Search

The outbreak of the COVID-19 pandemic has made widespread testing a need for controlling the disease. Numerous recent investigations have shown that many people with COVID-19 show no outward signs of illness. As a result, these patients are more likely to unwittingly spread the virus because they will not take a COVID-19 test. In order to get tested, patients will need to travel to a lab, putting others at risk of exposure. Recent studies have shown that people with COVID-19 who are asymptomatic have distinctive coughs and breathing patterns compared to the general population. This prompted the study of cough and breath sounds in COVID-19 patients as a means of differentiating them from those of non-COVID lung infection patients and the general population. In this article, we present a robust, efficient, and extensible method for identifying symptomatic patterns in biological audio signals. Cough digitized audio files are subjected to spectral analysis via a stationary wavelet transform (SWT). The proposed model employs ADASYN technique to handle the class imbalance problem. Also, features like Mel-frequency cepstral coefficients (MFCCs), log frame energies, zero crossing rate (ZCR), and kurtosis are extracted. For classification process, deep belief network (DBN) model is utilized. Finally, mayfly optimization (MFO) algorithm is exploited for optimal hyper-parameter tuning of the DBN model. The experimental validation of the proposed model takes place using open access dataset. Proposed method is compared with other methods in terms accuracy, specificity, sensitivity, F1-Score, precision and recall. The experimental outcomes demonstrated the betterment of the proposed model over other recent state of art approaches. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the presence of underlying chronic airway disease in individuals with chronic cough and dyspnea lasting longer than eight weeks and who had previously Coronavirus disease 2019 (COVID-19) and had no known lung disease. Methods: A total of 151 patients admitted to the respiratory diseases outpatient room with the complaint of cough and/or dyspnea that persisted for at least eight weeks following COVID-19 infection were accrued to the study. Demographic characteristics, smoking history, the severity of lung involvement on chest computed tomography in the acute phase of Covid-19 infection, and bronchodilator reversibility test results were recorded. Smoking history and forced expiratory volume in the first second (FEV1) were compared. Results: FEV1 increase ≥ 200 ml was observed in 40 (26.5%) patients. In 24 (15.9%) patients, an increase in FEV1 was found to be 200 ml and above, and the percentage of FEV1 was 12% or more. While 14 (9.3%) patients were diagnosed with asthma, 13 (8.6%) patients were diagnosed with nonreversible airflow obstruction (NRAO), and 1 (0.7%) patient was diagnosed with chronic obstructive pulmonary disease (COPD). Conclusions: COVID-19 infection may play a vital role in initiating asthma pathogenesis. It should be kept in mind that viral infection-related asthma may be the underlying cause of prolonged cough and dyspnea after COVID-19 infection. [ABSTRACT FROM AUTHOR]

The vast majority of covid-19 patients experience non-severe disease. Nonetheless, long-term symptoms may be common and the impact on quality of life is uncertain. This study aims to examine these aspects in a prospective, longitudinal cohort. Non-hospitalised patients with PCR-confirmed covid-19 were prospectively invited to self-report assessments of background data, symptoms and recovery, illness perception (BIPQ) and health-related quality of life (HR-Qol) measured by EQ5D-VAS. 154 patients were included (mean age 46 years, 69% female). The majority of participants (65%) had symptoms for 1–4 weeks and 12% more than 6 months. The most common symptoms were initially malaise, fatigue, headache, fever and cough and the most common long-term symptoms were impaired physical condition, fatigue, anosmia and headache. The BIPQ index had a negative correlation with the EQ5D-VAS score after the infection, but not with long-term symptoms. Mean differences in the EQ5D-VAS score were significantly lower after the infection and patients with long-term symptoms had a more pronounced negative effect in EQ5D-VAS scores. We found that most patients with non-severe covid-19 reported symptoms for 1–4 weeks and approximately 10% developed long-term symptoms. Non-severe covid-19 seems to have a negative influence on HR-Qol, especially in patients with long-term symptoms and with a greater burden from the disease. None of the initial symptoms could predict the presence of long-term symptoms. [ABSTRACT FROM AUTHOR]

Objective: Large international comparisons describing the clinical characteristics of patients with COVID-19 are limited. The aim of the study was to perform a large-scale descriptive characterization of COVID-19 patients with asthma. Methods: We included nine databases contributing data from January to June 2020 from the US, South Korea (KR), Spain, UK and the Netherlands. We defined two cohorts of COVID-19 patients ('diagnosed' and 'hospitalized') based on COVID-19 disease codes. We followed patients from COVID-19 index date to 30 days or death. We performed descriptive analysis and reported the frequency of characteristics and outcomes in people with asthma defined by codes and prescriptions. Results: The diagnosed and hospitalized cohorts contained 666,933 and 159,552 COVID-19 patients respectively. Exacerbation in people with asthma was recorded in 1.6–8.6% of patients at presentation. Asthma prevalence ranged from 6.2% (95% CI 5.7–6.8) to 18.5% (95% CI 18.2–18.8) in the diagnosed cohort and 5.2% (95% CI 4.0–6.8) to 20.5% (95% CI 18.6–22.6) in the hospitalized cohort. Asthma patients with COVID-19 had high prevalence of comorbidity including hypertension, heart disease, diabetes and obesity. Mortality ranged from 2.1% (95% CI 1.8–2.4) to 16.9% (95% CI 13.8–20.5) and similar or lower compared to COVID-19 patients without asthma. Acute respiratory distress syndrome occurred in 15–30% of hospitalized COVID-19 asthma patients. Conclusion: The prevalence of asthma among COVID-19 patients varies internationally. Asthma patients with COVID-19 have high comorbidity. The prevalence of asthma exacerbation at presentation was low. Whilst mortality was similar among COVID-19 patients with and without asthma, this could be confounded by differences in clinical characteristics. Further research could help identify high-risk asthma patients. KEY MESSAGES Asthma prevalence in COVID-19 patients varied internationally (5.2–20.5%).The prevalence of asthma exacerbation at presentation with COVID-19 in diagnosed and hospitalized patients was low.Comorbidities were common in COVID-19 patients with asthma. Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.2025392. [ABSTRACT FROM AUTHOR]

The main clinical manifestations of coronavirus disease 2019 (COVID-19) onset are respiratory symptoms, including cough, sputum, and dyspnea. However, a significant proportion of patients initially manifested non-respiratory symptoms, such as fever, myalgia, and diarrhea. Here, we compared the different characteristics and outcomes between the patients with respiratory symptoms and non-respiratory symptoms at illness onset. The patients admitted to the respiratory departments from eight hospitals in Hunan and Guangxi Province with nucleic acid-positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) were recruited. Epidemiological information, clinical manifestations, laboratory findings, and radiological characteristics, treatment regimens, and outcomes data were recorded and analyzed. The median age of the recruited 541 subjects was 43 years (IQR, 33–55). Of the 541 subjects, 404 (74.5%) subjects had initial symptom that were respiratory, while 137 (25.5%) subjects had non-respiratory symptoms. Respiratory COVID-19 subjects had more secondary bacterial infections (8.7% vs 0.0%, P < 0.001), needed the intensive care unit more (9.7% vs 2.2%, P = 0.005), non-invasive ventilation more (7.2% vs 1.5%, P = 0.004), developed ARDS more (11.4% vs 2.2%, P = 0.001) and needed longer time to recover (18.5 vs 16.7 days, P = 0.003) compared to predominately non-respiratory COVID-19 subjects. The multivariate model showed that age (OR = 1.04, P = 0.01), dyspnea (OR = 4.91, P < 0.001) and secondary bacterial infection (OR = 19.8, P < 0.001) were independently associated with development of ARDS among COVID-19 patients. We identify COVID-19 subjects with dyspnea at disease onset who have a worse prognosis. We also demonstrate age and secondary bacterial infections to be independently associated with ARDS development in subjects with COVID-19. ABBREVIATIONS: COVID-19: Coronavirus disease 2019; ARDS: acute respiratory distress syndrome; IQR: interquartile range; ICU: intensive care unit; CDC: Chinese Center for Disease Control and Prevention. [ABSTRACT FROM AUTHOR]

Although it was thought that children were not susceptible to 2019-nCoV in the early days of the COVID‐19 infection outbreak, there are currently reports of children and even one-day-old newborns being infected by the virus and hospitalized around the world. Recognizing the symptoms of the infection in children is of great value since a large number of children are asymptomatic or have mild symptoms, which may act as facilitators of the virus transmission. This review aimed to identify and summarize the existing evidence on clinical characteristics of COVID-19 in pediatric patients. A systematic search was conducted in the PubMed, Web of Science, Scopus, Google Scholar, and WHO database for eligible publications. The review proposal was registered with the PROSPERO. The quality assessment was done based on JBI Critical appraisal tools. The random-effects model was used to pool clinical features in the meta-analysis. From the identified 256 potentially relevant studies, 32 articles met the predetermined inclusion and exclusion criteria. Twenty-one studies fulfilled the criteria for this meta-analysis. Fever (58%) and cough (48%) were reported as the most common symptoms of infected children. Disease severity was mild in 51% and moderate in 39% of cases. A total of 63% of cases had respiratory and 25% of children had gastrointestinal symptoms, particularly diarrhea and nausea/vomiting. Approximately 24% of patients were asymptomatic. Results demonstrated that fever and cough were the most common symptoms of COVID-19-infected children and the majority of cases had mild-to-moderate disease severity. [ABSTRACT FROM AUTHOR]

The article reports that history of face masks has become a very popular topic in light of the COVID-19 pandemic, especially for news reporters and public health experts. Topics include why do Asians wear masks despite the lack of scientific evidence which sociologist Mitsutoshi Horii; and Asia's societal and cultural paradigm supports mask-usage hygienic practices without any empirical evidence.

The ongoing Covid-19 is a contagious disease, and it is characterised by different symptoms such as fever, cough, and shortness of breath. Rising concerns about Covid-19 have severely affected the healthcare system in all countries as the Covid-19 outbreak has developed at a rapid rate all around the globe. Intriguing, a clinically used drug, acetazolamide (a specific inhibitor of carbonic anhydrase, CA, EC 4.2.1.1), is used to treat high-altitude pulmonary oedema (HAPE), showing a high degree of clinical similarities with the pulmonary disease caused by Covid-19. In this context, this preliminary study aims to provide insights into some factors affecting the Covid-19 patients, such as hypoxaemia, hypoxia as well as the blood CA activity. We hypothesise that patients with Covid-19 problems could show a dysregulated acid–base status influenced by CA activity. These preliminary results suggest that the use of CA inhibitors as a pharmacological treatment for Covid-19 may be beneficial. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 pandemic has heightened the interest in particle-laden turbulent jets generated by breathing, talking, coughing and sneezing, and how these can contribute to disease transmission. We present quantitative measurement methods for such flows, while exploring and offering improvements for common shortcomings. We generate jets consisting of either liquid droplets or solid particles in an isothermal, quiescent and electrically isopotential experimental chamber that was constructed to control the effects of ambient forcing on jet behavior. For liquid droplets, we find promise in surface deposition analysis based on fluorescent tracer use. For particles, we explore the performance of commercially available adhesive sampling strips and develop conductive grounded carbon tape based sampling strips. We explore ways in which the smallest of thermal gradients or electrostatic charge issues can affect particle dispersion, and suggest practical methods to address these issues. The developed methods are applied to study the simultaneous deposition of ≈ 25, 50 and 200 μm solid particles from a particle laden turbulent jet with a mean velocity of 33.2 m/s. The deposition location as a function of particle size was compared to results from a simple numerical RANS model, and illustrates ways in which imprecise initial or boundary conditions can lead to a notable deviation from experimental results. The differences in deposition pattern seen in experimental and numerical results despite a carefully controlled environment and characterized particle ejection indicate the need for a more stringent numerical model validation, especially when studying fate and transport of mid-range (neither purely aerosol or ballistic) sized particles. [ABSTRACT FROM AUTHOR]

With airborne transmissions found as one of the major transmission routes of SARS-CoV-2, its transmission in airliner cabin environments drew special attention due to high number of imported cases and in-cabin transmissions. This study numerically investigated the transmission of COVID-19 by cough-induced particles in a cabin section of Boeing 737 model. One passenger was coughing in each case, while cough particles with measured size distributions were released during coughs and were tracked using the Lagrangian framework. Outcomes revealed that cough flow released by passengers could develop rapidly into a strong turbulent cough jet, breaking up the local airflow field. The released cough particles were largely dominated by the cough jet within 5 s, especially the first 1.5 s. Deposition of particles under 100 µm were relatively delayed when released from a window-seat location. Small particles (under 50 µm) released by a window-seat passenger were more likely to spread widely in the studied cabin section, which could lead to the highest exposure risks to nearby passengers. Also, due to ventilation design and seating arrangement, cough particles released by the middle-seat passenger were found easily trapped in his/her own local environment. Cough particles released from aisle-seat passengers had the least exposure risk to adjacent passengers. [ABSTRACT FROM AUTHOR]

New evidence from studies on risk factors for mortality in hemodialysis (HD) patients with COVID-19 became available. We aimed to review the clinical risk factors for fatal outcomes in these patients. We performed meta-analysis using the PubMed, EMBASE, and Cochrane databases. A fixed- or random-effects model was used for calculating heterogeneity. We used contour-enhanced funnel plot and Egger's tests to assess potential publication bias. Twenty-one studies were included. The proportion of males was lower in the survivor group than in the non-survivor group (OR = 0.75, 95% CI [0.61, 0.94]). The proportion of respiratory diseases was significantly lower in the survivor group than in the non-survivor group (OR = 0.42, 95% CI [0.29, 0.60]). The proportion of patients with fever, cough, and dyspnea was significantly lower in the survivor group (fever: OR = 0.53, 95% CI [0.31, 0.92]; cough: OR = 0.50, 95% CI [0.38, 0.65]; dyspnea: OR = 0.25, 95% CI [0.14, 0.47]) than in the non-survivor group. Compared with the non-survivor group, the survivor group had higher albumin and platelet levels and lower leucocyte counts. Male patients might have a higher risk of developing severe COVID-19. Comorbidities, such as respiratory diseases could also greatly influence the clinical prognosis of COVID-19. Clinical features, such as fever, dyspnea, cough, and abnormal platelet, leucocyte, and albumin levels, could imply eventual death. Our findings will help clinicians identify markers for the detection of high mortality risk in HD patients at an early stage of COVID-19. [ABSTRACT FROM AUTHOR]

There is limited information about the clinical characteristics, treatment and outcome of maintenance hemodialysis patients with COVID-19. Moreover, regional differences are also conceivable since the extend and severity of outbreaks varied among countries. In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of 37 maintenance hemodialysis patients (median age 64 years, 51% men) hospitalized with COVID-19 from 24 March to 22 May 2020 as confirmed by real-time PCR. The most common symptoms at admission were fatigue (51%), fever (43%), dyspnea (38%) and cough (35%). There were 59% mild/moderate patients and 41% severe/critical patients. Patients in the severe/critical group had a significantly higher atherosclerotic burden since diabetic kidney disease and vascular nephropathies were the most common primary kidney diseases and eighty percent of them had coronary heart disease. Also, Charlson comorbidity score was higher in this group. At admission chest X-ray, 46% had ground-glass abnormalities. Overall, 60% patients received hydroxychloroquine, 22% lopinavir–ritonavir, 11% tocilizumab, 24% systemic glucocorticoids, and 54% received prophylactic anticoagulation. Seven (19%) patients died during hospitalization and 30 were discharged. The main causes of death were cardiovascular (5 patients) and respiratory distress syndrome (2 patients). In Cox regression analysis, lower oxygen saturation, anemia and hypoalbuminemia at admission were associated with increased mortality. In conclusion, we observed a high mortality rate among maintenance hemodialysis patients hospitalized for COVID-19. Anemia, lower serum albumin and lower basal oxygen saturation at admission were factors associated with poor prognosis. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has inspired several studies on the fluid dynamics of respiratory events. Here, we propose a computational approach in which respiratory droplets are coarse-grained into an Eulerian liquid field advected by the fluid streamlines. A direct numerical simulation is carried out for a moist cough using a closure model for space-time dependence of the evaporation time scale. Stokes-number estimates are provided, for the initial droplet size of 10 μm, which are found to be ≪1, thereby justifying the neglect of droplet inertia, over the duration of the simulation. Several important features of the moist-cough flow reported in the literature using Lagrangian tracking methods have been accurately captured using our scheme. Some new results are presented, including the evaporation time for a 'mild' cough, a saturation-temperature diagram and a favourable correlation between the vorticity and liquid fields. The present approach can be extended for studying the long-range transmission of virus-laden droplets. [ABSTRACT FROM AUTHOR]

An editorial is presented on the Concern for Covid-19 cough, fever and impact on mental health. The article discusses that the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that causes Covid-19 is reported to have originated in a seafood market in the Chinese city of Wuhan; and the virus subsequently spread worldwide via human to human transmission.

Dear Editor, Despite recent advances, the effects of immune-modulating biologic therapies on the clinical course of COVID-19 remains unclear ([1]). Our findings also corroborate similar studies on SARS-CoV-2 infections in patients with atopic diseases undergoing dupilumab treatment. From the Italian-based DA-COVID-19 registry, Chiricozzi et al. noted that 15 of 1576 patients (0.9%) with AD on dupilumab, either monotherapy or combined therapy, had SARS-CoV-2 infection. [Extracted from the article]

Introduction: Central venous catheter (CVC) placement is one of the most commonly performed procedures in the intensive care unit for the institution of high-risk medications and nutrients. Despite the frequent use of ultrasound, inadvertent placement of CVC into the carotid artery is still possible. It carries significant morbidity due to the incidence of bleeding, arteriovenous fistula, and stroke. Methods: We present a case of accidental placement of CVC into the right carotid artery, which led to the right-sided temporoparietal stroke. Case Summary: A 71-year-old male was admitted to hospital with symptoms of cough, fatigue, and shortness of breath. He was diagnosed with coronavirus disease-19 and did require mechanical ventilation due to progressive hypoxic respiratory failure. The patient developed distributive shock and underwent CVC placement at the day of admission. On the 24th day of intubation, the patient was unable to move his left upper and lower extremities. Computed tomography (CT) head revealed showed a large temporoparietal stroke. CT Angiogram of head and neck revealed a misplaced CVC within the right common carotid artery. He was transferred to the Neuro ICU at our hospital where the patient underwent catheter removal and carotid artery sheath placement followed by dual antiplatelet therapy. Although the patient survived, he still required long-term facility placement due to the stroke. Conclusion: We reiterate that an experienced clinician must perform the CVC placement with ultrasound guidance and verify its placement with multiple confirmation techniques afterwards. Providers must manage unintentional carotid artery placement promptly to prevent long-term sequelae associated with it. [ABSTRACT FROM AUTHOR]

Face masks reduce the expulsion of respiratory aerosols produced during coughs and exhalations ("source control"). Factors such as the directions in which people are facing (orientation) and separation distance also affect aerosol dispersion. However, it is not clear how the combined effects of masking, orientation, and distance affect the exposure of individuals to respiratory aerosols in indoor spaces. We placed a respiratory aerosol simulator ("source") and a breathing simulator ("recipient") in a 3 m × 3 m chamber and measured aerosol concentrations for different combinations of masking, orientation, and separation distance. When the simulators were front-to-front during coughing, masks reduced the 15-min mean aerosol concentration at the recipient by 92% at 0.9 and 1.8 m separation. When the simulators were side-by-side, masks reduced the concentration by 81% at 0.9 m and 78% at 1.8 m. During breathing, masks reduced the aerosol concentration by 66% when front-to-front and 76% when side-by-side at 0.9 m. Similar results were seen at 1.8 m. When the simulators were unmasked, changing the orientations from front-to-front to side-by-side reduced the cough aerosol concentration by 59% at 0.9 m and 60% at 1.8 m. When both simulators were masked, changing the orientations did not significantly change the concentration at either distance during coughing or breathing. Increasing the distance between the simulators from 0.9 m to 1.8 m during coughing reduced the aerosol concentration by 25% when no masks were worn but had little effect when both simulators were masked. During breathing, when neither simulator was masked, increasing the separation reduced the concentration by 13%, which approached significance, while the change was not significant when both source and recipient were masked. Our results show that universal masking reduces exposure to respiratory aerosol particles regardless of the orientation and separation distance between the source and recipient. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 and other microbes within aerosol particles can be partially shielded from UV radiation. The particles refract and absorb light, and thereby reduce the UV intensity at various locations within the particle. Previously, we demonstrated shielding in calculations of UV intensities within spherical approximations of SARS-CoV-2 virions within spherical particles approximating dried-to-equilibrium respiratory fluids. The purpose of this paper is to extend that work to survival fractions of virions (i.e., fractions of virions that can infect cells) within spherical particles approximating dried respiratory fluids, and to investigate the implications of these calculations for using UV light for disinfection. The particles may be on a surface or in air. Here, the survival fraction (S) of a set of individual virions illuminated with a UV fluence (F, in J/m2) is assumed described by S(kF) = exp(-kF), where k is the UV inactivation rate constant (m2/J). The average survival fraction (Sp) of the simulated virions in a group of particles is calculated using the energy absorbed by each virion in the particles. The results show that virions within particles of dried respiratory fluids can have larger Sp than do individual virions. For individual virions, and virions within 1-, 5-, and 9-µm particles illuminated (normal incidence) on a surface with 260-nm UV light, the Sp = 0.00005, 0.0155, 0.22, and 0.28, respectively, when kF = 10. The Sp decrease to <10−7, <10−7, 0.077, and 0.15, respectively, for kF = 100. Results also show that illuminating particles with UV beams from widely separated directions can strongly reduce the Sp. These results suggest that the size distributions and optical properties of the dried particles of virion-containing respiratory fluids are likely important to effectively designing and using UV germicidal irradiation systems for microbes in particles. The results suggest the use of reflective surfaces to increase the angles of illumination and decrease the Sp. The results suggest the need for measurements of the Sp of SARS-CoV-2 in particles having compositions and sizes relevant to the modes of disease transmission. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains pandemic with considerable morbidity and mortality around the world. The aim of this study was to identify the predictors for clinical deterioration in patients with COVID-19 who did not show clinical deterioration upon hospital admission. Two hundred fifty-seven patients with confirmed COVID-19 pneumonia admitted to Guangzhou Eighth People's Hospital between 23 January and 21 March 2020 were retrospectively enrolled. Demographic data, symptoms, laboratory values, comorbidities and treatments were all collected. The study endpoint was clinical deterioration within 20 days from hospital admission. Univariate and multivariable logistic regression methods were used to explore the risk factors associated with clinical deterioration. A total of 49 (19%) patients showed clinical deterioration after admission. Compared with patients that did not experience clinical deterioration, clinically deteriorated patients had more dyspnea, cough and myalgia (65.3% versus 29.3%) symptoms and more had comorbidities (89.8% versus 36.1%). Clinical and laboratory characteristics at admission that were associated with clinical deterioration included senior age, diabetes, hypertension, myalgia, higher temperature, systolic blood pressure, C-reactive protein (CRP), procalcitonin, activated partial thromboplastin time, aspartate aminotransferase, alanine transaminase, direct bilirubin, plasma creatinine, lymphocytopenia, thrombocytopenia, decreased albumin and bicarbonate concentration. Medical history of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, calcium channel blockers and metformin were also risk factors. The four best predictors for clinical deterioration were CRP, procalcitonin, age and albumin. A "best" multivariable prediction model, resulting from using a variable selection procedure, included senior age, presentation with myalgia, and higher level of CRP and serum creatinine (bias-corrected c-statistic = 0.909). Sensitivity and specificity corresponding to a cut point of CRP ≥18.45 mg/L for predicting clinical deterioration were 85% and 74%, respectively. [ABSTRACT FROM AUTHOR]

Although several reports regarding COVID-19 among MM patients have been published at the time of writing [[6]], we still could not reach an agreement on risk co-variates and prognosis of COVID-19 in MM population. Since December 2019, when coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan and then spread worldwide, there have been several studies on SARS-CoV-2 infection in cancer patients [[1]]. Real-world assessment of the clinical impact of symptomatic infection with severe acute respiratory syndrome coronavirus (COVID-19 disease) in patients with multiple myeloma receiving systemic anti-cancer therapy. Hospital exposure to COVID-19 should be avoided and tailored chemotherapy regimens should be planned for MM patients during COVID-19 epidemic. [Extracted from the article]

Simple plastic face shields have numerous practical advantages over regular surgical masks. In light of the spreading COVID-19 pandemic, the potential of face shields as a substitution for surgical masks was investigated. In order to determine the efficacy of the protective equipment we used a cough simulator. The protective equipment considered was placed on a manikin head that simulated human breathing. Concentration and size distribution of small particles that reached the manikin respiration pathways during the few tens of seconds following the cough event were monitored. Additionally, water sensitive papers were taped on the tested protective equipment and the manikin face. In the case of frontal exposure, for droplet diameter larger than 3 μm, the shield efficiency in blocking cough droplets was found to be comparable to that of regular surgical masks, with enhanced protection for portions of the face that the mask does not cover. Additionally, for finer particles, down to 0.3 µm diameter, a shield blocked about 10 times more fine particles than the surgical mask. When exposure from the side was considered, the performance of the shield was found to depend dramatically on its geometry. While a narrow shield allowed more droplets and aerosol to penetrate in comparison to a mask under the same configuration, a slightly wider shield significantly improved the performance. The source control potential of shields was also investigated. A shield, and alternatively, a surgical mask, were placed on the cough simulator, while the breathing simulator, situated 60 cm away in the jet direction, remained totally exposed. In both cases, no droplets or particles were found in the vicinity of the breathing simulator. Conducted experiments were limited to short time periods after expiratory events, and do not include longer time ranges associated with exposure to suspended aerosol. Thus, additional evidence regarding the risk posed by floating aerosol is needed to establish practical conclusions regarding actual transmittance reduction potential of face shields and surgical face masks. [ABSTRACT FROM AUTHOR]

Dear Editor, The COVID-19 pandemic has changed the therapeutic algorithm for many dermatological diseases, particularly those where drugs are influencing the immune system. In 76 patients the therapy was ongoing, while in 28 patients the treatment was initiated during the pandemic. [Extracted from the article]

Dear Editor, Since the COVID-19 outbreak, different special measures have been applied in dermatological clinics, in order to reduce the spread of infection among both patients and physicians, with a reduction of face to face visits and an improved role given to the teledermatology ([1]). P. No evidence of increased risk for COVID-19 infection in patients treated with Dupilumab for atopic dermatitis in a high-epidemic area - Bergamo, Lombardy, Italy. The safety of dupilumab in COVID-19 patients has been reported also by Ferrucci et al. in two patients affected by both AD and COVID-19 ([6]). [Extracted from the article]

December 2021 will mark the second anniversary of initial reports from Wuhan, China, of human infection by Severe Acute Respiratory Distress Syndrome Coronavirus-2 (SARS-CoV-2), a novel positive-sense, single-stranded enveloped RNA virus transmitted via respiratory droplets and contaminated vectors, or fomites.[1],[2] As of this writing in August 2021, the pandemic has produced over 200 million confirmed cases from more than 200 countries, resulting in more than 4 million identified deaths.[3] As nearly half of these reported cases were from the United States and Europe - inhabitants of which together total just under 15% of the planet's population, there is good reason to believe that many regional rates of SARS-CoV-2 infection and of COVID-19-associated morbidity and mortality are spuriously low - particularly those from the developing world. Comparative evaluation of tears and nasopharyngeal swab for SARS-CoV-2 in COVID-19 dedicated intensive care unit patients. Presumed SARS-CoV-2 viral particles in the human retina of patients with COVID-19. 11 Seah I, Agrawal R. Can the coronavirus disease 2019 (COVID-19) affect the eyes?. [Extracted from the article]

The impact of COVID-19 pandemic on patients with chronic plaque psoriasis being treated with biologic therapy: the Northern Italy experience. Dear Editor, There is concern that patients on biologic treatment may be at risk because of COVID infection ([1]). [Extracted from the article]

This is a report of a case with mucous membrane pemphigoid (MMP) with severe eye involvement and concurrent COVID-19 treated successfully using simultaneous high dose intravenous immunoglobulin (IVIg) and anti-viral treatment as hydroxychloroquine, lopinavir/ritonavir, and ribavirin. He had finished a 2-g cycle of rituximab (RTX) in late January. He was receiving mycophenolate mofetil (MMF) for one month and 30 mg prednisolone for three months until his hospitalization. Prednisolone was tapered to 15 mg when current COVID-19 was suspected, considering his recent cough, dyspnea, and fever. [ABSTRACT FROM AUTHOR]