COVID-19, ¿una nueva enfermedad inesperada? / COVID-19, a new disease unexpected?

A finales del año 2019 se declaró un brote de neumonía atípica causado por el coronavirus SARS-CoV-2 en China. La epidemia se extendió por todo el mundo con mucha celeridad, sin que las medidas aplicadas por los distintos países para contenerla pudieran evitarlo. Aprincipios del año 2020 la Organización Mundial de la Salud declaró oficialmente la pandemia, que causó la paralización de toda actividad social y económica a nivel planetario. Esta situación no tiene precedentes cercanos, pero al menos muchos virólogos sabían de antemano que podría suceder. En este comentario tratamos la pandemia de COVID-19 desde un punto de vista histórico, dado que tenemos que buscar su origen no en 2019, sino en el año 2003 con la aparición del primer brote de SARS.(AU)

¿Qué sabemos del origen del COVID-19 tres años después? / What do we know about the origin of COVID-19 three years later?

More than three years have passed since the first case of a new coronavirus infection (SARS-CoV-2) in the city of Wuhan (Hubei, China). The Wuhan Institute of Virology was founded in that city in 1956 and the country’s first biosafety level 4 laboratory opened within that center in 2015. The coincidence that the first cases of infection emerged in the city where the virology institute’s headquarters is located, the failure to 100% identify the virus’ RNA in any of the coronaviruses isolated in bats, and the lack of evidence on a possible intermediate animal host in the contagion’s transmission make it so that at present, there are doubts about the real origin of SARS-CoV-2. This article will review two theories: SARS-CoV-2 as a virus of zoonotic origin or as a leak from the high-level biosafety laboratory in Wuhan (AU)

Han pasado más de tres años desde el primer caso de infección por un nuevo coronavirus (SARS-CoV-2) en la ciudad de Wuhan (Hubei, China). En esta misma ciudad se fundó en 1956 el Instituto de Virología de Wuhan y en 2015 abrieron en este centro el primer laboratorio de bioseguridad de nivel 4 del país. La coincidencia de ciudad entre los primeros casos de infección y la sede del instituto de virología, sumados a la fallida identificación del RNA del virus al 100% en ninguno de los coronavirus aislados en murciélagos, junto con la falta de evidencia sobre el posible animal intermediario en la transmisión de contagio, hacen que a fecha de hoy surjan dudas sobre el origen real del SARS-CoV-2. En este artículo revisaremos dos teorías, el SARS-CoV-2 como origen zoonótico o como escape del laboratorio de alta bioseguridad en Wuhan (AU)

Impactos reais e/ou potenciais da pandemia de Covid-19 na saúde mental de idosos / Real and/or potential impacts of the Covid-19 pandemic on the mental health in older adults / Impactos reales y/o potenciales de la pandemia de Covid-19 en la salud mental de los ancianos

A pandemia de COVID-19 e as medidas de controle para conter a disseminação do vírus, como o distanciamento social, trouxeram mudanças à rotina das pessoas, mundialmente. Esse contexto pode gerar impactos adversos para a saúde mental dos indivíduos, especialmente, àqueles em maior vulnerabilidade, os idosos. O objetivo desse estudo foi analisar na literatura os impactos reais e/ou potenciais da pandemia de COVID-19 na saúde mental de idosos. Trata-se de uma revisão integrativa de literatura com buscas realizadas na Biblioteca Virtual em Saúde, que utilizou a seguinte estratégia de busca: (Coronavírus OR "Infecções por Coronavirus" OR "Coronavirus Infections" OR COVID-19) AND (idoso OR elderly OR aged) AND ("Saúde Mental" OR "Mental Health"). Foram critérios de inclusão: artigos acessados na íntegra, sem distinção de ano e idioma, indexados até o dia 11 de novembro de 2020; e os critérios de exclusão: artigos com fuga do escopo da pesquisa, revisões de literatura, arquivos multimídia e duplicados. Foram encontrados 241 registros, e após a aplicação dos critérios de elegibilidade estabelecidos restaram 27 artigos para discussão. Dentre os impactos reais/potenciais da pandemia de COVID-19 na saúde mental dos idosos, abordados nos estudos, destaca-se a ansiedade, depressão, solidão, estresse, sensação de medo ou pânico, tristeza, suicídio/ideação suicida e insônia. Apesar disso, considera-se que há uma quantidade ainda escassa de estudos voltados especificamente para a população idosa que permitam aprofundar as discussões sobre esse tema.

The COVID-19 pandemic and control measures to contain the spread of the virus, such as social detachment, have brought changes to people's routine, worldwide. This context can generate adverse impacts on the mental health of individuals, especially those most vulnerable, the older adults. The aim of this study was to analyze in the literature the real and / or potential impacts of the COVID-19 pandemic on the mental health of the older adults. It is an integrative literature review with searches performed in the Virtual Health Library, which used the following search strategy: (Coronavírus OR "Infecções por Coronavirus" OR "Coronavirus Infections" OR COVID- 19) AND (idoso OR elderly OR aged) AND ("Saúde Mental" OR "Mental Health"). Inclusion criteria were: articles accessed in full, without distinction of year and language, indexed until November 11, 2020; and exclusion criteria: articles with escape the scope of the research, literature reviews, multimedia and duplicate files, 241 records were found, and after applying the established eligibility criteria, 27 articles remained for discussion, among the actual / potential impacts of the COVID-19 pandemic on older people, addressed in the studies, anxiety, depression, loneliness, stress, feeling of fear or panic, sadness, suicide / suicidal ideation and insomnia stand out. Despite this, there is still a small amount studies specifically aimed at the older population that allow further discussions on this topic.

La pandemia de covid-19 y las medidas de control para contener la propagación del virus, como el distanciamiento social, han supuesto cambios en la rutina de las personas en todo el mundo. Este contexto puede generar impactos adversos a la salud mental de los individuos, especialmente a los más vulnerables, los ancianos. El objetivo de este estudio fue analizar en la literatura los impactos reales y/o potenciales de la pandemia de COVID-19 en la salud mental de los ancianos. Se trata de una revisión bibliográfica integradora con búsquedas realizadas en la Biblioteca Virtual de Salud, que utilizó la siguiente estrategia de búsqueda: (Coronavirus OR "Coronavirus Infections" OR "Coronavirus Infections" OR COVID-19) AND (elderly OR aged) AND ("Mental Health" OR "Mental Health"). Los criterios de inclusión fueron: artículos accedidos en su totalidad, independientemente del año y el idioma, indexados hasta el 11 de noviembre de 2020; y los criterios de exclusión: artículos que estuvieran fuera del ámbito de la investigación, revisiones bibliográficas, archivos multimedia y duplicados. Se encontraron un total de 241 registros, y tras aplicar los criterios de elegibilidad establecidos, quedaron 27 artículos para su discusión. Entre los impactos reales/potenciales de la pandemia de COVID-19 en la salud mental de los ancianos, abordados en los estudios, destacan la ansiedad, la depresión, la soledad, el estrés, la sensación de miedo o pánico, la tristeza, la ideación suicida/suicida y el insomnio. A pesar de ello, se considera que todavía hay una escasa cantidad de estudios dirigidos específicamente a la población de edad avanzada que permitan profundizar en las discusiones sobre este tema.

Seroprevalence and Associated Risk Factors of Infectious Bronchitis Virus in Chicken in Northwest Ethiopia.

Avian infectious bronchitis virus is a highly contagious disease occurring in respiratory, urogenital, and reproductive tissues of chicken causing considerable losses due to death, egg drop, and reduced production. This preliminary study was conducted to investigate the prevalence of antibodies against infectious bronchitis virus (IBV) and to assess the potential risk factors in chickens of northwest Ethiopia. A cross-sectional study was conducted from November 2020 to June 2021. A total of 768 serum samples from three zones were collected. To investigate the presence of antibodies against IBV, the indirect ELISA serological test was applied. Positivity for anti-IBV antibodies was observed in 23.96% (95% CI: 20.98-27.14) of the samples. The mixed-effect logistic regression analysis of potential risk factors showed that IBV prevalence was significantly higher in young chickens than adults (p < 0.001) and higher in intensive farm type than in extensive type (p < 0.001). Based on the production purposes of the chickens, the odds of seropositivity for IB was significantly higher in layers than in broilers (p < 0.001) and dual purposes (p < 0.001). This study revealed higher seroprevalence in farms which had the "all-in-all-out" rearing method than in farms with different batches in one house with a significant difference (p < 0.001), higher seroprevalence in the poor ventilated type than in good ones (p < 0.001), and higher seroprevalence in the houses that did not remove used litter at all than houses of completely disposed and partially disposed litter (p=0.002). Moreover, disinfection of houses had significant effect on the occurrence of IB. Having personal protective equipment was significantly affecting the occurrence of IB, being higher in the farms that have no wearing clothes and shoe than in those having wearing clothes and shoe (p=0.002). In conclusion, the seroprevalence finding in the present study indicated that the organism is circulating among the population of chickens and high enough to cause significant economic losses Therefore, poultry houses should be cleaned, disinfected, and well ventilated and farm attendants should have separate farm shoe and clothes. Further studies on the virus isolation and molecular characterization of the target gene are needed in the study area.

COVID-19 tem impactos “devastadores” sobre as mulheres, afirma diretora da OPAS

A diretora da Organização Pan-Americana da Saúde (OPAS), Carissa F. Etienne, advertiu que a interrupção contínua dos serviços de saúde da mulher devido à COVID-19 poderia “destruir” mais de 20 anos de progresso na redução da mortalidade materna e o aumento do acesso ao planejamento familiar na América Latina e no Caribe.

Targeting highly pathogenic coronavirus-induced apoptosis reduces viral pathogenesis and disease severity.

Infection by highly pathogenic coronaviruses results in substantial apoptosis. However, the physiological relevance of apoptosis in the pathogenesis of coronavirus infections is unknown. Here, with a combination of in vitro, ex vivo, and in vivo models, we demonstrated that protein kinase R-like endoplasmic reticulum kinase (PERK) signaling mediated the proapoptotic signals in Middle East respiratory syndrome coronavirus (MERS-CoV) infection, which converged in the intrinsic apoptosis pathway. Inhibiting PERK signaling or intrinsic apoptosis both alleviated MERS pathogenesis in vivo. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV induced apoptosis through distinct mechanisms but inhibition of intrinsic apoptosis similarly limited SARS-CoV-2- and SARS-CoV-induced apoptosis in vitro and markedly ameliorated the lung damage of SARS-CoV-2-inoculated human angiotensin-converting enzyme 2 (hACE2) mice. Collectively, our study provides the first evidence that virus-induced apoptosis is an important disease determinant of highly pathogenic coronaviruses and demonstrates that this process can be targeted to attenuate disease severity.

Pathomechanisms, therapeutic targets and potent inhibitors of some beta-coronaviruses from bench-to-bedside.

Since the emergence of their primitive strains, the complexity surrounding their pathogenesis, constant genetic mutation and translation are contributing factors to the scarcity of a successful vaccine for coronaviruses till moment. Although, the recent announcement of vaccine breakthrough for COVID-19 renews the hope, however, there remains a major challenge of accessibility to urgently match the rapid global therapeutic demand for curtailing the pandemic, thereby creating an impetus for further search. The reassessment of results from a stream of experiments is of enormous importance in identifying bona fide lead-like candidates to fulfil this quest. This review comprehensively highlights the common pathomechanisms and pharmacological targets of HCoV-OC43, SARS-CoV-1, MERS-CoV and SARS-CoV-2, and potent therapeutic potentials from basic and clinical experimental investigations. The implicated targets for the prevention and treatment include the viral proteases (Mpro, PLpro, 3CLpro), viral structural proteins (S- and N-proteins), non-structural proteins (nsp 3, 8, 10, 14, 16), accessory protein (ns12.9), viroporins (3a, E, 8a), enzymes (RdRp, TMPRSS2, ADP-ribosyltransferase, MTase, 2'-O-MTase, TATase, furin, cathepsin, deamidated human triosephosphate isomerase), kinases (MAPK, ERK, PI3K, mTOR, AKT, Abl2), interleukin-6 receptor (IL-6R) and the human host receptor, ACE2. Notably among the 109 overviewed inhibitors include quercetin, eriodictyol, baicalin, luteolin, melatonin, resveratrol and berberine from natural products, GC373, NP164 and HR2P-M2 from peptides, 5F9, m336 and MERS-GD27 from specific human antibodies, imatinib, remdesivir, ivermectin, chloroquine, hydroxychloroquine, nafamostat, interferon-ß and HCQ from repurposing libraries, some iron chelators and traditional medicines. This review represents a model for further translational studies for effective anti-CoV therapeutic designs.

CPMPARISON between COVID-19 and MERS demographic data in Saudi Arabia: a retrospective study.

The outbreak of corona virus disease (COVID-19) caused by the new severe acute respiratory syndrome corona virus 2 began in Wuhan, China, resulting in respiratory disorders. In January of 2020, the World Health Organization declared the outbreak a pandemic owing to its global spread. Because no studies have investigated COVID-19 in Saudi Arabia, this study investigated similarities and differences between demographic data during the COVID-19 and Middle East respiratory syndrome (MERS) outbreaks in Saudi Arabia. A retrospective trend analysis was performed to assess demographic data of all laboratory-confirmed MERS and COVID-19 cases. Patients' charts were reviewed for data on demographics, mortality, citizenship, sex ratio, and age groups with descriptive and comparative statistics; the data were analyzed using a non-parametric binomial test and chi-square test. Of all COVID-19 patients in Saudi Arabia,78%were male patients and 22% were female patients. This proportion of male COVID-19 patients was similar to that of male MERS patients, which also affected male patients more frequently than female patients. The number of COVID-19-positive Saudi cases was lower than that of non-Saudi cases, which were in contrast to that of MERS; COVID-19 appeared to be remarkably similar to MERS with respect to recovered cases. However, the numbers of critical and dead COVID-19 patients have been much lower than those of MERS patients. The largest proportion of COVID-19 and MERS cases (44.05% and 40.8%, respectively) were recorded in the Western region. MERS and COVID-19 exhibited similar threats to the lives of adults and the elderly, despite lower mortality rates during the COVID-19 epidemic. Targeted prevention of and interventions against MERS should be allocated populations according to the areas where they inhabit. However, much more information regarding the dynamics and epidemiology of COVID-19 in Saudi Arabia is needed.Abbrevation : MERS: Middle East Respiratory syndrome; COVID-19: Corona Virus Disease 2019.

Risk factors for seasonal human coronavirus lower respiratory tract infection after hematopoietic cell transplantation.

Data are limited regarding risk factors for lower respiratory tract infection (LRTI) caused by seasonal human coronaviruses (HCoVs) and the significance of virologic documentation by bronchoalveolar lavage (BAL) on outcomes in hematopoietic cell transplant (HCT) recipients. We retrospectively analyzed patients undergoing allogeneic HCT (4/2008-9/2018) with HCoV (OC43/NL63/HKU1/229E) detected by polymerase chain reaction during conditioning or post-HCT. Risk factors for all manifestations of LRTI and progression to LRTI among those presenting with HCoV upper respiratory tract infection (URTI) were analyzed by logistic regression and Cox proportional hazard models, respectively. Mortality rates following HCoV LRTI were compared according to virologic documentation by BAL. A total of 297 patients (61 children and 236 adults) developed HCoV infection as follows: 254 had URTI alone, 18 presented with LRTI, and 25 progressed from URTI to LRTI (median, 16 days; range, 2-62 days). Multivariable logistic regression analyses showed that male sex, higher immunodeficiency scoring index, albumin <3 g/dL, glucose >150 mg/dL, and presence of respiratory copathogens were associated with occurrence of LRTI. Hyperglycemia with steroid use was associated with progression to LRTI (P < .01) in Cox models. LRTI with HCoV detected in BAL was associated with higher mortality than LRTI without documented detection in BAL (P < .01). In conclusion, we identified factors associated with HCoV LRTI, some of which are less commonly appreciated to be risk factors for LRTI with other respiratory viruses in HCT recipients. The association of hyperglycemia with LRTI might provide an intervention opportunity to reduce the risk of LRTI.

Revisión bibliográfica sobre la COVID 19 en pacientes con cáncer de pulmón / Bibliographic review on COVID 19 in patients with lung cancer

RESUMEN La COVID 19 es una enfermedad pandémica producida por el virus SARS-CoV-2, tiene dentro de los grupos vulnerables al cáncer de pulmón por presentar una inmunodepresión adquirida por los tratamientos oncoespecíficos administrados y esto conlleva a una mayor exposición a complicaciones si se contrae esta terrible infección que azota al mundo en la actualidad. El objetivo fue exponer los riesgos y complicaciones que tienen los pacientes con cáncer de pulmón que reciben tratamientos oncoespecíficos si se infectan con el SARS-COV-2. Se realizó una revisión sistemática de los principales artículos publicados en inglés y en español por autores cubanos y extranjeros en revistas de alto impacto a nivel mundial, información reportada por la Organización Mundial de la Salud, la red de Infomed y el Ministerio de Salud Pública de Cuba. Se concluyó que los pacientes con cáncer de pulmón no presentan un riesgo superior a la población general para contraer la COVID 19, sí existe cierta evidencia de que estos pacientes puedan sufrir una infección más grave si la adquieren (AU).

SUMMARY COVID-19 is a pandemic disease produced by SARS-CoV-2 virus; the group of patients with lung cancer is vulnerable to this disease because of presenting an acquired immune depression due to administered oncospecific treatments, leading to higher exposition to complications if the patient gets this terrible disease striking worldwide nowadays. The objective of this review was exposing the risk and complications affronted by patients suffering lung cancer with oncospecific treatment if they get infected by SARS-CoV-2. The authors carried out a systematic review of the main articles published in Spanish and English by Cuban and foreign authors in high impact journals around the world, information reported by the World Health Organization, INFOMED and the Ministry of Public Health of Cuba. It was concluded that patients with lung cancer are not at a higher risk of catching COVID-19 than general population; it does exist certain evidence of that these patients could suffer a more serious infection if they get the disease (AU).

How the world's collective attention is being paid to a pandemic: COVID-19 related n-gram time series for 24 languages on Twitter.

In confronting the global spread of the coronavirus disease COVID-19 pandemic we must have coordinated medical, operational, and political responses. In all efforts, data is crucial. Fundamentally, and in the possible absence of a vaccine for 12 to 18 months, we need universal, well-documented testing for both the presence of the disease as well as confirmed recovery through serological tests for antibodies, and we need to track major socioeconomic indices. But we also need auxiliary data of all kinds, including data related to how populations are talking about the unfolding pandemic through news and stories. To in part help on the social media side, we curate a set of 2000 day-scale time series of 1- and 2-grams across 24 languages on Twitter that are most 'important' for April 2020 with respect to April 2019. We determine importance through our allotaxonometric instrument, rank-turbulence divergence. We make some basic observations about some of the time series, including a comparison to numbers of confirmed deaths due to COVID-19 over time. We broadly observe across all languages a peak for the language-specific word for 'virus' in January 2020 followed by a decline through February and then a surge through March and April. The world's collective attention dropped away while the virus spread out from China. We host the time series on Gitlab, updating them on a daily basis while relevant. Our main intent is for other researchers to use these time series to enhance whatever analyses that may be of use during the pandemic as well as for retrospective investigations.

Análisis de los resultados en seguridad de pacientes y profesionales durante la pandemia COVID-19 en el contexto de la cirugía urgente / Analysis of the safety of patients and professionals during the COVID-19 pandemic in the context of emergency surgery

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Zoonotic origins and animal hosts of coronaviruses causing human disease pandemics: A review.

The first known severe disease caused by a coronavirus (CoV) in humans emerged with the severe acute respiratory syndrome (SARS) epidemic in China, which killed 774 people during its 2002/2003 outbreak. The Middle East respiratory syndrome (MERS) was the second human fatal disease, which started in 2012 in Saudi Arabia and resulted in 858 fatalities. In December 2019, a new virus, SARS-CoV-2 (COVID-19), originating from China, began generating headlines worldwide because of the unprecedented speed of its transmission; 5.2 million people were infected and 338 480 had been reported dead from December 2019 to May 2020. These human coronaviruses are believed to have an animal origin and had reached humans through species jump. Coronaviruses are well known for their high frequency of recombination and high mutation rates, allowing them to adapt to new hosts and ecological niches. This review summarises existing information on what is currently known on the role of wild and domesticated animals and discussions on whether they are the natural reservoir/amplifiers hosts or incidental hosts of CoVs. Results of experimental infection and transmission using different wild, domesticated and pet animals are also reviewed. The need for a One Health approach in implementing measures and practices is highlighted to improve human health and reduce the emergence of pandemics from these zoonotic viruses.

Patient and Provider Risk in Managing ST-Elevation Myocardial Infarction During the COVID-19 Pandemic: A Decision Analysis.

BACKGROUND: The optimal treatment strategy for treating ST-segment-elevation myocardial infarction (STEMI) in context of the coronavirus disease 2019 (COVID-19) pandemic is unclear given the potential risk of occupational exposure during primary percutaneous coronary intervention (PPCI). We quantified the impact of different STEMI treatment strategies on patient outcomes and provider risk in context of the COVID-19 pandemic. METHODS: Using a decision-analytic framework, we evaluated the effect of PPCI versus the pharmaco-invasive strategy for managing STEMI on 30-day patient mortality and individual provider infection risk based on presence of cardiogenic shock, suspected coronary territory, and presence of known or presumptive COVID-19 infection. RESULTS: For patients with low suspicion for COVID-19, PPCI had mortality benefit over the pharmaco-invasive strategy, and the risk of cardiac catheterization laboratory provider infection remained very low (<0.25%) across all subgroups. For patients with presumptive COVID-19 with cardiogenic shock, PPCI offered substantial mortality benefit to patients relative to the pharmaco-invasive strategy (7.9% absolute decrease in 30-day mortality), but also greater risk of provider infection (2.3% absolute increase in risk of provider infection). For patients with presumptive COVID-19 with nonanterior STEMI without cardiogenic shock, PPCI offered a 0.4% absolute mortality benefit over the pharmaco-invasive strategy with a 0.2% greater absolute risk of provider infection, and the tradeoff between patient and provider risk with PPCI became more apparent in sensitivity analysis with more severe COVID-19 infections. CONCLUSIONS: Usual care with PPCI remains the appropriate treatment strategy in the majority of cases presenting with STEMI in the setting of the COVID-19 pandemic. However, utilization of a pharmaco-invasive strategy in selected patients with STEMI with presumptive COVID-19 and low likelihood of mortality from STEMI and use of preventive strategies such as preprocedural intubation in high risk patients when PPCI is the preferred strategy may be reasonable to reduce provider risk of COVID-19 infection.

COVID-19, thromboembolic risk, and Virchow's triad: Lesson from the past.

COronavirus Infectious Disease which started in 2019 (COVID-19) usually presents with the signs and symptoms of pneumonia. However, a growing number of recent reports highlight the fact that the infection may be by far more than only a respiratory disease. There is evidence of an increased thromboembolic risk in COVID-19 patients, with a variety of manifestations in terms of ischemic stroke, deep vein thrombosis, acute pulmonary embolism, acute myocardial infarction, systemic arterial embolism, and placental thrombosis. The German physician Rudolph Virchow, about two centuries ago, described three pivotal factors contributing together to thromboembolic risk: endothelial injury, hypercoagulability, and blood stasis. COVID-19-associated hypercoagulability is unique and distinctive, and has its own features involving the immune system. Many of the drugs proposed and currently undergoing evaluation for the treatment of COVID-19 have one or more of the Virchow's triad elements as a target. The three factors outlined by Virchow are still able to explain the venous and arterial hypercoagulable state in the dramatic COVID-19 setting. Nowadays, we have decidedly more sophisticated diagnostic tools than Virchow had, but many of the challenges that we are facing are the same as Virchow faced in the 19th century.

Healthcare Workers Exposure Risk Assessment: A Survey among Frontline Workers in Designated COVID-19 Treatment Centers in Ghana.

BACKGROUND: Healthcare workers (HCWs) are faced with an elevated risk of exposure to SARS-COV-2 due to the clinical procedures they perform on COVID-19 patients. However, data for frontline HCWs level of exposure and risk of COVID-19 virus infection are limited. OBJECTIVE: We investigated the level of exposure and risk of COVID-19 virus infection among HCWs in COVID-19 treatment centers in Ghana. METHODS: A cross-sectional study was utilized in this study and HCWs were invited by convenience to participate in the study, 408 HCWs in 4 COVID-19 treatment centers participated in the study. Adherence to infection prevention and control (IPC) measures were used to categorized HCWs as low or high risk of COVID-19 virus infection. The WHO COVID-19 risk assessment tool was used to collect quantitative data from the study participants. RESULTS: There was a high (N = 328, 80.4%) level of occupational exposure to the COVID-19 virus. However, only 14.0% of the exposed HCWs were at high risk of COVID-19 virus infection. Healthcare workers who performed or were present during any aerosol-generating procedures (AGP) were 23.8 times more likely to be exposed compared to HCWs who did not perform or were absent during any AGP (AOR 23.83; 95% CI: 18.45, 39.20). High risk of COVID-19 virus infection was less likely among registered nurses (AOR = 0.09; 95% CI: 0.02, 0.60), HCWs who performed or were present during any AGP (AOR = 0.05; 95% CI: 0.01, 0.50) and HCWs with a master's degree qualification (AOR 0.06; 95% CI: 0.01, 0.63). CONCLUSION: Despite the high level of exposure to the COVID-19 virus among HCWs in the treatment centers, only 14.0% were at high risk of COVID-19 virus infection. To protect this group of HCWs, treatment centers and HCWs should continue to adhere to WHO and national IPC protocols in managing of COVID-19 cases.

Review of inflammatory bowel disease and COVID-19.

The first cases of a novel corona virus infection were reported in Wuhan China in December of 2019, followed by the declaration of an international pandemic by the World Health Organization in March 2020. Early reports of the virus, now known as severe acute respiratory syndrome coronavirus 2, and its clinical disease coronavirus disease 2019 (COVID-19), has shown higher rates of morbidity and mortality in the elderly and those with pre-existing medical conditions. Of particular concern is the safety of those with compromised immune systems. Inflammatory Bowel disease (IBD) is itself caused by a disordered immune response, with the most effective medical therapies being immune suppressing or modifying. As such, the risk of COVID-19, virus related outcomes, and appropriate management of IBD patients during the global pandemic is of immediate concern to gastroenterologists worldwide. There has been a rapid accumulation of clinical data and expert opinion on the topic. This review will highlight the latest source information on clinical observation/outcomes of the IBD population and provide a concise summary of the most up to date perspectives on IBD management in the age of COVID-19.

Coronavirus disease 2019 (COVID-19) in the heart transplant population: a single-centre experience.

OBJECTIVES: Few anecdotal cases have been reported in the literature regarding heart transplant recipients and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report our experience with 6 patients hospitalized in Northern Italy during the outbreak. METHODS: Of the 396 living heart transplant recipients from 1985 to 2020 included in the study, 6 patients developed the novel 2019 coronavirus disease. Risk factors, last follow-up characteristics, onset presentation, in-hospital course of disease and blood examinations data were collected for these patients. RESULTS: All patients were symptomatic and had positive results from a nasopharyngeal swab test for SARS-CoV-2. Of the 6 patients, 5 were hospitalized and 1 remained self-quarantined at home. Two patients died and 3 were discharged home. Two patients were admittted to the intensive care unit . Immunosuppressive therapy was modified with a median reduction comprising doses that were 50% cyclosporine and 50% mycophenolate. All patients received a medium-dose of corticosteroids as a bolus medication in addition to their therapy. All hospitalized patients received hydroxychloroquine; 2 patients received ritonavir/lopinavir. Broad-spectrum antibiotics for prophylaxis were administered to all. One patient had an ischaemic stroke and died of sepsis. CONCLUSIONS: In the absence of any strong evidence regarding the treatment of heart transplant recipients infected with SARS-CoV-2, we faced a new challenge in managing viral infection in an immunosuppressed population. Because immunomodulation interaction with the infection seems to be crucial for developing severe forms of the disease, we managed to reduce immunosuppressive therapy by adding medium doses of corticosteroids. Despite the limited number of affected patients, this report suggests that special considerations should be given to treating coronavirus disease in the heart transplant recipient population.