Abstract The coronavirus disease (COVID-19), during its course, may involve several organs, including the skin with a petechial skin rash, urticaria and erythematous rash, or varicella-like eruption, representing an additional effect of the SARS-CoV-2 infection, as commonly observed in other viral diseases. Considering that symptomatic COVID-19 patients generally undergo multi-drug treatments, the occurrence of a possible adverse drug reaction (ADR) presenting with cutaneous manifestations should be contemplated. Pleomorphic skin eruptions occurred in a 59-year-old Caucasian woman, affected by a stable form of Chronic lymphocytic leukaemia, and symptomatic SARS-CoV.2 infection, treated with a combination of hydroxychloroquine sulphate, darunavir, ritonavir, sarilumb, omeprazole, ceftriaxone, high-flow oxygen therapy devices, filgrastim (Zarzio®) as a single injection, and enoxaparin. The patient stopped all treatment but oxygen and enoxaparin and received a high-dose Desametasone with complete remission of dermatological impairment in 10 days. It is very important to differentially diagnose COVID-19 disease-related cutaneous manifestations, where is justified to continue the multi-drug antiviral treatment, from those caused by an adverse drug reaction, where it would be necessary to identify the possible culprit drug and to start an appropriate treatment.

To the editor: Covid19 pandemic started in Dec 2019 and has affected >10 million people (1). Despite usage of personal protective equipment many healthcare workers (HCW) have been affected globally with Covid19 and some have died (2-4). We need a chemoprophylaxis drug which can stop viral replication and hydroxychloroquine (HCQ) has been shown to do that in-vitro (5). There have been few studies on usage of HCQ for treatment of covid19 with mixed results (6-7). HCQ for post-exposure prophylaxis (a 5-day course) in a randomised control trial showed no benefit (8). Indian council of medical research (ICMR) had recommended weekly prophylaxis (400 mg once a week) for all HCW in contact or looking after proven Covid19 cases (9). As per a recent report from India 4 or more weekly HCQ doses give better protection against Covid19 in HCW (10). However, questions have been raised about safety & efficacy of HCQ as a prophylaxis for Covid19. We did a survey across 11 hospitals in 7 cities in India about HCQ prophylaxis amongst HCW.A total of 301 HCW reported to be taking HCQ 400 mg once a week dose. Hospitals were located in big cities (Mumbai, Delhi, Kolkata, Hyderabad, Gurgaon, Jaipur, Bangalore) designated as Covid19 hotspots. Males were 186 and females were 115. Median age was 34 years (range 22-65 years). Doctors were 126, nurses were 169 and others were 6. All were working in hospitals treating Covid19 patients. Only 3 HCW stopped HCQ (1 due to headache and other 2 got bored). Median weekly doses taken were 9 (range 1-10). Nearly 50% (151/301) had taken HCQ weekly for 9 weeks. Side effects were seen in 17 people (nausea-7, gastritis-5, joint pain-1, sweating-1, constipation-1, vertigo-1 & headchae-1). ECG was not done and G6PD assay was also not done for anyone. From drug interaction point of view, 11 HCW were on additional drugs. Amlodipine and losartan were being taken by 5 people each, 3 were on metformin, 1 on insulin and 2 were on other drugs. Four (1.3%) developed Covid19 within 2 weeks of starting HCQ and all had mild disease (fever and mild cough) and recovered fully. None needed oxygen or intensive care.A total of 108 HCW were not taking HCQ working in the same hospitals. Median age was 32.5 years (range 23-64 years). Male to female ratio was 1:2. Doctors were 35, Nurses-66 and others-7. Amongst them 29 (27%) developed Covid19. All had mild symptoms but 2 needed oxygen and ICU stay. All recovered fully. So only 1.3% developed covid19 amongst HCW on HCQ prophylaxis vs. 27% in those not taking HCQ prophylaxis (p value <0.0001).In conclusion, its feasible to give safely weekly HCQ prophylaxis to HCW. It seems to effective but a survey is not the best scientific approach to prove efficacy. A randomised controlled trial is needed to confirm efficacy of weekly HCQ amongst HCW.Disclosure – All authors have nothing to declare.Contribution – All authors have contributed to this manuscript.Funding - Nil

Title: Implementation of early management of iron deficiency in pregnancy during the SARS-CoV-2 pandemicStewart T1, Lambourne J2, Thorpe-Jones D1, Thomas DW1.1University Hospitals Plymouth NHS Trust, Plymouth, Devon, PL6 8DH. 2East Kent Hospitals NHS Foundation Trust, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, TN24 0LZ

We conducted a study that aimed to shed light on the effects of COVID-19 on the emotional state of pregnant and postpartum women, which are specifically vulnerable groups. A cross-sectional study based on a web questionnaire for the assessment of general emotional stressor during the quarantine period of COVID-19, from April 20th till May 7th. Overall, 356 women of whom 251 pregnant and 101 post-partum filled the questionnaire. Among 251 pregnant women, 199 (79.3 %) reported moderate-high stress, 145 (57.8 %) high anxiety. A hundred and three (41.0%) reported a high level of depression (PH2>3). Among pregnant women, the following were the most prevalent stressors: fear that someone in their family will acquire the virus (80.1%), concern for the health of the baby (77.7%), fear that someone close will die from COVID-19 (72.9%) and worry of being infected within the hospital (71.7%). Univariate analysis of stress revealed that age (χ2=10.93, p<.004) and income level (χ2=13.35, p<.001) were associated with the level of stress. Stepwise logistic regression revealed that both age and income levels below the mean were predictors of stress. Among the 165 multiparous pregnant women, age (25-34 vs. 35-44) as a predictor of stress (p<.04). Our study clearly showed an enormous negative effect of the COVID-19 pandemic on the emotional condition of both pregnant and postpartum women. This provides an insight into the relation between economy and emotional state during the uncertainty period. This adds challenges to the healthcare system in providing means and solutions during disasters

BackgroundCorona Virus Disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in Wuhan, China in late 2019, has spread across the globe, rapidly reaching classification as a pandemic. As of September 24, 2020, more than 31.7 million cases and 973,000 deaths have been identified worldwide and nearly every country has been impacted.1According to the World Health Organization (WHO) surveillance data, the African region (AFRO) has 1,154,171 confirmed cases and 24,464 deaths from COVID-19 as of September 24, 2020.1,2 Although there is optimism that the pandemic response in Africa will be informed by efforts from other regions of the world, there are unique socioeconomic and health aspects in the African context.3 Additionally, Africa faces a number of challenges in identifying and treating COVID-19 cases, including low relative per-capita health resources, a rapidly growing population, and multiple endemic infectious diseases.4Rwanda is an East African nation of more than 12 million people, with 83% of the population living in rural areas.5 Rwanda has made significant advancements in healthcare and economic development over the last 20 years and has emerged as a leader in healthcare in the East African region. The country operates under a universal healthcare model where public health insurance coverage is nearly 84%, with another 6% of the population covered through other insurance schemes.6 Rwanda has an estimated 1350 doctors, 9551 nurses, and 21,826 hospital beds for its 30 districts, for an average of 8919 people per doctor, 1261 people per nurse, and 552 people per bed.7 Per district, the population per doctor ranges from 1725 in Nyarugenge to 54,266 in Nyaruguru. The population per nurse ranges from 412 (Nyarugenge) to 3256 (Nyaruguru), and the population per bed from 288 (Nyarugenge) to 1025 (Nyagatare, Eastern Province).7 In comparison, the global averages for population per doctor, nurse, and bed are 666, 294, and 370, respectively, and averages in Sub-Saharan Africa for population per doctor, nurse, and bed are 5000, 1000, and 833, respectively.8 Rwanda has eight national referral hospitals, four provincial hospitals and 36 district hospitals.6 Locally, there are over 45,000 community health workers working at 499 health centers and 476 health posts, providing the population further access to the health system.6 While African countries have set up the Africa Task Force for Coronavirus Preparedness and Response (AFTCOR) in concert with the African Union Commission, the Africa Centres for Disease Control and Prevention (Africa CDC), and the WHO,5 the Rwandan government has also taken an engaged and innovative approach to COVID-19. As part of its COVID response, Rwanda announced the formation of a Joint Task Force on March 3rd, 2020 which created the Rwandan Coronavirus National Preparedness and Response Plan with the primary objective of “stopping the human-to-human transmission of the virus and caring for those affected”.9

Background: Coronavirus disease 2019 (COVID-19) is highly contagious and has affected the whole world. We aim to investigate the clinical and laboratory characteristics of COVID-19 patients in high altitude areas of Sichuan, China. Methods: In this retrospective cohort study, a total of 67 patients with laboratory-confirmed SARS-CoV-2 infection in Tibetan Qiang Autonomous Prefecture of Ngawa, Sichuan were included from February 1, 2020 to March 2, 2020. The clinical characteristics as well as their radiological and laboratory features were extracted. Results: 4(6.0%) patients were categorized into severe cases, 39(58.2%) were non-severe cases, and 24(35.8%) were asymptomatic cases. 46(68.7%) patients were associated with cluster infection events in this study. The most common symptoms were cough, sputum production, dyspnea, fatigue or myalgia, and headache. 7(10.4%) patients showed leucopenia and 20 (29.9%) patients showed lymphopenia. Lymphocyte count and neutrophil-to-lymphocyte ratio (NPR) was different between three groups. 14 (20.9%) patients had thrombocytopenia, prothrombin time (PT) and fibrinogen levels differed between groups. We also found significant difference of sodium, chloride, and calcium levels between three groups. Antiviral therapy did not lead to obvious adverse event or shorter duration from initial positive to subsequent negative nuclei acid tests. Advanced age, hypertension, high neutrophil count, neutrophil-to-lymphocyte ratio, fibrinogen, and lactate dehydrogenase level were identified as independent risk factors for symptomatic cases of COVID-19. Conclusions: The symptoms of patients in high altitude areas were mild and about one third were asymptomatic. We also identified several independent risk factors for symptomatic cases of COVID-19.

In late December 2019, Chinese citizens of the city of Wuhan, China, had shown symptoms of viral pneumonia that were not very common, with various presentations with different grades of severity, and poor response to the regular treatment. With tremendous clinical and research work, the causative of the disease outbreak has been identified as COVID-19 and has been recognized as the novel coronavirus (SARS-CoV-2), which later continued to make the headlines when the World Health Organization announced it as a pandemic on March 11, 2020, after it had hit many parts in the globe with worrying rates of morbidity and mortality. Although available data has expressed that moderate or even mild forms of the disease are expected amongst most of the pediatrics cases, very limited data are available on the prognosis and the complications of the disease on the immunocompromised, especially oncology patients. We report a case of relapsed Precursor B-cell acute lymphoblastic leukemia (ALL) of a child with Down syndrome (DS) and COVID-19 and outline the treatment regimen that we used.

We present a case of koebner phenomenon induced by friction, caused by tightness of ear loops of face mask, used as protective measure against spreading COVID-19 infection.

Coronavirus disease (COVID-19) is a novel disease with multi-system involvement, but majority of patients have pulmonary and cardiovascular involvement in the acute stages. The cardiovascular impact of acute COVID-19 is well recognized ranging from myocarditis arrhythmias, thrombotic occlusion of coronary arteries, spontaneous coronary artery dissection and micro-thrombi in small coronary vessels on autopsy findings. We report a case of young male who recovered from probable mild covid-19 infection presenting few weeks later with devastating cardiovascular involvement with severe left ventricular (LV) impairment due to non-ischemic cardiomyopathy, multiple LV thrombi and embolic stroke.

Tracing the globally circulating SARS-CoV-2 mutants is essential for the outbreak alerts and far-reaching epidemiological surveillance. The available technique to identify the phylogenetic clades through high-throughput sequencing is costly, time-consuming, and labor-intensive that hinders viral genotyping in low-income countries. Here, we propose a rapid, simple, and cost-effective amplification-refractory mutation system (ARMS)-based multiplex reverse-transcriptase PCR assay to identify six distinct phylogenetic clades: S, L, V, G, GH, and GR. This approach is applied on 24 COVID-19 positive samples as confirmed by CDC approved real-time PCR assay for SARS-CoV-2. Our multiplex PCR is designed in a mutually exclusive way to identify V-S and G-GH-GR clade variants separately. The pentaplex assay included all five variants and the quadruplex comprised of the triplex variants alongside either V or S clade mutations that created two separate subsets. The procedure was optimized in the primer concentration (0.2-0.6 µM) and annealing temperature (56-60°C) of PCR using a 3-5 ng/µl cDNA template synthesized upon random- and oligo(dT)-primer based reverse transcription. The different primer concentrations for the triplex and quadruplex adjusted to different strengths ensured an even amplification with a maximum resolution of all targeted amplicons. The targeted Sanger sequencing further confirmed the presence of the clade-featured mutations with another set of our designed primers. This multiplex ARMS-PCR assay is a sample, cost-effective, and convenient that can successfully discriminate against the circulating phylogenetic clades of SARS-CoV-2.

Objectives The COVID-19 disease had an incredible impact on both hospital-based and private practices in the field of otorhinolaryngology and head and neck surgery. Practical issues faced by both types of practice were not well addressed in most studies. A national study was designed to address these issues. Design Prospective questionnaire-based study Setting Online google questionnaire sent to members of the Czech Society of Otorhinolaryngology and Head and Neck Surgery Participants All doctors practicing Otorhinolaryngology in Czech Republic with access to online link to questionnaire between 15th April and 26th April 2020. Main outcome measures Primary aims of the study was to evaluate any significant differences between the two types of practice in the field of Otorhinolaryngology. We formulated null hypotheses stating there were no statistical differences in the preparation and availability of personal protective equipment amongst both practices a month after the first cases of COVID-19 in Czech Republic. Statistical analyses including the Mann-Whitney U test were performed to test the hypotheses. Results Analysis and results were based on completion of the entire questionnaire by the doctors. There were no statistically significant differences between both the practices, however individual analyses of both the practices showed a different outcome. Conclusion Despite our statistical results, it was observed that private practices faced more deficits and were more financially vulnerable. They were also other issues reported by both practices that could compromise the care of patients, functioning of workplaces and support of doctors.

We report the case of a 14-year-old male patient with no previous history of cardiovascular disease or thromboembolic episodes, admitted to our hospital with a severe form of COVID-19, in the 9th day of disease evolution, with acute respiratory and heart failure symptoms. Chest computer tomography showed bilateral multilobular ground-glass opacities, consolidations, and a sub segmental arterial branch thromboembolism. The echocardiography showed a dilated left ventricle with severely impaired left ventricular function (LVEF=30%) . Blood test showed extremely elevated NT pro-BNP (22 558 ng/L), inflammatory markers and D-dimers. The diagnosis of PIMS-TS, COVID-19 sepsis-related cardiomyopathy and pulmonary thromboembolism was made, with a favourable outcome under supportive treatment. Clinicians should be aware of this severe presentation of COVID-19 in children.

Background: Since the onset of the COVID-19 pandemic, concerns about health-related and economic hazards of the virus, the restrictions imposed by the public health measures, the lack of social interactions, and the financial losses have affected people’s mental health in various ways. People with diabetes are more vulnerable to comorbid mental illness that may interfere with treatment adherence and disease prognosis. This study explores the psychological state of Egyptian patients suffering from diabetes mellitus (DM) during the COVID-19 pandemic. Methods: Egyptian adults with DM were invited to participate through an online survey in the period from April 24 to May 12. The survey included sociodemographic information, questions assessing diabetes status, and general assessment of the psychological health status using the General Health Questionnaire (GHQ-12). Results: In total, 849 participants shared in the survey. 51.4% of the studied population were at risk, while 21.2% were at high risk of psychological distress. There was a statistically significant difference with the non-working group with a mean GHQ-12 score of 17.44, SD= 6.267, SE 0.491, 95% (16.47-18.41), and p-value of 0.01. Regarding the disease precautions, there was a statistically significant difference between home isolation and those who did not home isolate with a mean 16.23 and SD 6.285 compared to a mean 15.32 SD 5.701 p-value 0.028. There was a significantly increased number of 4 or more diabetes complications and comorbidities with a mean 20.60 SD 8.675, SE 2.240, (95% CI 15.80-25.40) with a p-value of less than 0.001 and mainly with hypertension as comorbidity. Conclusion: The current study shows that Egyptian patients suffering from DM are likely to psychological distress amid the COVID-19 pandemic. Risk factors included female gender, non-working, and patients with diabetic complications, particularly hypertension. Further attention to the psychological needs of Egyptian patients with DM amid the COVID-19 is recommended.

Key points: 1. In selected patients, biopsies of oropharyngeal lesions including the tonsils can be performed under local anaesthetic safely. 2. The technique described was found to be well tolerated by the patients and there were no adverse outcomes. 3. Performing these biopsies under local anaesthetic eliminates the morbidity associated with general anaesthesia. 4. Performing these biopsies under local anaesthetic increases operating room availability which is particularly important in the current economic climate and considering the covid-19 pandemic. 5. Performing these biopsies under local anaesthetic is thought to reduce the time from initial consultation to reaching a decision regarding treatment.

Background: The role of asthma as a risk factor for coronavirus 2019 (COVID-2019) morbidity and mortality is inconclusive and not fully understood. The primary objective was to evaluate the association between asthma history and mortality of COVID-19, and the secondary objective was to analyze the risk of COVID-19-related outcomes among patients with asthma compared to those without. Methods: Using clinical epidemiologic data from Korean Disease Control & Prevention, the risk for COVID-19-related morbidity and mortality were compared in patients with asthma and those without asthma among the participants who were confirmed to have COVID-19. A Cox proportional hazards regression model was used for mortality, and a linear regression model was used for morbidity scores. Results: The hazard ratio for death of patients with asthma versus those without was 2.48 (95% confidence interval (CI) 1.21-5.08, P=0.013) and 2.20 (95% CI 1.02-4.76, P=0.045) after full adjustment. The comorbidity of asthma was associated with an increase in the maximal morbidity score of COVID-19 compared to no asthma (estimated value of morbidity score (EV) = 0.44, 95% CI 0.16-0.73, P=0.003). Conclusion: Asthma is associated with an increased risk of mortality and morbidity in the Korean nationwide COVID-19 registry.

Objectives: To evaluate clinical outcomes of multidisciplinary vascular access support team (VAST) and the value of the service to critical care teams. Design: Prospectively collected data. Material and methods: All patients requiring vascular access at St Thomas’ Hospital, London over a 5-week period during the first wave of the pandemic in the UK. At the end of study period, online anonymised questionnaire administered to critical care team members, including nursing and medical professionals, to evaluate their experience of the service. Results: 122 patients aged 52.1 ± 13 years with high rate of pre-existing co-morbidities, underwent line insertion including 190 catheters (central venous n=182, arterial n=8). Median (range) number of 5 (0-17) lines were placed per day in patients of whom 90% tested positive for Severe Acute Respiratory Syndrome Coronavirus-type 2 pathogen (SARS-CoV-2). A single line was inserted in 146 out of 172 patients (76.8%) and n=36 patients (18.9%) ‘double puncture’ technique used. 45 line insertions (24%) had complications with minor [bleeding (n=19), line infection (n=10)] and 2 lines (1%) with major complication. The survey respondents, n=54 professionals, highlighted ease of referral and timely access placement (>90% responses); with agreement that VAST service saved them precious time and allow them to focus on other jobs. Conclusions: We describe the successful deployment of a multidisciplinary vascular access team with low complication rates and high rates of satisfaction. We recommend similar models can be considered by health services to optimise patient care and ICU management.

Asymptomatic Reactivation of SARS-CoV-2 in a Child with Neuroblastoma Characterised by Whole Genome SequencingSatya Prakash Yadav1, Dhwanee Thakkar1, Rahul C. Bhoyar2, Abhinav Jain2,3, Teena Wadhwa4, Mohamed Imran2,3, Bani Jolly2,3, Mohit Kumar Divakar2,3, Rohit Kapoor1, Neha Rastogi1, Disha Sharma2,3, Paras Sehgal2,3, Gyan Ranjan2,3, Sridhar Sivasubbu2,3, Smita Sarma4,Vinod Scaria2,3Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India.CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi, IndiaAcademy of Scientific and Innovative Research (AcSIR), Ghaziabad- 201002, IndiaDepartment of Microbiology, Medanta The Medicity, Gurgaon, Haryana, India.Correspondence : Dr Satya P Yadav, Pediatric Hematology Oncology & BMT Unit, Cancer Institute, Medanta -The Medicity, Gurgaon, Haryana, India 122001.Email:satya_1026@hotmail.com, Fax: +91 1244962222Total Pages - 4Abstract (word count) – N/ATable - 0Figure - 1Text (word count) – 479Running title –COVID-19 reactivation proven by sequencingKey words – COVID-19; Reactivation; SARS-CoV-2; Genome Sequencing; Neuroblastoma

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.

The best suggestion for COVID-19 in a non-infected pregnant population is still prevention: a commentaryRui-Hong Xue1, He-Feng Huang2,3,4,5

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.

ABSTRACTIt is sad to hear discussions among the president of the International Union of Immunological Societies and the presidents of 15 other national immunology societies1. Their actions against COVID-19 to individual government leaders were not swift. Inconsistent and slow prevention against COVID-19 may prolong the pandemic worldwide. The best surveillance should be implemented in the world as soon as possible.KEYWORDSCOVID-19; SARS; airborne; air travel; receptor ACE2; asymptomatic and presymptomaticIt is sad to hear discussions among the president of the International Union of Immunological Societies and the presidents of 15 other national immunology societies1. Their actions against COVID-19 to individual government leaders were not swift. SARS-CoV-2 was named after SARS by WHO on Feb. 1120202. From Feb. 11, expert scientists who should know the past lessons from SARS 17 years ago and MERS 8 years ago respectively should disseminate that SARS-Cov-2 is an airborneinfection virus which spreads person to person 3,4. They should also disseminate how to effectively prevent the airborne infection transmission. They should also ban air travel 4.Hoffmann et al. discovered that SARS-CoV-2 uses the SARS-CoVreceptor ACE2 for host cell entry on April 16in 20205.For mitigating the COVID-19 pandemic, the expert scientists should disseminate to the world on isolation of COVID-19asymptomatic and presymptomatic patients.They should also disseminate there is still no vaccine for SARS and MERS despite dozens of attempts to develop them6. Since there is no vaccine for COVID-19, urgent isolation is an only strategy for mitigating the pandemic where the robust surveillance withpatient’s detection plays a key role.Inconsistent and slow prevention against COVID-19 may prolong the pandemic worldwide. The best surveillance should be implemented in the world as soon as possible.References:1.Osier, F., Ting, J.P.Y., Fraser, J. et al. The global response to the COVID-19 pandemic: how have immunology societies contributed? Nat Rev Immunol 20, 594–602 (2020).https://doi.org/10.1038/s41577-020-00428-42.https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it3.https://www.who.int/csr/resources/publications/ICHC_booklet_FINAL.pdf4. https://www.who.int/health-topics/severe-acute-respiratory-syndrome#tab=tab_15. Hoffmann et al., 2020, Cell,181,271–280, April 16, 2020https://doi.org/10.1016/j.cell.2020.02.0526.https://www.mountsinai.org/about/newsroom/2020/itn-there-was-no-vaccine-for-sars-or-mers-will-there-be-one-for-the-new-coronavirus-josephine-ma-and-simone-mccarthy

Background The MAPK pathway, is a signal transduction pathway involved in the oncogenesis of a variety of pediatric tumors. The clinical use of BRAF inhibitors and MEK inhibitors is increasingly used in oncology practice. The toxicity profile of these drugs in the pediatric population, particularly in relation to development, growth and sexual maturation remains insufficiently studied. Procedure This study includes 22 pediatric patients with molecularly confirmed MAPK pathway driven tumors treated with MEK or BRAF between August 2014 and March 2020. Throughout treatment they underwent regular laboratory, endocrine, cardiac, ophthalmic and dermatologic evaluation. Toxicity was recorded and evaluated according to CTCA v4. Results Overall an adverse event frequency of 86% was encountered. Dermatological disorders accounted for 68% of the adverse events. Overall 8 patients suffered from severe adverse events including Erythema Nodosum, PLEVA-like rash, osteoporosis, Sarcoid-like massive lymphadenopathy, retinal toxicity and elevated liver enzymes & CPK. Four patients discontinued treatment as a result of adverse events. In this cohort we did not encounter any treatment-related abnormalities of sexual maturation or gonadal function nor statistically significant growth retardation, however a slower than expected growth rate was observed in one patient. In addition dose-dependent, non-symptomatic and within normal range for age decreased cardiac SF% was noted in two patients treated with MEK inhibitor. Conclusion Treatment with BRAF and MEK inhibitors was shown to be generally safe, we report drug tolerability of 82%. However, further prospective studies should be preformed to are characterize the full scope of side effects in the pediatric population.

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.

Background Cystic fibrosis (CF) is a chronic disease causing recurrent respiratory tract infections. Viral respiratory tract infections are more severe in CF. The first case of COVID-19 was seen in Turkey on March 11, 2020 and nationwide school closure and lockdown were implemented. School closure and home confinement might have adverse effects on children’s physical and mental health. In this study, we aimed to compare the effect of COVID-19 pandemic on psychological reactions of CF patients and healthy controls. Methods This is a controlled cross-sectional study including 7-18 year-old children with CF. The survey included questions regarding family environment and peer relations, self care and psychological reactions to COVID-19 pandemic. The questionnaire was applied to children via telephone call under parental supervision. Results We evaluated 132 CF patients and 135 their healthy peers. Mean age was 11.5±2.9 years in CF group and 11.8±3.2 years in control group (p=0.98). There were 55 girls (41.7%) in CF group and 81 girls (60%) in control group (p=0.027). The socioeconomic status of families was similar. CF patients was feeling less anxious about the COVID-19 pandemic compared to controls (p=0.01). CF patients were found to be less anxious for family members having the risk of COVID-19, less upset for the school closure, less anxious about the COVID-19 pandemic (p<0.001, 0.02, 0.01 respectively). Conclusion CF patients seem to show more resilience in coping with the pandemic. Appropriate psychological support should be provided to them and resilience strategies in coping with the pandemic should be nurtured.