# ent

id: cord-285897-ahysay2l
type: DNA
entity:
  CT scanners uCT 780 United Imaging China and Brilliance iCT 128 Philips Medical Systems the Netherlands with patients


id: cord-285897-ahysay2l
type: DISEASE
entity:
  hypertension diabetes cardiopathy disease chronic obstructive pulmonary disease cerebrovascular disease renal disease hepatitis B virus infection


id: cord-290490-u3mkfvxw
type: WORK_OF_ART
entity:
  The Use of Bronchoscopy During the COVID 19 Pandemic CHEST AABIP Guideline and Expert Panel Report Practice Guidelines for the Diagnosis and Management of Aspergillosis 2016


id: cord-337889-90q4py0j
type: DNA
entity:
  influenza 14 15 16 17 18 Severe Acute Respiratory Syndrome coronavirus SARS CoV 19 and Middle East Respiratory Syndrome coronavirus MERS CoV 20 21 22 23 24 25 26 27 28 Covid 19


id: cord-337889-90q4py0j
type: CELL_LINE
entity:
  WHO Line List Diabetes Mellitus Hypertension and Death among 32 Patients with MERS CoV Infection Saudi Arabia Impact of Comorbidity on Fatality Rate of Patients with Middle East Respiratory Syndrome A Comparative Study of Clinical Presentation and Risk Factors


id: cord-335465-sckfkciz
type: WORK_OF_ART
entity:
  the Treatment of Covid 19 Preliminary Report Effect of Dexamethasone in Hospitalized Patients with COVID 19 Preliminary Report Prediction


id: cord-335465-sckfkciz
type: WORK_OF_ART
entity:
  PROBAST A Tool to Assess the Risk of Bias and Applicability of Prediction Model Studies Assessment of Clinical Criteria for Sepsis


id: cord-335465-sckfkciz
type: ORG
entity:
  an Artificial Intelligence Framework for Data Driven Prediction of Coronavirus Clinical Severity Consortium N MC 19 R Development and Validation of a Survival Calculator for Hospitalized Patients


id: cord-335465-sckfkciz
type: ORG
entity:
  the CMTEG for Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID


id: cord-350166-loxe11d6
type: WORK_OF_ART
entity:
  The Business Case for Medical Device Quality Quantifying the Value of Open Source Hardware Development


id: cord-349958-126yb5se
type: WORK_OF_ART
entity:
  The Clinical Pharmacology of Etoposide and Teniposide Management of febrile neutropaenia ESMO Clinical Practice Guidelines Adjuvant


id: cord-355753-muefay2n
type: WORK_OF_ART
entity:
  The Use of Home Spirometry in Pediatric Cystic Fibrosis Patients Results of a Feasibility Study Development


id: cord-352502-vdm55zvq
type: ORG
entity:
  the Society of Thoracic Radiology the American College of Radiology and RSNA Radiol Cardiothorac Imaging False Negative Tests for SARS CoV 2 Infection Challenges and Implications


# bib

id: cord-012010-5h2ox3hu
author: Bos, Lieuwe D.J.
date: 2020-08-03
txt: ./txt/cord-012010-5h2ox3hu.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397944/
doi: 10.1183/13993003.02756-2020
summary:
  take issue with our interpretation of the respiratory physiology of COVID-19, arguing that it is based merely on "small cohort studies," instead arguing that "a high proportion of mechanically ventilated COVID-19 patients exhibit near-normal lung compliance." [1] Yet the low respiratory compliance of COVID19 patients has now been extensively demonstrated by studies totaling more than 800 COVID-19 patients [2] [3] [4] [5] [6] [7] [8] , including a direct comparison with non-COVID ARDS patients that revealed no difference in respiratory compliance. In his response to our Editorial, Dr. Rajendram reveals a curious misinterpretation of our Editorial: "Thus, whilst the net effect of the ARDSNet protocol is beneficial at the level of the study population, theoretically, it may harm select patients… contrary to the opinions of the Surviving Sepsis Campaign, and Bos and colleagues, the ARDSNet protocol is not a panacea." Putting aside the wishful thinking of a supportive intervention functioning as a "panacea" for a condition with persistent mortality of 30-40%, the correspondent (along with Drs. Cherian et al.) seems to think that we dispute the heterogeneity of ARDS, and advocate for a "one-size-fits-all" approach to its clinical management.

title:
  Response to “COVID-19 conundrum: Clinical phenotyping based on pathophysiology as a promising approach to guide therapy in a novel illness” and “Strengthening the foundation of the house of CARDS by phenotyping on the fly” and “COVID-19 phenotypes: leading or misleading?”

abstract:
  We argue that phenotyping of COVID-19 related ARDS should be done using careful, data-driven approaches.


id: cord-259453-1njd0c0x
title: Abnormal carbon monoxide diffusion capacity in COVID-19 patients at time of hospital discharge
author: Nusair, Samir
date: 2020-07-23
txt: ./txt/cord-259453-1njd0c0x.txt
cache: ./cache/cord-259453-1njd0c0x.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32703822/
doi: 10.1183/13993003.01832-2020
summary:
  In the discussion of their findings, the authors cite previous studies describing follow-up of severe acute respiratory syndrome (SARS) patients having impaired D LCO as the most common abnormality, with affected proportion of patients ranging from 15.5% to 43.6%. The conclusion which can be obtained from this study is that low D LCO is caused mainly by reduced alveolar volume, and not residual interstitial abnormalities or pulmonary vascular abnormalities caused by COVID-19. Besides, in order for an easier and direct comparison with some previous studies on pulmonary function in patients with severe acute respiratory syndrome (SARS) [4, 5] , D LCO /V A was kept in our report. In follow-up studies of rehabilitating SARS patients ranging from 0.5 to 2 years, the impaired D LCO was the most common abnormality, accounting for 15.5% to 43.6% [11] [12] [13] . Follow-up study on pulmonary function and lung radiographic changes in rehabilitating severe acute respiratory syndrome patients after discharge

abstract:
  On recovery from COVID-19 it is important to draw attention to the CO diffusion test and the actual meaning of the findings when considering the values of D(LCO) and D(LCO)/V(A) put together https://bit.ly/36k2O2Q


id: cord-274282-hvx5m2bx
title: Association between ages and clinical characteristics and outcomes of coronavirus disease 2019
author: Liu, Yang
date: 2020-04-27
txt: ./txt/cord-274282-hvx5m2bx.txt
cache: ./cache/cord-274282-hvx5m2bx.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32312864/
doi: 10.1183/13993003.01112-2020
summary:
  This study showed that clinical features and prognosis of the disease vary among patients of different ages and a thorough assessment of age may help clinicians worldwide to establish risk stratification for all COVID-19 patients. However, the ages related clinical characteristics, diseases courses and outcomes other than death in COVID-19 patients remain unclear. A unified observation endpoint date was set (March 7, 2020) in our study, primary outcome of the disease course and second outcome of respiratory failure rate for all COVID-19 patients in both groups were compared. In this study, we demonstrated that the clinical characteristics and outcomes of 221 COVID-19 patients were closely related to the different ages. In conclusion, the clinical features and prognosis of the disease vary among patients of different ages and a thorough assessment of age may help clinicians worldwide to establish risk stratification for all COVID-19 patients. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

abstract:
  Age significantly determined the clinical features and prognosis of the disease. The prognosis was worse in patients older than 60 years, calling for clinicians to pay more attention to patients on this special age. https://bit.ly/34DTI05


id: cord-275858-46jzw94p
title: COVID-19 and COPD
author: Leung, Janice M.
date: 2020-08-13
txt: ./txt/cord-275858-46jzw94p.txt
cache: ./cache/cord-275858-46jzw94p.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.02108-2020
doi: 10.1183/13993003.02108-2020
summary:
  Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study Clinical characteristics and co-infections of 354 hospitalized patients with COVID-19 in Wuhan, China: a retrospective cohort study Risk factors associated with clinical outcomes in 323 COVID-19 hospitalized patients in Wuhan, China Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan Clinical characteristics of laboratory confirmed positive cases of SARS-CoV-2 infection in Wuhan, China: a retrospective single center analysis A preliminary study on serological assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 238 admitted hospital patients Epidemiological, clinical, and virological characteristics of 465 hospitalized cases of coronavirus disease 2019 (COVID-19) from Zhejiang province in China. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China

abstract:
  COPD patients have increased risk of severe pneumonia and poor outcomes when they develop COVID-19. This may be related to poor underlying lung reserves or increased expression of ACE-2 receptor in small airways. https://bit.ly/37dSB8l


id: cord-277603-hpn1ovgo
title: To compare the incomparable: COVID-19 pneumonia and high-altitude disease
author: Strapazzon, Giacomo
date: 2020-06-25
txt: ./txt/cord-277603-hpn1ovgo.txt
cache: ./cache/cord-277603-hpn1ovgo.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32398299/
doi: 10.1183/13993003.01362-2020
summary:
  Some clinicians have found the clinical features of COVID-19 pneumonia to be similar to high-altitude pulmonary oedema (HAPE) [1] , and such theory has been amplified via social media. The assumption that the clinical features of COVID-19 pneumonia are similar to HAPE [1] may rely on the initial clinical presentation of COVID-19 patients, showing profound hypoxaemia with no respiratory distress, similar to patients with acute high-altitude disease that have a chemoreceptor dysfunction. The pathogenesis of the two diseases (HAPE and COVID-19 pneumonia) is clearly different, despite similarities in clinical features, chest imaging and bronchoalveolar lavage findings in later stages, as has recently been emphasised by LUKS et al. The use @ERSpublications COVID-19 pneumonia is a viral infection; high-altitude pulmonary oedema is a non-cardiogenic oedema. Clinicians should focus on the development of therapeutic strategies based on the pathogenesis of the disease, and should remember that COVID-19 pneumonia is a viral infection primarily leading to diffuse alveolar damage and airway inflammation.

abstract:
  COVID-19 pneumonia is a viral infection; high-altitude pulmonary oedema is a non-cardiogenic oedema. Some clinicians have found the clinical features similar. It is important to clarify such misconceptions to prevent erroneous treatment strategies https://bit.ly/2KOBi3F


id: cord-281193-sb7kgu24
author: Yang, Hai-Jun
date: 2020-08-03
txt: ./txt/cord-281193-sb7kgu24.txt
cache: ./cache/cord-281193-sb7kgu24.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.02439-2020
doi: 10.1183/13993003.02439-2020
summary:
  key: cord-281193-sb7kgu24 title: Re: Predictors of mortality for patients with COVID-19 pneumonia caused by SARSCoV-2: a prospective cohort study cord_uid: sb7kgu24 H. et al.''s paper published in the European Respiratory Journal. with COVID-19 pneumonia were associated with increased risk of death from this disease [1] . They further identified that CD3+CD8+ T-cells ⩽75 cells·μL −1 and cardiac troponin I especially ⩾0.05 ng·mL −1 could be used as predictors for mortality of patients with COVID-19 pneumonia using matched case-control study [1] . With great interest, we have read the full text of the paper and found that there are several issues which are worth to clarifying. We hope our comments will be helpful to improve the expression and increase the quality of the paper published by Du R et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study

title:
  Re: Predictors of mortality for patients with COVID-19 pneumonia caused by SARSCoV-2: a prospective cohort study

abstract:
  We found that there were several issues which are worth clarifying in Du R. H. et al.'s paper published in the European Respiratory Journal.


id: cord-285897-ahysay2l
author: Wu, Guangyao
date: 2020-07-02
txt: ./txt/cord-285897-ahysay2l.txt
cache: ./cache/cord-285897-ahysay2l.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32616597/
doi: 10.1183/13993003.01104-2020
summary:
  OBJECTIVE: To develop and validate machine-learning model based on clinical features for severity risk assessment and triage for COVID-19 patients at hospital admission. CONCLUSION: The machine-learning model, nomogram, and online-calculator might be useful to access the onset of severe and critical illness among COVID-19 patients and triage at hospital admission. Therefore, our objective is to develop and validate a prognostic machine-learning model based on clinical, laboratory, and radiological variables of COVID-19 patients at hospital admission for severity risk assessment during hospitalization, and compare the performance with that of PSI as a representative clinical assessment method. This international multicenter study analyzed individually and in combination, clinical, laboratory and radiological characteristics for COVID-19 patients at hospital admission, to retrospectively develop and prospectively validate a prognostic model and tool to assess the severity of the illness, and its progression, and to compare these with PSI scoring.

title:
  Development of a Clinical Decision Support System for Severity Risk Prediction and Triage of COVID-19 Patients at Hospital Admission: an International Multicenter Study

abstract:
  BACKGROUND: The outbreak of the coronavirus disease 2019 (COVID-19) has globally strained medical resources and caused significant mortality. OBJECTIVE: To develop and validate machine-learning model based on clinical features for severity risk assessment and triage for COVID-19 patients at hospital admission. METHOD: 725 patients were used to train and validate the model including a retrospective cohort of 299 hospitalised COVID-19 patients at Wuhan, China, from December 23, 2019, to February 13, 2020, and five cohorts with 426 patients from eight centers in China, Italy, and Belgium, from February 20, 2020, to March 21, 2020. The main outcome was the onset of severe or critical illness during hospitalisation. Model performances were quantified using the area under the receiver operating characteristic curve (AUC) and metrics derived from the confusion-matrix. RESULTS: The median age was 50.0 years and 137 (45.8%) were men in the retrospective cohort. The median age was 62.0 years and 236 (55.4%) were men in five cohorts. The model was prospectively validated on five cohorts yielding AUCs ranging from 0.84 to 0.89, with accuracies ranging from 74.4% to 87.5%, sensitivities ranging from 75.0% to 96.9%, and specificities ranging from 57.5% to 88.0%, all of which performed better than the pneumonia severity index. The cut-off values of the low, medium, and high-risk probabilities were 0.21 and 0.80. The online-calculators can be found at www.covid19risk.ai. CONCLUSION: The machine-learning model, nomogram, and online-calculator might be useful to access the onset of severe and critical illness among COVID-19 patients and triage at hospital admission.


id: cord-290080-hxte1gc1
title: On Tuberculosis and COVID-19 co-infection
author: Tadolini, Marina
date: 2020-06-25
txt: ./txt/cord-290080-hxte1gc1.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32586888/
doi: 10.1183/13993003.02328-2020
abstract: COVID-19 may boost tuberculosis given infection and mortality, further studies are needed
summary:
  In their correspondence, the Authors raised two important issues, namely the possible association between tuberculosis (TB) and COVID-19 (can infection by SARS-CoV-2 reactivate TB?) and the effects of TB on early mortality in co-infected patients. Our research letter reported the first cohort of patients with diagnosis of TB (including posttreatment sequelae) and COVID-19. At the time the article was submitted several countries in Africa, Europe and Latin America represented in the Global Tuberculosis Network (GTN) had no TB/COVID-19 patients to report. The Authors [1] also raised the important question whether TB has a real effect or ''weight'' in increasing the probability of death in COVID-19 patients. It is important to emphasise that the cohort of young migrants without co-morbidities reported elsewhere [3, 4] experienced a milder form of COVID-19 with no deaths. Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases Pulmonary rehabilitation is effective in patients with tuberculosis pulmonary sequelae


id: cord-290378-h4cof32m
title: High-flow nasal oxygen: a safe, efficient treatment for COVID-19 patients not in an ICU
author: Guy, Tiphaine
date: 2020-08-28
txt: ./txt/cord-290378-h4cof32m.txt
cache: ./cache/cord-290378-h4cof32m.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32859678/
doi: 10.1183/13993003.01154-2020
summary:
  SARS-CoV2 infected patients with non-hypercapnic acute hypoxemic respiratory failure can benefit from HFNO outside an ICU. Patients infected with SARS-CoV-2 can develop severe pneumonia and respiratory failure, which often require treatment in intensive care units (ICU) in Western European countries (2) . This report describes the use of HFNO to manage SARS-CoV-2 infected patients with respiratory failure on the pulmonology ward rather than in an ICU. The theoretical risk of virus aerosolization resulted in early published reports of critically ill SARS-CoV-2-infected patients in China not recommending the use of HFNO or non-invasive ventilation until the patient had been cleared of COVID-19 (4). While these results should be confirmed in larger studies, we believe that our data strongly suggest that SARS-CoV2 infected patients with non-hypercapnic acute hypoxemic respiratory failure can benefit from HFNO outside an ICU.

abstract:
  SARS-CoV2 infected patients with non-hypercapnic acute hypoxemic respiratory failure can benefit from HFNO outside an ICU. The technique appears to be safe for HCWs and could well liberate critical ICU resources.


id: cord-290490-u3mkfvxw
title: Confronting and mitigating the risk of COVID-19 Associated Pulmonary Aspergillosis (CAPA)
author: Armstrong-James, Darius
date: 2020-07-23
txt: ./txt/cord-290490-u3mkfvxw.txt
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extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.02554-2020
doi: 10.1183/13993003.02554-2020
summary:
  Cases of COVID-19 associated pulmonary aspergillosis (CAPA) are being increasingly reported and physicians treating patients with COVID-19-related lung disease need to actively consider these fungal co-infections. Influenza-associated pulmonary aspergillosis (IAPA) presents a known risk to critically unwell patients with influenza (12) (13) (14) and the clinical course of COVID-19 shows many features that are shared with severe influenza infection. Although the host risk factors and clinical characteristics of CAPA are not yet understood, those individuals fulfilling the criteria for proven or probable aspergillosis (13, 14) should then be treated according to current guidelines (31, 32) . Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: a retrospective study A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients Beta-Dglucan detection as a diagnostic test for invasive aspergillosis in immunocompromised critically ill patients with symptoms of respiratory infection: an autopsy-based study Invasive pulmonary aspergillosis complicating COVID-19 in the ICU -A case report

abstract:
  Cases of COVID-19 associated pulmonary aspergillosis (CAPA) are being increasingly reported and physicians treating patients with COVID-19-related lung disease need to actively consider these fungal co-infections.


id: cord-290712-flj352ql
title: Does Chemotherapy Reactivate SARS-CoV-2 in Cancer Patients Recovered from Prior COVID-19 Infection?
author: Bi, Jianping
date: 2020-09-04
txt: ./txt/cord-290712-flj352ql.txt
cache: ./cache/cord-290712-flj352ql.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32883679/
doi: 10.1183/13993003.02672-2020
abstract: Recovered COVID-19 cancer patients remain negative for SARS-CoV-2 after delivery of chemotherapy
summary:
  title: Does Chemotherapy Reactivate SARS-CoV-2 in Cancer Patients Recovered from Prior COVID-19 Infection? Those studies mainly addressed whether chemotherapy could predict for hospitalization, severe disease, and mortality in cancer patients with COVID-19 infection. To address this knowledge gap, this study''s findings suggest that administering chemotherapy to this population is associated with a very low short-term risk of SARS-CoV-2 reactivation. Third, the duration of follow-up in this study was relatively short and it may take a longer period of time to determine immune-related alterations caused by chemotherapy in cancer patients who have recovered from COVID-19 infection. Nevertheless, when conservatively interpreted, our study indicates no overt short-term increase in the risk for SARS-CoV-2 reactivation following immunosuppressive chemotherapy in this uniquely vulnerable population. To our knowledge, this is the first study reporting that recovered COVID-19 cancer patients remain negative in the short-term for SARS-CoV-2 after delivery of chemotherapy.


id: cord-293500-z28bws23
title: Cardiovascular comorbidity and its impact on patients with Covid-19
author: Guan, Wei-jie
date: 2020-04-27
txt: ./txt/cord-293500-z28bws23.txt
cache: ./cache/cord-293500-z28bws23.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32341104/
doi: 10.1183/13993003.01227-2020
abstract: Comorbid hypertension correlates with poorer outcomes in patients with Covid-19.
summary:
  Comorbid hypertension correlates with poorer outcomes in patients with Covid-19. We truly appreciate the comments from Sisnieguez et al., who have performed a further analysis on the potential association between cardiovascular comorbidities and the clinical outcomes of Covid-19 (in particular, the mortality) [1] . We also applaud the suggestion to thoroughly adjust for the potential confounding factors when interpreting the association between specific categories of cardiovascular comorbidities (e.g., hypertension) and the clinical outcomes of Covid-19. Our findings could have also been attributed to the relatively low proportion of patients with co-existing hypertension and coronary heart disease in our study. The causes for the association between cardiovascular diseases and the poor clinical outcomes of Covid-19 might be multifaceted, including but not limited to the interaction with the age, and the cardiac dysfunction due to viral infections. Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: a retrospective study


id: cord-293691-ewerquin
author: Sauerhering, Lucie
date: 2020-07-02
txt: ./txt/cord-293691-ewerquin.txt
cache: ./cache/cord-293691-ewerquin.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32616594/
doi: 10.1183/13993003.01826-2019
summary:
  RATIONALE: While severe coronavirus infections, including Middle East respiratory syndrome coronavirus (MERS-CoV) cause lung injury with high mortality rates, protective treatment strategies are not approved for clinical use. METHODS: Calu-3 cells and primary human alveolar epithelial cells (hAEC) were infected with MERS-CoV and treated with CsA or ALV or inhibitors targeting cyclophilin inhibitor-regulated molecules including Calcineurin, NFAT, or MAP kinases. To address the previously proposed antiviral activity of CsA in clinically relevant cells, we infected the human bronchial epithelial cell line Calu-3 and primary human alveolar epithelial cells (hAEC) with MERS-CoV and analyzed intracellular viral RNA and infectious particle release in presence of DMSO or CsA ( Figure 1 ). Our data demonstrated that silencing of IRF1 but not treatment by control siRNA lead to a significant increase in MERS-CoV released viral particles in CsA-treated cells ( Figure 6A , B).

title:
  Cyclophilin Inhibitors Restrict Middle East Respiratory Syndrome Coronavirus Via Interferon λ In Vitro And In Mice

abstract:
  RATIONALE: While severe coronavirus infections, including Middle East respiratory syndrome coronavirus (MERS-CoV) cause lung injury with high mortality rates, protective treatment strategies are not approved for clinical use. OBJECTIVES: We elucidated the molecular mechanisms by which the cyclophilin inhibitors Cyclosporin A (CsA) and Alisporivir (ALV) restrict MERS-CoV to validate their suitability as readily-available therapy in MERS-CoV infection. METHODS: Calu-3 cells and primary human alveolar epithelial cells (hAEC) were infected with MERS-CoV and treated with CsA or ALV or inhibitors targeting cyclophilin inhibitor-regulated molecules including Calcineurin, NFAT, or MAP kinases. Novel CsA-induced pathways were identified by RNA sequencing and manipulated by gene knockdown or neutralising antibodies. Viral replication was quantified by qRT-PCR and TCID(50). Data were validated in a murine MERS-CoV infection model. RESULTS: CsA and ALV both reduced MERS-CoV titers and viral RNA replication in Calu-3 and hAEC improving epithelial integrity. While neither Calcineurin nor NFAT inhibition reduced MERS-CoV propagation, blockade of c-Jun N-terminal kinase diminished infectious viral particle release but not RNA accumulation. Importantly, CsA induced interferon regulatory factor 1 (IRF1), a pronounced type-III-interferon (IFNλ) response and expression of antiviral genes. Down-regulation of IRF1 or IFNλ increased MERS-CoV propagation in presence of CsA. Importantly, oral application of CsA reduced MERS-CoV replication in vivo, correlating with elevated lung IFNλ levels and improved outcome. CONCLUSIONS: We provide evidence that cyclophilin inhibitors efficiently decrease MERS-CoV replication in vitro and in vivo via upregulation of inflammatory, antiviral cell responses, in particular IFNλ. CsA might therefore represent a promising candidate to treat MERS-CoV infection.


id: cord-296440-18vpg419
author: Beurnier, Antoine
date: 2020-07-30
txt: ./txt/cord-296440-18vpg419.txt
cache: ./cache/cord-296440-18vpg419.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.01875-2020
doi: 10.1183/13993003.01875-2020
summary:
  The objective of this study was to investigate the characteristics and outcomes of asthmatic patients with COVID-19 pneumonia who required hospitalisation during the spring 2020 outbreak in Paris, France. As the world faces the coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, concerns have arisen about a possible increased risk of asthma exacerbations. In Wuhan, authors pointed out a rate of 0.9% [3] , markedly lower than that in the local population; in another study investigating the clinical characteristics and allergy status of 140 patients infected by SARS-CoV-2 in Wuhan, no patient were reported as being asthmatic [3] . All adult patients hospitalized from March 15, 2020 to April 15, 2020 with a diagnosis of SARS-CoV-2 infection and reporting a history of asthma were included. Moreover, obesity, hypertension and diabetes were the most common comorbidities observed in our cohort of hospitalized asthmatics with COVID-19, which is consistent with earlier research in other patient groups [4] [23] .

title:
  Characteristics and outcomes of asthmatic patients with COVID-19 pneumonia who require hospitalisation

abstract:
  BACKGROUND: Viral respiratory infections are the main causes of asthma exacerbation. The susceptibility of asthmatics to develop an exacerbation when they present with severe pneumonia due to SARS-CoV-2 infection is unknown. The objective of this study was to investigate the characteristics and outcomes of asthmatic patients with COVID-19 pneumonia who required hospitalisation during the spring 2020 outbreak in Paris, France. METHODS: A prospective cohort follow-up was carried out from March 15 to April 15, 2020 in Bicêtre Hospital, University Paris-Saclay, France. All hospitalised patients with a SARS-CoV-2 infection who reported a history of asthma were included. RESULTS: Among 768 hospitalised patients, 37 (4.8%) reported a history of asthma, which had been previously confirmed by a pulmonologist in 85% of cases. Patients were mainly female (70%), non-smokers (85%), with a median age of 54 years (interquartile range, IQR 42–67). None of them presented with an asthma exacerbation. Twenty-two (59%) had major comorbidities and 31 (84%) had a body mass index ≥25 kg·m(−2). The most common comorbidities were obesity (36%), hypertension (27%) and diabetes (19%). All patients had a confirmed diagnosis of COVID-19 pneumonia on computed tomography of the chest. Eosinopenia was a typical biologic feature with a median count of 0/mm3 (IQR 0–0). Eleven patients (30%) were admitted in intensive care unit with three death (8.1%) occurring in the context of comorbidities. CONCLUSION: Asthmatics were not overrepresented among patients with severe pneumonia due to SARS-CoV-2 infection who required hospitalisation. Worst outcomes were observed mainly in patients with major comorbidities.


id: cord-296694-2js639bk
title: Thrombosis and COVID-19 pneumonia: the clot thickens!
author: Price, Laura C
date: 2020-06-18
txt: ./txt/cord-296694-2js639bk.txt
cache: ./cache/cord-296694-2js639bk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.01608-2020
doi: 10.1183/13993003.01608-2020
summary:
  The true prevalence of thrombosis associated with COVID-19 infection is unknown, as most studies to date do not include systematic and comprehensive investigation protocols. Two recent Dutch studies have reported cumulative incidences of thrombotic events between 48 and 49% respectively in their ICUs in patients with COVID-19 pneumonia [10, 11] . refine this further by describing a 50% cumulative incidence of pulmonary embolism (PE), diagnosed by CT-pulmonary angiogram (PA), in COVID-19 patients admitted to ICU in two hospitals of the University of Paris (ERJ ref Bompard). In addition to ACE2 mediated SARS-CoV-2 viral entry, recent reports of affinity of the SARS-CoV-2 spike protein and CD147, a membrane glycoprotein and extracellular matrix metalloproteinase inducer expressed on a variety of haematopoietic cell lines, suggest another potentially novel mechanism of thrombosis and inflammation in the arterial and venous circulations [27] . High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients

abstract:
  Pulmonary thrombosis appears to be common in Covid-19 pneumonia and takes two forms, proximal pulmonary emboli and/or distal thrombosis. We hypothesise mechanisms and discuss clinical implications.


id: cord-299679-6z9e5gi6
title: Clinical phenotypes of SARS-CoV-2: implications for clinicians and researchers
author: Rello, Jordi
date: 2020-05-21
txt: ./txt/cord-299679-6z9e5gi6.txt
cache: ./cache/cord-299679-6z9e5gi6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32341111/
doi: 10.1183/13993003.01028-2020
summary:
  Many intubated patients present with phenotype 4, characterised by pulmonary hypoxic vasoconstriction, being associated with severe hypoxaemia with "normal" (>40 mL·cmH(2)O(−1)) lung compliance and likely representing pulmonary microvascular thrombosis. Phenotype 5 is often associated with high plasma procalcitonin and has low pulmonary compliance, Which is a result of co-infection or acute lung injury after noninvasive ventilation. The clinical spectrum of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is broad, ranging from asymptomatic infection to flu-like illness (sometimes with digestive disturbances) to viral pneumonia. Phenotype 2 represents 80% of hospitalisations and is characterised by the presence of hypoxaemia or small opacities on chest radiographs and these patients should be referred for close respiratory monitoring ( particularly respiratory rate and oxygen saturation measure by pulse oximetry) because they are at risk of rapid deterioration progressing to death if intubation is not timely instituted.

abstract:
  Patients with COVID-19 present a broad spectrum of clinical presentation. Whereas hypoxaemia is the marker of severity, different strategies of management should be customised to five specific individual phenotypes. Many intubated patients present with phenotype 4, characterised by pulmonary hypoxic vasoconstriction, being associated with severe hypoxaemia with “normal” (>40 mL·cmH(2)O(−1)) lung compliance and likely representing pulmonary microvascular thrombosis. Phenotype 5 is often associated with high plasma procalcitonin and has low pulmonary compliance, Which is a result of co-infection or acute lung injury after noninvasive ventilation. Identifying these clinical phenotypes and applying a personalised approach would benefit the optimisation of therapies and improve outcomes.


id: cord-301318-9g547s2n
title: Novel Coronavirus Infection in Newborn Babies Under 28 Days in China
author: Zhang, Zhi-Jiang
date: 2020-04-09
txt: ./txt/cord-301318-9g547s2n.txt
cache: ./cache/cord-301318-9g547s2n.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.00697-2020
doi: 10.1183/13993003.00697-2020
summary:
  Little is known about features, outcomes and intrauterine transmission potential in newborn babies aged 28 days or less. We identified all infected newborn babies in China by March 13 and described the clinical features, treatment, outcomes and intrauterine transmission potential. To analyze the intrauterine transmission potential, mother''s disease onset (symptoms, timing of symptoms onset relative to delivery), diagnosis, Wuhan linkage (living in or visited Wuhan, or directly contacting visitors from Wuhan), delivery (delivery methods, hospital level, protection level, gestational age at delivery), mother-child contact (separation, breastfeeding) were collected. Based on the data sources we used in this retrospective study, 4 nucleic acid-confirmed neonatal infections were identified through systematic and comprehensive searching among the 81,026 confirmed cases in China as of March 13 (Table) . First, although a systematic and comprehensive searching was made for SARS-CoV-2 infection in newborn babies <28 days of age, incomplete identification of cases is possible.

abstract:
  Previous studies described the clinical features of Covid-19 in adults and infants under 1 year of age. Little is known about features, outcomes and intrauterine transmission potential in newborn babies aged 28 days or less. Through systematical searching, we identified 4 infections in newborn babies in China as of March 13. The age range was 30 h to 17 days old. Three were male. Two newborn babies had fever, 1 had shortness of breath, 1 had cough and 1 had no syndromes. Supportive treatment was provided for all 4 newborn babies. None required intensive unit care or mechanical ventilation. None had any severe complications. Three newborn babies recovered by the end of this study and had been discharged with 16, 23, and 30 days of hospital stay. All 4 mothers were infected by SARS-CoV-2, 3 showing symptoms before and 1 after delivery. Cesarean section was used for all 4 mothers, 3 at level III hospitals and 1 at a level II hospital. Three newborn babies were separated from mothers right after being born and were not breastfed. In summary, newborn babies are susceptible to SARS-CoV-2 infection. The symptoms in newborn babies were milder and outcomes were less severe as compared to adults. Intrauterine vertical transmission is possible but direct evidence is still lacking.


id: cord-307279-1yei5ifs
author: Nagra, Deepak
date: 2020-10-02
txt: ./txt/cord-307279-1yei5ifs.txt
cache: ./cache/cord-307279-1yei5ifs.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33008941/
doi: 10.1183/13993003.02340-2020
summary:
  title: Covid-19: Opacification score is higher in the right lung and right lung involvement is a better predictor of ICU admission In COVID-19 the right lung has higher degree of opacification on plain radiograph than the left lung. Right lung opacificiation is a stronger predictor for critical care admission and death. We extracted data from our EHR to build a risk score that predicted critical care admission or death. The extent of CXR abnormality was scored using an adapted radiographic assessment of lung oedema for COVID-19, as proposed by Wong et al (4) . In addition, opacification of the right lung was a stronger predictor of admission to critical care or die (see figure) . A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: An observational cohort study

title:
  Covid-19: Opacification score is higher in the right lung and right lung involvement is a better predictor of ICU admission

abstract:
  In COVID-19 the right lung has higher degree of opacification on plain radiograph than the left lung. Right lung opacificiation is a stronger predictor for critical care admission and death.


id: cord-307732-sdstnm9i
title: The influence of preventive strategies on COVID-2019 epidemic in Shenzhen, China
author: Yang, Kai
date: 2020-04-16
txt: ./txt/cord-307732-sdstnm9i.txt
cache: ./cache/cord-307732-sdstnm9i.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32299861/
doi: 10.1183/13993003.00599-2020
summary:
  Early identification of imported cases, prevention of family clustering transmission, preventive measures in the public area and strict infection control procedure in hospitals were crucial for successful prevention of COVID-19 in Shenzhen, China. Therefore, the purpose of this study was to analyze the epidemiology and preventive strategies in Shenzhen in order to understand the main transmission route and effective preventive strategies in cities with risk of imported cases, which may provide clue for better preventing outbreak of potential respiratory infectious disease, such as COVID-19 in cities with heavy population density and high proportion of external population. As early as January 19, when the National Health Commission announced the first imported case in Shenzhen, Shenzhen began to take temperature for people in main city entrances to screen imported cases, which was also widely used in the prevention of other respiratory infectious diseases, such as influenza in United States and SARS in China [11, 12] .

abstract:
  Early identification of imported cases, prevention of family clustering transmission, preventive measures in the public area and strict infection control procedure in hospitals were crucial for successful prevention of COVID-19 in Shenzhen, China.


id: cord-316058-eh4m5jqz
title: Short-term Outcomes of Coronavirus Disease 2019 and Risk Factors for Progression
author: Long, Li
date: 2020-04-20
txt: ./txt/cord-316058-eh4m5jqz.txt
cache: ./cache/cord-316058-eh4m5jqz.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.00990-2020
doi: 10.1183/13993003.00990-2020
summary:
  With a median follow-up time of 24.0 (17.5–30.0) days, progression occurred in 19.6% moderate, 27.8% severe, 66.7% critical COVID-19. This study aimed to investigate short-term outcomes of patients rated as different severities on admission, and to identify risk factors for progression, thereby, help the management of COVID-19 in clinical practice. On admission, the median disease duration was 6.0 (4.0-9.0) days, and the proportion of mild, moderate, severe, critical cases was 8 (2.6%), 245 (81.4%), 36 (12.0%), 12 (4.0%), respectively. 48 (19.6%) out of the 245 moderate patients experienced progression during hospitalization, among them, 14 (5.7%) turned moderate, 6 (2.5%) were discharged, while 21 (8.6%) were severe, 2 (0.8%) were critical, 5 (2.0%) died at the endpoint. A neutrophil-to-lymphocyte ratio ≥ 2.973 (hazard ratio *95% CI+: 2.641 *1.421-4.908], p = 0.002), age ≥ 50 years (2.504 *1.202-5.215], p = 0.014), male gender (2.004 [1.101-3.647], p = 0.023), and with comorbidity (1.969 [1.085-3.571], p = 0.026) were identified as risk factors for progression by multivariate Cox regression analyses.

abstract:
  With a median follow-up time of 24.0 (17.5–30.0) days, progression occurred in 19.6% moderate, 27.8% severe, 66.7% critical COVID-19. A neutrophil-to-lymphocyte ratio ≥2.973, age ≥50 years, male gender, and comorbidity were associated with progression.


id: cord-322075-e6whegrf
title: COVID-19 in Italy - Passing through bitter waters
author: Guglielmetti, Lorenzo
date: 2020-05-22
txt: ./txt/cord-322075-e6whegrf.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32444413/
doi: 10.1183/13993003.01812-2020
summary:
  The COVID-19 epidemic in Italy has shown many shortcomings of the national health care system but it also represents a historic opportunity to reinforce the central health care governance and reduce inequalities across the country [1, 2] In a recent editorial, Nava and co-authors pay a well-deserved tribute to the almost 200 health care workers who succumbed to COVID-19 in the country in less than 3 months since the first case was reported. [3] An obvious reason for Italy''s inadequate outbreak response can be found in years of neglect for the public sector, increased private expenditure, and health care budget cuts by governments of all political affiliations. Most patient transfers to relieve overwhelmed intensive care units were indeed performed inside the same region, or towards foreign countries. What Other Countries Can Learn From Italy During the COVID-19 Pandemic

abstract:
  The COVID-19 epidemic in Italy has shown many shortcomings of the national health care system but it also represents a historic opportunity to reinforce the central health care governance and reduce inequalities across the country


id: cord-322580-7ohso8hl
author: Stochino, Claudia
date: 2020-06-01
txt: ./txt/cord-322580-7ohso8hl.txt
cache: ./cache/cord-322580-7ohso8hl.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.01708-2020
doi: 10.1183/13993003.01708-2020
summary:
  Patients with active TB admitted to the hospital were analysed to assess the impact of COVID-19 on their clinical course as well as radiologic and laboratory consequences of the co-infection. $ at COVID-19 diagnosis compared to the last available CXR result; ^ isoniazid-resistance was detected only through genotypic drugsusceptibility test; * lung pattern at chest radiography; ** lung pattern at chest computed tomography scan; £ ferritin was n ot routinely assessed but was part of a set of exams to perform only in patients affected by COVID-19, however, due to the lag obtaining the swab results for SARS-CoV-2 it was not included; & Frequent blood transfusions to treat severe anaemia due to sickle cell disease; ‡ O2 supply ex novo; § O2 supply at admission ad then stopped; # oxygen supply was required temporarily due to pleural blebs rupture and consequent pneumothorax.

title:
  Clinical characteristics of COVID-19 and active tuberculosis co-infection in an Italian reference hospital

abstract:
  The COVID-19 infection rate was high in patient with active tuberculosis. Major clinical complications were seen only in two patients thus requiring ex novo oxygen supply, one of whom with advanced tuberculosis died. Nasal swab viral clearance was rapid.


id: cord-323480-h6z3vim0
title: Clinical Application of Intelligent Oropharyngeal-swab Robot: Implication for COVID-19 Pandemic
author: Li, Shao-Qiang
date: 2020-07-16
txt: ./txt/cord-323480-h6z3vim0.txt
cache: ./cache/cord-323480-h6z3vim0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.01912-2020
doi: 10.1183/13993003.01912-2020
summary:
  Clinical Application on the safety and effectiveness of Intelligent Oropharyngeal-swab Robot for the Implication for COVID-19 Pandemic [5] Remote controlled OPswab robot has the potential to avoid close contact between healthcare workers with patients, and thus reduce the risk of SARS-CoV-2 infection during sampling. Clinical application study was performed in 20 consecutive suspected COVID-19 patients from a fever clinic to compare the pathogen test results of the two methods. The Ct values showed 97% specimens as qualified, and no significant difference in the quality of the specimens was found in the four sampling force groups based on the sample GADPH Ct value. No differences in the success rate, swab quality, and pathogen discovery results were found between the oropharyngeal-swab robot and manual sampling methods. Though this was a preliminary, single-center study in limited COVID-19 patients, the sampling process of the intelligent oropharyngeal-swab robot is safe, with a high success rate of sampling.

abstract:
  Clinical Application on the safety and effectiveness of Intelligent Oropharyngeal-swab Robot for the Implication for COVID-19 Pandemic


id: cord-325565-cz9f65ca
author: Heederik, Dick J.J.
date: 2020-06-25
txt: ./txt/cord-325565-cz9f65ca.txt
cache: ./cache/cord-325565-cz9f65ca.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.01361-2020
doi: 10.1183/13993003.01361-2020
summary:
  The second study used European data and, based on simple correlation analyses, associated long term (Jan-Feb 2020) exposure to nitrogen oxides (NOx) in the troposphere (resolution ~7*3.5km), assessed using satellite data, and absolute numbers of COVID-19-related deaths. [5] Positive associations were seen between levels of nitrogen dioxide and nitrogen oxide and increased COVID-19 mortality and reported number of cases, without adjustment for population size, age distribution or other confounding variables. In particular the two ecological studies which crudely correlate reported numbers of COVID-19 cases or mortality to regional air pollution levels ignored the time of introduction of COVID-19 in the different areas, did not take into account disease dynamics in any way, and ignored basic epidemiologic principles by using inadequate measures of disease frequency. The effect of air pollution on disease prognosis can be studied using more conventional approaches after COVID-19 infection.

title:
  Go slow to go fast: A plea for sustained scientific rigor in air pollution research during the COVID-19 pandemic

abstract:
  Present studies on the role of air pollution and COVID-19 spread and prognosis in patients do not fulfill quality criteria and are at present not sufficiently informative.


id: cord-327169-sz4ildnd
author: Mondoni, Michele
date: 2020-08-28
txt: ./txt/cord-327169-sz4ildnd.txt
cache: ./cache/cord-327169-sz4ildnd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32859682/
doi: 10.1183/13993003.02767-2020
abstract: Utility and safety of bronchoscopy during SARS-CoV-2 outbreak
summary:
  The primary aim of the present study was to describe the diagnostic yield of bronchoscopy in patients with negative nasopharyngeal swab(s) and a clinical and radiological suspicion of COVID-19 pneumonia. The indications of bronchoscopy were: -diagnosis of SARS-CoV-2 pneumonia in patients with previously negative nasopharyngeal swab (clinical and radiological suspicion of pneumonia); -need for undelayable procedures in COVID-19 patients (e.g., massive hemoptysis, post-obstructive atelectasis). The diagnostic yield of bronchoscopy was calculated dividing the number of patients with a molecular diagnosis of SARS-CoV-2 infection following the collection of bronchoscopic specimens by the number of patients with a suspected diagnosis of COVID-19 pneumonia. This is to our knowledge the largest study on the diagnostic yield of bronchoscopy in patients with negative nasopharyngeal swabs and a clinical/radiological suspicion of SARS-CoV-2 infection. Urgent/life-saving bronchoscopies were performed in 31 patients with a confirmed COVID-19 diagnosis for obstructive atelectasis, suspected concomitant lower respiratory tract infections, severe hemoptysis, suspected tracheal lacerations in patients mechanically ventilated, tracheostomy complications, and suspected concomitant pulmonary tuberculosis.

title:
  Utility and safety of bronchoscopy during SARS-CoV-2 outbreak in Italy: a retrospective, multicenter study


id: cord-330093-asba80bi
title: Smoking, ACE-2 and COVID-19: ongoing controversies
author: Leung, Janice M.
date: 2020-07-16
txt: ./txt/cord-330093-asba80bi.txt
cache: ./cache/cord-330093-asba80bi.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.01759-2020
doi: 10.1183/13993003.01759-2020
abstract: Smoking increases severity of COVID-19 https://bit.ly/2yWp3jb
summary:
  Both research teams are reporting increased angiotensin-converting enzyme 2 (ACE-2) expression in airways of current smokers and those with COPD, with important implications for coronavirus disease 2019 (COVID-19) patients. Since ACE-2 has been shown to be the main receptor utilised by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to enter the host cells [2] , the authors conclude that nicotine is a risk factor for COVID-19. Here, we bring to the discussion whether the increased susceptibility and virulence of SARS-CoV-2 via α7-nAChR and the upregulation of small airway ACE-2 expression may also be relevant for those who vape using nicotine-based e-cigarettes. While smoking may not necessarily increase one''s risk for contracting COVID-19, the biological and inflammatory cascade that occurs upon severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may be particularly devastating for a smoker.


id: cord-331497-mipg4mg7
title: The potential impact of COVID-19-related disruption on tuberculosis burden
author: McQuaid, C. Finn
date: 2020-06-08
txt: ./txt/cord-331497-mipg4mg7.txt
cache: ./cache/cord-331497-mipg4mg7.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.01718-2020
doi: 10.1183/13993003.01718-2020
summary:
  We used a mathematical model of TB with an age-specific contact matrix calibrated to data from China, India and South Africa, [9] key high TB burden countries accounting for approximately 40% of global TB cases, [1] to estimate the relative impact of reductions in social contacts and health services due to COVID-19 on TB burden. In our worst case scenario, where COVID-19 interventions to reduce social contacts are minimal, but TB health services are badly affected, results suggest an increase in TB deaths of 23,516 (range 18,560-27,940), 149,448 (85,000-233,602) and 28,631 (19,963-40,011) in China, India and South Africa, respectively between 2020-2024, totalling 201,595 (123,523-301,553) additional TB deaths in these three countries alone. However, if these countries are able to minimise the impact on TB health service delivery, major reductions in social contacts could keep the number of additional TB deaths comparatively low. The potential impact of the COVID-19 response on tuberculosis in high-burden countries: a modelling analysis

abstract:
  Before the COVID-19 pandemic, over 4000 people were dying from tuberculosis (TB) every day [1]. As with past emergencies [2], the impact of COVID-19 on TB outcomes is a serious cause for concern [3] but is currently unknown. Health systems overload, due to high numbers of COVID-19 cases, as well as interventions necessary to limit the transmission of SARS-CoV-2, could result in severe reductions in health service availability and access for the detection and treatment of TB cases [4]. However, physical distancing interventions could also limit Mycobacterium tuberculosis transmission outside of households, where most transmission occurs [5]. This has not been adequately explored in existing work [6–8], and it is currently unclear whether social distancing could compensate for disruptions in TB services, and what the impact of these combined COVID-19 disruption effects on TB burden is likely to be.


id: cord-333131-affb4yln
author: Jacob, Joseph
date: 2020
txt: ./txt/cord-333131-affb4yln.txt
cache: ./cache/cord-333131-affb4yln.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32616598/
doi: 10.1183/13993003.01809-2020
summary:
  The National COVID-19 Chest Imaging Database (NCCID) is a repository of chest X-Ray, CT and MRI images and clinical data from COVID-19 patients across the UK, to support research and development of AI technology that may proffer insights into the disease. NCCID has put in place mechanisms to collate all chest imaging and prespecified clinical data from every UK hospital where patients undergo a RT-PCR test for COVID-19. The NCCID data and image transfer solutions are robust and secure, including those having been adapted from techniques tried and tested on numerous research studies involving large-scale medical image collection (9) . NCCID will collect chest radiographs in all RT-PCR COVID-19 positive patients in hospitals throughout the UK. 2) Computed tomography chest imaging: NCCID will collect all chest CT imaging in RT-PCR COVID-19 positive patients. 3) For all RT-PCR COVID-19 positive patients NCCID will acquire all chest imaging performed in the previous 3 years.

title:
  Using imaging to combat a pandemic: rationale for developing the UK National COVID-19 Chest Imaging Database

abstract:
  The National COVID-19 Chest Imaging Database (NCCID) is a repository of chest X-Ray, CT and MRI images and clinical data from COVID-19 patients across the UK, to support research and development of AI technology that may proffer insights into the disease.


id: cord-335198-qp964238
title: Pandemic Treatments on Trial: The bigger picture
author: Kotsimbos, T.
date: 2020-08-03
txt: ./txt/cord-335198-qp964238.txt
cache: ./cache/cord-335198-qp964238.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.02281-2020
doi: 10.1183/13993003.02281-2020
summary:
  Given the stated extremes above, there is a clear trade-off between "doing all that one can for individual patients with currently available information in a timely manner and despite significant uncertainty" and "group treatment of individuals to be enrolled in properly conducted but costly (effort, time and money) clinical trials for specific therapeutic approaches that will help inform the evidence-base for future patients". And how do we quickly establish and conduct difficult and costly randomized, controlled clinical trials for the most promising old and new therapies where there is a clear equipoise between possible benefits and potential risks? Paradoxically, the almost immediate establishment of a well-designed RCT to test the combination antiviral treatment lopinavir-ritonavir in Wuhan, China during the beginning of the pandemic exemplified this tension in a most unusual way when trial recruitment ceased early due to falling COVID19 case numbers (7).

abstract:
  The tension between immediately using any potentially useful novel therapy in COVID19 and trialling all novel therapies as rigorously as possible is addressed from a bigger picture perspective.


id: cord-335465-sckfkciz
author: Gupta, Rishi K.
date: 2020-09-25
txt: ./txt/cord-335465-sckfkciz.txt
cache: ./cache/cord-335465-sckfkciz.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.03498-2020
doi: 10.1183/13993003.03498-2020
summary:
  We aimed to address this knowledge gap by systematically evaluating the performance of proposed prognostic models, among consecutive patients hospitalised with a final diagnosis of COVID-19 at a single centre, when using predictors measured at the point of hospital admission. We also assessed the discrimination of each candidate model for standardised outcomes of: (a) our composite endpoint of clinical deterioration; and (b) mortality, across a range of pre-specified time horizons from admission (7 days, 14 days, 30 days and any time during hospital admission), by calculating time-dependent AUROCs (with cumulative sensitivity and dynamic specificity) [18] . In order to further benchmark the performance of candidate prognostic models, we then computed AUROCs for a limited number of univariable predictors considered to be of highest importance a priori, based on clinical knowledge and existing data, for prediction of our composite endpoints of clinical deterioration and mortality (7 days, 14 days, 30 days and any time during hospital admission).

title:
  Systematic evaluation and external validation of 22 prognostic models among hospitalised adults with COVID-19: An observational cohort study

abstract:
  BACKGROUND: The number of proposed prognostic models for COVID-19 is growing rapidly, but it is unknown whether any are suitable for widespread clinical implementation. METHODS: We independently externally validated the performance candidate prognostic models, identified through a living systematic review, among consecutive adults admitted to hospital with a final diagnosis of COVID-19. We reconstructed candidate models as per original descriptions and evaluated performance for their original intended outcomes using predictors measured at admission. We assessed discrimination, calibration and net benefit, compared to the default strategies of treating all and no patients, and against the most discriminating predictor in univariable analyses. RESULTS: We tested 22 candidate prognostic models among 411 participants with COVID-19, of whom 180 (43.8%) and 115 (28.0%) met the endpoints of clinical deterioration and mortality, respectively. Highest areas under receiver operating characteristic (AUROC) curves were achieved by the NEWS2 score for prediction of deterioration over 24 h (0.78; 95% CI 0.73–0.83), and a novel model for prediction of deterioration <14 days from admission (0.78; 0.74–0.82). The most discriminating univariable predictors were admission oxygen saturation on room air for in-hospital deterioration (AUROC 0.76; 0.71–0.81), and age for in-hospital mortality (AUROC 0.76; 0.71–0.81). No prognostic model demonstrated consistently higher net benefit than these univariable predictors, across a range of threshold probabilities. CONCLUSIONS: Admission oxygen saturation on room air and patient age are strong predictors of deterioration and mortality among hospitalised adults with COVID-19, respectively. None of the prognostic models evaluated here offered incremental value for patient stratification to these univariable predictors.


id: cord-337889-90q4py0j
title: Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis
author: Guan, Wei-jie
date: 2020-03-26
txt: ./txt/cord-337889-90q4py0j.txt
cache: ./cache/cord-337889-90q4py0j.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32217650/
doi: 10.1183/13993003.00547-2020
summary:
  After adjusting for age and smoking status, COPD [hazards ratio (HR) 2.681, 95% confidence interval (95%CI) 1.424–5.048], diabetes (HR 1.59, 95%CI 1.03–2.45), hypertension (HR 1.58, 95%CI 1.07–2.32) and malignancy (HR 3.50, 95%CI 1.60–7.64) were risk factors of reaching to the composite endpoints. Studies that address these limitations is needed to explore for the factors underlying the adverse impact of Our objective was to evaluate the risk of serious adverse outcomes in patients with Covid-19 by stratification according to the number and type of comorbidities, thus unraveling the sub-populations with poorer prognosis. These findings have provided further objective evidence, with a large sample size and extensive coverage of the geographic regions across China, to take into account baseline comorbid diseases in the comprehensive risk assessment of prognosis among patients with Covid-19 on hospital admission. Our findings suggested that, similar with other severe acute respiratory outbreaks, comorbidities such as COPD, diabetes, hypertension and malignancy predisposed to adverse clinical outcomes in patients with Covid-19.

abstract:
  BACKGROUND: The coronavirus disease 2019 (Covid-19) outbreak is evolving rapidly worldwide. OBJECTIVE: To evaluate the risk of serious adverse outcomes in patients with coronavirus disease 2019 (Covid-19) by stratifying the comorbidity status. METHODS: We analysed the data from 1590 laboratory-confirmed hospitalised patients 575 hospitals in 31 province/autonomous regions/provincial municipalities across mainland China between December 11(th), 2019 and January 31(st), 2020. We analyse the composite endpoints, which consisted of admission to intensive care unit, or invasive ventilation, or death. The risk of reaching to the composite endpoints was compared according to the presence and number of comorbidities. RESULTS: The mean age was 48.9 years. 686 patients (42.7%) were females. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached to the composite endpoints. 399 (25.1%) reported having at least one comorbidity. The most prevalent comorbidity was hypertension (16.9%), followed by diabetes (8.2%). 130 (8.2%) patients reported having two or more comorbidities. After adjusting for age and smoking status, COPD [hazards ratio (HR) 2.681, 95% confidence interval (95%CI) 1.424–5.048], diabetes (HR 1.59, 95%CI 1.03–2.45), hypertension (HR 1.58, 95%CI 1.07–2.32) and malignancy (HR 3.50, 95%CI 1.60–7.64) were risk factors of reaching to the composite endpoints. The HR was 1.79 (95%CI 1.16–2.77) among patients with at least one comorbidity and 2.59 (95%CI 1.61–4.17) among patients with two or more comorbidities. CONCLUSION: Among laboratory-confirmed cases of Covid-19, patients with any comorbidity yielded poorer clinical outcomes than those without. A greater number of comorbidities also correlated with poorer clinical outcomes.


id: cord-338351-y1t9emu1
title: Does bronchoscopy help the diagnosis in Covid-19 infection?
author: Ora, Josuel
date: 2020-06-11
txt: ./txt/cord-338351-y1t9emu1.txt
cache: ./cache/cord-338351-y1t9emu1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32527742/
doi: 10.1183/13993003.01619-2020
summary:
  The diagnosis of COVID-19 is mainly based on typical symptoms, history of exposure to an infected person and bilateral involvement on chest radiographs, and it is confirmed by a positive nucleic acid test for SARS-CoV-2 from numerous types of specimens including Oropharyngeal (OP) and nasopharyngeal (NP) swabs, anal swabs, stool, urine and bronchoalveoalr lavage fluid (BALF) 1,2 . Here we report our experience from a COVID-19 hospital in Rome, Italy, where patients with typical symptoms of the disease, suggestive CT scans and three NP/OP negative swabs performed on consecutive days and IgG and IgM serology negative for SARS-CoV-2 underwent bronchoscopy with BAL to define the diagnostic issue. In conclusion, our findings demonstrate that three negative swabs along with negative antibodies, despite a suggestive CT scan, can safely rule out the SARS-CoV-2 infection in suspected patients, hence to proceed in alternative diagnosis process.

abstract:
  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the agent responsible for the recent Coronavirus Disease 2019 (COVID-19) pandemic. This virus is predominantly spread through large droplets. The clinical features of COVID-19 are varied, ranging from asymptomatic to acute respiratory distress syndrome and multi-organ dysfunction [1].


id: cord-339934-g6ufz29l
title: Distinct features of SARS-CoV-2-specific IgA response in COVID-19 patients
author: Yu, Hai-qiong
date: 2020-05-13
txt: ./txt/cord-339934-g6ufz29l.txt
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url: https://doi.org/10.1183/13993003.01526-2020
doi: 10.1183/13993003.01526-2020
summary:
  In the case of respiratory infection, while IgM and IgG isotypes have been the primary emphasis in characterizing immunity, mucosal and systemic IgA responses that may play a critical role in the disease pathogenesis, have received much less attention. This pattern of humoral immune response is different in case of SARS-CoV infection, in which IgM and IgA showed similar chronological profiles in terms of both seroconversion time and antibody titres [5] , in line with the knowledge that viremia is common in SARS. Upregulated IgA production may be the result of increased levels of TGF-β and IL-10 that promote antibody switching in SARS-CoV-2 infection. Considering the roles of mucosal and systemic IgA in COVID-19, inducing IgA production, e.g. using Lactoferrin to activate canonical TGF-β signaling [13] , or retinoic acid to enhance lactoferrin-induced IgA responses [14] , has been proposed as novel therapies for severe COVID-19.

abstract:
  Humoral immune response to SARS-CoV-2 showed an early response of IgA, instead of IgM, in COVID-19 patients. As highlighted by our study, enhanced IgA responses observed in severe COVID-19 might confer damaging effects in severe COVID-19.


id: cord-344641-rog2h4g7
author: Franco, Cosimo
date: 2020-08-03
txt: ./txt/cord-344641-rog2h4g7.txt
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url: https://doi.org/10.1183/13993003.02130-2020
doi: 10.1183/13993003.02130-2020
summary:
  INTRODUCTION: The Coronavirus 2(SARS-CoV-2) outbreak spread rapidly in Italy and the lack of intensive care unit(ICU) beds soon became evident, forcing the application of noninvasive respiratory support(NRS) outside the ICU, raising concerns over staff contamination. Data were collected including medication, mode and usage of the NRS (i.e. high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), noninvasive ventilation(NIV)), length of stay in hospital, endotracheal intubation(ETI) and deaths. Variables recorded for each patient were obtained for the period from March 1 st until May 10 th 2020 and included the following: demographics (age, sex), comorbidities (type and number), respiratory condition at admission (respiratory rate (RR), PaO 2 /FiO 2 ratio), medications (type of drugs prescribed), mode and usage of the NRS (ventilatory settings for NIV and CPAP, and flow rate for HFNC), and stay in hospital (days).

title:
  Feasibility and clinical impact of out-of-ICU non-invasive respiratory support in patients with COVID-19 related pneumonia

abstract:
  INTRODUCTION: The Coronavirus 2(SARS-CoV-2) outbreak spread rapidly in Italy and the lack of intensive care unit(ICU) beds soon became evident, forcing the application of noninvasive respiratory support(NRS) outside the ICU, raising concerns over staff contamination. We aimed to analyse the safety of the hospital staff, the feasibility, and outcomes of NRS applied to patients outside the ICU. METHODS: In this observational study, data from 670 consecutive patients with confirmed COVID-19 referred to the Pulmonology Units in nine hospitals between March 1st and May 10th,2020 were analysed. Data were collected including medication, mode and usage of the NRS (i.e. high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), noninvasive ventilation(NIV)), length of stay in hospital, endotracheal intubation(ETI) and deaths. RESULTS: Forty-two health-care workers (11.4%) tested positive for infection, but only three of them required hospitalisation. Data are reported for all patients (69.3% male), whose mean age was 68 (sd 13) years. The PaO(2)/FiO(2) ratio at baseline was 152±79, and the majority of patients (49.3%) were treated with CPAP. The overall unadjusted 30-day mortality rate was 26.9% with 16%, 30%, and 30%, while the total ETI rate was 27% with 29%, 25% and 28%, for HFNC, CPAP, and NIV, respectively, and the relative probability to die was not related to the NRS used after adjustment for confounders. ETI and length of stay were not different among the groups. Mortality rate increased with age and comorbidity class progression. CONCLUSIONS: The application of NRS outside the ICU is feasible and associated with favourable outcomes. Nonetheless, it was associated with a risk of staff contamination.


id: cord-347046-u764muk6
title: Correlation and Causality: a Covid Conundrum
author: Morice, Alyn H.
date: 2020-08-28
txt: ./txt/cord-347046-u764muk6.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32859679/
doi: 10.1183/13993003.03174-2020
summary:
  They use the trajectory of deaths from COVID-19 from around the world to estimate the consequences of easing lockdown measures. They assume the current fall in the rate of COVID-19 related mortality is a consequence of lockdown; but is it? The pitfalls of using such tools in COVID-19 research have been highlighted recently [5] The results from the models used to predict the initial onslaught of the virus differed hugely leading to panic buying of ventilators and the creation of overflow (Nightingale in the UK) hospitals which were never used. The belief that we know the contribution that social measure have made to the evolution of the pandemic is wrong and so advising "[our] estimates are incompatible with a return to previous activities post "lockdown." is hubris which may have greater socio-economic and thus clinical consequences than the virus itself. Estimates of the ongoing need for social distancing and control measures post-"lockdown" from trajectories of COVID-19 cases and mortality Wrong but Useful -What Covid-19 Epidemiologic Models Can and Cannot Tell Us

abstract:
  I read with interest the two contributions by James Chalmers et al. to the 1st July edition of the Journal. In a reply to correspondence [1] concerning the ICS withdrawal controversy they suggest [2] that Alvar Agusti succumbs to the fallacy of post hoc, ergo, proctor hoc i.e. A occurred, then B occurred: Therefore, A caused B. However, as we know, correlation is not causality.


id: cord-349440-jxigsdzh
title: COVID-19 phenotypes: leading or misleading?
author: Gattinoni, Luciano
date: 2020-07-02
txt: ./txt/cord-349440-jxigsdzh.txt
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url: https://doi.org/10.1183/13993003.02195-2020
doi: 10.1183/13993003.02195-2020
summary:
  Comment to an Editorial where we invite the authors to express with clarity the risks they are referring to and how their argument is furthering the cause of patients and clinicians. After reading sentences such as "…by needlessly clouding the clinical picture, false phenotypes … upon inspection of patient data, simply do not exist" , It is not clear to us -and without a doubt to most readers -what sort of clear, and self-evident truth we (and other authors) have been trying to cloud. We note also with concern the conclusions of the editorial: "by prematurely phenotyping patients with COVID-19, we expose ourselves and our patients to considerable and preventable risk" and we invite the authors to express with clarity the risks they are referring to and how their argument is furthering the cause of patients and clinicians.

abstract:
  Comment to an Editorial where we invite the authors to express with clarity the risks they are referring to and how their argument is furthering the cause of patients and clinicians.


id: cord-349958-126yb5se
title: CANCER IN THE TIME OF COVID: Expert opinion on how to adapt current practice
author: Raskin, Jo
date: 2020-04-16
txt: ./txt/cord-349958-126yb5se.txt
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url: https://doi.org/10.1183/13993003.00959-2020
doi: 10.1183/13993003.00959-2020
summary:
   Standard of care in most patients is chemoradiotherapy with 4 cycles of cisplatin/etoposide as preferred chemotherapy regimen.  Replacing intravenous with oral etoposide to reduce time-in-hospital should be weighed against its lower biological availability and variable pharmacodynamics in a curative setting [6]  In patients with stage I SCLC surgical resection of the tumour, followed by adjuvant chemotherapy (4 cycles of cisplatin/etoposide) is indicated.  Consider giving cisplatin/pemetrexed instead of cisplatin/etoposide, or weekly carboplatin/paclitaxel in non-squamous NSCLC to limit time-in-hospital [9] .  Evaluate the indication for palliative chemotherapy, immunotherapy or both with extra care in elderly patients or patients with significant comorbidity, decreased performance (PS ≥2), social isolation, decubitus, urinary catheters, … especially in second or further lines [3] .  Consider limiting palliative chemotherapy to 4 cycles and omitting pemetrexed maintenance therapy [3] .  Palliative chemotherapy with 4 cycles of platinum/pemetrexed is recommended in all other cases of PS 0-1 patients.

abstract:
  The susceptibility of cancer patients to adverse outcome of viral infections is well known from past experiences, e.g. Influenza increasing the risk of hospital admission with respiratory distress four times, and the risk of death ten times, compared to patients without cancer [1].


id: cord-350166-loxe11d6
author: Garmendia, Onintza
date: 2020-04-20
txt: ./txt/cord-350166-loxe11d6.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32312862/
doi: 10.1183/13993003.00846-2020
summary:
  Our aim was to design and test an affordable and easy-to-build non-invasive bilevel pressure ventilator to allow reducing the serious shortage of ventilators in LMICs. METHODS: The ventilator was built using off-the-shelf materials available via e-commerce and was based on a high-pressure blower, two pressure transducers and an Arduino Nano controller with a digital display (total retail cost <75 US$), with construction details open source provided for free replication. CONCLUSION: The low-cost, easy-to-build non-invasive ventilator performs similarly as a high-quality commercial device, with its open-source hardware description, will allow for free replication and use in LMICs, facilitating application of this life-saving therapy to patients who otherwise could not be treated. To assess the performance of the novel bilevel pressure ventilator under wellcontrolled conditions, the prototype was evaluated in a bench test using an active patient simulator modelling the respiratory mechanics of patients with different levels of obstructive/restrictive diseases ( Figure 2 ).

title:
  Low-cost, easy-to-build non-invasive pressure support ventilator for under-resourced regions: open source hardware description, performance and feasibility testing

abstract:
  AIM: Current pricing of commercial mechanical ventilators in low/middle-income countries (LMICs) markedly restricts their availability, and consequently a considerable number of patients with acute/chronic respiratory failure cannot be adequately treated. Our aim was to design and test an affordable and easy-to-build non-invasive bilevel pressure ventilator to allow reducing the serious shortage of ventilators in LMICs. METHODS: The ventilator was built using off-the-shelf materials available via e-commerce and was based on a high-pressure blower, two pressure transducers and an Arduino Nano controller with a digital display (total retail cost <75 US$), with construction details open source provided for free replication. The ventilator was evaluated (and compared with a commercially available device (Lumis-150, Resmed): a) in the bench using an actively breathing patient simulator mimicking a range of obstructive/restrictive disease and b) in 12 healthy volunteers wearing a high airway resistance and thoracic/abdominal bands to mimic obstructive/restrictive patients. RESULTS: The designed ventilator provided inspiratory/expiratory pressures up to 20/10 cmH(2)O, respectively, with no faulty triggering or cycling both in the bench test and in volunteers. Breathing difficulty score rated (1–10 scale) by the loaded breathing subjects was significantly (p<0.005) decreased from 5.45±1.68 without support to 2.83±1.66 when using the prototype ventilator, which showed no difference with the commercial device (2.80±1.48; p=1.000). CONCLUSION: The low-cost, easy-to-build non-invasive ventilator performs similarly as a high-quality commercial device, with its open-source hardware description, will allow for free replication and use in LMICs, facilitating application of this life-saving therapy to patients who otherwise could not be treated.


id: cord-351349-ypaevb8b
title: SARS-CoV2 disrupts clinical research - the role of a rare disease-specific trial network
author: van Koningsbruggen-Rietschel, Silke
date: 2020-08-07
txt: ./txt/cord-351349-ypaevb8b.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32764115/
doi: 10.1183/13993003.02114-2020
summary:
  Rare disease patients may suffer delayed access to new drugs as SARS-CoV-2 is disrupting clinical trials. Here we present the results of several surveys performed within the European CF Society Clinical Trials Network (ECFS-CTN) that aimed to assess how the pandemic disrupted CF clinical trials and to rapidly share useful information about operational mitigation measures by clinical trial teams across Europe. Licensing and reimbursement of CFTR modulators varies by country and around 450 CF patients across ECFS-CTN sites currently access CFTR modulators via clinical trials. Four surveys were answered by clinical trial investigators and research coordinators in the 58 ECFS-CTN sites between March-May 2020 (Weeks 1, 2, 4 and 6). The Week 1 survey was performed just before initial FDA and EMA guidance in mid-March 2020 [3, 4] and showed that many sites had already prohibited new enrolment into trials and onsite monitoring visits ( Table 1) .

abstract:
  Rare disease patients may suffer delayed access to new drugs as SARS-CoV-2 is disrupting clinical trials. Our survey demonstrates that the European cystic fibrosis clinical trials network is ideally placed to track and address such disruption.


id: cord-351407-7vx9lzi0
title: JAK inhibitors in COVID-19: need for vigilance regarding increased inherent thrombotic risk
author: Mehta, Puja
date: 2020-07-06
txt: ./txt/cord-351407-7vx9lzi0.txt
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mime: text/plain
url: https://doi.org/10.1183/13993003.01919-2020
doi: 10.1183/13993003.01919-2020
summary:
  recently reported a cohort study of 137 patients with COVID-19 pneumonia, in which retrospective review of computed tomography pulmonary angiography (CTPA) scans demonstrated a cumulative incidence of pulmonary emboli (PE) of 24% overall and 50% in intensive care [2]. We recommend vigilance to the potentially increased thrombotic risk associated with JAKi, given the hypercoagulability of COVID-19 and our recent thromboprophylaxis recommendations for all hospitalised patients with COVID-19 [7]. Bompard et al recently reported a cohort study of 137 patients with COVID-19 pneumonia, in which retrospective review of computed tomography pulmonary angiography (CTPA) scans demonstrated a cumulative incidence of pulmonary emboli (PE) of 24% overall and 50% in intensive care 2 . Impact of Janus kinase inhibitors on risk of cardiovascular events in patients with rheumatoid arthritis: systematic review and meta-analysis of randomised controlled trials

abstract:
  There is accumulating evidence that COVID-19 is a hypercoagulable state. Reports of thrombotic events and autopsy findings of pulmonary thrombotic microangiopathy [1] in patients with COVID-19 are rising. Bompard et al. recently reported a cohort study of 137 patients with COVID-19 pneumonia, in which retrospective review of computed tomography pulmonary angiography (CTPA) scans demonstrated a cumulative incidence of pulmonary emboli (PE) of 24% overall and 50% in intensive care [2]. Although it was initially thought that insidious venous thromboembolic events (VTE) were mainly confined to ventilated patients [3], we now understand thrombotic risk to be a wider problem in COVID-19. An overexuberant host inflammatory response, in selected patients with severe COVID-19, may contribute to the high mortality. We recently recommended screening for virally-driven hyperinflammation in COVID-19 and proposed that immunomodulation in this subgroup of patients, may improve outcomes [4]. There are several ongoing, randomised controlled trials evaluating the therapeutic potential of Janus Kinase inhibitors (JAKi) in severe COVID-19 (table 1). JAKi have a purported advantage over other immunomodulatory strategies in COVID-19, as they may exert dual anti-inflammatory (blockade of multiple, pro-inflammatory cytokines simultaneously) and anti-viral effects (impeding cellular viral endocytosis [5, 6]) and have convenient oral administration, with relatively short half-lives. JAKi may interrupt the signalling of several pro-inflammatory cytokines implicated in the pathogenesis of hyperinflammation, including interleukin (IL)-6, which has been the focus of several clinical trials in COVID-19. JAKi may also inhibit the entry of the SARS-CoV-2 virus into the AT2 alveolar epithelial cells; baricitinib (a JAK1/2 inhibitor), is a numb-associated kinase (NAK) inhibitor, with a particularly high affinity for AP2-associated protein kinase 1 (AAK1), a pivotal regulator of clathrin-mediated viral endocytosis [5]. We recommend vigilance to the potentially increased thrombotic risk associated with JAKi, given the hypercoagulability of COVID-19 and our recent thromboprophylaxis recommendations for all hospitalised patients with COVID-19 [7].


id: cord-352502-vdm55zvq
title: Response to: Factors limiting the utility of bronchoalveolar lavage in the diagnosis of COVID-19
author: Salton, Francesco
date: 2020-09-17
txt: ./txt/cord-352502-vdm55zvq.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32943403/
doi: 10.1183/13993003.03383-2020
summary:
  Francesco Salton 1 , Pietro Geri 1 Deepak and Colleague misreported that BAL was negative for SARS-CoV-2 rRT-PCR in majority of cases, including 38 patients with "strong clinical and radiological suspicion for COVID-19". On the contrary, in the only 2 cases of our series in which CT scan showed typical signs of COVID-19 infection according to a recently published international consensus statement [2] , BAL was positive for SARS-CoV-2 despite previous negative upper respiratory tract swabs. Moreover, we reported that, when chest CT scan was normal, then both upper respiratory tract swabs and BAL were rRT-PCR-negative for SARS-CoV-2. These findings support our main observation that BAL is likely to be negative if one or more upper respiratory tract specimens and thoracic imaging are concordantly negative, therefore it should be only reserved for those cases in which a high clinical and radiological suspicion for COVID-19 stands despite negative upper respiratory tract swabs.

abstract:
  We aimed at evaluating not the diagnostic yield of BAL in COVID-19, but the agreement between negative upper respiratory tract swabs and BAL to exclude COVID-19, stressing that BAL is likely negative if swabs and chest CT are concordantly negative.


id: cord-354290-o5i4a7nl
author: Li, Jie
date: 2020-08-28
txt: ./txt/cord-354290-o5i4a7nl.txt
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mime: text/plain
url: https://doi.org/10.1183/13993003.03136-2020
doi: 10.1183/13993003.03136-2020
summary:
  We appreciate the comments of Elshof et al"s on our article "High-flow nasal cannula for COVID-19 patients: low risk of bio-aerosol dispersion" 1 and agree that further research is warranted to reduce risk of virus transmission from infected patients. The presented in vitro data 2 from a light detection of smoke dispersion distance and velocity model suggesting that high-flow nasal cannula (HFNC) generates larger dispersion distance than nonbreather mask and venturi mask is in contrast to reports from Hui et al, using a similar model 3 . The presented in vitro data 2 from a light detection of smoke dispersion distance and velocity model suggesting that high-flow nasal cannula (HFNC) generates larger dispersion distance than nonbreather mask and venturi mask is in contrast to reports from Hui et al, using a similar model 3 .

title:
  Author''s Reply on High-Flow Nasal Cannula for COVID-19 Patients: Low Risk of Bio-Aerosol Dispersion

abstract:
  We appreciate the comments of Elshof et al.'s on our article “High-flow nasal cannula for COVID-19 patients: low risk of bio-aerosol dispersion” [1] and agree that further research is warranted to reduce risk of virus transmission from infected patients. The presented in vitro data [2] from a light detection of smoke dispersion distance and velocity model suggesting that high-flow nasal cannula (HFNC) generates larger dispersion distance than nonbreather mask and venturi mask is in contrast to reports from Hui et al., using a similar model [3]. Presumably because the smoke used by Elshof et al. is larger (0.3–2.5 µm) [2] than that used by Hui et al. (≤1 µm) [3], the larger particles dispersing differently. It should be noted that smoke in both models represents only a small fraction of the range of bioaerosols generated by patients during breathing, speaking, coughing or sneezing [4]. Using the same size airway model, the authors observed that the dispersion distance decreased from 71 cm to 25 cm by changing the nasal cannula size from small to large when HFNC flow was set at 30 L·min(−1), however, when HFNC flow was set at 60 L·min(−1), the medium size nasal cannula generated shorter distance than both small and large nasal cannulas. This raises the role of proper fit of prong to nares and highlights the limitations of modelization. Regardless of the sizes of nasal cannula, the dispersion distance was higher with 60 L·min(−1) than 30 L·min(−1), which is inline with Hui et al. results [3] and may be expected, as higher velocity of the gas may carry exhaled smoke to a further distance. However, this effect of total flow did not occure when testing the the venturi mask. Strangely, the venturi mask with large open holes and total gas flow of 40 L·min(−1) generated shorter dispersion distance than normal breathing. These inconsistencies are difficult to interpret without comprehensive peer reviewe of extensive methods and results. Whether smoke imaging models truly reflect the natural features of the transportation and dispersion of bioaerosols generated by patients has not been established and results from these studies should be interpreted cautiously.


id: cord-355753-muefay2n
title: Challenges of evaluating lung function as part of cancer care during the COVID-19 pandemic
author: Garner, Justin L.
date: 2020-07-02
txt: ./txt/cord-355753-muefay2n.txt
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mime: text/plain
url: https://doi.org/10.1183/13993003.01621-2020
doi: 10.1183/13993003.01621-2020
summary:
  Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a newly identified agent foisted upon humanity and responsible for the contagious affliction, coronavirus disease 2019 (COVID-19) [1] that has rapidly evolved into a pandemic testing to their limits, and sometimes beyond, the capacity to respond of healthcare systems across the world [2]. To the editor, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a newly identified agent foisted upon humanity and responsible for the contagious affliction, coronavirus disease 2019 (COVID-19)(1)that has rapidly evolved into a pandemic testing to their limits, and sometimes beyond, the capacity to respond of healthcare systems across the world (2) . A promising alternative approach to evaluating lung function is that of quantitative computed tomography (qCT) imaging (13) , and whilst currently a research tool has the potential for transforming clinical practice.

abstract:
  Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a newly identified agent foisted upon humanity and responsible for the contagious affliction, coronavirus disease 2019 (COVID-19) [1] that has rapidly evolved into a pandemic testing to their limits, and sometimes beyond, the capacity to respond of healthcare systems across the world [2]. Management is purely supportive and social isolation crucial to containment [3]. Enforced reallocation of hospital resources and personnel to cope with the increasing numbers requiring hospital admission and intensive care [4] in the most trying of conditions has been at the expense of many hospital departments, among them those offering diagnostic and support services for lung cancer [5–7].


