetic and immunological factors. Metabolic factors like high prevalence of diabetes, obesity, metabolic syndrome and hypertension were also found to contribute to the increased risk of COVID-19 infection in BAME population. In addition, a large number of BAME population are working in jobs that involve regular and daily contact with public, and this may increase risk of encountering COVID-19 infection. Therefore, future research should address all these factors and generate the correct health policy that will allow us to combat the danger of COVID-19. We recommend the establishment of BAME alliance against COVID-19 in order to improve occupational risks and hazards, adequate income protection, culturally and linguistically appropriate public health communications and decreasing barriers in accessing healthcare. The BAME alliance will initially focus on (i) development of central system to record data about COVID-19 patients from BAME population (ii) involvement of healthcare professionals and researchers from ethnic minorities and (iii) multidisciplinary and inter-institution collaboration; for example, civil engineers and architects need to think about house design and ventilation that decrease risk of COVID-19 especially in BAME populations.

RevDate: 2020-08-13

Belmin J, Um-Din N, Donadio C, et al (2020)

Coronavirus Disease 2019 Outcomes in French Nursing Homes That Implemented Staff Confinement With Residents.

JAMA network open, 3(8):e2017533 pii:2769241.

Importance: Coronavirus disease 2019 (COVID-19) is a major threat to nursing homes. During the COVID-19 pandemic wave that hit France in March and April 2020, staff members of some French nursing homes decided to confine themselves with their residents on a voluntary basis to reduce the risk of entry of the severe acute respiratory syndrome coronavirus 2 into the facility.

Objective: To investigate COVID-19-related outcomes in French nursing homes that implemented voluntary staff confinement with residents.

This retrospective cohort study was conducted in French nursing homes from March 1 to May 11, 2020. Participants included residents and staff members of the nursing homes where staff participated in voluntary self-confinement as well as those of the facilities for elderly people where staff did not practice self-confinement. Rates of COVID-19 cases and mortality in the cohort of nursing homes with self confinement were compared with those derived from a population-based survey of nursing homes conducted by French health authorities.

Exposures: Nursing homes with staff who self-confined were identified from the media and included if the confinement period of staff with residents was longer than 7 days.

Main Outcomes and Measures: Mortality related to COVID-19 among residents and COVID-19 cases among residents and staff members. COVID-19 was diagnosed by primary care or hospital physicians on the basis of fever and respiratory signs (eg, cough, dyspnea) or a clinical illness compatible with COVID-19; COVID-19 diagnoses were considered confirmed if real-time reverse transcriptase-polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 on nasopharyngeal swab was positive and considered possible if the test had not been performed or results were negative. Cases of COVID-19 were recorded by a telephone interview with the directors of nursing homes with staff who self-confined and by a nationwide declaration survey to health authorities for all facilities.

Results: This study included 17 nursing homes in which 794 staff members confined themselves to the facility with their 1250 residents. The national survey included 9513 facilities with 385 290 staff members and 695 060 residents. Only 1 nursing home with staff who self-confined (5.8%) had cases of COVID-19 among residents, compared with 4599 facilities in the national survey (48.3%) (P < .001). Five residents (0.4%) in the nursing homes with staff who self-confined had confirmed COVID-19, compared with 30 569 residents (4.4%) with confirmed COVID-19 in the national survey (P < .001); no residents of facilities with self-confinement had possible COVID-19, compared with 31 799 residents (4.6%) with possible COVID-19 in the national survey (P < .001). Five residents (0.4%) in the nursing homes with staff who self-confined died of COVID-19, compared with 12 516 (1.8%) in the national survey (odds ratio, 0.22; 95% CI, 0.09-0.53; P < .001). Twelve staff members (1.6%) from the facilties with self-confinement had confirmed or possible COVID-19, compared with 29 463 staff members (7.6%) in the national survey (P < .001).

Conclusions and Relevance: In this cohort study of French nursing homes during the COVID-19 pandemic, mortality rates related to COVID-19 were lower among nursing homes that implemented staff confinement with residents compared with those in a national survey. These findings suggest that self-confinement of staff members with residents may help protect nursing home residents from mortality related to COVID-19 and residents and staff from COVID-19 infection.

RevDate: 2020-08-13

van de Veerdonk FL, Kouijzer IJE, de Nooijer AH, et al (2020)

Outcomes Associated With Use of a Kinin B2 Receptor Antagonist Among Patients With COVID-19.

JAMA network open, 3(8):e2017708 pii:2769237.

RevDate: 2020-08-13

Faust JS, Lin Z, C Del Rio (2020)

Comparison of Estimated Excess Deaths in New York City During the COVID-19 and 1918 Influenza Pandemics.

JAMA network open, 3(8):e2017527 pii:2769236.

RevDate: 2020-08-13

Balogun OD, Bea VJ, E Phillips (2020)

Disparities in Cancer Outcomes Due to COVID-19-A Tale of 2 Cities.

JAMA oncology pii:2769306 [Epub ahead of print].

RevDate: 2020-08-13

Xia S, Duan K, Zhang Y, et al (2020)

Effect of an Inactivated Vaccine Against SARS-CoV-2 on Safety and Immunogenicity Outcomes: Interim Analysis of 2 Randomized Clinical Trials.

JAMA pii:2769612 [Epub ahead of print].

Importance: A vaccine against coronavirus disease 2019 (COVID-19) is urgently needed.

Objective: To evaluate the safety and immunogenicity of an investigational inactivated whole-virus COVID-19 vaccine in China.

Interventions: In the phase 1 trial, 96 participants were assigned to 1 of the 3 dose groups (2.5, 5, and 10 μg/dose) and an aluminum hydroxide (alum) adjuvant-only group (n = 24 in each group), and received 3 intramuscular injections at days 0, 28, and 56. In the phase 2 trial, 224 adults were randomized to 5 μg/dose in 2 schedule groups (injections on days 0 and 14 [n = 84] vs alum only [n = 28], and days 0 and 21 [n = 84] vs alum only [n = 28]).

Interim analysis of ongoing randomized, double-blind, placebo-controlled, phase 1 and 2 clinical trials to assess an inactivated COVID-19 vaccine. The trials were conducted in Henan Province, China, among 96 (phase 1) and 224 (phase 2) healthy adults aged between 18 and 59 years. Study enrollment began on April 12, 2020. The interim analysis was conducted on June 16, 2020, and updated on July 27, 2020.

Main Outcomes and Measures: The primary safety outcome was the combined adverse reactions 7 days after each injection, and the primary immunogenicity outcome was neutralizing antibody response 14 days after the whole-course vaccination, which was measured by a 50% plaque reduction neutralization test against live severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Results: Among 320 patients who were randomized (mean age, 42.8 years; 200 women [62.5%]), all completed the trial up to 28 days after the whole-course vaccination. The 7-day adverse reactions occurred in 3 (12.5%), 5 (20.8%), 4 (16.7%), and 6 (25.0%) patients in the alum only, low-dose, medium-dose, and high-dose groups, respectively, in the phase 1 trial; and in 5 (6.0%) and 4 (14.3%) patients who received injections on days 0 and 14 for vaccine and alum only, and 16 (19.0%) and 5 (17.9%) patients who received injections on days 0 and 21 for vaccine and alum only, respectively, in the phase 2 trial. The most common adverse reaction was injection site pain, followed by fever, which were mild and self-limiting; no serious adverse reactions were noted. The geometric mean titers of neutralizing antibodies in the low-, medium-, and high-dose groups at day 14 after 3 injections were 316 (95% CI, 218-457), 206 (95% CI, 123-343), and 297 (95% CI, 208-424), respectively, in the phase 1 trial, and were 121 (95% CI, 95-154) and 247 (95% CI, 176-345) at day 14 after 2 injections in participants receiving vaccine on days 0 and 14 and on days 0 and 21, respectively, in the phase 2 trial. There were no detectable antibody responses in all alum-only groups.

Conclusions and Relevance: In this interim report of the phase 1 and phase 2 trials of an inactivated COVID-19 vaccine, patients had a low rate of adverse reactions and demonstrated immunogenicity; the study is ongoing. Efficacy and longer-term adverse event assessment will require phase 3 trials.

Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000031809.

RevDate: 2020-08-13

Jaklevic MC (2020)

Researchers Strive to Recruit Hard-Hit Minorities Into COVID-19 Vaccine Trials.

JAMA pii:2769611 [Epub ahead of print].

RevDate: 2020-08-13

Mulligan MJ (2020)

An Inactivated Virus Candidate Vaccine to Prevent COVID-19.

JAMA pii:2769609 [Epub ahead of print].

RevDate: 2020-08-13

Vahidy FS, Drews AL, Masud FN, et al (2020)

Characteristics and Outcomes of COVID-19 Patients During Initial Peak and Resurgence in the Houston Metropolitan Area.

JAMA pii:2769610 [Epub ahead of print].

RevDate: 2020-08-13

Dee EC, Mahal BA, Arega MA, et al (2020)

Relative Timing of Radiotherapy and Androgen Deprivation for Prostate Cancer and Implications for Treatment During the COVID-19 Pandemic.

JAMA oncology pii:2769299 [Epub ahead of print].

RevDate: 2020-08-13

Jones RT, Guest C, Lindsay SW, et al (2020)

Could bio-detection dogs be used to limit the spread of COVID-19 by travellers?.

Journal of travel medicine pii:5891691 [Epub ahead of print].

RevDate: 2020-08-13

Liew JW, Bhana S, Costello W, et al (2020)

The COVID-19 Global Rheumatology Alliance: evaluating the rapid design and implementation of an international registry against best practice.

Rheumatology (Oxford, England) pii:5891910 [Epub ahead of print].

OBJECTIVES: As the coronavirus disease 2019 pandemic developed there was a paucity of data relevant to people living with rheumatic disease. This led to the development of a global, online registry to meet these information needs. This manuscript provides a detailed description of the coronavirus disease 2019 Global Rheumatology Alliance registry development, governance structure, and data collection, and insights into new ways of rapidly establishing global research collaborations to meet urgent research needs.

METHODS: We use previously published recommendations for best practices for registry implementation and describe the development of the Global Rheumatology Alliance registry in terms of these steps. We identify how and why these steps were adapted or modified. In Phase 1 of registry development, the purpose of the registry and key stakeholders were identified on online platforms, Twitter and Slack. Phase 2 consisted of protocol and data collection form development, team building and the implementation of governance and policies.

RESULTS: All key steps of the registry development best practices framework were met, though with the need for adaptation in some areas. Outputs of the registry, two months after initial conception, are also described.

CONCLUSION: The Global Rheumatology Alliance registry will provide highly useful, timely data to inform clinical care and identify further research priorities for people with rheumatic disease with coronavirus disease 2019. The formation of an international team, easily able to function in online environments and resulting in rapid deployment of a registry is a model that can be adapted for other disease states and future global collaborations.

RevDate: 2020-08-13

Almaghlouth I, Islam T, Alamro N, et al (2020)

Mapping COVID-19 related research from Saudi Arabia, a scoping review. Between reality and dreams.

Saudi medical journal, 41(8):791-801.

OBJECTIVES: To map research production by Saudi-affiliated investigators in order to identify areas of strength and weakness. Method: We followed the Arksey and O'Malley (2005) framework. Medline and Cochrane databases were searched with a focus on identifying articles related to COVID-19 and Saudi Arabia following the PRISMA protocol. The study was conducted at King Saud University, Riyadh, Saudi Arabia between March and May 2020. Results: A total of 53 articles were ultimately included. Most of the research production from Saudi Arabia was opinion and narrative reviews related to the clinicopathological features of COVID-19 as well as control and prevention of virus spread. Conclusion: The results of this scoping review identify a relative deficiency in original research, which requires further investigation.

RevDate: 2020-08-13

Borno HT, Zhang S, S Gomez (2020)

COVID-19 disparities: An urgent call for race reporting and representation in clinical research.

Contemporary clinical trials communications, 19:100630 pii:100630.

Background: Racial/ethnic disparities in disease burden have gained the spotlight in the United States with the spread of SARS-CoV-2 and surge of COVID-19 cases. The problem of underrepresentation in clinical research persists today. In light of the considerable COVID-19 disparities observed, this study sought to assess the race reporting and representation among COVID-19 therapeutic studies published to date.

Methods: All published COVID-19 treatment-related clinical research studies with study participants in the United States were identified. For each study, the date published, treatment investigated, study design, race/ethnicity of participants, sample size and study site were recorded. For each study site, the race/ethnicity demographics of confirmed COVID-19 positive cases were identified utilizing online publicly available department of public health data.

Results: Six studies (n = 3, observational; n = 3, randomized clinical trial) have been published to date with participants in the United States. A subset (n = 4) reported race/ethnicity data in the publication. Black patients were underrepresented in all studies relative to the affected population in the cities in which the studies took place.

Conclusions: Given that racial/ethnic disparities in COVID-19 disease burden and outcomes have emerged in the United States, it is essential that all investigators uniformly report race/ethnicity data as well as attempt, in earnest, to obtain representativeness among study participants in order to ensure that we do not develop a further widening of the treatment gap during this pandemic.

RevDate: 2020-08-13

Singer BD (2020)

COVID-19 and the next influenza season.

Science advances, 6(31):eabd0086 pii:abd0086.

RevDate: 2020-08-13

Wayne DB, Green M, EG Neilson (2020)

Medical education in the time of COVID-19.

Science advances, 6(31):eabc7110 pii:abc7110.

RevDate: 2020-08-13

Vitali M, Bettinelli G, Salvato D, et al (2020)

Pseudoparalytic shoulder in a CoViD-19-positive patient treated with CPAP: A case report.

Trauma case reports, 29:100336 pii:100336.

The Authors report a case of a 46 years old man affected by severe acute respiratory syndrome caused by Novel Coronavirus 2019 and admitted to our hospital. The patient required continuous positive airway pressure therapy (CPAP) in the hospital ward and subsequently orotracheal intubation while in intensive care unit. The patient laid in lateral decubitus position for several hours every day while receiving CPAP therapy. During the hospitalization, he reported limitation of range of motion of the left upper limb, without any history of acute or previous trauma. The clinical appearance of the arm was suggestive of pseudoparalytic shoulder. This case emphasizes the importance of proper body positioning during invasive and non-invasive mechanical ventilation in order to prevent peripheral nerve compression and further disability.

RevDate: 2020-08-13

Haider AS, S Al-Salman (2020)

Dataset of Jordanian university students' psychological health impacted by using e-learning tools during COVID-19.

Data in brief, 32:106104 pii:106104.

A dataset was compiled to examine the psychosomatic impact of COVID-19's e-learning digital tools on Jordanian university students' well-being. In response to the state of emergency imposed by COVID-19, Jordanian universities switched to the online learning model as an alternative to traditional face-to-face education. The researchers designed a questionnaire that consists of two main sections; the first section included demographic information including gender, level/year, age, and cumulative average (GPA). The second section comprised five main constructs: (1) use of digital tools (mobile phone, laptop, i-pad) before and after COVID-19, (2) sleeping habits before and after COVID-19, (3) social interaction, (4) psychological state, and (5) academic performance. The researchers contacted different instructors teaching compulsory courses at four public and private universities and asked them to distribute the electronic questionnaire. Using the snowball sampling method, the questionnaire was delivered to students studying at the selected universities, and a total of 775 responses were received. The data were analyzed according to Likert's five-point scale, where frequencies and percentages were calculated. The data will be useful for researchers interested in studying the relationship between the e-learning model and psychosomatic disorders. Policymakers can use the data to identify university students' emotional and psychological needs and propose practical solutions for their educational well-being.

RevDate: 2020-08-13

Ejaz W, M Ittefaq (2020)

Data for understanding trust in varied information sources, use of news media, and perception of misinformation regarding COVID-19 in Pakistan.

Data in brief, 32:106091 pii:106091.

The current data from 537 Pakistani millennials tell us about their trust in different information sources, the use of news media, and the perception of misinformation regarding COVID-19 in Pakistan. The dataset includes variables such as age, marital status, gender, social class, residential area, trust in the source of information, use of news media for coronavirus information, and perception of misinformation regarding COVID-19 in Pakistan. We fielded a survey from April 24 to May 12, 2020, via Qualtrics to obtain a convenient sample of younger and older adults in Pakistan. During this time, the number of new cases increased from 12,733 to 34,336. The surge took place despite the country being under a strict nationwide lockdown with the government relentlessly seeking the support of its policies from the people. This data may help scholars to understand how people of Pakistan interacted with different information sources, in comparison with other countries.

RevDate: 2020-08-13

Marfak A, Achak D, Azizi A, et al (2020)

The hidden Markov chain modelling of the COVID-19 spreading using Moroccan dataset.

Data in brief, 32:106067 pii:106067.

The World Health Organization (WHO) declared in March 12, 2020 the COVID-19 disease as pandemic. In Morocco, the first local transmission case was detected in March 13. The number of confirmed cases has gradually increased to reach 15,194 on July 10, 2020. To predict the COVID-19 evolution, statistical and mathematical models such as generalized logistic growth model [1], exponential model [2], segmented Poisson model [3], Susceptible-Infected-Recovered derivative models [4] and ARIMA [5] have been proposed and used. Herein, we proposed the use of the Hidden Markov Chain, which is a statistical system modelling transitions from one state (confirmed cases, recovered, active or death) to another according to a transition probability matrix to forecast the evolution of COVID-19 in Morocco from March 14, to October 5, 2020. In our knowledge the Hidden Markov Chain was not yet applied to the COVID-19 spreading. Forecasts for the cumulative number of confirmed, recovered, active and death cases can help the Moroccan authorities to set up adequate protocols for managing the post-confinement due to COVID-19. We provided both the recorded and forecasted data matrices of the cumulative number of the confirmed, recovered and active cases through the range of the studied dates.

RevDate: 2020-08-13

Malik J, Javed N, Naeem H, et al (2020)

COVID-19 Associated Pneumonia and Pleural Effusion Masquerading as Heart Failure in Rheumatic Heart Disease.

European journal of case reports in internal medicine, 7(8):001842 pii:1842-1-15031-1-10-20200710.

The ongoing outbreak of coronavirus disease 2019 (COVID-19) that began in Wuhan, China, became an international emergency when thousands of people were infected around the world. COVID-19 emerged in Pakistan in April 2020, precipitating a nationwide lockdown. While some countries are now recovering from the pandemic, its peak is not estimated to occur in Pakistan until August 2020. We present a case of rheumatic heart disease with fever, myalgia and an unusual radiological finding of the virus.

LEARNING POINTS: Unusual radiological findings are being seen in COVID-19 patients.Pleural effusion in a mildly symptomatic patient is a rare presentation of the disease.Early aggressive treatment can produce dramatic improvement in COVID-19 pneumonia.

RevDate: 2020-08-13

Balata D, Mellergård J, Ekqvist D, et al (2020)

Non-Bacterial Thrombotic Endocarditis: A Presentation of COVID-19.

European journal of case reports in internal medicine, 7(8):001811 pii:1811-1-15256-1-10-20200720.

The SARS-CoV-2 virus is a newly emergent pathogen first identified in Wuhan, China, and responsible for the COVID-19 global pandemic. In this case report we describe a manifestation of non-bacterial thrombotic endocarditis with continuous peripheral embolization in a COVID-19-positive patient. The patient responded well to high-dose LMWH treatment with cessation of the embolic process.

LEARNING POINTS: Raising awareness of possible complications of COVID-19.To highlight the importance of the careful consideration of and dosage of anticoagulation in non-bacterial thrombotic endocarditis.

RevDate: 2020-08-13

Giugno V, Di Marzio G, Domanico A, et al (2020)

Lung Ultrasound (LUS) in COVID-19 Pneumonia: Usefulness in Two Atypical Cases.

European journal of case reports in internal medicine, 7(8):001800 pii:1800-1-14651-1-10-20200625.

Clinical experience and scientific articles have shown that patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be paucisymptomatic or asymptomatic at the time of diagnosis. In this paper, we will discuss two paucisymptomatic patients with blood tests suggestive for SARS-CoV-2 infection but with repeated negative nasopharyngeal swabs and without typical features of COVID-19 pneumonia on chest high-resolution computed tomography. In these cases, lung ultrasound helped to raise clinical suspicion of COVID-19 pneumonia and facilitate diagnosis.

LEARNING POINTS: During the current COVID-19 pandemic, lung ultrasound (LUS) is being used extensively to evaluate and monitor lung damage in infected patients.Several patients have been described with negative PCR swabs who tested positive for SARS-CoV-2 in bronchoalveolar lavage fluid.Typical signs of interstitial pneumonia on LUS strongly indicate COVID-19 pneumonia, thus suggesting further investigation and invasive tests to confirm the diagnosis.

RevDate: 2020-08-13

Lam G, McCarthy R, R Haider (2020)

A Peculiar Case of Priapism: The Hypercoagulable State in Patients with Severe COVID-19 Infection.

European journal of case reports in internal medicine, 7(8):001779 pii:1779-1-15061-1-10-20200712.

It is increasingly recognised that patients with severe COVID-19 infection have a significant risk of thromboembolic events. We describe a patient who rapidly deteriorated due to severe infection with COVID-19, and developed priapism in the last days of his life. We believe development of priapism may be associated with a prothrombotic state secondary to COVID-19 infection. This case report supports the widely reported increased incidence of thrombosis in patients with severe COVID-19 infection.

LEARNING POINTS: Prophylactic doses of anticoagulation may not be sufficient in patients with severe COVID-19 infection, but clinical trials of therapeutic dose anticoagulation are underway.Physicians should be vigilant and have a high suspicion for thrombosis in all patients with COVID-19 infection, even those who are anticoagulated.Presentations of thromboembolism and microemboli may be atypical.

RevDate: 2020-08-13

Chang YS (2020)

COVID-19 and allergy.

Asia Pacific allergy, 10(3):e34.

RevDate: 2020-08-13

Park S, Hahm DH, Joo M, et al (2020)

The role of Korean Medicine in the post-COVID-19 era: an online panel discussion part 2 - basic research and education.

Integrative medicine research, 9(3):100488.

Background: Experiencing difficulties and challenges though COVID-19 pandemic, there are voices that it needs to be discussed to seek direction of basic research and college education of Korean Medicine (KM) so that KM community can play a significant role in the future infectious disease outbreaks.

Methods: This paper summarizes the edited highlights of an online video meeting by Google meet on May 19, 2020, organized by the Korean Medicine Convergence Research Information Center. Five researchers specialized in immunology, microbiology, virology, preventive medicine, and herbology, respectively, presented what KM community should prepare for the future acute infectious disease outbreaks by learning from the previous research on antiviral effect of herbs for coronavirus and the experiences of the present COVID-19 pandemic.

Results: There are a lot of herbs or natural products with potential anti-coronavirus effects reported from in vitro experiments and despite criticism, many clinical trials on traditional herbal medicine for COVID-19 are being conducted. In addition to establishing research evidence, KM community should train and produce public health professionals among Korean Medicine Doctors (KMDs) and official participation in public healthcare system should be ensured in terms of regulation and policy. Newly developed KM treatments can be interpreted by the KM theories and also should be allowed by regulations for KMDs to utilize them.

Conclusion: The present online discussion suggested directions of basic research for acute viral infections diseases utilizing KM and how to enforce relevant education and regulations in the post-COVID-19 era.

RevDate: 2020-08-13

Molavi Vardanjani H, Heydari ST, Dowran B, et al (2020)

A cross-sectional study of Persian medicine and the COVID-19 pandemic in Iran: Rumors and recommendations.

Integrative medicine research, 9(3):100482.

Background: Traditional medicine structures such as Persian medicine (PM) are deeply rooted in the global health system. These modalities, if applied correctly, could help health systems overcome situations such as the coronavirus disease 2019 (COVID-19) pandemic. However, the mismanagement of such traditional structures results in fear, stress, anxiety, and risky behavior among society. The current study aimed to assess the penetration of the recommendations and rumors related to PM during the COVID-19 pandemic and the relationships of these recommendations and rumors with related health factors.

Methods: In a cross-sectional study performed in March 2020 (during the COVID-19 pandemic) in southern Iran, eligible participants were randomly selected. The participants completed a 29-item online questionnaire assessing different aspects of the rumors and recommendations pertaining to PM linked with the COVID-19 pandemic.

Results: In total, 523 participants took part in the survey. The mean fear score was 65.2/100. Approximately 99% of the study population had heard at least one of the rumors/recommendations of PM related to COVID-19. The average scores of disagreement with the rumors and recommendations linked to PM were 16.4/50 and 18.4/35, respectively. The fear score and the level of disagreement with the rumors were significantly related (p = 0.024).

Conclusions: The use of PM might be beneficial in the management of the COVID-19 pandemic provided that a revolution occurs in data sharing. Various approaches should be considered in the management of traditional medicine modalities such as PM during disease outbreaks to help overcome the current dilemma.

RevDate: 2020-08-13

Ruttens D, Van Kerrebroeck M, Vandewalle J, et al (2020)

Fever and an abnormal chest X-ray during the COVID-19 pandemic.

Respiratory medicine case reports, 31:101167 pii:101167.

During the COVID-19 pandemic, a 56-year-old man presented at our emergency department with fever and shortness of breath; Diffuse pulmonary nodular vascular spread lesions were found. Detailed history taking showed a four-week history of fever and night sweats. The man had been under treatment for 2 years with Adalimumab, a tumor-necrosis-factor (TNF) inhibitor, for ulcerative colitis. Before start, screening by tuberculin skin test was negative. Cultures en PCR on BAL and urine were positive for mycobacterium tuberculosis also ocular findings were present. The diagnosis of military tuberculosis was made.

RevDate: 2020-08-13

Elshereye A, B Erdinc (2020)

Multiple Lacunar Cerebral Infarcts as the Initial Presentation of COVID-19.

Cureus, 12(8):e9638.

Coronavirus Disease-19 (COVID-19) is a novel corona virus that started as an outbreak in the Hubei province of China in December 2019 and later became a pandemic affecting every continent on the planet. Patients with severe COVID-19 tend to develop acute thrombotic complications including myocardial infarction, pulmonary embolism, and ischemic stroke. We describe a case of a 75-year-old-female who presented with acute onset slurred speech and right sided facial droop. She was diagnosed with COVID-19 with acute ischemic stroke as the initial presentation. Stroke as the initial presentation of COVID-19 is rare and has not been described in the literature frequently. The purpose of this report is to raise awareness about this potential complication of COVID-19 as an initial presentation.

RevDate: 2020-08-13

Patel J, Patel R, Rodriguez LM, et al (2020)

Cardiovascular Considerations of Experimental Hydroxychloroquine Therapy on Patients Diagnosed With COVID-19: A Case Series Review.

Cureus, 12(7):e9151.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and its high virulence along with its variable presentation have generated a significant amount of interest within the medical community. The heterogeneous nature of the symptoms of the disease caused by SARS-CoV-2, coronavirus disease 2019 (COVID-19), ranging from being asymptomatic to severe acute respiratory distress syndrome (ARDS), has created significant interest in potential therapeutics. Given the lack of randomized controlled trials, most medications are experimental, and only anecdotal evidence is available so far regarding their efficacy. One medication that emerged as an early frontrunner as a promising therapeutic was hydroxychloroquine (HCQ), a common antimalarial and lupus drug. The adverse side effects that could result from its use did not gain much attention initially. We present the cases of two COVID-19-positive patients treated with HCQ at our institution, which showed adverse effects of the medication. While HCQ may have some therapeutic effect, it should be borne in mind that patients may experience more harm than benefit from its use.

LOAD NEXT 100 CITATIONS