COVID-19 pandemia is a major health emergency causing hundreds of deaths worldwide. The high reported morbidity has been related to hypoxia and inflammation leading to endothelial dysfunction and aberrant coagulation in small and large vessels. This review addresses some of the pathways leading to endothelial derangement, such as complement, HIF-1, and ABL tyrosine kinases. This review also highlights potential targets for prevention and therapy of COVID-19-related organ damage and discusses the role of marketed drugs, such as eculizumab and imatinib, as suitable candidates for clinical trials.

Background. The Middle East respiratory syndrome coronavirus (MERS-CoV) was discovered September 2012 in the Kingdom of Saudi Arabia (KSA). The first US case of MERS-CoV was confirmed on 2 May 2014. Methods. We summarize the clinical symptoms and signs, laboratory and radiologic findings, and MERS-CoVCspecific tests. Results. The patient is a 65-year-old physician who worked in a hospital in KSA where MERS-CoV patients were treated. His illness onset included malaise, myalgias, and low-grade fever. He flew to the United States on day of illness (DOI) 7. His first respiratory symptom, a dry cough, developed on DOI 10. On DOI 11, he presented to an Indiana hospital as dyspneic, hypoxic, and with a right lower lobe infiltrate on chest radiography. On DOI 12, his serum tested positive by real-time reverse transcription polymerase chain reaction (rRT-PCR) for MERS-CoV and showed high MERS-CoV antibody titers, whereas his nasopharyngeal swab was rRT-PCR negative. Expectorated sputum was rRT-PCR positive the following day, with a high viral load (5.31 10(6) copies/mL). He was treated with antibiotics, intravenous immunoglobulin, and oxygen by nasal cannula. He was discharged on DOI 22. The genome sequence was similar (>99%) to other known MERS-CoV sequences, clustering with those from KSA from June to July 2013. Conclusions. This patient had a prolonged nonspecific prodromal illness before developing respiratory symptoms. Both sera and sputum were rRT-PCR positive when nasopharyngeal specimens were negative. US clinicians must be vigilant for MERS-CoV in patients with febrile and/or respiratory illness with recent travel to the Arabian Peninsula, especially among healthcare workers.

On December 2019, a new coronavirus disease (COVID-19) emerged in China and spread worldwide, causing acute severe respiratory syndrome. Due to the increased transmission rate of the virus, it became of great importance the early diagnosis of the disease. The coronavirus pandemic led to the development of numerous tests in order to mass screening population for active viral load and for the identification of antibodies for epidemiological purposes. This review summarizes the different diagnostic tests available to the clinicians for the diagnosis and follow up of the SARS COV-2 infections.

BackgroundSARS-CoV-2 infection and its health consequences have disproportionally affected disadvantaged socio-economic groups globally. This study aimed to analyze the association between socio-economic conditions and having developed anti-SARS-CoV-2 antibodies in a population-based sample in the canton of Geneva, Switzerland. MethodsData was obtained from a population-based serosurvey of adults in Geneva and their household members, between November and December, 2020, towards the end of the second pandemic wave in the canton. Participants were tested for anti-SARS-CoV-2 antibodies. Socio-economic conditions representing different dimensions were self-reported. Mixed effects logistic regressions were conducted for each predictor to test its association with seropositive status as the main outcome. Results2,889 adults completed the study questionnaire and were included in the final analysis. Retired participants and those living in suburban areas had lower odds of a seropositive result when compared to employed participants (OR 0.42, 95% CI - 0.20 - 0.87) and those living in urban areas (OR 0.67, 95% CI - 0.46 - 0.97), respectively. People facing financial hardship for less than a year had higher odds of a seropositive result compared to those who had never faced them (OR 2.23, 95% CI - 1.01 - 4.95). Educational level, occupational position and household income were not associated with being seropositive, nor were ethnicity or country of birth. DiscussionWhile traditional measures of socio-economic position did not seem to be related to the risk of being infected in this sample, this study sheds lights on the importance of examining the broader social determinants of health when evaluating the differential impact of the pandemic within the population.

Coronovirus disease 2019 (COVID-19) infection, which originated from Wuhan, China, has seized the whole world in its grasp and created a huge pandemic situation before humanity. Since December 2019, genomes of numerous isolates have been sequenced and analyzed for testing confirmation, epidemiology, and evolutionary studies. In the first half of this article, we provide a detailed review of the history and origin of COVID-19, followed by the taxonomy, nomenclature and genome organization of its causative agent Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV-2). In the latter half, we analyze subgenus Sarbecovirus (167 SARS-CoV-2, 312 SARS-CoV, and 5 Pangolin CoV) genomes to understand their diversity, origin, and evolution, along with pan-genome analysis of genus Betacoronavirus members. Whole-genome sequence-based phylogeny of subgenus Sarbecovirus genomes reasserted the fact that SARS-CoV-2 strains evolved from their common ancestors putatively residing in bat or pangolin hosts. We predicted a few country-specific patterns of relatedness and identified mutational hotspots with high, medium and low probability based on genome alignment of 167 SARS-CoV-2 strains. A total of 100-nucleotide segment-based homology studies revealed that the majority of the SARS-CoV-2 genome segments are close to Bat CoV, followed by some to Pangolin CoV, and some are unique ones. Open pan-genome of genus Betacoronavirus members indicates the diversity contributed by the novel viruses emerging in this group. Overall, the exploration of the diversity of these isolates, mutational hotspots and pan-genome will shed light on the evolution and pathogenicity of SARS-CoV-2 and help in developing putative methods of diagnosis and treatment.

Type 2 diabetes (T2D) is one of the most common chronic metabolic disorders in adulthood worldwide, whose pathophysiology includes an abnormal immune response accompanied by cytokine dysregulation and inflammation. As the T2D-related inflammation and its progression were associated with the balance between pro and anti-inflammatory cytokines, anticytokine treatments might represent an additional therapeutic option for T2D patients. This review focuses on existing evidence for antihyperglycemic properties of disease-modifying antirheumatic drugs (DMARDs) and anticytokine agents (anti-TNF-, anti-interleukin-(IL-) 6, -IL-1, -IL-17, -IL-23, etc.). Emphasis is placed on their molecular mechanisms and on the biological rationale for clinical use. Finally, we briefly summarize the results from experimental model studies and promising clinical trials about the potential of anticytokine therapies in T2D, discussing the effects of these drugs on systemic and islet inflammation, beta-cell function, insulin secretion, and insulin sensitivity.

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic dramatically altered the delivery of surgical care. METHODS Members of the Southeastern Surgical Congress were surveyed regarding system adjustments, personal impact, and productivity losses. Subgroups were analyzed for disproportionate impact across practice models (academic/employed/private), practice communities (urban, suburban, rural), and practice case-mix categories (broad general surgery, narrow general surgery, specialty practice, hospital-based practice). RESULTS 135 respondents reported that 98.5% of surgeons and 97% of hospitals canceled elective cases. Practices and hospitals reduced staffing dramatically. Telemedicine was utilized by most respondents. Hospitals variably implemented system changes, developed tests, and set up diagnostic centers. Most surgeons anticipated resumption of practice and hospital activity by July 1, 2020. More than one-quarter reported worsened financial status and personal well-being. Interestingly, family/personal relationships were improved in more than one-third. Most surgeons anticipate reduced year-end case volumes, clinical productivity, and salary. In subgroup analyses, academic surgeons were more likely than employed and private-practice surgeons to use telemedicine and to work in hospitals with in-house COVID-19 testing. Private-practice surgeons expected decreased financial status, case volumes, relative value units (RVUs), and salary. More rural surgeons anticipate reduced salary than urban and suburban surgeons. Surgeons in narrow general surgery practice reported more furlough of employees than specialty surgeons, hospital-based surgeons, and broad-based general surgeons. Narrow-practice surgeons and specialists were more likely to report RVU reductions and improved family/personal relationships. DISCUSSION The COVID-19 slowdown affected surgeons throughout the southeastern United States. Variations between different practice models, communities, and case-mix categories may help inform surgeons in the future.

Physical activity and physical exercise are key factors to help the population to mitigate the effects that the current pandemic is causing on the mental and physical health of citizens worldwide. In such an extreme situation, it is highly recommended to be physically active. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background: The global epidemic of SARS-CoV-2 caused various deprivations and threats and forced the implementation of drastic restrictions in the whole world, including Poland. Objectives: Recognizing the consequences of the epidemic in the context of basic psychological needs satisfaction and frustration, the level of experienced stress, and the use of coping strategies. Design: The results of the pre-epidemic group (N = 626;aged 18 - 40) were compared with the results of the epidemic group (N = 282;aged 17 - 44). The following tests were used;BPNS&FS (Chen et al., 2015), PSS (Cohen et al., 1983), and COPE (Carver et al., 1989). Results: Women from the epidemic group reported higher levels of stress, lower satisfaction and higher frustration of autonomy and competence than the control group. Men from the epidemic group differed from the control group only by a higher frustration of autonomy. We found significant differences in coping strategy preference. The epidemic group was characterized by the following strategies: acceptance, mental disengagement, restraint, positive reinterpretation and growth, use of emotional social support, and use of humor. Conclusions: The results are consistent with previously documented reactions to uncontrolled and critical stressors and indicate the adaptability of undertaken coping efforts.

The global spread of COVID-19 has caused pandemics to be widely discussed. This is evident in the large number of scientific articles and the amount of user-generated content on social media. This paper aims to compare academic communication and social communication about the pandemic from the perspective of communication preference differences. It aims to provide information for the ongoing research on global pandemics, thereby eliminating knowledge barriers and information inequalities between the academic and the social communities. First, we collected the full text and the metadata of pandemic-related articles and Twitter data mentioning the articles. Second, we extracted and analyzed the topics and sentiment tendencies of the articles and related tweets. Finally, we conducted pandemic-related differential analysis on the academic community and the social community. We mined the resulting data to generate pandemic communication preferences (e.g., information needs, attitude tendencies) of researchers and the public, respectively. The research results from 50,338 articles and 927,266 corresponding tweets mentioning the articles revealed communication differences about global pandemics between the academic and the social communities regarding the consistency of research recognition and the preferences for particular research topics. The analysis of large-scale pandemic-related tweets also confirmed the communication preference differences between the two communities.

The primary function of the respiratory system of gas exchange renders it vulnerable to environmental pathogens that circulate in the air. Physical and cellular barriers of the respiratory tract mucosal surface utilize a variety of strategies to obstruct microbe entry. Physical barrier defenses including the surface fluid replete with antimicrobials, neutralizing immunoglobulins, mucus, and the epithelial cell layer with rapidly beating cilia form a near impenetrable wall that separates the external environment from the internal soft tissue of the host. Resident leukocytes, primarily of the innate immune branch, also maintain airway integrity by constant surveillance and the maintenance of homeostasis through the release of cytokines and growth factors. Unfortunately, pathogens such as influenza virus and Streptococcus pneumoniae require hosts for their replication and dissemination, and prey on the respiratory tract as an ideal environment causing severe damage to the host during their invasion. In this review, we outline the host-pathogen interactions during influenza and post-influenza bacterial pneumonia with a focus on inter- and intra-cellular crosstalk important in pulmonary immune responses.

OBJECTIVE: To characterize the hospitalization and death rates among patients with inflammatory arthritis (IA) affected by coronavirus disease 2019 (COVID-19) and to analyze the associations of comorbidities and immunomodulatory medications with infection outcomes. METHODS: Data on clinical and demographic features, maintenance treatment, disease course, and outcomes in individuals with IA (rheumatoid arthritis and spondyloarthritis) with symptomatic COVID-19 infection were prospectively assessed via web-based questionnaire followed by individual phone calls and electronic medical record review. Baseline characteristics and medication use were summarized for hospitalized and ambulatory patients, and outcomes with the different medication classes were compared using multivariable logistic regression. RESULTS: A total of 103 patients with IA were included in the study (80 with confirmed COVID-19 and 23 with high suspicion of COVID-19). Hospitalization was required in 26% of the participants, and 4% died. Patients who were hospitalized were significantly more likely to be older (P < 0.001) and have comorbid hypertension (P = 0.001) and chronic obstructive pulmonary disease (P = 0.02). IA patients taking oral glucocorticoids had an increased likelihood of being admitted for COVID-19 (P < 0.001), while those receiving maintenance anticytokine biologic therapies did not. CONCLUSION: Among patients with underlying IA, COVID-19 outcomes were worse in those receiving glucocorticoids but not in patients receiving maintenance anticytokine therapy. Further work is needed to understand whether immunomodulatory therapies affect COVID-19 incidence.

OBJECTIVES: Outbreaks and containment measures implemented to control them can increase stress in affected populations. The impact of the coronavirus disease 2019 (COVID-19) outbreak on perceived stress levels in the Jordanian population is unknown. The aim of the study was to determine the perceived stress level and factors associated with it in the Jordanian population during the COVID-19 outbreak. METHODS: Required data, such as those from the Perceived Stress Scale (PSS-10) and possible predictors of perceived stress, were collected through a Web-based survey. Statistical analysis was conducted through SPSS. RESULTS: The mean (SD) of perceived stress score was 19.8 (6.7). Regression analysis revealed that stress was increased in females, young adults, usually being stressed more than others by a health problem, increased perceived severity of the disease, increased overall worry score, and students worry regarding their studies/graduation. Perceived stress was decreased if participants self-rated health status score increased. CONCLUSIONS: In the context of increasing public health preparedness, the results of this study can be used in designing interventions to alleviate stress in susceptible segments of the Jordanian community.

OBJECTIVE: To provide a comprehensive description of demographic, clinical and radiographic characteristics; treatment and case outcomes; and risk factors associated with in-hospital death of patients hospitalised with COVID-19 in Brazil. DESIGN: Retrospective cohort study of hospitalised patients diagnosed with COVID-19. SETTING: Data from all hospitals across Brazil. PARTICIPANTS: 522 167 hospitalised patients in Brazil by 14 December 2020 with severe acute respiratory illness, and a confirmed diagnosis for COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of symptoms and comorbidities was compared by clinical outcomes and intensive care unit (ICU) admission status. Survival was assessed using Kaplan Meier survival estimates. Risk factors associated with in-hospital death were evaluated with multivariable Cox proportional hazards regression. RESULTS: Of the 522 167 patients included in this study, 56.7% were discharged, 0.002% died of other causes, 30.7% died of causes associated with COVID-19 and 10.2% remained hospitalised. The median age of patients was 61 years (IQR, 47-73), and of non-survivors 71 years (IQR, 60-80); 292 570 patients (56.0%) were men. At least one comorbidity was present in 64.5% of patients and in 76.8% of non-survivors. From illness onset, the median times to hospital and ICU admission were 6 days (IQR, 3-9) and 7 days (IQR, 3-10), respectively; 15 days (IQR, 9-24) to death and 15 days (IQR, 11-20) to hospital discharge. Risk factors for in-hospital death included old age, Black/Brown ethnoracial self-classification, ICU admission, being male, living in the North and Northeast regions and various comorbidities. Age had the highest HRs of 5.51 (95% CI: 4.91 to 6.18) for patients&#8805;80, compared with those &#8804;20. CONCLUSIONS: Characteristics of patients and risk factors for in-hospital mortality highlight inequities of COVID-19 outcomes in Brazil. As the pandemic continues to unfold, targeted policies that address those inequities are needed to mitigate the unequal burden of COVID-19.

BACKGROUND Surgery training programs in Canada and the United States have recognized the need to modify current models of training and education. The shifting demographic of surgery trainees, lifestyle issues and an increased trend toward subspecialization are the major influences. To guide these important educational initiatives, a contemporary profile of Canadian general surgery residents and their impressions of training in Canada is required. METHODS We developed and distributed a questionnaire to residents in each Canadian general surgery training program, and residents responded during dedicated teaching time. RESULTS In all, 186 surveys were returned for analysis (62% response rate). The average age of Canadian general surgery residents is 30 years, 38% are women, 41% are married, 18% have dependants younger than 18 years and 41% plan to add to or start a family during residency. Most (87%) residents plan to pursue postgraduate education. On completion of training, 74% of residents plan to stay in Canada and 49% want to practice in an academic setting. Almost half (42%) of residents identify a poor balance between work and personal life during residency. Forty-seven percent of respondents have appropriate access to mentorship, whereas 37% describe suitable access to career guidance and 40% identify the availability of appropriate social supports. Just over half (54%) believe the stress level during residency is manageable. CONCLUSION This survey provides a profile of contemporary Canadian general surgery residents. Important challenges within the residency system are identified. Program directors and chairs of surgery are encouraged to recognize these challenges and intervene where appropriate.

Background and Aim: The COVID-19 virus has influenced the whole world since late 2019 and has affected millions of people The combination of hydroxychloroquine (HQ) and azithromycin (AZ) has entered the protocols worldwide to reduce virus replication and take advantage of its immunomodulatory effects The frequency of QTc prolongation in combinational drug use, and its effect on the primary endpoint, as well as the predictive values of QTc prolongation are not clear Methods: The study was designed as a single-center, retrospective study 135 patients who received hydroxychloroquine, azithromycin and oseltamivir for suspected/definitive COVID-19 with viral pneumonia were examined Results: The mean age was 55 619 1 years and 61 (45%) patients were female According to the initial ECG values, the QTc1 value was found to be 422 4435 72 ms, while the QTc2 value was 446 9135 72 ms (p500 ms was 9 (6 6%) The number of patients with prolongation in QTc values &gt;60 ms was 11 (8 1%) The sum of frequency of prolongation in QTc was 16 2% in intensive care unit patients, when the frequency was 1 5% in low-risk patients in the inpatient unit An elevation in troponin values &gt;14 ng/L and a low GFR are predictors for QTc prolongation None of these patients developed a malignant arrhythmia or sudden cardiac death Conclusions: Hydroxychloroquine and azithromycin combinations used in COVID-19 patients cause a prolongation in the QTc The incidence of prolongation in QTc varies according to the comorbid characteristics and clinical status of the patients Before starting hydroxychloroquine and azithromycin, the risk factors and clinical status of the patients should be well evaluated

PURPOSE The purpose of this study was to assess the technical success rate and adverse events (AEs) associated with computed tomography (CT)-guided percutaneous gastrostomy for patients with head and neck cancer (HNC). MATERIALS AND METHODS This retrospective study included patients with HNC who had undergone CT-guided percutaneous gastrostomy between February 2007 and December 2013. Information regarding the patients' backgrounds, CT-guided percutaneous gastrostomy techniques, technical success rate, and AEs were obtained from the medical records. In all patients, the stomach was punctured under CT fluoroscopy with a Funada gastropexy device. RESULTS During the study period, 177 patients underwent CT-guided percutaneous gastrostomy. The most common tumor location was the oral cavity, followed by the pharynx and maxilla. The indication for CT-guided percutaneous gastrostomy were tumor obstruction in 78 patients, postoperative dysphagia in 55 patients, radiation edema in 43 patients, and cerebral infarction in 1 patient. The technical success rate was 97.7 %. The overall mean procedure time was 25.3 min. Major AEs occurred in seven patients (4.0 %), including bleeding (n = 4), colonic injury (n = 1), gastric tear (n = 1), and aspiration pneumonia (n = 1). Minor AEs occurred in 15 patients (8.5 %), which included peristomal leakage (n = 6), irritation (n = 4), inadvertent removal (n = 2), peristomal hemorrhage (n = 1), peristomal infection (n = 1), and wound granulation (n = 1). The mean follow-up period was 111 days (range 1-1106 days). CONCLUSION Our study suggests that CT-guided gastrostomy may be suitable in patients with HNC.

Chronic pancreatitis is a putative risk factor for pancreatic cancer. The aim of this study was to examine the magnitude and temporality of this association. We searched MEDLINE and EMBASE for observational studies investigating the association between chronic pancreatitis and pancreatic cancer. We computed overall effect estimates (EEs) with associated 95% confidence intervals (CIs) using a random-effects meta-analytic model. The EEs were stratified by length of follow-up from chronic pancreatitis diagnosis to pancreatic cancer (lag period). Robustness of the results was examined in sensitivity analyses. We identified 13 eligible studies. Pooled EEs for pancreatic cancer in patients with chronic pancreatitis were 16.16 (95% CI: 12.59-20.73) for patients diagnosed with pancreatic cancer within 2 years from their chronic pancreatitis diagnosis. The risk of pancreatic cancer in patients with chronic pancreatitis decreased when the lag period was increased to 5 years (EE: 7.90; 95% CI: 4.26-14.66) or a minimum of 9 years (EE: 3.53; 95% CI: 1.69-7.38). In conclusion, chronic pancreatitis increases the risk of pancreatic cancer, but the association diminishes with long-term follow-up. Five years after diagnosis, chronic pancreatitis patients have a nearly eight-fold increased risk of pancreatic cancer. We suggest that common practice on inducing a 2-year lag period in these studies may not be sufficient. We also recommend a close follow-up in the first years following a diagnosis of chronic pancreatitis to avoid overlooking a pancreatic cancer.

PURPOSE OF REVIEW: The purpose of this brief review is to highlight significant recent developments in survivorship research and care of older adults following cancer treatment. The aim is to provide insight into care and support needs of older adults during cancer survivorship as well as directions for future research. RECENT FINDINGS: The numbers of older adult cancer survivors are increasing globally. Increased attention to the interaction between age-related and cancer-related concerns before, during, and after cancer treatment is needed to optimize outcomes and quality of life among older adult survivors. Issues of concern to older survivors, and ones associated with quality of life, include physical and cognitive functioning and emotional well-being. Maintaining activities of daily living, given limitations imposed by cancer treatment and other comorbidities, is of primary importance to older survivors. Evidence concerning the influence of income and rurality, experiences in care coordination and accessing services, and effectiveness of interventions remains scant for older adults during survivorship. SUMMARY: There is a clear need for further research relating to tailored intervention and health care provider knowledge and education. Emerging issues, such as the use of medical assistance in dying, must be considered in this population.

OBJECTIVE To evaluate patient satisfaction after integration of audio-only virtual visits into a pre-existing prenatal care schedule within a large, county-based system during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHODS We implemented audio-only prenatal virtual visits in response to the SARS-CoV-2 pandemic within a large, county-based prenatal care system serving predominantly women with low socioeconomic status and limited resources. Using a four-question telephone survey, we surveyed a cross-section of patients who had opted to participate in virtual visits to assess their level of satisfaction surrounding audio-only visits. In addition, average clinic wait times and attendance rates by visit type were examined. RESULTS From March 17 to May 31, 2020, more than 4,000 audio-only virtual prenatal visits were completed in our system. After implementation, the percentage of visits conducted through the virtual platform gradually rose, with nearly 25% of weekly prenatal visits being performed through the virtual platform by the month of May. Clinic wait times trended downward after implementation of virtual visits (P<.001). On average, 88% of virtual prenatal visits were completed as scheduled, whereas only 82% of in-person visits were attended (P<.001). Hospital administration attempted to contact 431 patients who had participated in at least one virtual visit to assess patient satisfaction; 283 patients were reached and agreed to participate (65%). Ninety-nine percent of respondents reported that their needs were met during their audio-only virtual visits. The majority of patients preferred a combination of in-person and virtual visits for prenatal care, and patients reported many benefits with virtual visits. CONCLUSION Audio-only virtual prenatal visits-as a complement to in-person prenatal visits-have specific and distinct advantages compared with video-enabled telehealth in a vulnerable population of women and offer a viable option to increase access to care.