cord-253355-dii5zszf	2020	Patients presenting with ARDS need mechanical ventilation, as their lungs are unable to oxygenate blood on their own due to fluid accumulation. One way to manage this excess pressure of fluid build-up around the lung tissues is to relieve the dorsal alveoli by prompting the patient to lie face down on the stomach; this is called awake proning. Awake proning delays the use of mechanical ventilation and facilitates the patients with severe ARDS or severe pneumonia in maintaining the supply of oxygen to the body tissues. As it progresses, the disease presents with more severe symptoms like viral pneumonia, which causes acute respiratory distress syndrome (ARDS). The blood oxygen levels also improved after the cycles of prone positioning, and endotracheal intubation was avoided in patients with ARDS, which would have been the only option to opt from if awake proning was not administered [17] . A COVID-19 patient presenting with severe pneumonia or ARDS can be managed with awake proning as a supportive treatment to relieve symptoms.
cord-253580-q13qndic	2020	Public health emergencies have been demonstrated to have an impact on the behavioral health of the affected population as they may experience fear, anxiety, anger and post-traumatic stress disorder as consequences of their experiences. Although the Centers for Disease Control and Prevention (CDC) has outlined some behavioral health guide for affected individuals, how best to respond to psychological challenges during the crisis is not known. On March 11, the World Health Organization (WHO) declared 2019-nCoV a pandemic, citing more than 118,000 cases of the coronavirus illness in more than 110 countries and territories around the world and the sustained risk of further global spread. Furthermore, contact tracing and the mandatory quarantine isolation for two weeks, which is a crucial part of the public health responses to the 2019-nCoV pneumonia outbreak, could be a precursor for increased psychological distress such as posttraumatic stress disorder, anxiety and anger among suspected or confirmed cases [3, 4] .
cord-253704-y0t30xw3	2020	Even though severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed to principally affect the respiratory system, neurological involvements have already been reported in some published work. Neurological manifestations can further be subdivided into the central nervous system (headache, dizziness, alteration of the sensorium, ataxia encephalitis, stroke, and seizures) and peripheral nervous system (skeletal muscle injury and peripheral nerve involvement including hyposmia and hypogeusia) symptomatology. Even though severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed to mainly affect the respiratory system, neurological involvements have already been reported in some published work. In the present paper, we have reviewed the recently published or pre-print original articles, case reports, and existing open-source data-sets in order to delineate the spectrum of neurological disorders in SARS-CoV-2 positive cases. Another report from China describes a case of acute myelitis, possibly affecting the cervical spinal cord, as evidenced by the clinical features, in a known patient of SARS-CoV-2 infection [22] .
cord-255240-ltatgq3e	2020	We present the case of an 86-year-old woman who has a vascular dementia, Binswanger''s syndrome, and coronary artery disease, who presented with more than five CMBs. We present this case in order to highlight the dilemma of anti-platelet therapy in this group of patients and we demonstrate the cardinal radiologic features of CMBs. We then segue into the pathologic correlates of CMBs and associated risk factors. If the magnetic resonance imaging (MRI) scanner software is endowed with a left-handed reference frame such as Siemens, the CMBs appear hyperintense on the phase map. Hence one faces a therapeutic dilemma; with such extensive cerebral white matter disease and stable coronary artery disease, is anti-platelet therapy warranted in the presence of more than five CMBs? [ In the study by Lau et al., in 1811 patients who were prescribed anti-platelet therapy, the five-year risk of recurrent ischemic stroke and hemorrhagic stroke both increased with the number of CMBs [6] .
cord-255752-ofph98ac	2020	Infection associated with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been named coronavirus disease 2019 (COVID-19). We report the case of a two-year-old child who presented to our pediatric intensive care unit with febrile status epilepticus and was diagnosed to have COVID-19 infection. The emerging literature suggests that the SARS-CoV-2 infection can affect children, including all age groups, predominantly males, and cause milder disease compared to adult patients [2, 3] . We report the case of a two-year-old child who presented to our pediatric intensive care unit (PICU) with febrile status epilepticus and was diagnosed to have COVID-19 infection. A retrospective study from China reported that common neurological symptoms in adult patients with COVID-19 include headache, dizziness, and rarely seizures [12] . Our index case illustrates that SARS-CoV-2 associated COVID-19 can present with febrile seizure and febrile status epilepticus in children.
cord-258484-jwgtjisx	2020	Aim To study ground-glass opacities (GGO) not only from the coronavirus 2019 (COVID-19) pneumonia" perspective but also as a radiological presentation of other pathologies with comparable features. In the presence of typical imaging features (e.g. GGO and consolidation), the radiologist should focus on the pandemic and manage a suspect patient as COVID-19 positive until proven to be negative. Even if chest CT can detect lung anomalies before symptom onset, the findings follow a temporal pattern and are consistent with clinicopathological development: the first and most common feature is ground-glass opacity (GGO), which represents early alveolar damage, with bilateral subpleural distribution in the lower lobes; then, areas of consolidation appear and tend to coalesce on the underlying GGOs. Later, in this background, the "crazy paving" pattern can be seen, with thickened interlobular septa and intralobular lines. COVID-19 pneumonia was suspected because of the CT report and clinical presentation so an RT-PCR assay by nasopharyngeal swab was performed; interestingly, the virus was not detected in any patient.
cord-259660-x9sobzyw	2020	In the present report, we describe a premature newborn, who was born to a primigravida mother with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome and moderate COVID-19 pneumonia. The newborn tested positive at 12 hours of life for COVID-19 by real-time polymerase chain reaction (RT-PCR) of the tracheal aspirate sample [9] . The authors in one review reported 179 cases of newborns tested positive at birth, whose mothers were infected in the third trimester of pregnancy [5] . The authors of one study described that three newborns born to mothers with COVID-19 infection had positive antibodies (IgM and IgG) at birth [7, 8] . In the present report, the index newborn was tested positive at 12 hours of life without any features of symptomatic COVID-19 infection [9] . Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn A neonate born to mother with COVID-19 during pregnancy & HELLP syndrome: a possible vertical transmission
cord-260224-1aeqe7fh	2020	A 61-year-old male patient affected by stage IV prostate cancer with bone metastasis at diagnosis presented to our Wound Care Clinic complaining of ulcers on the right forearm that appeared two weeks prior following a referred domestic trauma. He presented no signs and symptoms of recrudescence of cutaneous and neurological cryptococcosis, but the cryptococcal antigen was still positive. There is no typical cutaneous lesion of cryptococcosis, but skin involvement is typically characterized by various non-specific presentations (e.g., papules, pustules, nodules, abscesses, edema, panniculitis, and ulcers) and can be due to a primary infection or due to a secondary systemic hematogenous spread [8] [9] [10] . Our patient presented with two large and necrotic ulcers on his right forearm and was treated with broad-spectrum antibiotics. The studies cited above and the clinical course of our patient showed that cutaneous symptoms in an immunocompromised patient should always alert about the possibility of an opportunistic infection such as cryptococcosis.
cord-261938-ls363vud	2020	In assessing medical fitness and healthcare mediations for refugees and migrant children, special consideration should be given to certain areas such as their distinct history, whether they are with their family or separated or unaccompanied, and whether they have been peddled or have been left behind. Children''s right to medical care is guaranteed by all the world leaders and Member States of the WHO European Region and is compiled in the Convention on the Rights of the Child (CRC), a convention guaranteeing the highest attainable standard of healthcare and treatment of illness and rehabilitation of the refugee, migrant, and asylum-seeking children similar to the children native to the host country [3] . A study reports of unaccompanied refugee and migrant children who were arriving in Germany with multidrug-resistant bacteria colonization at higher rates, and other records of a surge of measles, which is vaccine-preventable, have also been seen in asylum-seeking juveniles [14, 15] .
cord-262236-1lilrqts	2020	There was no statistically significant difference in overall survival based on ethnicity, healthcare status, or individual medical comorbidities, although a negative trend exists for diabetes. There was no statistically significant difference in overall survival based on ethnicity, healthcare status, or individual medical comorbidities, although a negative trend exists for diabetes. The purpose of this study was to explore the disease characteristics in a Brooklyn safety-net hospital affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the clinical course and outcomes of this uniquely diverse population. Deceased patients were then isolated and a multiple linear regression analysis was performed to compare each comorbidity to the overall days to death which yielded no statistically significant results. We do note a trend towards decreased survival in patients with diabetes (p=0.12), but no individual factor showed a statistically significant impact on overall mortality or median OS.
cord-262886-irmwqjfh	2020	Frequent hand washing implies a prolonged exposure to water and other chemical or physical agents and may induce several pathophysiologic changes, such as epidermal barrier disruption, impairment of keratinocytes, the subsequent release of proinflammatory cytokines, activation of the skin immune system, and delayed-type hypersensitivity reactions. This article aims to review the potential dermatological adverse effects that may arise due to frequent hand washing, as well as practical tips for preventing these uncomfortable skin reactions. Frequent hygienization of hands may generate various changes in skin texture, ranging from the development of cutaneous xerosis (dryness of the skin) up to irritant contact dermatitis (ICD) or, rarely, even allergic contact dermatitis (ACD). In these times, it is very important to adapt our hand washing habits to ensure efficient protection against the spread of COVID-19 while lowering the risk of skin adverse reactions. Regular skin hydration is a key component in preventing hand dermatitis as a consequence of frequent washing.
cord-263064-n4c0m5hn	2020	We report a case of a 73-year-old male with a history of diabetes mellitus, osteomyelitis, methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia who recently completed an extended intravenous course of cefazolin eight days back, and presented with MSSA bacteremia complicated by epidural abscess, endocarditis, and aortic root abscess. A 73-year-old male recently treated for methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia secondary to presumed source of non-healing diabetic foot ulcer (completed a six weeks course of intravenous (IV) cefazolin eight days ago, negative transesophageal echocardiogram (TEE)) presented to our emergency department with lower back pain with extension to the left flank region, urinary incontinence, and an altered mental status. For a patient with MSSA bacteremia and COVID-19, such as ours, CD4 and CD8 Tcell functional exhaustion may be why our patient required an extended course of IV antibiotic therapy. Our patient presented with a recurrent and persistent MSSA bacteremia and osteomyelitis, complicated by a spinal epidural abscess, bioprosthetic valve endocarditis and aortic root abscess despite appropriate antibiotic therapy.
cord-263179-uvq3hzga	2020	Virus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) or the 2019 novel coronavirus (2019-nCoV) belong to the broad family of coronaviruses (subgenus Sarbecovirus). The HCoV (human coronavirus) is responsible for up to 10% -30% of the upper respiratory tract infections globally [2] . Historically, HCoV''s were only responsible for mild infections until 2002, with the emergence of the severe acute respiratory syndrome (SARS) that started in the Guangdong province of China. Based on available data of SARS and MERS, the Centers for Disease Control and Prevention (CDC) has estimated an incubation period for the COVID-19 to be between two and 14 days [6] . There have been reported cases involving large populations showing people with varying incubation periods and the severity of symptoms based on age and immune status. The patient was placed on airborne, droplet, and contact isolation because of the high suspicion of coronavirus infection. Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease
cord-263901-hmqq9w1a	2020	Correct diagnosis of viral pneumonia based on chest CT indicates isolation and plays an important role in the management of patients suspected to have an infection, especially in the absence of scientifically proven treatment methods. Radiologists to have sufficient knowledge about the clinic and chest CT imaging of COVID-19 will help early detection of the infection and evaluation of the disease course. In a study from Wuhan, China, it was reported that COVID-19 had abnormal findings on chest CT even in asymptomatic patients [26] . In a study by radiologists from Wuhan, China, it was found that chest CT had a low misdiagnosis rate in COVID-19 and this method can help standardization of imaging and a rapid diagnosis [10] . Liu: Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases
cord-264122-n64tm6qr	2020	title: COVID-19 Fears May Be Worse Than the Virus: A Case of Cardiogenic Shock Secondary to Post-Myocardial Infarction Ventricular Septum Rupture We report a sad and unfortunate case of an 87-year-old female who was experiencing pressure-like chest pain but presented to the emergency room five days later out of fear of catching COVID-19 from the hospital. Ventricular septal rupture (VSR) is an uncommon but fatal mechanical complication of myocardial infarction (MI). Ventricular septal rupture following acute myocardial infarction Post-infarction ventricular septal defect: risk factors and early outcomes Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry Ventricular septal rupture after acute myocardial infarction Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database
cord-264180-0vd3tr9j	2020	All patients who remained for at least one-day inpatient post-lung surgery were assessed to see if they had an increased incidence of coronavirus infection during the hospital stay or at the follow-up office visit. As of April 20, 2020, we have reported 55 cases requiring intensive care unit (ICU) care at our tertiary medical center Boca Raton Regional Hospital (400 bedded hospital) in Florida and over 250 coronavirus positive patients. From February 1, 2020, to April 14, 2020, the patients who underwent lung surgery were evaluated for the incidence of coronavirus infection during the hospital stay and on postoperative follow-up. Patients underwent surgery after triage and if they fulfilled guidelines set by the American College of Surgeons and hospital review board, so that hospital resources were not exhausted during an increasing number of COVID cases in our community.
cord-265197-kxfj3ziu	2020	In the pandemic of corona virus disease-19 (COVID-19), recognizing and creating strategies to minimize these biases is crucial to optimize medical care for our patients. We describe a case of a 68-year-old male with decreased appetite, subjective fears, dry cough, and confusion presenting during the corona virus disease-19 (COVID-19) pandemic. This case brings into question how we approach medical decision making during the COVID-19 pandemic. On review of the case, the presenting symptoms were vague, yet we focused on dry cough and fever to lead us to a diagnosis of COVID-19. Recognition and strategies to prevent cognitive biases, especially during a pandemic, are crucial to optimize medical care for our patients. Although cognitive biases are known contributors to cognitive errors, we still are not sure of all the ways they play into medical decision making during this COVID-19 pandemic.
cord-266466-5sgfx7oq	2020	Here, we report the case of a 16-month-old female infant from Lebanon who presented with fever and severe diarrhea and tested positive for COVID-19. Her RT-PCR test was negative after five days of treatment, suggesting that children can clear the virus faster than adults. Most severe illness occurs in older adults but comparison with the pediatric population can be challenging as documented cases in infants and children have been scarce [3, 4] . On day 5, the RT-PCR test of the infant was negative, and the patient''s symptoms had resolved. Uniquely, our patient presented with fever and diarrhea; cough and other respiratory symptoms were not reported. Similarly, previous research in children indicates that the RT-PCR test becomes negative within 12 days (range: 6-22) after the presentation of symptoms [6] . This is the first case reported from the Middle East on an infant presenting with fever and diarrhea that tested positive for COVID-19.
cord-266478-642m488a	2020	title: Automated Inflating Resuscitator (AIR): Design and Development of a 3D-Printed Ventilator Prototype and Corresponding Simulation Scenario Based on the Management of a Critical COVID-19 Patient The aim of this technical report is twofold: first, to describe the design and manufacturing process of the automated inflating resuscitator (AIR), a 3D-printed ventilator training device which operates on the principle of pushing a bag valve mask; second, to present a simulation scenario that can be used for training health professionals how to use this and similar, low-cost, 3D-printed ventilators in the context of ventilator shortages caused by COVID-19. In addition to the description of the ventilator, we also present a simulation case using AIR to train safety, operational ability, crisis resource management, and communication skills. If there is a limited supply of participants, the paramedics team can only be reported by the facilitators, as the main objective of this simulation is training with the use of AIR and care involving a patient with COVID-19.
cord-266916-flskltdf	2020	Infection with COVID-19 typically presents with fever and upper respiratory symptoms like cough and dyspnea. A small proportion of mildly symptomatic patients present with atypical symptoms like diarrhea, thrombocytopenia, or bleeding tendencies [4] . We present a case of COVID-19, diagnosed with an isolated thrombocytopenia. Such studies state that decreasing trend of platelets confer a grave prognosis of COVID-19 infection and lead to a severe disease [8] . There is only one case report published recently on idiopathic COVID-19 associated thrombocytopenia [11] . Our patient was also mildly symptomatic and after ruling out all major causes of decreased platelets, it was postulated to be associated with the virus. Mechanism of thrombocytopenia in COVID-19 patients Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis Thrombocytopenia is independently associated with poor outcome in patients hospitalized for COVID-19 Isolated severe thrombocytopenia in a patient with COVID-19: a case report
cord-267006-gsevwptc	2020	Objectives The aim of this study was to identify factors and quality improvement strategies to improve coronary computed tomography angiography (CCTA) studies referred for fractional flow reserve derived from CT angiography (FFRCT) analysis. To evaluate potential issues, a question and answer session with a brief didactic lecture was given by an expert cardiovascular radiologist to the CT technologists and the nursing staff, including an overview of coronary artery imaging and the purpose of performing CCTA and FFRCT at our institution. To evaluate the effect of pre-scan medication use on overall CCTA image quality at our institution, the radiology nurses were instructed to give every patient nitroglycerine and a beta-blocker, if required and not contraindicated, to achieve a heart rate of <70 and preferably <60. A second random sample of 30 CCTA cases performed during the month of November 2019 was reviewed by the same expert cardiovascular radiologist to assess for early post-intervention changes following the initial medication changes to confirm that improvement could be seen in the visual quality score.
cord-267300-zbipv9er	2020	Even though end-stage renal disease (ESRD) patients are particularly susceptible to COVID-19 infection and can develop severe to critical disease, there are limited studies and case reports about COVID-19 in ESRD patients. Even though ESRD patients are particularly susceptible to COVID-19 infection and can develop severe to critical disease, there are limited studies and case reports about COVID-19 in ESRD patients. We report a case of an ESRD patient on regular hemodialysis with severe COVID-19 pneumonia. This report describes the clinical presentation of this disease in a hemodialysis patient, the diagnostic process, the laboratory and imaging investigations, as well as the course of treatment. reported five cases of COVID-19 disease in hemodialysis patients in Zhongnan Hospital of Wuhan University. Lopinavir-ritonavir and Ribavirin have been used successfully as monotherapies in the treatment of mild COVID-19 pneumonia in hemodialysis patients [8, 10] . COVID-19 in hemodialysis patients: a report of 5 cases
cord-268085-vpzrk8u7	2020	This outbreak is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is also commonly known as COVID-19. We reviewed the mechanisms, clinical manifestation, impact on pre-existing liver diseases, and recommendations endorsed by the several GI societies for the management and prevention of its transmission. This article aims to review the mechanisms, clinical manifestation, impact on pre-existing digestive diseases, and recommendations endorsed by the several GI societies for the management and prevention of its transmission. Clinical characteristics of hospitalized patients with SARS-CoV-2 and hepatitis B virus co-infection Exploring the mechanism of liver enzyme Abnormalities in patients with novel coronavirus-infected pneumonia Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.
cord-268760-31i0mpvn	2020	There is currently a lack of published case reports describing COVID-19 patients with the sole symptoms of anosmia and ageusia in the United States of America. This case report details a 60year-old woman with the chief complaint of right-sided headache along with anosmia and ageusia but was eventually found to be SARS-COV-2 positive. The most common COVID-19 symptoms include fever (43.8% on initial presentation and 88.7% during hospitalization), cough (67.8%), nasal congestion (4.8%), nausea or vomiting (5.0%), and diarrhea (3.8%) based on a research study of 1099 patients from China. Our patient had a very low clinical suspicion of COVID-19 infection, as she was afebrile along with no respiratory symptoms despite having anosmia and ageusia in the setting of headache caused by trigeminal neuralgia. Awareness of a possible COVID-19 infection should be raised in patients with the sole presentation of anosmia and ageusia despite the lack of published case reports or research findings on its exact mechanisms of action.
cord-269216-7ejmefxv	2020	As a result, the Council of Residency Directors (CORD) Advising Students Committee in EM (ASC-EM) created a dedicated IMG Advising Team to create a set of evidence-based advising recommendations based on longitudinal data from the National Residency Match Program (NRMP) and information collected from EM program directors and clerkship directors. Investigators from the CORD ASC-EM identified best-practice advising information through the collation of available literature, existing advising resources, members'' opinions, and the National Resident Matching Program (NRMP) data collected from 2009 to 2018, specifically focusing on the admission patterns for IMG applicants in comparison to U.S. senior applicants. Based on CORD survey results and available NRMP data (as of 2018), the CORD ASC-EM created a list of evidence-based recommendations for IMG applicants applying to ACGME EM residency programs to maximize their chance of matching.
cord-269503-ij4u980v	2020	This is a retrospective case series of four patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, admitted to St. Luke''s University Health Network ICU between 24 March 2020 and 5 April 2020. A study involving 138 patients infected with COVID-19 in Wuhan, China, demonstrated cardiogenic shock, arrhythmia, and acute cardiac injury to be among common complications; 8.7%, 16.7%, 7.2% respectively [1] . Patient demographics, comorbidities, presenting day of illness since symptom onset, admission heart rate, duration of illness at intubation, duration of illness at onset of bradycardia, vital signs [blood pressure, mean arterial pressure (MAP), oxygen saturation, respiratory rate, temperature], laboratory studies (including cTnI, ferritin, C-reactive protein, D-dimer, fibrinogen), as well as medications and dose adjustments were investigated and compared against episodes of bradycardia. As previously described, acute myocardial injury was thought to be the most common cardiac manifestation in COVID-19 patients and potential for developing cardiac arrhythmias has been noted in a few studies.
cord-270336-x1up9nvp	2020	We report a case of a 74-year-old patient who traveled from Europe to the United States and presented with encephalopathy and COVID-19. Since elderly patients with chronic medical conditions are at an increased risk of altered mental status in the setting of acute infections, patients with COVID-19 infection can also present with acute encephalopathy and changes in their level of consciousness. Here we report a case of a patient who presented with encephalopathy and was found to be infected with COVID-19. Elderly patients with chronic conditions are at an increased risk of altered mental status in the setting of acute infections. Since COVID-19 affects more the elderly and those with preexisting conditions, patients with prior neurological conditions and acute respiratory symptoms are at an increased risk of encephalopathy on initial presentation. Health care providers should be aware that patients with COVID-19 can present with encephalopathy in the acute setting and during hospitalization.
cord-270391-703js942	2020	
cord-271062-ev2efm10	2020	Similar symptoms, signs, and laboratory abnormalities between coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE) creates a diagnostic challenge to every physician, and emerging data show an association between COVID-19, hypercoagulable state, and venous thromboembolism. Since EKG finding of S(I) Q(III) T(III) pattern and right ventricular strain, and ECHO finding of right ventricular dysfunction are well described in PE but not in COVID-19, these bedside diagnostic tools can help identify COVID-19 patients with underlining PEs. Coronavirus disease 2019 (COVID-19) (caused by the SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2] virus) was first reported in China in December of 2019 [1, 2] . Fever, dry cough, fatigue, shortness of breath, pleuritic chest pain, and elevated D-dimer were some of the commonly reported symptoms in two retrospective studies in China; these data overlap with pulmonary embolism (PE) clinical presentation and laboratory tests [1] [2] [3] .
cord-271308-nypkr537	2020	Background: The coronavirus disease 2019 (COVID-19) pandemic affects the education of medical students around the world and countries have had differing responses in dealing with this dynamic situation. Final year students had already been working in hospitals since before the outbreak, with 35.0% of them assisting doctors in the treatment of COVID-19 positive patients during their placements. The final year students were asked about the changing workload since the beginning of the COVID-19 pandemic, contact to COVID-19 positive patients, possible infection, and the impact on future residencies. To evaluate the usefulness and gratitude of the voluntary work during COVID-19 pandemic, the 17 volunteering students were confronted with several statements that were answered using a 5-Point Likert Scale (Figure 1) . In addition, volunteers'' work was appreciated and valued more by the medical staff in comparison to final year students conducting their clinical placements (p<0.01).
cord-271404-tu8u1b1d	2020	Smokeless tobacco (SLT) consumption is of particular concern in countries in South Asia with high population densities, as it facilitates exposure to SARS-CoV-2 within or between communities by the act of public spitting. SLT-induced higher expression of angiotensin-converting enzyme 2 receptors along with the presence of furin in the oral mucosa and dysfunctional immune responses among SLT habitués increase viral dissemination and an individual''s susceptibility to COVID-19. There has not been much research on the increased risk of contracting COVID-19 for smokeless tobacco (SLT) users, although the use of these products is widely prevalent in South Asia and the Western Pacific region. The known action of the enzyme furin and the nicotine-induced increased expression of the ACE2 receptor result in COVID-19 viral tropism to the oral mucosal tissues in smokeless tobacco habitués [11] [12] [13] [14] [15] [16] [17] [18] [19] .
cord-272300-ck301hcu	2020	Background: The novel coronavirus disease 2019 (COVID-19) has impacted many countries across all inhabited continents, and is now considered a global pandemic, due to its high rate of infectivity. Methods: We explored the PubMed database and the World Health Organization (WHO) database for publications pertaining to COVID-19 since December 2019 up until March 18, 2020. Observational studies and therapeutic trials pertaining to COVID-19 are essential for assessing pathogenic characteristics and developing novel treatment options. Reports from countries with big numbers of confirmed cases would delineate risk factors, clinical features as well as treatment strategies for patients with COVID-19 [12] . The publication type was identified and only original articles and case reports were included in our study. This information begins with early-outbreak case reports and observational studies, where the basic characteristics of the novel disease are documented, and hence, awareness can be raised [23] .
cord-273044-ikk9d6wz	2020	title: Heated Air Delivery by Micro-Sauna: An Experimental Treatment Prototype Concept for Coronavirus Disease 2019 The present report describes the engineering of a micro-sauna prototype for the delivery of heated air. The present report describes the engineering of a micro-sauna prototype for the 1 2 1 delivery of heated air in a safe and tolerable manner. The present report demonstrates the feasibility of engineering a micro-sauna prototype for heated air delivery. The micro-sauna prototype, with its delivery of air heated to 80-90 degrees C, is more likely to be successful. Heated air delivery by a micro-sauna treatment prototype may prove beneficial in treating viral pathogens. A micro-sauna delivering air heated to 80-90 degrees C can be feasibly engineered from an electric heater, EMT conduit connector, anesthesia mask, and PID controller with thermocouple.
cord-273614-qmp2tqtb	2020	
cord-273741-ipnt6g0i	2020	Literature describes syndrome of inappropriate anti diuretic hormone (SIADH) as the mechanism of hyponatremia in COVID-19 requiring fluid restriction for management. We present a case of hypovolemic hyponatremia in a patient with COVID-19, which unlike SIADH, required fluid replacement early in the disease course for its correction. Hypovolemic hyponatremia should be distinguished from SIADH as these conditions employ different management strategies, and early diagnosis and management of hypovolemic hyponatremia affects morbidity and mortality. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been recently reported to manifest as hyponatremia secondary to syndrome of inappropriate anti diuretic hormone (SIADH ) [2] [3] [4] [5] [6] . With the prevalence of gastrointestinal (GI) symptoms in coronavirus disease 2019 (COVID-19), there is a possibility of hypovolemic hyponatremia secondary to GI loss [7] . An early clinical judgement should consider the volume status of the COVID-19 patients with hyponatremia to decide between fluid restriction and isotonic fluid replacement.
cord-274182-7z2tb0ll	2020	title: An Unusual Case of Moraxella osleonsis Bacteremia in an Immunocompetent Patient With SARS-CoV-2 Infection We report a case of an immunocompetent 59-year-old male with a recent SARS-CoV-2 infection that developed M.osleonsis bacteremia. While the specific mechanisms are not fully understood, it is becoming more evident that a SARS-CoV-2 infection may be making humans more susceptible to various systemic diseases, including the possibility of causing rare bacteremia. CD4+ and CD8+ T cell functional exhaustion may explain the reason why the patient in that case report presented with recurrent bacteremia and multi-organ infection. According to current literature, the level of peripheral Tregs is significantly reduced in severely affected COVID-19 patients compared to mild disease. Based on the currently published data, this is the first reported case of M.osleonsis bacteremia in a COVID-19 positive patient. This raises the question of whether the presence of a recent SARS-CoV-2 infection (or the presence of current COVID-19 antigen positivity) creates an immunocompromised state that predisposes patients to bacteremia.
cord-274632-d9z0m2l8	2020	Transplant patients are particularly at a higher risk of contracting COVID-19 because of their immunosuppressed state, and they have the propensity to develop opportunistic infections [1] . Transplant patients are particularly at a higher risk of contracting COVID-19 because of their immunosuppressed state, and they have the propensity to develop opportunistic infections [1] . Here, we describe a case of a renal transplant patient who developed COVID-19 and, unfortunately, died from the infection despite all medical management. The illness from COVID-19 in renal transplant recipients ranged from mild to severe, and few patients presented with atypical symptoms [1, 3] . Transplant patients constitute a population more vulnerable to develop COVID-19 because of their immunosuppressed state and higher risk for opportunistic infections. Case report of COVID-19 in a kidney transplant recipient: does immunosuppression alter the clinical presentation? Threatening drug-drug interaction in a kidney transplant patient with coronavirus disease 2019 (COVID-19)
cord-276150-hp174yft	2020	In our review, we determined that the key steps taken by Nepal included border control to prevent the importation of cases, strict quarantine in facilities for anyone entering the country, early case detection, and isolation of all infected cases irrespective of symptoms. Towards the end of March, there were five cases that had arrived from China, Europe, and Dubai that tested positive and were placed in isolation in COVID-19-designated hospitals in Kathmandu. On May 7, in order to increase the rate of testing in the limited number of facilities, PCR of pooled samples of individuals in quarantine and low risk for COVID-19 was started at a ratio of 1:5. After the initial cases introduced into Kathmandu by flight in early March as detailed above, there was a cohort of a few dozen Indian nationals adjacent to the border entering Nepal from India by land that tested positive.
cord-278106-ev1nx60h	2020	The Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become the most talked-about clinical entity in early 2020. Management presents its own set of challenges, including but not limited to, deciding whether postponing cancer treatment until the infection resolves is going to benefit the patient and how to organize all aspects of patient care when social contact is as limited as it is for patients newly diagnosed with COVID-19. found that the prevalence of cancer among patients infected with SARS-CoV-2 (COVID-19) was higher than in the general population [12] . We would strongly encourage clinicians to keep reporting any cases of cancer patients infected with SARS-CoV-2, their management, and the outcome in order to further our understanding of this complex issue. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges The treatment and outcome of a lung cancer patient infected with SARS-CoV-2
cord-278246-mnj0zmkn	2020	HCQ treated patients had higher rates of adverse clinical outcomes and side effects compared with the control populations. The treatment of COVID-19 positive patients with HCQ has been met with controversy, as there have been no large multicenter randomized control trials to support its use. Studies 1 and 2 both do not cross the effect line at 0, indicating that they are not in agreement with the mortality rate of HCQ treated COVID-19 positive patients. All studies, except Study 6, are in agreement with the results of a disease progression rate of HCQ treatment in patients with COVID [19] . These results seem to be in line with the meta-analysis'' of a slight disease improvement in COVID-19 patients treated with HCQ as compared with the controls. Our study looks at three disease outcome measures of treatment with HCQ in patients with COVID-19: mortality rates, progression rates, and severity rates.
cord-278722-hox9m5mv	2020	Conclusion The Virtual Conversation series emphasizing different medical aspects of COVID-19 provided a unique benefit to medical students'' understanding of the current landscape of healthcare, the anticipation of their future roles as physicians, connectedness with their community, and opportunity to practice flexibility as they begin to apply online learning with real-world situations in the health system. The Virtual Conversation series emphasizing different medical aspects of COVID-19 provided a unique benefit to medical students'' understanding of the current landscape of healthcare, the anticipation of their future roles as physicians, connectedness with their community, and opportunity to practice flexibility as they begin to apply online learning with real-world situations in the health system. As the COVID-19 pandemic evolved and social distancing measures were put into place, medical students faced numerous obstacles relating to their education such as the inability to gather with peers, lost sense of community, inadequate opportunities to practice crucial clinical skills, uncertainties of their roles in rotations, as well as individually grappling with virtual delivery of rigorous and difficult academic content while in quarantine [2, 3] .
cord-279435-ffgd2ets	2020	Healthcare providers, particularly ophthalmologists, are at high risk of a COVID-19 infection through unprotected contact with eye secretions during routine ophthalmic examinations that involve the use of direct ophthalmoscopy and slit-lamp examinations, which are usually performed in a setting that allows for close doctor-patient contact. In fact, ophthalmologists are at high risk of contracting the COVID-19 virus through unprotected eye contact with secretions during routine ophthalmic examinations with direct ophthalmoscopy and slit-lamp examinations, which are usually performed in a setting that has close doctor-patient contact. A three-stage control measure to reduce the transmission of the virus in the ophthalmology department in Hong Kong was based on text messaging to reschedule refill visits [6] ; a triage to identify patients with fever, conjunctivitis, and respiratory symptoms; asking those who recently traveled to areas infected with the virus to postpone their ophthalmology visits for 14 days; and the avoidance of micro-aerosol generating procedures, nasal endoscopy, and operations under general anesthesia.
cord-279737-b4c3txut	2020	SBCYOR is a coalition of professionals in healthcare, behavioral health, public education, law enforcement, emergency medical services (EMS) agencies, and juvenile detention centers throughout San Bernardino County, California. The San Bernardino County Youth Opioid Response (SBCYOR) program was formed to help mitigate the spread of OUD, increase access to MAT and reduce the risk of overdose for the youth populations. Its goal is to integrate the county''s available resources into a continuum of care to enable the youths of the community to grow into productive members of society, free of the burden of opioid use exposure, disorder and associated risks. The X waivered providers received extensive training and education in key aspects of MAT including identification of individuals who may benefit from treatment, safe and appropriate use of Federal Drug Administration-approved medications, strategies for communicating and educating patients and their families, and coordinating care with other community infrastructure.
cord-279846-g0ro8pbb	2020	We highlight the successful use of half-dose anticoagulation in the treatment of right atrial thrombus in a patient with COVID-19. To our knowledge, this is a first reported case of right atrial thrombus in a COVID-19 patient who was treated successfully with half-dose anticoagulation. In another three-center retrospective study of 184 COVID-19 ICU patients from the Netherlands, the authors reported 31% incidence of thrombotic complications. Therefore, the true incidence is likely higher.Our case supports the need to think of initiating therapeutic anticoagulation early in the course of critically ill patients with COVID-19. In addition to this, our case also highlights the use of half-dose anticoagulation therapy to treat a right atrial thrombus. To our knowledge, this is the first reported case of right atrial thrombus in a COVID-19 patient that resolved with a half dose of thrombolytic therapy. We highlight the ability to treat a right atrial thrombus in a patient with COVID-19 with half-dose anticoagulation.
cord-280050-fktc778q	2020	Methods We retrospectively analyzed data from 412 patients who were residents of East Karachi and tested positive for SARS-CoV-2 between February 26 to April 24, 2020. The primary aim of this retrospective observational study was to report the epidemiological features and statistics of individuals infected with COVID-19 from February 26 to April 24 from East Karachi, Pakistan, and contribute towards an accurate collection of figures from the country. The suspected or confirmed cases were clinically classified as asymptomatic, mild, moderate, severe, and critical, according to the National Institute of Health, Pakistan guidelines and are defined below in Table 1 [9]. Candidates with fever, symptoms of lower respiratory illness, and a travel history to Wuhan, China or other countries with uncontrolled COVID-19 cases or who have been in contact with an individual suspected of COVID-19 or with laboratory-confirmed COVID-19 in the preceding 14 days should be isolated and tested for the infection promptly [19] .
cord-280835-i28azljq	2020	We report the case of a 30-year-old female who presented with persistent rash, joint pain, and fever, along with positive antinuclear antibodies (ANA), diagnosed with this condition. We report a case of AOSD diagnosed on the basis of the Yamaguchi criterion and weakly positive antinuclear antibodies (ANA). Meanwhile, suspecting a broad differential of autoimmune etiology, workup was done, including complete blood count, basic metabolic profile, liver function test, urine analysis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ANA, complements, rheumatoid factor, hepatitis panel, human acquired immunodeficiency virus (HIV) rapid antigen test, and blood cultures. With the clinical findings, four major criteria, and one minor Yamaguchi criteria along with the ferritin value, she was diagnosed to have adult-onset Still''s disease and started on high-dose steroids when her rashes and joint pains decreased. Patients with AOSD typically present with fever, rash, arthralgia, fever exceeding 102.2 F, and sore throat, as seen in this case, though sore throat was absent.
cord-280935-ur9x4fsa	2020	
cord-285732-xew5ar1e	2020	No spontaneous air leak case series have been described in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patient population thus far. We described seven spontaneous air leak cases we found in our coronavirus disease 2019 (COVID-19) positive 976-patient cohort. Air leak in hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients has been sparsely published as case reports, however, the presence of non-invasive ventilation and positive airway pressure were reported prior to this finding [3] [4] . Studies of a severe acute respiratory syndrome with SARS did identify air leak as a frequent complication, often with no relation to intubation or positive pressure ventilation [1] [2] [3] [4] [5] . Of these, we found 20 cases of air leak; three traumatic/post-procedure, 10 post-intubation/mechanical ventilation, and seven spontaneous (five cases of pneumomediastinum and two isolated pneumothorax). One out of seven spontaneous air leak patients expired. Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome
cord-287544-n32iscmr	2020	title: Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19 A retrospective review was conducted on CCB use in hospitalized patients in search of any difference in outcomes related to specific endpoints: survival to discharge and progression of disease leading to intubation and mechanical ventilation. Nifedipine and amlodipine were found to be associated with significantly improved mortality and a decreased risk for intubation and mechanical ventilation in elderly patients hospitalized with COVID-19. Nifedipine and amlodipine were found to be associated with significantly improved mortality and a decreased risk for intubation and mechanical ventilation in elderly patients hospitalized with COVID-19. A retrospective review of patients on either nifedipine or amlodipine was conducted in search of any difference in outcomes, including survival to discharge and progression of disease leading to intubation and mechanical ventilation.
cord-288166-z4r0vnku	2020	As opportunities to participate in online continuing medical education (CME) increase, there is a reduction in the worldwide knowledge gap often due to a lack of resources to attend conferences and advanced training in person. Methods A total of 64 participants completed a 10-item anonymous online questionnaire to assess how their knowledge and applied practical skills improved by participating in online conferences, and whether this education modality adequately addresses challenges for countries with limited access to conferences or training. Item six, ''Virtual neurosurgical education can help to unify international neurosurgical knowledge'', had participants consider whether this form of education can fill the global gap in education, particularly for developing countries where there are limited resources and those who cannot attend conferences in person due to cost or logistics ( Figure 5 ). The questionnaire results indicate that respondents generally had a positive attitude toward online conferences and training and found neurosurgical online education to be useful.
cord-289854-p8okfa4b	2020	In this report, we outline the clinical presentation of a 40-year-old male who developed severe coughing and sneezing before presenting to the emergency department with confusion, somnolence, and respiratory distress. On hospital day four, his neurological examination deteriorated to quadriparesis and only cough and gag reflexes remaining intact after which his family opted for comfort measures only. Since initial reports in December 2019 from Wuhan, China, the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus two (SARS-CoV-2) has become a global pandemic. Our patient is a 40-year-old male with past medical history of obesity, hypertension, and type two diabetes mellitus who developed severe coughing and sneezing before presenting to the emergency department with confusion, somnolence, and respiratory distress. Severe cough was reported to cause cerebral hemorrhage in patients with whooping cough as early as 1885 [8] . Increased risk of intracerebral hemorrhage adds to the complexity of management of patients with COVID-19.
cord-291430-rsu6xviv	2020	He was subsequently found to have parathyroid carcinoma as the cause of the acute encephalopathy with impressive serum calcium and parathyroid hormone levels. According to a systemic review conducted from 1995-2003 by Ruda et al., parathyroid carcinoma accounted for 0.74% of cases out of the total study population of 22,225 patients [3] . On days 4-10 of hospitalization, the patient became more lucid as serum calcium level had normalized to 9.1 mg/dL with treatment. The patient remained to have normal serum calcium levels with elevated PTH levels for the next few days. The primary treatment for parathyroid carcinoma is surgical resection, as it offers the greatest chance for potential cure [11] . However, it is advised that the serum calcium levels should be controlled prior to surgery as our patient''s hypercalcemia was normalized after being treated with intravenous fluids, calcitonin, cinacalcet, and pamidronate. Surgical treatment of parathyroid carcinoma (review)
cord-291581-oyhzot4z	2020	HCP employed in this hospital who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace were included in this study. Protective measures against SARS-CoV-2 are of particular importance for HCP in direct contact with patients suffering from COVID-19 in the ambulatory as well as hospital setting. The apparent higher rate of infection among HCP may be due to lack of awareness among staff, insufficient protective measures, social gatherings outside the workplace, or contact with known patients with COVID-19 in the community. The aim of this study was to evaluate demographic and clinical characteristics, management, and in-hospital outcome of COVID-19 among HCP with self-reported fever or respiratory symptoms in a tertiary cardiac care hospital. From April 29 to July 20, 2020, HCP with self-reported fever or respiratory symptoms or close contact with the patient at home or at the workplace in the last 10 days were tested for SARS-CoV-2 infection.
cord-291877-7sgxiilt	2020	Patients who are developing ARDS secondary to COVID-19 pneumonia have been treated with self-proning intervals in combination with supplementation of oxygenation via high-flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NIPPV); however, a few patients have poor tolerance to the devices, leading to poor compliance and eventual worsening respiratory symptoms leading to intubation. In the current case report, we detail how a patient was able to successfully be self-proned with proper tolerance to HFNC and NIPPV while using dexmedetomidine, leading to discharge without the need for further oxygen supplementation at home. Our case details a patient with COVID-19 pneumonia who was successfully managed with awake self-proning while using dexmedetomidine in combination with HFNC and noninvasive positive pressure ventilation (NIPPV) during the beginning stages of the disease in order to promote increased adherence to proning cycles and oxygen support equipment, to prevent endotracheal intubation.
cord-292976-qctfl6r8	2020	Conclusions An online virtual synchronous boot camp increased students'' confidence in handling common topics encountered during residency and demonstrated an appropriate gain in knowledge using a comprehensive assessment. The goals of this study were to determine the effectiveness of the Internship Boot Camp on three measures: (1) level of confidence about entering their internship, (2) ability to develop a framework for responding to common challenges, and (3) ability to demonstrate an appropriate gain in clinical knowledge using a comprehensive post-course assessment. Fifty-three students from the Wayne State University School of Medicine who matched into a variety of non-surgical residencies were offered an ungraded elective entitled, "Intern Boot Camp." Before developing the boot camp curriculum, a needs assessment (a systematic process for determining and addressing needs or "gaps" existing in the knowledge and skills of medical students) was conducted through a voluntary online survey.
cord-293475-6ghjewxc	2020	
cord-293622-gdplbrsf	2019	We describe an immunocompromised and severely ill patient with Legionnaires'' disease and who also has allergies to both fluoroquinolones and macrolides; he was successfully treated using tigecycline, a third generation glycylcycline, indicating that tigecycline may serve as a safe and effective alternative therapeutic option for treatment of Legionnaires'' disease in select cases. A recently published case series describes eight patients with Legionnaires'' disease who were switched to tigecycline, often due to worsening sepsis and/or respiratory status, following initial exposure to macrolide and/or fluoroquinolone therapy (median of three days) [8] . While the integrated results of these two randomized controlled trials support the early use of tigecycline as empiric treatment of community-acquired pneumonia, one of these trials permitted switching to oral levofloxacin following at least three days of intravenous therapy if evidence of clinical improvement.
cord-294422-hsqphc3t	2020	The psychological response of HCPs to an epidemic could be dependent on many factors which may cause anxiety and stress such as feeling vulnerable to infection, lack of control over the situation, the spread of the virus, health of their family, and being isolated [11] . It can be also seen that many of the factors due to which HCPs suffer from these ill-effects can be potentially modified, for example, such as free provision of PPEs to all healthcare workers, promoting general public awareness about COVID-19, and building better infrastructure to encourage lighter work hours can all be carried out by the government and thus have a positive impact on the mental health of HCPs. In our study, high levels of anxiety, stress and depression among health care professionals were noted, which is a cause for concern. Since there is a high prevalence of anxiety, depression, and stress among HCPs treating COVID-19 patients, it is imperative to invest resources to promote the mental health welfare of frontline professionals.
cord-294788-9usyb1nn	2020	Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the virus strain that causes coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China in December 2019. It is suspected that the acute respiratory distress syndrome (ARDS)-like picture in SARS-CoV-2-infected patients is precipitated and worsened by the excess monocytes in response to GM-CSF, which is released by rapidly activated CD4+T-cell lineage [17] . have reported that the cytokine profile and the trend of the inflammatory markers of SARS-CoV-2-infected patients present similarly to the secondary hemophagocytic lymphohistiocytosis (sHLH), whose severe clinical presentation is related to the cytokine storm [23] . There is no consensus yet on how to treat SARS-CoV-2-infected patients who present with a wide spectrum of clinical symptoms and severity. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Epub ahead of print)
cord-294828-yemg28ds	2020	title: Persistence of Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Positivity in COVID-19 Recovered Patients: A Call for Revised Hospital Discharge Criteria The hospital discharge criteria for COVID-19 patients upon recovery includes the absence of respiratory symptoms, afebrile for the last three days, radiological improvement of chest exudates (by X-ray or CT scan), and two upper respiratory tract samples negative for viral RNA in RT-PCR assay, collected at the interval of at least 24 hours. WHO, in the latest newsletter "criteria for releasing COVID-19 patients from insolation," advised not to keep on waiting for RT-PCR to become negative; instead, the decision should be based on clinical and essential laboratory investigation like the presence of neutralizing antibodies. When the COVID-19 patient recovers, the discharge criteria from the hospital are meticulous, and the patient may wait a long time to be released from isolation because of the positive RT-PCR assay.
cord-296739-ujsqshjg	2020	Then, for each category of procedure, and for each of the preceding quarters included for the category, we used the cumulative counts to calculate the asymptotic standard error (SE) for the proportion of cases with LOS of <2 days. Applying our methodology with local LOS data will allow OR managers to estimate the number of patients on the elective OR schedule each day who will be hospitalized for longer than overnight, facilitating communication and decision-making with surgical departments when census considerations constrain the ability to run a full surgical schedule. The first summary measure compared was the percentage of patients previously undergoing the same 1 2 3 category of procedure as that scheduled whose hospital LOS was zero (i.e., ambulatory surgery) or one day (i.e., overnight stay) [1, 2] . In this study, we analyzed five years of data from a large teaching hospital to compare methods of estimating the percentages of cases with LOS of <2 days for each category of procedures.
cord-297222-2danzbqt	2020	
cord-297832-picpuzvo	2020	The number of patients with acute episodes of severe bronchospasm needing intubation and ventilatory support has increased rapidly during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease 2019 (COVID-19) pandemic. Anteroposterior chest X-ray at the time of acute bronchospasm with Radiographic Assessment of Lung Edema (RALE) score 2 The initial management comprised placing the patient in the prone position and administering oxygen at high flow through a non-rebreather mask with flow between 10 and 15 liters per minute until reaching 100% FiO 2 . To improve ventilatory mechanics and ultimately postpone the need for IMV due to acute bronchospasm in patients diagnosed with COVID-19, we put in place a therapeutic approach consisting of early respiratory therapy and pharmacological bronchospasm rescue approach. The therapeutic bundle of early respiratory therapy, consisting of deep inspiration with inspiratory hold, and pharmacological bronchospasm rescue decreased the need for invasive mechanical ventilation in patients with bronchospasm associated with SARS-CoV-2 and reduced the mortality rate.
cord-297878-c4cq92x8	2020	
cord-299125-kuvnwdn6	2020	title: Suspected Virus-Inducing Severe Acute Respiratory Distress Syndrome Treated by Multimodal Therapy Including Extracorporeal Membrane Oxygenation and Immune Modulation Therapy We report a case of suspected virus-inducing severe ARDS treated by multimodal therapy including extracorporeal membrane oxygenation (ECMO) and immune modulation therapy that led to a favorable outcome for the patient. The risk factor in the present case was unspecified pneumonia, and an unspecified virus was considered the most likely cause based on the negative results of all cultures, β-D glucan, and rapid test for bacteria and influenza. As the present case also showed marked hypoxia despite mechanical ventilation with a high concentration of oxygen and high PEEP, ECMO was introduced, and the lung rest setting was selected. We presented a case of suspected virus-inducing severe ARDS that was treated by multimodal therapy including ECMO and immune modulation therapy.
cord-300216-3mvfiuwc	2020	title: Subconjunctival Acute Bilateral Hemorrhages Due to Kawasaki Disease in a Costa Rican Girl: An Unusual Clinical Manifestation of the Disease Among the ocular manifestations in these patients, bilateral non-suppurative conjunctival injection and uveitis are the most common. We describe a six-year-old Costa Rican girl with acute Kawasaki disease who developed severe bilateral conjunctival injection with subsequent bilateral subconjunctival hemorrhages. To our knowledge, this is the first report from Latin America and among the few in the literature of a child in whom severe bilateral subconjunctival hemorrhages occur as a manifestation of Kawasaki disease. Kawasaki disease (KD) is an acute systemic vasculitis and the leading cause of acquired cardiac disease in children, with approximately 80% of cases occurring in children in the first five years of age. Rare ocular manifestations in an 11-year-old girl with incomplete Kawasaki disease: a case report
cord-300333-p73sz5bj	2020	
cord-300508-po2zolo8	2020	With the need to develop an approach to manage orthopaedic surgeries, we aimed to evaluate the most current data on all the surgical cases in our department including the results of the reverse-transcriptase polymerase chain reaction (RT-PCR) assay for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We also examined the results of PT-PCR for SARS-CoV-2, which was principally performed for all the surgical candidates in our department beginning May 13, and investigated their laboratory test results before surgery, their clinical signs and symptoms, which were reported to be related with COVID-19. evaluated 66 orthopaedic healthcare workers exposed to one patient who became positive for SARS-CoV-2 infection one week after admission, and reported that the RT-PCR assays were negative for all 66 healthcare workers, although 14 (21%) manifested clinical signs/symptoms suggestive of COVID-19, including cough (6.1%), sore throat (4.5%), nasal congestion (4.5%), dyspnoea (3.0%), fever (1.5%), headache, and myalgias (1.5%) [19] .
cord-301843-oxe22chd	2020	
cord-302244-uwicyuhk	2020	We present a case of a healthy 32-year-old male with no past medical history who presented with shortness of breath, tested positive for COVID-19, and was found to have a large acute saddle pulmonary embolism. Recent findings revealed that patients with severe cases of COVID19 who are admitted to the intensive care unit with respiratory failure had a predominant hypercoagulable state leading to thromboembolism [1] . We present a case of a healthy patient who presented to the hospital with dyspnea, was found to be COVID-19 positive, and was diagnosed with an acute saddle pulmonary embolism. The incidence of acute pulmonary embolism in a patient with COVID-19 remains unknown [6] . Our patient was a healthy male who presented with no risk factors for thromboembolic disease and no symptoms of viral pneumonia but still developed a large saddle embolism.
cord-302597-e8n5o69p	2020	
cord-302786-ibt7mupq	2020	Despite a growing report on clinical characteristics and prognosis of patients with COVID-19, the data in the special population, including transplant recipients, is still limited. We proposed that the pre-existing T-cell dysfunction from the long-term use of immunosuppressive agents in organ transplant recipients adversely affects COVID-19 prognosis and worsens COVID-19 mortality. However, impaired immune functions may paradoxically protect transplant patients from the hyper-inflammatory response to SARS-CoV-2 and thus dampen the disease severity. Long-term immunosuppressive therapy in organ transplant recipients may alter clinical features and outcomes of COVID-19. The long-term use of immunosuppressive medications in organ transplant recipients is associated with the decrease in T-cell number and function; TAC and MMF preferentially inhibit T-cell response. However, in this report, immunosuppressive agents were discontinued in patients with severe disease, presumably with high mortality risks. Preexisting T-cell immune response deficits from long-term use of immunosuppressive agents may worsen the prognosis of COVID-19 in transplant recipients.
cord-303659-mzez7v4d	2020	There are reports of patients who tested positive for SARS-Cov-2 after clinical recovery and initial clearance of the virus. There have been reports of patients who tested positive for SARS-Cov-2 after clinical recovery and initial documented clearance of the virus. The publications included COVID-19 positive patient data and the relapse of disease was confirmed by PCR; the full text was available for these publications. Data were collected in the following categories when available: Study design; Study country; Patient demographics; Clinical signs and symptoms; Laboratory findings; Imaging studies; Dynamics of the oropharyngeal swab test; Treatment of the first presentation; The clinical picture of relapse; Day of a positive result after confirmed negative We tabulated the data using Microsoft Excel (2010, Microsoft Corp, Redmond, WA). The study reports a total of 11 patients (6 females and 5 males), all from China, who tested positive for COVID-19.
cord-304090-l5rocsk5	2020	
cord-305397-4dx3q6o6	2020	
cord-305704-grzrkff9	2020	
cord-306108-ja0wyr5w	2020	Although SARS-CoV-2 infection predominantly causes pulmonary complications, such as pneumonia and ARDS, the disease has also been associated with a variety of cardiovascular complications, including acute myocardial injury, myocarditis, arrhythmia, heart failure, and venous thromboembolism [6] . Hence, one potential explanation for the higher likelihood of acquiring infection, and the increased risk of severe disease and adverse outcomes in patients with COVID-19 with pre-existing CVD, maybe the elevated secretion of ACE2 in these patients, thus making them more susceptible to direct viral damage to cardiac myocytes [33] ; but, this has not yet been demonstrated in pathology studies. In a single-center, retrospective cohort study including 188 patients with COVID-19 in Wuhan, China, conducted to explore whether heart injury occurred during COVID-19 on admission and later increased mortality, approximately 11.2% of patients had high-sensitivity cardiac troponin I (hs-TnI) exceeding the clinical upper normal limit on admission.
cord-306878-hmy3ovuq	2020	title: Refractory Acute Respiratory Distress Syndrome Secondary to COVID-19 Successfully Extubated to Average Volume-assured Pressure Support Non-invasive Ventilator Consequently, the use of respiratory devices that may potentially promote aerosolization like non-invasive positive pressure ventilation (NIPPV) for diseases such as obstructive sleep apnea (OSA), advanced chronic obstructive lung disease, pulmonary hypertension (PH), and neuromuscular respiratory disease has been called into question. We present a case of a patient with history of OSA and PH convalescing from refractory acute respiratory distress syndrome (ARDS) secondary to COVID-19 who was successfully extubated to average volume-assured pressure support (AVAPS). Strategic use of average volume-assured pressure support (AVAPS) mode of ventilation as a bridge in recovering COVID-19 has the potential to facilitate earlier extubation, conserve traditional ventilators, and prevent re-intubation/tracheostomies. We present a case of a patient with history of OSA and PH convalescing from refractory acute respiratory distress syndrome (ARDS) secondary to COVID-19 who was successfully extubated to AVAPS.
cord-307070-tqxvu3pu	2020	
cord-307306-ju0vcalk	2020	
cord-307357-qm456cik	2020	Patients may lack well-known risk factors such as intravenous drug use, previous history of IE, and prosthetic heart valves, which can make it more difficult to consider in the differential diagnosis, especially during the influenza season and novel coronavirus disease 2019 (COVID-19) pandemic in which there is an abundance of patients presenting with flu-like illness. Obtaining timely blood cultures and administering appropriate empiric antibiotics in the ED coupled with early transthoracic/transesophageal echocardiogram (TTE/TEE) are essential to guiding therapy once the patient is admitted to the hospital. A high index of suspicion is required, especially in patients with additional findings such as splenic abscess, embolic phenomenon, focal neurologic deficit, mycotic aneurysm, decompensated heart failure, new murmurs, or pleural effusions. A high index of suspicion is required, especially in patients with additional findings such as splenic abscess, embolic phenomenon, focal neurologic deficit, mycotic aneurysm, decompensated heart failure, new murmurs, or pleural effusions.
cord-307489-2liu4anc	2020	title: An Atypical Presentation of Acute Pulmonary Embolism With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pneumonia Clinical presentation and severity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) varies greatly amongst patients, as supported by recent literature. Here, we would like to describe a case of acute bilateral pulmonary embolism (PE) presenting with atypical gastrointestinal symptoms in a patient with SARS-CoV-2 infection. This atypical presentation of PE is unique to our case and highlights the significance of a high index of clinical suspicion for SARS-CoV-2 and its associated thrombogenic effect, even in patients with atypical symptoms. Here, we would like to describe a case of acute bilateral pulmonary embolism (PE) in a patient with SARS-CoV-2 pneumonia who mainly presented with gastrointestinal symptoms. Our patient however presented mainly with gastrointestinal symptoms, which have been reported with SARS-CoV-2; however, with significant hypoxia in the absence of a respiratory viral syndrome although with a low pretest probability for PE, we decided to further evaluate the patient for hypoxia.
cord-307697-ds4uw7y1	2020	Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. In contrast, doctors in Pakistan reported to have poor availability of PPE with only 37.4% (n = 130) having access to masks/N95 respirator, 34.5% (n = 120) to gloves, 13.8% (n = 48) to face-shields or goggles, and 12.9% (n = 44) to full-suit/gown. In our study, 73% of doctors from Pakistan and 58.4% from the US reported that HCWs in their hospitals had been infected with COVID-19. To conclude, there is a shortage of PPE in hospitals of the US and Pakistan due to COVID-19 and doctors are feeling scared working without adequate protection in the pandemic situation.
cord-307716-ffoiv1ma	2020	Management of Candidal osteomyelitis with surgical debridement and antifungal therapy is recommended by the Infectious Disease Society of America (IDSA) based on anecdotal case reports and open-label series [5] . The patient presented with pain and swelling of the right upper chest, which was found to be caused by fungal clavicular infection with Candida parapsilosis. The patient had a past medical history of diabetes mellitus type II, morbid obesity (body mass index of 47.4), obstructive sleep apnea on bilevel positive airway pressure (BiPAP), chronic obstructive pulmonary disease (COPD), major depressive disorder, fibromyalgia, hepatitis C secondary to intravenous drug use (IVDU), polysubstance abuse on suboxone maintenance therapy, anxiety disorder, closed body fracture of the sternum, and sternal osteomyelitis. Although the patient was not HIV-positive, he did have underlying health conditions and had undergone treatments associated with fungal osteomyelitis and diabetes, and had a history of IVDU and broad-spectrum antibiotic use [10] .
cord-310738-fnsf2qqm	2020	The aim of this study was to measure serum 25(OH)D, vitamin B12, and zinc levels in COVID-19 positive pregnant women to evaluate the role of these micronutrients in treatment and prevention. The aim of this study was to measure serum 25(OH)D, vitamin B12, and zinc levels in COVID-19 positive pregnant women to evaluate the role of these micronutrients in the prevention and to evaluate the possible cause between the blood levels of micronutrients and the COVID-19 infection. Pregnant women whose PCR test was positive for COVID-19, pregnancies older than eight weeks of gestation, and women who did not receive any antibacterial or antiviral treatment during the past three months or did not receive any 25(OH)D, vitamin B12, and zinc supplements during their pregnancy were included in the study. Additionally, it has been shown that serum zinc levels correlate positively with better immune response in pregnant women against infections [17] .
cord-311043-nidu7om2	2020	
cord-311676-pzatzadw	2020	
cord-314216-xx5xbjqu	2020	
cord-314507-fgrvrlht	2020	Objective To determine the impact of Level C personal protective equipment (PPE) on the time to perform intravenous (IV) cannulation and endotracheal intubation, both with and without the use of adjuncts. Methods This prospective, case-control study of emergency medicine resident physicians was designed to assess the time taken by each subject to perform endotracheal intubation using both direct laryngoscopy (DL) and video laryngoscopy (VL), as well as peripheral IV cannulation both with and without ultrasound guidance and with and without PPE. Our primary objective was to determine the impact of Level C PPE on the time to perform intravenous cannulation and endotracheal intubation, both with and without the use of adjuncts. studied 40 emergency physicians (residents) with and without Level C PPE and found no difference in the mean time to successful endotracheal intubation (17.86 sec vs.
cord-317863-xf0bn3cv	2020	The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, originated in Wuhan, China, and spread rapidly throughout the world, infecting millions and killing thousands. Additionally, it has a high incubation period (average 6.4 and range of 0-24 days) [2] , reproductive number (R0 ranged from 1.4 to 6.49, with a mean of 3.28) [3] , and reports have shown that the majority of patients are asymptomatic or have a mild response to the SARS-CoV-2 virus but release large amounts of viruses [2] . Furthermore, a chest X-ray showed no acute pathologies (Figure 3) , and the COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCT) was performed due to the recent outbreak of the SARS-CoV-2 virus, which came back positive. Other reports suggest a higher rate of cerebrovascular disease (mainly ischemic stroke) in severe COVID-19 patients as compared to non-severe cases [5] .
cord-317906-u5z5cpfk	2020	The novel coronavirus (SARS-CoV-2), belonging to a group of RNA-enveloped viruses and believed to be transmitted by aerosol route, is a worldwide pandemic. However, to our knowledge, there are minimal studies on the neurological manifestations in SARS-CoV-2 positive patients. Our review aims to identify the various neurological manifestations in SARS-CoV-2 positive patients, which could be an added advantage in the early diagnosis and prevention of further complications of the nervous system. Other non-neurological symptoms were diarrhea, anorexia, myalgia, sore throat, dyspnea, chest pain, fatigue, headache, arthralgia, nausea, and vomiting (see Figure 2 and Table 3 ) [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] . The presentation of olfactory symptoms in SARS-CoV-2-affected patients is due to the fact that the illness spreads through the cribriform plate, which is in close proximity to the olfactory region [30] . Neurological manifestations in COVID-19 caused by SARS-CoV-2
cord-317915-0javg3m8	2020	
cord-318321-jfpbkntx	2020	We focus on three scenarios of cancer care: 1) radiation therapy as an alternative to surgery when immediate surgery is not possible, 2) radiation therapy as a ''bridge'' to surgery, and 3) radiation options definitively or postoperatively, given the risk of hospitalization with high-dose chemotherapy. In this review, we discuss radiation therapy (RT) options for cancer patients in three settings: 1) RT as an alternative to surgery when immediate surgery is not possible, 2) RT as a ''bridge'' to surgery and 3), radiation options definitively or postoperatively, given the risk of hospitalization with high-dose chemotherapy. If the risk of hospitalization is high, a different approach should be used: 1) sequential chemotherapy and radiation, 2) reduction of chemotherapy dose, 3) use of a less toxic concurrent systemic or targeted therapy, or 4) RT alone with an option of altered fractionation to compensate for lack of chemotherapy.
cord-318520-hgjv7ot9	2020	
cord-318660-47dqa1dd	2020	Cloth masks have limited inward protection in healthcare settings where viral exposure is high but may be beneficial for outward protection in low-risk settings and use by the general public where no other alternatives to medical masks are available. Although guidelines from the World Health Organization (WHO) and Centre for Disease Control and Prevention (CDC) suggest various strategies to optimize the supply of PPE in healthcare settings [4, 7] , there are limited data on alternatives to surgical masks. In the current COVID-19 pandemic, Chinese recommendations on face mask use in community settings suggest that cloth masks could be used in a very low-risk population to prevent the spread of disease [13] . This review aims to integrate current studies and guidelines to determine the efficacy of cloth masks as both inward and outward protective equipment and whether they can be used in healthcare settings and/or the community in light of the PPE shortage.
cord-318787-z6q11loy	2020	This paper attempts to utilize the modified Susceptible-Exposed-Infectious-Recovered (SEIR) model incorporating the SD, testing, and infectiousness of exposed and infectious compartments to study the COVID-19 pandemic in Saudi Arabia. To study the dynamics of the COVID-19 epidemic, several modified SEIR models have been used to incorporate various measures, especially social distancing, testing, public responses, and mobility restrictions [2, [6] [7] [8] [9] . The objective of this paper is to model the COVID-19 pandemic in Saudi Arabia using SEIR, including SD, testing, and the infectiousness of exposed and infectious populations. Similarly, the cumulative active cases that include exposed and infectious populations fit closely and the Levene test (statistic=0.5088, p-value=0.4758) proves the same. The model results in the current scenario of restrictions and testings depict that there are multiple peaks for active cases (Figure 3) .
cord-320656-5gu6ejul	2020	In this case series, we analyzed nine patients from across our institution who were intubated to manage acute respiratory distress syndrome (ARDS) secondary to COVID-19 and subsequently developed post-extubation stridor. Our analysis suggests that prophylactic corticosteroids given in the 24-48 hours prior to elective extubation in female COVID-19 patients who were intubated for more than six days with consecutive days of intermittent prone ventilation may be helpful in reducing the incidence of post-extubation stridor in this population. In this case series, we present nine patients who required mechanical ventilation for acute respiratory distress syndrome (ARDS) secondary to COVID-19 and later developed post-extubation stridor. The patients presented in this case series possessed some of the well-described risk factors for the development of post-extubation stridor, specifically prolonged mechanical ventilation (9/9 were >8 days), obesity (6/9 had BMI >26.5), and female gender (7/9) [3] .
cord-321461-1s3y9kc5	2020	The novel coronavirus disease of 2019 (COVID-19) is caused by the binding of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) to angiotensin-converting enzyme 2 (ACE2) receptors present on various locations such as the pulmonary alveolar epithelium and vascular endothelium. This case series describes three distinct yet similar scenarios of COVID-19 positive patients with several underlying comorbidities, wherein two of the patients presented to our hospital with sudden onset right-sided weakness, later diagnosed with ischemic stroke, and one patient who developed an acute intracerebral hemorrhage during his hospital stay. A 76-year-old woman with a past medical history of type-II diabetes mellitus, chronic obstructive pulmonary disease (COPD) on nocturnal 3 L/min home oxygen, obstructive sleep apnea on BiPAP (bilevel positive airway pressure) at home, hypertension, and dyslipidemia was diagnosed with COVID-19 infection eight days prior to her admission. Stroke (both ischemic and hemorrhagic) occurring in the setting of COVID-19 is reported to have a worse patient prognosis, with a substantially higher risk of in-hospital mortality [9] .
cord-322048-m5vbkvju	2020	The common chest CT imaging of confirmed COVID-19 cases is discussed here, which shows ground-glass opacity, crazy paving, and consolidation. The common chest CT imaging of confirmed COVID-19 cases is reported here to aid prompt clinical diagnosis. Axial thin-section unenhanced CT images obtained on March 4, 2020 show crazy paving mostly in the left and right lower lobes of the lung (Figure 2) . Up to the present time, most COVID-19 cases have shown pure GGO and consolidative lesions in 60% of their early chest CT imaging [5, 9] . When radiologists see the common chest imaging findings of this new strain of coronavirus, they can identify COVID-19 cases in a timely manner based on the appropriate epidemiologic and demographic features. Chest CT findings in 2019 novel coronavirus (2019-nCoV) infections from Wuhan, China: key points for the radiologist.
cord-323020-9v44cg3b	2020	Objective The objective of the present study is to describe high-resolution CT (HRCT) chest manifestations of coronavirus disease 2019 (COVID-19) patients presenting to a tertiary healthcare facility in Punjab, Pakistan, and to analyze the distribution of the disease in lung fields. Each study was evaluated for the presence of ground-glass opacities (GGOs), consolidation, mixed pattern, distribution, crazy paving, reverse halo sign, nodules, pleural effusion, and other findings. Typical imaging features of COVID-19 on CT chest include ground-glass opacities (GGOs) and consolidation with bilateral and multilobe involvement and basal and peripheral predominance [5] . In this study, we describe the typical imaging features of COVID-19 pneumonia on CT chest in patients presenting to a tertiary care hospital in Punjab, Pakistan, and analyze the distribution of the disease in lung fields. The present study showed that the predominant pulmonary parenchymal pattern for this disease is ground-glass haze/opacity followed by consolidation, as seen in 88.5 and 52.8% of patients respectively.
cord-324159-jv3lknl8	2020	We present an interesting case of acute ischemic stroke in a 26-year-old patient with coronavirus disease 2019, who presented to the hospital initially with headache, vomiting, and right-sided numbness and tingling. Unusually large numbers of stroke cases have been reported worldwide in young patients [1, 2] , reinforcing our belief that COVID-19 is a systemic disease that affects not only the lungs but also other vital organs. COVID-19 has been linked to an increased risk of venous thromboembolism and arterial thrombosis, including stroke in case series from different health centers and anecdotal reports. A single health system identified five cases of acute ischemic stroke associated with COVID-19 over two weeks, with symptoms suggesting large-vessel occlusion; all patients were under 50 years of age [1] . The interesting question that arises from this case is whether young patients with COVID-19 have an increased risk of stroke in the presence of PFO, and should prophylactic anticoagulation be initiated to prevent stroke until these patients recover from their illness?
cord-324565-p3jl1vie	2020	This study aims to identify the most effective predictive biomarker such as C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), procalcitonin (PCT), and D-dimer, among others, in predicting the clinical outcome of the disease. Conclusion Inflammatory markers are a useful guide for predicting mortality, and the study results concluded that LDH, PCT, D-dimer, CRP, and ferritin were effective biomarkers. This study aims to identify the roles of these biomarkers (CRP, ferritin, LDH, PCT, and Ddimer), among others, in predicting the severity and clinical outcome during the disease. A study undertaken in Wuhan, China, that evaluated the clinical characteristics of COVID-19 patients also found an important association of CRP with severe disease prognosis. Our study showed that LDH is also significantly increased in patients experiencing a severe course of the disease compared to those with mild infections, thereby demonstrating its role as the most potential biomarker in predicting COVID-19 severity.
cord-324644-sz5n7a5z	2020	There was a case report that described a patient with COVID-19 with regional wall motion abnormalities who had a biopsy consistent with lymphocytic myocarditis but histopathological and viral genomic polymerase chain reaction (PCR) analysis of the biopsy did not reveal the SARS-CoV-2 viral genome to be present within the myocytes [3] . With this report, we aim to highlight an atypical presentation of COVID-19 (SARS-CoV-2)induced myocarditis as this patient was completely afebrile and had no respiratory symptoms, both of which are typical characteristics. Current consensus around COVID-19-induced myocardial injury is to maintain conservative management especially in those without suspected acute coronary syndrome (ACS) who have mild troponin elevation, as in our young patient. COVID-19-induced myocardial injury can present as a STEMI or non-STEMI (given the evidence of troponin leak) and without concurrent febrile illness or respiratory symptoms of the disease.
cord-325152-ffmo67hm	2020	Several cases of patients infected with coronavirus disease 2019 (COVID-19) presented with severe hyperglycemia along with ketoacidosis or hyperosmolar-hyperglycemic state during their acute phase of illness have been identified [3] . In our case, the patient remained mildly hyperglycemic during the course of his COVID-19 pneumonia; however, he presented with diabetic ketoacidosis six weeks after being discharged. In one study, three patients, who developed ketosis-prone diabetes mellitus immediately after documented viral infection with EBV or coxsackievirus and required insulin therapy on discharge, were followed for four to eight years; the first patient remained insulin-dependent throughout the life, the second one regained normal glucose tolerance, and the third one was being transitioned to oral antidiabetic medications [6] . Patients with COVID-19 infection who presented with diabetic ketoacidosis or hyperosmolar hyperglycemic state during the acute phase of infection have been identified [3, 9] . We reported a case of a young male who developed full-blown ketosis-prone type II diabetes mellitus status post-SARS-CoV-2 infection recovery.
cord-325531-riftp8g6	2020	We present a child with a new-onset isolated afebrile seizure in coronavirus disease 2019 (COVID-19). Despite being generally mild in children, we have witnessed vague clinical pictures in COVID-19, ranging from asymptomatic in the mildest form to severe respiratory distress [2] . Here, we aim to report an uncommon neurological manifestation, isolated afebrile seizure, in a child with COVID-19. Description of isolated afebrile seizure in COVID-19 is scarce among children, and neurological manifestations have not been extensively studied [6] [7] . Our case highlights seizure as one of the uncommon, but potential presentations of COVID-19 in children. investigated preliminary COVID-19 findings and found one out of 10 infected children with seizures, while others presented predominantly with fever, cough, and diarrhea [10] . As new cases are unfolding each day, it is essential to recognize seizure as a potential COVID-19 presentation in the pediatric age groups.
cord-325732-hva5dasd	2020	Methods This retrospective study examined the feasibility of providing a remote formative assessment of third-year medical student video-recorded oral presentation submissions centered on virtual case-based modules over a one-week time period after pediatric clerkship suspension (March 16th to 20th, 2020). This is a feasibility study requesting students to video-record an oral presentation centered on a virtual case-based module for formative assessment during a time period (March 16th, 2020 until March 19th, 2020) when Pennsylvania State College of Medicine third-year medical students were abruptly restricted from providing direct patient care during the pediatric clerkship. Third-year medical students -(1) part of our institution''s traditional curriculum, (2) rotated at the pediatric clerkship''s primary site or off-campus affiliate sites during the first month of the academic year (2020-2021), (3) were abruptly restricted from direct patient care due to the COVID-19 pandemic, and (4) completed a video-recorded oral presentation centered on a virtual case-based module -were included in this study.
cord-325971-volbaipv	2020	Several drugs are being tested in the trials, and the United States Food and Drugs Administration (FDA) has given Emergency Use Authorization (EUA) for remdesivir to treat COVID-19 patients on May 1, 2020 [5] . Therapeutic remdesivir treatment in MERS-CoV inoculated rhesus macaques resulted in the reduction in clinical signs, virus replication, and the absence of lung lesions in 2/6 remdesivirtreated animals along with the reduction in lesion severity in three additional animals. In a randomized controlled clinical trial of 1063 patients conducted by the National Institute of Allergy and Infectious Disease (NIAID), remdesivir has shown the efficacy in the early results against advanced COVID-19 (NCT04280705). In a retrospective observational study involving twenty patients with severe or critical COVID-19, treatment with tocilizumab in addition to lopinavir, methylprednisolone, other symptom relievers, and oxygen therapy, resulted in body temperature of all the patients returning to normal on the first day of receiving tocilizumab and significant relief of clinical symptoms synchronously in the following days.
cord-327214-kcbxyhhh	2020	The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus originated in Wuhan, China, and has spread rapidly across the world. According to Merad and Martin''s study, the hyper inflammation in severe COVID-19 patients shared similarities with cytokine release syndromes, including macrophages activation syndrome. Minimally invasive autopsies of three COVID-19 patients in Chongqing, China revealed damage to the alveolar structure with minor serous and fibrin exudation and hyaline membrane formation [8] . The hypercoagulable state has been linked to a poor prognosis in patients with severe COVID-19, which leads to a microthrombi formation in the lungs, lower limbs, hands, brain, heart, liver, and kidneys, as a result of the activation of the coagulation pathway. There is a strong association with the hyperinflammatory state, which can be explained by most of the signs and symptoms that are exhibited by COVID-19 patients, including most of the pathological findings. Fatal eosinophilic myocarditis in a healthy 17-year-old male with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2c)
cord-327224-e4rlbfin	2020	title: Environmental Health Burdens and Socioeconomic Status in Rhode Island: Using Geographic Information Systems to Examine Health Disparities in Medical School Using Rhode Island as a case study, we geocoded and visualized several environmental determinants of health via Geographic Information Systems (GIS) in the entire state and conducted a geospatial analysis to determine whether or not patterns existed along racial and class lines. We discovered that, on average, the worst-performing elementary schools, fast food restaurants, and Superfund sites in Rhode Island were clustered in neighborhoods with a larger black population and lower household income. In this study, we utilize a multi-disciplinary approach that combines GIS and citizen science to examine the distribution of environmental health burdens in Rhode Island using data from publicly available sources. This study is the first to utilize GIS to examine the relationship between community demographic data and the distribution of multiple sources of environmental health burden in Rhode Island.
cord-329412-pzv4dzow	2020	Methods: We inquired Twitter public data to access tweets related to telehealth from March 30, 2020 to April 6, 2020. The most common terms appearing alongside ''telehealth'' were "covid", "health", "care", "services", "patients", and "pandemic". The geographic distribution of tweets related to telehealth and having a specific location within the United States (n=19,367) was significantly associated with the number of confirmed Covid-19 cases reported in each state (p<0.001). Our study aims to analyze the dynamics of social media data related to telehealth and understand the public activity to strategically optimize and accelerate the digital health transformation. The 10 most common words apart from "telehealth" that appeared in these tweets were "COVID", "health", "care", "services", "patients", "pandemic", "coronavirus", "healthcare", "access", "need". In this study, we retrieved and analyzed public data available on Twitter to investigate the rapid shift in telehealth adoption amidst the recent coronavirus Covid-19 pandemics.
cord-329904-e05ywn5e	2020	We present a case of a healthy COVID positive individual, with no underlying comorbidities, who rapidly deteriorated overnight on readmission to the hospital after initial discharge and succumbed to this disease due to a superimposed bacterial infection with COVID pneumonia. This case report highlights the importance of educating COVID-19 positive patients about the precautions, as well as signs and symptoms of a superimposed bacterial infection, when their plan of care is in a home setting. It also emphasizes the potential role of checking procalcitonin levels as a part of routine laboratory investigation at initial presentation in all suspected as well as confirmed COVID-19 cases to rule out an on-going bacterial infection that can prove fatal in the course of the disease. Our emphasis from this case report is to highlight the risk of superimposed bacterial infection in COVID-19 patients.
cord-330655-crfj5adf	2020	The researchers confirmed the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the cerebrospinal fluid (CSF) by genome sequencing [4] . Due to suspicion of COVID-19-related encephalitis, the patient received two doses of tocilizumab (400 mg each) followed by intravenous (IV) immunoglobulin (1 g/kg) for five days. A study that specifically investigated this issue documented that 36% of the hospitalized patients with a confirmed diagnosis of an acute respiratory syndrome from COVID-19 infection had some neurological manifestations. The exact mechanism by which COVID-19 infects CNS is not well-understood due to a lack of experimental data, but it is considered a mutation of the Middle East respiratory syndrome (MERS) virus and severe acute respiratory syndrome (SARS) virus [3] . Two case series involving CSF analysis data from 12 patients reported that the CSF had no white blood cells and the PCR assay for SARS-CoV-2 was negative in all the patients [9, 10] . Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study
cord-330814-7incf20e	2020	Background and objective The recent pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a major concern for the people and governments across the world due to its impact on individuals as well as on public health. Conclusion Most healthcare professionals and the general public that we surveyed were well informed about SARS-CoV-2 and have been taking adequate measures in preventing the spread of the same. Social media platforms arguably support the conditions necessary for attitude change by exposing individuals to correct, accurate, health-promoting messages from healthcare professionals In order to investigate community responses to SARS-CoV-2, we conducted this online survey among the general public and healthcare professionals to identify awareness of SARS-CoV-2 (perceived burden and risk), trusted sources of information, awareness of preventative measures and support for governmental policies and trust in authority to handle SARS-CoV-2 outbreak and put forward policy recommendations in case of similar future conditions.
cord-331796-fo3i2jow	2020	Acute diarrhea is not an uncommon manifestation of Legionnaires disease, although isolated diarrhea symptoms with the absence of concurrent respiratory symptoms and no risk factors for Legionella makes this case a diagnostic challenge, leading to possible delay in appropriate management. We are presenting this case to inform physicians of the possibility of Legionnaires disease presenting as an isolated gastrointestinal involvement with no clinical symptoms of pneumonia at presentation. We report a case of Legionnaires disease with isolated gastrointestinal symptoms which can lead to a missed diagnosis and development of complications without treatment. We report a case of Legionnaires'' disease in 61-year-old female patient without any known history of travel, risk factors and pulmonary symptoms. The main goal of this case report is to familiarize physicians of the possibility of Legionnaires disease presenting as an isolated gastrointestinal involvement with no clinical symptoms of pneumonia at presentation.
cord-331927-b7pfm3i0	2020	Since the emergence of the coronavirus disease (COVID-19) pandemic, we have seen many cases and studies on the underlying pathophysiology of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia with or without respiratory failure. We have also learned that the angiotensin-converting enzyme receptor is one of the major entry sites of SARS-CoV-2 infection, and it might be one of the causes that predispose patients to DKA. also stated that the human pancreas also expresses ACE2, and therefore, patients with diabetes are more vulnerable to SARS-CoV-2 infection than the general population [9] . In our cases, the transient damage of pancreatic beta-cell function leading to reduced levels of serum C peptide may be the reason for our patients experiencing acute insulin-dependent DKA for a brief period during the course of COVID-19. COVID-19 may cause DKA by increasing insulin requirement induced by ACE2-mediated destruction of pancreatic beta cells, as evidenced by reversible decreased serum C peptide levels or other unexplored mechanisms.
cord-332065-afq26621	2020	The primary endpoint of this study is to compare whether there was a significant difference in the proportion of patients in each reported racial category presenting with stroke during the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A statistically significant increase in the number of Black and Hispanic patients presenting with strokes was noted in California, Pacific hospitals, Western hospitals, and all hospitals in the United States during various months studied comparing 2020 to 2019. Given the recent pandemic and racial disparity among patients afflicted with SARS-CoV-2 and the possible link of this virus and cerebrovascular accidents (CVA), we sought to analyze whether there was a disparity for stroke patients presenting to hospitals during this time using the Get with the Guidelines (GWTG) National Stroke Database. The primary endpoint of this study is to compare whether there was a significant difference in the proportion of patients in each reported racial category presenting to our institution with stroke during the COVID-19 pandemic caused by SARS-CoV-2.
cord-333808-deifddar	2020	Here we review the current literature around remote patient monitoring in cancer care and propose the use of reliable devices for capturing and reporting patient symptoms and physiology. In oncology, while implantable devices are not available, studies have shown that monitoring patient-reported outcomes reduces visits to the emergency department, decreases follow-up costs and improves overall survival [11] [12] [13] [14] . PRO-CTCAE™ (Patient-Reported Outcomes version of the Common Toxicity Criteria for Adverse Events) is a validated tool used to monitor and report toxicities related to cancer treatment in clinical trials. Emerging research shows benefits in outcomes and costs of cancer care through use of remote monitoring technology especially electronic patient reported outcomes (ePRO). Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial
cord-335625-z9ifjsil	2020	Herein, we are reporting the clinical features and outcomes of two patients with COVID-19 who initially presented with signs and symptoms of lithium toxicity. We report two patients initially presented with acute lithium intoxication in the setting of SARS-CoV-2 infection. The second patient had mild COVID-19 infection but complicated with AKI and lithium intoxication. Our report may point out that the clinical characteristics and outcomes of COVID-19 in patients with psychiatric illness and taking lithium are similar to those of the general population. Some patients may be quarantined at home due to mild symptoms of COVID-19 but at risk of lethal complications from medication toxicity. Prompt recognition and treatment of medication toxicity will prevent patients'' morbidity and mortality. Patients with psychiatric illness and taking lithium may have similar clinical features and outcomes of COVID-19 compared to those without.
cord-336488-opjjowcq	2020	The aim of this paper is to review the existing orthopaedic literature and to present the principles of management and care implemented in the orthopaedic departments of a tertiary academic hospital in Greece to operate during COVID-19 pandemic in order to mitigate the risk of in-hospital transmission of SARS-CoV-2 to the medical, nursing and administrative orthopaedic personnel. In addition, we presented the clinical indications to delineate orthopaedic patients who deserve emergency or urgent in-hospital care from those that can be treated in the outpatient setting, as well as from the day surgery clinics or could not be admitted in the hospital, in order to decrease the SARS-CoV-2 transmission load. The proposed principles of management and care are deployed below as (1) general management of the orthopaedic departments, (2) recommendations for the management of traumatic orthopaedic injuries, (3) hospital pathways for the admitted orthopaedic patients (4) workflow of the isolated and negative pressure COVID-19 operating theatre (COT) and (5) postoperative care of the COVID-19 infected patients.
cord-338288-vfcoyezy	2020	We report a case of a middle-aged man with DM and COVID-19 who developed seizure and altered mental status, found to have diabetic ketoacidosis (DKA), acute kidney injury, hypovolemic shock, and hyperammonemia all contributing to metabolic encephalopathy. The patient was subsequently intubated for airway protection; basic labs showed multiple abnormalities including: DKA with blood glucose (BG) 1100, anion gap 46, HCO 3 4 , beta hydroxybutyrate 65.6; he also had acute kidney injury (AKI) with creatinine (Cr) of 4.9 (baseline was 1.0), blood urea nitrogen 84 , potassium 6.4, sodium 146, chloride 96, phosphorus 18.7, lactic acid 17.3; there was also evidence of liver function abnormalities with elevated ammonia level at 244; arterial blood gas was consistent with high anion gap metabolic acidosis with pH 6.79, HCO 3 4, PaCO 2 36, PaO 2 473.
cord-339188-apgdzgfz	2020	Validated data on severe respiratory viral diseases and the correlation between mortality, immunocompromised status and existing chronic conditions in infected individuals indicate that a broad set of blood-based biomarkers may best serve to stratify risk and to set policy on containment strategies in populations [7] . What separates bad, good, and great programs is "a combination of good design built on behavior change theory, effective implementation using evidence-based practices, and credible measurement and evaluation." To further support the need for more thorough risk assessment, in a global study of 84 risks, the authors concluded "Increasingly detailed understanding of the trends in risk exposure and the relative risks for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends [9] .
cord-339786-elrzlbsg	2020	Studies and data so far on coronavirus infections from China, Singapore, and other countries showed that liver enzymes elevation could be seen in 20-50% of cases. In another study published in the Lancet in February 2020 by Huang et al., an increase in aspartate aminotransferase (AST) was observed in 62% in intensive care unit (ICU) patients compared to 25% in non-ICU patients, indicating that more severe disease correlates with worsening of liver enzymes [10] . Here, we report a case of acute liver failure in an elderly patient with COVID-19 infection who did not have a history of preexisting liver disease. Here, we report a case of acute liver failure in an elderly patient with COVID-19 infection who did not have a history of preexisting liver disease. In summary, we describe the first case of acute liver failure caused by the COVID-19 infection.
cord-340564-3fu914lk	2020	In this study, we present a severity score prediction model for COVID-19 pneumonia for frontal chest X-ray images. A neural network model that was pre-trained on large (non-COVID-19) chest X-ray datasets is used to construct features for COVID-19 images which are predictive for our task. Results This study finds that training a regression model on a subset of the outputs from this pre-trained chest X-ray model predicts our geographic extent score (range 0-8) with 1.14 mean absolute error (MAE) and our lung opacity score (range 0-6) with 0.78 MAE. In this work, we built and studied a model which predicts the severity of COVID-19 pneumonia, based on CXRs, to be used as an assistive tool when managing patient care. This "pre-training" step was performed on a large set of data in order to construct general representations about lungs and other aspects of CXRs that we would have been unable to achieve on the small set of COVID-19 images available.
cord-340660-ocvy1ge2	2020	Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is mostly implicated in soft tissue and skin infections. Here, we reported a case of a 58-year-old female with MRSA bacteremia and meningitis as confirmed by positive blood cultures and cerebrospinal fluid analysis; successfully managed with vancomycin and rifampin. This paper emphasizes the need for early recognition and interventions as soon as meningitis is suspected, while identifying a case where synergistic effects of antibiotics are utilized to improve the penetration of antibiotic therapy for adequate treatment. Fifteen days into her illness, the patient had the first negative blood culture, remained afebrile and improved clinically. Approximately 50% to 90% of patients with bacterial meningitis have positive blood cultures [5] . Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children
cord-341304-jdvzpvdx	2020	In December 2019, China reported a cluster of pneumonia patients infected by a new virus from the coronavirus family called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus quickly spread around the world and infected millions of people, and the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. On March 22, 2020, a 67-year-old female with a past medical history of asthma, coronary artery disease (status post-coronary artery bypass graft two years ago), hypertension, hyperlipidemia, and HIV on antiretroviral medications [bictegrav/emtricit/tenofov ala (Biktarvy® 50-200-25 mg tablet, Gilead Sciences, Foster City, CA) and darunavir/cobicistat (Prezcobix® 800 mg-150 mg tablet, Janssen Pharmaceutica, Beerse, Belgium)] was brought in by emergency medical services (EMS) for progressively worsening shortening of breath associated with weakness and two episodes of watery non-bloody diarrhea for one day. showed clinical improvement in the first case of COVID-19 in the United States after the use of remdesivir [8] .
cord-342666-7el8o6qq	2020	title: Strategies for Rational Use of Personal Protective Equipment (PPE) Among Healthcare Providers During the COVID-19 Crisis However, there are guidelines recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to maintain the supply in the wake of this increased demand of PPE, how the manufacturers should track their supplies, and how the recipients should manage them. It should be noted that according to the World Health Organization (WHO) guidelines, medical masks and respirators should only be reserved for healthcare workers [10] . 1) The healthcare professionals who are working with patients of COVID-19 and are in direct contact should have PPE consisting of gloves, gowns, masks, face shields, and goggles. Use Personal Protective Equipment (PPE) When Caring for Patients with Confirmed or Suspected COVID-19 Rational Use of Personal Protective Equipment ( PPE) for Coronavirus Disease ( COVID-19) : Interim Guidance
cord-343819-1uki4b3d	2020	We searched using PubMed and Google Scholar using keywords such as COVID-19, coronavirus, and their combination with pathological findings, clinical features, management, and treatment to search for relevant published literature. Patients with COVID-19 had pathological findings, like ground-glass opacities, consolidations, pleural effusion, lymphadenopathy, and interstitial infiltration of inflammatory cells. There is currently no recommended treatment for COVID-19, only supportive care like oxygen, and mechanical ventilation is provided to patients in severe respiratory distress [2] . In this review article, we aim to identify and highlight clinical features, pathological and radiological findings, and possible treatment options for COVID-19 patients and to organize the little information we have on this pathogen. Keywords used were novel coronavirus, COVID-19, pathological findings, antivirals, treatment, management, and passive immunity. Based on the studies reviewed, the findings on the CT scan of COVID-19 patients are groundglass opacities, consolidation, crazy paving pattern, and air bronchogram sign.
cord-344302-p0v6sl9x	2020	Therapeutic anticoagulation was empirically initiated with subcutaneous enoxaparin (1 mg/kg twice daily) given the hypercoagulable state observed in many COVID-19 patients with elevated D-dimer. The risk of thromboembolic events and the sheer magnitude of COVID-19-associated admissions have prompted many hospitals to establish novel protocols with which these individuals are provided anticoagulation at increased or even therapeutic doses compared to the more common prophylactic dose. A study of 449 COVID-19 patients demonstrated a statistically significant decrease in mortality (40.0% experimental, 64.2% control) in those receiving prophylactic doses of heparin and enoxaparin [14] . Given the cited relative deficiency of ATIII in CAC and nephrotic syndrome, one can hypothesize that an acute arterial thrombosis may have been avoided if this patient was started on an argatroban infusion from the beginning of his hospital course, which would have provided therapeutic anticoagulation independent of ATIII levels. COVID-19 associated acute limb ischemia in a patient on therapeutic anticoagulation: a case and literature review
cord-344413-9lj4g0tq	2020	We also reviewed some articles on the development of pneumothorax as a complication of COVID-19-associated pneumonia including tension pneumothorax, pneumomediastinum, and subcutaneous emphysema, in addition to case reports on cystic changes within the lungs as a sequel of COVID-19 infection. In view of the lack of previous history of underlying lung disease and the normal CXR on presentation along with the exclusion of some of the common causes of secondary pneumothorax, we think that COVID-19 pneumonia and its complication induced cystic changes within the lung and lead to spontaneous pneumothorax. COVID-19 could be a probable cause of spontaneous pneumothorax secondary to cystic changes and bullae formation within the lung parenchyma and should be kept in mind when evaluating patients with COVID-19 and shortness of breath, but we need further studies on the association between and pathophysiology of the occurrence of infection and pneumothorax. Spontaneous pneumothorax and subcutaneous emphysema in COVID-19 patient: case report.
cord-345546-v7t26oos	2020	There was a statistically significant negative correlation between serum iron levels and ADHD symptom severity. Iron deficiency in children with ADHD and lower ferritin levels have been associated with the severity of RLS symptoms [8] [9] . Our aim was to clarify the prevalence of narcolepsy symptoms among adult ADHD patients as compared to controls of the same age and gender. We also wanted to evaluate the association of low serum ferritin and iron levels to ADHD and symptoms of narcolepsy. A two-sample t-test, comparing WHO-5 scores among groups, revealed a statistically significant difference in favor of controls (means: 48.6 vs. As far as we know, no studies comparing adult ADHD patients with healthy controls, regarding narcoleptic symptoms, has been made before. UNS revealed three possible narcolepsy patients in the ADHD group. Attention-deficit/hyperactivity disorder (ADHD) symptoms in pediatric narcolepsy: a cross-sectional study
cord-346930-gl573ip9	2020	Although multiple drugs show promise in the treatment of COVID-19 via either inhibiting viral replication or preventing fusion of the virus to the ACE2 receptors, further investigation is still warranted and necessary before the admission of any type of pharmaceutical agent. This review explores various drugs and their mechanism of action which are either currently being used in clinical trials or may be used in the future for the treatment of COVID-19. Since the emergence of the virus in China in December of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread across the globe resulting in the current global pandemic. Arbidol (also known as Umifenovir) is a promising repurposed antiviral agent with a unique mechanism of action targeting the S protein/ACE2 interaction and inhibiting membrane fusion of the viral envelope to the host cell [7] .
cord-347406-9cvth7j4	2020	Today, faithful people worldwide share the consecrated bread and wine retracted from a chalice with a Holy Communion spoon. The issue of coronavirus transmission by sharing the Holy Communion has been a subject of debate between science and the Greek Orthodox Church. In this route, a study performed among 681 worshippers partaking Holy Communion disclosed that they did not exert a higher risk of infection compared to those with less or no religious service attendance [13] . The authors reported that although intinction did not eliminate the risk, significantly reduced the hazard of infection compared to the practice of sipping from a common communion cup. She also added that those who believe that through the Holy Communion receive the "body and the blood of Jesus Christ" and not simply wine and bread can partake without fearing the coronavirus [16] . Risk of infectious disease transmission from a common communion cup
cord-348411-nrhe8aek	2020	It is essential and obligatory for the scientific community and healthcare workers to assess and analyze the psychological impact caused by the coronavirus pandemic on children and adolescents, as several mental health disorders begin during childhood. Children exposed to stressors such as separation through isolation from their families and friends, seeing or being aware of critically ill members affected with coronavirus, or the passing of loved ones or even thinking of their own death from the virus can cause them to develop anxiety, panic attacks, depression, and other mental illnesses [11] [12] . The conducted literature search was through Medline, PubMed, PubMed Central, and Embase using the keywords, ''coronavirus,'' ''COVID-19,'' ''mental health,'' ''child and adolescent,'' ''behavioral impact,'' ''psychological conditions,'' ''quarantine,'' and ''online education.'' The indexed search aimed to identify literature and articles relevant to our focused topic.
cord-348823-u2gm3kyh	2020	About 80% of COVID-19 infections are mild or asymptomatic and never require hospitalization but about 5% of patients become critically ill and develop acute respiratory distress syndrome (ARDS). The widely used management for ARDS in COVID-19 has been in line with the standard approach, but the need to adjust the treatment protocols has been questioned based on the reports of higher mortality risk among those requiring mechanical ventilation. Although some antimalarial and antiviral drugs may prove effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), their safety and efficacy are still under clinical trials. We conducted a systematic review of case reports on ARDS in SARS-CoV-2 infection to summarize the clinical presentation, laboratory and chest imaging findings, management protocols, and outcome of ARDS in COVID-19-positive patients. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): a case series
cord-349868-lb2jcl8m	2020	We present the cases of two COVID-19-positive patients treated with HCQ at our institution, which showed adverse effects of the medication. Hydroxychloroquine (HCQ), a common antimalarial and lupus drug, has been shown to potentially reduce viral carriage and the number of symptomatic days in COVID-19 patients according to an open-label non-randomized French case study of 36 patients [2] . The purpose of this case series was to highlight some of the cardiovascular complications related to HCQ and to engage in a risk-benefit analysis of its use in mild/moderate presentations of COVID-19. We believe these are among the first few cases illustrating adverse cardiovascular effects of the experimental five-day HCQ therapy in mild/moderate presentations of COVID-19. Case 2, considered as low risk, demonstrated how HCQ therapy initiated in an outpatient resulted in an adverse outcome that led to hospital admission.
cord-350375-07l9hqsr	2020	Widespread, non-stop, and often sensational coverage of the coronavirus (COVID-19) has caught many governments flat-footed in efforts to protect the health and safety of their citizens. In response to the current global health event, the World Health Organization (WHO) declared COVID-19 a pandemic. Mass gatherings present a historic challenge in protecting the health and safety of attendees. Global sporting events, such as the Olympics and the World Cup, pose unique health risks to attendees and host nations. The WHO defines a mass gathering as a "concentration of people at a specific location for a specific purpose over a set period of time which has the potential to strain the planning and response resources of the country or community" [3] . In response, the WHO recently published, "Key planning recommendations for Mass Gatherings in the context of the current COVID-19 outbreak (Interim guidance)" [1] . World Health Organization: Public Health for Mass gatherings: Key Considerations
cord-351120-amo51jm7	2020	Background and Objectives: Two community studies outside the US showed asymptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults, but not in children <10 years of age. In this study, we assessed the prevalence of asymptomatic SARS-CoV-2 infection in children and adults in Marion County, Indiana. For this reason, we conducted a community-based study of the prevalence of asymptomatic SARS-CoV-2 infection in adults and children in Marion County, Indiana. Community surveys in Iceland and Italy that included symptomatic and asymptomatic individuals found a low prevalence of infection (0.8% to 2.6%), and both studies found no infection in children <10 years of age [3, 4] . In the state of Indiana, a community prevalence study of individuals >12 years of age found an active infection rate (by PCR) of 1.7% and an overall prevalence of current (PCR) or previous infection (SARS-CoV-2 antibody) of 2.8% [8] .
cord-351267-itdorszt	2020	In the aftermath of the Beirut port explosion, Lebanon received immense financial and medical support from the international community in a timely fashion, which secured first level care to victims of the explosion. Nevertheless, this forced Lebanon, which was considered a prominent tertiary medical hub in the Middle East, to slowly regress into an exclusive primary care provider. From the beginning of the Lebanese economic crisis which began around a year ago, many of the small-scale hospitals and medical centers faced threats of potential bankruptcy. Hospitals and medical centers have been suffering for months to keep up with the increase in demand for intensive care unit beds, medical equipment, and medications necessary to cater to patients with severe COVID-19 infections. Three of the major tertiary medical centers serving the Beirut area were severely damaged rendering them completely non-operational, and forcing them to evacuate their patients immediately.
cord-352102-ssk24jkx	2020	Appendectomy is the gold standard of treatment for acute appendicitis; however, recent evidence suggests conservative management with intravenous antibiotics may provide similar outcomes and can be used as an alternative in selected patients. Appendectomy is the gold standard of care for patients with acute appendicitis, but recent evidence showed that conservative treatment with intravenous antibiotics may provide similar outcomes [2] . Non-operative treatment for acute appendicitis has additional benefits, including the elimination of the mortality and morbidity risks associated with surgery, as well as the complications of anesthesia, infection, and bleeding, the obliteration of the long-term complications of abdominal surgery, such as bowel obstruction and chronic wound pain, a decrease in the treatment cost and the length of hospital stay [2] [3] [4] . Although there is increasing evidence that intravenous antibiotics can be used as alternative management, especially in patients with a high operative risk, appendectomy remains the gold standard of care for patients with acute appendicitis.
cord-352580-l6vkzja0	2020	Background Coronavirus disease 2019 (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), usually presents clinically with cough, fever, shortness of breath, and loss of taste and/or smell. COVID-19 can also present with neurologic signs and symptoms, including headache, hyposmia/anosmia, encephalopathy, meningoencephalitis, Guillain-Barré syndrome, stroke, and seizure. This subjective survey addressed 10 neurological manifestations of COVID-19: headache, altered sensation, nausea and vomiting, sudden hemiparesis (stroke), numbness and paresthesia, vertigo, ataxia, seizure, encephalitis/meningitis, Guillain-Barré Syndrome (GBS), and myelitis. Our study confirmed that headache (6%), altered level of consciousness and encephalopathy (2%), hemiparesis (stroke; 0.6%), GBS (0.3%) and seizure (0.3%) were the most frequently reported neurological presentations [5, 6, 7, 8] . A case study reported that a patient positive for SARS-CoV-2 presented with isolated sudden onset anosmia but no other symptoms of COVID-19 [11] .
cord-352640-fycwhyfv	2020	Our study is a short retrospective analysis of the demographic and clinical profiles of subjects presenting with a mild flu-like illness to our hospital who were tested for COVID-19. We present a short retrospective analysis of the demographic and clinical profiles of subjects presenting with a mild flu-like illness to our hospital who were tested for COVID-19. A retrospective analysis of data from subjects who presented to our hospital with mild flu-like illness between the months of March and May 2020 was conducted to understand the disease profile. Data were available for 3,026 subjects who presented to our hospital with either mild flu-like symptoms or with suspected exposure to a confirmed case of COVID-19 during the early phases of the pandemic. In this retrospective analysis, we report that among subjects presenting to the hospital with a mild flu-like illness, those who tested positive for COVID-19 were significantly older and more likely to be men.
cord-352828-4ecik6xw	2020	title: Two False Negative Test Results in a Symptomatic Patient with a Confirmed Case of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and Suspected Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) The pathogen known as severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), is notable for attacking the pulmonary system causing acute respiratory distress, but it can also severely affect other systems in at-risk individuals including cardiovascular compromise, gastrointestinal distress, acute kidney injury, coagulopathies, cutaneous manifestations, and ultimately death from multi-organ failure. We present a confirmed COVID-19 case that was transferred to our burn center for concern of Steven Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap syndrome after having two negative confirmatory COVID-19 tests at an outside hospital. We present a COVID-19 case that was transferred to our burn center for concern of Steven Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap syndrome after having two negative confirmatory COVID-19 tests at an outside hospital.
cord-353717-jjd90fyh	2020	title: A Case of Hemolytic Anemia With Acute Myocarditis and Cardiogenic Shock: A Rare Presentation of COVID-19 In this report, we present a case of acute hemolytic anemia with acute myocarditis and cardiogenic shock in a male patient with COVID-19 infection. In this report, we presented a case of a COVID-19 patient who developed acute myocarditis and severe acute hemolytic anemia, as evident from peripheral blood smear showing schistocytes (fragmented RBCs) in peripheral smear with acute severe anemia along with elevated LDH, which is also a surrogate marker for hemolysis. To date, no case of severe hemolytic anemias with stress cardiomyopathy/acute myocarditis in a patient of COVID-19 have been formally reported in the literature. To date, no case of severe hemolytic anemias with stress cardiomyopathy/acute myocarditis in a patient of COVID-19 have been formally reported in the literature.
cord-353824-0oyvia6d	2020	Here we present a case of a patient with COVID-19 who presented with acute ischemic stroke in the absence of common risk factors for cerebrovascular accidents. A 70-year-old male patient, with no prior comorbidities, presented to the emergency department (ED) with fever, cough, and shortness of breath for four days, and altered level of consciousness and right-sided weakness with the sensory loss for one day. Here we report a case of a patient with COVID-19 who presented with acute ischemic stroke without any predisposing conventional risk factors for cerebrovascular accident. Older age, high sequential organ failure assessment (SOFA) score, cardiovascular diseases, secondary infections, ARDS, acute renal injury, lymphopenia, and elevated liver enzymes, CRP, ferritin, fibrin, and d-dimers are some of the factors in COVID-19 cases which can identify patients at risk of in-hospital mortality [13] . COVID-19 is an independent risk factor for acute ischemic stroke
cord-354835-o0nscint	2020	The correlation coefficient was calculated by plotting dependant variables the number of COVID-19 cases and the number of deaths due to COVID 19 on the Y-axis and independent variables critical-care beds per capita, the median age of the population of the country, the number of COVID-19 tests per million population, population density (persons per square km), urban population percentage, and gross domestic product (GDP) expense on health care on the X-axis. We retrieved data between January 2020 and April 8, 2020, related to population and population density, the median age of the population of a country, urban population, number of COVID-19 testing employed per million population, GDP expense of each country on health, critical care beds available per capita, from various sources as mentioned in the reference section, stated next to each of these variables in Table 1 , along with the total number of COVID-19 cases and the case fatality rate (as per WHO Situation Report, 78 [2] ).
cord-356332-t0ahmh0h	2020	Ventricular septal defect (VSD) is a rare but lethal complication of myocardial infarction. VSD is a rare but lethal complication of myocardial infarction (MI), it is also referred to as a ventricular septal rupture (VSR). Patients with a right ventricular infarction or cardiogenic shock and a ventricular septal rupture have high in-hospital mortality rate [3] . He also had a transthoracic echocardiogram, which showed a left ventricular ejection fraction (LVEF) of 30-35%, ischemic cardiomyopathy, and muscular ventricular septal defects with left to right shunting and severely elevated pulmonary artery systolic pressure as seen in Video 1. Ventricular septal defect (VSD) is a rare mechanical complication of myocardial infarction, especially in the era of reperfusion therapy [2] . Ventricular septal defect is a known however rare complication of myocardial infarction. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction Hemodynamic complications of ventricular septal rupture after acute myocardial infarction