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Clinical Aspects

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28/07/2020 Manuscript
Epidemiology of invasive pulmonary aspergillosis among COVID-19 intuba...

Epidemiology of invasive pulmonary aspergillosis among COVID-19 intubated patients: a prospective study

OXFORD ACADEMY

Authors
Michele Bartoletti, Renato Pascale, Monica Cricca, Matteo Rinaldi, Angelo Maccaro, Linda Bussini, Giacomo Fornaro, Tommaso Tonetti, Giacinto Pizzilli, Eugenia Francalanci, Lorenzo Giuntoli, Arianna Rubin, Alessandra Moroni, Simone Ambretti, Filippo Trapani, Oana Vatamanu, Vito Marco Ranieri, Andrea Castelli, Massimo Baiocchi, Russell Lewis, Maddalena Giannella, Pierluigi Viale



ABSTRACT
Background In this study we evaluated the incidence of invasive pulmonary aspergillosis among intubated patients with critical coronavirus disease 2019 (COVID-19) and evaluated different case definitions of invasive aspergillosis.
Methods Prospective, multicentre study on adult patients with microbiologically confirmed COVID-19 receiving mechanical ventilation. All included participants underwent screening protocol for invasive pulmonary aspergillosis with bronchoalveolar lavage galactomannan and cultures performed on admission at 7 days and in case of clinical deterioration. Cases were classified as coronavirus associated pulmonary aspergillosis (CAPA) according to previous consensus definitions. The new definition was compared with putative invasive pulmonary aspergillosis (PIPA).
Results A total of 108 patients were enrolled. Probable CAPA was diagnosed in 30 (27.7%) of patients after a median of 4 (2-8) days from intensive care unit (ICU) admission. Kaplan-Meier curves showed a significant higher 30-day mortality rate from ICU admission among patients with either CAPA (44% vs 19%, p= 0.002) or PIPA (74% vs 26%, p<0.001) when compared with patients not fulfilling criteria for aspergillosis. The association between CAPA [OR 3.53 (95%CI 1.29-9.67), P=0.014] or PIPA [OR 11.60 (95%CI 3.24-41.29) p<0.001] with 30-day mortality from ICU admission was confirmed even after adjustment for confounders with a logistic regression model. Among patients with CAPA receiving voriconazole treatment (13 patients, 43%) A trend toward lower mortality (46% vs 59% p=0.30) and reduction of galactomannan index in consecutive samples was observed.
Conclusion We found a high incidence of CAPA among critically ill COVID-19 patients and that its occurrence seems to change the natural history of disease

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27/07/2020 Summary Report
COVID-19 Symptoms After Virologic Recovery

NEJM

Authors
Wendy S. Armstrong


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27/07/2020 Investigation
Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Rece...

Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)

JAMA

Authors
Valentina O. Puntmann, M. Ludovica Carerj, Imke Wieters, Masia Fahim; Christophe Arendt, Jedrzej Hoffmann, Anastasia Shchendrygina, Felicitas Escher, Mariuca Vasa-Nicotera, Andreas M. Zeiher, Maria Vehreschild, Eike Nagel



ABSTRACT
Importance Coronavirus disease 2019 (COVID-19) continues to cause considerable morbidity and mortality worldwide. Case reports of hospitalized patients suggest that COVID-19 prominently affects the cardiovascular system, but the overall impact remains unknown. Objective To evaluate the presence of myocardial injury in unselected patients recently recovered from COVID-19 illness. Design, Setting, and Participants In this prospective observational cohort study, 100 patients recently recovered from COVID-19 illness were identified from the University Hospital Frankfurt COVID-19 Registry between April and June 2020. Exposure Recent recovery from severe acute respiratory syndrome coronavirus 2 infection, as determined by reverse transcription–polymerase chain reaction on swab test of the upper respiratory tract. Main Outcomes and Measures Demographic characteristics, cardiac blood markers, and cardiovascular magnetic resonance (CMR) imaging were obtained. Comparisons were made with age-matched and sex-matched control groups of healthy volunteers (n = 50) and risk factor–matched patients (n = 57). Results Of the 100 included patients, 53 (53%) were male, and the median (interquartile range [IQR]) age was 49 (45-53) years. The median (IQR) time interval between COVID-19 diagnosis and CMR was 71 (64-92) days. Of the 100 patients recently recovered from COVID-19, 67 (67%) recovered at home, while 33 (33%) required hospitalization. At the time of CMR, high-sensitivity troponin T (hsTnT) was detectable (3 pg/mL or greater) in 71 patients recently recovered from COVID-19 (71%) and significantly elevated (13.9 pg/mL or greater) in 5 patients (5%). Compared with healthy controls and risk factor–matched controls, patients recently recovered from COVID-19 had lower left ventricular ejection fraction, higher left ventricle volumes, higher left ventricle mass, and raised native T1 and T2. A total of 78 patients recently recovered from COVID-19 (78%) had abnormal CMR findings, including raised myocardial native T1 (n = 73), raised myocardial native T2 (n = 60), myocardial late gadolinium enhancement (n = 32), and pericardial enhancement (n = 22). There was a small but significant difference between patients who recovered at home vs in the hospital for native T1 mapping (median [IQR], 1122 [1113-1132] ms vs 1143 [1131-1156] ms; P = .02) but not for native T2 mapping or hsTnT levels. None of these measures were correlated with time from COVID-19 diagnosis (native T1: r = 0.07; P = .47; native T2: r = 0.14; P = .15; hsTnT: r = −0.07; P = .50). High-sensitivity troponin T was significantly correlated with native T1 mapping (r = 0.35; P < .001) and native T2 mapping (r = 0.22; P = .03). Endomyocardial biopsy in patients with severe findings revealed active lymphocytic inflammation. Native T1 and T2 were the measures with the best discriminatory ability to detect COVID-19–related myocardial pathology. Conclusions and Relevance In this study of a cohort of German patients recently recovered from COVID-19 infection, CMR revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.

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27/07/2020 Report
Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19...

Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases

JAMA

Authors
Diana Lindner, Antonia Fitzek, Hanna Bräuninger, Ganna Aleshcheva, Caroline Edler, Kira Meissner; Katharina Scherschel, Paulus Kirchhof, Felicitas Escher, Heinz-Peter Schultheiss, Stefan Blankenberg, Klaus Püschel, Dirk Westermann



ABSTRACT
Importance Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be documented in various tissues, but the frequency of cardiac involvement as well as possible consequences are unknown.
Objective To evaluate the presence of SARS-CoV-2 in the myocardial tissue from autopsy cases and to document a possible cardiac response to that infection.
Design, Setting, and Participants This cohort study used data from consecutive autopsy cases from Germany between April 8 and April 18, 2020. All patients had tested positive for SARS-CoV-2 in pharyngeal swab tests.
Exposures Patients who died of coronavirus disease 2019.
Main Outcomes and Measures Incidence of SARS-CoV-2 positivity in cardiac tissue as well as CD3+, CD45+, and CD68+ cells in the myocardium and gene expression of tumor necrosis growth factor α, interferon γ, chemokine ligand 5, as well as interleukin-6, -8, and -18.
Results Cardiac tissue from 39 consecutive autopsy cases were included. The median (interquartile range) age of patients was 85 (78-89) years, and 23 (59.0%) were women. SARS-CoV-2 could be documented in 24 of 39 patients (61.5%). Viral load above 1000 copies per μg RNA could be documented in 16 of 39 patients (41.0%). A cytokine response panel consisting of 6 proinflammatory genes was increased in those 16 patients compared with 15 patients without any SARS-CoV-2 in the heart. Comparison of 15 patients without cardiac infection with 16 patients with more than 1000 copies revealed no inflammatory cell infiltrates or differences in leukocyte numbers per high power field.
Conclusions and Relevance In this analysis of autopsy cases, viral presence within the myocardium could be documented. While a response to this infection could be reported in cases with higher virus load vs no virus infection, this was not associated with an influx of inflammatory cells. Future investigations should focus on evaluating the long-term consequences of this cardiac involvement.

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27/07/2020 Articles
Covid-19 and the cardiovascular system: a comprehensive review

NATURE

Authors
Rafael Bellotti Azevedo, Bruna Gopp Botelho, João Victor Gonçalves de Hollanda, Leonardo Villa Leão Ferreira, Letícia Zarur Junqueira de Andrade, Stephanie Si Min Lilienwald Oei, Tomás de Souza Mello, Elizabeth Silaid Muxfeldt



ABSTRACT
Cardiac injury in patients infected with the novel Coronavirus (COVID-19) seems to be associated with higher morbimortality. We provide a broad review of the clinical evolution of COVID-19, emphasizing its impact and implications on the cardiovascular system. The pathophysiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by overproduction of inflammatory cytokines (IL-6 and TNF-α) leading to systemic inflammation and multiple organ dysfunction syndrome, acutely affecting the cardiovascular system. Hypertension (56.6%) and diabetes (33.8%) are the most prevalent comorbidities among individuals with COVID-19, who require hospitalization. Furthermore, cardiac injury, defined as elevated us-troponin I, significantly relates to inflammation biomarkers (IL-6 and C-reactive protein (CRP), hyperferritinemia, and leukocytosis), portraying an important correlation between myocardial injury and inflammatory hyperactivity triggered by viral infection. Increased risk for myocardial infarction, fulminant myocarditis rapidly evolving with depressed systolic left ventricle function, arrhythmias, venous thromboembolism, and cardiomyopathies mimicking STEMI presentations are the most prevalent cardiovascular complications described in patients with COVID-19. Moreover, SARS-CoV-2 tropism and interaction with the RAAS system, through ACE2 receptor, possibly enhances inflammation response and cardiac aggression, leading to imperative concerns about the use of ACEi and ARBs in infected patients. Cardiovascular implications result in a worse prognosis in patients with COVID-19, emphasizing the importance of precocious detection and implementation of optimal therapeutic strategies.

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25/07/2020 Articles
The impact of obesity on COVID-19 complications: a retrospective cohor...

The impact of obesity on COVID-19 complications: a retrospective cohort study

NATURE

Authors
Mohamed Nakeshbandi, Rohan Maini, Pia Daniel, Sabrina Rosengarten, Priyanka Parmar, Clara Wilson, Julie Minjae Kim, Alvin Oommen, Max Mecklenburg, Jerome Salvani, Michael A. Joseph, Igal Breitman



ABSTRACT
ackground Obesity is an epidemic in New York City, the global epicenter of the coronavirus pandemic. Previous studies suggest that obesity is a possible risk factor for adverse outcomes in COVID-19.
Objective To elucidate the association between obesity and COVID-19 outcomes.
Design Retrospective cohort study of COVID-19 hospitalized patients tested between March 10 and April 13, 2020.
Setting SUNY Downstate Health Sciences University, a COVID-only hospital in New York.
Participants In total, 684 patients were tested for COVID-19 and 504 were analyzed. Patients were categorized into three groups by BMI: normal (BMI 18.50–24.99), overweight (BMI 25.00–29.99), and obese (BMI ≥ 30.00).
Measurements Primary outcome was 30-day in-hospital mortality, and secondary outcomes were intubation, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and acute cardiac injury (ACI).
Results There were 139 patients (27%) with normal BMI, 150 patients who were overweight (30%), and 215 patients with obesity (43%). After controlling for age, gender, diabetes, hypertension, and qSOFA score, there was a significantly increased risk of mortality in the overweight (RR 1.4, 95% CI 1.1–1.9) and obese groups (RR 1.3, 95% CI 1.0–1.7) compared with those with normal BMI. Similarly, there was a significantly increased relative risk for intubation in the overweight (RR 2.0, 95% CI 1.2–3.3) and obese groups (RR 2.4, 95% CI 1.5–4.0) compared with those with normal BMI. Obesity did not affect rates of AKI, ACI, or ARDS. Furthermore, obesity appears to significantly increase the risk of mortality in males (RR 1.4, 95% CI 1.0-2.0, P = 0.03), but not in females (RR 1.2, 95% CI 0.77–1.9, P = 0.40).
Conclusion This study reveals that patients with overweight and obesity who have COVID-19 are at increased risk for mortality and intubation compared to those with normal BMI. These findings support the hypothesis that obesity is a risk factor for COVID-19 complications and should be a consideration in management of COVID-19.

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24/07/2020 Viewpoint
COVID-19 affects HIV and tuberculosis care

SCIENCE

Authors
Quarraisha Abdool Karim, Salim S. Abdool Karim



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21/07/2020 Clinical Investigation
“Missing” acute coronary syndrome hospitalizations during the COVID ‐1...

“Missing” acute coronary syndrome hospitalizations during the COVID ‐19 era in Greece: Medical care avoidance combined with a true reduction in incidence?

WILEY ONLINE LIBRARY

Authors
Michail I. Papafaklis, Christos S. Katsouras, Grigorios Tsigkas, Konstantinos Toutouzas, Periklis Davlouros, George N. Hahalis, Maria S. Kousta, Ioannis G. Styliadis, Konstantinos Triantafyllou, Loukas Pappas, Fotini Tsiourantani, Efthymia Varytimiadi, Zacharias‐Alexandros Anyfantakis, Nikolaos Iakovis. Paraskevi Grammata, Haralambos Karvounis, Antonios Ziakas, George Sianos, Dimitrios Tziakas, Evgenia Pappa, Anna Dagre, Sotirios Patsilinakos, Athanasios Trikas, Thomais Lamprou, Ioannis Mamarelis, Georgios Katsimagklis, Dimitri Karmpaliotis, Katerina Naka, Lampros K. Michalis



ABSTRACT
Background Reports from countries severely hit by the COVID‐19 pandemic suggest a decline in acute coronary syndrome (ACS)‐related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID‐19 incidence are not known.
Hypothesis ACS admissions were reduced in a country spared by COVID‐19.
Methods We conducted a nationwide study on the incidence rates of ACS‐related admissions during a 6‐week period of the COVID‐19 outbreak and the corresponding control period in 2019 in Greece, a country with strict social measures, low COVID‐19 incidence, and no excess in mortality.
Results ACS admissions in the COVID‐19 (n = 771) compared with the control (n = 1077) period were reduced overall (incidence rate ratio [IRR]: 0.72, P  < .001) and for each ACS type (ST‐segment elevation myocardial infarction [STEMI]: IRR: 0.76, P = .001; non‐STEMI: IRR: 0.74, P  < .001; and unstable angina [UA]: IRR: 0.63, P = .002). The decrease in STEMI admissions was stable throughout the COVID‐19 period (temporal correlation; R2 = 0.11, P = .53), whereas there was a gradual decline in non‐STEMI/UA admissions (R2 = 0.75, P = .026) following the progressively stricter social measures. During the COVID‐19 period, patients admitted with ACS presented more frequently with left ventricular systolic impairment (22.2 vs 15.5% control period; P  < .001).
Conclusions We observed a reduction in ACS hospitalizations during the COVID‐19 outbreak in a country with strict social measures, low community transmission, and no excess in mortality. Medical care avoidance behavior is an important factor for these observations, while a true reduction of the ACS incidence due to self‐isolation/quarantining may have also played a role.

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21/07/2020 Letter
Unexpected Features of Cardiac Pathology in COVID-19 Infection

AHA JOURNALS

Authors
Sharon E. Fox, Guang Li, Aibek Akmatbekov, Jack L. Harbert, Fernanda S. Lameira, J. Quincy Brown, Richard S. Vander Heide


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20/07/2020 Letter
Ketoacidosis in Children and Adolescents With Newly Diagnosed Type 1 D...

Ketoacidosis in Children and Adolescents With Newly Diagnosed Type 1 Diabetes During the COVID-19 Pandemic in Germany

JAMA

Authors
Clemens Kamrath, Kirsten Mönkemöller, Torben Biester, Tilman R. Rohrer, Katharina Warncke, Johanna Hammersen, Reinhard W. Holl



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20/07/2020 News
Covid-19: Study reveals six clusters of symptoms that could be used as...

Covid-19: Study reveals six clusters of symptoms that could be used as a clinical prediction tool

THE BMJ

Authors
Jacqui Wise



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17/07/2020 Articles
Recurrence of positive SARS-CoV-2 viral RNA in recovered COVID-19 pati...

Recurrence of positive SARS-CoV-2 viral RNA in recovered COVID-19 patients during medical isolation observation

NATURE

Authors
Bo Yuan, Han-Qing Liu, Zheng-Rong Yang, Yong-Xin Chen, Zhi-Yong Liu, Kai Zhang, Cheng Wang, Wei-Xin Li, Ya-Wen An, Jian-Chun Wang, Shuo Song



ABSTRACT
Recently, the recurrence of positive SARS-CoV-2 viral RNA in recovered COVID-19 patients is receiving more attention. Herein we report a cohort study on the follow-up of 182 recovered patients under medical isolation observation. Twenty (10.99%) patients out of the 182 were detected to be SARS-CoV-2 RNA positive (re-positives), although none showed any clinical symptomatic recurrence, indicating that COVID-19 responds well to treatment. Patients aged under 18 years had higher re-positive rates than average, and none of the severely ill patients re-tested positive. There were no significant differences in sex between re-positives and non-re-positives. Notably, most of the re-positives turned negative in the following tests, and all of them carried antibodies against SARS-CoV-2. This indicates that they might not be infectious, although it is still important to perform regular SARS-CoV-2 RNA testing and follow-up for assessment of infectivity. The findings of this study provide information for improving the management of recovered patients, and for differentiating the follow-up of recovered patients with different risk levels.

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17/07/2020 Reviews
COVID-19 in people with diabetes: understanding the reasons for worse ...

COVID-19 in people with diabetes: understanding the reasons for worse outcomes

THE LANCET

Authors
Matteo Apicella, Maria Cristina Campopiano, Michele Mantuano, Laura Mazoni, Alberto Coppelli, Stefano Del Prato



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17/07/2020 Articles
A literature review of 2019 novel coronavirus (SARS-CoV2) infection in...

A literature review of 2019 novel coronavirus (SARS-CoV2) infection in neonates and children

NATURE

Authors
Matteo Di Nardo, Grace van Leeuwen, Alessandra Loreti, Maria Antonietta Barbieri, Yit Guner, Franco Locatelli, Vito Marco Ranieri



ABSTRACT
At the time of writing, there are already millions of documented infections worldwide by the novel coronavirus 2019 (2019-nCoV or severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)), with hundreds of thousands of deaths. The great majority of fatal events have been recorded in adults older than 70 years; of them, a large proportion had comorbidities. Since data regarding the epidemiologic and clinical characteristics in neonates and children developing coronavirus disease 2019 (COVID-19) are scarce and originate mainly from one country (China), we reviewed all the current literature from 1 December 2019 to 7 May 2020 to provide useful information about SARS-CoV2 viral biology, epidemiology, diagnosis, clinical features, treatment, prevention, and hospital organization for clinicians dealing with this selected population.

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16/07/2020 Letter
Effect of COVID-19 on Tuberculosis Notification, South Korea

CDC (CENTERS FOR DISEASE CONTROL AND PREVENTION)

Authors
Nakwon Kwak, Seung-Sik Hwang, and Jae-Joon Yim



ABSTRACT
After South Korea raised its infectious disease alert to the highest level in response to coronavirus disease emergence, tuberculosis notification during the first 18 weeks of 2020 decreased significantly from the same period for each year during 2015–2019. Adequate measures to diagnose, control, and prevent tuberculosis need to be maintained.

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14/07/2020 Manuscript
Systemic fibrinolysis for acute pulmonary embolism complicating acute ...

Systemic fibrinolysis for acute pulmonary embolism complicating acute respiratory distress syndrome in severe COVID-19: a case series

OXFORD ACADEMY

Authors
Roberta Della Bona, Alberto Valbusa, Giovanni La Malfa, Daniele Roberto Giacobbe, Pietro Ameri, Niccolò Patroniti, Chiara Robba, Vered Gilad, Angelo Insorsi, Matteo Bassetti, Paolo Pelosi, Italo Porto


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12/07/2020 Reviews
Usefulness of echocardiography to detect cardiac involvement in COVID-...

Usefulness of echocardiography to detect cardiac involvement in COVID-19 patients

WILEY ONLINE LIBRARY

Authors
Matteo Cameli, Maria Concetta Pastore, Hatem Soliman Aboumarie, Giulia Elena Mandoli, Flavio D'Ascenzi, Paolo Cameli ,Elisa Bigio, Federico Franchi, Sergio Mondillo, Serafina Valente



ABSTRACT
Coronavirus disease 2019 (COVID‐19) outbreak is a current global healthcare burden, leading to the life‐threatening severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). However, evidence showed that, even if the prevalence of COVID‐19 damage consists in pulmonary lesions and symptoms, it could also affect other organs, such as heart, liver, and spleen. Particularly, some infected patients refer to the emergency department for cardiovascular symptoms, and around 10% of COVID‐19 victims had finally developed heart injury. Therefore, the use of echocardiography, according to the safety local protocols and ensuring the use of personal protective equipment, could be useful firstly to discriminate between primary cardiac disease or COVID‐19–related myocardial damage, and then for assessing and monitoring COVID‐19 cardiovascular complications: acute myocarditis and arrhythmias, acute heart failure, sepsis‐induced myocardial impairment, and right ventricular failure derived from treatment with high‐pressure mechanical ventilation. The present review aims to enlighten the applications of transthoracic echocardiography for the diagnostic and therapeutic management of myocardial damage in COVID‐19 patients.

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11/07/2020 Reviews
COVID-19, coagulopathy and venous thromboembolism: more questions than...

COVID-19, coagulopathy and venous thromboembolism: more questions than answers

SPRINGER LINK

Authors
Marco Marietta, Valeria Coluccio, Mario Luppi



ABSTRACT
The acute respiratory illnesses caused by severe acquired respiratory syndrome corona Virus-2 (SARS-CoV-2) is a global health emergency, involving more than 8.6 million people worldwide with more than 450,000 deaths. Among the clinical manifestations of COVID-19, the disease that results from SARS-CoV-2 infection in humans, a prominent feature is a pro-thrombotic derangement of the hemostatic system, possibly representing a peculiar clinicopathologic manifestation of viral sepsis. The severity of the derangement of coagulation parameters in COVID-19 patients has been associated with a poor prognosis, and the use of low molecular weight heparin (LMWH) at doses registered for prevention of venous thromboembolism (VTE) has been endorsed by the World Health Organization and by Several Scientific societies. However, some relevant issues on the relationships between COVID-19, coagulopathy and VTE have yet to be fully elucidated. This review is particularly focused on four clinical questions: What is the incidence of VTE in COVID-19 patients? How do we frame the COVID-19 associated coagulopathy? Which role, if any, do antiphospolipid antibodies have? How do we tackle COVID-19 coagulopathy? In the complex scenario of an overwhelming pandemic, most everyday clinical decisions have to be taken without delay, although not yet supported by a sound scientific evidence. This review discusses the most recent findings of basic and clinical research about the COVID-associated coagulopathy, to foster a more thorough knowledge of the mechanisms underlying this compelling disease.

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11/07/2020 Articles
Self-reported symptoms of SARS-CoV-2 infection in a non-hospitalized p...

Self-reported symptoms of SARS-CoV-2 infection in a non-hospitalized population: results from the large Italian web-based EPICOVID19 cross-sectional survey.

JMIR PUBLICATION

Authors
Fulvio Adorni, Federica Prinelli, Fabrizio Bianchi, Andrea Giacomelli, Gabriele Pagani, Dario Bernacchia, Stefano Rusconi, Stefania Maggi, Caterina Trevisan, Marianna Noale, Sabrina Molinaro, Luca Bastiani, Loredana Fortunato, Nithiya Jesuthasan, Aleksandra Sojic, Carla Pettenati, Marcello Tavio, Massimo Andreoni, Claudio Mastroianni, Raffaele Antonelli Incalzi, Massimo Galli



ABSTRACT
Background: Understanding the occurrence of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2)-like symptoms in a large non-hospitalized population, when the epidemic peak was occurring in Italy, is of paramount importance but data are scarce.
Objective: Aims of this study were to evaluate the association of self-reported symptoms with SARS-CoV-2 nasopharyngeal swab (NPS) test in non-hospitalized individuals and to estimate the occurrence of COVID-19-like symptoms in a larger non-tested population.
Methods: This is an Italian countrywide self-administered cross-sectional web-based survey on voluntary adults who completed an anonymous questionnaire in the period 13-21 April 2020. The associations between symptoms potentially related to SARS-CoV-2 infection and NPS results were calculated as adjusted odds ratios with 95% confidence intervals (aOR, 95%CI) by means of multiple logistic regression analysis controlling for age, sex, education, smoking habits, and the number of co-morbidities. Thereafter, for each symptom and for their combination, we calculated sensitivity, specificity, accuracy and AUC in a ROC analysis to estimate the occurrence of COVID-19-like infections in the non-tested population.
Results: A total of 171,310 responded to the survey (59.9% females, mean age 47.4 years). Out of the 4,785 respondents with known NPS test result, 4,392 were not hospitalized. Among them, the NPS positive respondents (n=856) most frequently reported myalgia (61.6%), olfactory and/or taste disorders (OTDs, 59.2%), cough (54.4%), and fever (51.9%) whereas 7.7% were asymptomatic. Multiple regression analysis showed that OTDs (aOR 10.3, [95%CI 8.4-12.7]), fever (2.5, 95%CI 2.0-3.1), myalgia (1.5, 95%CI 1.2-1.8), and cough (1.3, 95%CI 1.0-1.6) were associated with NPS positivity. Having two to four of these symptoms increased the aOR from 7.4 (95%CI, 5.6-9.7) to 35.5 (95%CI, 24.6-52.2). The combination of the four symptoms showed an AUC of 0.810 (95%CI 0.795-0.825) in classifying NPS-P, and was applied to the non-hospitalized and non-tested sample (n=165,782). We found that from 4.4% to 12.1% of respondents had experienced symptoms suggestive of COVID-19 infection.
Conclusions: Our results suggest that self-reported symptoms may be reliable indicators of SARS-CoV-2 infection in a pandemic context. A not negligible part (up to 12.1%) of the symptomatic respondents were left undiagnosed and potentially contributed to the spread of the infection.

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10/07/2020 Articles
Haematological characteristics and risk factors in the classification ...

Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study

THE LANCET

Authors
Danying Liao, Fen Zhou, Lili Luo, Min Xu, Hongbo Wang, Jiahong Xia, Yong Gao, Liqiong Cai, Zhihui Wang, Ping Yin, Yadan Wang, Lu Tang, Jun Deng, Heng Mei†, Yu Hu


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09/07/2020 Articles
Intensive care admissions of children with paediatric inflammatory mul...

Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study

THE LANCET

Authors
Patrick Davies, Claire Evans, Hari Krishnan Kanthimathinathan, Jon Lillie, Joseph Brierley, Gareth Waters, Mae Johnson, Benedict Griffiths, Pascale du Pré, Zoha Mohammad, Akash Deep, Stephen Playfor, Davinder Singh, David Inwald, Michelle Jardine, Oliver Ross, Nayan Shetty, Mark Worrall, Ruchi Sinha, Ashwani Koul, Elizabeth Whittaker, Harish Vyas, Barnaby R Scholefield*, Padmanabhan Ramnarayan



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08/07/2020 Manuscript
Risk Factors for Myocardial Injury and Death in Patients with COVID-19...

Risk Factors for Myocardial Injury and Death in Patients with COVID-19: Insights from a Cohort study with Chest Computed Tomography

OXFORD ACADEMY

Authors
Giuseppe Ferrante, Fabio Fazzari, Ottavia Cozzi, Matteo Maurina, Renato Bragato, Federico D’Orazio, Chiara Torrisi, Ezio Lanza, Eleonora Indolfi, Valeria Donghi, Riccardo Mantovani, Gaetano Liccardo, Antonio Voza, Elena Azzolini,, Luca Balzarini, Bernhard Reimers, Giulio G Stefanini, Gianluigi Condorelli, Lorenzo Monti



ABSTRACT
Aims Whether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19.
Methods and Results This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I > 20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th–75th percentile, 27–32) mm vs. 27.7 (25–30) mm,  < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02–1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02–1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%,  < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27–3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO/FiO ratio on admission were other independent predictors for both myocardial injury and death.
Conclusions An increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.

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08/07/2020 Report
Baricitinib as rescue therapy in a patient with COVID-19 with no compl...

Baricitinib as rescue therapy in a patient with COVID-19 with no complete response to sarilumab

SPRINGER LINK

Authors
A. Cingolani, A. M. Tummolo, G. Montemurro, E. Gremese, L. Larosa, M. C. Cipriani, G. Pasciuto, R. Liperoti, R. Murri, T. Pirronti, R. Cauda, M. Fantoni



ABSTRACT
A patient with COVID-19-related severe respiratory failure, with insufficient response to an antiretroviral therapy, hydroxychloroquine and Interleukin-6 (IL-6) antagonist therapy, presented a prompt resolution of the respiratory function and improvement in the radiological picture after baricitinib at an oral dose of 4 mg per day for 2 weeks.

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08/07/2020 Original Investigation
Clinical Characteristics of Patients With Coronavirus Disease 2019 (CO...

Clinical Characteristics of Patients With Coronavirus Disease 2019 (COVID-19) Receiving Emergency Medical Services in King County, Washington

JAMA

Authors
Betty Y. Yang, Leslie M. Barnard, Jamie M. Emert, Christopher Drucker, Leilani Schwarcz, Catherine R. Counts, David L. Murphy, Sally Guan, Kosuke Kume, Karen Rodriquez, Tracie Jacinto, Susanne May, Michael R. Sayre, Thomas Rea



ABSTRACT
Importance The ability to identify patients with coronavirus disease 2019 (COVID-19) in the prehospital emergency setting could inform strategies for infection control and use of personal protective equipment. However, little is known about the presentation of patients with COVID-19 requiring emergency care, particularly those who used 911 emergency medical services (EMS).
Objective To describe patient characteristics and prehospital presentation of patients with COVID-19 cared for by EMS.
Design, Setting, and Participants This retrospective cohort study included 124 patients who required 911 EMS care for COVID-19 in King County, Washington, a large metropolitan region covering 2300 square miles with 2.2 million residents in urban, suburban, and rural areas, between February 1, 2020, and March 18, 2020.
Exposures COVID-19 was diagnosed by reverse transcription–polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2 from nasopharyngeal swabs. Test results were available a median (interquartile range) of 5 (3-9) days after the EMS encounter.
Main Outcomes and Measures Prevalence of clinical characteristics, symptoms, examination signs, and EMS impression and care.
Results Of the 775 confirmed COVID-19 cases in King County, EMS responded to 124 (16.0%), with a total of 147 unique 911 encounters. The mean (SD) age was 75.7 (13.2) years, 66 patients (53.2%) were women, 47 patients (37.9%) had 3 or more chronic health conditions, and 57 patients (46.0%) resided in a long-term care facility. Based on EMS evaluation, 43 of 147 encounters (29.3%) had no symptoms of fever, cough, or shortness of breath. Based on individual examination findings, fever, tachypnea, or hypoxia were only present in a limited portion of cases, as follows: 43 of 84 encounters (51.2%), 42 of 131 (32.1%), and 60 of 112 (53.6%), respectively. Advanced care was typically not required, although in 24 encounters (16.3%), patients received care associated with aerosol-generating procedures. As of June 1, 2020, mortality among the study cohort was 52.4% (65 patients).
Conclusions and Relevance The findings of this cohort study suggest that screening based on conventional COVID-19 symptoms or corresponding examination findings of febrile respiratory illness may not possess the necessary sensitivity for early diagnostic suspicion, at least in the prehospital emergency setting. The findings have potential implications for early identification of COVID-19 and effective strategies to mitigate infectious risk during emergency care.

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07/07/2020 Letter
Striking the Balance Between Safety of Patients and Team Members With ...

Striking the Balance Between Safety of Patients and Team Members With Effective, High-quality Care

ELSEVIER

Authors
Denise Ignatowski, Sandra Zemke, Abby Payne, Bijoy K. Khandheria



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07/07/2020 Articles
Role of inflammatory markers in corona virus disease (COVID-19) patien...

Role of inflammatory markers in corona virus disease (COVID-19) patients: A review

SAGE JOURNALS

Authors
Jyoti Upadhyay, Nidhi Tiwari, Mohd N Ansari Mohd N Ansari



ABSTRACT
The whole world is locked down due to the outbreak of novel Coronavirus Disease 2019 (nCOVID-19). A novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus pandemic 2019. Investigating the role of inflammatory mediators and understanding the virology of nCOVID-19 virus help in designing a rational and effective therapy for this infection. This review provides an overview of the inflammatory mediators activated during nCOVID-19 infection and the pathophysiology of this viral infection. In this review, the authors have a detailed discussion about the types of viral strains of nCOVID-19, its mechanism of action, host immune response, and the dysregulation caused by the viruses in the host immune system causing disease progression. Understanding the role of inflammatory cytokines, chemokines, and clinical immunology will be the approach to find out the possible novel therapeutic interventions. Therapies involving regulation of immune responses help in inhibiting the various steps in the pathologies of infection. Also, updated knowledge regarding the dysregulation of immune system and disease outcome in critically ill patients serves as a precautionary measure in the development and evaluation of vaccine.

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06/07/2020 Articles
The clinical course of SARS-CoV-2 positive neonates

NATURE

Authors
Giuseppe De Bernardo, Maurizio Giordano, Giada Zollo, Fabrizia Chiatto, Desiree Sordino, Rita De Santis, Serafina Perrone



ABSTRACT
The COVID-19 pneumonia was firstly reported in Wuhan, China, in December 2019. The disease had a rapid spread all over the word becoming an international public health emergency. Limited data were available on COVID-19 positive neonates. We reviewed relevant literature to understand the clinical course of disease and transmission routes in affected neonates. The aim of the study was evaluating the clinical course and prognosis of SARS-CoV-2 positive neonates. Based on current literature, the hypothesis of vertical transmission of SARS-CoV-2, though conceivable, remains unproven. A research conducted on PubMed database from December 2019 to April 27, 2020 revealed that were reported 25 neonates affected by SARS-CoV-2. Main symptoms were fever, cough, or shortness of breath but often these neonates did not show other symptoms during length stay in hospital. No deaths occurred.

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06/07/2020 Original Scientific Paper
Liver involvement is not associated with mortality: results from a lar...

Liver involvement is not associated with mortality: results from a large cohort of SARS‐CoV‐2 positive patients

WILEY ONLINE LIBRARY

Authors
Francesca Romana Ponziani, Fabio Del Zompo, Antonio Nesci, Francesco Santopaolo, Gianluca Ianiro, Maurizio Pompili, Antonio Gasbarrini



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06/07/2020 Brief Report
Incidence of Deep Vein Thrombosis among non‐ICU Patients Hospitalized ...

Incidence of Deep Vein Thrombosis among non‐ICU Patients Hospitalized for COVID‐19 Despite Pharmacological Thromboprophylaxis

WILEY ONLINE LIBRARY

Authors
Angelo Santoliquido, Angelo Porfidia, Antonio Nesci, Giuseppe De Matteis, Giuseppe Marrone, Enrica Porceddu, Giulia Cammà, Igor Giarretta, Massimo Fantoni, Francesco Landi, Antonio Gasbarrini, Roberto Pola



ABSTRACT
Background A remarkably high incidence of VTE has been reported among critically ill patients with COVID‐19 assisted in the Intensive Care Unit (ICU). However, VTE burden among non‐ICU patients hospitalized for COVID‐19 that receive guideline‐recommended thromboprophylaxis is unknown.
Objectives To determine the incidence of VTE among non‐ICU patients hospitalized for COVID‐19 that receive pharmacological thromboprophylaxis.
Methods We performed a systematic screening for the diagnosis of deep vein thrombosis (DVT) by lower limb vein compression ultrasonography (CUS) in consecutive non‐ICU patients hospitalized for COVID‐19, independently of the presence of signs or symptoms of DVT. All patients were receiving pharmacological thromboprophylaxis with either enoxaparin or fondaparinux.
Results The population that we screened consisted of 84 consecutive patients, with a mean age of 67.6±13.5 years and a mean Padua Prediction Score of 5.1±1.6. Seventy‐two patients (85.7%) had respiratory insufficiency, required oxygen supplementation, and had reduced mobility or were bedridden. In this cohort, we found 10 cases of DVT, with an incidence of 11.9% (95% CI 4.98–18.82). Of these, 2 were proximal DVT (incidence rate 2.4%, 95% CI ‐0.87–5.67) and 8 were distal DVT (incidence rate 9.5%, 95% CI 3.23–5.77). Significant differences between subjects with and without DVT were D‐dimer >3,000 µg/L (P<0.05), current or previous cancer (P<0.05), and need of high flow nasal oxygen therapy and/or non‐invasive ventilation (P<0.01).
Conclusions DVT may occur among non‐ICU patients hospitalized for COVID‐19, despite guideline‐recommended thromboprophylaxis.

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03/07/2020 Articles
COVID-19 in patients with rheumatic disease in Hubei province, China: ...

COVID-19 in patients with rheumatic disease in Hubei province, China: a multicentre retrospective observational study

THE LANCET

Authors
Jixin Zhong, Guifen Shen, Huiqin Yang, Anbin Huang, Xiaoqi Chen, Li Dong, Bin Wu, Anbin Zhang, Linchong Su, Xiaoqiang Hou, Shulin Song, Huiling Li, Wenyu Zhou, Tao Zhou, Qin Huang, Aichun Chu, Zachary Braunstein, Xiaoquan Rao, Cong Ye, Lingli Dong


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03/07/2020 Comment
High-altitude populations need special considerations for COVID-19

NATURE

Authors
Arnar Breevoort, Giovanni A. Carosso, Mohammed A. Mostajo-Radji

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02/07/2020 Articles
Emergence of Kawasaki disease related to SARS-CoV-2 infection in an ep...

Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis

THE LANCET

Authors
Naim Ouldali, Marie Pouletty, Patricia Mariani, Constance Beyler, Audrey Blachier, Stephane Bonacorsi, Kostas Danis, Maryline Chomton, Laure Maurice, Fleur Le Bourgeois, Marion Caseris, Jean Gaschignard, Julie Poline, Robert Cohen, Luigi Titomanlio, Albert Faye, Isabelle Melki, Ulrich Meinzer


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01/07/2020 Case Report
Early Neonatal SARS-CoV-2 Infection Manifesting With Hypoxemia Requiri...

Early Neonatal SARS-CoV-2 Infection Manifesting With Hypoxemia Requiring Respiratory Support

PEDIATRICS

Authors
Mariateresa Sinelli, Giuseppe Paterlini, Marco Citterio, Alessia Di Marco, Tiziana Fedeli and Maria Luisa Ventura



ABSTRACT
We describe a case of neonatal SARS-CoV-2 infection, in an infant diagnosed 3 days after birth, and manifesting with silent hypoxemia, requiring respiratory support.
Abbreviations: COVID-19 — coronavirus disease PCR — polymerase chain reaction SARS-CoV-2 — severe acute respiratory syndrome coronavirus 2 In December 2019, an emergent new coronavirus was detected in Wuhan, China, as the cause of severe pneumonia.1 The virus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a disease named coronavirus disease (COVID-19) and has become a pandemic.2 At the end of February, a cluster of cases was identified in Northern Italy. Since then, SARS-CoV-2 has been responsible for more than 80 000 infections among Italian adults, with ∼10 neonatal cases detected. The disease seems to be mild in children and, to date, there are few reports in neonatal population. It is still not clear if there is vertical transmission of virus from mother to newborn and there is not a consensus on the appropriate infection control precautions to be used in the care of the newborn. We report a case of COVID-19 infection in a term newborn who required respiratory support after a vaginal delivery.

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01/07/2020 Original Articles
Characteristics, treatment, outcomes and cause of death of invasively ...

Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy

CRITICAL CARE AND RESUSCITATION

Authors
Alberto Zangrillo, Luigi Beretta, Anna Mara Scandroglio, Giacomo Monti, Evgeny Fominskiy, Sergio Colombo, Federica Morselli, Alessandro Belletti, Paolo Silvani, Martina Crivellari, Fabrizio Monaco, Maria Luisa Azzolini, Raffaella Reineke, Pasquale Nardelli, Marianna Sartorelli, Carmine D Votta, Annalisa Ruggeri, Fabio Ciceri, Francesco De Cobelli, More- no Tresoldi, Lorenzo Dagna, Patrizia Rovere-Querini, Ary Serpa Neto, Rinaldo Bellomo, Giovanni Landoni



ABSTRACT
Objective: Describe characteristics, daily care and outcomes of patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS).
Design: Case series of 73 patients.
Setting: Large tertiary hospital in Milan.
Participants: Mechanically ventilated patients with confirmed COVID-19 admitted to the intensive care unit (ICU) between 20 February and 2 April 2020.
Main outcome measures: Demographic and daily clinical data were collected to identify predictors of early mortality.
Results: Of the 73 patients included in the study, most were male (83.6%), the median age was 61 years (interquartile range [IQR], 54-69 years), and hypertension affected 52.9% of patients. Lymphocytopenia (median, 0.77 x 103 per mm3 ; IQR, 0.58-1.00 x 103 per mm3), hyperinflammation with C-reactive protein (median, 184.5 mg/dL; IQR, 108.2-269.1 mg/dL) and pro-coagulant status with D-dimer (median, 10.1 μg/m; IQR, 5.0-23.8 μg/m) were present. Median tidal volume was 6.7 mL/kg (IQR, 6.0-7.5 mL/kg), and median positive end-expiratory pressure was 12 cmH2O (IQR, 10-14 cmH2O). In the first 3 days, prone positioning (12-16 h) was used in 63.8% of patients and extracorporeal membrane oxygenation in five patients (6.8%). After a median follow-up of 19.0 days (IQR, 15.0-27.0 days), 17 patients (23.3%) had died, 23 (31.5%) had been discharged from the ICU, and 33 (45.2%) were receiving invasive mechanical ventilation in the ICU. Older age (odds ratio [OR], 1.12; 95% CI, 1.04-1.22; P = 0.004) and hypertension (OR, 6.15; 95% CI, 1.75-29.11; P = 0.009) were associated with mortality, while early improvement in arterial partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) ratio was associated with being discharged alive from the ICU (P = 0.002 for interaction).
Conclusions: Despite multiple advanced critical care interventions, COVID-19 ARDS was associated with prolonged ventilation and high short term mortality. Older age and pre-admission hypertension were key mortality risk factors.

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30/06/2020 Research
Risk Factors for Mortality in Patients with COVID-19 in New York City

SPRINGER LINK

Authors
Takahisa Mikami, Hirotaka Miyashita, Takayuki Yamada, Matthew Harrington, Daniel Steinberg, Andrew Dunn, Evan Siau



ABSTRACT
Background New York City emerged as an epicenter of the coronavirus disease 2019 (COVID-19) pandemic.
Objective To describe the clinical characteristics and risk factors associated with mortality in a large patient population in the USA.
Design Retrospective cohort study.
Participants 6493 patients who had laboratory-confirmed COVID-19 with clinical outcomes between March 13 and April 17, 2020, who were seen in one of the 8 hospitals and/or over 400 ambulatory practices in the New York City metropolitan area
Main Measures Clinical characteristics and risk factors associated with in-hospital mortality.
Key Results A total of 858 of 6493 (13.2%) patients in our total cohort died: 52/2785 (1.9%) ambulatory patients and 806/3708 (21.7%) hospitalized patients. Cox proportional hazard regression modeling showed an increased risk of in-hospital mortality associated with age older than 50 years (hazard ratio [HR] 2.34, CI 1.47–3.71), systolic blood pressure less than 90 mmHg (HR 1.38, CI 1.06–1.80), a respiratory rate greater than 24 per min (HR 1.43, CI 1.13–1.83), peripheral oxygen saturation less than 92% (HR 2.12, CI 1.56–2.88), estimated glomerular filtration rate less than 60 mL/min/1.73m2 (HR 1.80, CI 1.60–2.02), IL-6 greater than 100 pg/mL (HR 1.50, CI 1.12–2.03), D-dimer greater than 2 mcg/mL (HR 1.19, CI 1.02–1.39), and troponin greater than 0.03 ng/mL (HR 1.40, CI 1.23–1.62). Decreased risk of in-hospital mortality was associated with female sex (HR 0.84, CI 0.77–0.90), African American race (HR 0.78 CI 0.65–0.95), and hydroxychloroquine use (HR 0.53, CI 0.41–0.67).
Conclusions Among patients with COVID-19, older age, male sex, hypotension, tachypnea, hypoxia, impaired renal function, elevated D-dimer, and elevated troponin were associated with increased in-hospital mortality and hydroxychloroquine use was associated with decreased in-hospital mortality.

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30/06/2020 Analysis
Cerebrovascular disease is associated with the risk of mortality in co...

Cerebrovascular disease is associated with the risk of mortality in coronavirus disease 2019

SPRINGER LINK

Authors
Ying Wang, Li Shi, Yadong Wang, Guangcai Duan, Haiyan Yang




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30/06/2020 Articles
An international survey in Latin America on the practice of interventi...

An international survey in Latin America on the practice of interventional cardiology during the COVID-19 pandemic, with a particular focus on myocardial infarction

SPRINGER LINK

Authors
J. Mayol, C. Artucio, I. Batista, A. Puentes, J. Villegas, R Quizpe, V. Rojas, J. Mangione, J. Belardi



ABSTRACT
Introduction A reduction in the number of interventional cardiology procedures has emerged as a result of the COVID-19 pandemic. A survey was performed to quantify this decrease and the impact on the management of myocardial infarction in Latin America.
Methods A telematic survey was conducted for all countries in Latin America. Diagnostic catheterisations, coronary and structural interventions, as well as the incidence and delay to reperfusion therapy of myocardial infarction (STEMI), were recorded. Two periods were compared: from 24 February to 8 March 2020 (pre-COVID-19) and another 2‑week period that varied according to country (COVID-19).
Results Responses were obtained from 79 centres in 20 countries. There was a significant decrease in the number of diagnostic procedures (−65.2%), coronary interventions (−59.4%), structural therapeutics (−86.1%) and STEMI care (−51.2%). A decrease was noted in the incidence of STEMI, but also a delay in the time to STEMI reperfusion. While there was a variation in activity in interventional cardiology between countries, patient behaviour was rather homogeneous.
Conclusions A significant reduction in healthcare activity has been noted during the COVID-19 pandemic, including STEMI care, with the risk of increased mortality and/or morbidity following STEMI. Healthcare providers should encourage patients with suspected symptoms of STEMI to call for emergency care to ensure rapid diagnosis and timely reperfusion treatment.
What’s new? A marked reduction in interventional cardiology activity has been observed in Latin America during the COVID-19 pandemic, both in elective and emergency procedures, particularly in patients with STEMI.
In Latin America patient behaviour has been quite homogeneous, although varying quarantine measures in the individual countries have restricted mobility to different degrees. The health authorities should be alert regarding the care of STEMI patients during the COVID-19 pandemic.

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30/06/2020 Articles
The effect of frailty on survival in patients with COVID-19 (COPE): a ...

The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study

THE LANCET

Authors
Jonathan Hewitt, Ben Carter, Arturo Vilches-Moraga, Terence J Quinn, Philip Braude, Alessia Verduri, Lyndsay Pearce, Michael Stechman, Roxanna Short, Angeline Price, Jemima T Collins, Eilidh Bruce, Alice Einarsson, Frances Rickard, Emma Mitchell, Mark Holloway, James Hesford, Fenella Barlow-Pay, Enrico Clini, Phyo K Myint, Susan J Moug, Kathryn McCarthy


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29/06/2020 Letter
The negative impact of comorbidities on the disease course of COVID-19

SPRINGER LINK

Authors
Noémi Zádori, Szilárd Váncsa, Nelli Farkas, Péter Hegyi, Bálint Erőss


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29/06/2020 Articles
Impact of Coronavirus Disease 2019 outbreak on acute coronary syndrome...

Impact of Coronavirus Disease 2019 outbreak on acute coronary syndrome admissions: four weeks to reverse the trend

Authors
Marie Hauguel-Moreau, Rémy Pillière, Giulio Prati, Sébastien Beaune, Thomas Loeb, Simon Lannou, Sophie Mallet, Hazrije Mustafic, Céline Bégué, Olivier Dubourg, Nicolas Mansencal



ABSTRACT
Data whether the COVID-19 outbreak impacts the acute coronary syndromes (ACS) admissions and the time required to reverse the downward curve are scarce. We included all consecutive patients referred for an ACS who underwent PCI from February 17, 2020 to April 26, 2020 in a high-volume PCI coronary care unit. We compared the number of ACS patients in 2020 to the same period in 2018 and 2019. Predictors of adverse outcome in ST-elevation myocardial infarction (STEMI) patients were recorded: symptom-onset-to-first medical contact (FMC), and FMC-to-sheath insertion times. During the studied period (calendar weeks 8–17, 2018–2020), 144 ACS patients were included. In 2020, we observed two distinct phases in the ACS admissions: a first significant fall, with a relative reduction of 73%, from the week of lockdown (week 12) to 3 weeks later and then an increase of ACS. Median symptom-onset-to-FMC time was significantly higher in 2020 than in the two previous years (600 min [298–632] versus 121 min [55–291], p < 0.001). Median FMC-to-sheath insertion did not differ significantly (93 min [81–131] in 2020 versus 90 min [67–137] in 2018–2019, p = 0.57). The main findings are (1) a pattern of a U-curve in ACS admissions, with a first decrease in ACS admissions and a return to “normality” 4 weeks after; (2) a significant increase in the total ischemic time exclusively due to an increase in the symptom-onset-to-first-medical-contact time.

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29/06/2020 Research
Impact of coronavirus disease 2019 on pulmonary function in early conv...

Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase

BMC

Authors
Yiying Huang, Cuiyan Tan, Jian Wu, Meizhu Chen, Zhenguo Wang, Liyun Luo, Xiaorong Zhou, Xinran Liu, Xiaoling Huang, Shican Yuan, Chaolin Chen, Fen Gao, Jin Huang, Hong Shan, Jing Liu



ABSTRACT
Objective This study investigated the influence of Coronavirus Disease 2019 (COVID-19) on lung function in early convalescence phase.
Methods A retrospective study of COVID-19 patients at the Fifth Affiliated Hospital of Sun Yat-sen University were conducted, with serial assessments including lung volumes (TLC), spirometry (FVC, FEV1), lung diffusing capacity for carbon monoxide (DLCO),respiratory muscle strength, 6-min walking distance (6MWD) and high resolution CT being collected at 30 days after discharged.
Results Fifty-seven patients completed the serial assessments. There were 40 non-severe cases and 17 severe cases. Thirty-one patients (54.3%) had abnormal CT findings. Abnormalities were detected in the pulmonary function tests in 43 (75.4%) of the patients. Six (10.5%), 5(8.7%), 25(43.8%) 7(12.3%), and 30 (52.6%) patients had FVC, FEV1, FEV1/FVC ratio, TLC, and DLCO values less than 80% of predicted values, respectively. 28 (49.1%) and 13 (22.8%) patients had PImax and PEmax values less than 80% of the corresponding predicted values. Compared with non-severe cases, severe patients showed higher incidence of DLCO impairment (75.6%vs42.5%, p = 0.019), higher lung total severity score (TSS) and R20, and significantly lower percentage of predicted TLC and 6MWD. No significant correlation between TSS and pulmonary function parameters was found during follow-up visit.
Conclusion Impaired diffusing-capacity, lower respiratory muscle strength, and lung imaging abnormalities were detected in more than half of the COVID-19 patients in early convalescence phase. Compared with non-severe cases, severe patients had a higher incidence of DLCO impairment and encountered more TLC decrease and 6MWD decline.

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29/06/2020 Articles
Multisystem Inflammatory Syndrome in U.S. Children and Adolescents

THE NEW ENGLAND JOURNAL OF MEDICINE

Authors
Leora R. Feldstein, Erica B. Rose, Steven M. Horwitz, Jennifer P. Collins, Margaret M. Newhams, Mary Beth F. Son, Jane W. Newburger, Lawrence C. Kleinman, Sabrina M. Heidemann, Amarilis A. Martin, Aalok R. Singh, Simon Li, Keiko M. Tarquinio, Preeti Jaggi, Matthew E. Oster, Sheemon P. Zackai, Jennifer Gillen, Adam J. Ratner Rowan F. Walsh, Julie C. Fitzgerald, Michael A. Keenaghan, Hussam Alharash, Sule Doymaz, Katharine N. Clouser, John S. Giuliano, Jr., Anjali Gupta, Robert M. Parker, Aline B. Maddux, Vinod Havalad, Stacy Ramsingh, Hulya Bukulmez, Tamara T. Bradford, Lincoln S. Smith, Mark W. Tenforde, Christopher L. Carroll, Becky J. Riggs, Shira J. Gertz, Ariel Daube, Amanda Lansell, Alvaro Coronado Munoz, Charlotte V. Hobbs, Kimberly L. Marohn, Natasha B. Halasa, Manish M. Patel, Adrienne G. Randolph



ABSTRACT
BACKGROUND Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.
METHODS We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms.
RESULTS We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki’s disease–like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%).
CONCLUSIONS Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.)

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29/06/2020 Articles
Multisystem Inflammatory Syndrome in Children in New York State

THE NEW ENGLAND JOURNAL OF MEDICINE

Authors
Elizabeth M. Dufort, Emilia H. Koumans, Eric J. Chow, Elizabeth M. Rosenthal, Alison Muse, Jemma Rowlands, Meredith A. Barranco,, Angela M. Maxted, Eli S. Rosenberg, Delia Easton, Tomoko Udo, Jessica Kumar, Wendy Pulver, Lou Smith, Brad Hutton, Debra Blog, Howard Zucker



ABSTRACT
BACKGROUND A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome.
METHODS Hospitals in New York State reported cases of Kawasaki’s disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020.
RESULTS As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days.
CONCLUSIONS The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.

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29/06/2020 Editorial
Childhood Multisystem Inflammatory Syndrome — A New Challenge in the P...

Childhood Multisystem Inflammatory Syndrome — A New Challenge in the Pandemic

THE NEW ENGLAND JOURNAL OF MEDICINE

Authors
Michael Levin


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27/06/2020 Articles
Impact of COVID-19 outbreak on ischemic stroke admissions and inhospit...

Impact of COVID-19 outbreak on ischemic stroke admissions and inhospital mortality in North-West Spain

INTERNATIOANL JOURNAL OF STROKE

Authors
Herbert Tejada Meza, Álvaro Lambea Gil, Agustín Sancho Saldaña, Maite Martínez-Zabaleta, Patricia de la Riva Juez, Elena López-Cancio Martínez, María Castañón Apilánez, María Herrera Isasi, Juan Marta Enguita, Mercedes de Lera Alfonso, Juan F Arenillas, Jon Segurola Olaizola, Juan José Timiraos Fernández, Joaquín Sánchez, Mar Castellanos-Rodrigo, Alexia Roel, Ignacio Casado Menéndez, Mar Freijo, Alain Luna Rodriguez, Enrique Palacio Portilla, Yésica Jiménez López, Emilio Rodríguez Castro, Susana Arias Rivas, Javier Tejada García, Iria Beltrán Rodríguez, Francisco Julián-Villaverde, Maria Pilar Moreno García, José María Trejo-Gabriel-Galán, Ana Echavarría Iñiguez, Carlos Tejero Juste, Cristina Pérez Lázaro, Javier Marta Moreno



ABSTRACT
Background and purpose Spain has been one of the countries heavily stricken by COVID-19. But this epidemic has not affected all regions equally. We analyzed the impact of the COVID-19 pandemic on hospital stroke admissions and in-hospital mortality in tertiary referral hospitals from North-West Spain.
Methods Spanish multicenter retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. We recorded the number of patients admitted for ischemic stroke between 30 December 2019 and 3 May 2020, the number of IVT and EVT procedures, and in-hospital mortality.
Results In the study period, 2737 patients were admitted with ischemic stroke. There was a decrease in the weekly mean admitted patients during the pandemic (124 vs. 173, p<0.001). In-hospital mortality of stroke patients increased significantly (9.9% vs. 6.5%, p = 0.003), but there were no differences in the proportion of IVT (17.3% vs. 16.1%, p = 0.405) or EVT (22% vs. 23%, p = 0.504).
Conclusion We found a decrease in the number of ischemic stroke admissions and an increase in in-hospital mortality during the COVID-19 epidemic in this large study from North-West Spain. There were regional changes within the network, not fully explained by the severity of the pandemic in different regions.

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27/06/2020 Articles
Management of COVID-19 in people with epilepsy: drug considerations

SPRINGER LINK

Authors
Ali A. Asadi-Pooya, Armin Attar, Mohsen Moghadami, Iman Karimzadeh



ABSTRACT
People with epilepsy (PWE) are neither more likely to be infected by the coronavirus nor are they more likely to have severe COVID-19 manifestations because they suffer from epilepsy. However, management of COVID-19 in PWE may be more complicated than that in other individuals. Drug-drug interactions could pose significant challenges and cardiac, hepatic, or renal problems, which may happen in patients with severe COVID-19, may require adjustment to antiepileptic drugs (AEDs). In this review, we first summarize the potential drug-drug interactions between AEDs and drugs currently used in the management of COVID-19. We then summarize other challenging issues that may happen in PWE, who have COVID-19 and are receiving treatment.

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27/06/2020 Letter
Large artery ischemic stroke in severe COVID-19

SPRINGER LINK

Authors
Fernando Sierra-Hidalgo, Nuria Muñoz-Rivas, Pedro Torres Rubio, Kateri Chao, Mercedes Villanova Martínez, Paz Arranz García, Eva Martínez-Acebes


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27/06/2020 Clinical Picture
Myocarditis in a 16-year-old boy positive for SARS-CoV-2

THE LANCET

Authors
Massimiliano Gnecchi, Francesco Moretti, Emilio Maria Bassi, Sergio Leonardi, Rossana Totaro, Luciano Perotti, Valentina Zuccaro, Stefano Perlini, Lorenzo Preda, Fausto Baldanti, Raffaele Bruno, Luigi Oltrona Visconti


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25/06/2020 Comment
Decreased in-hospital mortality in patients with COVID-19 pneumonia

TAYLOR & FRANCIS ONLINE

Authors
Fabio Ciceri, Annalisa Ruggeri, Rosalba Lembo, Riccardo Puglisi, Giovanni Landoni, Alberto Zangrillo


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25/06/2020 Articles
COVID-19 in children and adolescents in Europe: a multinational, multi...

COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

THE LANCET

Authors
Florian Götzinger, Begoña Santiago-García, Antoni Noguera-Julián, Miguel Lanaspa, Laura Lancella, Francesca I Calò Carducci, Natalia Gabrovska, Svetlana Velizarova, Petra Prunk, Veronika Osterman, Uros Krivec, Andrea Lo Vecchio, Delane Shingadia, Antoni Soriano-Arandes, Susana Melendo, Marcello Lanari, Luca Pierantoni, Noémie Wagner, Arnaud G L’Huillier, Ulrich Heininger, Nicole Ritz, Srini Bandi, Nina Krajcar, Srđan Roglić, Mar Santos, Christelle Christiaens, Marine Creuven, Danilo Buonsenso, Steven B Welch, Matthias Bogyi, Folke Brinkmann, Marc Tebruegge,


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25/06/2020 Brief Report
Assessment of Acute Acral Lesions in a Case Series of Children and Ado...

Assessment of Acute Acral Lesions in a Case Series of Children and Adolescents During the COVID-19 Pandemic

JAMA

Authors
Juncal Roca-Ginés; Ignacio Torres-Navarro; Javier Sánchez-Arráez; Carlos Abril-Pérez; Oihana Sabalza-Baztán; Sergio Pardo-Granell, PharmG; Vicent Martínez i Cózar; Rafael Botella-Estrada; Montserrat Évole-Buselli


ABSTRACT
Importance A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently been identified as the cause of a pandemic called coronavirus disease 2019 (COVID-19). In this context, some associated skin diseases have been described. Cutaneous lesions referred to as acute acro-ischemia have been reported as a possible sign of COVID-19 in adolescents and children.
Objective To evaluate the pathogenesis of these newly described acute acral lesions.
Design, Setting, and Participants This prospective case series was conducted at La Fe University Hospital, a tertiary referral hospital in Valencia, Spain, between April 9 and April 15, 2020. Among 32 referred patients, 20 children and adolescents with new-onset inflammatory lesions did not have a diagnosis.
Exposures Patients were not exposed to any drug or other intervention.
Main Outcomes and Measures We performed reverse transcriptase–polymerase chain reaction for SARS-CoV-2 and a range of blood tests for possible origins of the lesions. Skin biopsies were performed in 6 patients.
Results Of the 20 patients enrolled, 7 were female and 13 were male, with an age range of 1 to 18 years. Clinical findings fit into the following patterns: acral erythema (6 patients), dactylitis (4 patients), purpuric maculopapules (7 patients), and a mixed pattern (3 patients). None of the patients had remarkable hematologic or serologic abnormalities, including negative antibodies to SARS-CoV-2. Biopsies performed in 6 patients showed histologic findings characteristic of perniosis.
Conclusions and Relevance The clinical, histologic, and laboratory test results were compatible with a diagnosis of perniosis, and no evidence was found to support the implication of SARS-CoV-2 infection.

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25/06/2020 Articles
Neurological and neuropsychiatric complications of COVID-19 in 153 pat...

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

THE LANCET

Authors
Aravinthan Varatharaj, Naomi Thomas, Mark A Ellul, Nicholas W S Davies, Thomas A Pollak, Elizabeth L Tenorio, Mustafa Sultan, Ava Easton, Gerome Breen, Michael Zandi, Jonathan P Coles, Hadi Manji, Rustam Al-Shahi Salman, David K Menon, Timothy R Nicholson, Laura A Benjamin, Alan Carson, Craig Smith, Martin R Turner, Tom Solomon, Rachel Kneen, Sarah L Pett, Ian Galea, Rhys H Thomas, Benedict D Michael


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24/06/2020 Original Paper
Cutaneous manifestations in hospitalized patients diagnosed as COVID-1...

Cutaneous manifestations in hospitalized patients diagnosed as COVID-19

WILEY ONLINE LIBRARY

Authors
Ozge Askin, Rozerin Neval Altunkalem, Dursun Dorukhan Altinisik, Tugba Kevser Uzuncakmak, Umit Tursen, Zekayi Kutlubay



ABSTRACT
Background Cutaneous manifestations of COVID‐19 disease have not yet been fully described.
Objectives To describe cutaneous manifestations of COVID‐19 disease in hospitalized patients.
Methods We examined the cutaneous manifestations of 210 hospitalized patients.
Results Cutaneous findings were observed during COVID‐19 infection in 52 of the patients. Lesions may be classified as erythematous scaly rash (32.7%), maculopapular rash (23%), urticarial lesions (13.5%), petechial purpuric rash (7.7%), necrosis (7.7%), enanthema and apthous stomatitis (5.8%), vesicular rash (5.8%), pernio (1.9%) and pruritus (1.9%). Cutaneous manifestations were observed statistically significantly more in certain age groups: patients of 55 to 64 and 65 to 74 years of age complained of more cutaneous manifestations than the other age groups. As for gender, there was no significant difference between male and female patients in terms of cutaneus findings. The relationship between comorbidity and dermatological finding status was statistically significant. The relationship increases linearly according to the comorbidities. According the statistical results the patients who were hospitalized in the intensive care unit had a higher risk of having cutaneous findings due to COVID‐19 infection.
Conclusions With this study we may highlight the importance of overlooked dermatological findings in patients that are hospitalized.

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24/06/2020 Case Report
Atrial fibrillation: a risk factor for unfavourable outcome in COVID-1...

Atrial fibrillation: a risk factor for unfavourable outcome in COVID-19? A case report

OXFORD ACADEMY

Authors
Sebastian Schnaubelt, Marie-Kathrin Breyer, Jolanta Siller-Matula, Hans Domanovits


ABSTRACT
Background Fulminant cardiac involvement in COVID-19 patients has been reported; the underlying suspected mechanisms include myocarditis, arrhythmia, and cardiac tamponade. In parallel, atrial fibrillation is common in the elderly population which is at particularly high risk for COVID-19 morbidity and mortality.
Case summary A 72-year-old male SARS-CoV2-positive patient was admitted to the intensive care unit due to delirium and acute respiratory failure. Atrial fibrillation known from history was exacerbated, and made complex rate and rhythm control necessary. Progressive heart failure with haemodynamic deterioration and acute kidney injury with the need for continuous renal replacement therapy were further aggravated by pericardial tamponade.
Discussion Treatment of acute heart failure in COVID-19 patients with a cytokine storm complicated by tachycardic atrial fibrillation should include adequate rate or rhythm control, and potentially immunomodulation.

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24/06/2020 Articles
Temporal radiographic changes in COVID-19 patients: relationship to di...

Temporal radiographic changes in COVID-19 patients: relationship to disease severity and viral clearance

NATURE

Authors
Xiaofan Liu, Hong Zhou, Yilu Zhou, Xiaojun Wu, Yang Zhao, Yang Lu, Weijun Tan, Mingli Yuan, Xuhong Ding, Jinjing Zou, Ruiyun Li, Hailing Liu, Rob M. Ewing, Yi Hu, Hanxiang Nie & Yihua Wang


ABSTRACT
COVID-19 is “public enemy number one” and has placed an enormous burden on health authorities across the world. Given the wide clinical spectrum of COVID-19, understanding the factors that can predict disease severity will be essential since this will help frontline clinical staff to stratify patients with increased confidence. To investigate the diagnostic value of the temporal radiographic changes, and the relationship to disease severity and viral clearance in COVID-19 patients. In this retrospective cohort study, we included 99 patients admitted to the Renmin Hospital of Wuhan University, with laboratory confirmed moderate or severe COVID-19. Temporal radiographic changes and viral clearance were explored using appropriate statistical methods. Radiographic features from HRCT scans included ground-glass opacity, consolidation, air bronchogram, nodular opacities and pleural effusion. The HRCT scores (peak) during disease course in COVID-19 patients with severe pneumonia (median: 24.5) were higher compared to those with pneumonia (median: 10) (p = 3.56 × 10 −12), with more frequency of consolidation (p = 0.025) and air bronchogram (p = 7.50 × 10−6). The median values of days when the peak HRCT scores were reached in pneumonia or severe pneumonia patients were 12 vs. 14, respectively (p = 0.048). Log-rank test and Spearman’s Rank-Order correlation suggested temporal radiographic changes as a valuable predictor for viral clearance. In addition, follow up CT scans from 11 pneumonia patients showed full recovery. Given the values of HRCT scores for both disease severity and viral clearance, a standardised HRCT score system for COVID-19 is highly demanded.

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24/06/2020 Reviews
Meta-analysis of chest CT features of patients with COVID-19 pneumonia

WILEY ONLINE LIBRARY

Authors
Ying Zheng, Ling Wang, Suqin Ben



ABSTRACT Objectives To perform a meta‐analysis regarding the chest CT manifestations of COVID‐19 pneumonia patients. Methods PubMed, Embase and Cochrane Library databases were searched from December 1st 2019 until May 1st, 2020 using the keywords of ‘COVID‐19 virus’, ‘the 2019 novel coronavirus’, ‘novel coronavirus’ and ‘COVID‐19’. Studies that evaluated the CT manifestations of common and severe COVID‐19 pneumonia were included. Results Among the 9736 searched results, fifteen articles describing 1453 common patients and 697 severe patients met the inclusion criteria. Based on the CT images, the common patients were less frequent to exhibit consolidation (OR=0.31), pleural effusion (OR=0.19), lymphadenopathy (OR=0.17), crazy‐paving pattern (OR=0.22), interlobular septal thickening (OR=0.27), reticulation (OR=0.20), traction bronchiectasis (OR=0.40) with over 2 lobes involved (OR=0.07) and central distribution (OR=0.18) while more frequent to bear unilateral pneumonia (OR=4.65) involving 1 lobe (OR =13.84) or 2 lobes (OR=6.95) when compared with severe patients. Other CT features including GGOs (P=0.404), air bronchogram (P=0.070), nodule (P=0.093), bronchial wall thickening (P=0.15), subpleural band (P=0.983), vascular enlargement (P=0.207) and peripheral distribution (P=0.668) did not have significant association with the severity of the disease. No publication bias among the selected studies was suggested (Harbord's tests, P>0.05 for all.) Conclusions We obtained reliable estimates of the chest CT manifestations of COVID‐19 pneumonia patients, which might provide an important clue for the diagnosis and classification of COVID‐19 pneumonia.

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24/06/2020 Letter
Determinants of COVID-19 disease severity in patients with cancer

NATURE

Authors
Elizabeth V. Robilotti, N. Esther Babady, Peter A. Mead, Thierry Rolling, Rocio Perez-Johnston, Marilia Bernardes, Yael Bogler, Mario Caldararo, Cesar J. Figueroa, Michael S. Glickman, Alexa Joanow, Anna Kaltsas, Yeon Joo Lee, Anabella Lucca, Amanda Mariano, Sejal Morjaria, Tamara Nawar, Genovefa A. Papanicolaou, Jacqueline Predmore, Gil Redelman-Sidi, Elizabeth Schmidt, Susan K. Seo, Kent Sepkowitz, Monika K. Shah, Jedd D. Wolchok, Tobias M. Hohl, Ying Taur, Mini Kamboj



ABSTRACT
As of 10 April 2020, New York State had 180,458 cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 9,385 reported deaths. Patients with cancer comprised 8.4% of deceased individuals1. Population-based studies from China and Italy suggested a higher coronavirus disease 2019 (COVID-19) death rate in patients with cancer2,3, although there is a knowledge gap as to which aspects of cancer and its treatment confer risk of severe COVID-194. This information is critical to balance the competing safety considerations of reducing SARS-CoV-2 exposure and cancer treatment continuation. From 10 March to 7 April 2020, 423 cases of symptomatic COVID-19 were diagnosed at Memorial Sloan Kettering Cancer Center (from a total of 2,035 patients with cancer tested). Of these, 40% were hospitalized for COVID-19, 20% developed severe respiratory illness (including 9% who required mechanical ventilation) and 12% died within 30 d. Age older than 65 years and treatment with immune checkpoint inhibitors (ICIs) were predictors for hospitalization and severe disease, whereas receipt of chemotherapy and major surgery were not. Overall, COVID-19 in patients with cancer is marked by substantial rates of hospitalization and severe outcomes. The association observed between ICI and COVID-19 outcomes in our study will need further interrogation in tumor-specific cohorts.

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23/06/2020 Articles
COVID‐19 Pandemic: Cardiovascular Complications and Future Implication...

COVID‐19 Pandemic: Cardiovascular Complications and Future Implications

SPRINGER LINK

Authors
Dhrubajyoti Bandyopadhyay, Tauseef Akhtar, Adrija Hajra, Manasvi Gupta, Avash Das, Sandipan Chakraborty, Ipsita Pal, Neelkumar Patel, Birendra Amgai, Raktim K. Ghosh, Gregg C. Fonarow, Carl J. Lavie, Srihari S. Naidu



ABSTRACT
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now a global pandemic with the highest number of affected individuals in the modern era. Not only is the infection inflicting significant morbidity and mortality, but there has also been a significant strain to the health care system and the economy. COVID-19 typically presents as viral pneumonia, occasionally leading to acute respiratory distress syndrome (ARDS) and death. However, emerging evidence suggests that it has a significant impact on the cardiovascular (CV) system by direct myocardial damage, severe systemic inflammatory response, hypoxia, right heart strain secondary to ARDS and lung injury, and plaque rupture secondary to inflammation. Primary cardiac manifestations include acute myocarditis, myocardial infarction, arrhythmia, and abnormal clotting. Several consensus documents have been released to help manage CV disease during this pandemic. In this review, we summarize key cardiac manifestations, their management, and future implications.

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23/06/2020 Articles
COVID-19 and thalassaemia: A position statement of the Thalassaemia In...

COVID-19 and thalassaemia: A position statement of the Thalassaemia International Federation

WILEY ONLINE LIBRARY

Authors
Dimitrios Farmakis, Anastasios Giakoumis, Lily Cannon, Michael Angastiniotis, Androulla Eleftheriou



ABSTRACT Objectives Many patients with haemoglobinopathies, including thalassaemia and sickle cell disease, are at increased risk of developing severe complications from the coronavirus disease 2019 (COVID‐19). Although epidemiologic evidence concerning the novel coronavirus (SARS‐CoV‐2) infection in these patients is currently lacking, the COVID‐19 pandemic represents a significant challenge for haemoglobinopathy patients, their families and their attending physicians.
Methods The present statement summarizes the key challenges concerning the management of haemoglobinopathies, with particular focus on patients with either transfusion‐dependent or non‐transfusion‐dependent thalassaemia, identifies the gaps in knowledge and suggests measures and strategies to deal with the pandemic, based on available evidence and expert opinions. Key areas covered include patients’ risk level, adaptation of haemoglobinopathy care, safety of blood transfusions, blood supply challenges, and lifestyle and nutritional considerations.
Conclusions The proposed measures and strategies may be useful as a blueprint for other disorders which require regular hospital visits, as well as for the timely adaptation of patient care during similar future pandemics.

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23/06/2020 Correspondence
Actions required to assure continuous supply of anti-rheumatic medicat...

Actions required to assure continuous supply of anti-rheumatic medication during the SARS- CoV-2/COVID-19 pandemic. Response to: ‘Treatment adherence behaviours in rheumatic diseases during pandemic COVID-19: a Latin American experience’ by Pineda-Sic et al

BMJ JOURNALS

Authors
Hendrik Schulze-Koops, Klaus Krueger, Christof Specker


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22/06/2020 Clinical Research
Clinical epidemiological analyses of overweight/obesity and abnormal l...

Clinical epidemiological analyses of overweight/obesity and abnormal liver function contributing to prolonged hospitalization in patients infected with COVID-19

NATURE

Authors
Xiang Hu, Xiaoqiong Pan, Wei Zhou, Xuejiang Gu, Feixia Shen, Bo Yang, Zhen Hu



ABSTRACT
Background/objectives During the 2019 coronavirus disease (COVID-19) outbreak, obesity may contribute to COVID-19 transmission and deterioration. In addition, many patients with COVID-19 infection have suffered liver damage which might contribute to a worse prognosis. We conducted a clinical epidemiological analysis to investigate the association of overweight/obesity and abnormal liver function (ALF) with hospitalized duration in patients infected with COVID-19.
Subjects/methods Fifty-eight patients with diagnosed COVID-19 (22 women & 36 men; average age: 49.2 ± 13.1 yr) were included, and their clinical data were collected at The Second Affiliated and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang. Overweight/obesity was determined as body mass index (BMI) ≥24 kg/m2, ALF was determined as alanine aminotransferase >40 U/L, and prolonged hospitalization was lasting more than the median value of the hospitalized days (19 days) in this population.
Results The proportions of prolonged hospitalization were elevated in patients with overweight/obesity and ALF compared with those without overweight/obesity (62.1% versus 26.1%, P = 0.010) and those without ALF (70.6% versus 41.5%, P = 0.043). Kaplan–Meier analysis showed that the hospitalized duration was increased from the patients with neither overweight/obesity nor ALF to those with either overweight/obesity or ALF, and to those with both of overweight/obesity and ALF (mean with 95% confidence interval: 16.4 [14.5–18.3] versus 25.3 [21.6–29.1] versus 28.3 [24.6–32.0], P for trend = 0.001). Being discharged from hospital in time was inversely and independently associated with BMI (hazard ratio [HR] = 0.75, 95% CI: 0.63–0.90, P for trend = 0.002) and ALT (HR = 0.95, 95% CI: 0.92–0.99, P for trend = 0.007).
Conclusions Present findings suggested that overweight/obesity and/or ALF contributed to predicting a probability of prolonged hospitalization in patients with COVID-19 infection, to whom extra attentions and precautions should be paid during clinical treatments.


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22/06/2020 Clinical Research
Clinical epidemiological analyses of overweight/obesity and abnormal l...

Clinical epidemiological analyses of overweight/obesity and abnormal liver function contributing to prolonged hospitalization in patients infected with COVID-19

NATURE

Authors
Xiang Hu, Xiaoqiong Pan, Wei Zhou, Xuejiang Gu, Feixia Shen, Bo Yang, Zhen Hu



ABSTRACT
Background/objectives During the 2019 coronavirus disease (COVID-19) outbreak, obesity may contribute to COVID-19 transmission and deterioration. In addition, many patients with COVID-19 infection have suffered liver damage which might contribute to a worse prognosis. We conducted a clinical epidemiological analysis to investigate the association of overweight/obesity and abnormal liver function (ALF) with hospitalized duration in patients infected with COVID-19.
Subjects/methods Fifty-eight patients with diagnosed COVID-19 (22 women & 36 men; average age: 49.2 ± 13.1 yr) were included, and their clinical data were collected at The Second Affiliated and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang. Overweight/obesity was determined as body mass index (BMI) ≥24 kg/m2, ALF was determined as alanine aminotransferase >40 U/L, and prolonged hospitalization was lasting more than the median value of the hospitalized days (19 days) in this population.
Results The proportions of prolonged hospitalization were elevated in patients with overweight/obesity and ALF compared with those without overweight/obesity (62.1% versus 26.1%, P = 0.010) and those without ALF (70.6% versus 41.5%, P = 0.043). Kaplan–Meier analysis showed that the hospitalized duration was increased from the patients with neither overweight/obesity nor ALF to those with either overweight/obesity or ALF, and to those with both of overweight/obesity and ALF (mean with 95% confidence interval: 16.4 [14.5–18.3] versus 25.3 [21.6–29.1] versus 28.3 [24.6–32.0], P for trend = 0.001). Being discharged from hospital in time was inversely and independently associated with BMI (hazard ratio [HR] = 0.75, 95% CI: 0.63–0.90, P for trend = 0.002) and ALT (HR = 0.95, 95% CI: 0.92–0.99, P for trend = 0.007).
Conclusions Present findings suggested that overweight/obesity and/or ALF contributed to predicting a probability of prolonged hospitalization in patients with COVID-19 infection, to whom extra attentions and precautions should be paid during clinical treatments.


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21/06/2020 Articles
Laboratory characteristics of patients infected with the novel SARS-Co...

Laboratory characteristics of patients infected with the novel SARS-CoV-2 virus

ELSEVIER

Authors
Chrysanthi Skevaki, Paraskevi C.Fragkou, Chongsheng Cheng, Min Xie, Harald Renz


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18/06/2020 Report
Acute respiratory distress syndrome due to SARS-CoV-2 and Influenza A ...

Acute respiratory distress syndrome due to SARS-CoV-2 and Influenza A co-infection in an Italian patient: Mini-review of the literature

ELSEVIER

Authors
Alessandra D’Abramoa, Luciana Leporea, Claudia Palazzoloa, Filippo Barrecab, Giuseppina Liuzzia, Eleonora Lallea , Emanuele Nicastria



ABSTRACT
A case of acute respiratory distress syndrome due to SARS-CoV-2 and Influenza A co-infection and a mini-review of the literature is reported. Even in COVID-19 epidemics, the early identification of concurrent respiratory pathogens is important to improve etiological diagnosis, preventive measures and patients’ clinical management and outcome.

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18/06/2020 Articles
COVID-19 in patients with rheumatic diseases in northern Italy: a sing...

COVID-19 in patients with rheumatic diseases in northern Italy: a single-centre observational and case–control study

THE LANCET

Authors
Micaela Fredi, Ilaria Cavazzana, Liala Moschetti, Laura Andreoli, Franco Franceschini


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17/06/2020 Letter
Delays in managing neurosurgical patients during the COVID-19 pandemic

EDIZIONE MINERVA MEDICA

Authors
Giulia PILLONI, Fabio SPANU, Irene FASCE, Alessandro ALì, Antonio VENTIMIGLIA, Marco MAIELLO, Luca BRUZZONE, Bernarda CAGETTI


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16/06/2020 Original Research
How to Build the Plane While Flying: VTE/PE Thromboprophylaxis Clinica...

How to Build the Plane While Flying: VTE/PE Thromboprophylaxis Clinical Guidelines for COVID-19 Patients

CAMBRIDGE UNIVERSITY PRESS

Authors
Alessandro Costa, Eric S. Weinstein, D. Ruby Sahoo, Stanley C. Thompson, Roberto Faccincani, Luca Ragazzoni



ABSTRACT v Over the years, the practice of medicine has evolved from authority-based to experience-based to evidence-based with the introduction of the scientific process, clinical trials, and outcomes-based data analysis (Tebala GD. Int J Med Sci. 2018;15(12):1397-1405). The time required to perform the necessary randomized controlled trials, a systematic literature review, and meta-analysis of these trials to then create, accept, promulgate, and educate the practicing clinicians to use the evidence-based clinical guidelines is typically measured in years. When the severe acute respiratory syndrome novel coronavirus-2 (SARS-nCoV-2) pandemic commenced in Wuhan, China at the end of 2019, there were few available clinical guidelines to deploy, let alone adapt and adopt to treat the surge of coronavirus disease 2019 (COVID-19) patients. The aim of this study is to first explain how clinical guidelines, on which bedside clinicians have grown accustomed, can be created in the midst of a pandemic, with an evolving scientific understanding of the pathophysiology of the hypercoagulable state. The second is to adapt and adopt current venous thromboembolism diagnostic and treatment guidelines, while relying on the limited available observational reporting of COVID-19 patients to create a comprehensive clinical guideline to treat COVID-19 patients.

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16/06/2020 Articles
Pattern of Emergency Department referral during the Covid-19 outbreak ...

Pattern of Emergency Department referral during the Covid-19 outbreak in Italy

EDIZIONE MINERVA MEDICA

Authors
Mattia BELLAN, Francesco GAVELLI, Eyal HAYDEN, Filippo PATRUCCO, Daniele SODDU, Anita Rebecca PEDRINELLI, Micol Giulia CITTONE, Eleonora RIZZI, Giuseppe Francesco CASCIARO, Veronica VASSIA, Raffaella LANDI, Mirta MENEGATTI, Maria Luisa GASTALDELLO, Michela BELTRAME, Emanuela LABELLA, Stelvio TONELLO, Gian Carlo AVANZI, Mario PIRISI, Luigi Mario CASTELLO, Pier Paolo SAINAGHI



ABSTRACT
Background
The coronavirus disease (COVID-19) outbreak is putting the European National Health Systems under pressure. Interestingly, Emergency Department (ED) referrals for reasons other than Covid-19 seem to have declined steeply. In the present paper, we aimed to verify how the Covid-19 outbreak changed ED referral pattern.
Methods We retrospectively reviewed the clinical records of patients referred to the ED of a University Hospital in Northern Italy from 1st March to 13th April 2020. We compared the following data with those belonging to the same period in 2019: number of EDs accesses, rate of hospital admission, frequencies of the most common causes of ED referral, priority codes of access.
Results The number of ED referrals during the Covid-19 outbreak was markedly reduced when compared to the same period in 2019 (3059 vs. 5691;-46.3%). Conversely, the rate of hospital admission raised from 16.9% to 35.4% (p<0.0001), with a shift toward higher priority codes of ED admission. In 2020, we observed both a reduction of the number of patients referred for both traumatic (513, 16.8% vs. 1544, 27.1%; χ2=118.7, p<0.0001) and non-traumatic (4147 vs. 2546) conditions. Among the latter, suspected Covid-19 accounted for 1101 (43.2%) accesses.
Conclusions The Covid-19 pandemic completely changed the pattern of ED referral in Italy, with a marked reduction of the accesses to the hospitals. This could be related to a limited exposure to traumas and to a common fear of being infected during EDs in-stay. This may limit the misuse of EDs for non- urgent conditions, but may also delay proper referrals for urgent conditions.

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15/06/2020 Articles
COVID-19 and breast cancer: Impact on patients and breast care centers

ELSEVIER

Authors
Federico Ghidinelli, Anna Bianchi



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15/06/2020 Image Focus
Myocardial work index: a glimmer of hope in COVID-19

EUROPEAN HEART JOURNAL

Authors
Akshar Jaglan , Sarah Roemer , M. Fuad Jan , Bijoy K. Khandheria


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14/06/2020 Letter
Critical Need for Implementation of Clinical Pharmacology Principles i...

Critical Need for Implementation of Clinical Pharmacology Principles in Developing Drugs for the Treatment or Prevention of COVID-19

ACCP (AMERICAN COLLEGE OF CLINICAL PHAMARCOLOGY)

Authors
Gina Pastino


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13/06/2020 Case Report
Successful management of the frst reported case in Austria of COVID‐19...

Successful management of the frst reported case in Austria of COVID‐19 with ARDS

SPRINGER LINK

Authors
T. Seitz, W. Hoepler, L. Weseslindtner, J. H. Aberle, S. W. Aberle, E. Puchhammer-Stoeckl, S. Baumgartner, M. Traugott, M. Karolyi, E. Pawelka, I. Niculescu, E. Friese, S. Neuhold, D. Stahl, C. Madl, A. Zoufaly, C. Wenisch, H. Laferl



ABSTRACT
We report the successful management of a patient with severe respiratory failure due to COVID-19 admitted to an intensive care unit complicated by secondary catheter-related infection of Candida glabrata. We are discussing some of the clinical challenges and the pitfalls in molecular diagnosis of SARS-CoV-2, including the fact that a positive PCR result may not always reflect infectiousness.

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12/06/2020 Correspondence
Neuropathological Features of Covid-19

THE NEW ENGLAND JOURNAL OF MEDICINE

Authors
Isaac H. Solomon, Erica Normandin, Shamik Bhattacharyya, Shibani S. Mukerji, Kiana Keller, Ahya S. Ali, Gordon Adams, Jason L. Hornick, Robert F. Padera, Jr., Pardis Sabeti


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12/06/2020 Correspondence
Natural History of Asymptomatic SARS-CoV-2 Infection

THE NEW ENGLAND JOURNAL OF MEDICINE

Authors
Aki Sakurai, Toshiharu Sasaki, Shigeo Kato, Masamichi Hayashi, Sei-ichiro Tsuzuki, Takuma Ishihara, Mitsunaga Iwata, Zenichi Morise, Yohei Do


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12/06/2020 Research
Factors Associated With Surgical Mortality and Complications Among Pat...

Factors Associated With Surgical Mortality and Complications Among Patients With and Without Coronavirus Disease 2019 (COVID-19) in Italy

JAMA

Authors
Francesco Doglietto, Marika Vezzoli, Federico Gheza, Gian Luca Lussardi, Marco Domenicucci, Luca Vecchiarelli, Luca Zanin, Giorgio Saraceno, Liana Signorini, Pier Paolo Panciani, Francesco Castelli, Roberto Maroldi, Francesco Antonio Rasulo, Mauro Roberto Benvenuti, Nazario Portolani, Stefano Bonardelli, Giuseppe Milano, Alessandro Casiraghi, Stefano Calza, Marco Maria Fontanella



ABSTRACT
Importance There are limited data on mortality and complications rates in patients with coronavirus disease 2019 (COVID-19) who undergo surgery.
Objective To evaluate early surgical outcomes of patients with COVID-19 in different subspecialties.
Design, Setting, and Participants This matched cohort study conducted in the general, vascular and thoracic surgery, orthopedic, and neurosurgery units of Spedali Civili Hospital (Brescia, Italy) included patients who underwent surgical treatment from February 23 to April 1, 2020, and had positive test results for COVID-19 either before or within 1 week after surgery. Gynecological and minor surgical procedures were excluded. Patients with COVID-19 were matched with patients without COVID-19 with a 1:2 ratio for sex, age group, American Society of Anesthesiologists score, and comorbidities recorded in the surgical risk calculator of the American College of Surgeons National Surgical Quality Improvement Program. Patients older than 65 years were also matched for the Clinical Frailty Scale score.
Exposures Patients with positive results for COVID-19 and undergoing surgery vs matched surgical patients without infection. Screening for COVID-19 was performed with reverse transcriptase–polymerase chain reaction assay in nasopharyngeal swabs, chest radiography, and/or computed tomography. Diagnosis of COVID-19 was based on positivity of at least 1 of these investigations.
Main Outcomes and Measures The primary end point was early surgical mortality and complications in patients with COVID-19; secondary end points were the modeling of complications to determine the importance of COVID-19 compared with other surgical risk factors.
Results Of 41 patients (of 333 who underwent operation during the same period) who underwent mainly urgent surgery, 33 (80.5%) had positive results for COVID-19 preoperatively and 8 (19.5%) had positive results within 5 days from surgery. Of the 123 patients of the combined cohorts (78 women [63.4%]; mean [SD] age, 76.6 [14.4] years), 30-day mortality was significantly higher for those with COVID-19 compared with control patients without COVID-19 (odds ratio [OR], 9.5; 95% CI, 1.77-96.53). Complications were also significantly higher (OR, 4.98; 95% CI, 1.81-16.07); pulmonary complications were the most common (OR, 35.62; 95% CI, 9.34-205.55), but thrombotic complications were also significantly associated with COVID-19 (OR, 13.2; 95% CI, 1.48-∞). Different models (cumulative link model and classification tree) identified COVID-19 as the main variable associated with complications.
Conclusions and Relevance In this matched cohort study, surgical mortality and complications were higher in patients with COVID-19 compared with patients without COVID-19. These data suggest that, whenever possible, surgery should be postponed in patients with COVID-19.

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12/06/2020 Reviews
From causes of aging to death from COVID-19

AGING

Authors
Mikhail V. Blagosklonny



ABSTRACT
COVID-19 is not deadly early in life, but mortality increases exponentially with age, which is the strongest predictor of mortality. Mortality is higher in men than in women, because men age faster, and it is especially high in patients with age-related diseases, such as diabetes and hypertension, because these diseases are manifestations of aging and a measure of biological age. At its deepest level, aging (a program-like continuation of developmental growth) is driven by inappropriately high cellular functioning. The hyperfunction theory of quasi-programmed aging explains why COVID-19 vulnerability (lethality) is an age-dependent syndrome, linking it to other age-related diseases. It also explains inflammaging and immunosenescence, hyperinflammation, hyperthrombosis, and cytokine storms, all of which are associated with COVID-19 vulnerability. Anti-aging interventions, such as rapamycin, may slow aging and age-related diseases, potentially decreasing COVID-19 vulnerability.

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11/06/2020 Point of view
Post-COVID-19 global health strategies: the need for an interdisciplin...

Post-COVID-19 global health strategies: the need for an interdisciplinary approach

SPRINGER LINK

Authors
Gemelli Against COVID-19 Post-Acute Care Study Group



ABSTRACT
For survivors of severe COVID-19 disease, having defeated the virus is just the beginning of an uncharted recovery path. What follows after the acute phase of SARS-CoV-2 infection depends on the extension and severity of viral attacks in different cell types and organs. Despite the ridiculously large number of papers that have flooded scientific journals and preprint-hosting websites, a clear clinical picture of COVID-19 aftermath is vague at best. Without larger prospective observational studies that are only now being started, clinicians can retrieve information just from case reports and or small studies. This is the time to understand how COVID-19 goes forward and what consequences survivors may expect to experience. To this aim, a multidisciplinary post-acute care service involving several specialists has been established at the Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). Although COVID-19 is an infectious disease primarily affecting the lung, its multi-organ involvement requires an interdisciplinary approach encompassing virtually all branches of internal medicine and geriatrics. In particular, during the post-acute phase, the geriatrician may serve as the case manager of a multidisciplinary team. The aim of this article is to describe the importance of the interdisciplinary approach––coordinated by geriatrician––to cope the potential post-acute care needs of recovered COVID-19 patients.

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11/06/2020 Articles
COVID-19 in adult patients with CHD: a matter of anatomy or comorbidit...

COVID-19 in adult patients with CHD: a matter of anatomy or comorbidities?

CARDIOLOGY IN THE YOUNG

Authors
Paolo Ferrero, Isabelle Piazza, Matteo Ciuffreda



ABSTRACT
Little is know about COVID-19 outcome in specific populations such as Adult congenital heart disease (ACHD) patients. We report three cases of adult patients with similar underlying dis- ease with completely different clinical severity at the time of COVID-19 infection. The patient with the most severe clinical course was obese and diabetic, suggesting that COVID-19 mortal- ity and morbidity in Adult congenital heart disease patients might be independent of anatomic complexity.


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08/06/2020 Research
Characteristics and outcomes of pregnant women admitted to hospital wi...

Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study

THE BMJ

Authors
Marian Knight, Kathryn Bunch, Nicola Vousden, Edward Morris, Nigel Simpson, Chris Gale, Patrick O’Brien, Maria Quigley, Peter Brocklehurst, Jennifer J Kurinczuk



ABSTRACT
Objectives To describe a national cohort of pregnant women admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, identify factors associated with infection, and describe outcomes, including transmission of infection, for mothers and infants.
Design Prospective national population based cohort study using the UK Obstetric Surveillance System (UKOSS).
Setting All 194 obstetric units in the UK.
Participants 427 pregnant women admitted to hospital with confirmed SARS-CoV-2 infection between 1 March 2020 and 14 April 2020.
Main outcome measures Incidence of maternal hospital admission and infant infection. Rates of maternal death, level 3 critical care unit admission, fetal loss, caesarean birth, preterm birth, stillbirth, early neonatal death, and neonatal unit admission.
Results The estimated incidence of admission to hospital with confirmed SARS-CoV-2 infection in pregnancy was 4.9 (95% confidence interval 4.5 to 5.4) per 1000 maternities. 233 (56%) pregnant women admitted to hospital with SARS-CoV-2 infection in pregnancy were from black or other ethnic minority groups, 281 (69%) were overweight or obese, 175 (41%) were aged 35 or over, and 145 (34%) had pre-existing comorbidities. 266 (62%) women gave birth or had a pregnancy loss; 196 (73%) gave birth at term. Forty one (10%) women admitted to hospital needed respiratory support, and five (1%) women died. Twelve (5%) of 265 infants tested positive for SARS-CoV-2 RNA, six of them within the first 12 hours after birth.
Conclusions Most pregnant women admitted to hospital with SARS-CoV-2 infection were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes, and transmission of SARS-CoV-2 to infants was uncommon. The high proportion of women from black or minority ethnic groups admitted with infection needs urgent investigation and explanation.

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03/06/2020 Research
Kawasaki-like multisystem inflammatory syndrome in children during the...

Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study

THE BMJ

Authors
Julie Toubiana, Clément Poirault, Alice Corsia, Fanny Bajolle, Jacques Fourgeaud, François Angoulvant, Agathe Debray, Romain Basmaci, Elodie Salvador, Sandra Biscardi, Pierre Frange, Martin Chalumeau, Jean-Laurent Casanova, Jérémie F Cohen,Slimane Allali

ABSTRACT

Objectives To describe the characteristics of children and adolescents affected by an outbreak of Kawasaki-like multisystem inflammatory syndrome and to evaluate a potential temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Design Prospective observational study.

Setting General paediatric department of a university hospital in Paris, France.

Participants 21 children and adolescents (aged ≤18 years) with features of Kawasaki disease who were admitted to hospital between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020.

Main outcome measures The primary outcomes were clinical and biological data, imaging and echocardiographic findings, treatment, and outcomes. Nasopharyngeal swabs were prospectively tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) and blood samples were tested for IgG antibodies to the virus.

Results 21 children and adolescents (median age 7.9 (range 3.7-16.6) years) were admitted with features of Kawasaki disease over a 15 day period, with 12 (57%) of African ancestry. 12 (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. 17 (81%) required intensive care support. All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers. 19 (90%) had evidence of recent SARS-CoV-2 infection (positive RT-PCR result in 8/21, positive IgG antibody detection in 19/21). All 21 patients received intravenous immunoglobulin and 10 (48%) also received corticosteroids. The clinical outcome was favourable in all patients. Moderate coronary artery dilations were detected in 5 (24%) of the patients during hospital stay. By 15 May 2020, after 8 (5-17) days of hospital stay, all patients were discharged home.

Conclusions The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.

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01/06/2020 Correspondence
Acute myocardial injury: a novel clinical pattern in children with COV...

Acute myocardial injury: a novel clinical pattern in children with COVID-19

The Lancet

Authors
Andrea Wolfler, Savina Mannarino, Vania Giacomet, Anna Camporesi, Gianvincenzo Zuccotti

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