Since December 2019, the rapid spread of SARS CoV-2 across the border, shuffled into a world pandemic situation with an alarming rate of morbidity and mortality. Concerns are mounting as the reports indicate tangled circumstances among the COVID-19 patients due to blood coagulopathy followed by organ dysfunction. COVID-19 induced an alteration in coagulation function increase the risk of pulmonary embolism and deep vein thrombosis associated with poor prognosis as well as high mortality. An elevated level D-dimer and other fibrin degrading protein are documented among the patients with COVID-19; especially in severe cases. Differences in coagulopathy among severe and non-severe cases, required prompt attention to adopt a more effective management strategy.

Tonsillitis accounts for between 5 and 10% of all cases of illness seen by the general practitioner. This has been a rather stable prevalence over the last 100 years or so. The analysis of the incidence by age shows, for both tonsillitis and sore throat, a relatively high incidence in childhood and young adults, while after that period there is a fall with age. Laryngitis, on the other hand, appears to occur more frequently among adults than among children. The incidence of tonsillitis, sore throat and other pharynx diseases is higher among females than males. There is no indication among school-age children that there is a higher incidence in women. There is a fairly regular seasonal variation in incidence as well, with higher incidence in winter and spring. The UK was put into lockdown on 23 March 2020 in an unprecedented step to attempt to limit the spread of coronavirus. From an audit of over a total population of 9534 people, starting from the beginning of the lockdown to the 18 May 2020, the number of patients with diagnosis of tonsillitis was audited. The data were compared to those recorded in the 5 precedent five years during the very same period of time. Tonsillitis accounted, on average, for 8% of all cases of illness seen by the general practitioner from 2015 to 2019. The mean number of patients seen for tonsillitis was 805.8 with SD of 28.96. In 2020, the number of cases of tonsillitis was 593. From 2015 to 2020, the higher incidence in the female sex was confirmed from all the age bands>19.  The greatest drop in cases was not recorded in the age group 0 to 9, but - in the order - 10 to 19, 20 to 29 and 30 to 39 with a reduction above the 30% in the first 2 age bands. Overall, the drop was seen across all the age bands.

There is increasing evidence that COVID-19 infection predisposes to thromboembolism. A 71 years-old male patient was admitted to ICU for COVID-19 related pneumonia. He developed a high troponin rise up to 6715 ng/L. By transthoracic echocardiography, we found akinesia of the full right ventricular apex with a mobile hyperechogenic mass, highly suggestive of thrombus. Unfractionated Heparin was started immediately. A subsequent echocardiogram showed no mass. To our knowledge, this is the first case showing a thrombus formation in the context of right ventricular apical akinesia in COVID-19 patients. There is upcoming evidence that the clinical relevance of thromboembolic complications may be a serious issue in COVID-19 patients even in the absence of any obvious risk factor. Our case clearly demonstrate that, in patients with COVID-19 infection and troponin rise, echocardiography should be performed to rule out possible thrombotic complications

Background: COVID-19 is a new pandemic disease with severe respiratory outcome. However, there is little evidence of this condition during pregnancy based on small case series reports. Objective: to perform a systematic review and meta-analysis of proportions of case series focused on maternal and perinatal outcomes of COVID-19 during pregnancy. Search strategy: LILACS and Medline were searched from inception until April 24th, 2020. Selection criteria: all case series or case control studies involving SARS-CoV2 infection during pregnancy and neonatal period were identified. Excluded were duplicated data, case reports of individual patients or without clinical data. Data collection and analysis: a total of 14 studies were included. When possible, pooled proportions with 95% confidence interval through a random effect model were estimated. Heterogeneity was estimated with the use of I2 statistics and Tau2 test. Main results: Most common symptoms were fever (58%; I2= 69%) and cough (33%; I2= 65%). A pathognomonic CT-Scan was observed in 92% of patients (I2= 0%). Lymphopenia and increased D-dimer were observed in 50% (I2= 82%), and 80% (I2= 0%) of patients at admission, respectively. There were no maternal deaths, with 2 cases of neonatal death, both with negative SARS-CoV2 PCR. Vertical transmission was observed in 5 neonates. Conclusions: This systematic review and meta-analysis confirms that COVID-19 during pregnancy is associated with good maternal and perinatal outcome. Evidence of vertical transmission should be confirmed with larger cohorts. Funding: none. Key words: meta-analysis, COVID-19, vertical transmission, perinatal outcome, pregnancy.

The manuscript aims to describe the effect of COVID-19 virus on the patients suffering with neurological diseases. The outbreak of COVID-19 is serious and it becomes epidemic worldwide. It is observed from the literature survey that COVID-19 virus can easily affect the persons having neurological diseases. The manuscript also focuses on the mechanism of action of the COVID-19 virus on the nervous system with precaution majors. Patients with COVID-19 show various symptoms of neurological manifestations including stroke, impaired consciousness, seizures, agitation, unsteadiness, dizziness, confusion, localized neuralgia and cognitive impairment. The COVID-19 virus affect the Central Nervous System, makes the patients clinical condition worse and it may cause the death of the patient. It can be concluded from the literatures that COVID-19 virus versen the neurological condition of patients and may leads to severe manifestations.

Objectives The primary aim of the study is to provide recommendations for the investigation and management of patients with new onset anosmia during the COVID-19 pandemic Design After undertaking a literature review, we used the RAND/UCLA methodology with a multi-step process to reach consensus about treatment options, onward referral imaging. Setting and participants An expert panel consistent of 15 members was assembled. A literature review was undertaken prior to the study and evidence was summarised for the panellists. Main outcome measures The panel undertook a process of ranking and classifying appropriateness of different investigations and treatment options for new onset anosmia during the COVID-19 pandemic. Using a 9-point Likert scale, panellists scored whether a treatment was: Not recommended, optional, or recommended. Consensus was achieved when more than 70% of responses fell into the category defined by the mean. Results Consensus was reached on the majority of statements after 2 rounds of ranking. Disagreement meant no recommendation was made regarding one treatment, using Vitamin A Drops. Alpha lipoic acid was not recommended, olfactory training was recommended for all patients with persistent anosmia of more than 2 weeks duration, and oral steroids, steroid rinses and omega 3 supplements may be considered on an individual basis. Recommendations have been made regarding the need for referral and investigation have been made. Conclusion This study identified the appropriateness of olfactory training, different medical treatment options, referral guidelines and imaging for patients with COVID-19 related anosmia. The guideline may evolve as our experience of COVID-19 develops.

COVID-19 pandemic presents an unprecedented challenge to identify effective drugs for treatment. Despite multiple clinical trials using different agents, there is still a lack of specific treatment for COVID-19. Having the possible role in suppressing inflammation, immune modulation, antiviral and improving respiratory symptoms, this review discusses the potential role of methylxanthine drugs like pentoxifylline and caffeine in the management of COVID-19 patients. COVID-19 pathogenesis for clinical features like severe pneumonia, acute lung injury (ALI) / acute respiratory distress syndrome (ARDS), and multi-organ failures are excessive inflammation, oxidation, and cytokine storm by the exaggerated immune response. Drugs like pentoxifylline have already shown improvement of the symptoms of ARDS and caffeine has been in clinical use for decades to treat apnea of prematurity (AOP) in preterm infants and improve respiratory function. Both pentoxifylline and caffeine are well-known anti-inflammatory and anti-oxidative molecules that have already shown to suppress Tumor Necrosis Factor (TNF-α) as well as other inflammatory cytokines in pulmonary diseases, and this may be beneficial for better clinical outcomes in COVID-19 patients. Pentoxifylline enhances blood flow, improves microcirculation and tissue oxygenation, and caffeine also efficiently improves microcirculation, reduces cardiovascular disease, and an effective analgesic. There are significant shreds of evidence that proved the properties of pentoxifylline and caffeine against virus-related diseases as well. Along with the aforementioned evidences and high safety profiles, both pentoxifylline and caffeine offer a glimpse of considerations for future use as a potential adjuvant to COVID-19 treatment. However, additional clinical studies are required to confirm this speculation.

Disguising agents for transmitting Novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): Mobile phone & Paper currency

The outbreak of COVID-19 as a pandemic has shaken the global health system and economy by their roots. This epidemic is still spreading and showing no signs of decreasing trend. Vaccination is the only effective and economical means to control this pandemic. A number of research institutions and pharmaceutical companies have plunged into the race of vaccine development against COVID-19 which are in various stages of development. An intriguing fact of coronavirus infections is that in every decade of 21st century there is a new major coronavirus epidemic viz. SARS in 2002, MERS in 2012, and now COVID-19; and such epidemics are expected in future too. Since, maximum biological characteristics of SARS-CoV-2 are still obscure the scientists are relying on the information available on SARS-CoV and to some extent on MERS-CoV for designing and development of COVID-19 vaccines. But there is a need of vigorous testing for immunogenicity, safety, efficacy, and level of protection conferred in the hosts. This review focuses on the challenges and prospects of vaccine development against COVID-19. It highlights seriousness, bottlenecks in vaccine development, possible vaccine candidates, different vaccine strategies, safety evaluation issues, and vaccine production process pertaining to COVID-19 based on the knowledge acquired on SARS and MERS vaccine development in the past.

Social disparity in magnifying glass: the inequality among the vulnerable people during COVID-19 pandemicKeywords: COVID-19; SARS-COV-2; social disparity; vulnerable peopleThe editorial written by Stein and Ometa, (2020) [1] about the dilemma between health system and socioeconomic conditions created by the Covid-19 pandemic has called our attention as a very appropriated topic. Indeed, there are different repercussion in all aspects in unequal societies, which goes from financial issues to the chances to adhere of the current recommended measures of the WHO. For instance, social distancing and basic personal hygiene without proper social, economic and healthcare support may contribute to exacerbate disparity in fragile societies.In Brazil, the virus SARS-COV-2 is spreading fast and crashing our healthcare system and economy. The government is struggling to pay the financial supporting defined by the congress of 600 Brazilian real per month (about 100USD) for all the living costs and only reached around 15% of the population.Demographic data show that 48% of Brazilians live in places without sewage and 35 million do not have access to running water in their homes [2]. Furthermore, 5-10% live in slum-like areas known as “favelas” [3], where most residences accommodate an average of 5 individuals per room with a housing density 10x higher than the rest of the city [4]. Finally, 40.6% of the Brazilian working-age population are in the informal economy, living without social protection [5]. Keeping these in mind, how can these vulnerable people protect themselves in times of COVD-19? How can they keep basic hygiene without regular running water and sewage? How to accomplish social distancing living in over-crowded places?If the COVID-19 wasn´t challenging enough, Brazil still struggles with other important infectious diseases, such as Dengue fever, Zika e Chikungunya. These viral mosquito-borne infections (Aedes aegypti mosquito) are endemic in Brazil and can show initial similar signs and symptoms to COVID-19. The rainy season is the most favourable time for mosquito proliferation and disease spread [6], which this year the seasonality (usually peaks in April) is coinciding with the spread of SARS-COV-2 in Brazil [7]. Socially vulnerable people are more prone to acquire Aedes aegypti-related infections due to poor housing, poor sanitation and high-density population housing in “favelas” [8] [9].Current recommendations for people with COVID-19 mild illness is to stay at home. However, the panic-state created by the COVID-19 pandemic is taking these vulnerable people, which may be suffering of mosquito-borne infections, to health units and exposing them to SARS-COV-2. Thus, the overlapping of infections is overburdening even more the health system and increasing the transmission rate of COVID-19 in Brazil. Furthermore, many people in the informal market don´t have bank accounts and are agglomerating in huge lines in bank branches to get the financial aid. While many developed countries have struggled to give assistance to COVID-19 patients, Brazil must battle against two powerful enemies. So, the hard question to answer is: how many extra souls will be lost due to Brazil´s chronic problems?Brazil was used as an example we know well, but many other non-developed countries, especially the African ones may be struggling with some of these problems as well.

Introduction: The COVID-19 pandemic caused by the SARS-CoV-2 virus has altered the healthcare environment for the management of head and neck cancers.  The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits.Methods: Creation of consensus document.Results: The process yielded a consensus statement among a wide range of practitioners involved in the management of head and neck cancer patients in a multi-hospital tertiary care health system. Conclusions: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature. 

Background: Management of head and neck cancers (HNC) in Radiation Oncology in the COVID-19 era is challenging. Aim of our work is to report organization strategies at a Radiation Therapy (RT) Department in the first European area experiencing the COVID-19 pandemic. Methods: We focused on 1) dedicated procedures for HNC, 2) radiation treatment scheduling and 3) healthcare professionals’ protection applied during the Covid-19 breakdown (from 1st March to 30th April 2020). Results: Applied procedures are reported and discussed. Forty-three pts were treated. Image-guided, Intensity Modulated RT was performed in all cases. Median overall treatment time (OTT) was 50 (IQR: 47-54.25) days. RT was interrupted/delayed in seven pts (16%) for suspected COVID-19 infection. Two health professionals managing HNC pts were proven as COVID-19 positive. Conclusion: Adequate and well-timed organization allowed for the optimization of HNC pts balancing at the best of our possibilities pts’ care and personnel’s safety.

BACKGROUND: Initially identified in December 2019 in China, the 2019 Coronavirus disease (COVID-19) is now affecting more than 200 countries and territories around the world. Given the current unavailability of an effective medical cure for COVID-19, a public health strategy of reduced social contact and shelter in place has been adopted worldwide. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, determining loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines an insurmountable obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare. AIMS: In this paper we discuss the potential role of telepsychiatry and other cutting-edge technologies in the management of mental health assistance. We narratively review the literature to examine advantages and risks related to the massive application of these new therapeutic settings, along with the possible limitations and ethical concerns. RESULTS: Telemental health services are particularly feasible and appropriate for the support of patients, family members and health-care providers during this COVID-19 pandemic. The integration of telepsychiatry with other technological innovations (e.g., mobile apps, virtual reality, big data and artificial intelligence) opens up interesting future perspectives for the improvement of mental health assistance. CONCLUSION: The COVID-19 pandemic situation shows us how vast the amount of untreated mental illnesses can be. The pandemic crisis can contribute to spread, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.

In the last three months, most research groups have shifted their focus to the fight against the COVI-2 infection (COVID-19). Many scientists worked to understand how the virus is transmitted and able to mutate or how it can be sensitive to new and old drugs. Up to now, the results obtained in this field were not always promising and, sometimes, completely inconclusive, as in the case of chloroquine (1). However, the recent discovery on benefits deriving from use of such anticoagulants for Covid-19 patients, has increased the success of treatment (2). In fact, as reported by Tang et al (2), since the disseminated intravascular coagulation and coagulopathy can contribute to patients’ death, anticoagulant administration resulted as being associated with decreased mortality in severe COVID-19 pneumonia (2). Tang et al(2) also assessed that low molecular weight heparin (LMWH) regimen seems to be associated with better prognosis in severe COVID-19 patients meeting sepsis-induced coagulopathy criteria or with markedly elevated D-dimer. Along with other experimental treatments, or in combination, these findings have dramatically reduced the number of patients needing intensive cares, with a lightening of the workload of the emergency departments and a definitive improvement in the ratio of deaths to infected (2,3). However, although with some concerns mainly related to the schemes of LMWH administration, using of prophylactic-doses of LMWH was recommended by the International Society on Thrombosis and Haemostasis (ISTH) for all recovered COVID-19 patients, except for those with an active haemorrhage or with a platelet count < 25 x 109/L. (3).While many drugs are still under investigation in clinical trials (4), after a rapid approval by the medical agencies of different countries, there are no definitive results. In this regard, very recently, a research group focused on different treatments administered to Chinese individuals showing as there is no proven regimen from conventional medicine (4). Nevertheless, most reports managed the patients with lopinavir/ritonavir, ribavirin, beta-interferon, glucocorticoid and supportive treatment with remdesivir undergoing clinical trial (4). After an extensive revision of the latest national and provincial clinical guidelines, retrospective cohort studies, and case series regarding the treatment of COVID-19 by add-on Chinese medicine, Chan et al. (4) concluded that, due to the paucity of strongly evidence-based treatments, the current data only suggest that Chinese medicine could be considered as an adjunctive therapeutic option in the management of COVID-19.In this scenario, where nothing seems to be completely clear, and after reading the paper published by Berger et al (5), I would like to open the discussion on the following topic that has not been covered by the current literature.I am referring to the fact that no available data are reported about any possible relationship between Covid-2 effects and patients under chemotherapy regimen with PARP-1 inhibitors. My empirical consideration, not still supported by literature data, emerged from my experience gained in the last ten years research on the oncogenetic features of PARP-inhibition in women suffering from ovarian cancer (6). Noteworthy, patients under anti-PARP-1 regimens (5), particularly those with pancreatic, prostate, ovarian and breast cancers (most of them enrolled in clinical trials), might be more protected by the Covid-2 severe effects like the thrombotic events. I underline as for bevacizumab drug an association with venous thromboembolism has been reported in ovarian cancer patients, mostly in patients with elevated D-dimer level and high BMI before chemotherapy (5). These findings were never reported for Olaparib. Regarding PARP pathway, several studies showed as the inhibition of poly-ADP ribose polymerase-1 (PARP-1) reduced organ dysfunction in post-myocardial infarction remodelling, ischemia-reperfusion injury, diabetic retinopathy, septic shock, diabetes, and atherosclerosis, attenuating diseases associated with vascular smooth muscle and endothelial dysfunction. The latter is a specific feature of Covid-19 (3). Mathews et al. (7) demonstrated that PARP-1, when activated by oxidative and nitrosative stress, consumes cellular energy and precipitates endothelial cell death. Therefore, inhibition of PARP-1 prevented ROS- and RNS-induced HUVEC death, not only by maintaining cellular energy, but also through a novel mechanism via VEGFR2, Akt, and Bad phosphorylation. All these findings are very interesting when translated to the possible mechanisms surrounding the disseminated intravascular coagulation and coagulopathy processes leading to either patient’s severe symptoms or death related to Covid-19. Noteworthy, the inflammatory process, cytokine storm, and lung injury can result in an increased risk of thrombosis for Covid-2 positive patients (3,4). In this setting, use of anti-PARP drugs in non-oncological indications, although still under debate, was reported as being of benefit inflammatory disorders such as arthritis, psoriasis, colitis, asthma, diabetic complications and cardiovascular diseases (5). Moreover, although data on total incidence of thrombotic events in COVID-19 is still uncertain, we can assume that individuals with increasing age, obesity, comorbidities and cancer are at higher risk of these events. Based on the scientific evidences regarding a potential anti-inflammatory and anti-thrombosis effect of PARP-1 inhibitors (5), the scientific community should be encouraged to investigate the PARP-1-inhibitors in the treatment of Covid-19, particularly due to the mitigation effects of all pathways promoting the inflammatory and thrombotic cascades, respectively (2,3).PARP enzymes (PARP-1 and PARP-2) play a pivotal role in sustaining the genome stability. PARP inhibitors are small molecule mimetics of nicotinamide which bind to PARP’s catalytic domain to inhibit poly-ADP-ribosylation (PARylation) of target proteins (5). Considering that different forms of PARP inhibitors are present now on the market (olaparib, veliparib, talazoparib, niraparib and rucaparib), there will be an easy access to these medications for using in either new clinical trials and/or in translational studies.Finally, although a risk of genotoxicity can be also associated to PARP-1 inhibitors long term administration (5), this issues alone should not be a reason to exclude a study drug for testing in a non‐oncological indication, like Covid-19 condition. As for LMWH, also in this case different schemes of administration should be evaluated in order to achieve the best benefit for patients. Therefore, I agree with Bergeret al (5) who stated that there are no sufficient reasons to exclude studies based on PARP inhibitor in other non-oncological settings. For these reasons, why do not encourage both basic and translational research on PARP-1 inhibitor effects and severe forms of Covid-19?The above considerations are far from being provocative, but they are only aimed to stimulate a thought on this specific topic. I would be grateful to the Editor if, through the publication of this paper, it would allow us to open up the debate on the subject.

COVID-19 outbreak has been a serious threat and it has been reported with different presentations and complications, here we report a 39 year old healthy male who presented with respiratory symptoms and investigation revealed that he is positive for SARS-CoV-2 and work up for Leukocytosis confirmed the diagnosis of CML.

The coronavirus disease 2019 (COVID-19) outbreak, which has caused millions of confirmed infections and thousands of deaths, has been the most devastating worldwide crises recently. The main clinical symptoms of confirmed COVID-19 cases include fever, dry cough, general fatigue, respiratory symptoms, diarrhoea and sore throat, similar to those of acute respiratory distress syndrome. SARS-CoV-2, the causative agent of COVID-19, belongs to a novel coronavirus strain against which no drug or vaccine currently exists. Therefore, research units around the world have been actively developing efficient diagnostic tools and new drugs. This review summarises the clinical manifestations of COVID-19, analyses the viral genome sequence and life cycle, identifies methods for preventing viral transmission, discusses possible molecular pharmacologic mechanisms and approaches in the development of anti-SARS-CoV-2 virus therapeutic agents and introduces management measures against COVID-19 in Taiwan, especially policies for a name-based mask distribution system. Finally, we summarise traditional Chinese medicines (TCM) for COVID-19. Based on all the information accumulated in this review, development of novel anti-viral agents, vaccines for SARS-CoV-2 therapy or an effective combination therapy can be expected. Finally, we would like to extend our best regards to the frontline health workers in their global fight against COVID-19.

Aims: The aim of this double-blind randomized clinical trial was to determine the effects of FBX in comparison with hydroxychloroquine (HCQ) on clinical symptoms, laboratory tests and chest CT findings in patients with COVID-19-causing moderate symptomatic disease. Methods: We conducted a randomized, double blind clinical trial involving adult outpatients’ patients with COVID-19 infection, which causes the moderate respiratory illness. Sixty patients were randomly assigned to receive either FBX or HCQ for 5 days. The measured variables were clinical and laboratory data including rate of fever, cough, berating rate, C-Reactive Protein level, lymphocytes count at onset of admission and was well as at 5 days of treatments. In addition, CT lesions were evaluated on admission and 14 days of treatments in both groups. Results: Fever, cough and tachypnea significantly mitigated in both groups after five days of treatments. The lymphocytes count significantly increased in both treatment groups and the CRP values were dropped in normal range (negative) in major of patients receiving FBX or HCQ treatment. It was not observed any significantly difference between FBX and HCQ in frequency of these symptoms. The mean percentages of CT abnormality scores were significantly reduced to 7.3% and 8% after 14 days of FBX and HCQ treatments, respectively. In adult outpatients with moderate symptomatic Covid-19, the effectiveness of FBX was same to HCQ in improvement of clinical manifestations, laboratory tests and CT lesions. Conclusion: These findings suggest FBX as an alternative treatment for Covid-19 infection in patients with contraindication or precaution to HCQ.

We report a case of a 17-year-old healthy male presenting with multisystem hyperinflammatory shock temporally associated with COVID-19. Cardiac involvement was suspected based on evidence of significant cardiac injury (elevated cardiac biomarkers, electrocardiographic and echocardiographic abnormalities). Cardiac magnetic resonance imaging was performed demonstrating global biventricular systolic dysfunction, as well as a small area of T2 hyperintensity and mid wall late gadolinium enhancement. This case discusses the varied cardiac involvement in pediatric patients with COVID-19 infection and highlights that cardiac injury is not just limited to hyperinflammatory syndrome related global dysfunction but a more focal myocarditis can also be seen.

Coronavirus (COVID-19), as a respiratory disease, has become a serious globally issue (December 2019), China. There is a strong immunenutrition relationship with the respiratory viruses as coronavirus. Moreover, a decline in the immunity function is regularly inevitable with poor micronutrient, inflammation and the declining (T cell) function. Nutrition weapon can be one of the main factors for immune response activation. Therefore, there is a globally necessary need to join hands for human survival. This report focuses on the recommendations for maintaining an efficient immune system during quarantine are; getting balanced healthy food, supplements and planning meal times accompanied by light sports for immune cell triggering and functional expression against coronavirus.

Novel coronavirus (COVID-19) outbreak infections have posed a considerable impendences globally, while millions of infections and thousands of death rates are gradually reported day by day. Due to the instant absence of vaccine, it is extremely necessary to find out unconventional, ecofriendly and effective approaches to control/prevent the further spreading of this serious infection. The present article expresses the potential nutritional recommendations from prevention of novel Covid-19 pandemic infection. It also provides facts about the bioactive ingredients of special supplements, foods and herbs for human immune system reinforcement against the infection.

Postnatal SARS-CoV-2 Infection and Immunological Reaction: A Prospective Family Cohort Study

Anxiety and Depression Scores in Maternity Healthcare Workers during the Covid-19 PandemicGillian A. Corbett1, Sarah J. Milne1, Suruchi Mohan2, Shuja Reagu3, Stephen W. Lindow1, Mark P. Hehir1, Michael P O’connell1.

Letter to the EditorCoronavirus disease COVID-19 has deeply modified national health services with a profound impact on hospital and in particular emergency and intensive care units (ICU) activities. As recently reported in Italy pediatric emergency accesses substantially decreased likely due to the instructions to prevent overcrowding in emergency rooms and spread of SARS-CoV-2 infection and to fear of the infection.1 At the Santobono-Pausilipon Hospital (Neaples), pediatric emergency accesses in March 2020 were only one fifth of those registered in 2019 in the same period. Likewhise a marked reduction of consultations occurred also in family pediatricians clinics.2We report here 3 children who arrived at hospital in life-threatening conditions at the onset of Acute Lymphoblastic Leukemia (ALL) between March 14 and April 10, 2020.First case: a 2-year-old-child arrived at the emergency department with a 15 days history of fatigue, pallor and dyspnea, in a comatose state, with severe anemia, respiratory distress, hematemesis and metabolic acidosis. Chest X-ray showed interstitial pneumonia. Blood tests showed: hemoglobin 2.7 gr/dL, WBC count 185.000/μl, platelets (PTL) 10.000/μl, LDH 3609 U/L. Peripheral blood was diagnostic for CD10, CD19 and CD58 positive ALL (B-lineage ALL). The patient, admitted at the ICU, intubated, transfused with RBC, PTL and plasma, died 12 hours after arrival at the hospital due to progressive worsening of clinical conditions. The nasal swab was negative for SARS-CoV-2 and positive for adenovirus.Second case: a 5-year-old-child arrived at the emergency department with a one month history of respiratory distress. Imaging showed a mediastinal mass compressing the brachiocephalic vein, the aorta, the pulmonary trunk and the left pulmonary artery, tracheal deviation, compression of the left main bronchus, left lung atelectasis and pleural effusion. Blood tests showed: hemoglobin 14.5 gr/dL, WBC count 37.000/μl, PTL 294.000/μl, LDH 6153 U/L, creatinine 1.9 mg/dl. Peripheral blood was diagnostic for CD5, CD7, CyCD3 and CD8 positive ALL (T-ALL). Steroid treatment was started. Clinical conditions deteriorated rapidly with cardiac and renal failure. The patient, admitted to ICU 2 hours after arrival at the hospital and intubated, died 24h later. The nasal swab was negative for SARS-CoV-2.Third Case: a 4-year-old child arrived at the hospital with one month history of fever, cough and shortness of breath treated at home with antibiotics and steroids without improvement. Imaging showed a mediastinal mass compressing the left brachiocephalic, azygos and superior cava veins, and right pulmonary artery and vein; mild tracheal deviation, compression of the left main bronchus; pericardial and pleural effusion; nephro-hepato-splenomegaly and ascites. Due to signs of cardiac tamponade, pericardiac and pleural drainage were placed and the patient was admitted at ICU and intubated. Blood tests showed: normal hemoglobin, WBC and PTL counts; LDH 2732 U/L, creatinine 2.98 mg/dl, K 8 mEq/L, Ca 5.4 mEq/L. Bone marrow was diagnostic for CD2, CD5, CD7, CD99 and CyCD3 positive ALL (T-ALL). Treatment with steroids was started. Due to progressive renal failure hemodialysis was performed for 9 days. Clinical conditions improved with rapid shrinking of mediastinal masses and resolution of pericardial and pleural effusion. The patient was thus extubated and treatment for ALL was instituted with good response to induction therapy. The nasal swab was negative for SARS-CoV-2.The 3 cases of ALL here described, 2 of them fatal, arrived at the hospital in critical conditions, most likely as a consequence of fear of COVID-19. Delay in diagnosis of neoplastic disease is a well-known problem in low-middle income countries (LMIC), but is quite rare in high-income countries (HIC). Actually, this combination of events never occurred in the past at the Santobono-Pausilipon Hospital, where, at the time of writing, no SARS-CoV-2 positive cases have been identified among children treated for cancer.Considering low prevalence of virus spreading in children and that SARS-CoV-2 positive children are generally asymptomatic or have a very mild course of the disease there is a substantial risk that collateral effects of COVID-19 pandemic, i.e. delays in diagnosis, chemotherapeutic treatments and treatment of chemotherapy complications, may be worse than those posed by the disease itself.3,4,7 Recently the major pediatric cancer scientific associations have expressed great concern on the risk that fear to access to medical care raised by Covid-19 may cause these delays not only in LMIC but also in HIC with dramatic consequences we are not used to face.5-6 Our experience confirms the occurrence of these collateral effects, indicating that there is a need of awareness of this risk and careful medical attention to assure timely diagnoses and adequate treatment adherence in childhood cancer.

Introduction: Coronaviruses (CoV) are a diverse group of viruses described in the literature since 1960. In particular SARS-CoV and MERS-CoV, and a deadly recent COVID-2019 infection [3], which is now causing a worldwide outbreak in the first half of 2020. SARS-CoV was discovered in China in 2002. This new virus was found in the city of Wuhan, in the province of Hubei, in central China, where 11 million inhabitants live. Objective: Due to the chaos of the coronavirus, worldwide, and because it is a new deadly virus, the present study aimed to carry out a systematic study on the global status of the new coronavirus COVID-2019 and aspects of previous SARS-CoV infections and MERS- CoV. Methods: The present study was followed by the Systematic Review in relation to the new coronavirus COVID-2019. The research was conducted from January to March 2020. A total of 89 clinical studies were compared and submitted to the eligibility analysis and, after that, 50 studies were selected, following the systematic review rules – PRISMA. The COCHRANE instrument was adopted to assess the quality of the included studies. Major findings and conclusion: The COVID-2019 pandemic is notorious. In some regions of the planet, it appears to be out of control. In case of suspicion in the region, tests are essential to identify it in the early stages of infection. These tests will guide quarantine decisions and other public health measures to limit the spread of contagion. However, it now seems likely that advanced support is needed to identify and isolate infected patients, as well as drugs that help control the virus, and, above all, to the promising solution for this circumstance, vaccines to control the epidemiological situation in each region. These measures are expected to reduce the proportion of infections, decrease the growth and spread of the coronavirus and, especially, in which countries are anxiously awaiting, the development of effective drugs and vaccines for COVID-2019. Keywords: COVID-2019. SARS-CoV. MERS-CoV. Pandemic. Contagion. Coronavirus.