Dear Editor,At 29th of February the World Health Organization (WHO) reported 85403 confirmed globally confirmed case of COVID-19 [1]. COVID-19 is dramatically increasing in Italy, the last report from the ministry of health on the 9th of march reported the presence of 9172 confirmed cases and 733 patients in intensive care unit (ICU) [2]. We agree with Chan et al that physicians managing airway procedures are at particularly high risk to contract the COVID-19 infection [3]. We support the authors that claimed for a full protective wearing including N95 respirator, gown, cap, eye protection, and gloves, during aerosol generating procedures (AGP) [3]. However, we’d like to focus the attention on the tracheostomy procedures in COVID-19 patients since otolaryngologists, anesthesiologists and intensive care physicians are at high risk of contracting the infection during tracheostomy [3]. Tracheostomy is required in case of prolonged mechanical ventilation and intensive care unit (ICU) stay [4]. Surgical tracheostomy is an AGP associated with an increased risk severe acute respiratory distress (SARS) infection [5]. Strict adherence to infection control guidelines in SARS is mandatory in performing tracheostomy in ICU or operating room [6].Few years ago, we proposed the double lumen endotracheal tube (DLET) for percutaneous tracheostomy in critically ill patients [7]. DLET was equipped with an upper channel that allows passage of a bronchoscope during the percutaneous tracheostomy and with a lower channel exclusively dedicated to patient ventilation [7]. The lower channel is equipped with a distal cuff positioned just above the carina that may allow a safe mechanical ventilation by keeping stable gas-exchange and limiting the spread of aerosol during the procedure [7]. During the percutaneous procedure, the puncture of the anterior tracheal wall, Seldinger insertion, dilatation, and cannula positioning were all performed with the DLET correctly placed in the trachea. The DLET was removed at the end of the tracheostomy when the cannula is inserted and correctly positioned with the FFB [7].Surgical tracheostomy in COVID-19 patients should be done with a close collaboration between otolaryngologists, preforming the surgical procedure, and anesthesiologists or intensive care physicians managing the general anesthesia and the airway.When a surgical tracheostomy is done under general anesthesia, just before the surgeon makes the tracheal stoma, the endotracheal tube is withdrawn, so that the cuff of the tube is not in the surgical field [8]. But when the surgeon makes the tracheal incision, ventilation is lost and the surgeon has to be quick enough to create the soma and insert the tracheostomy tube in a short time [8]. During this procedure a large spread of aerosol may occur. To avoid the aerosol, we suggest to push down the endotracheal tube beyond the site chosen for the tracheal stoma at the beginning of the procedure. The endotracheal tube should reach the tracheal carina so the cuff is surely distal to the tracheostomy site. By checking the airway pressure and the end-tidal CO2, on the mechanical ventilator we can realize if the endotracheal tube is still in the lower tract of the trachea or in the endobronchial tract. Our previous experience with the DLET demonstrated that the endotracheal tube and the tracheal cannula can be simultaneously inserted inside the trachea [7]. According to this, pushing down the endotracheal tube and cuffed it at the level of the carina may avoid the spread of aerosol and, then, may add an extra security for the medical staff during a procedure at high risk of generating aerosol.ReferencesCoronavirus disease 2019 (COVID-19) Situation Report – 40.https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200229-sitrep-40-covid-19.pdfItalian Minister of Health. COVID-19 Italian cases.http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?lingua=italiano&id=5351&area=nuovoCoronavirus&menu=vuotoChan YJK, Wong EWY, Lam W. Practical Aspects of Otolaryngologic Clinical Services During the 2019 Novel Coronavirus EpidemicAn Experience in Hong Kong. JAMA Otolaryngol Head Neck Surg. Published online March 20, 2020. doi:10.1001/jamaoto.2020.0488Vargas M, Sutherasan Y, Antonelli M, Brunetti I, Corcione A, Laffey JG, et al. Tracheostomy procedures in the intensive care unit: an international survey. Critical Care 2015;19:291-301Tran K, Cimon K, Severn M et al. Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. . PLoS ONE 2012; 7(4): e35797. doi:10.1371/journal.pone.0035797Chun-Wing A, Yin -Chun L, Kit-Ying L. Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS). Int. J. Med. Sci. 2004 1(1): 1-10Vargas M, Servillo G, Tessitore G, Aloj F, Brunetti I, Arditi E, et al. Percutaneous dilatational tracheostomy with a double-lumen endotracheal tube. A Comparison of Feasibility, Gas Exchange, and Airway Pressures. Chest 2015; 147:1267-74Walts PA, Sudish CM, DeCamp MM. Techniques of surgical tracheostomy. Clin Chest Med 24 (2003) 413 – 422

Background: The Coronavirus disease – 2019 (COVID-19) pandemic is a global health crisis and Otolaryngologists are at increased occupational risk of contracting COVID-19. There are currently no uniform best-practice recommendations for Otolaryngologic surgery in the setting of COVID-19.Methods: We reviewed relevant publications and position statements regarding the management of Otolaryngology patients in the setting of COVID-19. Recommendations regarding clinical practice during the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) outbreaks were also reviewed.Results: Enhanced personal protective equipment (N95 respirator and face shield or powered air-purifying respirator, disposable cap and gown, gloves) is required for any Otolaryngology patient with unknown, suspected, or positive COVID-19 status. Elective procedures should be postponed indefinitely, and clinical practice should be limited to patients with urgent or emergent needs. Conclusion: We summarize current best-practice recommendations for Otolaryngologists to ensure safety for themselves, their clinical staff, and their patients.

The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities.There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists and otolaryngologists.  Health workers represent between 3.8% to 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter).All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55-65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Healthcare facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for cancer patients.For those who are working with COVID-19 infected patients’ isolation is compulsory in the following settings: a) unprotected close contact with COVID-19 pneumonia patients: b) onset of fever, cough, shortness of breath and other symptoms (gastrointestinal complaints, anosmia and dysgeusia have been reported in a minority of cases).For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (e.g.; rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia) it is strongly recommended that all healthcare personnel wear personal protective equipment (PPE) such as N95, gown, cap, eye protection and gloves.The procedures described are essential in trying to maintain safety of healthcare workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.

A novel respiratory pathogen, SARS-CoV-2 has recently received worldwide attention and has been declared a public health emergency of global concern. Entry of SARS-CoV-2 is mediated through the viral spike glycoprotein (S2). Afterwards, the virus gets hold of the host cell machinery by employing the use of viral main protease 3CLpro and NSP15 endoribonuclease. In the present in silico study, active site mapping of the viral virulence factors was rendered by means of DoG Site Scorer. The possibility of repurposing of 2-deoxy-D-glucose (2-DG), a radio-chemo-modifier drug used for optimizing cancer therapy, and one of its derivative (1, 3, 4, 6-Tetra-O-acetyl-2-deoxy-D-glucopyranose, has been investigated by conducting ligand-receptor docking. Binding pose depictions of ligands and viral receptors were assessed by employing molecular dynamics analysis. Molinspiration and Toxicity Estimation Software tools were used to assess the drug likeliness, bioactivity indices and ADMETox values. 2-DG can dock efficiently with viral main protease 3CLpro as well as NSP15 endoribonuclease, thus efficiently inactivating these viral receptors leading to incapacitation of the SARS-CoV-2 virus. Such incapacitation was possible by means of formation of a hydrogen bond between 2-DG and proline residues of viral protease. The 2-DG derivative formed a hydrogen bond with the glutamine amino acid residues of the viral spike glycoprotein. The present in silico study supports the potential benefits of using 2-DG and its glucopyranose derivative as repurposed drugs/prodrugs for mitigating the novel COVID-19 infection. Since both these moieties present no signs of serious toxicity, further empirical studies on model systems and human clinical trials to ascertain effective dose-response are warranted and should be urgently initiated.

COVID-19 has emerged as a new viral illness with potential for significant morbidity and mortality. Pregnant women are high risk for contracting the virus or suffering from complications, however data regarding the effect of COVID-19 on pregnancy is limited to case reports from affected countries. The pathophysiology of COVID-19 infection may provide insights of the threat to mother and fetus. In this review we collate available evidence of harm caused by COVID-19 to mothers and their offspring in all trimesters. Obstetricians must understand the risks posed by this pandemic to effectively counsel women who are currently pregnant or planning conception.

Since end of December 2019, a cluster of patients with pneumonia of unknown origin was reported from Wuhan, Hubei province, China. They shared a connection with the Huanan South China Seafood Market in Wuhan, and now it has been confirmed that the disease is caused by a novel coronavirus (officially named COVID-19). According to real-time statistics from Johns Hopkins University in the United States, as of 5:30 on the 31st, Beijing time, the number of confirmed cases of COVID-19 pneumonia in the world has exceeded 770,000, reaching 777,286, and the number of deaths has reached 37,140. Currently, clinicians have found some atypical cases with positive chest CT findings may present with negative results of RT-PCR for COVID-19. The timely diagnosis, isolation and treatment of these patients will help control the further spread of COVID-19.

The novel coronavirus 2019 (COVID-19) pandemic is rapidly advancing across the globe despite public and personal health measures. Antivirals and nutritional supplements have been proposed as potentially useful against SARS-CoV-2 (virus that causes COVID-19), but few have been clinically established. Lactoferrin (Lf) is a naturally occurring and non-toxic glycoprotein that is orally available as a nutritional supplement and has established in vitro anti-viral efficacy against a wide range of virus including SARS-CoV, a closely related corona virus to SARS-CoV-2 (virus that causes COVID-19). Furthermore, Lf possesses unique immunomodulatory and anti-inflammatory effects that maybe especially relevant to the pathophysiology of severe COVID-19 cases. We review the underlying biological mechanisms of Lf as antiviral and immune regulator, and propose its unique potential as preventative and adjunct treatment for COVID-19. We hope that further research and development of Lf nutritional supplementation would establish its role for COVID-19.

First gaining worldwide attention in February 2020, COVID-19 has infected 500,000, and taken the lives of 21,000 as of the 27th March 20201. In response to the rapidly escalating global crisis, most countries have employed drastic measures such as travel bans and nationwide lockdowns in an urgent attempt to slow down viral spread so as not to overwhelm limited healthcare resources. “Social distancing” is the catchphrase of the day. Singapore saw her first imported case on the 23rdJanuary 20202 and felt déjà vu , having experienced the Severe Acute Respiratory Syndrome [SARS] outbreak in 2003.Singapore’s response to SARS demonstrated two key priorities: sustainability of patient care and protection of healthcare professionals [HCPs]. While manpower was reorganised into teams segregated by time, place and expertise, many important hospital functions such as medical education and intermediate exam preparation for specialist trainees [STs] were ignored3 4. The only training was “on-the-job,” focusing on essential care. Both specialist and general training for junior doctors was neglected despite their frontline role. The situation with COVID-19 is no different, and globally we are already witnessing a negative impact on education and training5. While understandable, work-arounds do exist. In Singapore, we have been preparing for this6and our unit made it an early priority to continue medical education while balancing increased service needs and the requirement to avoid congregation. With the COVID-19 pandemic expected to last until the end of 2020 and possibly beyond, we share our strategies.To safeguard HCPs and ensure continuity of services in the inevitable event that HCPs contract COVID-19, hospitals nationwide have implemented team segregation. In our department, different teams work shifts to cover five geographically distinct service areas- outpatient services [two teams], emergency department [four teams], labour ward [four teams], sonography unit [two teams] and inpatient services [two teams]. The greatly increased manpower needs, non-standard working hours, the need to avoid congregation and depletion of staff through illness initially stopped our morning didactic sessions. However, within two weeks, we started using videoconferencing methods for synchronous distance teaching. While the use of videoconferencing in medical education is not new7 8, it has found revived utility in these times. The lead and assistant program directors created a timetable with topics blueprinted to the Royal College of Obstetricians and Gynaecologists membership examination [MRCOG] syllabus incorporating Green Top Guidelines, NICE guidelines, TOG articles and other RCOG documents such as consent advice, good practice, scientific impact papers, audits and key publications. This timetable was divided amongst the STs who committed to 1-2 sessions each per month. They were encouraged to select topics which represented personal knowledge gaps. The format comprises a 30-minute presentation with assessment of learning through Q&A, EMQs or SBA. These sessions are facilitated by senior faculty with our programme coordinators tracking education hours and attendance by verifying on-screen presence. We hold sessions at 0730hrs as it constitutes a quieter period prior to hand over and when most STs are awake. Those who are commuting, off work, or on quarantine / stay home notice still find it easy to participate.Zoom® [Zoom Video Communications Inc., San Jose, California, USA] has several features which have greatly assisted our mission. The most significant is its stability over a wide variety of platforms [i.e. smart phones and computers] running different operating systems over local 4G networks. Presenters found the “Share Screen” function very user friendly to allow voice-over teaching with their presentation slides. A pre-determined, recurrent meeting code is fixed for the morning session. Zoom® also allows recordings of the session which are stored on a hospital-based intranet server together with the presentation slides and the source guideline or article. This serves as a form of asynchronous teaching for those who missed the session or wish to revise.Comical usage of virtual backgrounds and participation of some our STs’ very young children at home brought in humour and gave a sense of solidarity at a time of isolation. Senior STs revealed themselves as natural peer trainers regarding exam technique. Interestingly, some of our junior STs felt that this style of teaching was more interactive than our typical Departmental didactic sessions. One remarked, “Zoom® meetings are more fun and meaningful because they are directed at what is really important for us to know and it is easy to ask questions fearlessly.” This is a positive consequence as many cultures fear “losing face” by asking questions in an audience of senior faculty. The end of the meeting also allows for any “on the ground” operational issues to be raised while serving as a conduit to pass on information from department leaders.A vital aspect of Singapore’s response to COVID-19 was to cut all non-time-sensitive surgical cases in order to boost surge critical care capacity and redistribute manpower and resources. In our unit, there is an 80-90% reduction in operating for benign gynaecology cases with only obstetric and gynaecologic oncology cases proceeding. Due to manpower constraints, all surgeries and on-table consultations are being undertaken by consultants with house officer assistance. As a result, STs’ gynaecological operative training has been greatly reduced. To partly address this, we started Zoom®-based surgical sharing sessions by experienced faculty, taping segments of current surgical cases or using archived videos to train on anatomy, surgical principles and pre- and post-operative care. A session on the management of ovarian cysts in pregnancy coincided with three recent cases and was particularly well received. Although videoconferencing has a role in surgical training9, it is very clear that it will not entirely remedy case-log deficiencies and the loss of hands-on experience. Simulators housed within the Department are available for individual use and we plan to incorporate these into “live” sessions.The MRCOG examinations, which are used to certify competence for progression within Singapore’s obstetrics and gynaecology specialist training programme, have been postponed10. To keep our exam candidates’ preparedness honed while waiting for the next exam window, we have also continued in-house Zoom® OSCE practice sessions. Prior to this pandemic, our STs were supported to take up RCOG Associate status in order to facilitate access to the RCOG’s excellent e-learning11 12 portal. We strongly recommend it as a staple for asynchronous learning as it is a repository for a wide array of modules pertaining to core knowledge, case discussions, technical skills and professionalism. Many Colleges globally have similar material, and these should be explored.This pandemic will undoubtedly affect the training and psychosocial wellbeing of STs who constitute a major component of the frontline staff. Disruption to training affects confidence and exam cancellations instil fear for the future as key purchases and family plans are put on hold. However, while this pandemic is expected to last until the end of the year, women’s health issues will continue to exist. It is important for the global community of obstetricians and gynaecologists to start seeing how to ensure continuity of training in this new environment. We offer a few simple suggestions on how to achieve this despite dyssynchronous rosters, home stay notices, anxiety, exhaustion and illness. Anecdotally, our STs report have found solidarity in a time of isolation through these morning sessions and it probably contributes to their ability to cope. The pandemic of today is daunting. We need to support our STs because to do so is to invest into the future of women’s health.

Lung ultrasound (LU) has rapidly become a tool for assessment of patients stricken by the novel coronavirus 2019 (COVID-19). Over the past two and a half months (January, February and first half of March 2020) we have used this modality for identification of lung involvement along with pulmonary severity in patients with suspected or documented COVID-19 infection. Use of LU has helped us in clinical decision making and reduced the use of both chest x-rays and computed tomography (CT).

Orleans Parish in Louisiana is in the midst of an exponentially increasing number of patient admissions with COVID-19 and respiratory symptoms. Patients have been described having CT findings most consistent with an Early stage (< 7 days from symptoms onset) or an Advanced stage (8-14 days from symptoms onset).We describe and illustrate those Early and Advanced stage CT findings from patients with documented COVID-19 who have been admitted to University Medical Center in New Orleans, Louisiana.

A 57-year-old man was diagnosed with acute aortic dissection (AAD), but had marked infiltration shadows in his right lung. Intraoperative findings showed that large subadventitial hematomas had spread from the ascending aorta to the right pulmonary artery, which may have caused the infiltration of the lung. Subadventitial hematoma must be considered in rare cases of AAD with pulmonary infiltration.

Background: The corona virus disease 2019 (COVID-19) outbreak originating in Wuhan, Hubei province, China, coincided with chunyun, the period of mass migration for the annual Spring Festival. To contain its spread, China adopted unprecedented nationwide interventions on January 23 2020. These policies included large-scale quarantine, strict controls on travel and extensive monitoring of suspected cases. However, it is unknown whether these policies have had an impact on the epidemic. We sought to show how these control measures impacted the containment of the epidemic. Methods: Web of Science database was searched on February 26, 2020 for Corona virus (COVID-19) publications published between 1997 to 2020. It was performed on the same day in order to avoid the possible bias came from update on the database because the metrics are changing over time. All publication types were considered; however publications as errata were excluded. Analysis parameters include year of publication, publication type, patterns of international collaboration, research institutions, journals, impact factor, h-index, language, and times cited. Results: A total of 12612Corona virus (COVID-19) research publications were published across the world. The Corona virus (COVID-19) associated publications were originated from 25 countries/territories, indicating the international spread of Corona virus (COVID-19) research. The USA was the largest contributor, with 4524 articles published over 32 years, followed by Peoples R China(2667 articles). The total number of citations for these publications has already achieved 8,015, with an average of 9.01 citations per each publication. The h-index for Corona virus (COVID-19) -associated publications was 48. The USA also have the highest h-index (32), followed by KSA (26) and UK (22). Netherland produced the greatest proportion of publications with international research collaboration (72.7 %) followed by the UK (71 %) and Germany (69.1 %) out of the total number of publications for each country.

COVID-19 pandemic disease spread by SARS-COV-2 single-strand structure RNA virus belongs to the 7th generation of the coronavirus family. Following an unusual replication mechanism, its extreme ease of transmissibility has put many counties under lockdown. With a cure for the infection uncertain in the near future, the pressure currently lies in the current healthcare infrastructure, policies, government activities, and behaviour of the people to contain the virus. This research seeks to understand the spreading patterns of the COVID-19 virus through exponential growth modelling and identifies countries that have showed an initial sign of containment until 26th March 2020. Post identification of countries that have shown an initial sign of containment, predictive supervised machine learning models were built with infrastructure, environment, policies, and infection related independent variables. For the purpose, COVID-19 infection data across 42 countries were used. Logistic regression results shows a positive significant relationship of healthcare infrastructure and lockdown policies on the sign of early containment in countries. Machine learning models based on logistic regression, decision tree, random forest, and support vector machines were developed and are seen to have accuracies between 76.2% to 92.9% to predict early sign of infection containment. Other policies and activities taken by countries to contain the infection are also discussed.

Coronaviruses are a large group of viruses which are found in avian and mammalian species. It has been reported that, the identification and characterization of a novel coronavirus (2019-nCoV) which caused a pandemic of acute respiratory syndrome in humans in Wuhan, China. By 26 January 2020 it has caused 2,050 laboratory-confirmed infections with 56 fatal cases. Furthermore, it was found that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus.The new coronavirus SARS-CoV-2 binds with human respiratory cells in order to hijack them to produce more viruses. The new virus attaches to a receptor on respiratory cells called angiotensin-converting ACE2. The most abundant protein in coronavirus is the nucleocapsid protein.

Objective: To study the pregnancy outcomes of vaginal delivery and neonatal prognosis during the epidemic of COVID-19, and to summarize the management of vaginal delivery. Design: Retrospective review of medical records Setting: Zhongnan Hospital of Wuhan University, Wuhan, China Sample: Pregnant women (n=63) with vaginal delivery from January 20 to March 02, 2020 Methods: Retrospectively analyzed the outcomes of vaginal delivery in 10 pregnant women with clinical diagnosis of COVID-19 and 53 pregnant women without COVID-19 from January 20 to March 02, 2020. The related laboratory tests, imaging tests and the SARS-CoV-2 nucleic acid tests results were also analyzed in neonates delivered by pregnant woman with clinical diagnosis of COVID-19. Main Outcome Measures: Delivery outcomes and neonatal outcomes Results: (1) There were no significant differences in gestational weeks, postpartum hemorrhage (245±49.72ml vs 237±85.99ml), and perineal resection rates (10% vs 7.55%) between the two groups. (2) There were no significant differences in birth weight of neonates(3283±449g vs 3274±456g) and neonatal asphyxia between the two groups. Results of the blood routine, throat swabs test for nucleic acid of SARS-CoV-2 and chest radiograph of neonates delivered by pregnant woman with clinical diagnosis of COVID-19 showed no signs of the SARS-CoV-2 infection. Conclusions: Pregnant women with mild COVID-19 can delivery vaginally without exacerbation of COVID-19 and without increasing the risk of SARS-CoV-2 infection in the neonates. Keywords: COVID-19；outcomes of vaginal delivery；neonatal prognosis；management Tweetable abstract：Pregnant women with mild COVID-19 can try vaginal delivery

We are proposing a new hypothesis for the antiviral mechanism of hydroxychloroquine (HCQ), based on our computer aided docking studies. HCQ is a clinical trial drug under investigation for the treatment of Covid-19 pandemic. SARS-CoV-2 is the causative agent of the Covid-19 and it binds to host’s bromodomain proteins BRD-2/4. The bromodomain proteins are readers of acetylated histones and play a critical role for host’s hype-immune response to this pathogen. Covid-19 virus protein E mimics acetylated histones and binds at the same site on BRD-2. We propose that the hijacking of BRD-2/4 by SARS-CoV-2, can be thwarted by the use of inhibitors of BRD-2/4. Preliminaryin-silico docking studies with HCQ, indicates that it binds to the same pocket on BRD-2 where viral envelope protein E binds. Therefore, HCQ may acts as a BRD-2 inhibitor, thereby preventing “cytokine storm” initiated by SARS-CoV-2 virus. Another FDA approved drug celecoxib (Celebrex) binds in the same pocket of BRD-2 and the key amino acid interactions between the drug and protein are conserved. Thus, celecoxib may offer innovative path for controlling the Covid-19 pandemic.

Purpose : Pulmonary ultrasound can rapidly identify the etiology of acute respiratory failure (ARF) and assess treatment response. The often-subjective classification of abnormalities makes it difficult to document change over time and communicate findings across providers. The study goal was to develop a simple, scoring system that would allow for standardized documentation, have high inter-provider agreement, and correlate with clinical metrics.Methods : rospective of adults intubated for ARF performed at intubation, 48-hours, and extubation. A total lung score (TLS) was calculated. Clinical metrics and final diagnosis were extracted from the medical record.Results : TLS correlated positively with mortality (p=0.0), ventilator hours (p0.00), intensive care unit and hospital length of stay (p=0.00, p=0.0), and decreasing PaO2/FiO2 (p0.00). Agreement of findings was very good (kappa=0.83). Baseline TLS differed significantly between ARF categories (non-pulmonary, obstructive, and parenchymal disease).Conclusions : A quick, was associated with clinical metrics including mortality among a diverse population of patients intubated for ARF. In addition to diagnostic and prognostic information at the bedside, a standardized and quantifiable approach to PU provides objectivity in serial assessment and may enhance communication of findings between providers.

A document by Marzieh Zamaniyan, written on Authorea.

Emerging pathogens have been an eternal threat to mankind. In a series of pandemics caused by notorious coronaviruses, a newly emerged virus is creating panic among world population. Originating in late December, 2019 from Wuhan, China, the SARS-CoV-2 is spreading its terror throughout the world. The virus is rapidly transmitted due to unavailability of effective theranostics. In this study, multiple sequence alignment of SARS-CoV-2 spike protein was done and four novel inserts were found in comparison to SARS-CoV. Using computational informatics tool viz. IEDB B-cell epitopes prediction tool, B-cell immunogenic epitopes of SARS-CoV-2 spike protein was predicted. Five novel potent epitopes i.e. ‘71SGTNGTKRFDN81, 247SYLTPG252, 634RVYST638, 675QTQTNSPRRARSV687 and 1054QSAPH1058 were selected as antigenic determinants and their docking with the 3D structure of ACE2 receptor was delineated. The quantum of information generated by this study will prove beneficial for development of effective therapeutics, diagnostics and multiepitopic vaccines to combat this ongoing menace.

The current outbreak of COVID-19 has escalated into a global health crisis. Investigations into the epidemic have taken place upon an unprecedented stage of rapid, open-platform science, including vastly improved access to unreviewed preprint research.I quantified preprint responses to COVID-19 by examining 785 preprints posted to English-language preprint servers (bioRxiv, n = 140; medRxiv, n = 561; arXiv, n = 84). Preprint research during the current outbreak has been enormously accelerated, with an average of 11.9 preprints posted per day – over a hundred-fold higher than that during 2014’s West African ebolavirus outbreak.While this boom in preprints has enabled valuable knowledge sharing of scientific developments, novel challenges have become apparent. Unfounded conclusions from unreviewed research have played a clear role in public misinformation about the epidemic. I provide recommendations to improve accountability and transparency surrounding preprints, a vital step for future outbreaks as open-platform epidemiology continues to advance.

Coronavirus Disease 2019 (COVID-19) is an emerging disease with a rapid increase in cases and deaths since its first identification in Wuhan, China, in December 2019. As of March 21, 2020, more than 193,327 confirmed cases of COVID-19 have been reported in 178 countries and states, and Italy is currently the country with the highest number of confirmed casesoutside of China. The WHO declared a public health emergency of international concern (PHEIC) on January 30, 2020, and characterised the COVID-19 situation as a pandemic on March 11, 2020, in response to the human-to-human transmission and rapid growth of the outbreak. The popularity of COVID-19 has obviously entered a new stage and has spread rapidly in countries outside China. As the front-line clinical workers, Obstetricians and Gynaecologists should be vigilant to assess whether pregnant women or female patients are suspected or confirmed of infection, improve their knowledge of prevention and treatment of COVID-19, and take effective precautionary measures.Here, we reviewed the current understanding of COVID-19, combined with the particularity of the patients in gynecology and obstetrics, and share our experience of current clinical practice recommendations and precautions taken at frontline, and discuss how obstetricians and gynaecologists should prepare themselves to deal with the outbreak of this disease.

Convalescent plasma may be of clinical benefit for treatment of 2019 Novel Coronavirus. We conducted a systematic review and meta-analysis of these interventions, including Middle East respiratory syndrome-Coronavirus (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV) to summarize reliable evidences of the treatment.Methods:Three major electronic databases (PubMed, Google scholar) were searched，Several studies were collected for Meta-analysis.Results:Seven studies were included in Meta-analysis, including a total number of 416 patients with SARS and 169 patients with MERS infection. Meta-analysis shows that in critically ill patients, the Convalescent plasma can reduced mortality significently. (odds ratio [OR]=0.27;95% confidence interval [CI]=0.15-0.50; I2=0%;P = 0.47).Conclusions:The therapy of Convalescent plasma can reduce mortality of patients with Coronavirus，and it need to be further verified with Large-scale clinical trial.

The COVID19 virus has plagued the world, as a cellular and molecular biologist, I am presenting this commentary after careful analysis of the genomic structure of the virus and its effects on the lungs.Why does it affect the older generation more compared to young adults and children?The free radical theory of aging proposes that organisms age because they accumulate oxidative damage1-3. I postulate this causes the older population to have an increase in reactive oxygen species (ROS) 4-7, which partially reduces metabolites of molecular oxygen generated as by-products of various cellular processes, such as respiration1,8. This creates a condition of hypoxia, particularly in the lungs as the lung volume and capacity decreases with age9.Another interesting phenomena to note is that severe acute respiratory syndrome (SARS-CoV) virus, which is genetically similar to corona virus, are known to proliferate in hypoxia conditions. Hence, making the older generation more susceptible to disease.Another point to be noted is the lungs are highly vulnerable to viral infection as the express increased cell surface proteins that the viruses use to gain entry into the cell10. Latest research shows that ACE2 (Angiotensin-converting enzyme 2) has been identified as a potential SARS-CoV2 receptor and is highly expressed in the lungs11-12. One of the severe manifestations of corona virus is lung fibrosis, even when the patient is recovered, the lung function declines by 20-30%13-15. The initiation of lung fibrosis occurs as ROS species are generated by NADPH oxidase-4 (NOX4), the pathway it triggers is angiotensin II (AngII) type 1 receptor (AT1R) axis which causes increased ROS production in lung fibroblasts16. Angiotensin-converting enzyme 2 (ACE2) counteracts this inhibition via the RhoA/Rock pathway by reducing NOX4-derived ROS16. My hypothesis is that as the SARS-CoV2 virus enters the bloodstream, infecting the lung cells, it uses all the available ACE2 receptors, which causes an elevation in AngII-AT1R axis, which leads to activation of NOX4-derived ROS-mediated RhoA/Rock pathway, creating a hypoxic environment, this further facilitates viral multiplication and causes chronic obstructive in the lungs. Therefore, pharmacological antioxidants can act as potential drug targets in this scenario.In layman’s terms- for this virus to multiply, it requires hypoxic conditions and it creates this by attacking the lung surface protein that prevents hypoxia. Potentially, if we have more antioxidants in our body the lesser chance of the virus finding the ideal conditions to proliferate.

Background and purpose: Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome- Coronavirus 2 (SARS-CoV2) is a highly contagious disease that has infected more than 200,000 patients and led to more than 10000 deaths in 166 countries in less than four months. New medications are needed to combat this disease. Since the process of discovery, development and approval of new drugs is long, old drugs can be repurposed for treatment of COVID-19. Oseltamivir is used for management of COVID-19 and Influenza A. Rimantadine is an alternative drug to oseltamivir for management of influenza A. Therefore, it is possible that rimantadine can be used for management of COVID-19 as an alternative to oseltamivir. The purpose of the study is to verify the potential of rimantadine as a drug for COVID-19 Methods: The SARS-CoV2 nucleocapsid was downloaded from the Protein databank and the chemical structure of rimantadine downloaded from Pubchem. Molecular docking of the nucleocapsid as the receptor and rimantadine as the ligand was done using avogadro and chimera software. Prediction of pharmacokinetic properties was done using SWISSADME website while the toxicity properties predicted using the ProTox server. Results: The interactions between rimantadine and the SARS-CoV2 nucleocapsid involved conventional hydrogen bonding with threonine & asparagine; attractive charge interaction with aspartate and Pi-alkyl interaction with tryptophan. Rimantadine has high gastrointestinal activity, very few drug-drug interactions and is relatively safe. Conclusion: Rimantadine binds to the SARS-CoV2 nucleocapsid and can thus be used for management of COVID-19. Keywords: Rimantadine, COVID-19, SARS-CoV2, Oseltamivir