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159,400 | A critical analysis of corona related data: What the more reliable data can imply for Western-Europe | We present a less common type of discussion about COVID-19 data, beginning with the observation that the number of people reported deceased following COVID-19 infection is currently the most reliable dataset to be used. When the available real-life data are visualized for a number of European countries, they reveal the commonly seen exponential increase, though with different absolute rates, and over time different periods. More interesting information is obtained upon inspection of the daily increments in deaths. These curves look very similar to those for China, and seem to indicate that in European countries that have imposed more strict human-human contact measures, in particular Italy and Spain, where we have seen a decrease in daily deaths since early April, it is to be expected it will take 40-50 days from the end of March until this number has fallen to negligible levels. Taking the initial increase in the number of deaths for Germany, and combining this with typical values for the mortality reported in the literature and the published number of daily contacts for the working population, we calculated an initial increase in infections of 20 per day by a single infected person with an average human-human contact number of 22, decreasing to 5.5 after the first 10 days. The high number at the outset is likely related to outbreaks in a high local concentration of people. |
159,401 | Myeloid-derived suppressor cells in obstetrical and gynecological diseases | Myeloid-derived suppressor cells (MDSCs) are a heterogeneous group of myeloid-origin cells which have immunosuppressive activities in several conditions, such as cancer and inflammation. Recent research has also associated MDSCs with numerous obstetrical and gynecological diseases. During pregnancy, MDSCs accumulate to ensure maternal-fetal immune tolerance, whereas they are decreased in patients who suffer from early miscarriage or preeclampsia. While the etiology of endometriosis is still unknown, abnormal accumulation of MDSCs in the peripheral blood and peritoneal fluid, alongside an increased level of reactive oxygen species (ROS) has been observed in these patients, which is central to the cellular immune regulations by MDSCs. Additionally, the regulation of MDSCs observed in tumors is also applicable to gynecologic neoplasms, including ovarian cancer and cervical cancer. More recently, emerging evidence has shown that there are high levels of MDSCs in premature ovarian failure (POF) and in vitro fertilization (IVF), but the underlying mechanisms are unknown. In this review, the generation and mechanisms of MDSCs are summarized. In particular the modulation of these cells in immune-related obstetrical and gynecological diseases is discussed, including potential treatment options targeting MDSCs. |
159,402 | Meaning at the end of meaning: Nihilism, great nonsense, and praxis in the shadow of extinction | I suggest in this essay that the responses to the coronavirus pandemic by the North Atlantic elite ought to be accounted in part to the circulation of nihilism as a struc-ture of feeling under late capitalism I then pose the question, how ought we think of meaning and meaning making under the shadow of ongoing extinction? © 2020 Penn State University Press All rights reserved |
159,403 | Reflexiones sobre los riesgos ocupacionales en trabajadores de salud en tiempos pandémicos por COVID-19/ Reflections on occupational risks in health workers in pandemic times by COVID-19 | Introducción: En las prácticas laborales de los trabajadores de la salud, los riesgos laborales se desarrollan principalmente en el entorno hospitalario, y estos profesionales están expuestos habitualmente a múltiples riesgos. Objetivo: Reflexionar sobre los riesgos laborales que involucran a los trabajadores de la salud en la pandemia del nuevo coronavirus (COVID-19). Métodos: Es un ensayo cualitativo teórico-reflexivo, basado en literatura nacional e internacional. La búsqueda de estudios fue posible debido a la elección de descriptores controlados: "Riesgos laborales", "Personal de salud", "Infecciones por coronavirus", "Coronavirus", y extensas bases de datos latinoamericanas e internacionales. Se han incluido las producciones publicadas en los últimos cinco años. Resultados: El escenario de la pandemia de COVID-19 causa incertidumbres a los trabajadores de la salud que trabajan en la primera línea para hacer frente al virus. Las características epidemiológicas del nuevo coronavirus y cómo actúa a largo plazo no se conocen por completo. Por lo tanto, los riesgos laborales en los que están involucrados los trabajadores se han exacerbado a veces, en vista del nivel de infectividad que tiene el virus, además de sus consecuencias para la salud física y mental de toda la sociedad. Conclusiones: Es esencial conocer y controlar los riesgos a los que están expuestos los trabajadores de la salud y, por lo tanto, establecer estrategias de prevención y minimización de enfermedades.(AU) |
159,404 | Emerging evidence for neuropsycho-consequences of COVID-19 | The pandemic novel coronavirus disease (COVID-19) has become a global concern in which respiratory system is not the only one involved. Previous researches have presented the common clinical manifestations including respiratory symptoms (i.e., fever and cough), fatigue and myalgia. However, there is limited evidence for neurological and psychological influences by SARS-CoV-2. In this review, we discuss the common neurological manifestations of COVID-19 including acute cerebrovascular disease (i.e., cerebral hemorrhage) and muscle ache. Possible viral transmission to the nervous system may occur via circulation, an upper nasal transcribrial route and/or conjunctival route. Also, we cannot ignore the psychological influence on the public, medical staff and confirmed patients. Dealing with public psychological barriers and performing psychological crisis intervention are an important part of public health interventions. |
159,405 | Emerging evidence for neuropsycho-consequences of COVID-19 | The pandemic novel coronavirus disease (COVID-19) has become a global concern in which respiratory system is not the only one involved. Previous researches have presented the common clinical manifestations including respiratory symptoms (i.e., fever and cough), fatigue and myalgia. However, there is limited evidence for neurological and psychological influences by SARS-CoV-2. In this review, we discuss the common neurological manifestations of COVID-19 including acute cerebrovascular disease (i.e., cerebral hemorrhage) and muscle ache. Possible viral transmission to the nervous system may occur via circulation, an upper nasal transcribrial route and/or conjunctival route. Also, we cannot ignore the psychological influence on the public, medical staff and confirmed patients. Dealing with public psychological barriers and performing psychological crisis intervention are an important part of public health interventions. |
159,406 | Ticking bomb: Prolonged faecal shedding of novel coronavirus (2019-nCoV) and environmental implications | The current global coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a tremendous public health challenge globally While the respiratory transmission of SARS-CoV-2 has been established, evolving reports on the impact of the gastrointestinal system and the prolonged faecal shedding of SARS-CoV-2 show the likelihood of faecally mediated transmission The increasing evidential presence of SARS-CoV-2 in wastewater and faecal material poses a significant public health threat which may potentiate global vulnerability to high risk of human exposure through environmental drivers especially in less developed countries While extensively exploring the likelihood of faecally mediated SARS-CoV-2 transmission, infection control and prevention measures aimed at mitigating this pandemic should holistically include environmental drivers |
159,407 | The CoviD-19 crisis: An opportunity to integrate food democracy into post-pandemic food systems | The world economy is sliding yet into another recession (having arguably barely recovered from the previous economic downturn) due to the worldwide pressures and tensions created by the COVID-19 pandemic. 1With most countries in the world under lockdown (or in similar situations), almost all food is now consumed in the household. Arguably, agricultural producers and the retail industry appear to be the best placed to weather the storm in order to respond to such a change in demand. However, this is overly simplistic. Recent news of empty shelves in supermarkets whilst dairy farmers have been forced to pour milk down the drain have gone viral. |
159,408 | COVID-19 in New Zealand and the impact of the national response: a descriptive epidemiological study | BACKGROUND: In early 2020, during the COVID-19 pandemic, New Zealand implemented graduated, risk-informed national COVID-19 suppression measures aimed at disease elimination. We investigated their impacts on the epidemiology of the first wave of COVID-19 in the country and response performance measures. METHODS: We did a descriptive epidemiological study of all laboratory-confirmed and probable cases of COVID-19 and all patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in New Zealand from Feb 2 to May 13, 2020, after which time community transmission ceased. We extracted data from the national notifiable diseases database and the national SARS-CoV-2 test results repository. Demographic features and disease outcomes, transmission patterns (source of infection, outbreaks, household transmission), time-to-event intervals, and testing coverage were described over five phases of the response, capturing different levels of non-pharmaceutical interventions. Risk factors for severe outcomes (hospitalisation or death) were examined with multivariable logistic regression and time-to-event intervals were analysed by fitting parametric distributions using maximum likelihood estimation. FINDINGS: 1503 cases were detected over the study period, including 95 (6·3%) hospital admissions and 22 (1·5%) COVID-19 deaths. The estimated case infection rate per million people per day peaked at 8·5 (95% CI 7·6-9·4) during the 10-day period of rapid response escalation, declining to 3·2 (2·8-3·7) in the start of lockdown and progressively thereafter. 1034 (69%) cases were imported or import related, tending to be younger adults, of European ethnicity, and of higher socioeconomic status. 702 (47%) cases were linked to 34 outbreaks. Severe outcomes were associated with locally acquired infection (crude odds ratio [OR] 2·32 [95% CI 1·40-3·82] compared with imported), older age (adjusted OR ranging from 2·72 [1·40-5·30] for 50-64 year olds to 8·25 [2·59-26·31] for people aged ≥80 years compared with 20-34 year olds), aged residential care residency (adjusted OR 3·86 [1·59-9·35]), and Pacific peoples (adjusted OR 2·76 [1·14-6·68]) and Asian (2·15 [1·10-4·20]) ethnicities relative to European or other. Times from illness onset to notification and isolation progressively decreased and testing increased over the study period, with few disparities and increasing coverage of females, Maori, Pacific peoples, and lower socioeconomic groups. INTERPRETATION: New Zealand's response resulted in low relative burden of disease, low levels of population disease disparities, and the initial achievement of COVID-19 elimination. FUNDING: Ministry of Business Innovation and Employment Strategic Scientific Investment Fund, and Ministry of Health, New Zealand. |
159,409 | Spectrum of chest computed tomographic (CT) findings in coronavirus disease-19 (COVID-19) patients in India | PURPOSE: To report the spectrum of chest computed tomographic (CT) imaging findings in coronavirus disease-19 (COVID-19) infected Indian patients. METHODS: This was a prospective descriptive study comprising 147 consecutive reverse transcriptase polymerase chain reaction (RT-PCR) positive patients who underwent CT chest. Prevalence, distribution, extent and type of abnormal lung findings were recorded. RESULTS: Among the total study cohort of 147 patients, 104 (70.7 %) were males and 43 (29.3 %) were females with mean age of 40.9⯱â¯17.2 years (range 24-71 years). We observed lung parenchymal abnormalities in 51 (34.7 %) cases whereas 96 (65.3 %) RT-PCR positive cases had a normal chest CT. Only 12.2 % of the patients were dyspneic, 6.1 % had desaturation, 7.4 % had increased respiratory rate and 10.9 % had comorbidities. Among the patients with abnormal CT findings bilateral 39/51 (76.5 %), multilobar (88.2 %) lung involvement with a predominant peripheral and posterior distribution was commonly observed. With regards to the type of opacity, ground glass opacity (GGO) was the dominant abnormality found in all 51 (100 %) cases. Pure GGO was observed in 15 (29.4 %), GGO with crazy paving pattern was seen in 15 (29.4 %) and GGO mixed with consolidation was noted in 21(41.2 %). Peri-lesional or intralesional segmental or subsegmental pulmonary vessel enlargement was observed in 36 (70.6 %) cases. CONCLUSION: In this study population predominantly with mild symptoms and few comorbidities, two-thirds of RT-PCR positive patients had a normal chest CT; whereas the remaining patients showed typical findings of predominant GGOs with a bilateral distribution and peripheral predominance. |
159,410 | PPAR-γ Is Critical for HDAC3-Mediated Control of Oligodendrocyte Progenitor Cell Proliferation and Differentiation after Focal Demyelination | Disruption of remyelination contributes to neurodegeneration and cognitive impairment in chronically disabled patients. Valproic acid (VPA) inhibits histone deacetylase (HDAC) function and probably promotes oligodendrocyte progenitor cell (OPC) proliferation and differentiation; however, the relevant molecular mechanisms remain unknown. Here, focal demyelinating lesions (FDLs) were generated in mice by two-point stereotactic injection of lysophosphatidylcholine (LPC) into the corpus callosum. Cognitive functions, sensorimotor abilities and histopathological changes were assessed for up to 28 days post-injury with or without VPA treatment. Primary OPCs were harvested and used to study the effect of VPA on OPC differentiation under inflammatory conditions. VPA dose-dependently attenuated learning and memory deficits and robustly protected white matter after FDL induction, as demonstrated by reductions in SMI-32 and increases in myelin basic protein staining. VPA also promoted OPC proliferation and differentiation and increased subsequent remyelination efficiency by day 28 post-FDL induction. VPA treatment did not affect HDAC1, HDAC2 or HDAC8 expression but reduced HDAC3 protein levels. In vitro, VPA improved the survival of mouse OPCs and promoted their differentiation into oligodendrocytes following lipopolysaccharide (LPS) stimulation. LPS caused OPCs to overexpress HDAC3, which translocated from the cytoplasm into the nucleus, where it directly interacted with the nuclear transcription factor PPAR-γ and negatively regulated PPAR-γ expression. VPA decreased the expression of HDAC3 and promoted remyelination and functional neurological recovery after FDL. These findings may support the use of strategies modulating HDAC3-mediated regulation of protein acetylation for the treatment of demyelination-related cognitive dysfunction. |
159,411 | The Risk and Impact of COVID-19 Pandemic on Immunosuppressed Patients: Cancer, HIV, and Solid Organ Transplant Recipients | Toward the end of the year 2019, there was the eruption of an acute respiratory syndrome, which is widely referred as coronavirus disease (COVID-19) from Wuhan, Hubei Province. The disease causes a range of respiratory illnesses, which are fatal. The COVID-19 disease has spread globally and has significantly impacted the health delivery systems, travel regulations, and economic activities and has posed and upsurge of responsibilities for the frontline healthcare workers. Due to the nature of the COVID-19 disease, it has typically caused complications which include pneumonia, multiple organ dysfunction together with renal failure, and acute respiratory distress syndrome. As of date, there is no approved vaccine or treatment for COVID-19 though there are ongoing research studies to formulate a treatment. COVID-19 is highly contagious, and the risk of infection is higher for patients with immunesuppressed patients than regular patients. The immunesuppressed conditions include cancer, HIV, and patients with solid organ transplants (SOT). This paper aims to review the risk and impact of COVID-19 on immunesuppressed patients, with a focus on cancer, HIV, and patients with SOT and the essence of special parameters for their care and management. Despite the fatal effects of this global pandemic, the findings of this study indicate the high risk which immunosuppressed patients have to contract the disease; thus, the governments and health delivery systems have to offer them extra support and treatment. |
159,412 | The Long Shot | The article focuses on small vaccine maker Novavax, which will receive 2 billion U S dollar from the U S government and a nonprofit organization to develop coronavirus vaccine in the U S It is one of just seven vaccine makers to win funding from Operation Warp Speed, the multiagency U S government effort aiming to manufacture quickly at least 300 million doses of COVID-19 vaccines Novavax is working to win the first approvals from regulators as it will have a huge market advantage |
159,413 | COVID-19 Waves: Importance of Accumulative Mortality per Million Inhabitants | The reported number of new cases underestimates the real spread of COVID-19 pandemic because of non-tested asymptomatic people and limited global access to reliable diagnostic tests. In this context, COVID-19 mortality with confirmed diagnosis becomes an attractive source of information to be included in the analysis of perspectives and proposals. Objective data are required to calculate the capacity of resources provided by health systems. New strategies are needed to stabilize or minimize the mortality surge. However, we will not afford this goal until more alternatives were available. We still need an effective treatment, an affordable vaccine, or a collective achievement of sufficient immunity (reaching up to 70% of the whole population). At any time, the arriving waves of the pandemic are testing the capacity of governments. The health services struggle to keep the plateau in a steady-state below 100 deaths per million inhabitants. Therefore, it is necessary to increase the alternatives and supplies based on the current and near-future expected demands imposed by the number of deaths by COVID-19. Estimating COVID-19 mortality in various scenarios with the gradual release of social constraints will help predict the magnitude of those arriving waves. |
159,414 | Common misconceptions regarding COVID-19 among health care professionals: An online global cross-sectional survey | Background: The COVID-19 pandemic has taken the world by storm, with cases continuously increasing by the hour and with a shortage of information regarding the virus available to the general public Despite the availability of trusted online sources, there are still misconceptions relating to the virus floating around This study aimed to find out the level of misconceptions among healthcare professionals (HCPs) worldwide about the ensuing COVID-19 pandemic Materials and Methods: A descriptive cross sectional study was conducted through a global online survey The self-administered questionnaire was designed and registered at an online website (Kwiksurveys) A total of 652 participants from 35 different countries across the world responded Statistical analysis was performed using SPSS version 23 Socio-demographic and discipline characteristics were compared with the help of the chi-square test and univariate and multivariate logistic regression to find significant relationships Results: Among all HCPs, general physicians (61 2%) were the most common respondents The responses from females (63 3%) almost doubled those of men, and nearly half of the participants were working in private institutes (49 2%) Additionally, the major source of information used by HCPs about COVID-19 was social media (55 4%) Regarding misconception assessment, 71 6% of participants had correct concepts regarding COVID-19 However, 28 4% had incorrect information Female HCPs were 1 49 times more likely to have correct concepts compared to males (OR=1 49, 95% CI=1 04-2 14) Conclusions: The majority of the HCPs were keeping themselves up-to-date with current information concerning the knowledge, prevention, and hygiene practices of COVID-19 infection However, some misconceptions are deeply rooted in the mindsets of HCPs worldwide and need to be addressed by the continuous professional development of HCPs The availability of reliable sources of information on the pandemic should be encouraged, with adequate explanations also available to the general public in simple terms © 2020, Universidad de Concepcion All rights reserved |
159,415 | Cost-effectiveness analysis of genetic diagnostic strategies for Lynch syndrome in Italy | Lynch syndrome (LS) is an autosomal dominant condition caused by pathogenic variants in mismatch repair (MMR) genes that predispose individuals to different malignancies, such as colorectal cancer (CRC) and endometrial cancer. Current guidelines recommended testing for LS in individuals with newly diagnosed CRC to reduce cancer morbidity and mortality in relatives. Economic evaluations in support of such approach, however, are not available in Italy. We developed a decision-analytic model to analyze the cost-effectiveness of LS screening from the perspective of the Italian National Health System. Three testing strategies: the sequencing of all MMR genes without prior tumor analysis (Strategy 1), a sequential IHC and MS-MLPA analysis (Strategy 2), and an age-targeted strategy with a revised Bethesda criteria assessment before IHC and methylation-specific MLPA for patients ≥ than 70 years old (Strategy 3) were analyzed and compared to the "no testing" strategy. Quality Adjusted Life Years (QALYs) in relatives after colonoscopy, aspirin prophylaxis and an intensive gynecological surveillance were estimated through a Markov model. Assuming a CRC incidence rate of 0.09% and a share of patients affected by LS equal to 2.81%, the number of detected pathogenic variants among CRC cases ranges, in a given year, between 910 and 1167 depending on the testing strategy employed. The testing strategies investigated, provided one-time to the entire eligible population (CRC patients), were associated with an overall cost ranging between 1,753,059.93-10,388,000.00. The incremental cost-effectiveness ratios of the Markov model ranged from 941.24 /QALY to 1,681.93 /QALY, thus supporting that "universal testing" versus "no testing" is cost-effective, but not necessarily in comparison with age-targeted strategies. This is the first economic evaluation on different testing strategies for LS in Italy. The results might support the introduction of cost-effective recommendations for LS screening in Italy. |
159,416 | Weekly updates of national living evidence-based guidelines: Methods for the Australian Living Guidelines for Care of People with COVID-19 | BACKGROUND: The Australian National COVID-19 Clinical Evidence Taskforce is a consortium of 31 Australian health professional organisations developing living, evidence-based guidelines for care of people with COVID-19 which are updated weekly This paper describes the methods used to develop and maintain the guidelines METHODS: The guidelines use GRADE methods and are designed to meet Australian NHMRC standards Each week, new evidence is reviewed, current recommendations are revised and new recommendations made These are published in MAGIC and disseminated through traditional and social media Relevant new questions to be addressed are continually sought from stakeholders and practitioners For prioritised questions, the evidence is actively monitored and updated Evidence surveillance combines horizon scans and targeted searches An Evidence Team appraises and synthesises evidence and prepares evidence-to-decision frameworks to inform development of recommendations A Guidelines Leadership Group oversees the development of recommendations by multidisciplinary Guidelines Panels and is advised by a Consumer Panel RESULTS: and Discussion: The Taskforce formed in March 2020, and the first recommendations were published two weeks later The guidelines have been revised and republished on a weekly basis for 24 weeks, and as of October 2020 contain over 90 treatment recommendations, suggesting that living methods are feasible in this context CONCLUSIONS: The Australian Guidelines for Care of People with COVID-19 provide an example of the feasibility of living guidelines, and an opportunity to test and improve living evidence methods |
159,417 | Prevention of COVID-19 infection with emphasizing on ablution | According to the World Health Organization's (WHO) recommendations, washing hands frequently with soap and water for 20 seconds is an effective way to prevent COVID-19 infection Every Muslim is obliged to perform ablution before prayers Wash your hands up to your wrists once, rinse your mouth and nose three times each, wash face from head to chin twice and hands from elbow to fingertips once, and anoint part of the head and legs However, in each complete ablution, washing is performed 10 times, and in each day, 30 times This wash cannot replace the WHO guidelines, but it can be effective in preventing COVID-19 infection |
159,418 | Early phylogenetic estimate of the effective reproduction number of SARS-CoV-2 | To reconstruct the evolutionary dynamics of the 2019 novel-coronavirus recently causing an outbreak in Wuhan, China, 52 SARS-CoV-2 genomes available on 4 February 2020 at Global Initiative on Sharing All Influenza Data were analyzed. The two models used to estimate the reproduction number (coalescent-based exponential growth and a birth-death skyline method) indicated an estimated mean evolutionary rate of 7.8 × 10-4 subs/site/year (range, 1.1 × 10-4 -15 × 10-4 ) and a mean tMRCA of the tree root of 73 days. The estimated R value was 2.6 (range, 2.1-5.1), and increased from 0.8 to 2.4 in December 2019. The estimated mean doubling time of the epidemic was between 3.6 and 4.1 days. This study proves the usefulness of phylogeny in supporting the surveillance of emerging new infections even as the epidemic is growing. |
159,419 | Early phylogenetic estimate of the effective reproduction number of SARS-CoV-2 | To reconstruct the evolutionary dynamics of the 2019 novel-coronavirus recently causing an outbreak in Wuhan, China, 52 SARS-CoV-2 genomes available on 4 February 2020 at Global Initiative on Sharing All Influenza Data were analyzed. The two models used to estimate the reproduction number (coalescent-based exponential growth and a birth-death skyline method) indicated an estimated mean evolutionary rate of 7.8 × 10-4 subs/site/year (range, 1.1 × 10-4 -15 × 10-4 ) and a mean tMRCA of the tree root of 73 days. The estimated R value was 2.6 (range, 2.1-5.1), and increased from 0.8 to 2.4 in December 2019. The estimated mean doubling time of the epidemic was between 3.6 and 4.1 days. This study proves the usefulness of phylogeny in supporting the surveillance of emerging new infections even as the epidemic is growing. |
159,420 | Development and validation of a risk factor-based system to predict short-term survival in adult hospitalized patients with COVID-19: a multicenter, retrospective, cohort study | BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a public health emergency of global concern. We aimed to explore the risk factors of 14-day and 28-day mortality and develop a model for predicting 14-day and 28-day survival probability among adult hospitalized patients with COVID-19. METHODS: In this multicenter, retrospective, cohort study, we examined 828 hospitalized patients with confirmed COVID-19 hospitalized in Wuhan Union Hospital and Central Hospital of Wuhan between January 12 and February 9, 2020. Among the 828 patients, 516 and 186 consecutive patients admitted in Wuhan Union Hospital were enrolled in the training cohort and the validation cohort, respectively. A total of 126 patients hospitalized in Central Hospital of Wuhan were enrolled in a second external validation cohort. Demographic, clinical, radiographic, and laboratory measures; treatment; proximate causes of death; and 14-day and 28-day mortality are described. Patients' data were collected by reviewing the medical records, and their 14-day and 28-day outcomes were followed up. RESULTS: Of the 828 patients, 146 deaths were recorded until May 18, 2020. In the training set, multivariate Cox regression indicated that older age, lactate dehydrogenase level over 360 U/L, neutrophil-to-lymphocyte ratio higher than 8.0, and direct bilirubin higher than 5.0 µmol/L were independent predictors of 28-day mortality. Nomogram scoring systems for predicting the 14-day and 28-day survival probability of patients with COVID-19 were developed and exhibited strong discrimination and calibration power in the two external validation cohorts (C-index, 0.878 and 0.839). CONCLUSION: Older age, high lactate dehydrogenase level, evaluated neutrophil-to-lymphocyte ratio, and high direct bilirubin level were independent predictors of 28-day mortality in adult hospitalized patients with confirmed COVID-19. The nomogram system based on the four factors revealed good discrimination and calibration, suggesting good clinical utility. |
159,421 | Longitudinal evidence for persistent anxiety in young adults through COVID-19 restrictions [version 1;peer review: awaiting peer review] | The coronavirus disease 2019 (COVID-19) pandemic and related mitigation measures are associated with poorer mental health in cross-sectional and longitudinal surveys However, it’s unclear if this represents an adaptive response to an unprecedented event that is short lived, or the beginning of longer mental health problems that persist beyond the initial outbreak of the pandemic We used data from the index generation of the Avon Longitudinal Study of Parents and Children (young people aged 26-29) to examine anxiety at the beginning of the COVID-19 pandemic (April 2020) and again once restrictions were eased (June 2020) We compared these to two pre-pandemic assessments of anxiety measured 2013/2014 and 2015/17 We found that the percentage of individuals with anxiety was almost double during the COVID-19 assessments compared to pre-pandemic levels, with 15% of individuals having anxiety at both occasions (persistent anxiety) Being female, those with per-existing mental health conditions, a history of financial problems and those who had reported difficulties accessing mental health information were at greater risk of persistent anxiety Our findings suggest that anxiety in response to COVID-19 is not just an initial reaction but potentially the start of a persistent problem that extends beyond the pandemic Efforts must be made to address risk groups who could be disproportionally affected as a result of the COVID-19 pandemic and related mitigation measures |
159,422 | Post-COVID-19 Action: Guarding Africa's Crops against Viral Epidemics Requires Research Capacity Building That Unifies a Trio of Transdisciplinary Interventions | The COVID-19 pandemic has shown that understanding the genomics of a virus, diagnostics and breaking virus transmission is essential in managing viral pandemics. The same lessons can apply for plant viruses. There are plant viruses that have severely disrupted crop production in multiple countries, as recently seen with maize lethal necrosis disease in eastern and southern Africa. High-throughput sequencing (HTS) is needed to detect new viral threats. Equally important is building local capacity to develop the tools required for rapid diagnosis of plant viruses. Most plant viruses are insect-vectored, hence, biological insights on virus transmission are vital in modelling disease spread. Research in Africa in these three areas is in its infancy and disjointed. Despite intense interest, uptake of HTS by African researchers is hampered by infrastructural gaps. The use of whole-genome information to develop field-deployable diagnostics on the continent is virtually inexistent. There is fledgling research into plant-virus-vector interactions to inform modelling of viral transmission. The gains so far have been modest but encouraging, and therefore must be consolidated. For this, I propose the creation of a new Research Centre for Africa. This bold investment is needed to secure the future of Africa's crops from insect-vectored viral diseases. |
159,423 | Validation and Psychometric Evaluation of the Italian Version of the Fear of COVID-19 Scale | Background: The advent of COVID-19 worldwide has led to consequences for people's health, both physical and psychological, such as fear and anxiety. This is the case in Italy, one of the countries most affected by the pandemic. Given the heightened fear concerning COVID-19 in Italy., the present study analyzed the psychometric properties of the Italian version of the Fear of COVID-19 Scale (FCV-19S). Methods: The sample comprised 250 Italian participants who were administered Italian versions of the FCV-19S, the Hospital Anxiety and Depression Scale (HADS), and the Severity Measure for Specific Phobia-Adult (SMSP-A). Several psychometric tests were performed to investigate the validity and reliability of the test including confirmatory factor analysis. Results: Analysis of the data showed satisfactory psychometric characteristics and confirmed the scale's unidimensional properties. The seven FCV-19S items had acceptable correlations with the test total (from .443 to .784). Furthermore, the loadings on the factor were significant and strong (from .684 to .897). The internal consistency was very good (α = .871). Construct validity for the FCV-19S was supported by significant and positive correlations with the HADS (r=.649) and SMSP-A (r=.703). Conclusions: The Italian version of the Fear of COVID-19 Scale is valid and reliable in assessing fear of COVID-19 among the general Italian population. |
159,424 | Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics | BACKGROUND: COVID-19 infections have been shown to be associated with a range of thromboembolic disease. OBJECTIVE: To describe our endovascular experience in a consecutive series of patients with COVID-19 who presented with large vessel occlusions, and to describe unique findings in this population. METHODS: Mechanical thrombectomy was performed on five consecutive patients with COVID-19 with large vessel occlusions. A retrospective study of these patients was performed. Patient demographics, laboratory values, mechanical thrombectomy technique, and clinical and angiographic outcomes were reviewed. RESULTS: Four patients with COVID-19 presented with anterior circulation occlusions and one patient with COVID-19 presented with both anterior and posterior circulation occlusions. All patients had coagulation abnormalities. Mean patient age was 52.8 years. Three patients presented with an intracranial internal carotid artery occlusion. Two patients presented with an intracranial occlusion and a tandem thrombus in the carotid bulb. One patient presented with an occlusion in both the internal carotid and basilar arteries. Clot fragmentation and distal emboli to a new vascular territory were seen in two of five (40%) patients, and downstream emboli were seen in all five (100%) patients. Patient clinical outcome was generally poor in this series of patients with COVID-19 large vessel occlusion. CONCLUSION: Our series of patients with COVID-19 demonstrated coagulation abnormalities, and compared with our previous experience with mechanical thrombectomy in large vessel occlusion, this group of patients were younger, had tandem or multiple territory occlusions, a large clot burden, and a propensity for clot fragmentation. These patients present unique challenges that make successful revascularization difficult. |
159,425 | Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics | BACKGROUND: COVID-19 infections have been shown to be associated with a range of thromboembolic disease. OBJECTIVE: To describe our endovascular experience in a consecutive series of patients with COVID-19 who presented with large vessel occlusions, and to describe unique findings in this population. METHODS: Mechanical thrombectomy was performed on five consecutive patients with COVID-19 with large vessel occlusions. A retrospective study of these patients was performed. Patient demographics, laboratory values, mechanical thrombectomy technique, and clinical and angiographic outcomes were reviewed. RESULTS: Four patients with COVID-19 presented with anterior circulation occlusions and one patient with COVID-19 presented with both anterior and posterior circulation occlusions. All patients had coagulation abnormalities. Mean patient age was 52.8 years. Three patients presented with an intracranial internal carotid artery occlusion. Two patients presented with an intracranial occlusion and a tandem thrombus in the carotid bulb. One patient presented with an occlusion in both the internal carotid and basilar arteries. Clot fragmentation and distal emboli to a new vascular territory were seen in two of five (40%) patients, and downstream emboli were seen in all five (100%) patients. Patient clinical outcome was generally poor in this series of patients with COVID-19 large vessel occlusion. CONCLUSION: Our series of patients with COVID-19 demonstrated coagulation abnormalities, and compared with our previous experience with mechanical thrombectomy in large vessel occlusion, this group of patients were younger, had tandem or multiple territory occlusions, a large clot burden, and a propensity for clot fragmentation. These patients present unique challenges that make successful revascularization difficult. |
159,426 | Disability and quality of life before and during the COVID-19 outbreak: A cross-sectional study in inflammatory bowel disease patients | Background/Aim: Inflammatory bowel disease (IBD) is a chronic disorder affecting patients' health-related quality of life (HRQoL) which adds to their disability. Little is known about the impact of the COVID-19 pandemic on HRQoL of IBD patients. We aimed to evaluate HRQoL in IBD patient's pre- and post-COVID-19 pandemic using the IBD-disk questionnaire and explore associations between socio demographic factors, disease types, severity and impaired HRQoL in patients with IBD. Patients and Methods: A cross-sectional study was conducted at a tertiary care centre in Saudi Arabia between November 2019 and March 2020 at the outpatient IBD clinics. The HRQoL of patients was assessed using the 10-item IBD-disk questionnaire. Results: A total of 59 IBD patients (40 Crohn's disease, 19 Ulcerative colitis) with a mean disease duration of 3.5 years were included. Most of the patients (77.97%) were on biologics while 35.59% were on immune modulators, 16.94% on 5-ASA, and 3.38% were on corticosteroids. There was no difference between any of the 10 IBD-disk variables pre and post-COVID-19 pandemic apart from the perception of body image, where there was a slightly more negative perception with an increase from 2.53 to 3.39 (P = 0.05) There was no significant difference in HRQoL between patients with ulcerative colitis and Crohn's disease in any of domains. Conclusion: The current study showed that disability and HRQoL appears to be unaffected by the COVID-19 pandemic among our cohort, however further studies with longer follow up and larger sample size is needed. |
159,427 | Disability and quality of life before and during the COVID-19 outbreak: A cross-sectional study in inflammatory bowel disease patients | Background/Aim: Inflammatory bowel disease (IBD) is a chronic disorder affecting patients' health-related quality of life (HRQoL) which adds to their disability. Little is known about the impact of the COVID-19 pandemic on HRQoL of IBD patients. We aimed to evaluate HRQoL in IBD patient's pre- and post-COVID-19 pandemic using the IBD-disk questionnaire and explore associations between socio demographic factors, disease types, severity and impaired HRQoL in patients with IBD. Patients and Methods: A cross-sectional study was conducted at a tertiary care centre in Saudi Arabia between November 2019 and March 2020 at the outpatient IBD clinics. The HRQoL of patients was assessed using the 10-item IBD-disk questionnaire. Results: A total of 59 IBD patients (40 Crohn's disease, 19 Ulcerative colitis) with a mean disease duration of 3.5 years were included. Most of the patients (77.97%) were on biologics while 35.59% were on immune modulators, 16.94% on 5-ASA, and 3.38% were on corticosteroids. There was no difference between any of the 10 IBD-disk variables pre and post-COVID-19 pandemic apart from the perception of body image, where there was a slightly more negative perception with an increase from 2.53 to 3.39 (P = 0.05) There was no significant difference in HRQoL between patients with ulcerative colitis and Crohn's disease in any of domains. Conclusion: The current study showed that disability and HRQoL appears to be unaffected by the COVID-19 pandemic among our cohort, however further studies with longer follow up and larger sample size is needed. |
159,428 | Unprepared for Financial Shocks: Emergency Savings and Credit Card Debt | We measure readiness to face emergency expenses using data from a representative survey of U S consumers Our main findings are as follows: (1) there is substantial heterogeneity in financial readiness, with lowest-income, least-educated, unemployed, and Black consumers most likely to have $0 saved for emergency expenses;(2) the amount of emergency savings is correlated with payment choice: Less financially prepared individuals use cash more and credit cards less, compared to those with higher emergency savings;(3) while people with low emergency savings rely more on cash than credit cards, they revolve more debt, and so a financial shock is costlier for them;(4) changes in income from one year to the next do not appear to affect the likelihood of revolving on credit cards or increase the amount borrowed, although the data were collected before the COVID-19 pandemic For those with little or no savings and already financially vulnerable, even a temporary financial shock—an unexpected negative income shock (such as a layoff or a short-term government shutdown) or an unexpected expenditure (such as a medical expense or a car repair)—could have severe financial consequences, exacerbated by the high cost of borrowing on credit cards (JEL D12, D14, D15, E21) © 2020 Western Economic Association International |
159,429 | Systems thinking for health emergencies: use of process mapping during outbreak response | Process mapping is a systems thinking approach used to understand, analyse and optimise processes within complex systems. We aim to demonstrate how this methodology can be applied during disease outbreaks to strengthen response and health systems. Process mapping exercises were conducted during three unique emerging disease outbreak contexts with different: mode of transmission, size, and health system infrastructure. System functioning improved considerably in each country. In Sierra Leone, laboratory testing was accelerated from 6 days to within 24 hours. In the Democratic Republic of Congo, time to suspected case notification reduced from 7 to 3 days. In Nigeria, key data reached the national level in 48 hours instead of 5 days. Our research shows that despite the chaos and complexities associated with emerging pathogen outbreaks, the implementation of a process mapping exercise can address immediate response priorities while simultaneously strengthening components of a health system. |
159,430 | Impact of COVID-19 on the qualitative and quantitative aspect of household solid waste | Houshold waste is the residue generated daily by people as a result of consuming goods and services The qualitative and quantitative aspects depend on the lifestyle and standard of living of citizens Hence a change in habits, following an economic or health crisis, can influence the production of waste and its composition The objective of the present work is to assess the impact of lockdown on the generation of trash and on the habits related to the consumption of goods in two communes in Morocco More specifically, this study would investigate the behavior of citizens with regard to protective equipment against the coronavirus COVID-19 The results of the survey show that there is an influence of lockdown on the items purchased during this period, with an increase in the purchase of disinfectant products and a decrease in the consumption of meat and canned goods Thus, the results showed that the quantity of organic fractions had decreased in the domestic waste with the appearance of other fractions such as residues of cleaning products In addition, the survey conducted showed that 87% of respondents mix coronavirus protective equipment with household waste, which may contribute to the spread of the virus Concerning the quantitative aspect, the weighups showed that the monthly rate of increase of waste production between the months of February and March 2019 and the corresponding period in 2020 have decreased from +11 41% to +3 8% in the city of Khenifra (from 2,572 ton in Mars 2019 to 2,456 ton in the correspondent period in 2020) and from +4 73% to-1 23% in the center of Tighassaline (from 136 ton in Mars 2019 to 123 ton in the correspondent period in 2020) |
159,431 | COVID-19: How has the scientific community risen to the challenge? | As the novel coronavirus SARS-CoV-2 spreads around the world, scientists have raced to develop vaccines and tests in order to curb the infection. |
159,432 | Ultraviolet C Induced Skin Reaction from Ultraviolet Germicidal Irradiation of N95 Respirators During the COVID-19 Pandemic | With the depletion of personal protective equipment (PPE) during the COVID-19 pandemic, methods for decontamination of N95 filtering facepiece respirators (FFR) are being implemented at institutions throughout the United States Ultraviolet germicidal irradiation (UVGI) involves administration of ultraviolet C (UVC) irradiation to cause DNA damage to inactivate pathogens on surfaces including FFRs With the widespread use of this technology may come unintended side effects We present the case of a patient who developed a skin reaction following UVC exposure from a UVGI device |
159,433 | State and Local Government Pension Funding on the Eve of the COVID-19 Recession | This article examines the funding of public pension plans through 2019 Particular attention is paid to the impact of the Governmental Accounting Standards Board?s Standard No 68 It addressed (1) discount rates, (2) amortization periods, (3) asset valuation and smoothing, and (4) the actuarial cost method used The combined effect of these measures has been to increase the amount of public pension underfunding significantly The actuarial funded ratio of the 126 plans in the Public Plans Database went from 101 9 in 2001 to 71 9 in 2019, on the eve of the COVID-19 recession It will no doubt continue to worsen in the years ahead The extent of that likely worsening is also explored |
159,434 | Moral injury in the wake of coronavirus: Attending to the psychological impact of the pandemic | Moral injury is a helpful lens through which we can better understand and prepare for the downstream psychosocial impact faced by health care providers during the coronavirus pandemic. Moral injury is psychological weight caused by a transgression of one's own or shared morals and values and can manifest as guilt, shame, inability to self-forgive, demoralization, and, in the worst case, self-harming behaviors. Given the morally challenging and life-threatening decisions our health care workers need to make daily in the face of consistent and ongoing death and loss, it is important to prepare for moral injury and the psychological toll by offering psychological support early and as often as needed at both the personal and institutional level. (PsycInfo Database Record (c) 2020 APA, all rights reserved). |
159,435 | Moral injury in the wake of coronavirus: Attending to the psychological impact of the pandemic | Moral injury is a helpful lens through which we can better understand and prepare for the downstream psychosocial impact faced by health care providers during the coronavirus pandemic. Moral injury is psychological weight caused by a transgression of one's own or shared morals and values and can manifest as guilt, shame, inability to self-forgive, demoralization, and, in the worst case, self-harming behaviors. Given the morally challenging and life-threatening decisions our health care workers need to make daily in the face of consistent and ongoing death and loss, it is important to prepare for moral injury and the psychological toll by offering psychological support early and as often as needed at both the personal and institutional level. (PsycInfo Database Record (c) 2020 APA, all rights reserved). |
159,436 | Mitochondrial DNA Copy Number is Associated with Attention Deficit Hyperactivity Disorder | BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children. Several hypotheses have been proposed to explain its etiology. Mitochondrial dysfunction (MD) is suggested to be one of the causes of Attention Deficit Hyperactivity Disorder. The objective of the study was to evaluate the relationship between MD and ADHD by investigating mitochondrial DNA (mtDNA) levels from peripheral blood leukocytes, one of the best biomarkers of mitochondrial dysfunction. SUBJECTS AND METHODS: This study included 56 children aged 6-16 years who were diagnosed with ADHD for the first time and 56 age- and sex-matched children without ADHD. Real-time PCR was performed to determine the relative mtDNA copy number in each study participant. RESULTS: The mean mtDNA copy number of the case group was 57.623±24.827 and that of the control group was 44.204±18.926 (p=0.002). The mtDNA copy number of the case group was higher than that of the control group. Results of ROC curve analysis provided a mtDNA cutoff value of 45. CONCLUSION: Significantly higher mtDNA copy number in ADHD group may suggest mitochondrial dysfunction in the etiopathogenesis of ADHD. |
159,437 | Distributed model predictive control of positive Markov jump systems | This paper proposes a new distributed model predictive control (DMPC) for positive Markov jump systems subject to uncertainties and constraints. The uncertainties refer to interval and polytopic types, and the constraints are described in the form of 1-norm inequalities. A linear DMPC framework containing a linear performance index, linear robust stability conditions, a stochastic linear co-positive Lyapunov function, a cone invariant set, and a linear programming based DMPC algorithm is introduced. A global positive Markov jump system is decomposed into several subsystems. These subsystems can exchange information with each other and each subsystem has its own controller. Using a matrix decomposition technique, the DMPC controller gain matrix is divided into nonnegative and non-positive components and thus the corresponding stochastic stability conditions are transformed into linear programming. By virtue of a stochastic linear co-positive Lyapunov function, the positivity and stochastic stability of the systems are achieved under the DMPC controller. A lower computation burden DMPC algorithm is presented for solving the min-max optimization problem of performance index. The proposed DMPC design approach is extended for general systems. Finally, an example is given to verify the effectiveness of the DMPC design. |
159,438 | A framework for assessing glaucoma progression using structural and functional indices jointly | PURPOSE: While many tests and indices are available to identify glaucoma progression, using them in combinations may decrease overall specificity. The aim of this study was to develop a framework for assessing glaucoma progression using structural and functional indices jointly for a fixed specificity. METHODS: The study included 337 eyes of 207 patients with ocular hypertension or primary open-angle glaucoma selected from the Diagnostic Innovations in Glaucoma Study or the African Descent and Glaucoma Evaluation Study. All patients had at least 9 visits. Each visit had retinal nerve fiber layer thickness (RNFLT) and mean sensitivity from static automated perimetry (SAP MS) measured within a one-month window. Simple linear regression was applied to assess deterioration in each index for series of 5 to 9 visits. To identify progression using the two indices jointly, marginal significance levels set at a specificity of 95% were derived for two criteria: ANY (worsening on either RNFLT or SAP MS) and ALL (worsening on both RNFLT and SAP MS). Positive rate (percentage of eyes flagged as progressing) was determined individually for each index, as well as for the ANY and ALL criteria. RESULTS: Compared to SAP MS, RNFLT had higher positive rates (15% to 45%) for all series lengths. For the joint analyses, the positive rate was on average 12% higher for the ANY criterion compared to the ALL criterion. While RNFLT-alone had comparable positive rates and time-to-detection as the ANY criterion, each uniquely identified a subset of eyes (Kappa = 0.55 to 0.75). CONCLUSIONS: This study provides a simple framework for assessing glaucoma progression with data from two tests jointly, without compromising specificity. This framework can be extended to include two or more parameters, can accommodate global or regional indices, and can eventually be used with novel parameters identified as predictive of glaucoma progression. |
159,439 | SNPs or RNA modifications? Concerns on mutation-based evolutionary studies of SARS-CoV-2 | SARS-CoV-2 is still rampaging throughout the world while the many evolutionary studies on it are simultaneously springing up. Researchers have simply utilized the public RNA-seq data to find out the so-called SNPs in the virus genome. The evolutionary analyses were largely based on these mutations. Here, we claim that we reliably detected A-to-G RNA modifications in the RNA-seq data of SARS-CoV-2 with high signal to noise ratios, presumably caused by the host's deamination enzymes. Intriguingly, since SARS-CoV-2 is an RNA virus, it is technically impossible to distinguish SNPs and RNA modifications from the RNA-seq data alone without solid evidence, making it difficult to tell the evolutionary patterns behind the mutation spectrum. Researchers should clarify their biological significance before they automatically regard the mutations as SNPs or RNA modifications. This is not a problem for DNA organisms but should be seriously considered when we are investigating the RNA viruses. |
159,440 | SNPs or RNA modifications? Concerns on mutation-based evolutionary studies of SARS-CoV-2 | SARS-CoV-2 is still rampaging throughout the world while the many evolutionary studies on it are simultaneously springing up. Researchers have simply utilized the public RNA-seq data to find out the so-called SNPs in the virus genome. The evolutionary analyses were largely based on these mutations. Here, we claim that we reliably detected A-to-G RNA modifications in the RNA-seq data of SARS-CoV-2 with high signal to noise ratios, presumably caused by the host's deamination enzymes. Intriguingly, since SARS-CoV-2 is an RNA virus, it is technically impossible to distinguish SNPs and RNA modifications from the RNA-seq data alone without solid evidence, making it difficult to tell the evolutionary patterns behind the mutation spectrum. Researchers should clarify their biological significance before they automatically regard the mutations as SNPs or RNA modifications. This is not a problem for DNA organisms but should be seriously considered when we are investigating the RNA viruses. |
159,441 | Spatial patterns of multidrug-resistant tuberculosis: correlation with sociodemographic variables and type of notification | OBJECTIVE: Correlate the cases of multidrug-resistant tuberculosis and its spatial patterns with the type of notification and sociodemographic variables. METHOD: Ecological study carried out in the municipality of Belém, with 77 cases of multidrug-resistant tuberculosis registered in the Special Treatment Information System for Tuberculosis, between 2012 and 2016. For analysis, the data was debugged followed by geo-referencing in ArcGis 10.3 and Terra View 4.2.2. To relate the cases with the type of notification, the BioEstat 5.4 software was used, with a significance level of 95%. RESULTS: Of the total, 40 (52%) were new cases; 27 (35%), relapses; and ten (13%) were re-enrolled after leaving. Multidrug-resistant tuberculosis was randomly distributed and related to income, household, territorial cluster and water supply. There was a concentration of cases in two administrative districts, corresponding to 28.5% and 27.3% of the total, with a median Sociodemographic Index. CONCLUSION: Behavior of multidrug-resistant tuberculosis influenced by sociodemographic indicators. |
159,442 | Neurological Implications of COVID-19 Infections | The magnitude of the COVID-19 pandemic will result in substantial neurological disease, whether through direct infection (rare), para-infectious complications (less rare), or critical illness more generally (common). Here, we raise the importance of stringent diagnosis and data collection regarding neurological complications of COVID-19; we urge caution in the over-diagnosis of neurological disease where it does not exist, but equally strongly encourage the concerted surveillance for such conditions. Additional to the direct neurological complications of COVID-19 infection, neurological patients are at risk of harm from both structural limitations (such as number of intensive care beds), and a hesitancy to treat with certain necessary medications given risk of nosocomial COVID-19 infection. We therefore also outline the specific management of patients with neuroinflammatory diseases in the context of the pandemic. This article describes the implications of COVID-19 on neurological disease and advertises the Neurocritical Care Society's international data collection collaborative that seeks to align data elements. |
159,443 | The association of PTSD symptom severity with amygdala nuclei volumes in traumatized youths | The amygdala is a core component in neurobiological models of stress and stress-related pathologies, including post-traumatic stress disorder (PTSD). While numerous studies have reported increased amygdala activity following traumatic stress exposure and in PTSD, the findings regarding amygdala volume have been mixed. One reason for these mixed findings may be that the amygdala has been considered as a homogenous entity, while it in fact consists of several nuclei with unique cellular and connectivity profiles. Here, we investigated amygdala nuclei volumes of the basolateral and the centrocorticomedial complex in relation to PTSD symptom severity in 47 young survivors from the 2011 Norwegian terror attack 24-36 months post-trauma. PTSD symptoms were assessed 4-5, 14-15 and 24-36 months following the trauma. We found that increased PTSD symptom severity 24-36 months post-trauma was associated with volumetric reductions of all basolateral as well as the central and the medial nuclei. However, only the lateral nucleus was associated with longitudinal symptom development, and mediated the association between 4-5 months and 24-36 months post-trauma symptoms. The results suggest that the amygdala nuclei may be differentially associated with cross-sectional and longitudinal measures of PTSD symptom severity. As such, investigations of amygdala total volume may not provide an adequate index of the association between amygdala and stress-related mental illness. |
159,444 | Outcome of trauma and orthopaedic surgery at a UK District General Hospital during the Covid-19 pandemic | Introduction: There are suggestions that elective surgery performed during the incubation period of COVID-19 infection may cause an immediate impairment of cell-mediated immunity, leading to high morbidity and mortality. However is contrasting data about the associated mortality. Since the outbreak, our unit has maintained a prospective database recording Trauma and Orthopaedic surgical activity. Our aim was to share our experience of the first 3 months with prospective data on outcome of essential surgery during the covid-19 peak. Our focus in this report was on the mortality rate as services begin to open. Methods: We prospectively collected data during the peak of the pandemic in the UK, for fracture neck of femur patients (NOF) the most commonly performed surgical procedure and the most vulnerable during this period. We compared this Covid-19 cohort of NOFs against a cohort of NOF's during the same time in 2019 and another cohort of NOF's in 2020 outside the lockdown period to compare mortality rates and give a broader perspective. Results: During the period March 1, 2020 to May 31, 2020, total of 206 patients were operated. Ninety-four fracture NOF and another one hundred twelve essential surgical procedures were performed. In the NOF cohort, there were nine patients that died. Three of them were covid-19 positive, one was not tested and the rest five were covid-19 negative. There was no mortality reported in the non NOF group. Conclusion: In our unit, during the lock down period, mortality rate in patients undergoing fracture NOF was not significantly different from a similar cohort earlier in the year and similar period last year. We have not observed any mortality, to date in the Non NOF procedures carried out. |
159,445 | Non-Placement WIL: The Case of an Exercise Prescription Clinic | Universities globally have continued to strategically increase work-integrated learning (WIL) opportunities for students to enhance graduate employability However, meeting the needs of the increasing number of placements in industry settings places challenges on employers and academic programme coordinators This paper examines an innovative teaching and learning initiative demonstrating non-placement WIL practice on-campus and online through an exercise prescription clinic (EPC) The benefits provided by these opportunities have not only been for student learning, but for clients, in particular those impacted by neurological and/or muscular skeletal problems The development of the on-campus EPC has focused on key elements of good practice in WIL highlighted by Agnew, Pill and Orrell (2017) The recent Covid-19 pandemic and the related government restrictions have resulted in the on-campus EPC being flipped online, requiring adaptability and flexibility of both students and clients This paper reinforces the importance of developing WIL experiences that enhance the learning outcomes for both the student and the client It also highlights the transferability of authentic industry non-placement WIL clinical experiences for future health professionals to both on-campus and online settings, which enable students the opportunity to engage with a range of clients in a safe environment, enhancing both personal and professional learning outcomes |
159,446 | Mobility Based SIR Model For Pandemics -- With Case Study Of COVID-19 | In the last decade, humanity has faced many different pandemics such as SARS, H1N1, and presently novel coronavirus (COVID-19). On one side, scientists are focusing on vaccinations, and on the other side, there is a need to propose models that can help us in understanding the spread of these pandemics as it can help governmental and other concerned agencies to be well prepared, especially from pandemics, which spreads faster like COVID-19. The main reason for some epidemic turning into pandemics is the connectivity among different regions of the world, which makes it easier to affect a wider geographical area, often worldwide. In addition, the population distribution and social coherence in the different regions of the world is non-uniform. Thus, once the epidemic enters a region, then the local population distribution plays an important role. Inspired by these ideas, we proposed a mobility-based SIR model for epidemics, which especially takes into account pandemic situations. To the best of our knowledge, this model is first of its kind, which takes into account the population distribution and connectivity of different geographic locations across the globe. In addition to presenting the mathematical proof of our model, we have performed extensive simulations using synthetic data to demonstrate our model's generalizability. To demonstrate the wider scope of our model, we used our model to forecast the COVID-19 cases for Estonia. |
159,447 | LY6E impairs coronavirus fusion and confers immune control of viral disease | Zoonotic coronaviruses (CoVs) are substantial threats to global health, as exemplified by the emergence of two severe acute respiratory syndrome CoVs (SARS-CoV and SARS-CoV-2) and Middle East respiratory syndrome CoV (MERS-CoV) within two decades1-3. Host immune responses to CoVs are complex and regulated in part through antiviral interferons. However, interferon-stimulated gene products that inhibit CoVs are not well characterized4. Here, we show that lymphocyte antigen 6 complex, locus E (LY6E) potently restricts infection by multiple CoVs, including SARS-CoV, SARS-CoV-2 and MERS-CoV. Mechanistic studies revealed that LY6E inhibits CoV entry into cells by interfering with spike protein-mediated membrane fusion. Importantly, mice lacking Ly6e in immune cells were highly susceptible to a murine CoV-mouse hepatitis virus. Exacerbated viral pathogenesis in Ly6e knockout mice was accompanied by loss of hepatic immune cells, higher splenic viral burden and reduction in global antiviral gene pathways. Accordingly, we found that constitutive Ly6e directly protects primary B cells from murine CoV infection. Our results show that LY6E is a critical antiviral immune effector that controls CoV infection and pathogenesis. These findings advance our understanding of immune-mediated control of CoV in vitro and in vivo-knowledge that could help inform strategies to combat infection by emerging CoVs. |
159,448 | Characterization of SETD1A haploinsufficiency in humans and Drosophila defines a novel neurodevelopmental syndrome | Defects in histone methyltransferases (HMTs) are major contributing factors in neurodevelopmental disorders (NDDs). Heterozygous variants of SETD1A involved in histone H3 lysine 4 (H3K4) methylation were previously identified in individuals with schizophrenia. Here, we define the clinical features of the Mendelian syndrome associated with haploinsufficiency of SETD1A by investigating 15 predominantly pediatric individuals who all have de novo SETD1A variants. These individuals present with a core set of symptoms comprising global developmental delay and/or intellectual disability, subtle facial dysmorphisms, behavioral and psychiatric problems. We examined cellular phenotypes in three patient-derived lymphoblastoid cell lines with three variants: p.Gly535Alafs*12, c.4582-2_4582delAG, and p.Tyr1499Asp. These patient cell lines displayed DNA damage repair defects that were comparable to previously observed RNAi-mediated depletion of SETD1A. This suggested that these variants, including the p.Tyr1499Asp in the catalytic SET domain, behave as loss-of-function (LoF) alleles. Previous studies demonstrated a role for SETD1A in cell cycle control and differentiation. However, individuals with SETD1A variants do not show major structural brain defects or severe microcephaly, suggesting that defective proliferation and differentiation of neural progenitors is unlikely the single underlying cause of the disorder. We show here that the Drosophila melanogaster SETD1A orthologue is required in postmitotic neurons of the fly brain for normal memory, suggesting a role in post development neuronal function. Together, this study defines a neurodevelopmental disorder caused by dominant de novo LoF variants in SETD1A and further supports a role for H3K4 methyltransferases in the regulation of neuronal processes underlying normal cognitive functioning. |
159,449 | Ending coronavirus lockdowns will be a dangerous process of trial and error | The world is holding its breath After the novel coronavirus made its way from China around the world, one country after another adopted harsh measures to stop SARS-CoV-2 from spreading and overwhelming hospitals They have hit the pause button on their economies and their citizens’ lives, stopping sports events, religious services, and other social gatherings School closures in 188 countries affect more than 1 5 billion students Borders are closed and businesses shuttered While some countries are still seeing daily case numbers increase, others—first in Asia but increasingly in Europe—have managed to bend the curve, slowing the transmission of COVID-19 |
159,450 | [Consideration on improving public health emergency management ability of current medical health system] | COVID-19 is a Public Health Emergency of International Concern (PHEIC) Direct economic loss is expected to be much more than that of SARS outbreak in 2003 The risk factors of COVID-19 epidemic at the early stage incluede the misjudgment of the epidemic, delay in reporting this emerging infectious disease, nosocomial infection-caused transmission of the virus into local communities, and weak public health interventions The infection rate (or the incidence) reflects the prophylactic effect in population Case fatality reflects the therapeutic effect of clinical intervention There were sufficient medical resources at the national top levels accumulated in Wuhan Furthermore, medical professionals and sufficient medical supplies from other provinces have been assigned to join in the fighting against the epidemic in Wuhan However, the case fatality in Wuhan has being kept the highest in China, indicating that clinical treatment for this virus-caused emerging infectious disease, whose pathogenesis remains to be elucidated, had a limited effect in controlling this epidemic The unusual, extremely costly public health interventions including the temporarily city quarantine and transportation ban issued by the central government are crucial in controlling this epidemic The control of epidemic indicates the importance of public health measures but also reflected its insufficient capacity in China Recently, profit-seeking mechanism run in Chinese health service system disorganized the balance of clinical service and public health service patterns in China, promoting the vicious circle of "attaching importance to clinical treatment and despising disease prophylaxis" , damaging the infrastructure of public health capacity, thus contributing to the formation of the inevitability in various fortuities of public health emergency To strength the capacity of our medical service system to respond to public health emergency efficiently, two key issues should be considered First, public health service, which should be fixed as the health section of the governments' public services by the law, must be greatly improved to meet the increasing health needs of the publics Second, the vicious circle of profit-seeking-caused "attaching importance to clinical treatment and despising disease prophylaxis" should be immediately broken to optimize the national health service system in China by increasing the investment in public health service |
159,451 | [Consideration on improving public health emergency management ability of current medical health system] | COVID-19 is a Public Health Emergency of International Concern (PHEIC). Direct economic loss is expected to be much more than that of SARS outbreak in 2003. The risk factors of COVID-19 epidemic at the early stage incluede the misjudgment of the epidemic, delay in reporting this emerging infectious disease, nosocomial infection-caused transmission of the virus into local communities, and weak public health interventions. The infection rate (or the incidence) reflects the prophylactic effect in population. Case fatality reflects the therapeutic effect of clinical intervention. There were sufficient medical resources at the national top levels accumulated in Wuhan. Furthermore, medical professionals and sufficient medical supplies from other provinces have been assigned to join in the fighting against the epidemic in Wuhan. However, the case fatality in Wuhan has being kept the highest in China, indicating that clinical treatment for this virus-caused emerging infectious disease, whose pathogenesis remains to be elucidated, had a limited effect in controlling this epidemic. The unusual, extremely costly public health interventions including the temporarily city quarantine and transportation ban issued by the central government are crucial in controlling this epidemic. The control of epidemic indicates the importance of public health measures but also reflected its insufficient capacity in China. Recently, profit-seeking mechanism run in Chinese health service system disorganized the balance of clinical service and public health service patterns in China, promoting the vicious circle of "attaching importance to clinical treatment and despising disease prophylaxis" , damaging the infrastructure of public health capacity, thus contributing to the formation of the inevitability in various fortuities of public health emergency. To strength the capacity of our medical service system to respond to public health emergency efficiently, two key issues should be considered. First, public health service, which should be fixed as the health section of the governments' public services by the law, must be greatly improved to meet the increasing health needs of the publics. Second, the vicious circle of profit-seeking-caused "attaching importance to clinical treatment and despising disease prophylaxis" should be immediately broken to optimize the national health service system in China by increasing the investment in public health service. |
159,452 | Oral anticoagulation and clinical outcomes in COVID-19: An Italian multicenter experience | BACKGROUND: Since the body of evidence addressing the coagulation derangements caused by Coronavirus disease (COVID-19) has been constantly growing, we investigated whether pre-hospitalization oral anticoagulation (OAC) or in-hospital heparin treatment could have a protective role among COVID-19 patients. METHOD: In this cohort study, consecutive COVID-19 patients admitted to four different Italian Institutions were enrolled. Baseline demographic, clinical, laboratory, and radiological characteristics, as well as in-hospital treatment and outcomes were evaluated. The primary outcome was mortality. RESULTS: A total of 844 COVID-19 patients were enrolled as study cohort, n = 65 (7.7%) taking OACs prior to hospitalization. Regarding clinical outcomes, OAC patients developed acute hypoxemic respiratory failure (AHRF) more frequently than non-OAC patients as well as presenting a higher mortality rate (44.6% vs 19.8%, p < 0.001). At overall multivariate logistical regression, use of heparin (n = 394, 46.6%) was associated with a better chance of survival to hospital discharge (OR 0.60 [0.38-0.94], p < 0.001), in particular in patients with AHRF, with no association found with the use of OACs. In a sub-analysis, the highest mortality rate was found for AHRF patients when heparin was not administered. CONCLUSION: In our cohort, OACs appeared to be ineffective in reducing mortality rate, while heparin resulted to be a useful treatment when lung disease was sufficiently severe, potentially suggesting a crucial role of microthrombosis in severe COVID-19. Due to the relatively small number of COVID-19 patients treated with OACs included in our analysis and their higher number of comorbidities, larger studies are needed in order to confirm our findings. |
159,453 | Wearing one for the team: views and attitudes to face covering in New Zealand/Aotearoa during COVID-19 Alert Level 4 lockdown | INTRODUCTION Mass masking is emerging as a key non-pharmaceutical intervention for reducing community spread of COVID-19. However, although hand washing, social distancing and bubble living have been widely adopted by the 'team of 5 million', mass masking has not been socialised to the general population. AIM To identify factors associated with face masking in New Zealand during COVID-19 Alert Level 4 lockdown to inform strategies to socialise and support mass masking. METHODS A quantitative online survey conducted in New Zealand during April 2020 invited residents aged ≥18 years to complete a questionnaire. Questions about face masking were included in the survey. The sample was drawn from a commissioned research panel survey, with boosted sampling for Maori and Pacific participants. Responses were weighted to reflect the New Zealand population for all analyses. RESULTS A total of 1015 individuals participated. Self-reported beliefs were strongly related to behaviours, with respondents viewing face masking measures as 'somewhat' or 'very' effective in preventing them from contracting COVID-19 more likely to report having worn a face mask than respondents who viewed them as 'not at all' effective. The strongest barriers to face mask use included beliefs that there was a mask shortage and that the needs of others were greater than their own. DISCUSSION Highlighting the efficacy of and dispelling myths about the relative efficacy of mask types and socialising people to the purpose of mass masking will contribute to community protective actions of mask wearing in the New Zealand response to COVID-19. |
159,454 | Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the US | IMPORTANCE: Little is known about the association between the coronavirus disease 2019 (COVID-19) pandemic and the level and content of primary care delivery in the US OBJECTIVE: To quantify national changes in the volume, type, and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based vs telemedicine encounters DESIGN, SETTING, AND PARTICIPANTS: Analysis of serial cross-sectional data from the IQVIA National Disease and Therapeutic Index, a 2-stage, stratified nationally representative audit of outpatient care in the US from the first calendar quarter (Q1) of 2018 to the second calendar quarter (Q2) of 2020 MAIN OUTCOMES AND MEASURES: Visit type (office-based or telemedicine), overall and stratified by patient population and geographic region;assessment of blood pressure or cholesterol measurement;and initiation or continuation of prescription medications RESULTS: In the 8 calendar quarters between January 1, 2018, and December 31, 2019, between 122 4 million (95% CI, 117 3-127 5 million) and 130 3 million (95% CI, 124 7-135 9 million) quarterly primary care visits occurred in the US (mean, 125 8 million;95% CI, 121 7-129 9 million), most of which were office-based (92 9%) In 2020, the total number of encounters decreased to 117 9 million (95% CI, 112 6-123 2 million) in Q1 and 99 3 million (95% CI, 94 9-103 8 million) in Q2, a decrease of 21 4% (27 0 million visits) from the average of Q2 levels during 2018 and 2019 Office-based visits decreased 50 2% (59 1 million visits) in Q2 of 2020 compared with Q2 2018-2019, while telemedicine visits increased from 1 1% of total Q2 2018-2019 visits (1 4 million quarterly visits) to 4 1% in Q1 of 2020 (4 8 million visits) and 35 3% in Q2 of 2020 (35 0 million visits) Decreases occurred in blood pressure level assessment (50 1% decrease, 44 4 million visits) and cholesterol level assessment (36 9% decrease, 10 2 million visits) in Q2 of 2020 compared with Q2 2018-2019 levels, and assessment was less common during telemedicine than during office-based visits (9 6% vs 69 7% for blood pressure;P < 001;13 5% vs 21 6% for cholesterol;P < 001) New medication visits in Q2 of 2020 decreased by 26 0% (14 1 million visits) from Q2 2018-2019 levels Telemedicine adoption occurred at similar rates among White individuals and Black individuals (19 3% vs 20 5% of patient visits, respectively, in Q1/Q2 of 2020), varied by region (low of 15 1% of visits [East North Central region], high of 26 8% of visits [Pacific region]), and was not correlated with regional COVID-19 burden CONCLUSIONS AND RELEVANCE: The COVID-19 pandemic has been associated with changes in the structure of primary care delivery, with the content of telemedicine visits differing from that of office-based encounters |
159,455 | Research progress of new coronavirus COVID-19 | Coronavirus is a common and ancient virus family The coronaviruses have led to outbreaks and epidemic among the population for many times until recent now, including the severe acute respiratory syndrome coronavirus(SARS-CoV) causing severe acute respiratory syndrome in 2003, human coronavirus NL63(HCoV-NL63) found in 2004, human coronavirus HPU1(HCoV-HKU1) found in 2005, coronavirus causing Middle East Respiratory Syndrome(MERS-CoV) in 2012 and novel coronavirus(2019-nCoV) causing COVID-19 in China in Dec, 2019 The novel coronavirus has been officially named as 2019-nCoV by the International Committee for the Classification of Viruses The coronavirus is widely present in bats and is also found in birds, cats, dogs, pigs, mice, horses, whales, pangolins and humans The epidemics that were caused by the virus have attracted the attention of people from all walks of life, the diseases caused by the virus aroused severe panic The study of its etiology may facilitate the understanding of the causes for the epidemic and control the spread of the virus |
159,456 | Ibuprofen and thromboembolism in SARS-COV2 | Recent and developing literature has begun reporting on the incidence of thromboembolic events associated with COVID-19. Klok et al. analysed 184 SARS-CoV2-positive ICU patients in two Dutch University Hospitals, reporting an incidence of thrombotic complications to be 31%, with Pulmonary Embolism (PE) comprising 81% of these complications. [1] Moreover, Cui et al. reports on a population of 81 ICU patients at the Union Hospital, Wuhan, an incidence of 25% in VTE, also possibly related to worse prognosis.[2] Wang et al. collected data from 1026 COVID-19 positive patients in 31 provincial administrative regions in China and found 40% of the patients as high risk for VTE according to the Padua Prediction Score, with 11% being predicted to go on developing VTE. [3] Other reports and studies have also discussed the role of acute PE in COVID-19. Recent studies have also reported and advised on the use of prophylactic Low Molecular Weight Heparin (LMWH) in COVID-19 patients, to prevent the severe outcomes associated with thromboembolic complications. |
159,457 | Ibuprofen and thromboembolism in SARS-COV2 | Recent and developing literature has begun reporting on the incidence of thromboembolic events associated with COVID-19. Klok et al. analysed 184 SARS-CoV2-positive ICU patients in two Dutch University Hospitals, reporting an incidence of thrombotic complications to be 31%, with Pulmonary Embolism (PE) comprising 81% of these complications. [1] Moreover, Cui et al. reports on a population of 81 ICU patients at the Union Hospital, Wuhan, an incidence of 25% in VTE, also possibly related to worse prognosis.[2] Wang et al. collected data from 1026 COVID-19 positive patients in 31 provincial administrative regions in China and found 40% of the patients as high risk for VTE according to the Padua Prediction Score, with 11% being predicted to go on developing VTE. [3] Other reports and studies have also discussed the role of acute PE in COVID-19. Recent studies have also reported and advised on the use of prophylactic Low Molecular Weight Heparin (LMWH) in COVID-19 patients, to prevent the severe outcomes associated with thromboembolic complications. |
159,458 | COVID-19 in humanitarian settings: documenting and sharing context-specific programmatic experiences | Humanitarian organizations have developed innovative and context specific interventions in response to the COVID-19 pandemic as guidance has been normative in nature and most are not humanitarian specific In April 2020, three universities developed a COVID-19 humanitarian-specific website ( www covid19humanitarian com ) to allow humanitarians from the field to upload their experiences or be interviewed by academics to share their creative responses adapted to their specific country challenges in a standardised manner These field experiences are reviewed by the three universities together with various guidance documents and uploaded to the website using an operational framework The website currently hosts 135 guidance documents developed by 65 different organizations, and 65 field experiences shared by 29 organizations from 27 countries covering 38 thematic areas Examples of challenges and innovative solutions from humanitarian settings are provided for triage and sexual and gender-based violence Offering open access resources on a neutral platform by academics can provide a space for constructive dialogue among humanitarians at the country, regional and global levels, allowing humanitarian actors at the country level to have a strong and central voice We believe that this neutral and openly accessible platform can serve as an example for future large-scale emergencies and epidemics |
159,459 | SARS-CoV-2 in rural Latin America. A population-based study in coastal Ecuador | Antibodies to SARS-CoV-2 were detected in 303/673 rural Ecuadorian adults (45%), 77% of whom had compatible clinical manifestations. Seropositivity was associated with the use of open latrines. Our findings support the fears of mass spread of SARS-CoV-2 in rural Latin America and cannot exclude a contributing role for fecal-oral transmission. |
159,460 | Therapeutic Relationship in eHealth-A Pilot Study of Similarities and Differences between the Online Program Priovi and Therapists Treating Borderline Personality Disorder | eHealth programs have been found to be effective in treating many psychological conditions. Regarding Borderline Personality Disorder (BPD), few programs have been tested; nevertheless, results are promising. The therapeutic alliance is an important factor predicting treatment outcome in BPD. However, we do not know yet to what extent BPD patients form a therapeutic alliance with an eHealth tool and how this relationship differs from the relationship with their human therapist. This study aims to address this question using priovi, an interactive schema therapy-based eHealth tool for BPD. Semi-structured interviews were conducted to explore how patients perceived the therapeutic alliance with priovi and its differences compared to the alliance with their human therapist (N = 9). Interview data were analyzed following the procedures of qualitative content analysis. Additionally, the Working Alliance Inventory (WAI-SR) was administered in two versions (regarding the human therapist and priovi, N = 16) every three months during the treatment phase of one year. Results indicate that patients were able to form a good therapeutic relationship with priovi, but it differed from the relationship to their human therapist. Important categories were "priovi is helpful, supportive and always there" and "priovi is less flexible". WAI ratings for the task subscale were high in both relationships but significantly higher in WAItherapist compared to WAIpriovi in two measurements (nine-months measurement: t = 2.76, df = 15, p = 0.015; twelve-months measurement: t = 3.44, df = 15, p = 0.004). These results indicate that BPD patients can form a functioning alliance with an eHealth program and that eHealth programs may be especially useful for psychoeducation and cognitive exercises. |
159,461 | Does temperature and humidity influence the spread of Covid-19?: A preliminary report | INTRODUCTION: Climate change has been known to influence infectious diseases The reason for this being the fact;disease agents and their vectors each have particular environments that are optimal for growth, survival, transport, and dissemination MATERIALS AND METHODS: The WHO's website was accessed to look for the Novel Coronavirus (COVID-19) situation dashboard and comprehensively study and assess the report An attempt was made to look for countries, areas or territories with maximum and minimum number of cases of lab confirmed COVID cases Further, we entered the words "Climate" in google for each of the aforementioned countries and searched for the results A comparison was established by including countries from both the hemispheres (northern and southern) The preliminary analysis was based on the reports from countries with established testing facilities for Covid-19 RESULTS: The report suggests that countries with higher number of cases are the countries with cold weather These are also the countries with low humidity which could be favoring the transmission and survival of the SARS-COV-2 CONCLUSIONS: The results though preliminary point to a pattern which favors the hypothesis that the extensive spread of Covid-19 maybe limited by temperature and humidity |
159,462 | Chronicles of conflicting care in confinement: Documenting the work experiences of seven ‘patient zeros’ | This article documents the experiences of a group of working women who were amongst the first diagnosed with COVID-19 in their country. Through interviews at two points in time, personal diaries and WhatsApp conversations, we lay bare how feelings of shame, hate and guilt for being patient zeros intersect with the experience of intensified care work during the lockdown. Care during the confinement became a central feature of everyday life and often took a virtual turn, both among families and friends as well as in the distanced workplace. Yet meaningful caregiving from the organizations in times of economic uncertainty was mostly lacking and passed on to individual employees who felt a moral and gendered obligation to substitute for the corporate carelessness. The conflicts of care that emerged out of this situation came at the cost of self-care. We argue that, although the women in our study are mostly privileged, there is a surprising amount of suffering that took place. Finally, we question our own care ethics as researchers in further burdening those suffering in pandemic times to participate in this study. |
159,463 | Metagenomic Next-Generation Sequencing of Nasopharyngeal Specimens Collected from Confirmed and Suspect COVID-19 Patients | Metagenomic next-generation sequencing (mNGS) offers an agnostic approach for emerging pathogen detection directly from clinical specimens In contrast to targeted methods, mNGS also provides valuable information on the composition of the microbiome and might uncover coinfections that may associate with disease progression and impact prognosis To evaluate the use of mNGS for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and/or other infecting pathogens, we applied direct Oxford Nanopore long-read third-generation metatranscriptomic and metagenomic sequencing Nasopharyngeal (NP) swab specimens from 50 patients under investigation for CoV disease 2019 (COVID-19) were sequenced, and the data were analyzed by the CosmosID bioinformatics platform Further, we characterized coinfections and the microbiome associated with a four-point severity index SARS-CoV-2 was identified in 77 5% (31/40) of samples positive by RT-PCR, correlating with lower cycle threshold (Ct) values and fewer days from symptom onset At the time of sampling, possible bacterial or viral coinfections were detected in 12 5% of SARS-CoV-2-positive specimens A decrease in microbial diversity was observed among COVID-19-confirmed patients (Shannon diversity index, P = 0 0082;Chao richness estimate, P = 0 0097;Simpson diversity index, P = 0 018), and differences in microbial communities were linked to disease severity (P = 0 022) Furthermore, statistically significant shifts in the microbiome were identified among SARS-CoV-2-positive and -negative patients, in the latter of whom a higher abundance of Propionibacteriaceae (P = 0 028) and a reduction in the abundance of Corynebacterium accolens (P = 0 025) were observed Our study corroborates the growing evidence that increased SARS-CoV-2 RNA detection from NP swabs is associated with the early stages rather than the severity of COVID-19 Further, we demonstrate that SARS-CoV-2 causes a significant change in the respiratory microbiome This work illustrates the utility of mNGS for the detection of SARS-CoV-2, for diagnosing coinfections without viral target enrichment or amplification, and for the analysis of the respiratory microbiome IMPORTANCE SARS-CoV-2 has presented a rapidly accelerating global public health crisis The ability to detect and analyze viral RNA from minimally invasive patient specimens is critical to the public health response Metagenomic next-generation sequencing (mNGS) offers an opportunity to detect SARS-CoV-2 from nasopharyngeal (NP) swabs This approach also provides information on the composition of the respiratory microbiome and its relationship to coinfections or the presence of other organisms that may impact SARS-CoV-2 disease progression and prognosis Here, using direct Oxford Nanopore long-read third-generation metatranscriptomic and metagenomic sequencing of NP swab specimens from 50 patients under investigation for COVID-19, we detected SARS-CoV-2 sequences by applying the CosmosID bioinformatics platform Further, we characterized coinfections and detected a decrease in the diversity of the microbiomes in these patients Statistically significant shifts in the microbiome were identified among COVID-19-positive and -negative patients, in the latter of whom a higher abundance of Propionibacteriaceae and a reduction in the abundance of Corynebacterium accolens were observed Our study also corroborates the growing evidence that increased SARS-CoV-2 RNA detection from NP swabs is associated with the early stages of disease rather than with severity of disease This work illustrates the utility of mNGS for the detection and analysis of SARS-CoV-2 from NP swabs without viral target enrichment or amplification and for the analysis of the respiratory microbiome |
159,464 | Foot-and-Mouth Disease Virus 3B Protein Interacts with Pattern Recognition Receptor RIG-I to Block RIG-I-Mediated Immune Signaling and Inhibit Host Antiviral Response | Foot-and-mouth disease is a highly contagious disease of pigs, sheep, goats, bovine, and various wild cloven-hoofed animals caused by foot-and-mouth disease virus (FMDV) that has given rise to significant economic loss to global livestock industry. FMDV 3B protein is an important determinant of virulence of the virus. Modifications in 3B protein of FMDV considerably decrease virus yield. In the current study, we demonstrated the significant role of 3B protein in suppression of type I IFN production and host antiviral response in both human embryonic kidney HEK293T cells and porcine kidney PK-15 cells. We found that 3B protein interacted with the viral RNA sensor RIG-I to block RIG-I-mediated immune signaling. 3B protein did not affect the expression of RIG-I but interacted with RIG-I to block the interaction between RIG-I and the E3 ubiquitin ligase TRIM25, which prevented the TRIM25-mediated, Lys63-linked ubiquitination and activation of RIG-I. This inhibition of RIG-I-mediated immune signaling by 3B protein decreased IFN-ß, IFN-stimulated genes, and proinflammatory cytokines expression, which in turn promoted FMDV replication. All of the three nonidentical copies of 3B could inhibit type I IFN production, and the aa 17A in each copy of 3B was involved in suppression of IFN-related antiviral response during FMDV infection in porcine cells. Together, our results indicate the role of 3B in suppression of host innate immune response and reveal a novel antagonistic mechanism of FMDV that is mediated by 3B protein. |
159,465 | COVID-19 preventive behaviors and its related beliefs among health workers: The role of threat and coping appraisals | Aims Health workers are at high risk of novel coronavirus (Covid-19) and preventive behaviors play an important role in reducing the incidence and deaths of this infection Therefore, the aim of the present study was to investigate COVID-19 Preventive Behaviors and its Related Beliefs among Health Workers of Hamadan province using the Extended Parallel Process Model (EPPM) Instruments & Methods This cross-sectional descriptive study was conducted on 950 health workers in Hamadan, in 2020 who were selected by multistage random sampling method The data were collected using a questionnaire including demographic information and EPPM constructs Data were analyzed in STATA 14 using descriptive statistics and Pearson correlation test Findings Behaviors of avoiding contact with others and frequent hand washing with soap and water with 97 8% and 95 3%, respectively, had the highest frequency among health personnel The condition of EPPM constructs was evaluated at a relatively favorable level Also, 46 0% of health personnel were involved in the risk perception process Conclusions It is necessary to improve the level of perceived self-efficacy of employees and also to emphasize the effectiveness of the recommended strategies in the prevention of Covid-19 disease Copyright © 2020, ASP Ins |
159,466 | Association of smoking status with outcomes in hospitalised patients with COVID-19 | INTRODUCTION: Smoking causes inflammation of the lung epithelium by releasing cytokines and impairing mucociliary clearance. Some studies have linked smoking with severity of illness of COVID-19 whereas others have found no such association. METHODS: This was a retrospective analysis of all adults hospitalised with COVID-19 from 9 March to 18 May 2020. RESULTS: 1173 patients met the study criteria. 837 patients never smoked whereas 336 patients were either current smokers or past smoker and were grouped together in smokers group. Patients in smokers group were more likely to be male and had higher incidence of underlying chronic obstructive pulmonary disease (19% vs 6%, p<0.001), HIV infection (11% vs 5%,p<0.001), cancer (11% vs 6%, p=0.005), congestive heart failure (15% vs 8%, p<0.001), coronary artery disease (15% vs 9%, p=0.3), chronic kidney disease (11% vs 8%, p=0.037) and end-stage renal disease (10% vs 6%, p=0.009) compared with non-smokers. Outcome analysis showed that smokers were more likely to develop critical illness requiring mechanical ventilation (47% vs 37% p=0.005). Univariate Cox model for survival analysis by smoking status showed that among smokers only current smokers had higher risk of death compared with never smokers (HR 1.61, 95% CI 1.22 to 2.12, p<0.001). In the multivariate approach, Cox model for the survival, female sex, young age, low serum lactate dehydrogenase and systemic steroid use were associated with overall improved survival. CONCLUSION: In our large single-centre retrospective database of patients hospitalised with COVID-19, smoking was associated with development of critical illness and higher likelihood of death. |
159,467 | Identification of Homo sapiens Cancer Classes based on Fusion of Hidden Gene Features | Classification of Homo sapiens cancer genes in molecular level is a challenging research issue as they are extremely pseudo random in nature. Signature gene features need to be exposed to distinctly identify the gene class. Tree-structured filter bank is chosen to perform feature extraction and dimension reduction of the genes. Extracted gene features are fused using Gaussian mixture probability distribution function and identify different cancer classes depending on amount of correlation and exploiting maximum likelihood function. The algorithm is tested on 161 sample gene data of 7 different cancer classes. Sensitivity, specificity, accuracy, precision and F-score are used as metrics to judge the performance of the system and ROC is plotted in comparison with existing electrical network model based classifier. The proposed classifier can identify more than stated number of cancer classes which is a major limitation of the existing electrical network based method. The proposed algorithm is validated by comparing the results with other seven existing image processing based methods. |
159,468 | Role of Damage-Associated Molecular Patterns in Light of Modern Environmental Research: A Tautological Approach | Two prominent models emerged as a result of intense interdisciplinary discussions on the environmental health paradigm, called the "exposome" concept and the "adverse outcome pathway" (AOP) concept that links a molecular initiating event to the adverse outcome via key events. Here, evidence is discussed, suggesting that environmental stress/injury-induced damage-associated molecular patterns (DAMPs) may operate as an essential integrating element of both environmental health research paradigms. DAMP-promoted controlled/uncontrolled innate/adaptive immune responses reflect the key events of the AOP concept. The whole process starting from exposure to a distinct environmental stress/injury-associated with the presence/emission of DAMPs-up to the manifestation of a disease may be regarded as an exposome. Clinical examples of such a scenario are briefly sketched, in particular, a model in relation to the emerging COVID-19 pandemic, where the interaction of noninfectious environmental factors (e.g., particulate matter) and infectious factors (SARS CoV-2) may promote SARS case fatality via superimposition of both exogenous and endogenous DAMPs. |
159,469 | IFN-γ is an independent risk factor associated with mortality in patients with moderate and severe COVID-19 infection | BACKGROUND: Innate and adaptive immune responses have been evaluated in infected patients with COVID-19. The severity of the disease has been supposed to be associated with some profile not reported with other bacterial and viral pneumonia. We proposed a study in patients with moderate to severe COVID-19 infection to evaluate the interleukin patterns and its role as prognosis factors. METHODS: A prospective cohort with moderate and severe cases of COVID-19 infection from June to July 2020. Blood samples from patients were collected regularly to evaluate IFN-γ, TNF-α, IL-4, IL-6, and IL-10. Clinical, laboratory, radiological data, and outcomes were recorded. The outcome variable was in-hospital death, survival, mechanical ventilation, and admission at the intensive care unit. Data are presented in median and interquartile range [IQR]. RESULTS: We evaluated the Th1 and Th2 responses according to evolution, distinguishing possible predictive markers. The IFN-γ median of 323 pg/mL [IQR 166-570] was found in patients who died and 208 pg/mL [IQR 155-392] in the survival group (p = 0.017). IFN-γ was also higher in the early stages of the disease (394 pg/mL [IQR 229-575] against 162 pg/mL [IQR 117-259], p < 0.001). IL-4 that was increased in late-stage (182 pg/mL [IQR 162-199] against 131 pg/mL [IQR 124-152], p < 0.001) but not associated with mortality. Also, death was also related to male gender (relative risk = 1.5 [95 % confidence interval = 1.1-2.0]). CONCLUSION: Our results suggest that the activation of the host immune response between Th1 or Th2 in COVID-19 infection may be related to the final result between discharge or death. This implies an attempt to control cytokines, such as IFN-γ, with combined therapies for clinical treatment. |
159,470 | IFN-gamma is an independent risk factor associated with mortality in patients with moderate and severe COVID-19 infection | BACKGROUND: Innate and adaptive immune responses have been evaluated in infected patients with COVID-19 The severity of the disease has been supposed to be associated with some profile not reported with other bacterial and viral pneumonia We proposed a study in patients with moderate to severe COVID-19 infection to evaluate the interleukin patterns and its role as prognosis factors METHODS: A prospective cohort with moderate and severe cases of COVID-19 infection from June to July 2020 Blood samples from patients were collected regularly to evaluate IFN-gamma, TNF-alpha, IL-4, IL-6, and IL-10 Clinical, laboratory, radiological data, and outcomes were recorded The outcome variable was in-hospital death, survival, mechanical ventilation, and admission at the intensive care unit Data are presented in median and interquartile range [IQR] RESULTS: We evaluated the Th1 and Th2 responses according to evolution, distinguishing possible predictive markers The IFN-gamma median of 323 pg/mL [IQR 166-570] was found in patients who died and 208 pg/mL [IQR 155-392] in the survival group (p = 0 017) IFN-gamma was also higher in the early stages of the disease (394 pg/mL [IQR 229-575] against 162 pg/mL [IQR 117-259], p 0 001) IL-4 that was increased in late-stage (182 pg/mL [IQR 162-199] against 131 pg/mL [IQR 124-152], p 0 001) but not associated with mortality Also, death was also related to male gender (relative risk = 1 5 [95% confidence interval = 1 1-2 0]) CONCLUSION: Our results suggest that the activation of the host immune response between Th1 or Th2 in COVID-19 infection may be related to the final result between discharge or death This implies an attempt to control cytokines, such as IFN-gamma, with combined therapies for clinical treatment |
159,471 | Coronavirus Disease 2019 Suspicion: A Case Report Regarding a Male Emergency Medical Service Pilot With Newly Diagnosed Sarcoidosis | A 38-year-old emergency medical service Bell 214 male pilot with a dry cough, fever, anorexia, fatigue, and sweating for the past 3 days; an oral temperature of 38°C; blood pressure of 105/65 mm Hg; heart rate of 94 beats/min; respiratory rate of 21 breaths/min; and pulse oximetry of 93% on room air was suspicious for coronavirus disease 2019. Surprisingly, reverse transcription polymerase chain reaction was negative, but bilateral hilar adenopathy was reported in his chest radiography as a new challenge. The pathologic report of the adenopathy biopsy was noncaseating sarcoid-type granulomas. Serologic tests showed a serum angiotensin-converting enzyme level of 58 nmol/mL/min. The bronchoalveolar lavage fluid CD4/CD8 ratio was 3.68. The bronchoalveolar lavage findings provided an accurate sarcoidosis diagnosis, and a high-resolution computed tomographic scan revealed stage 1 pulmonary involvement. Because of the pulmonary involvement, clinical manifestations, use of inhaled fluticasone, and need for longer and accurate follow-up and to protect against coronavirus disease 2019, he has been temporarily suspended until the final assignment. |
159,472 | Coronavirus Disease 2019 Suspicion: A Case Report Regarding a Male Emergency Medical Service Pilot With Newly Diagnosed Sarcoidosis | A 38-year-old emergency medical service Bell 214 male pilot with a dry cough, fever, anorexia, fatigue, and sweating for the past 3 days; an oral temperature of 38°C; blood pressure of 105/65 mm Hg; heart rate of 94 beats/min; respiratory rate of 21 breaths/min; and pulse oximetry of 93% on room air was suspicious for coronavirus disease 2019. Surprisingly, reverse transcription polymerase chain reaction was negative, but bilateral hilar adenopathy was reported in his chest radiography as a new challenge. The pathologic report of the adenopathy biopsy was noncaseating sarcoid-type granulomas. Serologic tests showed a serum angiotensin-converting enzyme level of 58 nmol/mL/min. The bronchoalveolar lavage fluid CD4/CD8 ratio was 3.68. The bronchoalveolar lavage findings provided an accurate sarcoidosis diagnosis, and a high-resolution computed tomographic scan revealed stage 1 pulmonary involvement. Because of the pulmonary involvement, clinical manifestations, use of inhaled fluticasone, and need for longer and accurate follow-up and to protect against coronavirus disease 2019, he has been temporarily suspended until the final assignment. |
159,473 | COVID-19 aus der Sicht der Gastroenterologie | Acute ischemic stroke (AIS) is a life-threatening complication of coronavirus disease 2019 (COVID-19) infection Increasing reports suggest an association between COVID-19 and AIS, although the underlying mechanism remains uncertain We performed a systematic review to characterize the clinical characteristics, neuroimaging findings, and outcomes of AIS in COVID-19 patients A literature search was performed in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 29th May 2020 All studies reporting AIS occurrence in COVID-19 patients were included A total of 39 studies comprising 135 patients were studied The pooled incidence of AIS in COVID-19 patients from observational studies was 1 2% (54/4466) with a mean age of 63 4 ± 13 1 years The mean duration of AIS from COVID-19 symptoms onset was 10 ± 8 days, and the mean NIHSS score was 19 ± 8 Laboratory investigations revealed an elevated mean d-dimer (9 2 ± 14 8 mg/L) and fibrinogen (5 8 ± 2 0 g/L) Antiphospholipid antibodies were detected in a significant number of cases The majority of AIS neuroimaging patterns observed was large vessel thrombosis, embolism or stenosis (62 1%, 64/103), followed by multiple vascular territory (26 2%, 27/103) A high mortality rate was reported (38 0%, 49/129) We report the pooled incidence of AIS in COVID-19 patients to be 1 2%, with a high mortality rate Elevated d-dimer, fibrinogen and the presence of antiphospholipid antibodies appear to be prominent in COVID-19 patients with concomitant AIS, but further mechanistic studies are required to elucidate their role in pathogenesis |
159,474 | Effect of a nurse-led hypertension management program on quality of life, medication adherence and hypertension management in older adults: A randomized controlled trial | AIM: This study evaluated the effects of a nurse-led hypertension management program on quality of life, medication adherence and hypertension management in older adults. METHODS: A total of 74 hypertensive older adults residing in two different nursing homes were randomized to the intervention group (n = 37) or control group (n = 37). The intervention group participated in a training program consisting of 20 weeks of health education and motivational meetings. Data were collected using a hypertension management knowledge and behavior questionnaire, quality of life scale, Morisky Medication Adherence Scale, and measurements of blood pressure and anthropometric and biochemical parameters. Data were analyzed using the χ2 -test, Wilcoxon signed-rank test and Mann-Whitney U-test. RESULTS: Post-test systolic (118.64 ± 10.04 mmHg) and diastolic (77.83 ± 5.34 mmHg) blood pressures, and total cholesterol levels (178.43 ± 25.59 mg/dL) were significantly lower in the intervention group compared with the control group (130.54 ± 15.08 mmHg, 82.70 ± 7.69 mmHg, 200.7 ± 34.57 mg/dL, respectively). Post-test hypertension knowledge score (20.75 ± 1.01), medication adherence rate (100.0%), and quality of life scale physical component (58.42 ± 13.93) and mental component (64.24 ± 12.85) scores were significantly higher in the intervention group than in the control group (12.21 ± 2.48; 64.9%; 44.36 ± 16.73; 53.93 ± 15.71, respectively). In addition, mean post-test body mass index (27.19 ± 4.62 kg/m2 ), weight (74.81 ± 15.33 kg), waist circumference (93.29 ± 15.20 cm), hip circumference (107.67 ± 14.05 cm) and total cholesterol (178.43 ± 25.59 mg/dL) values were lower than pretest (28.13 ± 4.96 kg/m2 ; 77.37 ± 16.56 kg; 97.83 ± 16.23 cm; 112.89 ± 14.37 cm; 194.78 ± 38.64 mg/dL, respectively) in the intervention group. CONCLUSIONS: The nurse-led hypertension management program implemented in this study provides an example of an effective program to guide nurses who work with older adults. Geriatr Gerontol Int 2020; â¢â¢: â¢â¢-â¢â¢. |
159,475 | Neuronal Ablation of Alpha/Beta Interferon (IFN-α/ß) Signaling Exacerbates Central Nervous System Viral Dissemination and Impairs IFN-γ Responsiveness in Microglia/Macrophages | Alpha/beta interferon (IFN-α/ß) signaling through the IFN-α/ß receptor (IFNAR) is essential to limit virus dissemination throughout the central nervous system (CNS) following many neurotropic virus infections. However, the distinct expression patterns of factors associated with the IFN-α/ß pathway in different CNS resident cell populations implicate complex cooperative pathways in IFN-α/ß induction and responsiveness. Here we show that mice devoid of IFNAR1 signaling in calcium/calmodulin-dependent protein kinase II alpha (CaMKIIα) expressing neurons (CaMKIIcre:IFNARfl/fl mice) infected with a mildly pathogenic neurotropic coronavirus (mouse hepatitis virus A59 strain [MHV-A59]) developed severe encephalomyelitis with hind-limb paralysis and succumbed within 7 days. Increased virus spread in CaMKIIcre:IFNARfl/fl mice compared to IFNARfl/fl mice affected neurons not only in the forebrain but also in the mid-hind brain and spinal cords but excluded the cerebellum. Infection was also increased in glia. The lack of viral control in CaMKIIcre:IFNARfl/fl relative to control mice coincided with sustained Cxcl1 and Ccl2 mRNAs but a decrease in mRNA levels of IFNα/ß pathway genes as well as Il6, Tnf, and Il1ß between days 4 and 6 postinfection (p.i.). T cell accumulation and IFN-γ production, an essential component of virus control, were not altered. However, IFN-γ responsiveness was impaired in microglia/macrophages irrespective of similar pSTAT1 nuclear translocation as in infected controls. The results reveal how perturbation of IFN-α/ß signaling in neurons can worsen disease course and disrupt complex interactions between the IFN-α/ß and IFN-γ pathways in achieving optimal antiviral responses.IMPORTANCE IFN-α/ß induction limits CNS viral spread by establishing an antiviral state, but also promotes blood brain barrier integrity, adaptive immunity, and activation of microglia/macrophages. However, the extent to which glial or neuronal signaling contributes to these diverse IFN-α/ß functions is poorly understood. Using a neurotropic mouse hepatitis virus encephalomyelitis model, this study demonstrated an essential role of IFN-α/ß receptor 1 (IFNAR1) specifically in neurons to control virus spread, regulate IFN-γ signaling, and prevent acute mortality. The results support the notion that effective neuronal IFNAR1 signaling compensates for their low basal expression of genes in the IFN-α/ß pathway compared to glia. The data further highlight the importance of tightly regulated communication between the IFN-α/ß and IFN-γ signaling pathways to optimize antiviral IFN-γ activity. |
159,476 | [Analysis of variation and evolution of SARS-CoV-2 genome] | OBJECTIVE: To analyze the evolution and variation of SARS-CoV-2 during the epidemic starting at the end of 2019 METHODS: We downloaded the full-length genome sequence of SARS-CoV-2 from the databases of GISAID and NCBI Using the software for bioinformatics including MEGA-X, BEAST, and TempEst, we constructed the genomic evolution tree, inferred the time evolution signal of the virus, calculated the tMRCA time of the virus and analyzed the selection pressure of the virus during evolution RESULTS: The phylogenetic tree showed that SARS-CoV-2 belonged to the Sarbecovirus subgenus of beta Coronavirus genus together with bat coronavirus BetaCoV/bat/Yunnan/RaTG13/2013, bat-SL-CoVZC45, bat-SL-CoVZXC21 and SARS-CoV The genomic sequences of SARS-CoV-2 isolated from the ongoing epidemic showed a weak time evolution signal with an average tMRCA time of 73 days (95% CI: 38 9-119 3 days) No positive time evolution signal was found between SARS-CoV-2 and BetaCoV/bat/Yunnan/RaTG13/2013, but the former virus had a strong positive temporal evolution relationship with bat-SL-CoVZC45 and SARS-CoV The major cause for mutations of SARS-CoV-2 was the pressure of purification selection during the epidemic CONCLUSIONS: SARS-CoV-2 may have emerged as early as November, 2019, originating most likely from bat-associated coronavirus This finding may provide evidence for tracing the sources and evolution of the virus |
159,477 | [Analysis of variation and evolution of SARS-CoV-2 genome] | OBJECTIVE: To analyze the evolution and variation of SARS-CoV-2 during the epidemic starting at the end of 2019. METHODS: We downloaded the full-length genome sequence of SARS-CoV-2 from the databases of GISAID and NCBI. Using the software for bioinformatics including MEGA-X, BEAST, and TempEst, we constructed the genomic evolution tree, inferred the time evolution signal of the virus, calculated the tMRCA time of the virus and analyzed the selection pressure of the virus during evolution. RESULTS: The phylogenetic tree showed that SARS-CoV-2 belonged to the Sarbecovirus subgenus of ß Coronavirus genus together with bat coronavirus BetaCoV/bat/Yunnan/RaTG13/2013, bat-SL-CoVZC45, bat-SL-CoVZXC21 and SARS-CoV. The genomic sequences of SARS-CoV-2 isolated from the ongoing epidemic showed a weak time evolution signal with an average tMRCA time of 73 days (95% CI: 38.9-119.3 days). No positive time evolution signal was found between SARS-CoV-2 and BetaCoV/bat/Yunnan/RaTG13/2013, but the former virus had a strong positive temporal evolution relationship with bat-SL-CoVZC45 and SARS-CoV. The major cause for mutations of SARS-CoV-2 was the pressure of purification selection during the epidemic. CONCLUSIONS: SARS-CoV-2 may have emerged as early as November, 2019, originating most likely from bat-associated coronavirus. This finding may provide evidence for tracing the sources and evolution of the virus. |
159,478 | Is the COVID-19 disease associated with de novo nephritic syndrome? | INTRODUCTION: This study aims to determine the incidence of de novo nephritic syndrome (NS) in COVID-19 patients and identify its associated factors METHODS: All ward patients with COVID-19 pneumonia were investigated After determining the inclusion and exclusion criteria, the study population was identified The urine dipstick test and urine protein creatinine ratio (UPCR) measurements were performed Patients with de novo NS findings, nasopharyngeal swab, and urine RT-PCR tests were performed simultaneously RESULTS: This descriptive cross-sectional study was conducted with 21 patients with COVID-19 The mean age of the patients was 42 2±8 8 years, and 71 4% of them were male The mean duration of follow-up was 28 4±9 3 days The urine RT-PCR test was positive in one patient (4 8%) Improvements were observed in hematuria by 71 4%, and proteinuria by 85 7% at the end of the follow-up A significant decrease in the measured UPCR was found in comparison to the baseline(P=0 000) Also, improvements were recorded in the complete blood counts, inflammatory parameters, ferritin, and coagulation tests, compared to the baseline There was a positive correlation between baseline UPCR and ferritin, and a negative correlation between baseline UPCR and sodium values CONCLUSION: COVID-19-induced de novo nephritic syndrome may occur mainly due to tubulointerstitial involvement and often results in spontaneous remission However, why these findings were not present in all patients who had no comorbidities is not clear |
159,479 | Spatiotemporal patterns and trends of community transmission of the pandemic COVID-19 in South Asia: Bangladesh as a case study | South Asian (SA) countries have been fighting with the pandemic novel coronavirus disease 2019 (COVID-19) since January 2020. Earlier, the country-specific descriptive study has been done. Nevertheless, as transboundary infection, the border sharing, shared cultural and behaviour practice, effects on the temporal and spatial distribution of COVID-19 in SA is still unveiled. Therefore, this study has been revealed the spatial hotspot along with descriptive output on different parameters of COVID-19 infection. We extracted data from the WHO and the worldometer database from the onset of the outbreak up to 15 May 2020. Europe has the highest case fatality rate (CFR; 9.22%), whereas Oceania has the highest (91.15%) recovery rate from COVID-19. Among SA countries, India has the highest number of cases (85,790), followed by Pakistan (38,799) and Bangladesh (20,065). However, the number of tests conducted was minimum in this region in comparison with other areas. The highest CFR was recorded in India (3.21%) among SA countries, whereas Nepal and Bhutan had no death record due to COVID-19 so far. The recovery rate varies from 4.75% in the Maldives to 51.02% in Sri Lanka. In Bangladesh, community transmission has been recorded, and the highest number of cases were detected in Dhaka, followed by Narayanganj and Chattogram. Dhaka and its surrounding districts, Faridpur and Madaripur district of Bangladesh, is in the hotspot on the spatiotemporal tendency. But no cold spot was pointed out in Bangladesh. Three hotspots and three cold spots at different confidence levels were detected in India. Findings from this study suggested the "test, trace, and isolation" approach for earlier detection of infection to prevent further community transmission of COVID-19. |
159,480 | Coronavirus disease 2019: challenges of managing a rapidly emerging infection | The objective of the article was to discuss the epidemiology, transmission, pathogenesis, clinical manifestations, investigation, treatment, and infection control and prevention of COVID-19 |
159,481 | Wuchang Fangcang Shelter Hospital: Practices, Experiences, and Lessons Learned in Controlling COVID-19 | In early January 2020, the outbreak of the new corona virus pneumonia (Corona Virus Disease 2019, COVID-19) occurred. Wuhan, the capital city of Hubei province, became the epicenter of the disease in China. The rapid growth of patients had exceeded the maximum affordability of local medical resources. A large comprehensive gymnasium was converted into Wuchang Fangcang Shelter Hospital in order to provide adequate medical beds and appropriate care for the confirmed patients with mild to moderate symptoms. For these hospitalized patients with COVID-19, medication became the mainstay of therapy. From 5th February to 10th March, a team of pharmacists successfully completed drug supplies and pharmaceutical services for 1124 patients and approximately 800 medical staff, and, while doing so, received zero complaint, and experienced zero disputes and zero pharmacist infection. This paper summarizes the development and construction of the pharmacy, human resource allocation of pharmacists, pharmacy administration, and pharmaceutical services. It aims to review a 34-day period of pharmaceutical practice and serve as a reference for other health professionals working on COVID-19 prevention and treatment in other regions. |
159,482 | Human B cell clonal expansion and convergent antibody responses to SARS-CoV-2 | During virus infection B cells are critical for the production of antibodies and protective immunity Here we show that the human B cell compartment in patients with diagnostically confirmed SARS-CoV-2 and clinical COVID-19 is rapidly altered with the early recruitment of B cells expressing a limited subset of IGHV genes, progressing to a highly polyclonal response of B cells with broader IGHV gene usage and extensive class switching to IgG and IgA subclasses with limited somatic hypermutation in the initial weeks of infection We identify extensive convergence of antibody sequences across SARS-CoV-2 patients, highlighting stereotyped naive responses to this virus Notably, sequence-based detection in COVID-19 patients of convergent B cell clonotypes previously reported in SARS-CoV infection predicts the presence of SARS-CoV/SARS-CoV-2 cross-reactive antibody titers specific for the receptor-binding domain These findings offer molecular insights into shared features of human B cell responses to SARS-CoV-2 and other zoonotic spillover coronaviruses |
159,483 | Human B Cell Clonal Expansion and Convergent Antibody Responses to SARS-CoV-2 | B cells are critical for the production of antibodies and protective immunity to viruses. Here we show that patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who develop coronavirus disease 2019 (COVID-19) display early recruitment of B cells expressing a limited subset of IGHV genes, progressing to a highly polyclonal response of B cells with broader IGHV gene usage and extensive class switching to IgG and IgA subclasses with limited somatic hypermutation in the initial weeks of infection. We identify convergence of antibody sequences across SARS-CoV-2-infected patients, highlighting stereotyped naive responses to this virus. Notably, sequence-based detection in COVID-19 patients of convergent B cell clonotypes previously reported in SARS-CoV infection predicts the presence of SARS-CoV/SARS-CoV-2 cross-reactive antibody titers specific for the receptor-binding domain. These findings offer molecular insights into shared features of human B cell responses to SARS-CoV-2 and SARS-CoV. |
159,484 | Lessons from the Covid-19 pandemic: Sustainability is an indispensable condition of global health security | Among the possible developments of the Covid-19 pandemic at the international and national levels is the advancement of the Global Health Security (GHS) agenda. On the one hand, GHS might be able to give priority to health problems on the political agenda-setting, on the other, however, it might open up space for public security actors in decision-making processes to the detriment of the power of health authorities. This article critically analyzes the concept and the progress of the GHS agenda seeking to demonstrate that there can be no security in matters of public health when sustainability in its multiple dimensions is not taken into account. At the end, sustainability has a twofold responsibility: to maintain the consistency and permanence of emergency response actions, especially with investments in public health systems, with universal access, and to minimize the structural causes of pandemics linked to the environment. |
159,485 | Prevalence of posttraumatic and general psychological stress during COVID-19: A rapid review and meta-analysis | Emerging evidence suggests rates of posttraumatic stress and psychological stress in the general population are elevated due to COVID-19. However, a meta-analysis is needed to attain more precise prevalence estimates due to between-study variability. Thus, we performed a rapid review and meta-analysis of posttraumatic stress and general psychological stress symptoms during COVID-19. Electronic searches were conducted up to May 26th, 2020 using key terms: mental illness and COVID-19. A total of k = 14 non-overlapping studies were identified for inclusion. Random effects meta-analyses indicated that the pooled prevalence of posttraumatic stress symptoms and psychological stress in the general population was 23.88% and 24.84%, respectively. In both meta-analyses, the prevalence of stress symptoms was higher in unpublished compared to peer-reviewed studies. Overall, nearly one-in-four adults experienced significant stress due to the COVID-19 pandemic. Psychological resources and services must be allocated to help address the mental health burden of COVID-19. High quality, longitudinal research on the long-term mental health effects of the pandemic is greatly needed. |
159,486 | Impact of population density on Covid-19 infected and mortality rate in India | The Covid-19 is a highly contagious disease which becomes a serious global health concern. The residents living in areas with high population density, such as big or metropolitan cities, have a higher probability to come into close contact with others and consequently any contagious disease is expected to spread rapidly in dense areas. However, recently, after analyzing Covid-19 cases in the USA researchers at the Johns Hopkins Bloomberg School of Public Health, London school of economics, and IZA-Institute of Labour Economics conclude that the spread of Covid-19 is not linked with population density. Here, we investigate the influence of population density on Covid-19 spread and related mortality in the context of India. After a detailed correlation and regression analysis of infection and mortality rates due to Covid-19 at the district level, we find moderate association between Covid-19 spread and population density. |
159,487 | Angiotensin Converting Enzyme 2 (ACE2) in Pregnancy: Preeclampsia and Small for Gestational Age | Introduction: An imbalance in angiotensin (Ang) peptides could contribute to the pathophysiology of preeclampsia (PE) and poor fetal growth Methods: We measured maternal plasma levels of Ang peptides and converting enzymes in non-pregnant women (n = 10), in normal pregnant women (n = 59), women delivering small for gestational age babies (SGA, n = 25) across gestation (13–36 weeks) and in women with PE (n = 14) in their third trimester Results: Plasma ACE, ACE2, and Ang-(1-7) levels, and ACE2 activity were significantly higher in normal pregnant women compared with non-pregnant women;neprilysin (NEP) levels were not changed In SGA pregnancies, ACE and ACE2 levels were higher in early-mid pregnancy compared with normal pregnant women In women with PE, plasma ACE, ACE2, NEP, and Ang-(1-7) levels and ACE2 activity were lower than levels in normal pregnant women Conclusion: The higher plasma ACE2 levels and activity in pregnancy could be driving the higher Ang-(1-7) levels The early gestation increases in ACE and ACE2 levels in SGA pregnancies highlights the possibility that these enzymes could be used as potential early biomarkers of poor fetal growth In women with PE, the reduced ACE2 and NEP levels at term, could be contributing to the reduction in Ang-(1-7) levels These findings suggest that dysfunctional relationships between two key enzymes in the circulating RAS are involved in the pathogenesis of PE and SGA Since soluble ACE2 can prevent binding of the novel coronavirus, SARS-CoV-2, to membrane bound ACE2, the interplay between ACE2 and the coronavirus and its impact in pregnancy requires further investigation |
159,488 | Excessive Neutrophils and Neutrophil Extracellular Traps in COVID-19 | Background: Cases of excessive neutrophil counts in the blood in severe coronavirus disease (COVID-19) patients have drawn significant attention. Neutrophil infiltration was also noted on the pathological findings from autopsies. It is urgent to clarify the pathogenesis of neutrophils leading to severe pneumonia in COVID-19. Methods: A retrospective analysis was performed on 55 COVID-19 patients classified as mild (n = 22), moderate (n = 25), and severe (n = 8) according to the Guidelines released by the National Health Commission of China. Trends relating leukocyte counts and lungs examined by chest CT scan were quantified by Bayesian inference. Transcriptional signatures of host immune cells of four COVID19 patients were analyzed by RNA sequencing of lung specimens and BALF. Results: Neutrophilia occurred in 6 of 8 severe patients at 7-19 days after symptom onset, coinciding with lesion progression. Increasing neutrophil counts paralleled lesion CT values (slope: 0.8 and 0.3-1.2), reflecting neutrophilia-induced lung injury in severe patients. Transcriptome analysis revealed that neutrophil activation was correlated with 17 neutrophil extracellular trap (NET)-associated genes in COVID-19 patients, which was related to innate immunity and interacted with T/NK/B cells, as supported by a protein-protein interaction network analysis. Conclusion: Excessive neutrophils and associated NETs could explain the pathogenesis of lung injury in COVID-19 pneumonia. |
159,489 | [Practice and thinking of acute respiratory infection surveillance for the response of emerging respiratory diseases in Shanghai] | Shanghai Municipal Center for Disease Control and Prevention has implemented an active comprehensive surveillance project of acute respiratory infections in adults in Shanghai, including influenza like illness (ILI) and severe acute respiratory infection (SARI). By testing and identifying a variety of respiratory pathogens, it was found that influenza viruses were the main pathogens in 172 ILI cases in 2019. The positive rates of influenza A (H1N1) pdm09 virus, influenza A (H3N2) virus and influenza B virus Victoria lineage were 30.81%, 14.53% and 30.55%, respectively. The positive detection of influenza A (H1N1) pdm09 virus peaked in the first quarter. The positive rate of enterovirus/human rhinovirus was 6.40%, with a positive detection peak in the third quarter, while the positive rate of adenovirus was 4.65% with a positive detection peak in the second quarter of the year. Two human coronavirus (HCoV)-OC43 positive samples, 1 HCoV-HKU1 positive sample and 1 HCoV-NL63 positive sample were detected, respectively, and no HCoV-229E positive sample was detected. The detection rate of Staphylococcus aureus was 17.44%, and the detection rate of Klebsiella pneumoniae was 9.88%. Influenza viruses were also the main pathogens in 1 447 SARI cases. The positive rates of influenza A (H1N1) pdm09 virus, influenza A (H3N2) virus and influenza B virus Victoria lineage were 5.46%, 1.73% and 0.30%, respectively. The positive detection of influenza A (H1N1) pdm09 virus (17.50%) peaked in the first quarter. The total positive detection rate of enterovirus/human rhinovirus was 2.97%, the positive detection peaked in the first quarter. The positive rate of Mycoplasma pneumoniae was 3.25% and the positive rate of Legionella was 1.04%. 5 HCoV-229E positive samples, 10 HCoV-OC43 positive samples, 7 HCoV-HKU1 positive samples and 6 HCoV-NL63 positive samples were detected. Eight strains of Staphylococcus aureus, 4 strains of Pseudomonas aeruginosa and 3 strains of Klebsiella pneumoniae were detected after cultures. By implementing the active surveillance, we not only detected a case of human infection with avian influenza A(H7N9) virus in time, but also preliminary understood the pathogenic spectrum characteristics and seasonality of ILI and SARI in Shanghai. In recent years, the surveillance methods have been continuously improved and the number of sentinel hospitals has increased gradually. In particular, for the response to COVID-19, the Surveillance Information Reporting System of Acute Respiratory Infection based on HIS system has been promoted to cover the whole city, which might lay a foundation for the active surveillance and early warning of emerging infectious diseases in the future. |
159,490 | Large vessel stroke and COVID-19: Case report and literature review | The clinical signs of coronavirus disease-19 (COVID-19) can be heterogenous because of the diversity of potential organ involvement. We describe a 58-year-old woman who developed new-onset dysarthria and hemiplegia and was found to be COVID-19-positive. This is among the first cases of COVID-19 presenting solely with focal neurologic deficits. |
159,491 | Implementation of rapid SARS-CoV-2 antigenic testing in a laboratory without access to molecular methods: Experiences of a general hospital | BACKGROUND: The COVID-19 Ag (Antigen) Respi-Strip assay is a new immunochromatographic diagnostic tool recently available for antigenic diagnosis of SARS-CoV-2. The proposed sensitivity is not higher than 60 %, but its high specificity allows both quick decisions for the management of patients and confirmation by molecular diagnosis for only negative tests. However, from the first tests performed, we suspected that the sensitivity observed with routine use was much lower than that announced by the manufacturer. MATERIALS AND METHODS: Over a period of one month, we compared the negative results obtained with the COVID-19 Ag Respi-Strip kit with those obtained from qRT-PCR performed in a laboratory qualified for the molecular diagnosis of SARS-CoV-2. All samples tested were naso-pharyngeal smears from UTM-RT medium. RESULTS: Of 774 patients tested, 714 negative samples were sent for confirmation, and 159 were found to be positive by qRT-PCR. The median positive percentage agreement was 23.9 % (95 % CI: 14.2 %-38.2 %). The Cohen's kappa score was 0.35. CONCLUSION: Using this immunochromatographic assay as a triage test did not significantly reduce the number of samples outsourced for COVID-19 confirmation by qRT-PCR. In addition, even if the turn-around time is short, the assay is completely manual, which is not suitable for large volumes of routine samples. The sensitivity of this rapid test is poor, and improvements are needed to enhance its performance. |
159,492 | European environment policy for the circular economy: Implications for business and industry stakeholders | European Union (EU) institutions and agencies are increasingly raising awareness on the circular economy agenda They are encouraging marketplace stakeholders to engage in sustainable production and consumption behaviors by reducing, reusing, restoring, refurbishing, and recycling resources in all stages of their value chain Therefore, this research evaluates the latest European environmental policies including its ?new circular economy plans for a cleaner and more competitive Europe ? Afterwards, it presents a systematic literature review that is focused on the circular economy in the EU context The findings suggest that there are a number of opportunities as well as challenges for the successful planning, organization, implementation, and measurement of circular economy practices for sustainable supply chains in Europe This contribution identifies key implications and provides reasonable recommendations to policy makers and industry practitioners |
159,493 | Buying time for an effective epidemic response: The impact of a public holiday for outbreak control on COVID-19 epidemic spread | Rapid responses in the early stage of a new epidemic are crucial in outbreak control. Public holidays for outbreak control could provide a critical time window for a rapid rollout of social distancing and other control measures at a large population scale. The objective of our study was to explore the impact of the timing and duration of outbreak-control holidays on the coronavirus disease 2019 (COVID-19) epidemic spread during the early stage in China. We developed a compartment model to simulate the dynamic transmission of COVID-19 in China starting from January 2020. We projected and compared epidemic trajectories with and without an outbreak-control holiday that started during the Chinese Lunar New Year. We considered multiple scenarios of the outbreak-control holiday with different durations and starting times, and under different assumptions about viral transmission rates. We estimated the delays in days to reach certain thresholds of infections under different scenarios. Our results show that the outbreak-control holiday in China likely stalled the spread of COVID-19 for several days. The base case outbreak-control holiday (21 d for Hubei province and 10 days for all other provinces) delayed the time to reach 100â000 confirmed infections by 7.54 d. A longer outbreak-control holiday would have had stronger effects. A nationwide outbreak-control holiday of 21 d would have delayed the time to 100â000 confirmed infections by nearly 10 d. Furthermore, we find that outbreak-control holidays that start earlier in the course of a new epidemic are more effective in stalling epidemic spread than later holidays and that additional control measures during the holidays can boost the holiday effect. In conclusion, an outbreak-control holiday can likely effectively delay the transmission of epidemics that spread through social contacts. The temporary delay in the epidemic trajectory buys time, which scientists can use to discover transmission routes and identify effective public health interventions and which governments can use to build physical infrastructure, organize medical supplies, and deploy human resources for long-term epidemic mitigation and control efforts. |
159,494 | Delivering a work-integrated learning postgraduate course during COVID-19: Experiences, challenges and strategies | COVID-19 has had a significant impact on teaching and learning in postgraduate education In particular, work integrated learning, in health care settings, has been disrupted in many ways negatively impacting student learning Our Clinical Redesign courses are designed to deliver work-integrated learning in partnership with healthcare organisations to deliver workplace projects in real time, which has been complicated by COVID-19 This reflection examines the challenges that arose in the healthcare redesign teaching and learning space during the COVID-19 pandemic We explore the experiences of our work-integrated learning students using Johns' reflection model (1) Our students faced disruption to their education, workplaces and personal lives, and the experiences of our teaching team whose teaching philosophies were challenged In response to the ongoing challenges, we developed strategies for supporting our students including the development of virtual projects for students who no longer had access to their workplaces or project appropriate resources |
159,495 | Impact along the HIV pre-exposure prophylaxis "cascade of prevention" in western Kenya: a mathematical modelling study | INTRODUCTION: Over one hundred implementation studies of HIV pre-exposure prophylaxis (PrEP) are completed, underway or planned. We synthesized evidence from these studies to inform mathematical modelling of the prevention cascade for oral and long-acting PrEP in the setting of western Kenya, one of the world's most heavily HIV-affected regions. METHODS: We incorporated steps of the PrEP prevention cascade - uptake, adherence, retention and re-engagement after discontinuation - into EMOD-HIV, an open-source transmission model calibrated to the demography and HIV epidemic patterns of western Kenya. Early PrEP implementation research from East Africa was used to parameterize prevention cascades for oral PrEP as currently implemented, delivery innovations for oral PrEP, and future long-acting PrEP. We compared infections averted by PrEP at the population level for different cascade assumptions and sub-populations on PrEP. Analyses were conducted over the 2020 to 2040 time horizon, with additional sensitivity analyses for the time horizon of analysis and the time when long-acting PrEP becomes available. RESULTS: The maximum impact of oral PrEP diminished by over 98% across all prevention cascades, with the exception of long-acting PrEP under optimistic assumptions about uptake and re-engagement after discontinuation. Long-acting PrEP had the highest population-level impact, even after accounting for possible delays in product availability, primarily because its effectiveness does not depend on drug adherence. Retention was the most significant cascade step reducing the potential impact of long-acting PrEP. These results were robust to assumptions about the sub-populations receiving PrEP, but were highly influenced by assumptions about re-initiation of PrEP after discontinuation, about which evidence was sparse. CONCLUSIONS: Implementation challenges along the prevention cascade compound to diminish the population-level impact of oral PrEP. Long-acting PrEP is expected to be less impacted by user uptake and adherence, but it is instead dependent on product availability in the short term and retention in the long term. To maximize the impact of long-acting PrEP, ensuring timely product approval and rollout is critical. Research is needed on strategies to improve retention and patterns of PrEP re-initiation. |
159,496 | Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19 | The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102-105 gc/ml) and feces (ca. 102-107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105-1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector. |
159,497 | Consensus on predictors of clinical deterioration in emergency departments: A Delphi process study | AIM: The study aim was to determine relevance and applicability of generic predictors of clinical deterioration in emergency departments based on consensus among clinicians. METHODS: Thirty-three predictors of clinical deterioration identified from literature were assessed in a modified two-stage Delphi-process. Sixty-eight clinicians (physicians and nurses) participated in the first round and 48 in the second round; all treating hospitalized patients in Danish emergency departments, some with pre-hospital experience. The panel rated the predictors for relevance (relevant marker of clinical deterioration) and applicability (change in clinical presentation over time, generic in nature and possible to detect bedside). They rated their level of agreement on a 9-point Likert scale and were also invited to propose additional generic predictors between the rounds. New predictors suggested by more than one clinician were included in the second round along with non-consensus predictors from the first round. Final decisions of non-consensus predictors after second round were made by a research group and an impartial physician. RESULTS: The Delphi-process resulted in 19 clinically relevant and applicable predictors based on vital signs and parameters (respiratory rate, saturation, dyspnoea, systolic blood pressure, pulse rate, abnormal electrocardiogram, altered mental state and temperature), biochemical tests (serum c-reactive protein, serum bicarbonate, serum lactate, serum pH, serum potassium, glucose, leucocyte counts and serum haemoglobin), objective clinical observations (skin conditions) and subjective clinical observations (pain reported as new or escalating, and relatives' concerns). CONCLUSION: The Delphi-process led to consensus of 19 potential predictors of clinical deterioration widely accepted as relevant and applicable in emergency departments. |
159,498 | The prediction of COVID-19 spread in Iran from 15 March to 15 April 2020 | Background: Over 150,000 confirmed cases, around 140 countries, and about 6,000 death occurred owing to coronavirus disease 2019 (COVID-19) pandemic in China, Italy, Iran, and South Korea Iran reported its first confirmed cases of COVID-19 in Qom City on 19 February 2020 and has the third-highest number of COVID-19 deaths after China and Italy and the highest inWestern Asia |
159,499 | Trajectories of vital signs in patients with COVID-19 | BACKGROUND: The global pandemic of coronavirus disease 2019 (COVID-19) has placed a huge strain on UK hospitals. Early studies suggest that patients can deteriorate quickly after admission to hospital. The aim of this study was to model changes in vital signs for patients hospitalised with COVID-19. METHODS: This was a retrospective observational study of adult patients with COVID-19 admitted to one acute hospital trust in the UK (CV) and a cohort of patients admitted to the same hospital between 2013-2017 with viral pneumonia (VI). The primary outcome was the start of continuous positive airway pressure/non-invasive positive pressure ventilation, ICU admission or death in hospital. We used non-linear mixed-effects models to compare changes in vital sign observations prior to the primary outcome. Using observations and FiO2 measured at discharge in the VI cohort as the model of normality, we also combined individual vital signs into a single novelty score. RESULTS: There were 497 cases of COVID-19, of whom 373 had been discharged from hospital. 135 (36.2%) of patients experienced the primary outcome, of whom 99 died in hospital. In-hospital mortality was over 4-times higher in the CV than the VI cohort (26.5% vs 6%). For those patients who experienced the primary outcome, CV patients became increasingly hypoxaemic, with a median estimated FiO2 (0.75) higher than that of the VI cohort (estimated FiO2 of 0.35). Prior to the primary outcome, blood pressure remained within normal range, and there was only a small rise in heart rate. The novelty score showed that patients with COVID-19 deteriorated more rapidly that patients with viral pneumonia. CONCLUSIONS: Patients with COVID-19 who deteriorate in hospital experience rapidly-worsening respiratory failure, with low SpO2 and high FiO2, but only minor abnormalities in other vital signs. This has potential implications for the ability of early warning scores to identify deteriorating patients. |
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