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1071 covid-19 Wiley Open Research Preprints

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covid-19 metabolomics health policy methods: t cells methods: cytokines children lung ultrasound evaluation evidence-based medicine interferons thermal stability during storage clinical governance venous thromboembolism glycosylation mucosal immunity methods: igg asthma sars-cov-2 and covid-19 covid methods: b cells spirometry cardiac pharmacology serum bank general obstetrics maternity services + show more keywords
spike and rbd clinical safety psychiatry nutrition letter experience ios interleukins bioprocess antenatal care serological survey infectious disease: virology obstetrics and gynaecology methods: immunizations serologic elisa assay imaging haematology emergency medicine sars-co-v2 sars-cov2 medical disorders in pregnancy coronavirus disease 2019 health services research healthcare critical care medicine sars-cov geriatric medicine corona production and purification innate immunity thrombosis epidemiology sars-cov-2 pulmonary function testing (pft) aerosol biology medical ethics infectious diseases inflammation pneumology infections
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Please note: These are preprints and have not been peer reviewed. Data may be preliminary.
Paediatric Attendances and Acuity in the Emergency Department during the COVID-19 Pan...
Katy Rose
Kerry Van Zyl

Katy Rose

and 4 more

October 22, 2020
Aim: To investigate the difference in both numbers and acuity of presentations to the Paediatric Emergency Department (PED) during the peak time period of the current global SARS-CoV-2 pandemic. Design: This single centre retrospective observational study used routinely collected electronic health data to compare patient presentation characteristics between 21st March and 26th April 2020 compared to the equivalent time period in 2019. Results: There was a 90% decrease in attendances to PED, with a 10.23% reduction re-attendance rate. Children presenting were younger during the pandemic, with a median age difference of 2 years. They were more likely to present in an ambulance (9.63%), be admitted to hospital (5.75%) and be assigned the highest two Manchester triage categories (6.26%). There was a non-significant trend towards longer lengths of stay. The top 10 presenting complaints remained constant (although the order changed) between time periods. There was no difference in mortality or admission to PICU. Implications: Our data demonstrates that there has been a significant decrease in numbers of children seeking emergency department care. It suggests that presenting patients were proportionally sicker during the pandemic; however, we would argue that this is more in keeping with appropriate acuity for PED presentations, as there were no differences in PICU admission rate or mortality. We explore some of the possible reasons behind the decrease in presentations and the implications for service planning ahead of the winter months.
Coronavirus-19 Outbreak in Children: Different clinical status of a disease in childr...
Yaşar Hüseyin  Onganlar
Havva Hande Keser Şahin

Yaşar Hüseyin Onganlar

and 2 more

October 21, 2020
COVID-19 disease, caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), first appeared in Wuhan, China, and spread throughout the world in a short period of time (1). On 30 January 2020, WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC) and than on 11 March 2020, WHO declared the Coronavirus as a pandemic. The pandemic was called as COVID-19.
Knowledge of Syrian refugee mothers and their attitude towards Covid-19 disease in ch...
Shereen Hamadneh
Jehan Hamadneh

Shereen Hamadneh

and 4 more

October 21, 2020
Objectives: To explore Knowledge and perceptions about COVID-19, among Syrian refugee mothers in Irbid governorate, the first outbreak of coronavirus in Jordan. Methods: This is an exploratory cross-section study was conducted among Syrian refugee mothers, who were currently pregnant or have a newborn child. The data collected through an online survey in April 2020 in North Jordan. Results: A total of 389 Syrian refugee mothers have participated in the study. The study showed that 66% of mothers often access information regarding COVID-19. The main used resources for information, were Facebook pages’ posters (87%), WhatsApp groups’ messages (69%), Television News (53%). While 21% indicated that they access a professional database or governmental websites. In general, Syrian refugee mothers appear well knowledgeable about COVID-19 the transition ways and prevention measures, and aspects that should be considered when diagnosing Coronavirus cases. However, they appeared to have a lack of knowledge about the aspects that should be considered for the transition of COVID-19 between the mother and the child and the concepts about the smoking risks associated with COVID-19. Conclusions: There is less focusing on media on aspects or still understudying of concepts about the smoking risks associated with COVID-19 and concepts around the transition of COVID-19 between the mother and the child. Providing health education regarding COVID-19 to mothers in Irbid would be helpful.
Production of high-quality SARS-CoV-2 antigens: impact of bioprocess and storage on g...
Rute Castro
Lígia Nobre

Rute Castro

and 24 more

October 19, 2020
SARS-CoV-2 is an RNA coronavirus that causes severe acute pneumonia, also known as COVID 19 disease. The World Health Organization declared the COVID-19 outbreak in January 2020 and a pandemic 2 months later. Serological assays are valuable tools to study virus spread among the population and, importantly, to identify individuals that were already infected and would be potentially immune to a virus re-infection. SARS-CoV-2 Spike protein and its Receptor Binding Domain (RBD) are the antigens with higher potential to develop SARS-CoV-2 serological assays. Moreover, structural studies of these antigens are key to understand the molecular basis for Spike interaction with angiotensin converting enzyme 2 receptor, hopefully enabling the discovery and development of COVID-19 therapeutics. Thus, it is urgent that significant amounts of this protein became available at the highest quality. In this work we evaluated the impact of different and scalable bioprocessing approaches on Spike and RBD production yields and, more importantly, in these antigens’ quality attributes. Using negative and positive sera collected from human donors, we show an excellent performance of the produced antigens, assessed in serologic ELISA tests, as denoted by the high specificity and sensitivity of the test. We have shown that, despite of the human cell host and the cell culture strategy used, for production scales ranging from 1 L to up to 30 L, final yields of approx. 2 mg and 90 mg per liter of purified bulk for Spike and RBD, respectively, could be obtained. To the best of our knowledge these are the highest yields for RBD production reported to date. An in-depth characterization of SARS CoV-2 Spike and RBD proteins was also performed, namely the antigens oligomeric state, glycosylation profiles and thermal stability during storage. The correlation of these quality attributes with ELISA performance show equivalent reactivity to SARS CoV 2 positive serum, for all Spike and RBD produced, and for all the storage conditions tested. Overall, we provide herein straightforward protocols to produce high-quality SARS CoV-2 Spike and RBD antigens, that can be easily adapted to both academic and industrial settings; and integrate, for the first time, studies on the impact of bioprocess with an in-deep characterization of these proteins, correlating antigens glycosylation and biophysical attributes to performance of COVID-19 serologic tests. We strongly believe that our work will contribute to advance the current and recent knowledge on SARS-CoV-2 proteins and support the scientific society that is persistently searching for solutions for COVID-19 pandemics.
Association between asthma and clinical mortality/morbidity in COVID-19 patients usin...
Hyo Geun Choi
Jee Hye Wee

Hyo Geun Choi

and 9 more

October 15, 2020
Association between asthma and clinical mortality/morbidity in COVID-19 patients using clinical epidemiologic data from Korean Disease Control & PreventionHyo-Geun Choi1, Jee Hye Wee2, So Young Kim2, Joo-Hee Kim3, Hwan Il Kim3, Ji-Young Park3, Sunghoon Park3, Yong Il Hwang3, Seung Hun Jang3, and Ki-Suck Jung31 Departments of Otorhinolaryngology-Head & Neck Surgery, Hallym UniversitySacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea2 Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department ofMedicine, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Anyang, Korea
Immunological Reason for Mild Effection of Children to COVID-19, A Key Factor for Nov...
Esmaeil Farshi
John Smith

Esmaeil Farshi

and 1 more

October 09, 2020
Coronaviruses are important human and animal pathogens. We will show that probably antibodies don’t have essential role in immunity against COVID-19 in long term, but a type of white globules named T cells may have critical role in immunity against COVID-19. T cells have long time memory to remain in blood. The most important point for investigation of such issue is mild effection of children to COVID-19. While the milder COVID-19 disease in children is remained secretly till this paper, but its understanding will provide important information about the disease. It may also suggest important protective mechanisms and targets for future therapies. Then a main factor in producing a vaccine for COVID-19 maybe consideration of mild infection report of children by COVID-19 comparing adults’ infection that causes conclusion of higher resistance of immune system of children comparing adults. We identified this could be because immunity of children is based on innate immunity (phagocytes) while adults are based on antibodies. Our results show innate immune system including phagocytes contribute severely to the elimination of COVID-19 in both mouse model and human. Our results also show the elimination of COVID-19 required the activation of B cells by CD4+ T cells. CD4+ T cells play an important role in elimination of COVID-19 in primary effection. We measured IgM and IgG in human patients including adults and kids and found that IgM and IgG in kids’ patients are much higher than other adults patients.
SARS-CoV-2 infection in pregnancy during the first wave of COVID-19 in the Netherland...
Evelien Overtoom
Ageeth Rosman

Evelien Overtoom

and 6 more

October 09, 2020
Objective: Description of characteristics, risk factors, management strategies and maternal, obstetric and neonatal outcomes of SARS-CoV-2 infected pregnant women in the Netherlands. Design: Multi-centre prospective nationwide population-based cohort study. Setting: Nationwide. Population: All pregnant women in the Netherlands with confirmed SARS-CoV-2 infection in home-isolation or admitted to hospital between March 1st, 2020 and August 31st, 2020. Methods: Pregnant women with positive PCR or antibody tests were registered using the Netherlands Obstetrics Surveillance System. Testing occurred according to national guidelines (selective testing). Data from the national birth registry (Perined) and Dutch National Institute for Public Health and the Environment (RIVM) were used as reference. Main Outcome Measures: Incidence of pregnant women with SARS-CoV-2 infection. Maternal, obstetric and neonatal outcomes including hospital and critical care admission, clinical management and mode of birth. Results: Of 312 registered women, 65 (20%) were admitted to hospital, of whom 5 (2%) to intensive care and 9 (14%) to obstetric high care units. Risk factors for admission were non-Caucasian background (n=28; OR 6.67, 95%CI 4.08-10.90) and being overweight or obese (n=38; OR 2.64, 95%CI1.51 to 4.61). Hospital and intensive care admission were higher compared to age-matched infected women (respectively, OR 14.57, 95%CI 10.99-19.03 and OR 5.02, 95%CI 2.04-12.34). One maternal death occurred. Caesarean section after labour onset was increased (OR 2.50; 95%CI 1.57-3.97). Conclusions: Pregnant women with SARS-CoV-2 infection are at increased risk of hospital admission, ICU admission and caesarean section. Funding: No funding was received. Keywords: Pregnancy, COVID-19, SARS-CoV-2, Pregnancy complications, Pregnancy outcome, Obstetric surveillance system.
Risk factors for severe and critically ill COVID-19 patients: a review
Ya-dong Gao
Mei Ding

Ya-dong Gao

and 19 more

October 08, 2020
The coronavirus disease 2019 pandemic (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an unprecedented global social and economic impact, and numerous deaths. Many risk factors have been identified in the progression of COVID-19 into a severe and critical stage, including old age, male gender, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung disease, heart, liver and kidney diseases, tumors, clinically apparent immunodeficiencies, local immunodeficiencies, such as early type-I interferon secretion capacity, and pregnancy. Possible complications include acute respiratory distress syndrome, shock, disseminated coagulopathy, acute kidney injury, pulmonary embolism, and secondary bacterial pneumonia. The development of lymphopenia and eosinopenia are laboratory indicators of COVID-19. Laboratory parameters to monitor disease progression include lactate dehydrogenase, procalcitonin, high-sensitivity C-reactive protein, proinflammatory cytokines such as interleukin (IL)-6, IL-1, Krebs von den Lungen-6 (KL-6) and ferritin. The development of a cytokine storm and extensive chest computed tomography imaging patterns are indicators of a severe disease. In addition, socioeconomic status, diet, lifestyle, geographical differences, ethnicity, exposed viral load, day of initiation of treatment, and quality of health care have been reported to influence individual outcomes. In this review, we highlight the scientific evidence on the risk factors of COVID-19.
Authors’ reply re: Implications for the future of Obstetrics and Gynaecology followin...
Lorraine Kasaven
Srdjan Saso

Lorraine Kasaven

and 10 more

October 06, 2020
Dear Sir, Whilst the primary focus of our commentary was to reflect upon the multitude of clinical and institutional changes prompted by COVID-19 to help adopt a more streamlined approach to healthcare,1we thank Herron et al for highlighting the importance of partner support during labour.2 However, we note that even during the peak of the first wave of infections, the Royal College of Obstetricians and Gynaecologists (RCOG) continued to advocate the presence of a single birth partner throughout labour. Many obstetric units, including our own, managed to successfully adhere to this practice throughout the pandemic. However, guidance from the RCOG for women attending antenatally, for face to face clinic appointments or ultrasound scans, was to attend alone. This was subsequently implemented in most hospitals in order to reduce the number of visitors.1 Whilst necessary during the initial fear and uncertainty surrounding COVID-19, moving forward it is important to consider the potential negative impact of partner non-attendance antenatally, as well as intrapartum. Partners often positively encourage women to seek care and prepare for birth complications, thereby preventing delay in treatment and helping to manage expectations, which have been shown to positively impact outcomes.3 Whilst undoubtedly an exciting time for many, pregnancy and the prospect of motherhood is daunting to others. Partners provide support and facilitate decision making throughout the antenatal process, particularly in difficult circumstances such as following the diagnosis of a missed miscarriage, during counselling for pregnancies affected by genetic abnormalities, or after an intrauterine death. The restrictions on partner attendance may therefore inadvertently prevent a number of women seeking care during pregnancy, for fear of having to face procedures or receiving bad news alone. Evidence from a London hospital supports this notion after demonstrating a significant increase in stillbirth rate during the pandemic compared to pre-pandemic (9.31 per 1000 births Vs 2.38 per 1000 births; p=0.01). Of significance, no cases were affected by COVID-19, nor were there any post-mortem findings suggestive of the virus.4The utilisation of remote consultations with a woman and her partner offers a suitable option in appropriately triaged cases.1 Even in remote consultations where inadvertent difficult decisions arise, the presence and support of their partner facilitates collaborative decision making. Ironically, those with high risk enough pregnancies to warrant in person consultations, where additional support could offer significant value, are those whereby partners are not permitted. Prior to the pandemic, partners often reported feeling excluded, fearful of the uncertainty of pregnancy and labour and frustrated by perceived lack of support from healthcare professionals.5 This may subsequently negatively impact their relationship because of the inability to adequately support their partners. Their exclusion from the majority of antenatal care therefore, may not only negatively impact psychological wellbeing of women which may in turn result in suboptimal outcomes, but also negatively impact their future relationship. As such, we agree with Herron et al and support their notion that attempts should be made towards delivering individualised patient centred care both antenatally and intrapartum.Lorraine S Kasaven1,2, Srdjan Saso1,2, Jen Barcroft1,2, Joseph Yazbek1,2, Karen Joash1, Catriona Stalder1, Jara Ben Nagi,2 J Richard Smith,1,2 Christoph Lees1,2, Tom Bourne1,2, Benjamin P Jones1,21 Queen Charlotte’s and Chelsea Hospital, Department of Cancer and Surgery, Imperial College NHS Trust, W12 0HS London, UK.2 Imperial College London, Department of Cancer and Surgery, London W12 0NN, UK.
The Impact of Charlson Comorbidity Index on mortality from SARS-CoV-2 virus infection...
YELDA VAROL
Burcin Hakoglu

YELDA VAROL

and 11 more

October 05, 2020
Objective: The aim of this study is to find out the potential risk factors including Charlson Comorbidity index (CCI) score associated with death in COVID-19 cases hospitalized due to pneumonia and try to find a novel COVID-19 mortality score for daily use. Methods: All patients diagnosed as confirmed or probable COVID-19 pneumonia whom hospitalized in our Chest Diseases Education and Research Hospital between March 11, 2020 and May 15,2020 were enrolled. The optimal cut-off values, sensitivity and specificity values and odds ratios to be used in mortality prediction of the novel scoring system created from these parameters were calculated by ROC analysis according to the area under the curve and Youden index. Results: Over 383 patients (n:33 deceased, n:350 survivors) univariate and multivariate regression analysis showed that CCI and lymphocyte ratio were prognostic factors for COVID-19 related mortality. Using this analysis, a novel scoring model CoLACD (CoVID-19 Lymphocyte ratio, Age, CCI score, Dyspnea) was established. The cut-off value of this scoring system, which determines the mortality risk in patients, was 2.5 points with 82% sensitivity and 73% specificity (AUC = 0.802, 95% CI 0.777-0.886, p <0.001). The risk of mortality was 11.8 times higher in patients with a CoLACD mortality score higher than 2.5 points than patients with a score lower than 2.5 (OR = 11.8 95% CI 4.7-29.3 p <0.001). Conclusion: This study showed that by using the CoLACD mortality score, clinicians may achieve a prediction of mortality in COVID-19 patients hospitalized for pneumonia.
Management considerations for a critically ill 26-gestational week patient with COVID...
Mohamad  Khatib
Victor  Olagundoye

Mohamad Khatib

and 5 more

October 05, 2020
Coronavirus-2019 (COVID-19) pandemic is a global health challenge where pregnant women are potentially more vulnerable to respiratory infections. We describe the successful management of a case a 35 years old pregnant woman, G3, P1, with a history of caesarian section who tested positive for COVID-19 and required critical care support
Elastase and Exacerbation of Neutrophil Innate Immunity are Involved in Multi-Viscera...
Jean Louis Gueant
Rosa Maria Rodriguez-Gueant

Jean Louis Gueant

and 13 more

October 05, 2020
Background: Many arguments suggest that neutrophils could play a prominent role in COVID-19. However, the role of key components of neutrophil innate immunity in severe forms of COVID-19 has deserved insufficient attention. We aimed to evaluate the involvement of Neutrophil Elastase, histone-DNA, and DNases in systemic and multi-organ manifestations of COVID-19. Methods: We performed a multicenter study of markers of neutrophil innate immunity in 155 cases consecutively recruited in a screening center (ambulatory subjects), local hospitals, and two regional university hospitals. The case were evaluated according to clinical and biological markers of severity and multi-organ manifestations and compared to 35 healthy controls. Results: Blood Neutrophil Elastase, histone-DNA, myeloperoxidase-DNA and free dsDNA were dramatically increased, and DNase activity decreased by 10-fold, compared to controls. Neutrophil Elastase and histone-DNA were associated with intensive care admission, body temperature, lung damage and markers of cardiovascular outcomes, renal failure and increased IL-6, IL-8 and CXCR2. Neutrophil Elastase was an independent predictor of the computed tomography score of COVID-19 lung damage and the number of affected organs, in multivariate analyses. The increased blood concentrations of NE and neutrophil extracellular traps were related to exacerbation of neutrophil stimulation through IL8 and CXCR2 increased concentrations and increased serum DAMPs, and to impaired degradation of NETs as a consequence of the dramatic decrease of blood DNase activity. Conclusion: Our results point out the key role of neutrophil innate immunity exacerbation in COVID-19. Neutrophil Elastase and DNase could be potential biomarkers and therapeutic targets of severe systemic manifestations of COVID-19.
Impulse Oscillometry -- A reasonable option to monitor lung functions in the era of C...
Neeraj Gupta
Anil Sachdev

Neeraj Gupta

and 2 more

October 05, 2020
Spirometry, a gold standard technique for measuring lung functions, has been restricted to a select cohort of patients in current COVID-19 pandemic due to the enhanced risk of disease dissemination. To monitor pulmonary functions in various obstructive (e.g., asthma) and restrictive diseases (e.g., COVID-19 pneumonia) on in- and out-patients serially, there is an urgent requirement of an alternate reliable test. Impulse Oscillometry (IOS) measures lung functions by working at tidal volumes and thus reduces the risk of potential aerosol generation. Feasibility of IOS in smaller children and its ability to detect parenchymal and peripheral airway involvement are other advantages over conventional spirometry. IOS could be a potential solution to periodically monitor lung functions in current pandemic situation to keep a check on diseases affecting lung functionality.
Can Tenofovir diphosphate be a candidate drug for Sars-Cov2? First clinical perspecti...
Omer Kutlu

Omer Kutlu

October 01, 2020
COVID-19 pandemic continues to spread across the world in late September 2020. To date, total cases of COVID-19 exceed 33 million including 996.342 deaths according to the WHO data. Although hydroxychloroquine, oseltamivir, remdesivir, favipiravir have been reported as an anti-SARS-CoV-2 effect, it is still unclear the fully effective protective drug and treatment. Herein, we report a woman under Tenofovir diphosphate who live and close contact with his COVID-19 positive husband. Although she had close contact with his husband without measure in the home she did not show any symptoms and signs of COVID-19 and her PCR test along with antibody test negative. Given the high reproduction number of SARS-CoV-2 and long-term close contact of the case, it can be speculated that Tenofovir could interfere with the transmission of COVID-19.
Lung ultrasound in the diagnosis and monitoring of 30 children with Coronavirus Disea...
Anna  Maria Musolino
Maria Supino

Anna Musolino

and 10 more

October 01, 2020
Background: The Coronavirus Disease 2019 (COVID-19) is causing of the new global pandemic and is responsible for millions of infections and thousands of deaths in the world. The lung ultrasound is a non-invasive and easily repeatable tool and can be carried out by the pediatrician at the bedside of children with a consequent reduction in the risk of transmission of the virus. Objective: To determine whether the lung ultrasound is a useful tool in identifying the signs of lung involvement in children with COVID-19 and whether can monitor the course of the disease. Methods: The study was made in the emergency department in a tertiary level pediatric hospital. All patients with swab-confirmed COVID-19 infection were subjected a lung ultrasound within 6 hours from admission and after 96 hours. Results: Among a total of 30 children, 18 (60%) were males, 4 reported exertional dyspnea and only 1 chest pain. The mean oxygen saturation was 98.8 ± 1.0 % in ambient air in emergency department and no patient needed oxygen therapy during hospitalization. After 96 hours we had observed ultrasound abnormality al the lung ultrasound only in 20% of the children. We found a statistically significant reduction in pleural irregularities (30% vs 16.7; p: .001) and in B lines (50% vs 20%; p: .008). Conclusions: lung ultrasound is safe and useful tool in detecting lung involvement in children with COVID-19 and in monitoring these patients during the course of disease.
A comment on “Serological survey of SARS-CoV-2 for experimental, domestic, companion...
Ning Zhang
Qin Xu

Ning Zhang

and 3 more

October 01, 2020
In May 2020, Deng et al. (2020) published their article providing the evidence that no SARS-CoV-2-specific antibodies were detected in 1,914 samples which excluded the possibility of 35 animal species as intermediate host for SARS-CoV-2 in Transboundary and Emerging Diseases. In order to ensure the stability of SARS-CoV-2-specific antibodies in storage serum samples, we strongly suggest that standard serum banks should be established.
The role of red blood cells exchange in Sickle cell disease in a patient with COVID-1...
Lina Okar
Maya aldeeb

Lina Okar

and 2 more

October 01, 2020
COVID-19 related pneumonia overlaps with ACS, one of the most common acute presentations in SCD patients.We present a case of 22-year-old SCD patient presented to the emergency department with mild respiratory symptoms turned out to be COVID-19 positive and received red blood cell exchange to avoid the possibility of deterioration.
Children and young adults hospitalized for  severe COVID-19 exhibit thrombotic coagul...
William Mitchell
Jennifer Davila

William Mitchell

and 8 more

February 09, 2021
We report the clinical and laboratory coagulation characteristics of 27 pediatric and young adult patients (2 months to 21 years) treated for symptomatic COVID-19 at a children’s hospital in the Bronx, New York between March 1 and May 31, 2020. D-Dimer was > 0.5 ug/mL (upper limit of normal) in 25 (93%) patients at admission; 11 (41%) developed peak D-Dimer > 5 ug/mL during admission. Seven (26%) patients developed venous thromboembolism: three with deep vein thrombosis and four with pulmonary embolism. Requirement of increased ventilatory support was a risk factor for thrombosis (p=0.006). Three of eight (38%) patients on prophylactic anticoagulation developed thrombosis, however no patients developed VTE on low molecular weight heparin prophylaxis titrated to anti-Xa level. Manifestation of COVID-19 disease was severe or critical in 16 (59%) patients. Four (15%) patients died of COVID-19 complications: all had comorbidities. Elevated D-dimer and increased VTE rate were observed in this young cohort, particularly in those with severe respiratory complications suggesting thrombotic coagulopathy. More data is needed to guide thromboprophylaxis in this age group.
Lessons from a pandemic: do not force your patients into the bed of Procrustes!
Theodor Alexandru Voiosu
Andrei Mihai Voiosu

Theodor Alexandru Voiosu

and 1 more

October 01, 2020
The frantic search for a cure or prophylactic treatment of COVID-19 has unfortunately led to a dropping of the guard of many medical specialists resulting in widespread adoption of unproven treatment modalities. The recent article regarding the inconsistent physician attitudes towards hydroxychloroquine paints a depressing picture of the actual practices during the so-called era of evidence-based medicine. On this backdrop, we comment on how Romania (where this survey took place) has imposed some of the most severe lockdown measures in Europe, including the forced hospitalization of all confirmed with SARS-CoV-2 infection. Additionally, a therapeutic guideline was written into law, endorsing concomitant use of several drugs with unproven antiviral efficiency. This unprecedented situation has resulted in the sometimes indiscriminate prescription of off-label drugs, with a non-negligible risk of adverse reactions, especially in fragile patients with coexisting conditions. In light of the experience accrued in a COVID-19 dedicated unit, the authors discuss the importance of avoiding polypharmacy and administering all antiviral drugs within the confines of rigorously conducted clinical trials.
Brain natriuretic peptide is an indicator for early risk-stratification and managemen...
pengping li
Wei Wu

pengping li

and 20 more

October 01, 2020
Background and Purpose: Coronavirus disease (COVID-19) has resulted in high mortality worldwide. However, information regarding cardiac markers for precise risk-stratification is limited. We aimed to discover a sensitive and reliable early-warning biomarker for optimizing management and improving COVID-19 patients’ prognosis. Experiments Approach: This retrospectively single-center case series was conducted between February 4 and April 10, 2020. 3,046 consecutive COVID-19 patients who were receiving treatment at Wuhan Huoshenshan Hospital in China were included. Serum levels of cardiac markers and coronary artery disease (CAD) diagnosis were collected after admission. Single-cell RNA-sequencing was performed to analyze severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor expression. Key Results: Median patient age was 60 years; 1,461 (49.5%) were female, and 1,515 (51.3%) were in a severe/critical condition. Compared to mild/moderate patients, severe/critical patients showed significantly higher levels of cardiac markers within the first week after admission. Among severe/critical COVID-19 patients, those with abnormal serum levels of brain natriuretic peptide had a significantly higher mortality than patients with normal levels. Severe/critical COVID-19 patients with pre-existing CAD (165/1,515) had more cases of abnormal brain natriuretic peptide levels than those without CAD. Enhanced SARS-CoV-2 receptor expression was observed in patients with CAD. Regression analysis revealed patients with elevated brain natriuretic peptide were at a higher risk of death. Conclusion and Implications: Brain natriuretic peptide is an effective biomarker for early risk assessment in COVID-19 patients with or without pre-existing CAD. Monitoring BNP status will improve the risk-stratification management and prognosis of patients within one week after admission.
A Tale of Two Pandemics: COVID-19 and Misinformation
Richard Stein
Oana Ometa

Richard Stein

and 5 more

September 28, 2020
Conspiracy theories, omnipresent in traditional and modern societies [1], span demographic strata and political differences [2] and have fascinated people for ages [3]. While many conspiracy theories are harmless and may even be entertaining, the ones related to medical and public health topics can be particularly dangerous for the individual and collective well-being [3]. This second category includes misinformation and conspiracy theories related to COVID-19, which is likely one the most significant pandemics of our lifetime. Compounding the challenges that it opened for the economy, social and political sciences, and biomedical, translational, and clinical research, COVID-19 also propelled discussions about conspiracy theories and media health literacy to the forefront of public health in ways that were nearly impossible to predict.Situations of crisis, fear, and uncertainty increase the likelihood of conspiratorial thinking [4]. A key difference between COVID-19 and the 1918 flu pandemic, which is sometimes used as a reference, is that a highly interconnected world, to a great extent on social media, is setting the stage for distributing information and misinformation about COVID-19 [5]. In the short time since the beginning of the pandemic, the number of COVID-19-related conspiracy theories increased and propagated on social media. According to some metrics, online sensationalist and conspiratorial sites and articles generate more user engagement than more reputable sources such as the World Health Organization and the US Centers for Disease Control and Prevention [6] or mainstream news media such as the BBC and New York Times [7].An important way in which misinformation related to COVID-19 differs from misinformation that impacts other health-related topics is its multi-layered nature, in the sense that it concomitantly targets multiple facets of the pandemic. These include misinformation and conspiracies casting doubt on the very existence of the virus, minimizing the value of long-proven preventive strategies, and questioning the safety, efficacy, and potential ulterior motives of a vaccine that is not even available yet, and not sure it will ever be. In the wake of COVID-19, an ocean of misinformation [8] that spans all these domains has accumulated faster than for many other health-related topics. As a result, mutually incompatible and contradictory conspiracy theories were sometimes being endorsed and circulated together [9]. Misinformation and disinformation during the pandemic contributed to the demonization of health care workers [10]. As patients avoided hospitals or had difficulties making appointments in the wake of the pandemic, they experienced delays in accessing healthcare for various medical conditions [11-14]. An increased mortality from acute heart disease was reported in several countries [15]. In this context, ambiguous messages about the pandemic endanger the delivery of healthcare in virtually all clinical areas and can place patients at a heightened risk of complications.Some conspiratorial claims include assertions that COVID-19 is a hoax, arguments that the virus was created artificially [16, 17] and spread on purpose [18] as a bioweapon [19], or allegations that governments are using the emergency situation to pursue their anti-democratic goals [20]. As early as in January 2020, social media stories contained claims that 5G technologies either caused or accelerated the spread of the pandemic [21, 22]. Other conspiracies argued that people in power are taking advantage of the pandemic as a plan to inject microchip quantum-dot spy software and monitor people [8]. Videos or articles perpetuating these theories were viewed by millions of people on social media platforms. Another conspiracy theory, circulating in several languages, claimed that the swab test reaches the back of the nasopharynx and damages the blood brain barrier, and urged people to refuse testing [23, 24]. Yet another conspiracy theory, spread thousands of times on social media, claimed that testing itself infects people with the coronavirus and urged them to refuse testing [23].The use of face masks has become a passionately debated topic [25, 26], even though many studies support their benefit against SARS-CoV, SARS-CoV-2, MERS-CoV, [27, 28], flu, and seasonal coronaviruses [29]. Some people wearing masks have faced alienation or discrimination [30]. Claims on social media that the virus crosses the masks, and therefore the mask is useless, have been circulating together with claims that the virus persists on the surface of the mask and wearing a mask would, therefore, infect people, or that the mask could “activate the virus” [31]. Other social media claims include warnings that masks may cause fungal or bacterial pneumonia [32] or oxygen deprivation and carbon dioxide poisoning [33], an especially worrisome complication for children and pregnant women, despite evidence that no differences exist in heart rate and oxygen saturation between pregnant and non-pregnant women wearing N95 respirators for a short period of time [34].Most recently, warnings on social media advised people of the dangers of having their temperature checked upon entering closed spaces, based on the false claim that infrared light damages their pineal gland, when in reality infrared thermometers detect radiation emitted by the body [35, 36]. Other pseudoscientific claims advanced unproven therapies, including homeopathic arsenic-based products or colloidal silver solutions [22], advocated for prophylactic vitamin megadoses [37], promoted vitamin C and garlic as miracle remedies [38], and recommended ginger, hot pepper, and lemon to limit the impact of the pandemic [39].A vaccine is highly anticipated but not yet available, and it is uncertain which of the several vaccines that are currently pursued will succeed, if any. As of late July 2020, ~200 vaccine candidates were under active development and 15 were in human clinical trials [40]. Prior to the widespread use of social media and crowdsourcing to obtain medical information and advice, the spread of infectious disease outbreaks was usually limited to confined geographic locations; now, the availability of misinformation widens the footprint of its harm. Vaccine-related misinformation on social media is rampant. In late April 2020, a false story that circulated claimed that one of the first volunteers in the UK during a COVID-19 vaccine trial died from complications [41]. Another conspiracy theory claimed that the vaccine will be used to establish a global surveillance network [42]. Additionally, various social media posts are already providing advice on how to avoid the vaccine. A WebMD poll in late July 2020 found that if a COVID-19 vaccine was available, fewer than one-third of the respondents would take it in the first 90 days, and fewer than one-half of the people would take it in the first year [43].Each of these conspiracy theories may be destructive in itself. While it is challenging to demonstrate the direct influence of any given conspiracy theory on an individual’s behavior, there are some suggestive trends. In the wake of the misinformation linking 5G technologies to the pandemic, attacks were perpetrated against telecommunication masts on several continents, and engineers were subjected to verbal and physical abuse [44]. Between April 2-6, 2020, it was estimated that at least 20 phone masts were damaged in the UK. This included a hospital in Birmingham, UK, whose phone mast was set on fire [21]. There are previous examples to illustrate the heavy price of denial and misinformation in the wake of an infectious disease crisis. During the HIV/AIDS pandemic, claims that the virus does not exist or that it does not cause AIDS were incredibly harmful [38]. When the South African government, in its widely criticized denialist approach [45], withheld lifesaving drugs and promoted non-tested alternative solutions instead [46], the public health damage was incalculable and estimated to have claimed >330,000 lives [47-49].Anti-vaccination rhetoric and conspiracies are not new. They existed since Edward Jenner’s time, when some rumors claimed that vaccination will make people grow horns [50, 51]. The themes have been strikingly similar across time, and include distrust of the medical establishment or governments mandating vaccination; revulsion at the idea of introducing unknown substances into the body; accusations that the ingredients are harmful; or suspicion that the real motives behind vaccines are to make people sick or to control the population. Like many conspiracy theories, some worries over history have been rooted in a kernel of truth. Such examples include the Tuskegee Syphilis Study, where the government and the medical establishment have abused their power at the cost of people’s health [52-54]; the rare cases when contaminated vaccines caused harm [55-57]; or instances when vaccination was used as a cover for intelligence operations [58]. During the Zika virus epidemic, some of the conspiracy theories claimed that the disease was caused by vaccines, and an Australian anti-vaccination Facebook group emphasized that the vaccine used to prevent diphtheria, tetanus, and pertussis in pregnant women was introduced in Brazil only months before the Zika outbreak [59-61]. This makes it understandable, to a certain extent, why some people continue to view vaccines with suspicion.A paradox in the vaccination debate seems to be the fact that even though vaccines have well-known and widely-reported adverse effects [62-64], most conspiratorial discussions focus on false claims about adverse effects that were never linked to vaccines, while the actual adverse effects, that scientists and regulators are attempting to address and avoid, are rarely discussed, if ever. What makes the COVID-19 vaccine refusal so different is that the debates are directed against a vaccine that was not even manufactured yet. Amidst these multiple layers of misinformation and conspiratorial discourse, the potential for damage is unpredictable, poignant, and difficult to manage, and the challenges associated with bringing the pandemic under control adopt a new, amplified, and more acute perspective.On the bright side, overall, social media harbors a larger volume of accurate information than misinformation [65]. The sobering news is that misinformation seems to be more popular [65], become more prevalent over time [66], and spread faster, farther, and deeper [67, 68]—though whether this is true of health emergencies is less clear [69]. Several studies found that COVID-19 conspiracy beliefs negatively correlate with COVID-19 health-protective behaviors [70, 71], and individuals who support COVID-19 conspiracy theories are less likely to accept the advice of public health experts [72].Even though social media made it easier to disseminate misinformation, it is not clear to what extent it causes more people to believe in them. Surveys of public opinion around conspiratorial beliefs, particularly during an ongoing global event such as the current pandemic, should be interpreted with caution. The responses to such surveys depend on the questions asked. As noted, conspiracy theories often make a multitude of specific, sometimes mutually contradictory claims; COVID-19 conspiracy theories are no exception. As a result, it is difficult for a single survey to cover all variants of any given conspiracy theory. While research suggests that endorsement of one conspiracy theory predicts the endorsement of others, general conspiratorial ideation has been found to be relatively weakly predictive of general conspiracy claims about COVID-19, and even more weakly predictive of a plethora of specific claims [71]. Even more basic aspects of survey design such as the wording of available response options can have a substantial influence on responses [73]. The extent to which such surveys over- or underestimate true engagement with conspiracy theories is therefore unknown. It must also be noted that misinformation constitutes only a small fraction of people’s news consumption, and that news consumption itself is only a small fraction of people’s overall information diet [74]. The nuances of public opinion around conspiracy claims should receive increased attention in the years to come, as they have the potential to directly impact public health.Even though initial surveys indicate that many people would hesitate to adopt a coronavirus vaccine, it is important not to over-extrapolate, as responses to hypothetical questions may reflect many unstated assumptions and variables. However, the link merits increased focus over the coming months and years. We also need to recognize that hesitancy does not necessarily suggest that someone is a conspiracy theorist, or that they won’t actually seek vaccination should it become a reality with demonstrated safety and efficacy. A lot remains to be understood about people’s attitudes towards vaccines, and we should support this topic to further develop in the years to come.As we are exploring the best way forward during the COVID-19 pandemic, an ongoing challenge and a critical task will be to understand how to limit the rapid spread of misinformation, for which the term “infodemic” was coined to reflect its amplitude and extent [75-77]. Prompt, effective, and targeted interventions that seek to delegitimize misinformation emerge as an important strategy to reduce its impact. It was suggested that social media users should take advantage of the mechanisms available to report misinformation on the respective platforms [21]. More extensive efforts need to be dedicated to advance and promote media and social media literacy, and to interrogate the impact of misinformation, disinformation, and conspiratorial thinking on the different facets of this pandemic and of other public health emergencies. For sure, the road ahead will be long and tortuous.
Reactivated world war two traumatic memories in COVID19 lock down period
Inès Bigarré
Caroline Landon

Inès Bigarré

and 3 more

September 28, 2020
Lockdown measures because of COVID-19 pandemic have had a major impact on patients’ mental health. We present the case of an 80-year-old patient, reactivating World War Two memories during lockdown period. We looked for posttraumatic stress disorder (PTSD). She also presented with a rheumatoid arthritis flare after disease control
Is there any association of COVID-19 with Testicular Pain and Epididymo-orchitis
Caner Ediz
Hasan Huseyin Tavukcu

Caner Ediz

and 6 more

September 28, 2020
Aims: This study aims to analyze the novel Coronavirus disease (COVID-19) related testicular pain in hospitalized patients due to COVID-19 and to review as an etiological factor for epididymitis, orchitis or both. Methods: A total of 91 patients were included in the study. A questionnaire was formed for the questioning of testicular pain or epididymo-orchitis in patients with COVID-19. Demophrahics and past medical history was also recorded. Patients’ neutrophil and lymphocyte counts, neutrophil-lymphocyte ratios (NLR), C-reactive protein (CRP) levels and D-dimer values were recorded. Patients with COVID-19 were divided into two groups according to absence or presence of testicular pain or epididymo-orchitis as group 1 and group 2. All results were compared for both groups. Results: The median age of patients was similar in both groups. Testicular pain was occured in 10.98% of the patients. Clinical presentation of epididymo-orchitis was diagnosed in only one patient. No statistically significant difference was reported in terms of patients’ age, levels of CRP and D-Dimer or NLR and results of questionnaire form queries between the two groups (p>0.05). Conclusion: Testicular pain was observed more frequently in hospitalized COVID-19 cases. While no inflammation marker which is related to predict of testicular pain or epididymo-orchitis was found in patients with COVID-19.
COVID-19 and late-onset hypertension with hyporeninaemic hypoaldosteronism
Amit Mandal
Jason Kho

Amit Mandal

and 3 more

September 28, 2020
COVID-19 and late-onset hypertension with hyporeninaemic hypoaldosteronismAmit K J Manda, MB, FRCP(Ed), FRCP, FACP1Jason Kho MBBCh, BAO1Sofia Metaxa, MD, PhD 1Constantinos G Missouris, MD, FRCP, FACP1,21Wexham Park Hospital, Frimley Health NHS Foundation Trust, UK2University of Cyprus Medical School, Nicosia, Cyprus
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