Surveillance for Pressure Injuries on Admission to Inpatient Rehabilitation Hospitals During the COVID-19 Pandemic.

OBJECTIVE: To determine if the incidence of pressure injuries (PIs) on admission to an inpatient rehabilitation hospital (IRH) system of care was increased during the early coronavirus disease 2019 (COVID-19) pandemic period. DESIGN: Retrospective survey chart review of consecutive cohorts. Admissions to 4 acute IRHs within 1 system of care over the first consecutive 6-week period of admitting patients positive for COVID-19 during the initial peak of the COVID-19 pandemic, April 1-May 9, 2020. A comparison was made with the pre-COVID-19 period, January 1-February 19, 2020. SETTING: Four acute IRHs with admissions on a referral basis from acute care hospitals. PARTICIPANTS: A consecutive sample (N=1125) of pre-COVID-19 admissions (n=768) and COVID-19 period admissions (n=357), including persons who were COVID-19-positive (n=161) and COVID-19-negative (n=196). MAIN OUTCOME MEASURES: Incidence of PIs on admission to IRH. RESULTS: Prevalence of PIs on admission during the COVID-19 pandemic was increased when compared with the pre-COVID-19 period by 14.9% (P<.001). There was no difference in the prevalence of PIs in the COVID-19 period between patients who were COVID-19-positive and COVID-19-negative (35.4% vs 35.7%). The severity of PIs, measured by the wound stage of the most severe PI the patient presented with, worsened during the COVID-19 period compared with pre-COVID-19 (χ2 32.04%, P<.001). The length of stay in the acute care hospital before transfer to the IRH during COVID-19 was greater than pre-COVID-19 by 10.9% (P<.001). CONCLUSIONS: During the early part of the COVID-19 pandemic time frame, there was an increase in the prevalence and severity of PIs noted on admission to our IRHs. This may represent the significant burden placed on the health care system by the pandemic, affecting all patients regardless of COVID-19 status. This information is important to help all facilities remain vigilant to prevent PIs as the pandemic continues and potential future pandemics that place strain on medical resources.

Reducing contacts to stop SARS-CoV-2 transmission during the second pandemic wave in Brussels, Belgium, August to November 2020.

To evaluate the effect of physical distancing and school reopening in Brussels between August and November 2020, we monitored changes in the number of reported contacts per SARS-CoV-2 case and associated SARS-CoV-2 transmission. The second COVID-19 pandemic wave in Brussels was the result of increased social contact across all ages following school reopening. Physical distancing measures including closure of bars and restaurants, and limiting close contacts, while primary and secondary schools remained open, reduced social mixing and controlled SARS-CoV-2 transmission.

CoroDet: A deep learning based classification for COVID-19 detection using chest X-ray images.

BACKGROUND AND OBJECTIVE: The Coronavirus 2019, or shortly COVID-19, is a viral disease that causes serious pneumonia and impacts our different body parts from mild to severe depending on patient's immune system. This infection was first reported in Wuhan city of China in December 2019, and afterward, it became a global pandemic spreading rapidly around the world. As the virus spreads through human to human contact, it has affected our lives in a devastating way, including the vigorous pressure on the public health system, the world economy, education sector, workplaces, and shopping malls. Preventing viral spreading requires early detection of positive cases and to treat infected patients as quickly as possible. The need for COVID-19 testing kits has increased, and many of the developing countries in the world are facing a shortage of testing kits as new cases are increasing day by day. In this situation, the recent research using radiology imaging (such as X-ray and CT scan) techniques can be proven helpful to detect COVID-19 as X-ray and CT scan images provide important information about the disease caused by COVID-19 virus. The latest data mining and machine learning techniques such as Convolutional Neural Network (CNN) can be applied along with X-ray and CT scan images of the lungs for the accurate and rapid detection of the disease, assisting in mitigating the problem of scarcity of testing kits. METHODS: Hence a novel CNN model called CoroDet for automatic detection of COVID-19 by using raw chest X-ray and CT scan images have been proposed in this study. CoroDet is developed to serve as an accurate diagnostics for 2 class classification (COVID and Normal), 3 class classification (COVID, Normal, and non-COVID pneumonia), and 4 class classification (COVID, Normal, non-COVID viral pneumonia, and non-COVID bacterial pneumonia). RESULTS: The performance of our proposed model was compared with ten existing techniques for COVID detection in terms of accuracy. A classification accuracy of 99.1% for 2 class classification, 94.2% for 3 class classification, and 91.2% for 4 class classification was produced by our proposed model, which is obviously better than the state-of-the-art-methods used for COVID-19 detection to the best of our knowledge. Moreover, the dataset with x-ray images that we prepared for the evaluation of our method is the largest datasets for COVID detection as far as our knowledge goes. CONCLUSION: The experimental results of our proposed method CoroDet indicate the superiority of CoroDet over the existing state-of-the-art-methods. CoroDet may assist clinicians in making appropriate decisions for COVID-19 detection and may also mitigate the problem of scarcity of testing kits.

COVID-19 pneumonia-ultrasound, radiographic, and computed tomography findings: a comprehensive pictorial essay.

Ultrasound, chest X-ray, and computed tomography (CT) have been used with excellent results in diagnosis, first assessment, and follow-up of COVID-19 confirmed and suspected patients. Ultrasound and chest X-ray have the advantages of the wide availability and acquisition at the patient's bed; CT showed high sensitivity in COVID-19 diagnosis. Ground-glass opacities and consolidation are the main CT and X-ray features; the distribution of lung abnormalities is typically bilateral and peripheral. Less typical findings, including pleural effusion, mediastinal lymphadenopathies, the bubble air sign, and cavitation, can also be visible on chest CT. Radiologists should be aware of the advantages and limitations of the available imaging techniques and of the different pulmonary aspects of COVID-19 infection.

COVIDetection-Net: A tailored COVID-19 detection from chest radiography images using deep learning.

In this study, a medical system based on Deep Learning (DL) which we called "COVIDetection-Net" is proposed for automatic detection of new corona virus disease 2019 (COVID-19) infection from chest radiography images (CRIs). The proposed system is based on ShuffleNet and SqueezeNet architecture to extract deep learned features and Multiclass Support Vector Machines (MSVM) for detection and classification. Our dataset contains 1200 CRIs that collected from two different publicly available databases. Extensive experiments were carried out using the proposed model. The highest detection accuracy of 100 % for COVID/NonCOVID, 99.72 % for COVID/Normal/pneumonia and 94.44 % for COVID/Normal/Bacterial pneumonia/Viral pneumonia have been obtained. The proposed system superior all published methods in recall, specificity, precision, F1-Score and accuracy. Confusion Matrix (CM) and Receiver Operation Characteristics (ROC) analysis are also used to depict the performance of the proposed model. Hence the proposed COVIDetection-Net can serve as an efficient system in the current state of COVID-19 pandemic and can be used in everywhere that are facing shortage of test kits.

CT features of novel coronavirus pneumonia (COVID-19) in children.

A serious epidemic of COVID-19 broke out in Wuhan, Hubei Province, China, and spread to other Chinese cities and several countries now. As the majority of patients infected with COVID-19 had chest CT abnormality, chest CT has become an important tool for early diagnosis of COVID-19 and monitoring disease progression. There is growing evidence that children are also susceptible to COVID-19 and have atypical presentations compared with adults. This review is mainly about the differences in clinical symptom spectrum, diagnosis of COVID-19, and CT imaging findings between adults and children, while highlighting the value of radiology in prevention and control of COVID-19 in pediatric patients. KEY POINTS: • Compared with adults, pediatric patients with COVID-19 have the characteristics of lower incidence, slighter clinical symptoms, shorter course of disease, and fewer severe cases. • The chest CT characteristics of COVID-19 in pediatric patients were atypical, with more localized GGO extent, lower GGO attenuation, and relatively rare interlobular septal thickening. • Chest CT should be used with more caution in pediatric patients with COVID-19 to protect this vulnerable population from risking radiation.

Radiomics nomogram for the prediction of 2019 novel coronavirus pneumonia caused by SARS-CoV-2.

OBJECTIVES: To develop and validate a radiomics model for predicting 2019 novel coronavirus (COVID-19) pneumonia. METHODS: For this retrospective study, a radiomics model was developed on the basis of a training set consisting of 136 patients with COVID-19 pneumonia and 103 patients with other types of viral pneumonia. Radiomics features were extracted from the lung parenchyma window. A radiomics signature was built on the basis of reproducible features, using the least absolute shrinkage and selection operator method (LASSO). Multivariable logistic regression model was adopted to establish a radiomics nomogram. Nomogram performance was determined by its discrimination, calibration, and clinical usefulness. The model was validated in 90 consecutive patients, of which 56 patients had COVID-19 pneumonia and 34 patients had other types of viral pneumonia. RESULTS: The radiomics signature, consisting of 3 selected features, was significantly associated with COVID-19 pneumonia (p < 0.05) in both training and validation sets. The multivariable logistic regression model included the radiomics signature and distribution; maximum lesion, hilar, and mediastinal lymph node enlargement; and pleural effusion. The individualized prediction nomogram showed good discrimination in the training sample (area under the receiver operating characteristic curve [AUC], 0.959; 95% confidence interval [CI], 0.933-0.985) and in the validation sample (AUC, 0.955; 95% CI, 0.899-0.995) and good calibration. The mixed model achieved better predictive efficacy than the clinical model. Decision curve analysis demonstrated that the radiomics nomogram was clinically useful. CONCLUSIONS: The radiomics model derived has good performance for predicting COVID-19 pneumonia and may help in clinical decision-making. KEY POINTS: • A radiomics model showed good performance for prediction 2019 novel coronavirus pneumonia and favorable discrimination for other types of pneumonia on CT images. • A central or peripheral distribution, a maximum lesion range > 10 cm, the involvement of all five lobes, hilar and mediastinal lymph node enlargement, and no pleural effusion is associated with an increased risk of 2019 novel coronavirus pneumonia. • A radiomics model was superior to a clinical model in predicting 2019 novel coronavirus pneumonia.

Coronavirus disease 2019 (COVID-19) imaging reporting and data system (COVID-RADS) and common lexicon: a proposal based on the imaging data of 37 studies.

BACKGROUND: In the vast majority of the laboratory-confirmed coronavirus disease 2019 (COVID-19) patients, computed tomography (CT) examinations yield a typical pattern and the sensitivity of this modality has been reported to be 97% in a large-scale study. Structured reporting systems simplify the interpretation and reporting of imaging examinations, serve as a framework for consistent generation of recommendations, and improve the quality of patient care. PURPOSE: To compose a comprehensive lexicon for description of the imaging findings and propose a grading system and structured reporting format for CT findings in COVID-19. MATERIAL AND METHODS: We updated our published systematic review on imaging findings in COVID-19 to include 37 published studies pertaining to diagnostic features of COVID-19 in chest CT. Using the reported imaging findings of 3647 patients, we summarized the typical chest CT findings, atypical features, and temporal changes of COVID-19 in chest CT. Subsequently, we extracted a list of descriptive terms and mapped it to the terminology that is commonly used in imaging literature. RESULTS: We composed a comprehensive lexicon that can be used for documentation and reporting of typical and atypical CT imaging findings in COVID-19 patients. Using the same data, we propose a grading system with five COVID-RADS categories. Each COVID-RADS grade corresponds to a low, moderate, or high level of suspicion for pulmonary involvement of COVID-19. CONCLUSION: The proposed COVID-RADS and common lexicon would improve the communication of findings to other healthcare providers, thus facilitating the diagnosis and management of COVID-19 patients. KEY POINTS: • Chest CT has high sensitivity in diagnosing the coronavirus disease 2019 (COVID-19). • Structured reporting systems simplify the interpretation and reporting of imaging examinations, serve as a framework for consistent generation of recommendations, and improve the quality of patient care. • The proposed COVID-RADS and common lexicon would improve the communication of findings to other healthcare providers, thus facilitating the diagnosis and management of COVID-19 patients.

COVID-19 pneumonia: CT findings of 122 patients and differentiation from influenza pneumonia.

OBJECTIVES: To investigate the clinical and chest CT characteristics of COVID-19 pneumonia and explore the radiological differences between COVID-19 and influenza. MATERIALS AND METHODS: A total of 122 patients (61 men and 61 women, 48 ± 15 years) confirmed with COVID-19 and 48 patients (23 men and 25 women, 47 ± 19 years) confirmed with influenza were enrolled in the study. Thin-section CT was performed. The clinical data and the chest CT findings were recorded. RESULTS: The most common symptoms of COVID-19 were fever (74%) and cough (63%), and 102 patients (83%) had Wuhan contact. Pneumonia in 50 patients with COVID-19 (45%) distributed in the peripheral regions of the lung, while it showed mixed distribution in 26 patients (74%) with influenza (p = 0.022). The most common CT features of the COVID-19 group were pure ground-glass opacities (GGO, 36%), GGO with consolidation (51%), rounded opacities (35%), linear opacities (64%), bronchiolar wall thickening (49%), and interlobular septal thickening (66%). Compared with the influenza group, the COVID-19 group was more likely to have rounded opacities (35% vs. 17%, p = 0.048) and interlobular septal thickening (66% vs. 43%, p = 0.014), but less likely to have nodules (28% vs. 71%, p < 0.001), tree-in-bud sign (9% vs. 40%, p < 0.001), and pleural effusion (6% vs. 31%, p < 0.001). CONCLUSIONS: There are significant differences in the CT manifestations of patients with COVID-19 and influenza. Presence of rounded opacities and interlobular septal thickening, with the absence of nodules and tree-in-bud sign, and with the typical peripheral distribution, may help us differentiate COVID-19 from influenza. KEY POINTS: • Typical CT features of COVID-19 include pure ground-glass opacities (GGO), GGO with consolidation, rounded opacities, bronchiolar wall thickening, interlobular septal thickening, and a peripheral distribution. • Presence of rounded opacities and interlobular septal thickening, with the absence of nodules and tree-in-bud sign, and with the typical peripheral distribution, may help us differentiate COVID-19 from influenza.

Comparison of chest CT findings between COVID-19 pneumonia and other types of viral pneumonia: a two-center retrospective study.

OBJECTIVES: To compare the pulmonary chest CT findings of patients with COVID-19 pneumonia with those with other types of viral pneumonia. METHODS: This retrospective review includes 154 patients with RT-PCR-confirmed COVID-19 pneumonia diagnosed between February 11 and 20, 2020, and 100 patients with other types of viral pneumonia diagnosed between April 2011 and December 2020 from two hospitals. High-resolution CT (HRCT) of the chest was performed. Data on location, distribution, attenuation, maximum lesion range, lobe involvement, number of lesions, air bronchogram signs, Hilar and mediastinal lymph node enlargement, and pleural effusion were collected. Associations between imaging characteristics and COVID-19 pneumonia were analyzed with univariate and multivariate logistic regression models. RESULTS: A peripheral distribution was associated with a 13.04-fold risk of COVID-19 pneumonia, compared with a diffuse distribution. A maximum lesion range > 10 cm was associated with a 9.75-fold risk of COVID-19 pneumonia, compared with a maximum lesion range ≤ 5 cm, and the involvement of 5 lobes was associated with an 8.45-fold risk of COVID-19 pneumonia, compared with a maximum lesion range ≤ 2. No pleural effusion was associated with a 3.58-fold risk of COVID-19 pneumonia compared with the presence of pleural effusion. Hilar and mediastinal lymph node enlargement was associated with a 2.79-fold risk of COVID-19 pneumonia. CONCLUSION: A peripheral distribution, a lesion range > 10 cm, involvement of 5 lobes, presence of hilar and mediastinal lymph node enlargement, and no pleural effusion were significantly associated with 2019-novel coronavirus pneumonia. KEY POINTS: • A peripheral distribution, a lesion range > 10 cm, involvement of 5 lobes, presence of hilar and mediastinal lymph node enlargement, and no pleural effusion were significantly associated with COVID-19 compared with other types of viral pneumonia.

Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China.

OBJECTIVES: The purpose of this study was to observe the imaging characteristics of the novel coronavirus pneumonia. METHODS: Sixty-three confirmed patients were enrolled from December 30, 2019 to January 31, 2020. High-resolution CT (HRCT) of the chest was performed. The number of affected lobes, ground glass nodules (GGO), patchy/punctate ground glass opacities, patchy consolidation, fibrous stripes and irregular solid nodules in each patient's chest CT image were recorded. Additionally, we performed imaging follow-up of these patients. RESULTS: CT images of 63 confirmed patients were collected. M/F ratio: 33/30. The mean age was 44.9 ± 15.2 years. The mean number of affected lobes was 3.3 ± 1.8. Nineteen (30.2%) patients had one affected lobe, five (7.9%) patients had two affected lobes, four (6.3%) patients had three affected lobes, seven (11.1%) patients had four affected lobes while 28 (44.4%) patients had 5 affected lobes. Fifty-four (85.7%) patients had patchy/punctate ground glass opacities, 14 (22.2%) patients had GGO, 12 (19.0%) patients had patchy consolidation, 11 (17.5%) patients had fibrous stripes and 8 (12.7%) patients had irregular solid nodules. Fifty-four (85.7%) patients progressed, including single GGO increased, enlarged and consolidated; fibrous stripe enlarged, while solid nodules increased and enlarged. CONCLUSIONS: Imaging changes in novel viral pneumonia are rapid. The manifestations of the novel coronavirus pneumonia are diverse. Imaging changes of typical viral pneumonia and some specific imaging features were observed. Therefore, we need to strengthen the recognition of image changes to help clinicians to diagnose quickly and accurately. KEY POINTS: • High-resolution CT (HRCT) of the chest is critical for early detection, evaluation of disease severity and follow-up of patients with the novel coronavirus pneumonia. • The manifestations of the novel coronavirus pneumonia are diverse and change rapidly. • Radiologists should be aware of the various features of the disease and temporal changes.

Corticosteroid treatment of patients with coronavirus disease 2019 (COVID-19).

OBJECTIVES: To assess the efficacy of corticosteroid treatment of patients with coronavirus disease 2019 (COVID-19). DESIGN, SETTING: Observational study in the two COVID-19-designated hospitals in Wuhu, Anhui province, China, 24 January - 24 February 2020. PARTICIPANTS: Thirty-one patients infected with the severe acute respiratory coronavirus 2 (SARS-CoV-2) treated at the two designated hospitals. MAIN OUTCOME MEASURES: Virus clearance time, length of hospital stay, and duration of symptoms, by treatment type (including or not including corticosteroid therapy). RESULTS: Eleven of 31 patients with COVID-19 received corticosteroid treatment. Cox proportional hazards regression analysis indicated no association between corticosteroid treatment and virus clearance time (hazard ratio [HR], 1.26; 95% CI, 0.58-2.74), hospital length of stay (HR, 0.77; 95% CI, 0.33-1.78), or duration of symptoms (HR, 0.86; 95% CI, 0.40-1.83). Univariate analysis indicated that virus clearance was slower in two patients with chronic hepatitis B infections (mean difference, 10.6 days; 95% CI, 6.2-15.1 days). CONCLUSIONS: Corticosteroids are widely used when treating patients with COVID-19, but we found no association between therapy and outcomes in patients without acute respiratory distress syndrome. An existing HBV infection may delay SARS-CoV-2 clearance, and this association should be further investigated.

Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group.

INTRODUCTION: This statement was planned on 11 March 2020 to provide clinical guidance and aid staff preparation for the coronavirus disease 2019 (COVID-19) pandemic in Australia and New Zealand. It has been widely endorsed by relevant specialty colleges and societies. MAIN RECOMMENDATIONS: Generic guidelines exist for the intubation of different patient groups, as do resources to facilitate airway rescue and transition to the "can't intubate, can't oxygenate" scenario. They should be followed where they do not contradict our specific recommendations for the COVID-19 patient group. Consideration should be given to using a checklist that has been specifically modified for the COVID-19 patient group. Early intubation should be considered to prevent the additional risk to staff of emergency intubation and to avoid prolonged use of high flow nasal oxygen or non-invasive ventilation. Significant institutional preparation is required to optimise staff and patient safety in preparing for the airway management of the COVID-19 patient group. The principles for airway management should be the same for all patients with COVID-19 (asymptomatic, mild or critically unwell). Safe, simple, familiar, reliable and robust practices should be adopted for all episodes of airway management for patients with COVID-19. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Airway clinicians in Australia and New Zealand should now already be involved in regular intensive training for the airway management of the COVID-19 patient group. This training should focus on the principles of early intervention, meticulous planning, vigilant infection control, efficient processes, clear communication and standardised practice.

Recommendations for a safety dental care management during SARS-CoV-2 pandemic.

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted mainly through droplets, sneezes and aerosols, there is a high risk of transmission during dental procedures. This report describes measures that can be adopted by oral healthcare personnel to minimize the risk of cross-contamination in clinical practice during the current SARS-CoV-2 pandemic.

Dado que el SARS-CoV-2, causante de síndrome respiratorio agudo severo, se transmite principalmente por medio de gotitas, estornudos y aerosoles, existe un alto riesgo de transmisión durante los procedimientos dentales. En este informe se describen las medidas que puede adoptar el personal de salud bucodental para reducir al mínimo el riesgo de contaminación cruzada en la práctica clínica durante la actual pandemia por SARS-CoV-2.

Como o SARS-CoV-2, que causa síndrome respiratória aguda grave, é transmitido principalmente por gotículas, espirros e aerossóis, há um alto risco de transmissão durante os procedimentos odontológicos. Este relatório descreve os passos que podem ser tomados pelo pessoal de saúde oral para minimizar o risco de contaminação cruzada na prática clínica durante a actual pandemia do SARS-CoV-2.

Comparing South Korea and Italy's healthcare systems and initiatives to combat COVID-19.

Italy and South Korea have two distinctly different healthcare systems, causing them to respond to public health crises such as the COVID-19 pandemic in markedly different ways. Differences exist in medical education for both countries, allowing South Korean medical graduates to have a more holistic education in comparison to their Italian counterparts, who specialize in medical education earlier on. Additionally, there are fewer South Korean physicians per 1000 people in South Korea compared to Italian physicians per 1000 people in Italy. However, both countries have a national healthcare system with universal healthcare coverage. Despite this underlying similarity, the two countries addressed COVID-19 in nearly opposite manners. South Korea employed technology and the holistic education of its physician community, despite having a smaller proportion of physicians in society, to its advantage by implementing efficacious drive-through centers that test suspected individuals rapidly and with little to no contact with healthcare staff, decreasing the possibility of transmission of COVID-19. Conversely, Italy is presently considered the epicenter of the outbreak in Europe and has recorded the highest death toll of any country outside of mainland China. This is partially due to the reactionary nature of Italy's public health measures compared to South Korea's proactive response. The different healthcare responses of South Korea and Italy can inform decisions made by public health bodies in other countries, especially in countries across the Americas, which can selectively adopt policies that have worked in curtailing the spread of COVID-19 and learn from mistakes made by both countries.

Italia y Corea del Sur tienen dos sistemas de atención sanitaria claramente diferentes, lo que hace que respondan a crisis de salud pública como la pandemia por COVID-19 de maneras marcadamente distintas. Existen diferencias en la educación médica de ambos países, lo que permite a los graduados de medicina de Corea del Sur tener una educación más holística en comparación con sus homólogos italianos, que siguen una especialización médica de manera más temprana. Además, en Corea del Sur hay menos médicos por cada 1 000 personas en comparación con Italia. Sin embargo, ambos países tienen un sistema nacional de salud con cobertura universal. A pesar de esta similitud subyacente, los dos países abordaron la COVID-19 de maneras casi opuestas. A pesar de contar con una proporción menor de médicos en la sociedad, Corea del Sur empleó la tecnología y la educación holística de su comunidad médica a su favor al implementar centros de examen de personas con sospecha de infección sin descender del automóvil, que permitían una atención rápida y con poco o ningún contacto con el personal de salud, lo que disminuyó la posibilidad de transmisión de la enfermedad. Por el contrario, Italia es considerada actualmente el epicentro del brote en Europa y ha registrado el mayor número de muertes que cualquier otro país fuera de la China continental. Esto se debe en parte a la naturaleza reactiva de las medidas de salud pública de Italia en comparación con la respuesta proactiva de Corea del Sur. Las diferentes respuestas sanitarias de Corea del Sur e Italia pueden orientar las decisiones que deben tomar los organismos de salud pública de otros países, especialmente en la Región de las Américas, que pueden adoptar selectivamente políticas que han funcionado para reducir la propagación de la COVID-19 y aprender de los errores cometidos por ambos países.

A Itália e a Coreia do Sul têm dois sistemas de saúde distintos, o que os leva a responder a crises de saúde pública, como a pandemia COVID-19, de formas marcadamente diferentes. Existem diferenças na educação médica dos dois países, permitindo que os médicos sul-coreanos tenham uma educação mais holística em comparação com os seus homólogos italianos, que seguem uma especialização médica mais cedo. Além disso, há menos médicos por 1 000 pessoas na Coreia do Sul do que em Itália. No entanto, ambos os países têm um sistema nacional de saúde com cobertura de saúde universal. Apesar desta semelhança subjacente, os dois países abordaram a COVID-19 de maneiras quase opostas. Apesar de ter uma proporção menor de médicos na sociedade, a Coreia do Sul utilizou a tecnologia e a educação holística de sua comunidade médica a seu favor, implementando centros de rastreio para pessoas com suspeita de infecção sem sair do carro, o que permitiu cuidados imediatos e pouco ou nenhum contacto com o pessoal de saúde, diminuindo assim a possibilidade de transmissão da COVID-19. Por outro lado, a Itália é atualmente considerada o epicentro do surto na Europa e tem registrado o maior número de mortes de qualquer país fora da China continental. Isto deve-se em parte à natureza reactiva das medidas de saúde pública da Itália em comparação com a resposta pró-ativa da Coreia do Sul. As diferentes respostas de saúde da Coreia do Sul e da Itália podem informar as decisões das agências de saúde pública de outros países, especialmente da Região das Américas, que podem adoptar seletivamente políticas que tenham funcionado na redução da disseminação da COVID-19 e aprender com os erros cometidos por ambos os países.

To breastfeed or not to breastfeed? Lack of evidence on the presence of SARS-CoV-2 in breastmilk of pregnant women with COVID-19.

A rapid systematic review was carried out to evaluate the current evidence related to the presence of SARS-CoV-2 in breast milk from pregnant women with COVID-19. Eight studies analyzing the presence of SARS-CoV-2 RNA in the breast milk of 24 pregnant women with COVID-19 during the third trimester of pregnancy were found. All patients had fever and/or symptoms of acute respiratory illness and chest computed tomography images indicative of COVID-19 pneumonia. Most pregnant women had cesarean delivery (91.7%) and two neonates had low birthweight (< 2 500 g). Biological samples collected immediately after birth from upper respiratory tract (throat or nasopharyngeal) of neonates and placental tissues showed negative results for the presence SARS-CoV-2 by RT-PCR test. No breast milk samples were positive for SARS-CoV-2 and, to date, there is no evidence on the presence of SARS-CoV-2 in breast milk of pregnant women with COVID-19. However, data are still limited and breastfeeding of women with COVID-19 remains a controversial issue. There are no restrictions on the use of milk from a human breast milk bank.

Se llevó a cabo una revisión sistemática rápida para evaluar la evidencia disponible sobre la presencia de SARS-CoV-2 en la leche materna de mujeres embarazadas afectadas con COVID-19. Se encontraron ocho estudios que analizaron la presencia de ARN de SARS-CoV-2 en la leche materna de 24 mujeres embarazadas con COVID-19 durante el tercer trimestre del embarazo. Todas las pacientes tenían fiebre o síntomas de enfermedad respiratoria aguda e imágenes de tomografía computarizada de tórax indicativas de neumonía por COVID-19. La mayoría de las mujeres embarazadas (91,7%) tuvieron un parto por cesárea y dos neonatos presentaron bajo peso al nacer (< 2 500 g). Las muestras biológicas recogidas inmediatamente después del parto de las vías respiratorias superiores (faringe o nasofaringe) de los neonatos y los tejidos placentarios mostraron resultados negativos para SARS-CoV-2 mediante RT-PCR. Ninguna muestra de leche materna fue positiva para SARS-CoV-2 y, hasta la fecha, no hay evidencia de la presencia de SARS-CoV-2 en la leche materna de las mujeres embarazadas con COVID-19. Sin embargo, los datos disponibles todavía son limitados y la lactancia materna en las mujeres con COVID-19 sigue siendo un tema controvertido. No hay restricciones para el uso de leche materna de banco.

Foi realizada uma revisão sistemática rápida para avaliar as evidências atuais relacionadas à presença da SARS-CoV-2 no leite materno de mulheres grávidas com COVID-19. Foram encontrados oito estudos analisando a presença de RNA do SARS-CoV-2 no leite materno de 24 gestantes com COVID-19 durante o terceiro trimestre de gravidez. Todas as pacientes apresentavam febre ou sintomas de doença respiratória aguda e imagens de tomografia computadorizada do tórax indicativas de pneumonia pela COVID-19. A maioria das gestantes teve parto cesáreo (91,7%) e dois recém-nascidos tiveram baixo peso ao nascer (< 2 500 g). As amostras biológicas coletadas imediatamente após o nascimento do trato respiratório superior (faringe ou nasofaringe) de neonatos e tecidos placentários apresentaram resultados negativos para a presença do SARS-CoV-2 pelo teste RT-PCR. Nenhuma amostra de leite materno foi positiva para o SARS-CoV-2 e, até à data, não há evidências da presença do SARS-CoV-2 no leite materno de mulheres grávidas com COVID-19. No entanto, os dados ainda são limitados e a amamentação de mulheres com COVID-19 continua a ser uma questão controversa. Não há restrições ao uso de leite de um banco de leite materno humano.

Clinical trials on drug repositioning for COVID-19 treatment.

The World Health Organization (WHO) was informed on December 2019 about a coronavirus pneumonia outbreak in Wuhan, Hubei province (China). Subsequently, on March 12, 2020, 125,048 cases and 4,614 deaths were reported. Coronavirus is an enveloped RNA virus, from the genus Betacoronavirus, that is distributed in birds, humans, and other mammals. WHO has named the novel coronavirus disease as COVID-19. More than 80 clinical trials have been launched to test coronavirus treatment, including some drug repurposing or repositioning for COVID-19. Hence, we performed a search in March 2020 of the clinicaltrials.gov database. The eligibility criteria for the retrieved studies were: contain a clinicaltrials.gov base identifier number; describe the number of participants and the period for the study; describe the participants' clinical conditions; and utilize interventions with medicines already studied or approved for any other disease in patients infected with the novel coronavirus SARS-CoV-2 (2019-nCoV). It is essential to emphasize that this article only captured trials listed in the clinicaltrials.gov database. We identified 24 clinical trials, involving more than 20 medicines, such as human immunoglobulin, interferons, chloroquine, hydroxychloroquine, arbidol, remdesivir, favipiravir, lopinavir, ritonavir, oseltamivir, methylprednisolone, bevacizumab, and traditional Chinese medicines (TCM). Although drug repurposing has some limitations, repositioning clinical trials may represent an attractive strategy because they facilitate the discovery of new classes of medicines; they have lower costs and take less time to reach the market; and there are existing pharmaceutical supply chains for formulation and distribution.

En diciembre de 2019 fue informado a la Organización Mundial de la Salud (OMS) un brote de neumonía por coronavirus en Wuhan, provincia de Hubei, China. Al 12 de marzo de 2020, se habían notificado 125 048 casos y 4 614 muertes. El coronavirus es un virus ARN envuelto del género Betacoronavirus distribuido en aves, seres humanos y otros mamíferos. La OMS ha denominado a la nueva enfermedad por coronavirus COVID-19. Se han puesto en marcha más de 80 ensayos clínicos para evaluar un tratamiento para el coronavirus, que incluyen algunos ensayos de reposicionamiento de medicamentos para la COVID-19. En marzo de 2020 se llevó a cabo una búsqueda de los ensayos clínicos registrados en la base de datos clinicaltrials.gov. Los criterios de elegibilidad para los estudios recuperados fueron tener un número de identificación de la base de datos clinicaltrials.gov; describir el número de participantes y el período del estudio; describir las condiciones clínicas de los participantes; y emplear intervenciones con medicamentos ya estudiados o aprobados para cualquier otra enfermedad en pacientes infectados con el nuevo coronavirus SARS-CoV-2 (2019-nCoV). Es esencial destacar que este artículo solo recoge los ensayos que figuran en la base de datos clinicaltrials. gov. Se identificaron 24 ensayos clínicos relacionados con más de 20 medicamentos, como inmunoglobulina humana, interferones, cloroquina, hidroxicloroquina, arbidol, remdesivir, favipiravir, lopinavir, ritonavir, oseltamivir, metilprednisolona, bevacizumab y medicina tradicional china. Aunque el reposicionamiento de medicamentos tiene algunas limitaciones, el reposicionamiento de los ensayos clínicos puede representar una estrategia atractiva porque facilita el descubrimiento de nuevas clases de medicamentos; estos tienen costos más bajos y tardan menos en llegar al mercado; y existen cadenas de suministro farmacéutico que apoyan la formulación y la distribución.

A Organização Mundial da Saúde (OMS) foi informada, em dezembro de 2019, sobre um surto de pneumonia por coronavírus em Wuhan, província de Hubei (China). Posteriormente, em 12 de março de 2020, 125 048 casos e 4 614 mortes haviam sido registrados. O coronavírus é um vírus RNA envelopado do gênero Betacoronavírus, distribuído em aves e em humanos e outros mamíferos. A OMS designou a nova doença por coronavírus como COVID-19. Mais de 80 ensaios clínicos foram iniciados para testar tratamentos para o coronavírus, incluindo alguns de reposicionamento de medicamentos para o COVID-19. Assim, em março de 2020 realizou-se uma busca na base de dados clinicaltrials.gov. Os critérios de elegibilidade para os estudos recuperados foram: conter o número identificador da base de dados clinicaltrials.gov; descrever o número de participantes e o período do estudo; descrever as condições clínicas dos participantes; e utilizar intervenções para tratamento de doentes infectados com o novo coronavírus SARS-CoV-2 (2019-nCoV) com medicamentos já estudados ou aprovados para qualquer outra doença. É essencial salientar que este artigo apenas capturou ensaios listados na base de dados clinicaltrials.gov. Foram identificados 24 ensaios clínicos envolvendo mais de 20 medicamentos, tais como imunoglobulina humana, interferons, cloroquina, hidroxicloroquina, arbidol, remdesivir, favipiravir, lopinavir, ritonavir, oseltamivir, metilprednisolona, bevacizumabe e medicamentos chineses tradicionais. Embora o reposicionamento de medicamentos tenha algumas limitações, os ensaios clínicos de reposicionamento podem representar uma estratégia atraente, porque facilitam a descoberta de novas classes de medicamentos, têm custos mais baixos, levam menos tempo para chegar ao mercado e se beneficiam de cadeias de fornecimento farmacêutico já existentes para formulação e distribuição.

[Analysis of the correlation between lymphocyte subsets and severity of corona virus disease 19].

OBJECTIVE: To understand the differences in lymphocyte subsets in patients with different clinical classifications of corona virus disease 19 (COVID-19). METHODS: Eighty-one patients with COVID-19 who were admitted to the isolation ward under the responsibility of three medical aid teams in the Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from February 8, 2020 to March 28, 2020, were selected to collect clinical data. According to the relevant diagnostic criteria, the disease status of the patients was classified into moderate cases (n=35), severe cases (n=39) and critical cases (n=7) when lymphocyte subset testing was performed. Their blood routine tests, lymphocyte subsets and other indicators were tested to compare whether there were differences in each indicator between the patients of different clinical classification groups. RESULTS: The differences in the absolute count of total lymphocytes, T-lymphocytes, CD4+T-lymphocytes, CD8+T-lymphocytes and natural killer (NK) cells among the three groups of patients were all statistically significant (P < 0.05), and the critical cases were significantly lower than the moderate and severe cases in the above indicators, and the indicators showed a decreasing trend with the severity of the disease. In 22 patients, the six indicators of the absolute count of T-lymphocytes, B-lymphocytes, CD4+T-lymphocytes, CD8+T-lymphocytes and NK cells, CD4+/CD8+ ratio were all within the normal reference range in the first test, and 59 patients had abnormalities of the above indicators, with the absolute count of NK cells and CD8+ T lymphocytes decreasing most frequently (61%, 56%). The patients with the absolute count of NK cells and CD8+ T lymphocytes below the normal reference range were one group, and the remaining abnormal patients were the other group. There were more critical cases in the former group (moderate : severe : critical cases were 4 : 8 : 7 vs. 19 : 21 : 0, respectively, P=0.001), and all the deaths were in this group (6 cases vs. 0 case, P=0.001). The absolute B lymphocyte count was below the normal reference range in 15 patients, and the remaining 64 cases were within the normal range. The ratio of moderate, severe and critical cases in the reduced group was 4 : 7 : 4, and the ratio of critical cases was more in normal group which was 30 : 31 : 3, and the difference between the two groups was statistically significant (P=0.043). CONCLUSION: The more critical the clinical subtype of patients with COVID-19, the lower the absolute count of each subset of lymphocytes.

[Detection and evaluation of SARS-CoV-2 nucleic acid contamination in corona virus disease 19 ward surroundings and the surface of medical staff's protective equipment].

OBJECTIVE: To determine the environmental contamination degree of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in corona virus disease 2019 (COVID-19) wards, to offer gui-dance for the infection control and to improve safety practices for medical staff, by sampling and detecting SARS-CoV-2 nucleic acid from the air of hospital wards, the high-frequency contact surfaces in the contaminated area and the surfaces of medical staff's protective equipment in a COVID-19 designated hospital in Wuhan, China. METHODS: From March 11 to March 19, 2020, we collected air samples from the clean area, the buffer room and the contaminated area respectively in the COVID-19 wards using a portable bioaerosol concentrator WA-15. And sterile premoistened swabs were used to sample the high-frequency contacted surfaces in the contaminated area and the surfaces of medical staff's protective equipment including outermost gloves, tracheotomy operator's positive pressure respiratory protective hood and isolation clothing. The SARS-CoV-2 nucleic acid of the samples were detected by real-time fluorescence quantitative PCR. During the isolation medical observation period, those medical staff who worked in the COVID-19 wards were detected for SARS-CoV-2 nucleic acid with oropharyngeal swabs, IgM and IgG antibody in the sera, and chest CT scans to confirm the infection status of COVID-19. RESULTS: No SARS-CoV-2 nucleic acid was detected in the tested samples, including the 90 air samples from the COVID-19 wards including clean area, buffer room and contaminated area, the 38 high-frequency contact surfaces samples of the contaminated area and 16 surface samples of medical staff's protective equipment including outermost gloves and isolation clothing. Moreover, detection of SARS-CoV-2 nucleic acid by oropharyngeal swabs and IgM, IgG antibodies in the sera of all the health-care workers who participated in the treatment for COVID-19 were all negative. Besides, no chest CT scan images of medical staff exhibited COVID-19 lung presentations. CONCLUSION: Good ventilation conditions, strict disinfection of environmental facilities in hospital wards, guidance for correct habits in patients, and strict hand hygiene during medical staff are important to reduce the formation of viral aerosols, cut down the aerosol load, and avoid cross-infection in isolation wards. In the face of infectious diseases that were not fully mastered but ma-naged as class A, it is safe for medical personnel to be equipped at a high level.

[Investigation of protective exposure risk events in nurses against corona virus disease 2019 in Wuhan].

OBJECTIVE: To investigate the current situation of virus exposure risk incidents of nurses against corona virus disease 2019 (COVID-19) in Wuhan, and to provide reference evidence for nursing managers to protect nursing staff who were working in the isolation ward. METHODS: In the study, 308 nursing staff against COVID-19 working in the isolation ward in Wuhan were conveniently selected to participate in the investigation. The designed questionnaires including 7 kinds of protective exposure risk events were made by the team of researchers on the basis of literature review and interview with the nurses in Wuhan. All the participants recalled their working experience in the status of dressing in personal protective equipment and filled in the questionnaires online by WeChat according to the same instruction. RESULTS: The questionnaires were filled in validly by a total of 304 nursing staff, of whom 88.8% received emergency training on the prevention and dealing measurement of exposure risk events. The incidence of shoe cover contamination, falling off or torn was relatively high, about 53.6%. Due to the protection of gloves, the incidence of hand or skin contamination was relatively low, about 14.1%. The most nervousness of protective exposure risk event for nurses was N95 mask contamination, falling off or shifting, with a score of 8.2±2.3, showing a higher psychiatric burden. Single factor analysis found that the number of days in Wuhan was different, the number of the types of protective risk events occurred was different (χ2=14.562, P=0.024), orderly multivariate Logistic regression found that men were the independent protective factor for the number of the types of protective exposure risk events that occurred (P=0.019). CONCLUSION: Protective exposure risk events may occur in the work of nursing staff working in the isolation ward in Wuhan. It is necessary to guide nurses to prevent the occurrence of protective exposure risk events and effectively deal with them, so as to prevent virus exposure and reduce psycholo-gical burden.