The Coronavirus Disease 2019 (COVID-19) Pandemic

In silico Study to Evaluate the Antiviral Activity of Novel Structures against 3C-like Protease of Novel Coronavirus (COVID-19) and SARS-CoV

BACKGROUND

Globally, over 4.3 million laboratory confirmed cases of COVID-19 have been reported from over 105 countries. No FDA approved antiviral is available for the treatment of this infection. Zhavoronkov et al., with their generative chemistry pipeline, have generated structures that can be potential novel drug-like inhibitors for COVID-19, provided they are validated. 3C-like protease (3CLP) is a homodimeric cysteine protease that is present in coronaviruses. Interestingly, 3CLP is 96.1% structurally similar between SARS-CoV and SARS-CoV-2.

OBJECTIVE

To evaluate interaction of generated structures with 3CLP of SARS-CoV (RCSB PDB ID: 4MDS).

METHODS

Crystal structure of human SARS-CoV with a non-covalent inhibitor with resolution: 1.598 Å was obtained and molecular docking was performed to evaluate the interaction with generated structures. The MM-GBSA and IFD-SP were performed to narrow down to the structures with better binding energy and IFD score. The ADME analysis was performed on top 5 hits and further MD simulation was employed for top 2 hits.

RESULTS

In XP docking, IFD-SP and molecular dynamic simulation studies, the top 2 hits 32 and 61 showed interaction with key amino acid residue GLU166. Structure 61, also showed interaction with HIS164. These interactions of generated structure 32 and 61, with GLU166 and HIS164, indicate the binding of the selected drug within the close proximity of 3CLP. In the MD simulation, the protein- ligand complex of 4MDS and structure 61 was found to be more stable for 10ns.

CONCLUSION

These identified structures can be further assessed for their antiviral activity to combat SARS-CoV and COVID-19.

Knowledge, attitude and practice of patients with chronic diseases towards COVID-19 pandemic in Dessie town hospitals, Northeast Ethiopia

BACKGROUND AND AIMS

Corona virus disease-19 first detected in China, December 2019. The government of Ethiopia takes preventive measures but the number of peoples infected with COVID-19 has been increased. Control of the pandemic requires changing of knowledge, attitude and practice of people. Hence, the objective of this study was to assess chronic disease patients' knowledge, attitude and practice towards COVID-19 pandemic.

METHODS

Institution based cross-sectional study was done among 413 chronic disease patients from July 20 to August 5, 2020 in Dessie town hospitals. Multinomial logistic regression analysis was used and significant association declared at p-value of <0.05.

RESULTS

From the total participants 34.6%, 81.4% and 40.7% had good knowledge, attitude and practice while 35.1%, 12.1% and 24.7% had moderate knowledge, attitude and practice towards COVID-19 pandemic, respectively. In multinomial logistic regression young age, urban residency, attainment of secondary education and presence of additional co-morbidity were predictors of moderate knowledge whereas urban residency, not attended formal education and presence of additional co-morbidity were predictors of good knowledge about COVID-19. Household family size and presence of additional co-morbidity were factors significantly associated with moderate practice of COVID-19 prevention methods. Furthermore, male sex, household family size, knowledge of COVID-19 and attitude towards COVID-19 were factors significantly associated with good practice of COVID-19 prevention methods.

CONCLUSION

Significant number of chronic disease patients had poor knowledge and practice towards COVID-19. Therefore, government, health professionals, Medias, researchers and health institution should do to improve the gaps of chronic diseases patients.

Early and consecutive RT-PCR tests with both oropharyngeal swabs and sputum could improve testing yield for patients with COVID-19: An observation cohort study in China

Objective

The real-time polymerase chain reaction (RT-PCR) test is recommended for the diagnosis of COVID-19 and provides a powerful tool to identify new infections and facilitate contact tracing. In fact, as the prevalence of COVID-19 decreases, this RT-PCR testing remains as the main preventive measure to avoid rebound. However, inconsistent results can lead to misdiagnoses in the clinic. These inconsistencies are due to the variability in (1) the collection times of biological samples post infection, and (2) sampling procedures.

Methods

We applied the Kaplan–Meier method and multivariate logistic regression on RT-PCR results from 258 confirmed patients with COVID-19 to evaluate the factors associated with negative conversion. We also estimated the proportion (%) of negative conversion among patients who had tested twice or more, and compared the proportions arising from oropharyngeal swabs, sputum, and combined double testing, respectively.

Main results

The proportion of negative conversion was 6.7% on day 4, 16.4% on day 7, 41.0% at 2 weeks, and 61.0% at 3 weeks post-admission. We also found that 34.1% and 60.3% of subjects had at least one negative RT-PCR result on days 7 and 14 after the onset of symptoms, respectively. The proportion of negative conversions following sputum testing was higher than that from oropharyngeal swabs in the early stages but this declined after the onset of symptoms.

Conclusion

In the absence of effective treatments or vaccines, efficient testing strategies are critical if we are to control the COVID-19 epidemic. According to this study, early, consecutive and combined double testing, will be the key to identify infected patients, particularly for asymptomatic and mild symptomatic cases. These strategies will minimize misdiagnosis and the ineffective isolation of infected patients.

Community knowledge, attitude and practices to SARS-CoV-2 disease 2019 (COVID-19): A cross-sectional study in Woldia town, Northeast Ethiopia

SARS-CoV-2 disease 2019 (COVID-19) is pandemic and currently becomes a serious cause of death worldwide. It is caused by a SARS-CoV-2 belonging to a family known as corona virus. The aim of this study is to assess the community knowledge, attitude and practice strategy implementation on SARS-CoV-2 disease 2019 (COVID-19). A cross-sectional survey study was done from July to October, 2020 in Woldia town, Northeast Ethiopia. Interviewer-administered questionnaire was used to collect data from 404 respondents. Data collected were analyzed using descriptive statistics and chi-square test with a 95% confidence interval to know the association of socio-demographic characteristics with the knowledge, attitude and practices towards COVID-19. From a total of 404 responses collected (64.1%, n = 259/404), (50.7%, n = 205/404) and (39.6%, n = 160/404) of the respondents were between ages 18–39 years, males and were diploma and above, respectively. The majority of the respondents had good knowledge about the transmission mode and symptoms of COVID-19 and they obtained information mainly through mass media. The knowledge of the respondents about the transmission mode of COVID-I9 through coughing and sneezing, direct contact with infected person and touching contaminated materials was statistically associated with education and occupation (p <0.001). Among the total respondents (53.7%, n = 217/404) had a negative attitude that COVID-19 pandemic will not be controlled. The attitude of the respondents towards successfully controlling of COVID-I9 was statistically associated in terms of age, marital status, education and occupation (p < 0.001). Most of the respondents (63.1%, n = 255/404), (58.9%, n = 238/404), (66.8%, n = 270/404) and (63.9%, n = 258/404) did not wash hands with soap, avoidance of touching the nose and mouth, practicing social distancing and wearing of face masks in public or crowded places, respectively. The practices of the respondents towards COVID-19 were statistically associated with sex, marital status, education and occupation (p < 0.01). COVID-19 is currently the cause of death and it has a great impact on the economy, politics and social interactions in the study area. The government should strength the health system by increasing surveillance activities in detecting cases. Our findings suggest that the community should practice the WHO and EMoH recommendations to minimize the spread of the virus.

COVID-19, Chikungunya, Dengue and Zika Diseases: An Analytical Platform Based on MALDI-TOF MS, IR Spectroscopy and RT-qPCR for Accurate Diagnosis and Accelerate Epidemics Control

COVID-19 and arboviruses (ARBOD) epidemics co-occurrence is a great concern. In tropical and subtropical regions, ARBOD diseases such as chikungunya, dengue, and Zika are frequent. In both COVID-19 and ARBOD cases, an accurate diagnosis of infected patients is crucial to promote adequate treatment and isolation measures in COVID-19 cases. Overlap of clinical symptoms and laboratory parameters between COVID-19 and ARBOD present themselves as an extra challenge during diagnosis. COVID-19 diagnosis is mainly performed by quantitative reverse polymerase chain reaction (RT-qPCR), while ARBOD diagnosis is performed by serology, detection of antigen or antibody, and molecular diagnosis. In this review, the epidemiologic profile of arboviruses and SARS-CoV-2 is analyzed, and potential risks of symptom overlap is addressed. The implementation of an analytical platform based on infrared (IR) spectroscopy, MALDI-TOF mass spectrometry, and RT-qPCR is discussed as an efficient strategy for a fast, robust, reliable, and cost-effective diagnosis system even during the co-occurrence of virus outbreaks. The spectral data of IR spectroscopy and MALDI-TOF MS obtained from COVID-19 infected and recovered patients can be used to build up an integrated spectral database. This approach can enable us to determine quickly the groups that have been exposed and have recovered from COVID-19 or ARBOD, avoiding misdiagnoses.

Prevalence of mental health problems in frontline healthcare workers after the first outbreak of COVID-19 in China: a cross-sectional study

Background

More than 210,000 medical workers have fought against the outbreak of Coronavirus Disease 2019 (COVID-19) in Hubei in China since December 2019. However, the prevalence of mental health problems in frontline medical staff after fighting COVID-19 is still unknown.

Methods

Medical workers in Wuhan and other cities in Hubei Province were invited to participate a cross-sectional and convenience sampling online survey, which assessed the prevalence of anxiety, insomnia, depression, and post-traumatic stress disorder (PTSD).

Results

A total of 1,091 responses (33% male and 67% female) were valid for statistical analysis. The prevalence was anxiety 53%, insomnia 79%, depression 56%, and PTSD 11%. Healthcare workers in Wuhan were more likely to face risks of anxiety (56% vs. 52%, P = 0.03) and PTSD (15% vs. 9%, P = 0.03) than those in other cities of Hubei. In terms of educational attainment, those with doctoral and masters’ (D/M) degrees may experience more anxiety (median of 7.0, [interquartile range (IQR) 2.0–8.5] vs. median 5.0 [IQR 5.0–8.0], P = 0.02) and PTSD (median 26.0 [IQR 19.5–33.0] vs. median 23.0 [IQR 19.0–31.0], P = 0.04) than those with lower educational degrees.

Conclusions

The mental problems were an important issue for the healthcare workers after COVID-19. Thus, an early intervention on such mental problems is necessary for healthcare workers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01743-7.

BTK inhibitors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Systematic Review

ImportanceThe Bruton tyrosine kinase (BTK) regulates B cell and macrophage signaling, development, survival, and activation. BTK inhibition was shown to protect against lethal influenza-induced acute lung injury in mice. Inhibiting BTK has been hypothesized to ameliorate lung injury in patients with severe coronavirus disease 2019 (COVID-19). ObjectiveTo evaluate the use of BTK inhibitors (BTKinibs) during COVID-19 and assess how they may affect patient outcomes.Evidence ReviewWe searched PubMed, Embase, and Web of Science: Core on December 30, 2020. Clinical studies with at least 5 COVID-19 patients treated with BTKinibs were included. Case reports and reviews were excluded.FindingsOne hundred twenty-five articles were identified, 6 of which met inclusion criteria. Sample size ranged from 6 to 126 patients. Patient populations included subjects hospitalized with COVID-19 (6/6) and admitted to the intensive care unit (5/6). Patient age ranged between 35 and 98 years. Four studies included patients already receiving BTKinibs for their lymphoproliferative disease, 1 for Waldenstrom's macroglobulinemia and 3 for chronic lymphocytic leukemia (CLL). The most common clinical outcomes measured were oxygen requirements (4/6) and hospitalization rate or duration (3/6). Differences in standard-of-care reflected the date of study and pre-existing conditions in the various patient cohorts. Full-dose acalabrutinib was evaluated in 2 studies, one study evaluated full-dose ibrutinib, and another study evaluated both ibrutinib and acalabrutinib. The remainder 2 studies described outcomes in CLL patients on multiple BTKinibs and other CLL-targeted treatments. Three studies showed decreased oxygen requirements in patients who started or continued BTKinibs. All three studies that evaluated hospitalization rate or duration found favorable outcomes in those on BTKinibs. Conclusions and RelevanceBTKinib use was associated with decreased oxygen requirements and decreased hospitalization rates and duration. However, randomized clinical trials are needed to validate the beneficial effects of BTKinibs for acute SARS-CoV-2 infection.

High-Resolution CT Chest Findings in Suspected COVID-19 Pneumonia Patients With Negative Real-Time Polymerase Chain Reaction Assay

Objective The study was conducted with the objective of describing High-resolution computed tomography (HRCT) chest findings of clinically suspected COVID-19 patients having a negative real-time polymerase chain reaction (RT-PCR) assay as well as prevalence and distribution of the HRCT chest manifestations consistent with the diagnosis of COVID-19 pneumonia. Methods This descriptive cross-sectional study was conducted prospectively on a total of 48 patients with high clinical suspicion for COVID-19 and a negative RT-PCR assay that was presented to the Diagnostic Radiology Department of Capital Hospital, Islamabad from July 2020 to December 2020. These patients were included via non-probability consecutive sampling, had a positive history of contact with a known COVID-19 patient and/or any two of the following signs and symptoms; fever, cough, malaise, body aches, arthralgia, new-onset loss of taste and smell, and dyspnea or oxygen saturation less than 85%. A detailed history was sought after informed consent and all these patients underwent non-contrast HRCT chest scans that were reported by an experienced consultant radiologist. The scans showing positive features for COVID-19 pneumonia were assessed for the nature and distribution of the disease. Results Amongst 48 suspects with negative RT-PCR assay, 38 (79.2%) showed ground-glass opacities, a hallmark feature of COVID-19 pneumonia. A total of 22 (57.89%) of these 38 patients had ground-glass opacities with a crazy-paving pattern, nine (23.68%) mixed ground-glass opacities with consolidation, and seven (18.42%) had pure ground-glass opacities. Among these 79.2% suspects, ground-glass opacities were multifocal in 37 (97.37%), bilateral in 35 (92.10%), peripheral in 36 (94.74%), and dorsally located in 32 (81.6%) cases. Subpleural atelectatic bands were seen in 18 (47.36%) of these, bronchovascular markings were prominent in 15 (39.47%), and reverse halo sign was positive in nine (23.68%) cases. Out of the rest of the cases, three were diagnosed as interstitial lung disease, two as chronic lung disease, and one as active pulmonary tuberculosis. Conclusion The majority of clinically suspected cases for COVID-19 showed hallmark findings on non-contrast HRCT chest scans in keeping with coronavirus disease regardless of a negative RT-PCR assay.

How were Non-COVID pulmonary patients and diseases affected from COVID-19 pandemic period?

OBJECTIVE

This study aimed to focus on non-COVID-19 patients during the process when all physicians focused on COVID-19 patients. Patients with pulmonary diseases in the COVID-19 pandemic period were analyzed.

MATERIAL AND METHODS

Non-COVID-19 cases who were hospitalized in the pulmonology clinic, outpatients, and patients who applied to the non-COVID-19 emergency service and requested a pulmonology consultation in the period from March 16, 2020 to May 15, 2020 and in the same period of the previous year (i.e., from March 16, 2019 to May 15, 2019) were included in this study.

RESULTS

In the pandemic period, it was found that there was an 84% decrease in outpatient admissions, a 43% decrease in inpatients, and a 75% decrease in emergency services. During the pandemic period, in outpatient setting, male and younger case admissions increased, admissions with chronic obstructive pulmonary disease (COPD), and interstitial lung diseases decreased, whereas the frequency of admission to asthma, pneumonia, and pulmonary thromboembolism increased. In the period of the pandemic, patients with asthma, COPD, and lung cancer were less hospitalized, whereas patients with pulmonary thromboembolism, pneumonia, and pleural effusion were hospitalized more. In non-COVID-19 patient treatments during the pandemic period, usage of a metered dose inhaler increased.

CONCLUSION

During the COVID-19 pandemic, non-COVID pulmonary pathologies decreased significantly, and there was a change in the profile of the patients. From now on, to be prepared for pandemic and similar extraordinary situations, to organize hospitals for the epidemic, to determine health institutions to which nonepidemic patients can apply, to make necessary plans in order not to neglect the nonepidemic patients, and to develop digital health service methods, especially telemedicine, would be appropriate.

Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes

Coronavirus disease 2019 (COVID-19) has become a pandemic, but its reported characteristics and outcomes vary greatly amongst studies. We determined pooled estimates for clinical characteristics and outcomes in COVID-19 patients including subgroups by disease severity (based on World Health Organization Interim Guidance Report or Infectious Disease Society of America/American Thoracic Society criteria) and by country/region. We searched Pubmed, Embase, Scopus, Cochrane, Chinese Medical Journal, and preprint databases from 1 January 2020 to 6 April 2020. Studies of laboratory-confirmed COVID-19 patients with relevant data were included. Two reviewers independently performed study selection and data extraction. From 6007 articles, 212 studies from 11 countries/regions involving 281 461 individuals were analyzed. Overall, mean age was 46.7 years, 51.8% were male, 22.9% had severe disease, and mortality was 5.6%. Underlying immunosuppression, diabetes, and malignancy were most strongly associated with severe COVID-19 (coefficient =  53.9, 23.4, 23.4, respectively, all P < .0007), while older age, male gender, diabetes, and hypertension were also associated with higher mortality (coefficient = 0.05 per year, 5.1, 8.2, 6.99, respectively; P = .006-.0002). Gastrointestinal (nausea, vomiting, abdominal pain) and respiratory symptoms (shortness of breath, chest pain) were associated with severe COVID-19, while pneumonia and end-organ failure were associated with mortality. COVID-19 is associated with a severe disease course in about 23% and mortality in about 6% of infected persons. Individuals with comorbidities and clinical features associated with severity should be monitored closely, and preventive efforts should especially target those with diabetes, malignancy, and immunosuppression.

Mechanisms in Which Smoking Increases the Risk of COVID-19 Infection: A Narrative Review

At present, COVID-19 continues to spread around the world. People are generally susceptible to SARS-CoV-2. The elderly, serious chronic underlying diseases, high-risk pregnancy, severe obesity and other factors are related to the progression of COVID-19 to severe, critical illness, and even death caused by deterioration of the disease. The relationship between smoking and COVID-19 seems to be controversial. The smoking rate of hospitalized COVID-19 patients is significantly lower than that of the general population. Therefore, smoking can reduce COVID-19 infection and protect the respiratory tract. Subsequently, many scholars have carried out research on this, thinking that this is a wrong and misleading conclusion. According to WHO, smoking is significantly related to the severity of COVID-19, which is one of the important risk factors for the deterioration and poor prognosis of COVID-19. This article reviews the mechanism of smoking increasing the risk of COVID-19 infection.

Protocol for a patient-reported experience measures (PREMs) survey of patients discharged during the COVID-19 pandemic and their family caregivers

INTRODUCTION

In the Swiss canton of Valais, the first cases of SARS-CoV-2 were detected on 28 February 2020. Discharged patients' and their family caregivers' experiences in relation to safety, quality of care, trust and communication during the COVID-19 hospitalisation period remain unexplored. The study aims to collect the patient-reported experience measures (PREMs) survey of patients discharged during the COVID-19 pandemic and their family caregivers.

METHODS AND ANALYSIS

Patients aged ≥18 years, hospitalised between 28 February and 11 May 2020 and then discharged home, plus their family caregivers will be invited to complete a self-administrated questionnaire made up of 14 closed questions and 1 open-ended question. The questionnaire will include items on the patient's hospital trajectory and assess the interpersonal trust placed in nurses and physicians based on Krajewska-Kułak et al's Trust in Nurse Scale and Anderson et al's Trust in Physician Scale. Participants' perceived stress will be assessed using Cohen et al's Perceived Stress Scale. Feelings of safety will be examined based on Dryhurst et al's questionnaire on Risk Perception During Pandemics. After ethical clearance, data will be collected using a postal paper questionnaire and via an online web link. Descriptive and inferential statistics will be computed, and the open question will undergo a qualitative thematic analysis. We will analyse perceptions of the different hospital trajectories experienced by patients undergoing surgery with and without a SARS-CoV-2 infection.

ETHICS AND DISSEMINATION

The Human Research Ethics Committee of Vaud (2020-02025) authorised this study. Gathering experiences and learning about the impact of the COVID-19 pandemic on the social determinants of health among discharged patients and families fit in well with the Triple Aim framework and the PREMs survey. The study will formulate recommendations to support interventions in the face of the second wave of COVID-19 pandemic and their effects on patients' and their family caregivers' experiences.

Knowledge and Practice Toward Prevention of SARS-CoV-2 Among Healthcare Workers at Delghi Primary Hospital During a Massive Test Campaign in Northwest Gondar, Ethiopia: Institution-Based Descriptive Cross-Sectional Survey

BACKGROUND

Since December 29, 2019, severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been spreading and is associated with notoriously increased morbidity and mortality of populations worldwide, including Ethiopia. Medicine and the healthcare system have been challenged by both first and second-waves of SARS-CoV-2. During this entire crisis, the main purpose of this study was to determine the current evidence on the level of awareness and prevention practice of healthcare workers (HCWs) at the district primary hospital, Delghi Primary Hospital (DPH) regarding COVID-19 in the overall effort to control the spread of the virus.

METHODS

Institutional-based descriptive cross-sectional analysis was performed between late August and September 20, 2020. Participants of the study were HCWs with various occupations at DPH, North West Gondar, Ethiopia. In this study, among 112 health professions, we included a total of 104 HCWs. Written consent was obtained for willingness of the study participants from the DPH administrative office. Then, using a pre-tested, structured, and self-administered questionnaire, data were collected. The questionnaire included socio-demographics, sources of information, knowledge, and practice measures regarding COVID-19. The collected data were analyzed through IBM SPSS version 20. As a cut-off value, ≥8 out of 15 knowledge questions and ≥7 out of 14 practice questions were considered good knowledge and practice, respectively.

RESULTS

The result of this study showed the majority of the respondents were male (71/104, (68.3%)), with a median age of 28 (minimum age 20 and maximum age 50) years. Thus, 94.2% (n=98/104) was the overall rate of correctly answered questions out of 15 knowledge questions. However, 40.6% of them had poor prevention practices. 73.1% of participants used regular hand-washing with soap and 64.4% used hand sanitizer and handshake avoidance equally for prevention purposes. Whereas, social distancing rule and mask-wearing were reported as impracticable by 55.8% and 44.2%, respectively.

CONCLUSION

94.2% of HCWs had a good level of knowledge about COVID-19; in contrast, lack of preventive practice was observed. This implies that there is a gap between knowledge and implementation of preventive measures toward the disease.

Structural analysis of COVID-19 spike protein in recognizing the ACE2 receptor of different mammalian species and its susceptibility to viral infection

The pandemic COVID-19 was caused by a novel Coronavirus-2 (SARS-CoV-2) that infects humans through the binding of glycosylated SARS-CoV-2 spike 2 protein to the glycosylated ACE2 receptor. The spike 2 protein recognizes the N-terminal helices of the glycosylated metalloprotease domain in the human ACE2 receptor. To understand the susceptibility of animals for infection and transmission, we did sequence and structure-based molecular interaction analysis of 16 ACE2 receptors from different mammalian species with SARS-CoV-2 spike 2 receptor binding domain. Our comprehensive structure analysis revealed that the natural substitution of amino acid residues Gln24, His34, Phe40, Leu79 and Met82 in the N-terminal α1 and α2 helices of the ACE2 receptor results in loss of crucial network of hydrogen-bonded and hydrophobic interactions with receptor binding domain of SARS-CoV-2 spike protein. Another striking observation is the absence of N-glycosylation site Asn103 in all mammals and many species, lack more than one N-linked glycosylation site in the ACE2 receptor. Based on the loss of crucial interactions and the absence of N-linked glycosylation sites we categorized Felis catus, Equus caballus, Panthera tigris altaica, as highly susceptible while Oryctolagus cuniculus, Bos Tauras, Ovis aries and Capra hircus as moderately susceptible species for infection. Similarly, the E. asinus, Bubalus bubalis, Canis lupus familiaris, Ailuropoda melaleuca and Camelus dromedarius are categorized as low susceptible with Loxodonta Africana, Mus musculus, Sus scrofa and Rattus rattus as least susceptible species for SARS-CoV-2 infection.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13205-020-02599-2.

COVID-19 pandemic reduces the negative perception of oral health-related quality of life in adolescents

Purpose

As people around the world are facing the Covid-19 outbreak, their perception of oral health problems could be changed. This study aimed to evaluate the immediate effects of the Covid-19 pandemic on oral health-related quality of life (OHRQoL) of adolescents.

Methods

A cohort study with schoolchildren from southern Brazil was conducted. Data on adolescents’ OHRQoL were collected from December 2019 to February 2020 (T1), before the Brazilian Covid-19 outbreak. Posteriorly, the data were collected again in June and July of 2020 (T2), under the Brazilian Covid-19 outbreak. The OHRQoL was assessed using the Brazilian short version of the CPQ11-14. Demographic and socioeconomic characteristics and the degree of social distancing were also assessed. Changes in OHRQoL between T1 and T2 were evaluated by adjusted Multilevel Poisson regression models for repeated measures.

Results

From 290 individuals evaluated at T1, 207 were reevaluated at T2 (response rate of 71.3%). The overall CPQ11-14 mean score was significantly lower during the pandemic, reducing from 10.8 at T1 to 7.7 at T2. This significant reduction was also observed for all CPQ domains, indicating a lower negative impact of oral conditions on adolescents' quality of life during the pandemic. Adolescents from families that had a middle or low degree of social distancing during the pandemic and whose parents were harmed in employment had higher CPQ11-14 scores.

Conclusion

Overall and specific-domains CPQ-14 scores were significantly lower during the Brazilian Covid-19 outbreak, indicating a decrease in the perception of oral health problems by adolescents over that period.

Why Are COVID-19 Mortality Rates by Country or Region So Different?: An Ecologic Study of Factors Associated with Mortality from Novel Coronavirus Infections by Country

Background

In order to find out the factors associated with the large disparities in COVID-19 mortality rates by country, we conducted an ecological study by linking existing statistics. In Japan, a large variation was observed in between geographical areas when assessing mortality. We performed a regional correlation analysis to find factors related to regional mortality.

Methods

This study design was an ecologic study. A multiple regression analysis was performed with COVID-19 mortality rates of different countries as the dependent variable together with various health care and economic factors. We calculated the cumulative mortality rate as of June 30, 2020. For the regional correlation analysis of Japan, 47 prefectures were divided into nine regions. The factors examined were health care and tourism. Data for 33 Organization for Economic Co-operation and Development (OECD) countries were analyzed. In Japan's regional analysis, the whole country was classified into nine regions.

Results

Factors related to mortality were the incidence of Kawasaki disease (KD), number of computed tomographies (CTs), and alcohol consumption. Mortality was low in countries with high incidence of KD and high number of CTs, as well as in countries with high alcohol consumption. In European countries, high smoking prevalence and a high Gini coefficient were positively related to high mortality. According to a regional analysis in Japan, mortality was related to proportion of population in the densely inhabited districts, the number of foreign visitors per capita, and the number of Chinese visitors per capita.

Conclusion

Low mortality in East Asia was associated with specific disease morbidity (KD), alcohol consumption, and CT numbers. It was suggested that the mortality gap in Japan was related to the number of foreign tourists and the proportion of population in the densely inhabited districts.

COVID-19-The Potential Beneficial Therapeutic Effects of Spironolactone during SARS-CoV-2 Infection

In March 2020, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared a global pandemic by the World Health Organization (WHO). The clinical course of the disease is unpredictable but may lead to severe acute respiratory infection (SARI) and pneumonia leading to acute respiratory distress syndrome (ARDS). It has been shown that pulmonary fibrosis may be one of the major long-term complications of COVID-19. In animal models, the use of spironolactone was proven to be an important drug in the prevention of pulmonary fibrosis. Through its dual action as a mineralocorticoid receptor (MR) antagonist and an androgenic inhibitor, spironolactone can provide significant benefits concerning COVID-19 infection. The primary effect of spironolactone in reducing pulmonary edema may also be beneficial in COVID-19 ARDS. Spironolactone is a well-known, widely used and safe anti-hypertensive and antiandrogenic medication. It has potassium-sparing diuretic action by antagonizing mineralocorticoid receptors (MRs). Spironolactone and potassium canrenoate, exerting combined pleiotropic action, may provide a therapeutic benefit to patients with COVID-19 pneumonia through antiandrogen, MR blocking, antifibrotic and anti-hyperinflammatory action. It has been proposed that spironolactone may prevent acute lung injury in COVID-19 infection due to its pleiotropic effects with favorable renin–angiotensin–aldosterone system (RAAS) and ACE2 expression, reduction in transmembrane serine protease 2 (TMPRSS2) activity and antiandrogenic action, and therefore it may prove to act as additional protection for patients at highest risk of severe pneumonia. Future prospective clinical trials are warranted to evaluate its therapeutic potential.

Traditional Chinese medicine Lianhua Qingwen for treating COVID-19: A protocol for a meta-analysis and systematic review of randomized controlled trials

BACKGROUND

Since the outbreak of coronavirus disease 2019 (COVID-19) in 2019, it has swept the world with rapid development and is one of the infectious diseases that seriously threatened global public health. Because of the complex pathogenesis, high infectivity, and high fatality rate of COVID-19, there are no effective treatments for this epidemic at present. Traditional Chinese Medicine (TCM) has a long clinical history in the prevention and treatment of such acute infectious diseases. The therapeutic effect of Lianhua Qingwen (LHQW) on this new coronary pneumonia has attracted the attention of all walks of life, and relevant research reports continue to appear. Here, we intend to conduct a systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy of LHQW in COVID-19 patients.

METHODS

We will search each database from the built-in until Dec 2020. The English literature mainly search the Cochrane Library, EMBASE, PubMed, and Web of Science, while the Chinese literature come from CNKI, VIP, Chinese Biomedical Database (CBM), Chinese Science Citation Database (CSCD), and Wan Fang database. Simultaneously, we will retrieve clinical registration tests. This study only screens the RCT of LHQW against COVID-19 and evaluates its efficacy and safety. We will use the Cochrane Handbook to systematically review interventions to assess the risk of bias. The protocol will be reported according to the approach and preferred report items for systematic review and meta-analysis protocols (PRISMA - P). Finally, RevMan software version 5.3 will be used for meta-analysis.

RESULTS

The systematic review and meta-analysis aim to review and pool current clinical outcomes of LHQW for treating COVID-19.

CONCLUSION

This study will provide further evidence for the efficacy and safety of LHQW in the treatment of COVID-19.

INPLASY REGISTRATION NUMBER

INPLASY2020120043.

Hospital-Acquired SARS-Cov-2 Infections in Patients: Inevitable Conditions or Medical Malpractice?

Despite numerous measures to contain the infection and limit its spread, cases of SARS-CoV-2 infections acquired in hospitals have been reported consistently. In this paper, we will address issues of hospital-acquired COVID-19 in hospitalized patients as well as medico-legal implications. After having conducted a literature search, we will report on papers on hospital-acquired SARS-CoV-2 infections. Ten scientific papers were selected and considered suitable for further analysis. According to several reports, the SARS-CoV-2 hospital-acquired infection rate is 12–15%. Hospital-acquired COVID-19 represents a serious public health issue, which is a problem that could create reluctance of patients to seek hospital treatment for fear of becoming infected. Healthcare personnel should do all that is necessary to address the problem and prevent further spreading, such as rigorous compliance with all procedures for containing the spread. From a medical-legal point of view, multiple aspects must be considered in order to understand whether the infection is a result of “malpractice” or an inevitable condition.

E-Learning amid the COVID-19 Lockdown: Standpoint of Medical and Dental Undergraduates

BACKGROUND AND OBJECTIVE

The corona-virus (COVID-19) pandemic has had devastating impacts on not only the health and socio-economic conditions but also on the education sector in various countries. Consequently, the world of education entered a new era of E-learning. This descriptive study, thus, aims to evaluate the standpoint of medical and dental undergraduates regarding E-learning amid the Covid-19 lockdown.

METHODS

A descriptive online questionnaire was used to gather responses via Google forms. The questionnaire consisted of questions categorized as technology access, online skills and relationships, students' views, and student's perception of possible advantages of E-learning. Two hundred and eighty three medical and dental students of CMH Lahore Medical College participated in the study.

RESULTS

One hundred and seventy nine female and 104 male students responded to the questionnaire. The results of the study showed students encouraging the accommodation of E-learning into current teaching practices. Students agreed online study material not only provides flexibility in the learning process (p=0.003) but also saves time (p = 0.012). Female participants showed a more positive readiness response towards e learning than males (p =0.001). Results also showed students have easier access to online teaching resources. Regarding online lectures, the students believe that online lectures were more organized (p= 0.001) and stimulated student interest (p=0.026). Students believe that frequent participation in the learning process is important for success in online education (p=0.002).

CONCLUSION

Undergraduate medical and dental students from the said private medical college are well equipped and ready to shift towards online education.

A review: Antibody-dependent enhancement in COVID-19: The not so friendly side of antibodies

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), represents an unprecedented global public health emergency with economic and social consequences. One of the main concerns in the development of vaccines is the antibody-dependent enhancement phenomenon, better known as ADE. In this review, we provide an overview of SARS-CoV-2 infection as well as the immune response generated by the host. On the bases of this principle, we also describe what is known about the ADE phenomenon in various viral infections and its possible role as a limiting factor in the development of new vaccines and therapeutic strategies.

Possible prospects for using modern magnesium preparations for increasing stress resistance during COVID-19 pandemic

Introduction: The relevance of the issue of increasing stress resistance is due to a significant deterioration in the mental health of the population caused by the special conditions of the disease control and prevention during the COVID-19 pandemic. Recently, the decisive role in the severity of clinico-physiological manifestations of maladjustment to stress is assigned to magnesium ions.

The aim of the work was to study the magnesium importance in the body coping mechanisms under stress for the pathogenetic substantiation of the magnesium correction in an unfavorable situation of disease control and prevention during the COVID-19 pandemic.

Materials and methods: The theoretical basis of this scientific and analytical review was an analysis of modern Russian and foreign literature data posted on the electronic portals MEDLINE, PubMed-NCBI, Scientific Electronic Library eLIBRARY.RU, Google Academy, and CyberLeninka.

Results and discussion: It was shown that the total magnesium level in the body plays the indicator role of the body functional reserves. Acute and chronic stresses significantly increase the magnesium consumption and cause a decrease in its body content. Magnesium deficiency is one of the main pathogenetic mechanisms of reducing stress resistance and adaptive body reserves. Arising during the COVID-19 pandemic, increased nervous and emotional tension, the lack of emotional comfort and balance can lead to the onset or deterioration of magnesium deficiency, which manifests itself in mental burnout and depletion of adaptive capacities. The inability to synthesize magnesium in the body necessitates including foodstuffs high in magnesium in the population diet during this period. The appointment of magnesium preparations is pathogenetically justified with moderate and severe magnesium deficiency. This therapy should take into account the major concomitant diseases, severity of magnesium deficiency, and a patient’s age.

Conclusion: magnesium correction, carried out during the COVID-19 pandemic, will contribute to increasing stress resistance, preventing mental diseases and improving the population’s life quality.

Nanomedicine & Nanotoxicology Future Could Be Reshaped Post-COVID-19 Pandemic

Since its first emergence in December 2019, the coronavirus-2 infection has quickly spread around the world and the severity of the pandemic has already re-shaped our lives. This review highlights the role of nanotechnology in the fight against this pandemic with a focus on the design of effective nano-based prevention and treatment options that overcome the limitations associated with conventional vaccines and other therapies. How nanotechnology could be utilized to understand the pathology of the ongoing pandemic is also discussed as well as how our knowledge about SARS-CoV-2 cellular uptake and toxicity could influence future nanotoxicological considerations and nanomedicine design of safe yet effective nanomaterials.

Patterns and associated factors of COVID-19 knowledge, attitude, and practice among general population and health care workers: A systematic review

INTRODUCTION

Coronavirus disease 2019 is a pandemic disease, requiring persons around the world to take immediate action to reduce the risk of infection. This study was aimed to summarize the patterns and determinants of coronavirus disease 2019 knowledge, attitude, and practice among general populations and health workers.

METHODS

A cross-sectional study from PubMed, HINARI, and Scopus were searched from March 16 to July 30, 2020. The review was done in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses-2009.

RESULT

We found 56 articles upon the initial search. Finally, 21 studies were filtered to be studied in this systematic review. Overall, the majority of the articles that were previously published had good knowledge about coronavirus disease 2019 that lies in the ranges from 40% to 99.5%. A good attitude lies in the ranges from 70% to 97.1%. Among impact of coronavirus disease 2019 on mental health, only anxiety was reported that ranges from 24.6% to 96.3%. We found the variable practice towards combating coronavirus disease 2019. Several factors were associated with poor knowledge, attitudes, and practice skills regarding the pandemic of coronavirus disease 2019 such as level of education, occupation, income, gender, age, residence, work experience, religion, having media, marital status, and race.

CONCLUSION

The majority of the articles that were previously published had found good knowledge and attitude about coronavirus disease 2019 and variable reports for practice to combat the disease. Most of them were severely worried about the disease. Therefore, the mental effect of the coronavirus disease 2019 should be studied at large, and every country should implement the strategy to combat the disease to increase the level of practice.

Understanding the COVID-19 pandemic from a gender perspective

Under the threat of the new coronavirus pandemic, women have been uniquely impacted financially, economically, and socially. However, in terms of disease incidence and lethality, women perform better than men. The main reason is that, in addition to women's own hormonal protection, women's immune systems are superior to those of men. Women also exhibit more protective behavior (e.g., hand-washing) and more closely follow protection guidelines, which greatly reduces the chance of infection. In the future, more studies that adopt a gender perspective are needed to understand the various dilemmas faced by women in infectious diseases and pandemics; only then can women demonstrate better outcomes.

Cutaneous, skin histopathological manifestations and relationship to COVID-19 infection patients

COVID-19 diseases have been a nationwide pandemic condition. However, cutaneous, skin histopathological manifestations of COVID-19 infection are not well described. Our study aims are to present heterogeneous cutaneous, histopathological manifestations in COVID-19 patients, to investigate the possible relationship between cutaneous manifestations and histopathological features in COVID-19 infection. We performed a systemic review in PubMed database and Chinese medical journal search engines which were wangfang.data (http://www.wanfangdata.com.cn/), Science China (http://www.cnki.net/) until June 17th, 2020. Search terms "COVID-19," "SARS-Coronavirus-2" and "Coronavirus" were used in combination with "cutaneous," "rash," "skin," "dermatology." Seventy-five papers were included with confirmed COVID-19 infection. The most frequent cutaneous manifestation of COVID-19 present was erythema, nearly 38.4%. Trunk was the most affected location, presenting in 51.4% patients. Rash occurred before onset of other symptoms was in 5.3% patients. Seventy-seven patients were received treatments. Rash was dismissed in 49% patients, improved in 21.2% patients ranged from 0 to 17 days. The histopathological examination present in 39 patients. Skin is one of target organs affected by COVID-19 infection. Cutaneous manifestations should be paid more attention. It can help doctors diagnose COVID-19 infection in prodromal stage, understand progression, and determine prognosis of COVID-19 infection.

COVID-19 vaccine-readiness for anti-CD20-depleting therapy in autoimmune diseases

Although most autoimmune diseases are considered to be CD4 T cell- or antibody-mediated, many respond to CD20-depleting antibodies that have limited influence on CD4 and plasma cells. This includes rituximab, oblinutuzumab and ofatumumab that are used in cancer, rheumatoid arthritis and off-label in a large number of other autoimmunities and ocrelizumab in multiple sclerosis. Recently, the COVID-19 pandemic created concerns about immunosuppression in autoimmunity, leading to cessation or a delay in immunotherapy treatments. However, based on the known and emerging biology of autoimmunity and COVID-19, it was hypothesised that while B cell depletion should not necessarily expose people to severe SARS-CoV-2-related issues, it may inhibit protective immunity following infection and vaccination. As such, drug-induced B cell subset inhibition, that controls at least some autoimmunities, would not influence innate and CD8 T cell responses, which are central to SARS-CoV-2 elimination, nor the hypercoagulation and innate inflammation causing severe morbidity. This is supported clinically, as the majority of SARS-CoV-2-infected, CD20-depleted people with autoimmunity have recovered. However, protective neutralizing antibody and vaccination responses are predicted to be blunted until naive B cells repopulate, based on B cell repopulation kinetics and vaccination responses, from published rituximab and unpublished ocrelizumab (NCT00676715, NCT02545868) trial data, shown here. This suggests that it may be possible to undertake dose interruption to maintain inflammatory disease control, while allowing effective vaccination against SARS-CoV-29, if and when an effective vaccine is available.

SARS-CoV-2 and RT-PCR in asymptomatic patients: Results of a cohort of workers at El Dorado International Airport in Bogotá, 2020

Introducción.

La pandemia de COVID-19 ha ocasionado cerca de 25 millones de casos en el mundo. Se ha descrito que los pacientes asintomáticos pueden ser fuentes de transmisión. Sin embargo, es difícil detectarlos y no es claro su papel en la dinámica de transmisión del virus, lo que obstaculiza la implementación de estrategias para la prevención.

Objetivo.

Describir el comportamiento de la infección asintomática por SARS-CoV-2 en una cohorte de trabajadores del Aeropuerto Internacional El Dorado "Luis Carlos Galán Sarmiento" de Bogotá, Colombia.

Materiales y métodos.

Se diseñó una cohorte prospectiva de trabajadores del Aeropuerto El Dorado. El seguimiento se inició en junio de 2020 con una encuesta a cada trabajador para caracterizar sus condiciones de salud y trabajo. Cada 21 días se tomó una muestra de hisopado nasofaríngeo para detectar la presencia del SARS-CoV-2 mediante reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR). Se analizó el comportamiento del umbral del ciclo (cycle threshold) de los genes ORFlab y N según el día de seguimiento.

Resultados.

En los primeros tres seguimientos de la cohorte se encontró una incidencia de la infección por SARS-CoV-2 del 16,51 %. La proporción de contactos positivos fue del 14,08 %. La mediana del umbral del ciclo fue de 33,53.

Conclusión.

Se determinaron las características de la infección asintomática por el SARS-CoV-2 en una cohorte de trabajadores. La detección de infectados asintomáticos sigue siendo un reto para los sistemas de vigilancia epidemiológica.

Students' and lecturers' perspective on the implementation of online learning in dental education due to SARS-CoV-2 (COVID-19): a cross-sectional study

BACKGROUND

On account of physical distancing measures, universities worldwide are strongly affected by SARS-CoV-2 (COVID-19). Thus, the dental school of Justus-Liebig-University Giessen (Germany) transferred the established "face-to-face" learning to online learning in the spring term 2020. The aim of this study was to assess the students' and lecturers' perspectives on the implementation of online learning due to COVID-19, using a questionnaire survey.

METHODS

After the online period, all students and lecturers were asked to fill out an online questionnaire containing evaluative statements regarding handling, didactic benefit, motivation, and overall assessment. Furthermore, the questionnaire for lecturers contained additional aspects regarding knowledge gain in terms of providing online learning. Besides that, students and lecturers were asked for the amount of online learning in the future curriculum (independent of COVID-19). Data were subjected to regression analysis and T-test (p < .05).

RESULTS

36.8% of students preferred "face-to-face" learning instead of sole online learning. An increase of know how concerning online teaching was observable for lecturers. Both, students and lecturers, want to keep up with online courses in the future curriculum. However, in terms of the optimal amount of online learning a significant difference between students' and lecturers' perspective was observed. While students suggested 53.2% (24.9) (mean (standard deviation)) lecturers only stated 38.6% (21.5).

CONCLUSIONS

Within the limitation of this study, students' and lecturers' showed a predominantly positive perspective on the implementation of online learning, providing the chance to use online learning even beyond COVID-19 in the future curriculum.

What could we learn from SARS when facing the mental health issues related to the COVID-19 outbreak? A nationwide cohort study in Taiwan

There were several studies about the psychiatric and mental health issues related to the severe adult respiratory syndrome (SARS) outbreak in 2003, however, the association between SARS and the overall risk of psychiatric disorders and suicides has, as yet, to be studied in Taiwan. The aim of this study is to examine as to whether SARS is associated with the risk of psychiatric disorders and suicide. A total of 285 patients with SARS and 2850 controls without SARS (1:10) matched for sex, age, insurance premium, comorbidities, residential regions, level of medical care, and index date were selected between February 25 and June 15, 2003 from the Inpatient Database Taiwan's National Health Insurance Research Database. During the 12-year follow-up, in which 79 in the SARS cohort and 340 in the control group developed psychiatric disorders or suicide (4047.41 vs. 1535.32 per 100,000 person-years). Fine and Gray's survival analysis revealed that the SARS cohort was associated with an increased risk of psychiatric disorders and suicide, and the adjusted subdistribution HR (sHR) was 2.805 (95% CI: 2.182-3.605, p < 0.001) for psychiatric disorders and suicide. The SARS cohort was associated with anxiety, depression, sleep disorders, posttraumatic stress disorder/acute stress disorder (PTSD/ASD), and suicide. The sensitivity analysis revealed that the SARS group was associated with anxiety, depression, sleep disorders, PTSD/ASD, and suicide after the individuals with a diagnosis of psychiatric disorders and suicide were excluded within the first year, and with anxiety, depression, and sleep disorders, while those in the first five years were excluded. In conclusion, SARS was associated with the increased risk of psychiatric disorders and suicide.

Severe COVID-19: what have we learned with the immunopathogenesis?

The COVID-19 outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global major concern. In this review, we addressed a theoretical model on immunopathogenesis associated with severe COVID-19, based on the current literature of SARS-CoV-2 and other epidemic pathogenic coronaviruses, such as SARS and MERS. Several studies have suggested that immune dysregulation and hyperinflammatory response induced by SARS-CoV-2 are more involved in disease severity than the virus itself.Immune dysregulation due to COVID-19 is characterized by delayed and impaired interferon response, lymphocyte exhaustion and cytokine storm that ultimately lead to diffuse lung tissue damage and posterior thrombotic phenomena.Considering there is a lack of clinical evidence provided by randomized clinical trials, the knowledge about SARS-CoV-2 disease pathogenesis and immune response is a cornerstone to develop rationale-based clinical therapeutic strategies. In this narrative review, the authors aimed to describe the immunopathogenesis of severe forms of COVID-19.

The good, the bad and the ugly of COVID-19 lockdown effects on wildlife conservation: Insights from the first European locked down country

The COVID-19 pandemic zoonosis has determined extensive lockdowns worldwide that provide an unprecedented opportunity to understand how large-scale shifts of human activities can impact wildlife. We addressed the impacts of the COVID-19 lockdown on wildlife in Italy, the first European country that performed a countrywide lockdown, and identified potentially beneficial and negative consequences for wildlife conservation and management. We combined a qualitative analysis of social media information with field data from multiple taxa, data from citizen science projects, and questionnaires addressed to managers of protected areas. Both social media information and field data suggest that a reduction of human disturbance allowed wildlife to exploit new habitats and increase daily activity. The field data confirmed some positive effects on wildlife conservation, such as an increase in species richness in temporarily less-disturbed habitats, a higher breeding success of an aerial insectivorous bird, and reduction of road-killing of both amphibians and reptiles. Despite some positive effects, our data also highlighted several negative impacts of the COVID-19 crisis on wildlife. The lower human disturbance linked to lockdown was in fact beneficial for invasive alien species. Results from questionnaires addressed to managers of protected areas highlighted that the COVID-19 lockdown interrupted actions for the control of invasive alien species, and hampered conservation activities targeting threatened taxa. Furthermore, the reduction of enforcement could cause a surge of illegal killing of wildlife. The COVID-19 crisis, besides having deep socio-economic impacts, might profoundly affect wildlife conservation, with potentially long-lasting effects.

Anosmia and ageusia associated with coronavirus infection (COVID-19) - what is known?

In 2020 a new pandemic caused by the SARS-CoV-2 coronavirus is affecting the lives of millions of patients and healthcare workers worldwide. The clinical picture of this infection is in a dynamic process of discovery, and more symptoms emerge as the clinicians observe and diagnose manifestations that affect multiple organs. Anosmia (loss of smell), and ageusia (loss of taste) become more frequently cited as independent symptoms or in association with the most common manifestations of the disease, such as fever, cough and dyspnea. A thorough screening program will prevent most nosocomial and community-acquired infections by promoting efficient triage and specific measures such as isolation of the patients. Therefore, it is important to include frequent symptoms in the anamnesis and questionnaires to select those patients who might benefit from testing, isolation, and treatment. This study summarizes the existing data regarding the association of anosmia and ageusia with the SARS-CoV-2 infection. It also aims to describe manifestations of these, particularly in the clinical picture of all symptomatic patients.

Histopathological findings in the advanced natural evolution of the SARS-CoV-2 infection

We are reporting a case of natural evolution and pathological data from a young person that was diagnosed with coronavirus disease 2019 (COVID-19). All data has been collected from the autopsy of a 30-year-old female, which was performed by the Department of Forensic Medicine from Emergency County Hospital, Drobeta Turnu Severin, Mehedinţi County, Romania. The infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed by reverse transcription polymerase chain reaction (RT–PCR) on the lung tissue which was obtained during autopsy. This case provides the opportunity to study the natural evolution of COVID-19 pneumonia in a young person with clinical signs of pneumonia but without associated comorbidities. The patient had not received any treatment. The histopathological examination of the lung revealed a process of productive proliferation, proteinaceous and fibrin-macrophagic interalveolar spaces exudate, and lesions consistent with vasculitis. In the heart, we identified a cardiac thrombus. These changes are likely to suggest an advanced natural evolution of SARS-CoV-2 virus infection.

Patient safety associated with the surgical treatment of bone and soft tissue tumours during the COVID-19 pandemic-results from an observational study at the Oxford Sarcoma Service

Purpose

Deferring cancer surgery can have profound adverse effects including patient mortality. During the COVID-19 pandemic, departmental reorganisation and adherence to evolving guidelines enabled provision of uninterrupted surgical care to patients with bone and soft tissue tumours (BST) in need of surgery. We reviewed the outcomes of surgeries on BST during the first two months of the pandemic at one of the tertiary BST centres in the UK.

Materials and methods

Between 12 March 2020 and 12 May 2020, 56 patients of a median age of 57 years (18–87) underwent surgery across two sites: index hospital (n = 27) and COVID-free facility (n = 29). Twenty-five (44.6%) patients were above the age of 60 years and 20 (35.7%) patients were in ASA III and ASA IV category. The decision to offer surgery was made in adherence with the guidelines issued by the NHS, BOOS and BSG.

Results

At a minimum follow-up of 30 days post-surgery, 54 (96.4%) patients were recovering well. Thirteen patients (23.2%) had post-operative complications which included four (7.1%) patients developing pulmonary embolism. The majority of complications (12/13 = 92.7%) occurred in ASA III and IV category patients. Four (7.1%) patients contracted COVID-19, of which three required escalation of care due to pulmonary complications and two (3.6%) died. Patients < 60 years of age had significantly less complications than those > 60 years (p < 0.001). Patients operated on in the COVID-free facility had fewer complications compared with those operated on at the index hospital (p < 0.027).

Conclusion

In spite of the favourable results in majority of our patients, our study shows that patients with sarcoma operated at the height of the pandemic are at a risk of contracting COVID-19 and also having associated with mortality. The use of a COVID-free facility, surgery in patients < 60 60 years and in ASA I & II category are associated with better outcomes. If a second wave occurs, a serious consideration should be given to ways of minimising the risk of contracting COVID-19 in these vulnerable patients either by using COVID-free facilities or delaying treatment until peak of infection has passed.

Depression and Anxiety among Iranian Medical Students during COVID-19 Pandemic

Objective: COVID-19 has spread throughout the world and has become a global pandemic. This situation can cause psychological distress among people, especially health care workers.

This study aimed to determine depression and anxiety levels among Iranian medical students during the COVID-19 pandemic.

Method: In this cross sectional study, we designed an online survey of Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) questionnaires. The survey link was sent to 500 medical clerks and interns studying at Tehran University of Medical Sciences (TUMS).

Results: A total of 64.6% of the students completed the survey. The prevalence of mild to severe anxiety and depression among them was 38.1% and 27.6%, respectively. Anxiety and changes in sleep patterns were the most common symptoms. Higher levels of anxiety were related to female gender, lower grade point average (GPA), and experience of COVID-19 symptoms. Students with lower GPA and prior experience of COVID-19 symptoms were more likely to feel depressed.

Conclusion: Depression and anxiety did not significantly differ among Iranian medical students before and after the COVID-19 outbreak. Somatic symptoms of depression are more common during this pandemic and need particular attention in future similar situations. A higher GPA is related to lower anxiety and depression among medical students.

Effect of advanced nursing care on psychological disorder in patients with COVID-19: A protocol of systematic review

BACKGROUND

This study will explore the effect of advanced nursing care (ANC) on psychological disorder (PD) in patients with Coronavirus Disease 2019 (COVID-19).

METHODS

This study will search the following electronic databases up to June 30, 2020: Cochrane Library, PUBMED, EMBASE, PsycINFO, Web of Science, OpenGrey, Cumulative Index to Nursing and Allied Health Literature, CNKI, and WANGFANG. We will not impose any language limitations. Two authors will independently identify titles/abstracts and full-text of all potential studies, and will collect data from eligible studies. Additionally, study quality will be assessed by Cochrane risk of bias. If necessary, we will conduct meta-analysis if sufficient trials are included.

RESULTS

This study will explore the effect of ANC on PD in patients with COVID-19 through outcome indicators.

CONCLUSION

The findings of this study may supply summarized evidence of ANC for the management of PD in COVID-19.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42020187610.

Knowledge, Attitude and Practice Towards COVID-19 Among Chronic Disease Patients at Addis Zemen Hospital, Northwest Ethiopia

Purpose

The recent outbreak of coronavirus disease 2019 (COVID-19) is the worst global crisis after the Second World War. Since no successful treatment and vaccine have been reported, efforts to enhance the knowledge, attitudes, and practice of the public, especially the high-risk groups, are critical to manage COVID-19 pandemic. Thus, this study aimed to assess knowledge, attitude, and practice towards COVID-19 among patients with chronic disease.

Patients and Methods

A cross-sectional study was conducted among 404 chronic disease patients from March 02 to April 10, 2020, at Addis Zemen Hospital, Northwest Ethiopia. Both bivariable and multivariable logistic regression analyses with a 95% confidence interval were fitted to identify factors associated with poor knowledge and practice towards COVID-19. The adjusted odds ratio (AOR) was used to determine the magnitude of the association between the outcome and independent variables. P-value <0.05 was considered statistically significant.

Results

The mean age of the participants was 56.5±13.5. The prevalence of poor knowledge and poor practice was 33.9% and 47.3%, respectively. Forty-one percent of the participants perceived that avoiding of attending a crowded population is very difficult. Age (AOR=1.05, (95% CI (1.01–1.08)), educational status of “can’t read and write” (AOR=7.1, 95% CI (1.58–31.93)), rural residence (AOR=19.0, 95% CI (6.87–52.66)) and monthly income (AOR=0.8, 95% CI (0.79–0.89)) were significantly associated with poor knowledge. Being unmarried (AOR=3.9, 95% CI (1.47–10.58)), cannot read and write (AOR=2.7, 95% CI (1.03–7.29)), can read and write (AOR=3.5, 95% CI (1.48–8.38)), rural residence (AOR=2.7, 95% CI (1.09–6.70)), income of <7252 Ethiopian birr (AOR=2.3, 95% CI (1.20–4.15)) and poor knowledge (AOR=8.6, 95% CI (3.81–19.45)) were significantly associated with poor practice.

Conclusion

The prevalence of poor knowledge and poor practice was high. Leaflets prepared in local languages should be administered and health professionals should provide detailed information about COVID-19 to their patients.

Assessment of Hydroxychloroquine and Chloroquine Safety Profiles: A Systematic Review and Meta-Analysis

BACKGROUND

Recently, chloroquine (CQ) and its derivative hydroxychloroquine (HCQ) have emerged as potential antiviral and immunomodulatory options for the treatment of 2019 coronavirus disease (COVID-19). To examine the safety profiles of these medications, we systematically evaluated the adverse events (AEs) of these medications from published randomized controlled trials (RCTs).

METHODS

We systematically searched PubMed, MEDLINE, Cochrane, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the ClinicalTrials.gov for all the RCTs comparing CQ or HCQ with placebo or other active agents, published before March 31, 2020. The random-effects or fixed-effects models were used to pool the risk estimates relative ratio (RR) with 95% confidence interval (CI) for the outcomes.

RESULTS

The literature search yielded 23 and 17 studies for CQ and HCQ, respectively, that satisfied our inclusion criteria. Of these studies, we performed meta-analysis on the ones that were placebo-controlled, which included 6 studies for CQ and 14 studies for HCQ. We did not limit our analysis to published reports involving viral treatment alone; data also included the usage of either CQ or HCQ for the treatment of other diseases. The trials for the CQ consisted of a total of 2,137 participants (n=1,077 CQ, n=1,060 placebo), while the trials for HCQ involved 1,096 participants (n=558 HCQ and n=538 placebo). The overall mild or total AEs were statistically higher comparing CQ or HCQ to placebo. The AEs were further categorized into four groups and analyses revealed that neurologic, gastrointestinal, dermatologic, and ophthalmic AEs were higher in participants taking CQ compared to placebo. Although this was not evident in HCQ treated groups, further analyses suggested that there were more AEs attributed to other organ system that were not included in the categorized meta-analyses. Additionally, meta-regression analyses revealed that total AEs was affected by dosage for the CQ group.

CONCLUSIONS

Taken together, we found that participants taking either CQ or HCQ have more AEs than participants taking placebo. Precautionary measures should be taken when using these drugs to treat COVID-19.

Examining Anxiety, Life Satisfaction, General Health, Stress and Coping Styles During COVID-19 Pandemic in Polish Sample of University Students

PURPOSE

The purpose of this study is to examine the association of anxiety with self-rated general health, satisfaction with life, stress and coping strategies of university students during the COVID-19 pandemic outbreak in Poland.

PARTICIPANTS AND METHODS

A total of 914 university students, ranged in age between 18 and 40 years old (M = 23.04, SD = 2.60), participated in an online survey. The study was performed between 30 March and 30 April 2020, during the general coronavirus quarantine. Participants completed a standard psychological questionnaire, including General Anxiety Disorder (GAD-7), General Self-Rated Health (GSRH), Satisfaction With Life Scale (SWLS), Perceived Stress Scale (PSS), and Coping Inventory for Stressful Situations (CISS).

RESULTS

The majority of students (65%) showed mild to severe GAD and a high level of perceived stress (56%). Those students who had the worst evaluated current GSRH, in comparison to the situation before the COVID-19 outbreak, also demonstrated higher levels of anxiety, perceived stress, and emotion-oriented coping styles. The study indicates that the variance of anxiety during the COVID-19 outbreak may be explained for about 60% by such variables, like high stress, low general self-rated health, female gender, and frequent use of both emotion-oriented and task-oriented coping styles.

CONCLUSION

University students experience extremely high stress and anxiety during quarantine period and they need professional help to cope with COVID-19 pandemic. The results of this study may help prepare appropriate future intervention and effective prevention programs at universities.