Abstract Objective To study the impacts of obstetric complications and anxiety among pregnant women in non-epizootic area which are caused by COVID-19. Design Retrospective cohort. Setting China. Population or sample the women who delivered in the third trimester of pregnancy in Qingdao Municipal hospital for the year the months March and April, 2019 and 2020. Method This paper is based on the clinical data from This paper makes a detailed analysis of the problems that can arise because of special circumstances related with delivery history, personal physical symptoms, anxiety index, adverse complications as well as neonatal birth weight. Result Comparing with the same period between 2019 and 2020, maternal age(32.12±5.32vs31.01±4.21, P<0.05) and the ratio of macrosomia(12.10%vs2.53%)are increasing steadily. Meanwhile, times of prenatal visits (10.49±2.15vs10.89±1.81, P<0.05) and score of PHQ-9（1.46±2.09vs4.96±1.38, P<0.05）are to fall significantly。 Conclusion It is helpful to relieve the negative emotion of fear and anxiousness for the pregnant women if they can be encouraged and soothed by social support. The leading cause why regular checkups are decreasing is due to the fear of the epidemic and the transport restrictions, which, in return, may result in a lack of effective management in fetal weight. The COVID-19 had no giant effect on the third trimester of pregnant women. Government as well as obstetric practitioners should strengthen the education of fetal weight management during the pregnancy. Keywords Pregnancy; COVID-19; obstetric complications; anxiety Tweetable abstract The COVID-19 had no giant effect on the third trimester of pregnant women in the non-epizootic area China.

Aim: To assess effect of high-dose vitamin C on cardiac injury in coronavirus disease 2019 (COVID-19). Methods: The study was designed based on the severe and critically ill COVID-19 with cardiac injury. Demographics and baseline clinical characteristics were collected and analyzed in addition to laboratory examinations including inflammatory markers on admission and at 14 days after treatment from the electronic medical records. Participants were followed-up for 14 days after treatment with high-dose vitamin C in addition to conventional therapy. Result: The patients (n = 113) were categorized into the improved cardiac injury (ICI) group (n = 70) and the non-improved cardiac injury (NICI) group (n = 43). Overall, 51 (45.1%) patients were administrated with high-dose vitamin C, the percentages of patients treated with high-dose vitamin C were higher in the ICI group than that in the NICI group (52.8% vs 32.5%, P = 0.035). Further analysis showed that concentrations of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, interleukin-2 receptor (IL-2R), IL-6 and IL-8 significantly decreased at 14 days after treatment in patients treated with high-dose vitamin C compared with those in patients administrated without high-dose vitamin C. Meanwhile, similar results were also observed regarding changes in inflammatory markers from baseline to 14 days after treatment in patients receiving high-dose vitamin C. Conclusion: High-dose vitamin C can improve cardiac injury through preventing hyper-inflammatory response in severe and critically ill COVID-19.

Background Pediatric patients represent approximately 2% of overall confirmed cases of COVID-19. Illness severity and symptoms differ from adults. Most cases in children are mild but various studies have reported severe and critical cases as well as fatal outcomes. Methods A systematic review and meta-analysis of the available literature was performed. Frequencies were used for reporting categorical variables. Meta-analyses were performed using the binary random effects model for symptoms frequencies in children and illness severity. Results We found 44 studies (n=6026), 38 were used for quantitative synthesis to estimate the frequency of symptoms in the pediatric population with Covid-19 and illness severity, 44 were used for qualitative synthesis. The most common symptoms were fever 64% (CI 95% 54-72%), cough 42% (CI 95% 37-48%) and gastrointestinal symptoms like vomit 31% (CI 95% 17-47%) and diarrhea 28% (CI 95% 17-40%). For illness severity 2% (CI 95%0-5%) were severe and 3% (CI 95% 1-6%) were critical. Children <1-year-old had the higher odds of severe/critical cases with an OR of 2.07 (IC95% 1.40-3.05). All patients were hospitalized, and a total of 10.34% children admitted to PICU. The mortality rate was 0.16% (8/487). A total of 141 patients developed PIMS-TS and only one died. Conclusions: Most cases in children were non-severe, nevertheless children less than 1 year had the higher risk of severe/critical cases. Symptoms frequencies encountered from major to minor were fever, cough and gastrointestinal symptoms. More testing in children should be done in order to understand transmission characteristics in the pediatric population.

Having lived through the havoc of COVID-19 in a hospital situated in one of the hardest hit zip codes in the United States, the thought that another wave could loom in the fall is bracing. Obstetricians at our institution have cared for well over 200 COVID-19-infected pregnant women, and are acutely aware of the herculean effort it took to reorganize the service to accommodate the needs of women infected with this new pathogen.1 Many institutions, including ours, modified the frequency of prenatal visits, among other measures, to minimize in-person contacts, in an effort to reduce the likelihood of viral spread. However, it is those changes, along with our prior experience of treating women unimmunized against influenza that leads to our concern that a singular focus on COVID-19 could leave pregnant women at risk from a more familiar threat.While COVID-19 is a threat to the health of individuals and society, its effect on pregnancy is less clear. Thus far, few COVID-19-infected pregnant women have required ICU care, and to date three maternal deaths has been reported in the United States.2-4 The toll of influenza in pregnancy is more clearly documented and is more severe.5Now that the first wave is ebbing in New York, we are seeing fewer and fewer cases but still diagnose about 15 infections per week in our hospital. That pattern is the converse of what is being seen in large swaths of the country. Despite the higher prevalence seen earlier in the epidemic in New York, and the fact that many of those women needed respiratory support, only two women in our hospital required admission to the intensive care unit (ICU), and only one needed ventilator support. Mercifully, none died. During the preceding influenza season, whose end overlapped with the start of the COVID-19 pandemic, we treated six women with influenza who required admission to the ICU, only one of whom had been vaccinated against influenza. As opposed to our COVID-19 cases (putting aside the more rigorous application of social distancing), there were clearly missed opportunities to have prevented some of the morbid events caused by influenza.Admittedly, the higher admission rate to the ICU may be misleading. It is certainly possible that criteria for admission to ICUs, like almost all other aspects of care, evolved during the COVID-19 crisis. There was such a rapid and dramatic increase in the need for ICU beds in our hospital (from a baseline of 40 mid-March, 2020 to a peak of 140 mid-April; 2020, internal data) that more stringent criteria for admission may have been applied and some of our COVID-19 patients that were cared for on the wards, may have been cared for in an ICU in less harrowing times. But even given that possibility, the fact that a similar number of women were extremely ill with influenza raises grave concerns going forward.In the first instance, co-infection with COVID-19 and influenza, as well as other viruses, has been reported.6 Co-infection events will make diagnosis of either entity more difficult, and could potentially increase morbidity. Thus, both because of the risks of co-infection, and the known risks of influenza in pregnancy, providers can’t afford to take their “eye off the ball,” and become less vigilant about vaccinating patients, even if some of the new protocols for fewer visits or telehealth visits remain in place. With fewer visits comes the risk of missing both the vaccination “window” and the opportunity to incorporate vaccination as an essential component of health maintenance. In addition, obstetricians’ performance as vaccinators has been less than ideal as only approximately half of pregnant women get influenza vaccines.7In addition to vaccination, obstetricians must remain vigilant in order to prevent progression of disease among those who get infected. Oseltamivir provides the opportunity for secondary prevention.8 It has been shown to reduce maternal ICU admission and mortality.9 Yet, as with vaccination, even before the COVID-19 epidemic, it was underutilized.10Beyond committing to better use of medical interventions for influenza, obstetricians have to assure that just because they have lived through COVID-19, and the world’s attention remains fixed on COVID-19, they don’t become so COVID-19-focused, that they fail to include influenza in the differential diagnosis of women reporting respiratory symptoms in the fall. Every fever and ache will not be COVID-19. If we delay consideration of the diagnosis of influenza, we will lose the opportunity to use Oseltamivir before the window of eligibility closes. In the post-pandemic world, it will be hard to avoid cognitive biases, such as the availability heuristic (a strategy for making judgments about likelihood of occurrence based on the salience of the information) and confirmation bias (the tendency to gather evidence that confirms preexisting expectations, typically by emphasizing or pursuing supporting evidence while dismissing or failing to seek contradictory evidence). These can result in physicians being hammers and every respiratory symptom, a COVID-19 nail; especially when rapid COVID-19 tests are not uniformly available and don’t yet have uniformly high quality. This is the reverse of one of the most cited examples of the availability heuristic, “In influenza season, it is tempting to consider all patients with fever and myalgias as having influenza.”11 An enhanced situational awareness, i.e., recognizing the influence of recent diagnoses on your diagnostic proclivities, will become an ever more crucial antidote to the hard earned reflex response to fevers and aches that developed during the first wave of COVID-19.We know from history that influenza recurs both in epidemic and pandemic forms, and that an initial wave can be a “herald wave” for the following one.12 Hence, it is our responsibility not to let the current COVID pandemic prevent us from properly dealing with the possibility of overlapping epidemics (seasonal influenza and COVID) in the fall. Vaccination, rapid recourse to antivirals (e.g., Oseltamivir), and community mitigation measures will be more important than ever. COVID-19 can kill, but so can influenza, and if we do our jobs, we can reduce that toll.

Background: The pandemic caused by Coronavirus disease 2019, has caused great impact worldwide. Risk factors for severe outcomes have been identified, but asthma seems not to be one of them. Objectives: Our principal purpose is to analyze personal characteristics in severe asthma patients, in treatment with monoclonal antibody, belonging to the Health Department of Castellon, in order to see if these variables affect the probability of being infected by SARS-Cov-2. Methods: This is an observational study. Patients recruited had severe asthma in treatment with monoclonal antibody. A questionnaire was elaborated. Aspects evaluated were: COVID-19 symptoms, asthma control, exposition to the disease, and lifestyle before the pandemic. Serological tests were done by using total SARS-Cov-2 antibody test. Results: 108 patients were enrolled in the study, of whom 106 patients were included. 11 patients declared suggestive COVID-19 symptoms. A total of 21 patients had a serology test done, giving positive results 2 of them. 27 patients needed medical attention, being asthma exacerbation the most common symptom. 71,7% of patients had a normal or high level of social activity before the pandemic. Statistic significance was achieved for medical assistance, asthma control and contact with SARS-Cov-2 positive patients. Conclusion: Personal external factors in severe asthma patients do not influence the probability of being affected by the disease. We can hypothesize that these patients do not have an increased susceptibility for being infected by the virus. Bad asthma control was the main reason for medical assistance during the pandemic.

A novel virus, severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19) worldwide appeared in 2019. Currently, we do not have a medicament that treats the disease. One of the rea-sons for the absence of treatment is related to the scarcity of detailed scientific knowledge of the members of the Coro-naviridae family, including the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Structural studies of the MERS-CoV proteins in the current literature are extremely limited. We present here detailed characterization of the struc-tural properties of MERS-CoV macro domain in aqueous solution at the atomic level with dynamics. For this study, we conducted extensive replica exchange molecular dynamics simulations linked to a generative neural networks and we use the resulting trajectories for structural analysis. We perform structural clustering based on the radius of gyration and end-to-end distance of MERS-CoV macro domain in aqueous solution with dynamics at the atomic level. We also report and analyze the residue-level intrinsic disorder features, flexibility and secondary structure. Furthermore, we study the pro-pensities of this macro domain for protein-protein interactions and for the RNA and DNA binding. Results are in agree-ment with available nuclear magnetic resonance spectroscopy findings and present more detailed insights into the struc-tural properties of MERS CoV macro domain. Overall, this work further shows that neural networks can be used as an exploratory tool for the studies of CoV family molecular conformational space at the nano level.

Background: New corona virus (COVID-19), as an international health threat poses a challenge to physical and psychological resilience globally. The aim of this survey is to explore the level of awareness, health seeking behaviors and preventive measures towards COVID19 among Najran university students. Methodology: By adopting a convenient sampling technique, a cross-sectional study was carried out at Najran university. A self-reporting electronic questionnaire had been utilized for collecting data. A total of 684 students were voluntary completed the questionnaire. Results: The mean age of the participants was 20.2±14.1, The most cited source for obtaining information about COVID-19 was the social media (51%). Females showed higher level of knowledge and awareness about the symptoms of the disease than males (74.3% vs 69.9%) respectively, although the difference was not significant with (P-value >0.05). In regard to compliance with preventive measures, medical students were significantly aware and complying with various preventives measures towards COVID-19 (P-value <0.05). Moreover, females seem to be very keen in seeking medical advices when needed significantly more than males (P-value<0.05). Almost more than 66% of the respondents know the recommended precautions in terms of wearing masks, not to touch outdoors surfaces directly and avoiding crowded places. 556(81.3%) of the participants believe that they should wear face masks outdoors. 6% of the participants prefer to take some herbs daily in different forms to avoid getting infected with COVID-19. Females had an overall higher mean of tension level towards getting infected than males (mean± SD was 5.61 ±1.65 vs 4.55± 1.63) respectively. Conclusion: It was concluded that our students have high level of knowledge and awareness about COVID-19, beside positive attitudes preventive measures and acceptable health seeking behaviors. It is highly recommended to assess the entire Najran community level of awareness so as to design educational programs when needed.

Background: Echocardiography derived myocardial performance may be impaired.Objectives: To evaluate cardiac involvement including cardiac biomarkers, echocardiographic findings in patients with COVID-19 and to explore the effect of cardiac impairment on short-term outcome.Methods: This study cohort was conducted from February 9, 2020, to March 28, 2020, in a single center at Wuhan Leishenshan Hospital. 213 patients whose echocardiography were included. Demographic data, laboratory results, echocardiographic findings were analyzed. Results:Among 213 patients confirmed with COVID-19,150 non-critical patients and 35 critical patients were discharged. 28 critical patients needed invasive mechanical ventilation, 16 of whom died during the hospitalization, and another 12 patients were transferred for continued treatment with tracheotomy. The incidence of cardiovascular complications including acute myocardial injury, arrhythmia and acute myocardial infarction was higher in critical group . A total of 108 patients had abnormities on echocardiography. 26(12.2%) patients have presented the signs of pulmonary hypertension and the presence of pulmonary hypertension in critical group was higher than that in non-critical group The cardiac biomarkers at admission in critical patients were significantly higher compared with non-critical patients.Multivariate analysis showed high-sensitivity cardiac troponin I elevation and echocardiographic signs of pulmonary hypertension ere independent risk factors of adverse outcome.CONCLUSIONS: The elevation of cardiac markers and echocardiographic signs of pulmonary hypertension are risk factors of adverse outcome in patients with COVID-19. It’s meaningful to combine echocardiography with cardiac markers to evaluate the prognosis of patients with COVID-19.

During the first phase of COVID-19 pandemic in Italy, several strategies have been taken to deal with the pandemic outbreak. The Regional Authority of Lombardy remodeled the hospitalization system in order to allocate appropriate resources to treat COVID-19 patients and to identify “Hub/Spoke” hospitals for highly specialized medical activities. The Hubs hospitals were required to guarantee full time evaluation of all patients presenting with cardiovavascular diseases with an independent pathway for patients with suspect or confirmed COVID-19 infection. San Raffaele Hospital was identified as Hub for cardiovascular emergencies and the Vascular Surgery Department was remodeled to face this epidemic situation. Surgical treatment was reserved only to symptomatic, urgent or emergent cases. Large areas of the hospital were simultaneously reorganized to assist COVID-19 patients. During this period, 135 patients were referred to San Raffaele Vascular Surgery Department. COVID-19 was diagnosed in 24 patients and, among them, acute limb ischemia was the most common cause of admission. At this time, the COVID-19 trend is in decline in Italy and the local authorities reorganized the health care system in order to return to normal activities avoiding new escalations of COVID-19 cases. Several strategies have been taken to ensure the safety of the San Raffaele hospital, and maintaining potentially suspected patients with COVID-19 separated from other patients. The aim of this paper is to report the remodeling of the Vascular Surgery Department of San Raffaele Hospital as regards the strategies of preparation, escalation, de-escalation and return to normal activities during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic introduced an abrupt change in human behavior globally. Here, we discuss unique insights into the eco-evolutionary role of pathogens in ecosystems and present data that indicates the pandemic can fundamentally change our learning choices. This pathogen has indirectly affected many organisms and processes by globally changing the behavior of humans to avoid being infected. The pandemic also changed our learning behavior by affecting the relative importance of information and forcing teaching and learning into a framework that accommodates human behavioral measures to avoid disease transmission. Not only are these indirect effects on the environment occurring through a unique mechanistic pathway in ecology, the pandemic along with its effects on us provides a profound example of the role risk can play in the transmission of information between the at-risk. Ultimately, these changes in our learning behavior led to this special issue “Taking learning online in Ecology and Evolution.” The special issue was a call to the community to take learning in new directions, including online and distributed experiences. The topics examined include a significant component of DIY ecology and evolution that is experiential and but done individually, opportunities to use online tools and apps to be more inclusive, student-focused strategies for teaching online, how to reinvent conferences, strategies to retain experiential learning safely, emerging forms of teaching such as citizen science, apps and podcasting, and ideas on how to accommodate ever changing constraints in the college classroom, to name a few. The collective consensus in our fields is that these times are challenging but we can continue to improve and innovate on existing developments, and more broadly and importantly, this situation may provide an opportunity to reset some of the existing practices that fail to promote an effective and inclusive learning environment.

Aim. Repurposing strategies to address the COVID-19 pandemic have been accelerated. As both pregnant and pediatric patients are likely to be excluded from most planned investigations, the list of repurposed options and the available data on these drugs and vaccines provides a baseline risk assessment and identifies gaps for targeted investigation. Methods. Clinical trials have been searched and reviewed; twenty-three repurposed drugs and drug combinations and 9 candidate vaccines have been assessed regarding the availability of relevant data in pediatrics and pregnant women and to evaluate expected or unanticipated risk. Results. Thirteen of the repurposed drugs or drug combinations are indicated for use in pediatrics in some age category albeit for indications other than COVID-19; 10 of these are indicated for use in pregnant women. Even in cases where these drugs are indicated in the populations, source data from which safety and or dosing could be extrapolated for use in COVID-19 is sparse. Vaccine trials are ongoing and generally exclude pregnant women; only in a few instances have pediatric subgroups been planned for enrollment. Data from individual case studies and RWD may suggest that subpopulations of both pediatric patients and pregnant women may be more at risk, particularly those in an increased inflammatory state. Conclusion. In conjunction with more prospective collaboration, plans are evolving to ensure that we will be better prepared to address similar situations especially in pediatrics and pregnant women where experience is limited and actual practice relies heavily on leveraging data from other populations and indications.

AIM: To report on the clinical, laboratory and radiological findings of adolescents who presented during the SARS-CoV-2 surge with symptoms of COVID-19, did not test positive for the infection and were diagnosed with e-cigarette and vaping product use associated lung injury (EVALI). Methods: A retrospective review of 12 cases of EVALI admitted to the Bristol Meyers Squibb Children’s Hospital between February 2020 and June 2020 was conducted. Results: The ages of the patients ranged from 14 to 19 years. There were 6 males and 6 females. Three patients had a past history of anxiety, depression or other psychiatric/mental health disorder, nine had prolonged coagulation profile (PT,PTT and/or INR) and eleven had elevated inflammatory markers. Eleven needed respiratory support. All 12 were negative for SARS-CoV-2 PCR. Four were tested for IgG Antibodies and were negative. As these cases were admitted to rule out COVID infection, initial treatment included hydroxychloroquine. Steroids were started only after SARS-CoV-2 PCR was shown to be negative. Urine THC was positive in all cases. CXR and CT findings showed ground glass opacities. CONCLUSIONS: Clinical and radiological features are similar in both EVALI and SARS-CoV-2 infection. Inflammatory markers are elevated in both conditions. A detailed social and substance use history in patients presenting with ‘typical’ COVID pneumonia like illness is important. EVALI should be ruled in early to start the appropriate treatment. Given the ongoing pandemic, pediatricians and other health care providers need to be aware of other conditions that can masquerade as SARS-CoV-2.

Susceptibility of turkeys, chickens and chicken embryos to SARS-CoV-2 virus was evaluated by experiment inoculation. Turkeys and chickens were inoculated using a combination of intranasal, oral and ocular routes. Both turkeys and chickens did not develop clinical disease or antibodies to the virus following inoculation. Viral RNA was not detected in oral and cloacal swabs and in tissues using quantitative real-time RT-PCR. In addition, chicken embryos were inoculated using the yolk sac, intravenous, chorioallantoic membrane and allantoic cavity routes did not support replication of the virus. SARS-COV-2 virus does not affect both turkeys and chickens in the current genetic state and does not pose any potential risk to establish in both species of domestic poultry.

The current COVID-19 pandemic has a huge impact on society and economy and represents one of the biggest challenges for healthcare systems all over the world. Reports from health-care-institutions in different countries show a variety of crisis exit strategies. Although experiences in handling of the pandemic have accumulated over the last 7 months, it is clear that measures to prevent a collapse of the health-care-systems have to be adapted to local political and socioeconomic structures. The aim of this review is to give insight in crisis exit strategies in Switzerland, highlighting the role and impact of COVID-19 in the field of cardiac surgery.

Background: Several predictors for the severity of coronavirus disease 2019 (COVID-19) have been reported. However, chronic airway inflammation characterized by accumulated lymphocytes or eosinophils may affect the pathogenesis of COVID-19. Methods: In this retrospective cohort study, we reviewed medical records of all laboratory confirmed COVID-19 patients with chronic bronchitis, chronic obstructive pulmonary disease (COPD) and asthma admitted in Sino-French New City Branch of Tongji Hospital, a large regional hospital in Wuhan, China, from January 26th to April 3rd. The Tongji Hospital ethics committee approved this study. Results: There were 59 patients with underlying chronic airway inflammation including chronic bronchitis, COPD and asthma. When compared with non-severe patients, severe patients were more likely to have decreased lymphocyte counts (0.6vs.1.1×10⁹/L, p<0.001), eosinopenia (<0.02×10⁹/L, 73%vs.24%, p<0.001), increased lactate dehydrogenase (LDH) (471.0vs.230.0 U/L, p<0.001) and elevated IL-6 level (47.4vs.5.7 pg/ml, p=0.002) on admission. Eosinopenia and elevated LDH were significantly associated with disease severity in both univariate and multivariate regression models included the above variables. Eosinopenia was also an independent risk factor for mortality of this cohort in a multivariate model included the above variables. Moreover, eosinophil counts and LDH levels tended to return to normal range over time in both groups after treatment and severe patients recovered slower than non-severe patients, especially eosinophil counts. Conclusions: Eosinopenia and elevated LDH are potential predictors of disease severity in COVID-19 patients with underlying chronic airway diseases. Theses predictors may help clinicians identify the severe COVID-19 patients with chronic bronchitis, COPD and asthma.

BACKGROUND: The coronavirus disease-2019 (COVID-19) is still rapidly spreading worldwide, and remains a global health crisis. We investigated the impact of asthma on the prevalence and outcomes of COVID-19 and identify the risk factors for delayed viral clearance. METHODS: Adult patients with COVID-19 admitted to 10 hospitals in Daegu were retrospectively registered, and their clinical information was collected. Delayed viral clearance was divided into two groups based on 30 days. RESULTS: A total of 2,200 patents were evaluated, and the prevalence of asthma in COVID-19 was 3.2%. Compared with Korea nationwide survey data, there were no differences in asthma prevalence. In the univariate analysis, the risk of death (13.6% vs 6.4%, P = 0.021) and high flow oxygen therapy (18.2% vs 10.5%, P = 0,048) was increased in asthma patients, with a stronger tendency among elderly, women, and overweight patients. However, in a multivariate analysis using the logistic regression model, any clinical outcomes according to asthma was not significant. The risk factors for delayed viral clearance were older age >65 years (Odds ratio [95% confidence interval] 2.002 [1.292–3101]), dementia (3.123 [1.833–5.321]), skin rash (15.943 [1.613–157.535]), and anemia (2.156 [1.061–2.377]), whereas headache (0.673 [0.485–0.932]) lowered the risk. CONCLUSIONS: There may be a difference depending on phenotypes, but asthma prevalence was not significantly different in patients with COVID-19, and asthma did not affect outcomes of COVID-19. Older age, dementia, headache, skin rash, and anemia were independently associated with delayed viral clearance.

Structural, electronic, topological, vibrational and molecular docking studies have been performed for both enantiomeric S(-) and R(+) forms of potential antiviral to COVID-19 chloroquine (CQ) combining DFT calculations with SQMFF methodology. Hybrid B3LYP/6-311++G** calculations in gas phase and aqueous solution predict few energy differences between both forms. Solvation energies of S(-) and R(+) form are predicted in -55.07 and 59.91 kJ/mol, respectively. Low solvation energies of both forms are justified by the presence of only four donor and acceptor H bonds groups, as compared with other antiviral agents. MK charges on the Cl1, N2, N3 and N4 atoms and AIM calculations could support the high stability of R(+) form in solution according to the higher reactivity predicted for the S(-) form in this medium. Antiviral to COVID-19 niclosamide shows higher reactivity than both forms of CQ. Complete vibrational assignments of 153 vibration modes for both forms and scaled force constants have been reported here. Reasonable concordances were found between predicted and available 1H-NMR, 13C-NMR and UV-Vis spectra. Additionally, NMR and UV-visible spectra suggest the presence of two forms of CQ in solution. A molecular docking study was performed to identify the potency of inhibition of Chloroquine molecule against COVID-19 virus

Background: With the epidemic of COVID-19, the health care workers (HCWs) require proper respiratory personal protective equipment (rPPE) against viral respiratory infectious diseases. However, there is little published evidence comparing their efficacy. Therefore, we conducted a network meta-analysis (NMA) to compare the efficacy of rPPEs and the wearing manner preventing from the viral respiratory infectious diseases (VRID). Methods: This NMA protocol was registered in PROSPERO (CRD42020179489). PubMed, the Cochrane Library, Web of Science, and EMBASE were searched by computer to collect cluster randomized control trials of comparing the effectiveness of rPPEs and wearing manner in preventing HCWs from VRID. The primary outcome was the incidence of laboratory-confirmed viral respiratory infection. The secondary outcome was the incidence of CRI. The Bayesian NMA was conducted to use the control group as the comparison group. Incidence of the VRID and CRI were reported as network odds ratio (network OR) and 95% credibility interval (CrI). Results: Six studies encompassed 11,828 HCWs and seven interventions were included. In terms of the incidence of laboratory-confirmed viral respiratory infection, the continuous wearing of N95 respirator (network OR, 0.48; 95% CrI 0.27 to 0.86; SUCRA score, 85.4) showed more effective than the control group. In terms of the incidence of CRI, there are no interventions that showed more effective than the control group. Conclusion: There are significant differences in preventive efficacy among current rPPEs. Our result suggests that continuous wearing of N95 respirator can serve as the best preventive rPPE for HCWs from the VRID.

INTRODUCTION: The SARS-CoV-2 coronavirus pandemic has caused more than fifteen million infections worldwide. Our aim is to investigate the differentiating characteristics in asthmatic patients with SARS-CoV-2 infection in the community of Castilla la Mancha. METHODS: We used the Savana® software and its algorithm based on Big Data and artificial intelligence, performed a retrospective search of the diagnoses of COVID 19 and asthma in the digitized medical records with positive RT-PCR results for SARS-CoV-2, and analysed the demographic characteristics, comorbidities, hospitalization data and deaths. RESULTS: 6,310 patients with positive RT-PCR for SARS-CoV-2 were selected, of which 577 had a diagnosis of asthma with a prevalence of 9.14%. The mean age in SARS-CoV-2 (SC2) was 59 ±19 years of age and in SARS-CoV2-asthma (SC2-A) 55 ±20 years of age. SC2 included 2983 (41%) men and 3327 (59%) women, while SC2-A included 198 (31%) men and 379 (69%) women. High blood pressure (BP) was the most common comorbidity in both groups (51%). 2,164 SC2 (34.2%) and 131 SC2-A (22.7%) required hospitalization with an asthma prevalence of 6.05%. 250 SC2 (3.96%) and 21 SC2-A (3.64%) died. CONCLUSION: The prevalence of asthma in our SARS-CoV-2 positive RT-PCR population was 9.14% and 6.05% in hospitalized patients. HBP is the most frequent comorbidity in both groups, and smoking is the only one with significant differences, more frequent in asthmatics. Mortality is lower in patients with asthma

A valid measurement of the SARS-CoV-2 incubation period is needed for case definitions and for adapting appropriate isolation measures but is challenging in an emergency context. The objective was to systematically review recent literature of reported estimates of the distribution of incubation period of SARS-CoV-2 for describing the distribution and its variability and dispersion through meta-analysis. A systematic review search was carried out up to July 1st 2020 of all identified references available reporting the SARS-CoV-2 incubation. Individual mean and standard deviation were used to produce the pooled estimate. Heterogeneity was also assessed using I2 statistics and sources of heterogeneity were explored using a meta-regression. The main outcome was the SARS-CoV-2 incubation period defined as the time from exposure to onset of clinical illness. In total, 43 studies were eligible, including 12 (27.9%) cohorts and 31 (72.1%) case reports and series. The pooled estimate of the mean incubation period across the studies was 6.24 days, 95% CI [5.80;6.69] ranging from 2.33 to 17.60 days. Shorter incubation periods were reported in cohorts compared to case series (p<0.01) and among studies with high proportions of males (p<0.05). The mean incubation period will help for identification times of exposure but determinants of its variations/range might be explored for potential links with clinical outcome or early pathogenic steps. The impact of individuals with extreme values of incubation on the outbreak dynamic should be evaluated taking account for the basic reproductive number. A real time of meta-analysis, called the InCoVid Lyon, is proposed.

Reports of children with cancer and COVID-19 from U.S.A and Europe had informed most patients presented with mild disease. Experience from upper and lower middle-income countries is needed to corroborate these findings. This report describes the experience with cancer patients in a tertiary care level hospital, in Mexico City. Of 24 symptomatic patients, 14 had a positive RT-PCR test. Eight required low-flow supplemental oxygen. None required critical care. One patient died due to pulmonary hemorrhage. Even though the infection seems to have an uncomplicated clinical course, it is necessary to ensure that all seeking medical attention do so safely.

Since the WHO defined the diffusion of novel coronavirus, Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) as pandemic, the global effort has been on finding a cure and preventing transmission. As a consequence, people are going through many psychological problems in adjusting to the current lifestyles and fear of the disease. The link between the psychological effects of quarantine and arrhythmias has been poorly explored. However it is known that sudden catastrophic events i.e. earthquake are associated with an increase in sudden cardiac deaths. Acute stress and anxiety could act as a trigger for ventricular arrhythmias, which are found to have increased significantly after an earthquake. Quarantine induced a chronic stress enforced by alarming news reports in the media. Closure of businesses increased the stress due the expected crisis after the lockdown. Stress activates both the sympathetic nervous system and the axis of the renin-angiotensin-aldosterone system, leading to an increased risk of cardiac events. The aim of the present editorial is to analyze the potential impact of quarantine –induced stress on the development of arrhythmias.

Providing complex therapies such as ECMO during outbreaks of infectious diseases has singular challenges. The impact of the SARS-CoV-2 pandemic has implied a mentality change by force of circumstances, and cardiac surgery has not been stranger to this trend. The need to treat critically ill patients with an unknown evolution has compelled cardiovascular surgeons to decide whether or not to implant an ECMO system, despite the limited scientific evidence available in the context of COVID-19. To add some confusion, doubts were raised about its potential deleterious outcome in COVID-19 patients, due to its effect on lymphocyte counts and interleukin-6 concentrations. The care of the critically ill patient in a moment of national emergency in Spain took precedence over those possible formal doubts. The Spanish perspective on Ventricular Assist Devices during and after the COVID-19 pandemic, focused on ECMO as a particular case of mechanical circulatory support, is presented. We address both the challenges posed by the pandemic and the organizational model established in Spain; changes in ECMO therapy and some lessons learned for the next outbreaks are also described. It is not about reinventing the wheel in each country; it is enough to learn from experience and take advantage of the knowledge generated by those who have already gone through similar situations in our environment.

COVID-19 hit hard worldwide. There has been an impact on global activity of cardiac surgery. Spain has been one of the hardest hit countries with one of the highest per population incidences and death. Cardiac surgical activity has suffered a negative impact all over the country. The following is an overview of the epidemiology and impact on resources, the caseload and surgical societal implemented recommendations, the description of the ECMO activity and nosocomial transmission among healthcare workers.